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Summary Background As a consequence of improved survival rates after burn injury occupational reintegration of burn survivors has gained increasing significance. We aimed to develop a precise patient questionnaire as a tool to evaluate factors contributing to occupational reintegration. Material and methods A questionnaire comprising 20 questions specifically evaluating occupational reintegration was developed under psychological supervision. The single-center questionnaire study was implemented in patients with burn injuries who were admitted to the 6‑bed burn intensive care unit (BICU) of the General Hospital of Vienna, Austria (2004–2013). The questionnaire was sent to burn survivors of working age (18–60 years) with an abbreviated burn severity index (ABSI) of 6 or greater, a total burn surface area (TBSA) of 15% or greater, and a BICU stay of at least 24 h. Results A total of 112 burn survivors met the inclusion criteria and were contacted by mail. Of the 112 patients 11 (10%) decided to participate in the study and 218/220 questions (99%) in 11 patients were answered. Out of 11 patients 7 (64%) reported successful return to work and 4 of 11 (36%) did not resume their occupation. Advanced age, longer BICU and hospital stays, higher TBSA, burn at work, lower education, and problems with esthetic appearance seemed to impair patients’ return to their occupation. Conclusion When implementing the questionnaire, severely burned patients with higher age, lower education, and longer hospital and BICU stay seemed at high risk for failed reintegration in their profession after burn injury.

Hyperbaric oxygen therapy (HBOT) has been shown to improve tissue hypoxia, neovascularization and ischemia reperfusion injury and reduce pathologic inflammation in various clinical settings and was proposed to be a game changer in treatment of burns. Improved and faster wound healing as well as a reduction of morbidity and mortality after thermal and concomitant carbon monoxide poisoning are expected. In defiance of the observed benefits for burn wounds and carbon monoxide poisoning in animal models and few randomized controlled trials there is an ongoing controversy regarding its use, indications and cost effectiveness. Furthermore, the use of HBOT, its indications and the evidence behind its efficiency are still widely unknown to most physicians involved in the treatment of burn patients. Therefore, a review of the up to date evidence-based literature was performed with a focus on available data of HBOT in burn care, to elaborate its use in acute thermal injury and carbon monoxide intoxication. Although beneficial effects of HBOT seem very likely insufficient evidence to support or disprove the routine use of HBOT in the treatment of burn care was found. Although difficult to carry out because of the high interindividual variability of burns and chronic wounds, the need for larger high-quality prospective randomized double-blinded controlled multicenter trials are necessary to be able to evaluate useful applications, expense and cost-efficiency of HBOT for burn care.

Background Despite advances in surgery and critical care, candidemia remains a significant cause of morbidity and mortality in patients with extensive burns. Methods A retrospective single-center cohort study was performed on 174 patients admitted to the Burn Intensive Care Unit of the General Hospital of Vienna (2007–2013). An AIC based model selection procedure for logistic regression models was utilized to identify factors associated with the presence of candidemia. Results Twenty (11%) patients developed candidemia on median day 16 after ICU admission associated with an increased overall mortality (30% versus 10%). Statistical analysis identified the following factors associated with proven candidemia: younger age (years) odds ratio (OR):0.96, 95% confidence interval (95% CI):0.92–1.0, female gender (reference male) OR:5.03, 95% CI:1.25–24.9, gastrointestinal (GI) complications requiring surgery (reference no GI complication) OR:20.37, 95% CI:4.25–125.8, non-gastrointestinal thromboembolic complications (reference no thromboembolic complication) OR:17.3, 95% CI:2.57–170.4 and inhalation trauma (reference no inhalation trauma) OR:7.96, 95% CI:1.4–48.4. Conclusions Above-mentioned patient groups are at considerably high risk for candidemia and might benefit from a prophylactic antifungal therapy. Younger age as associated risk factor is likely to be the result of the fact that older patients with a great extent of burn body surface have a lower chance of survival compared to younger patients with a comparable TBSA.

