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Flow-controlled ventilation (FCV) is a new mechanical ventilation mode that maintains constant flow during inspiration and expiration with standard tidal volumes via cuffed narrow-bore endotracheal tubes. Originating in manually operated 'expiratory ventilation assistance', FCV extends this technique by automatic control of airway flow, monitoring of intratracheal pressure and control of peak inspiratory pressure and end-expiratory pressure. FCV has not yet been described in a clinical study.The aim of this study was to provide an initial assessment of FCV in mechanically ventilated patients undergoing ear, nose and throat surgery and evaluate its potential for future use.An observational study.Two German academic medical centres from 24 November 2017 to 09 January 2018.Consecutive patients (≥ 18 years) scheduled for elective ear, nose and throat surgery. Exclusion criteria were planned laser surgery, intended fibreoptic awake intubation, emergency procedures, increased risk of aspiration, American Society of Anesthesiologists (ASA) physical status more than III and chronic obstructive pulmonary disease classified as GOLD stage more than II.Peri-operative use of FCV provided by a new type of ventilator (Evone) via a narrow-bore endotracheal tube (Tritube).Minute volume, respiratory rate, intratidal tracheal pressure amplitude (Δp) and end-tidal CO2 (PetCO2) were recorded every 5 min. All adverse events were noted. Data are presented as median [IQR].Sixteen patients provided 15 evaluable data sets. A minute volume of 5.0 [4.4 to 6.4] l min and a respiratory rate of 9 [8 to 11] min generated a PetCO2 of 4.9 [4.8 to 5.0] kPa. Δp was 10 [9 to 12] cmH2O. Five adverse events were recorded: a tube obstruction due to airway secretions and four tube dislocations (two attributed to coughing, two not study-related).FCV achieves adequate PetCO2 levels with minute volume and Δp in the normal range. Tritube's high flow resistance may increase the likelihood of tube dislocations if the patient coughs. Although further evaluation is necessary, FCV provides a new option for short-term mechanical ventilation. The successful operation of FCV with narrow-bore tubes contributes to the armamentarium for airway management.DRKS00013312.

It has been suggested that energy dissipation in the airways during mechanical ventilation is associated with an increased probability of ventilator induced lung injury (VILI). We hypothesise that energy dissipation in the airways may be minimised by ventilating with constant flow during both the inspiration and expiration phases of the respiratory cycle. We present a simple analysis and numerical calculations that support our hypothesis and show that for ventilation with minimum dissipated energy not only should the flows during inspiration and expiration be controlled to be constant and continuous, but the ventilation should also be undertaken with an I:E ratio that is close to 1:1.

