Management of acute respiratory distress syndrome using pumpless extracorporeal lung assist

Purpose: To describe the use of a pumpless extracorporeal lung assist device in the treatment of severe acute respiratory distress syndrome (ARDS). Clinical features: A 15-yr-old girl developed severe post-traumatic ARDS. After all conventional treatment strategies failed, we inserted a pumpless extracorporeal lung assist device. This device consists of an arterial cannula inserted into the femoral artery, and a membrane oxygenator with a venous cannula that returns the oxygenated blood back to the patient's femoral vein. Since the driving force is the patient's blood pressure, a roller pump with its negative side effects is not needed. The device allowed removal of excessive PaCO2 and, by applying minimal ventilation, minimization of further ventilator-induced lung injury. The pumpless extracorporeal lung assist device remainedin situ for ten days without any adverse side effect. During this time, the lung recovered such that mechanical ventilation could be reinstalled cautiously. The device was then removed and, after a prolonged period of intensive care, the patient recovered without any sequelae. Conclusion: In this case of a severely damaged lung, an arteriovenous pumpless extracorporeal lung assist was a helpful device to remove elevated CO2 and reduce mechanical stress by applying minimal ventilation. This device is simple to operate and has the potential of being used routinely in the treatment of severe ARD

Improved endothelial function after a modified harvesting technique of the internal thoracic artery

Objective: One of the most important factors in bypass surgery is the preservation of endothelial function in the arterial graft. It was of interest, therefore, whether a slightly modified preparation procedure during surgery could contribute to improved endothelial function of the graft. We compared the functional activity of internal thoracic arteries (ITA) prepared according to the traditional harvesting method with occlusion by a clip, dissection at the distal end and storage of the artery in papaverine until its implantation (CA) with the functional activity of arteries which were also prepared and wrapped in papaverine, but were left perfused and dissected immediately before their anastomoses (PA). Methods: Samples of ITA were obtained from a total number of 28 patients, undergoing bypass surgery, and randomly distributed into two groups. The arteries were cut into rings and suspended in organ baths, containing Krebs-Henseleit solution, for isometric tension recording. Cumulative concentration response curves were determined for the contractile agents endothelin-1 (ET-1), 5-hydroxytryptamine (5-HT), noradrenaline (NA) and potassium chloride (KCl) and the relaxant compounds acetylcholine (ACH) and sodium nitroprusside (SNP) during active tone induced by 30 mM KCl. Results: ET-1 and 5-HT stimulated rings from both groups within the same concentration ranges but elicited significantly (P<0.05) higher contractile responses in CA compared to PA. By contrast, concentration response curves for KCl and NA where nearly superimposable. On the other hand, maximal endothelium-dependent relaxant responses to ACH proved to be significantly stronger in PA (0.84±0.20 g) as compared to CA (0.31±0.05 g, P<0.05) while endothelium independent relaxant responses to SNP where similar in both groups. Conclusion: These data suggest that leaving the ITA perfused during harvesting might improve considerably the endothelial function of the graf

Association of Communication Interventions to Discuss Code Status With Patient Decisions for Do-Not-Resuscitate Orders: A Systematic Review and Meta-analysis