Gastrointestinal complications occur frequently in intensive care patients with severe burns. Intestinal infarction and its deleterious consequences result in high mortality despite rapid surgical intervention. Our objective was to evaluate the aetiology of gastrointestinal infarction in intensive care patients with severe burns.We retrospectively evaluated all of the severe-burn victims at the burn unit of the Medical University of Vienna from 01/2002 to 06/2012 for whom a gastrointestinal infarction was diagnosed during their inpatient stay on computed-tomography, in the context of acute laparotomy, or upon autopsy by aetiology.After a severe thermal injury, 17 patients suffered a gastrointestinal infarction during their stay. In 82% of those patients, non-occlusive mesenteric ischaemia (NOMI) was identified as the cause of the gastrointestinal infarction. Patients with an embolic infarction tended to be older (78.0years embolism vs. 53.4 NOMI, mean, p0.01), with a lower abbreviated burn severity index (8.7 embolism vs. 10.4 NOMI, mean, p0.02) and a smaller total body surface area burned (20% embolism vs. 48% NOMI, mean, p0.01) than those with a non-occlusive mesenterial ischaemia. No patients with an embolic infarction or any of the females in the entire gastrointestinal infarction group survived this event, resulting in a mortality rate of 100% for the embolic infarction group and female group. The decisive factor for surviving a NOMI was age (median age: male survivors 28years vs. nonsurvivors 66years (of this median, males=72years and females=60years), p0.02).The results of our study clearly demonstrate that in severe-burn intensive care patients, non-occlusive mesenteric ischaemia is the most frequent cause of gastrointestinal infarction and that the decisive factor for survival is the patient's age.

The objective was primarily to identify risk factors for bloodstream infections (BSI) caused by different pathogens.A retrospective single-center cohort study was performed on 472 burn patients with an abbreviated burn severity index (ABSI)≥3, a total burn surface area (TBSA)≥10%, and an ICU stay of at least 24h. Risk factors for different BSI pathogens were analyzed by competing risks regression model of Fine and Gray.A total of 114 burn patients developed 171 episodes of BSIs caused by gram-negative bacteria (n=78;46%), gram-positive bacteria (n=69;40%), and fungi (n=24;14%) median after 14days (range, 1-164), 16days (range, 1-170), and 16days (range, 0-89), respectively. A total of 24/114 patients (21%) had fatal outcomes. Isolation of the most common bloodstream isolates Enterococcus sp. (n=26), followed by Candida sp. and Pseudomonas sp. (n=22 for both) was significantly associated with increased TBSA (p≤0.006) and ABSI (p0.0001) and need for fasciotomy (p0.01). The death risk of patients with MDR gram-negative bacteremia was significantly increased by a hazard ratio of 12.6 (95% CI:4.8-32.8; p0.0001).A greater TBSA and ABSI were associated with a significantly higher incidence of BSIs caused by Pseudomonas sp., Enterococcus sp. and Candida sp.

Schwer verbrannte Patienten sollten so rasch als moglich in spezialisierten Zentren behandelt werden. Traditionelle Konzepte zur hamodynamischen Therapie konnen zu einer Uberinfusion und weiteren Komplikationen fuhren. Die unkritische Volumengabe in der Akutphase nach alleiniger Formelberechnung entsprechend der verbrannten Korperoberflache fuhrt zur massiven interstitiellen Odembildung und der weiteren Verschlechterung der Organfunktionen. Das erweiterte hamodynamische Monitoring ist die Voraussetzung zur Optimierung der Kreislaufsituation mit Infusionslosungen und Katecholaminen. Innerhalb der ersten Stunden nach dem Verbrennungstrauma sollten Normwerte fur Herzindex und Sauerstoffversorgung erreicht werden.

