15 results on '"H.-P. Bruch"'
Search Results
2. Management of an outbreak of multiresistant Acinetobacter baumanii infection in a surgical intensive care unit
- Author
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C Zimmermann, H-P Bruch, F Seyfried, Elke Muhl, M Prang, A Henning, J Lewejohann, and M Hansen
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Mechanical ventilation ,medicine.medical_specialty ,business.industry ,Septic shock ,medicine.medical_treatment ,Convalescence ,media_common.quotation_subject ,Pleural empyema ,Critical Care and Intensive Care Medicine ,medicine.disease ,Surgery ,Pneumonia ,Respiratory failure ,Poster Presentation ,Medicine ,Endoscopic stenting ,business ,Central venous catheter ,media_common - Abstract
The first report of multiresistant Acinetobacter baumanii (MRAB) was published in 1994. We report about an outbreak sensitive to Polimyxin only. In June 2006 a German holidaymaker (male, 70 years old; patient 1) in Greece felt dyspnea, thoracic pain and fever. He went to a hospital in Crete. CT indicated left-sided pleural empyema, mediastinal emphysema, pericardial effusion and pneumonia. Rapid deterioration lead to septic shock with need for mechanical ventilation. He came to our ICU (15 beds and six IMC beds) via air transport. Endoscopy showed esophagus perforation with need for operation and endoscopic stenting. Several BALs and a central venous catheter from the beginning showed MRAB with intermediate susceptibility to meropenem/aminoglycosides only. The patient received meropenem and gentamycin at first. Despite isolation, MRAB spread over and infected eight more patients in separate rooms and different sections of the ICU 32 days later. Further transmission occurred within a few days: three male patients with multiple trauma (42, 20, and 62 years old; patients 2, 3, and 4), cardia carcinoma (female, 66 years old; patient 5), necrotizing pancreatitis (female, 78 years old; patient 6), splenomegaly owing to polycythaemia vera (male, 74 years old; patient 7 – MRAB diagnosis postmortem), rectal carcinoma (female, 76 years old; patient 8 – isolation because of MRSA infection even before) and respiratory failure after gastric banding (female, 41 years; patient 9). All patients suffered from septic shock with high fever, needed high volume replacement and catecholamines several times and prolonged mechanical ventilation. MRAB was isolated in the tracheal secretion or BAL in all patients, in abdominal drainage (patient 6), and in central venous catheter (patient 5). Environmental investigations showed no problematic circumstances. Colistin i.v. is not available in Germany so it had to be procured from the USA, which caused a delay of treatment for a few days. Another delay occurred because of the rapid growing number of patients who needed Colistin. Patients were treated with an adjusted dosage for 16 days. All patients of the ICU were isolated to avoid new infections as a precaution. After convalescence of two patients, all MRAB patients were moved to the IMC, which was converted to an ICU for this period, to isolate infected patients from uninfected. Three out of nine patients died. All these laborious measures with a great expenditure of logistics worked well; no further transmissions were observed.
- Published
- 2007
3. [Untitled]
- Author
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H-P Bruch, E Rieh, J Lewejohann, B Börner, and Elke Muhl
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medicine.medical_specialty ,ARDS ,Respiratory distress ,business.industry ,Oxygenation index ,Oxygenation ,respiratory system ,Lung injury ,Critical Care and Intensive Care Medicine ,medicine.disease ,Prone ventilation ,Prone position ,Internal medicine ,medicine ,Cardiology ,Breathing ,Intensive care medicine ,business - Abstract
In acute respiratory failure (ARF), in particular acute lung injury (ALI) and respiratory distress syndrome (ARDS), an intervention in the form of rotational therapy (RT) or the prone position (PP) may improve oxygenation by recruiting alveoli situated in dorsal-dependent regions and by alteration of the ventilation/perfusion ratio. The efficacy of this interventions can be demonstrated among other parameters by the course of the oxygenation index. The aim of our study is to analyze the prognostic value of the course of the oxygenation index before and after such an intervention.
- Published
- 2006
4. [Untitled]
- Author
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M Hansen, P Kujath, H-P Bruch, J Lewejohann, and C Zimmermann
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Pathology ,medicine.medical_specialty ,biology ,business.industry ,medicine.medical_treatment ,Mucocutaneous zone ,Perineural invasion ,Immunosuppression ,Critical Care and Intensive Care Medicine ,medicine.disease ,biology.organism_classification ,chemistry.chemical_compound ,chemistry ,Rhizopus ,medicine ,Disseminated disease ,Caspofungin ,Zygomycosis ,business ,Mycosis - Abstract
Zygomycosis caused by Rhizopus species (Rhsp) is an aggressive and rapidly progressive opportunistic fungal infection in immunocompromised patients. It comprises mucocutaneous, rhinocerebral, pulmonary, urological and disseminated infections. Predisposing factors are immunosuppression owing to severe diseases, immune defects or metabolic disturbances like diabetic ketoacidosis. Rhizopus infections are characterized by angioinvasive growth, necroses of infected tissue and perineural invasion. The invasion of blood vessels is remarkable for a fungal infection. The mortality of zygomycosis is very high, especially for disseminated disease and if immunosuppression cannot be corrected.