Whether specific communication interventions to discuss code status alter patient decisions regarding do-not-resuscitate code status and knowledge about cardiopulmonary resuscitation (CPR) remains unclear.; To conduct a systematic review and meta-analysis regarding the association of communication interventions with patient decisions and knowledge about CPR.; PubMed, Embase, PsycINFO, and CINAHL were systematically searched from the inception of each database to November 19, 2018.; Randomized clinical trials focusing on interventions to facilitate code status discussions. Two independent reviewers performed the data extraction and assessed risk of bias using the Cochrane Risk of Bias Tool. Data were pooled using a fixed-effects model, and risk ratios (RRs) with corresponding 95% CIs are reported.; The study was performed according to the PRISMA guidelines.; The primary outcome was patient preference for CPR, and the key secondary outcome was patient knowledge regarding life-sustaining treatment.; Fifteen randomized clinical trials (2405 patients) were included in the qualitative synthesis, 11 trials (1463 patients) were included for the quantitative synthesis of the primary end point, and 5 trials (652 patients) were included for the secondary end point. Communication interventions were significantly associated with a lower preference for CPR (390 of 727 [53.6%] vs 284 of 736 [38.6%]; RR, 0.70; 95% CI, 0.63-0.78). In a preplanned subgroup analysis, studies using resuscitation videos as decision aids compared with other interventions showed a stronger decrease in preference for life-sustaining treatment (RR, 0.56; 95% CI, 0.48-0.64 vs 1.03; 95% CI, 0.87-1.22; between-group heterogeneity P &lt; .001). Also, a significant association was found between communication interventions and better patient knowledge (standardized mean difference, 0.55; 95% CI, 0.39-0.71).; Communication interventions are associated with patient decisions regarding do-not-resuscitate code status and better patient knowledge and may thus improve code status discussions

A new cable-tie-based sternal closure device: infectious considerations.

To determine the difference in sternal infection and other infectious events between conventional wire and cable-tie-based closure techniques post-sternotomy in a collective of patients after cardiac surgery. The sternal ZipFix™ (ZF) system consists of a biocompatible poly-ether-ether-ketone (PEEK) cable-tie that surrounds the sternum through the intercostal space and provides a large implant-to-bone contact. Between 1 February 2011 and 31 January 2012, 680 cardiac operations were performed via sternotomy at our institution. After the exclusion of operations for active endocarditis and early mortality within 7 days, 95 patients were exclusively closed with ZF and could be compared with 498 who were closed with conventional wires (CWs) during the same period. A multivariable logistic regression analysis, including body mass index, renal impairment and emergency as suspected confounders and inverse propensity weights was performed on the infection rate. Total infection rate was 6.1%, with a total of 36 diagnosed sternal infections (5 in ZF and 31 in CW). Comparing ZF with CW with regard to sternal infection, there is no statistically significant difference related to the device (odds ratio: 0.067, confidence interval: 0.04-9.16, P=0.72). The propensity modelling provided excellent overlap and the mean propensity was almost the same in both groups. Thus, we have observed no difference in receiving either ZF or CW. No sternal instability was observed with the ZF device, unlike 4/31 patients in the CW group. The overall operation time is reduced by 11 min in the ZF group with identical perfusion and clamping times. Our study underlines a neutral effect of the sternal ZipFix™ system in patients regarding sternal infection. Postoperative complications are similar in both sternal closure methods. The cable-tie-based system is fast, easy to use, reliable and safe

Der IBD-Control-Fragebogen: Deutsche Übertragung und Validierung des standardisierten Fragebogens zur Messung des Outcomes aus Patientensicht bei chronisch entzündlichen Darmerkrankungen