Dear Editor, Patients with thermal injury are vulnerable to local and systemic infections. Candida spp. were the second most common pathogens isolated from catheter tips in European countries (9.1 %) [1]. Although several studies were performed to evaluate the clinical relevance of Candida spp. colonization of intravascular catheters, burn patients were only rarely studied [2–5]. Patients suffering from severe burns with an Abbreviated Burn Severity Index (ABSI) C6, a length of ICU stay C24 h, a survival of more than 7 days and central venous catheter (CVC) tip culture yielding C15 colony-forming units of Candida spp. met the general inclusion criteria for this study. Patients were categorized into two groups based on their final outcome. Group I consisted of subjects with ‘‘poor outcome’’ (patients with positive CVC tip cultures for Candida spp. that suffered from subsequent or catheter related candidemia); Group II consisted of subjects with ‘‘good outcome’’ (patients with positive CVC tip cultures for Candida spp. that did not suffer from subsequent or catheter-related candidemia) (Table 1). Candidemia was defined as the presence of at least one positive blood culture for any Candida spp. Catheter-related candidemia was defined as detection of the same Candida sp. from the CVC tip and blood culture, obtained 48 h before to 48 h after CVC removal. Subsequent candidemia was defined as the occurrence of candidemia C48 h after CVC removal. Tip cultures, screening for fungal or bacterial pathogens, are always performed when a CVC is removed. A total of 38/194 (20 %) patients met the inclusion criteria for the present study (Table 1). Of these

To quantify the effect of superimposed high-frequency jet ventilation on lung recruitment in adult patients with acute lung injury.Prospective clinical study in the intensive care unit of a university teaching hospital.Eight adults suffering from acute lung injury with a mean lung injury score of 2.6+/-0.6 and pronounced atelectasis in at least two lung quadrants. The cause was either pneumonia ( n=5) or postoperative sepsis ( n=3).Superimposed high-frequency jet ventilation was initiated in patients following a mean of 4.4+/-1.7 days of conventional ventilation. Before and 4 h after the start of superimposed high-frequency jet ventilation differential lung volumes were determined by volumetry using computed tomography.Superimposed high-frequency jet ventilation significantly increased the lung volume of every patient due to alveolar recruitment. This was achieved despite lower peak inspiratory pressures and higher PaO(2)/FIO(2) ratios than with conventional ventilation.Treatment with superimposed high-frequency jet ventilation for 4 h resulted in rapid alveolar recruitment in dependent lung areas, improved gas exchange, and better arterial oxygenation. It offers an effective and advantageous alternative to conventional ventilation for ventilatory management of respiratory insufficient patients.

Objective: Single-frequency high-frequency jet ventilation (HFJV) is an established ventilatory technique during laryngotracheal surgery. This study describes the clinical use of combined HFJV, characterised by the simultaneous application of a low-frequent (LF) and a high-frequent (HF) jet stream. Methods: Two jet streams with different pulsatile frequency (HF approx. 10 Hz, LF 10-30 bpm) and adjustable driving pressures were applied supraglottically by means of a special jet laryngoscope in patients undergoing elective laryngotracheal surgery during total intravenous anaesthesia. HFJV was performed using a pneumatic or electronic jet respirator connected to the central gas supply. Results: 134 patients were submitted to tubeless HFJV applying the double-jet technique using the jet-laryngoscope. Duration of HFJV was ≤ 30 min in 60 patients (45%), between 30 and 60 min in 49 patients (36%), and ≥ 60 min in 25 patients (19%). Classification into 3 groups according to weight ((I < 65 kg, II = 65 - 84 kg, III ≥85 kg) using driving pressures of 1,52±0,47 bar, 1,64±0,78 bar, and 1,69±0,67 bar for the HF jet and 1,78±0,54 bar, 1,90±0,48 bar, and 2,00±0,49 bar for the NF jet demonstrated differences in paO 2 (156±45 [I] vs 126±34 [II] vs 96±18 [III] mm Hg) and paCO 2 (42±9 und 44±8 vs 48±8 mm Hg) using comparable F jet O 2 (0,6±0,2). Supraglottic pressures were 11,6±6,8, 11,5±7,0, und 12,6±7,1 cm H 2 O (I-III). No ventilator-related adverse events were observed. Conclusion: Tubeless supraglottic HFJV utilizing two jet streams with low and high frequency was effective in patients during laryngotracheal surgery. The application of two jet streams results in phasic changes of airway pressures between an inspiratory and expiratory pressure level, and facilitates application of enlarged tidal volumes. As demonstrated, oxigenation and ventilation is compromised by increased body weight. Superimposed HFJV (double-jet technique) enables the supraglottic ventilation of heavy patients and/ or in the presence of airway stenoses during laryngotracheal surgery without need to use maximum driving pressures.