- Published
- 2005
5. [Untitled]
- Author
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Elke Muhl, J Lewejohann, B Börner, E Rieh, and H-P Bruch
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medicine.medical_specialty ,ARDS ,Supine position ,Lung ,Respiratory distress ,business.industry ,Oxygenation ,respiratory system ,Lung injury ,Critical Care and Intensive Care Medicine ,medicine.disease ,respiratory tract diseases ,Prone position ,medicine.anatomical_structure ,Internal medicine ,medicine ,Breathing ,Cardiology ,Intensive care medicine ,business - Abstract
In acute respiratory failure (ARF), in particular acute lung injury (ALI) and respiratory distress syndrome (ARDS), change from the supine position (SP) to the prone position (PP) or the use of kinetic therapy can improve oxygenation by recruiting alveoli situated in dorsal-dependent regions of the lung and by alteration of the ventilation/perfusion ratio. The efficacy of this intervention can be demonstrated by the course of oxygenation index. The aim of our study is to compare prone position ventilation (PP) and kinetic therapy (KT) in the first 5 days after intervention in patients with acute respiratory failure.
- Published
- 2005
6. [Untitled]
- Author
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E Rieh, J Lewejohann, H-P Bruch, and Elke Muhl
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medicine.medical_specialty ,ARDS ,Lung ,business.industry ,Oxygenation index ,Oxygenation ,respiratory system ,Lung injury ,Critical Care and Intensive Care Medicine ,medicine.disease ,respiratory tract diseases ,Prone position ,medicine.anatomical_structure ,Internal medicine ,Cardiology ,Breathing ,Medicine ,business ,Intensive care medicine ,Perfusion - Abstract
In acute respiratory failure, classified as acute lung injury (ALI) or the more severe acute respiratory distress syndrome (ARDS), prone position ventilation (PPV) can improve oxygenation by recruiting alveoli situated in dorsal-dependent regions of the lung and by alteration of the ventilation/perfusion ratio. The aim of our study is to analyze the prognostic value of the change of oxygenation after starting prone position ventilation in ARF.
- Published
- 2003
7. [Untitled]
- Author
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Elke Muhl, E Rieh, H-P Bruch, and J Lewejohann
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medicine.medical_specialty ,ARDS ,Supine position ,Respiratory distress ,Oxygenation index ,business.industry ,Oxygenation ,Lung injury ,Critical Care and Intensive Care Medicine ,medicine.disease ,Surgery ,Prone position ,Intensive care ,Anesthesia ,medicine ,business - Abstract
In acute respiratory failure (ARF), in particular acute lung injury (ALI) and respiratory distress syndrome (ARDS), change from supine (SP) to prone position (PP) can improve oxygenation. The efficacy of this intervention can be demonstrated by the course of oxygenation index. Nevertheless prone position ventilation (PPV) showed no improvement in survival so far. Endpoint for the assessment of therapeutic effects of an intervention like PPV is generally the mortality rate. The aim of our study is to attempt to analyze the discrepancy between positive effects of prone position ventilation on oxygenation index in ARF and the comparatively high mortality rates despite of this intervention. We studied 110 consecutive patients with ALI (n = 18) and ARDS (n = 92) at mean age 66 ± 13 [SE] years in a clinical follow-up design at a surgical ICU in a university hospital, who met the criteria of the American European consensus definition. All patients were ventilated intermittent in SP and in PP (135° left/right-side-position) for at least 6 hours/day. Data collection included apart from baseline characteristics individual oxygenation index and underlying diseases of the patients, in particular if of benign or malignant nature. We compared individual oxygenation index (PaO2/FiO2) before and after start of prone position (SPSS® T-test) and the data set of each patient with outcome. PPV was well tolerated in all n = 110 patients and showed an significant increase of PaO2/FiO2 in n = 106 within the first 6 hours (SP 149 ± 0.52 vs PP 230 ± 0.73 mmHg [mean ± SEM]). In the remaining four cases there was a positive effect within the first 24 hours. Sixty-seven (61%) of the patients died in the course of intensive care therapy and 43(39%) survived. Seven died with an oxygenation index below 100, another 36 with a ratio below 200, 17 below 300 and seven above 300 mmHg. Patients with a malignant underlying disease as cofactor had a 1.8 times higher and those with sepsis a 3.15 times higher risk to die during their ICU-stay despite of PPV. Despite of positive effects of PPV on oxygenation in our patients a considerable part of them died. To our amazement oxygenation index previous to death was not the main problem for most part of the patients in that phase. Malignant diseases in history and sepsis during the ICU-stay seem to increase the risk to die in the course of ALI or ARDS regardless the use of PPV conspicuously. Our results show that for the assessment of a therapeutic intervention in acute respiratory failure not only mortality as an endpoint seems to be suitable, but also important clinical cofactors.