Comparison of home hemodialysis to continuous ambulatory peritoneal dialysis. We evaluated prospectively various outcome measurements of patients assigned initially to continuous ambulatory peritoneal dialysis (CAPD) and home hemodialysis (HHD) from February 1979 to August 1981 and the causes for failures of the techniques. Morbidity was assessed by time in hospital/time on dialysis. Fifty-six patients were trained for CAPD and 37 for HHD. Those assigned to CAPD experienced an increased frequency of hospitalization (7.5% CAPD, 2.8% HHD, respectively) primarily due to episodes of peritonitis. There was also a higher modality failure rate (43% vs. 16%). However, the groups were not comparable in all respects. For example, the CAPD population included 21 patients with major cardiovascular diseases versus only three in the HHD group. The demographic characteristics of both populations including race, sex, age, income, place of residence, marital status, and education were similar. At the time of this study there is no direct evidence showing that healthy patients otherwise able to perform HHD may be maintained with less morbidity for a prolonged period utilizing CAPD. Therefore, we suggest that HHD is the home method of choice for patients able to proceed with this technique. CAPD may be indicated for patients in whom the period of home dialysis is expected to be relatively short and who would be otherwise unable to carry out home dialysis, for example, patients awaiting transplantation and those unable to be maintained on hemodialysis because of impaired cardiac function. To fully evaluate CAPD as a long-term maintenance therapy, a prospective trial must be performed. Comparaison de la dialyse a domicile a la dialyse peritoneale continue ambulatoire. Nous avons evalue prospectivement diverses mesures du devenir de malades mis initialement en dialyse peritoneale continue ambulatoire (CAPD) ou en dialyse a domicile (HHD) du 1979 fevrier au 1981 aout, et les raisons des echecs de ces techniques. La morbidite a ete mesuree par le temp a l'hopital/temp en dialyse. Cinquante-six malades ont ete entraines pour la CAPD, trente-sept pour l'HHPD. Ceux mis en CAPD ont eu une augmentation accrue de frequence d'hospitalisation (7,5% CAPD, 2,8% HHD, respectivement) essentiellement due a des episodes de peritonite. Il y avait egalement un taux d'echec superieur (43% contre 16%). Cependant les groupes n'etaient pas comparables sur tous les plans. Par exemple, la population de CAPD comprenait 21 malades avec des maladies cardiovasculaires graves, contre seulement trois dans le groupe HHD. Les caracteristiques demographiques de population, notamment la race, le sexe, l'âge, le revenu, le lieu de residence, l'etat marital, et l'education etaient identiques. Pour l'instant il n'y a pas de preuve directe indiquant que les sujets en bonne sante qui seraient autrement capables d'etre en HHD pourraient etre maintenus avec une plus faible morbidite pendant une periode prolongee en CAPD. C'est pourquoi nous suggerons que l'HHD est la methode de choix a domicile pour les malades capables de suivre cette technique. La CAPD pourrait etre indiquee chez les malades chez qui la duree de dialyse a domicile risque d'etre relativement courte, et qui pourraient etre incapables d'entreprendre la dialyse a domicile, par exemple les malades en attente de transplantation, et les malades ne pouvant etre maintenus en hemodialyse en raison d'une alteration de la fonction cardiaque. Afin d'evaluer l'interet de la CAPD comme un traitement d'entretien a long terme, une etude prospective randomisee doit etre entreprise.

The aim of this study was to collect additional data on validity in further standardizing the Bell Alcoholism Scale of Adjustment as an instrument to measure acceptance of the illness nature of alcoholism. The scale was administered to 215 patients at the beginning (Time 1) and at the end (Time 2) of their participation in an alcohol-and-drug treatment program. On admission, the mean score was 110, and at discharge 97, a statistically significant decrease. In an earlier study, the mean scores were 131 and 121 for Time 1 and Time 2. The differences in the means in these two studies are discussed in terms of possible cultural changes that have presumedly come about as a result of awareness campaigns about alcoholism carried out during the 14 yr. since the first study was conducted. In addition, the present study indicated that the more highly educated patients showed significantly greater acceptance at the beginning of treatment than those whose education was less than or limited to high school. Education should be taken into account when interpreting scores.

Peritonitis is the most important complication of continuous ambulatory peritoneal dialysis (CAPD). We reviewed our experience with peritonitis over a 2 1/2-year period. Our patients spent 4% of their total time on dialysis in hospital due to peritonitis. Thirty-eight percent of the episodes of peritonitis were treated without hospitalization. We evaluated the dialysate bag change technique as commonly performed with currently available devices (extension tubing and titanium Luerlock Tenckhoff catheter adapter). The aseptic techniques described for dialysis extension tubing changes appear adequate (with no increased incidence of peritonitis demonstrated shortly after an extension tubing set change). Long-term sterility is maintained at the dialysate bag puncture port and at the orifice of the dialysis catheter adapter (no positive cultures from the bag port and orifice of the titanium adapter). Etiologic diagnosis of uremia was not a risk factor predisposing to peritonitis. The incidence of peritonitis was greater among patients with less formal education and lower income. Out data suggest that patients with less formal education and of lower economic status be carefully evaluated before commencing CAPD.