Background: High-frequency jet ventilation (HFJV) is an alternative ventilatory approach in airway surgery and for facilitating gas exchange in patients with pulmonary insufficiency. We have developed a new technique of combined HFJV utilising two superimposed jet streams. In this study we describe the application of tubeless supralaryngeal HFJV during laryngotracheal laser surgery in infants and children. Methods: Tubeless combined HFJV characterised by the simultaneous supralaryngeal application of a low-frequency (LF) and a high-frequency (HF) jet stream was evaluated in a clinical study in 10 children undergoing elective laryngotracheal CO2 laser surgery. Additionally, pressure and flow characteristics were determined with the use of a paediatric test lung. HFJV was applied by means of a modified Kleinsasser laryngoscope with integrated metal injectors. In addition to pulse oximetry, monitoring of ECG, heart rate and blood pressure, supraglottic airway pressure was measured and arterial blood gases were analysed. Results: Tubeless combined HFJV was used in 10 infants and children (mean age 4.6 yr, range 2 months–10 years) undergoing 17 consecutive endoscopic procedures with CO2 laser microsurgery of the larynx or the trachea under general anaesthesia.The mean duration of supralaryngeal HFJV was 46 min (range 15–75 min). Mean driving pressures of the HF and the LF jet streams were 0.75 bar and 0.95 bar, respectively. Inspiratory oxygen ratios were in the range 0.4–1.0. HFJV resulted in mean PaO2 and PaCO2 values of 19.7 kPa and 6.1 kPa, respectively. No complications during HFJV were observed. In the test lung, combined HFJV applied with driving pressures of 0.7–1.0 bar and 0.9–1.2 bar for HF and LF jet ventilation, respectively, resulted in maximum peak and baseline distal airway pressures of 17.6 cm H2O and 5.4 cm H2O, respectively. Conclusion: The application of the combined double frequency HFJV was effective in maintaining gas exchange in the presence of laryngeal or tracheal stenoses. It provided good visibility of anatomical structures and offered space for surgical manipulation, avoiding the use of combustible material inside the larynx or trachea.

Die superponierte Hochfrequenz Jet-Ventilation (SHFJV) wurde als alternative Beatmungstechnik bei Patienten mit Lungenversagen eingesetzt. Um diese Beatmungsform optimal applizieren zu konnen, wurde ein spezieller Jet-Adapter entwickelt. Methoden: Dieser Jet-Adapter aus Kunststoff besteht aus einem T-Stuck mit vier Kunststoffkanulen und kann an jeden handelsublichen Endotrachealtubus konnektiert werden. Eine Umintubation auf einen speziellen Jet-Tubus vor dem Beginn der SHFJV ist unnotig. Die simultane hoch- und niederfrequente Beatmung erfolgt uber zwei Dusen. Zwei weitere Kanulen dienen der kontinuierlichen Messung des Beatmungsdrucks und der Befeuchtung des Atemgases. Uber den Querschenkel des T-Stucks wird ein Atemgasquerstrom geleitet. Eine zusatzliche, verschliesbare Offnung im Querschenkel des T-Stucks ermoglicht das Einfuhren eines Absaugkatheters oder eines Bronchoskops, so das keine Diskonnektion vom Respirator erforderlich ist. Ergebnisse: Mit dem Jet-Adapter kann 1. die SHFJV angewendet werden, 2. der Beatmungsdruck kontinuierlich gemessen werden, 3. die Befeuchtung und Erwarmung der Atemgase durchgefuhrt und 4. Medikamente appliziert oder NO zugeleitet werden Schlusfolgerung: Der Jet-Adapter gewahrleistet mit der SHFJV eine suffiziente Beatmung, die mit anderen therapeutischen Moglichkeiten kombiniert werden kann.