- Published
- 2002
8. Do we need a basis bolus concept for sedoanalgesia of mechanically ventilated patients in ICU?
- Author
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H-P Bruch, J Gleiβ, Elke Muhl, S Lewejohann, J Lewejohann, and H-J Düpree
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Mechanical ventilation ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Neurological status ,Hemodynamics ,Physical examination ,Critical Care and Intensive Care Medicine ,Intensive care unit ,Sedoanalgesia ,law.invention ,Autonomic nervous system ,Bolus (medicine) ,law ,Meeting Abstract ,Medicine ,business ,Intensive care medicine - Abstract
Tolerance for mechanical ventilation is generally achieved by continuous application of analgesics and sedatives. Their effect is usually controlled by physical examination. The dosage in daily routine occasionally is not adapted to the patients needs in the circardian course. Evidence exists that classical neurological and hemodynamic parameters do not always reflect the level of sedoanalgesia. Neuromonitoring with heart-rate-variability (HRV) is a new opportunity to evaluate the patients neurological status. HRV is a window for usually invisible central autonomic regulation. This phenomenon is caused by oscillation in the interval between consecutive heart beats. It represents a quantitative marker of autonomic activity. Currently monitoring of autonomic nervous system is no routine tool for mechanically ventilated patients. Our study presents first results of continous neuromonitoring of autonomic nervous system with heart-rate-variability in the setting of an intensive care unit.
- Published
- 2000
9. The importance of prone position ventilation in ARDS for the improvement of oxygenation index
- Author
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H-P Bruch, S Lewejohann, J Gleiβ, J Lewejohann, H-J Düpree, and Elke Muhl
- Subjects
ARDS ,medicine.medical_specialty ,Supine position ,business.industry ,Oxygenation index ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,medicine.disease ,Surgery ,Prone position ,Internal medicine ,Hemofiltration ,Meeting Abstract ,medicine ,Breathing ,Cardiology ,Inverse ratio ventilation ,business ,Perfusion - Abstract
In acute respiratory distress syndrome (ARDS) change from supine (SP) to prone position can improve gas exchange by recruiting alveoli situated in dorsal dependent regions and by alteration of ventilation/perfusion ratio. The aim of this study was to investigate the effect of prone position (PP) after application of high fractional inspired oxygen (hFiO2), inverse ratio ventilation (IRV), positive end exspiratory pressure (PEEP)as well as kinetic therapy (KT) and hemofiltration (HF) did not lead to a breakthrough in treatment of severe ARDS.
- Published
- 2000
10. Sudden cardiac failure following treatment of metabolic alkalosis with hydrochloric acid
- Author
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J Gleiβ, S Lewejohann, H-P Bruch, S Knorr, J Lewejohann, and H-J Düpree
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medicine.medical_specialty ,business.industry ,musculoskeletal, neural, and ocular physiology ,medicine.medical_treatment ,Gastric reflux ,digestive, oral, and skin physiology ,Metabolic alkalosis ,macromolecular substances ,Critical Care and Intensive Care Medicine ,medicine.disease ,digestive system diseases ,Parenteral nutrition ,nervous system ,Meeting Abstract ,Medicine ,Diuretic ,business ,Intensive care medicine - Abstract
Severe metabolic alkalosis is a common problem in ICU due to high gastric reflux, diuretic drugs or parenteral nutrition. The mortality is considerable. Therapy of severe metabolic alkalosis with hydrochloric acid is widely accepted and described as save and effective.