The records of 104 patients treated prophylactically with heparin during gradual carotid ligation after rupture of an intracranial aneurysm, 11 patients, who received heparin after the development of an ischemic neurological deficit during clamp closure, and 46 patients who did not receive heparin during clamp closure were reviewed. The incidence of ischemic neurological deficit, both permanent and transient, was 19.2% in the prophylactic heparin group compared with 38.6% in the control group. The incidence of recurrent intracranial hemorrhage was 9.6% in the heparin group vs. 26.1% in the control group. All differences were statistically significant at or below P less than 0.01 by the Mantel-Haenszel statistical test. Possible mechanisms for the reduction in morbidity and mortality in patients receiving heparin are discussed.

Beginning in July 1977, cold potassium-induced cardioplegia has been used in 60 consecutive patients undergoing correction of congenital heart defects in whom the aorta was cross damped. Ages ranged from 4 weeks to 18 years (mean 5.8 years); 40 percent were less than 24 months of age. Surgery included correction of ventricular septal defect (32), tetralogy of Fallot (16), atrioventricular canal (6), transposition of great arteries (1), double outlet right ventricle (1), aortic valvotomy (3), and aortic valve replacement (1). Three patients (2 TOF, 1 AVC) died postoperatively, one most likely due to technical error, and two unexplained. We have been impressed by the incidence of spontaneous defibrillation (75 percent), the decreased need for intraoperative inotropic support (3.3 percent), the normal immediate postoperative cardiac index (mean = 2.85 L/min/M 2 ), as well as by the improved operative exposure provided by this technique.

This study was undertaken to ascertain whether 19 patients maintained on continuous ambulatory peritoneal dialysis (CAPD) for at least 1 year experienced any deterioration in peritoneal membrane function. Selected serum chemistries and skinfold measurements were also evaluated to determine whether patients dialyzed by CAPD could maintain a normal nutritional status. This study demonstrates that patients maintained on CAPD had stable dialysate protein losses, glucose absorption from the dialysate, and constant urea, creatinine, and sodium removal. When these patients were subdivided by incidence of peritonitis, the group with a lower incidence of peritonitis (one episode every 349 +/- 155 SEM days) showed stable serum protein concentration and improvement in upper arm area whereas the group with a high incidence of peritonitis (one episode every 95 +/- 7 SEM days) showed a reduction in upper arm muscle area. Thus, our data suggest that over a 1-year period, there is no deterioration in peritoneal membrane characteristics and CAPD is effective in maintaining the nutritional status of the patient. However, both membrane function and nutritional status may be impaired by frequent episodes of infection.

Twenty patients with the ascites of chronic liver disease were investigated for in vivo evidence of active coagulation within ascites by detection of fibrin monomer. Increased levels of fibrin monomer, increased fibrin/fibrinogen degradation products, and absent or low levels of fibrinogen in the ascites of all patients tested confirmed the presence of intraperitoneal coagulation when ascites is present.

We evaluated the influence of dialysate flow rates upon peritoneal clearance of urea, creatine, protein losses into dialysate, glucose disappearance from dialysate, sodium removal from the patient during dialysis, and ultrafiltration rate in 64 patients undergoing intermittent peritoneal dialysis. We evaluated three dialysate flow rates: 2 L/h, 3 L/h, and 4 L/h. All dialysate contained 1.5% glucose. The clearance of urea in milliliters per minute (2-L series 14.0, 3-L series 15.1, 4-L series 17.6) and creatinine in milliliters per minute (2-L series 9.3, 3-L series 10.6, 4-L series 11.6) determined at a dialysate flow rate of 4 L/h was significantly greater than the clearances determined at 3 and 2 L/h of dialysate flow (P less than 0.05). The clearance of glucose from the peritoneal cavity in milliliters per minute (2-L series 6.9, 3-L series 7.9, 4-L series 8.9) was significantly greater for the 4-L series as compared with the 2-L series (P less than 0.05). There were no other significant differences. Neither sex, race, previous episodes of peritonitis, nor etiology of renal failure influenced the results. Given the high cost of dialysate, we recommend dialysate flows of 2 L/h if a patient has a residual renal clearance of 2.5 mL/min. Although increasing dialysate flow rate may compensate for renal clearances significantly less than this, we believe the patient should be offered hemodialysis, continuous cyclic peritoneal dialysis (CCPD), or continuous ambulatory peritoneal dialysis (CAPD).