To evaluate the development of demographics and outcome of very old (>80 years) critically ill patients admitted to intensive care units. All consecutive patients admitted to 41 Austrian intensive care units (ICUs) over an 11-year period. We performed a retrospective cohort study of prospectively collected data. To compare parameters over time, patients were divided into three groups (group I from 1998 until 2001, group II from 2002 to 2004, and group III from 2005 to 2008). A total of 17,126 patients older than 80 years of age were admitted over the study period. The proportion of very old patients increased from 11.5% (I) to 15.3% (III) with a significant higher prevalence of females in all groups (on average 63.2%). Severity of illness also increased over time, even when corrected for age. Use of noninvasive mechanical ventilation increased over the years. However, risk-adjusted mortality rates [observed-to-expected (O/E) ratios] decreased from 1.14 [confidence interval (CI) 1.11–1.18] to 1.02 (CI 0.99–1.05). This improvement in outcome was confirmed on multivariate analysis: for every year delay in ICU admission, the odds to die decreased by 3%. Moreover, females exhibited a better outcome compared with males. The relative and absolute numbers of very old patients increased over the study period, as did the severity of illness. Despite this, risk-adjusted hospital mortality improved over the study period. Females dominated in the very old patients and exhibited moreover a better outcome compared with males.

Aminophylline is usually used during anaesthesia to treat bronchospasm but recent findings suggest that it can also be used to shorten recovery time after general anaesthesia. However, it is unclear whether aminophylline shows similar properties during a steady-state phase of deep surgical anaesthesia. We therefore wanted to test the hypothesis that the administration of aminophylline leads to an increase in bispectral index as a surrogate parameter suggesting a lighter plane of anaesthesia. The study was designed as a double-blind, randomised, controlled trial with two main groups (aminophylline and placebo) and two subgroups (sevoflurane and propofol). We studied 60 patients. The injection of aminophylline 3 mg x kg(-1) was associated with significant increases in bispectral index up to 10 min after its injection, while heart rate and blood pressure did not change. It appears that aminophylline has the ability to partially antagonise the sedative effects of general anaesthetics.

Background Superimposed high-frequency jet ventilation (SHFJV), which does not require any tracheal tubes or catheters, was developed specifically for use in laryngotracheal surgery. SHFJV uses two jet streams with different frequencies simultaneously and is applied in the supraglottic space using a jet laryngoscope and jet ventilator. Methods Between 1990 and 2004, SHFJV was studied in 1515 consecutive patients (including 158 children requiring laryngotracheal surgery) prospectively. Ventilation was performed with an air/oxygen mixture and anaesthesia was administered i.v. Results Adequate oxygenation and ventilation was achieved in 1512 patients. Arterial blood gas analyses (BGA) were performed between 1990 and 1994; thereafter BGA was only performed in patients with high-grade stenosis of the larynx/trachea or high-risk patients [n=623, mean P a O 2 133.8 (39.4) mm Hg and mean P a CO 2 42.3 (10.1) mm Hg]. There were no significant changes in P a O 2 or P a CO 2 during the entire period of SHFJV. No complications secondary to the ventilation technique were observed; in particular, no barotrauma occurred. Three patients required tracheal intubation. SHFJV was also successfully used for laser surgery (n=312). It proved to be a safe mode of ventilation without any complications such as airway fire, major haemorrhage, or aspiration of debris. Conclusion SHFJV is an advanced ventilation mode playing a pivotal role in the (open) ventilatory support/ventilation of patients with laryngotracheal stenosis. It is particularly indicated in cases of severe stenosis and offers optimal conditions for laryngotracheal surgery, including laser surgery and stent implantation techniques.

Operationen im muskuloskeletalen Bereich, vor allem bei Manipulationen am Periost, gehoren zu den schmerzhaftesten Eingriffen des gesamten chirurgischen Spektrums. Dies manifestiert sich in einem hoheren Analgetikabedarf in der unmittelbar postoperativen Phase. Um den Anspruchen einer adaquaten Schmerztherapie in der Orthopadie gerecht zu werden, wurden in enger Kooperation zwischen den Universitatskliniken fur Orthopadie und Anasthesie und Intensivmedizin I und II der Medizinischen Universitat Wien Konzepte erstellt, die den Patienten eine fruhzeitige postoperative Rehabilitation ermoglichen. Weitgehende Schmerzreduktion verbessert die Lebensqualitat und verkurzt die Aufenthaltsdauer. Das Spektrum der Universitatsklinik fur Orthopadie beinhaltet neben allgemein orthopadischen Operationen auch solche aus den Bereichen Knochen- und Weichteiltumoren, Wirbelsaule, Sport-, Kinder- und Rheumaorthopadie. Operationen werden sowohl stationar als auch ambulant durchgefuhrt. Ziel dieser Arbeit ist es, die aus der Kooperation zwischen Orthopaden und Anasthesisten entwickelten Konzepte zur perioperativen Schmerztherapie darzustellen.