- Published
- 2000
11. Continuous hemodiafiltration with bicarbonate- and lactate-buffered replacement fluids in septic shock
- Author
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S Lewejohann, H-P Bruch, J Lewejohann, J Gleiβ, Elke Muhl, and H-J Düpree
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medicine.medical_specialty ,business.industry ,Septic shock ,Critically ill ,Bicarbonate ,Impaired liver function ,Metabolism ,Critical Care and Intensive Care Medicine ,medicine.disease ,chemistry.chemical_compound ,chemistry ,Continuous hemodiafiltration ,Anesthesia ,Meeting Abstract ,medicine ,Intensive care medicine ,business - Abstract
Acid-base imbalances are an important aspect while using continuous renal replacement techniques in critically ill patients. The quality of replacement fluid needs to be considered regarding to the acid-base requirements especially in septic patients. Commonly used replacement fluids contain lactate as buffer. Whereas lactate has to enter the Cori- or Citrate-Cycle to become effective as a buffer, bicarbonate can act immediately. The metabolism of lactate in addition is depending on the impaired liver function of patients with septic shock and represents an oxygen consuming process.
- Published
- 2000
12. Differences in phagocytosis by polymorphonuclear leucocytes (PMNs) and monocytes (Mos) in endotoxemia and endotoxin (ET) tolerance
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H. Brade, K. H. Staubach, J Nolde, H-P Bruch, and L. Song
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Fluorescence intensity ,medicine.diagnostic_test ,business.industry ,Phagocytosis ,Meeting Abstract ,Immunology ,medicine ,Control animal ,Critical Care and Intensive Care Medicine ,business ,Flow cytometry - Published
- 2000
13. Fiberoptic bronchoscopy of the intubated patient with life-threatening hemoptysis
- Author
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H-P Bruch, Elke Muhl, J Gleiβ, H-J Düpree, and J Lewejohann
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medicine.medical_specialty ,Respiratory failure ,business.industry ,Meeting Abstract ,Medicine ,Acute respiratory failure ,Fiberoptic bronchoscopy ,Critical Care and Intensive Care Medicine ,business ,Intensive care medicine ,Surgery - Abstract
Bleeding into the tracheobronchial tree is a potentially fatal occurrence for intubated patients. The subsequent acute respiratory failure requires an effective therapy. Fiberoptic bronchoscopy represents an easy available technique for the diagnosis and treatment of this type of hemoptysis.
- Published
- 1999
14. Downregulation of procalcitonin in mechanicaly ventilated patients
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H-P Bruch, J Gleiβ, S Lewejohann, H-J Düpree, and J Lewejohann
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congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,business.industry ,Inflammatory response ,bacterial infections and mycoses ,Critical Care and Intensive Care Medicine ,Procalcitonin ,Downregulation and upregulation ,Internal medicine ,Meeting Abstract ,parasitic diseases ,Emergency medicine ,Medicine ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
Procalcitonin (PCT) has recently attracted attention as a possible marker of the systemic inflammatory response to infection. Downregulation of PCT in healthy human subjects after repetitive injection of endotoxin has been published. This effect was not investigated in critical ill patients so far.
- Published
- 1999
15. Induction of endotoxin (ET) tolerance by atoxic endotoxin - a new prophylactic concept to the septic syndrome
- Author
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H. P. Bruch, M Sabranski, H. Brade, H. Weber, K. H. Staubach, and L. Song
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business.industry ,Observation period ,Inflammation ,Rhodopseudomonas sphaeroides ,Pharmacology ,Critical Care and Intensive Care Medicine ,Bioinformatics ,Immunization ,Meeting Abstract ,Immunology ,Emergency Medicine ,medicine ,medicine.symptom ,business ,Septic syndrome - Abstract
Repeated, small doses of ET induces resistance to subsequent larger doses of ET in both animals and men. This preconditioning, termed ET tolerance is a well-controlled active response that is orchestrated to prevent excessive inflammation. The ET of distantly related Gram-negative bacterial species like the sulfur-containing or the sulfur-free purple bacteria appear to have low endotoxicity or to be completely non-toxic but maintain many of the beneficial immunomodulatory activities. The present experiment was designed to test the response to the non-toxic ET of Rhodopseudomonas sphaeroides to protect the animals after 5 days of immunization against a continuous ET challenge-dose of 250 ng/kg BW/h over a 12 h observation period. Results are summarized in the Table below. Clinical signs of endotoxemia could be observed in both groups within the first hour of the experiment. However, in contrast to the tolerant animals which appeared cardiorespiratorily stable for most of the observation period, the control animals sustained serious reductions in MAP, CO and arterial PaO2 (see Table). While only one animal survived in the control group only one animal died in the tolerant group during the observation period. The encouraging results of this study emphasize the potential role of atoxic ET as a therapeutic agent. As a new prophylactic approach ET tolerance as such seems interesting — as prophylaxis in high-risk patients it may prevent septic complications. The tolerance state however is relative and never complete — it can be overcome by raising the ET challenge dose or adding other negative stimuli like second or subsequent hit. Table
- Published
- 1997
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