Single-frequency high-frequency jet ventilation (HFJV) is an established ventilatory technique during laryngotracheal surgery. This study describes the clinical use of combined HFJV, characterised by the simultaneous application of a low-frequent (LF) and a high-frequent (HF) jet stream.Two jet streams with different pulsatile frequency (HF approx. 10 Hz, LF 10-30 bpm) and adjustable driving pressures were applied supraglottically by means of a special jet laryngoscope in patients undergoing elective laryngotracheal surgery during total intravenous anaesthesia. HFJV was performed using a pneumatic or electronic jet respirator connected to the central gas supply.134 patients were submitted to tubeless HFJV applying the double-jet technique using the jet-laryngoscope. Duration of HFJV wasor = 30 min in 60 patients (45%), between 30 and 60 min in 49 patients (36%), andor = 60 min in 25 patients (19%). Classification into 3 groups according to weight ((I65 kg, II = 65-84 kg, IIIor = 85 kg) using driving pressures of 1.52 +/- 0.47 bar, 1.64 +/- 0.78 bar, and 1.69 +/- 0.67 bar for the HF jet and 1.78 +/- 0.54 bar, 1.90 +/- 0.48 bar, and 2.00 +/- 0.49 bar for the NF jet demonstrated differences in paO2 (156 +/- 45 [I] vs 126 +/- 34 [II] vs 96 +/- 18 [III] mm Hg) and paCO2 (42 +/- 9 und 44 +/- 8 vs 48 +/- 8 mm Hg) using comparable FjetO2 (0.6 +/- 0.2). Supraglottic pressures were 11.6 +/- 6.8, 11.5 +/- 7.0, und 12.6 +/- 7.1 cm H2O (I-III). No ventilator-related adverse events were observed.Tubeless supraglottic HFJV utilizing two jet streams with low and high frequency was effective in patients during laryngotracheal surgery. The application of two jet streams results in phasic changes of airway pressures between an inspiratory and expiratory pressure level, and facilitates application of enlarged tidal volumes. As demonstrated, oxigenation and ventilation is compromised by increased body weight. Superimposed HFJV (double-jet technique) enables the supraglottic ventilation of heavy patients and/or in the presence of airway stenoses during laryngotracheal surgery without need to use maximum driving pressures.

Despite advances and technical developments in the area of intensive care medicine it has not been possible to lower the mortality of patients with pulmonary insufficiency. Therefore, alternative ventilation strategies have been developed and applied. One of these ventilation techniques is superimposed high-frequency jet ventilation (SHFJV). For optimal application of SHFJV we designed a special jet-adapter.This jet-adapter made of plastic consists of a T-piece and four central, small-bore cannulas and can be connected to any commercially available endotracheal tube. Therefore, it does not require reintubation with an endotracheal jet tube when beginning SHFJV. The simultaneous high-frequency and low-frequency jet ventilation is performed over two jet-nozzles that have been designed according to optimal flow dynamic measurements. Two further cannulas are used for continuous airway pressure monitoring and humidification of the applied gases. A pre-warmed and humidified bias flow with exactly defined oxygen concentration is led through the cross-part of the T-piece for gas entrainment. Additionally, the cross-part contains a port that can be opened for endotracheal suctioning or bronchoscopy and makes disconnection of the jet adapter from the endotracheal tube for either purpose unnecessary.The jet adapter can be used: (1) to apply SHFJV; (2) to measure airway pressures continuously; (3) to humidify and warm inspired gases; (4) to administer medications or add nitrous oxide by the inspiratory route, enabling combination with new therapeutic possibilities in the management of patients with severe ARDS.

Intra-operative segmental wall motion abnormalities (SWMA) detected by transoesophageal echocardio- graphy (TOE) have been shown to be a sensitive indicator of myocardial ischaemia. To determine the incidence and characteristics of segmental wall motion abnormalities and to relate these changes to peri-operative myocardial ischaemia, biplane TEE, electrocardiogram (ECG) (II + V5) and pulmonary capillary wedge pressure (PCWP) were continuously monitored in 62 consecutive patients with ischaemic heart disease undergoing non-cardiac surgery. Short-axis view at mid-papillary level in transverse scan (T-scan) and long-axis in longitudinal (L-scan) two-chamber view were used for wall motion analysis. New segmental wall motion abnormalities were detected in 16 of 64 patients (25%) using biplane transoesophageal echocardiography. Monoplane transoesophageal echocardiography showed a sensitivity of 75% and a specificity of 100%, electrocardiogram two lead showed a sensitivity of 56% and a specificity of 98%, whereas pulmonary capillary wedge pressure had a sensitivity of 25%, and a specificity of 93% and pressure rate quotient (PRQ)

In patients with acute transient myocardial ischaemia, changes in left ventricular filling produce alterations in transmitral diastolic flow velocity and isovolumic relaxation time. In this study a scoring system derived from isovolumic relaxation time and indices from transmitral flow velocity was used to evaluate perioperative transient myocardial ischaemia. Fifty three patients with known coronary artery disease or at risk were studied. Ischaemic events were assessed using Doppler transoesophageal echocardiography midoesophageal left ventricular four-chamber view planes. Diastolic Doppler ratios of peak early to atrial peak (E/A), deceleration time, deceleration rate and isovolumic relaxation time were scored using standard methods. An evaluation of peri-operative ischaemic events could be important for patients with a non-ischaemic cause for abnormal segmental wall motion, as the use of a two-dimensional scoring system has limitations. Acute changes in the Doppler ratio of peak early to atrial peak must be interpreted cautiously during surgery. Diastolic dysfunction commonly occurs during ischaemia and recognition of this may alter the approach to monitoring as well as to treatment.

Superimposed high-frequency jet ventilation (SHFJV) is a special form of combined high-frequency jet ventilation described in other studies as an effective respiratory therapy of acute lung injury (ALI) patients. We compared this technique with conventional mechanical ventilation in oleic-acid-induced ALI piglets over a study period of 5 hours. After ALI induction, 18 pigs were randomly assigned to three groups. A SHFJV group with a high-frequency (500 bpm) and a low-frequency (15–20 bpm) jet stream and a PEEP of 10 cmH2O; a CPPV group (continuous positive pressure ventilation) presenting VT = 10 ml/kg, I:E = 1:1, PEEP = 10 cmH2O; and a IPPV group (control group; intermittent positive pressure ventilation) VT = 10 ml/kg, I:E = 1:1, zero PEEP. SHFJV animals showed an earlier and more efficient improvement in oxygenation compared with group B (90 vs 180 min; PaO2 70.5 ± 11.3 vs 41.2 ± 7.9 kPa) despite lower mean airway pressures applied (16 ± 1.4 vs 22 ± 1.8 mbar). CO2 elimination was also more effective (6.0 ± 1.4 vs 8.2 ± 1.6) although peak airway pressures were the lowest (30 ± 3.8 vs 45 ± 4.6 mmHg). SHFJV may therefore be useful in ALI management.

Background Adequate humidification in long-term jet ventilation is a criticalaspect in terms of clinical safety.

Inhaled nitric oxide (NO) reduces pulmonary hypertension in severe ARDS and improves arterial oxygenation by redistributing blood flow to areas with a normal ventilation/perfusion ratio [1]. As high peak inspiratory pressure (PIP) may contribute to pulmonary damage ventilatory strategies like high-frequency (HF) ventilation search to minimize PIP. This study was designed to evaluate the combined benefits of superimposed high-frequency jet-ventilation (SHFJV), a new HF jet-ventilation technique, with addition of inhalational NO.

Superimposed high-frequency jet-ventilation (SHFJV) is a new form of a combined high frequency (HF) jet ventilation technique in treatment of ARDS. Since the HF jet-stream improves oxygenation partially due to enhancement of the intra-pulmonary gas mixture [1] the question arises which frequency would be the most effective. Animal models and in vitro experiments demonstrate that the best results may be achieved with frequencies close to the resonant frequency (RF) of the lungs [1,2]. In this study we tried to find RF using SHFJV.