Hintergrund Auf dem Weg zu einer wertebasierten und patientenzentrierten medizinischen Versorgung rückt das subjektiv vom Patienten empfundene Ergebnis einer Behandlung zunehmend in den Fokus. Als Messinstrument dienen dabei Patient-reported Outcome Measures (PROMs). Bei chronisch entzündlichen Darmerkrankungen hat sich der englischsprachig validierte Fragebogen IBD-Control zur Messung des Behandlungserfolgs aus Patientensicht etabliert. Da dieser bisher nicht auf Deutsch vorliegt, machte sein Einsatz in der deutschsprachigen Schweiz im Vorfeld eine Übersetzung sowie Validierung notwendig. Methoden Die englischsprachige Originalversion des IBD-Control-Fragebogens wurde mittels „forward-backward translation“ ins Deutsche übertragen und anschließend an 154 Patienten mit Morbus Crohn oder Colitis ulcerosa validiert. Resultat Die Übersetzung des IBD-Control erfolgte durch eine multidisziplinäre Expertengruppe sowie Fachübersetzer. Der IBD-Control-D zeigte eine große Akzeptanz. Eine starke Korrelation zwischen dem IBD-Control-8-Subscore mit der visuellen Analogskala des IBD-Control-D (r=0,632) zeigt die Validität des Instruments. Die Konstruktvalidität zeigt sich in der starken Korrelation zwischen der Krankheitsaktivität der letzten 6 Monate und dem IBD-Control-8-Subscore (r=0,640) sowie dem IBD-Control-VAS-Score (r=0,622) sowie zwischen dem IBD-Control-8-Subscore und dem Harvey Bradshaw Index (r=–0,620) und dem partiellen Mayo Score (r=–0,679) wie auch zwischen dem IBD-Control-VAS-Score und dem Harvey Bradshaw Index (r=–0,484) sowie dem Mayo Score (r=–0,435). Die interne Konsistenz ist gegeben (Cronbachs α = 0,840). Schlussfolgerung Mit der hier vorgestellten deutschen Version des IBD-Control, dem IBD-Control-D, liegt nun auch im deutschsprachigen Raum ein valides, benutzerfreundliches und geeignetes Instrument vor, um das subjektive Krankheitsempfinden und das Behandlungsoutcome im Kontext chronisch entzündlicher Darmerkrankungen zu erfassen. = Background Subjectively perceived results of treatment will be in the center of defining treatment success on the way to value-based and patient-centered health care. Patient-reported outcome measures (PROMs) serve as an instrument to measure treatment success. In inflammatory bowel disease (IBD), measuring treatment success from a patient’s point of view is performed with the validated IBD-Control questionnaire. Because the IBD-Control questionnaire has not been published in German yet, the translation and validation of the IBD-Control in the German-speaking part of Switzerland was necessary before use. Methods We have translated the English original version of the IBD-Control questionnaire into German in a state-of-the-art procedure of „forward-backward translation” and validated the translated IBD-Control questionnaire with 154 patients with Crohn’s disease or with ulcerative colitis. Results Professional health care and translation experts have contributed to the translation of the IBD-Control into German. The IBD-Control-D is an accepted questionnaire. Spearmans Rho showed high consistency between the IBD-Control-8-Subscore and the IBD-Control-VAS-Score (r=0.632). The disease activity in the past 6 months highly correlated with the IBD-8 subscore (r=0.640) as well as with the IBD-Control-VAS-Score (r=0.622). The IBD-Control-8-Subscore highly correlated with the Harvey Bradshaw Index (r=–0.620) and the partial Mayo Score (r=–0.679), as well as the IBD-Control-VAS-Score with the Harvey Bradshaw Index (r=–0.484) and the Mayo Score (r=–0.435), showing sufficient construct validity. The result is the German version of the IBD-Control, the IBD-Control-D, published here. Conclusion The original English version is a valid instrument, and its use has proven to be a suitable instrument in German-speaking areas to make the subjective feeling of illness and treatment outcome measurable

Effects of the novel polymer gel LeGoo on human internal thoracic arteries

Established hemostatic devices can injure vessel wall integrity. LeGoo (Pluromed, Woburn, MA), a novel poloxamer gel with reverse thermosensitive properties, is a new device for temporary occlusion of blood vessels. The present study investigated the effects of LeGoo on vascular function and morphology

Les langues finno-ougriennes aujourd’hui II

Ce numéro poursuit l'entreprise lancée avec le no 44, c'est-à-dire qu'il passe en revue les langues finno-ougriennes de Russie centrale et du Nord dans leur position socio-linguistique. Les auteurs de ces articles sont des chercheurs linguistes, anthropologues, mais aussi des locuteurs et utilisateurs des langues finno-ougriennes ou des écrivains. Trois langues ne sont pas représentées dans ce recueil d'études: le mokcha, le permiak et le mansi. Mais la situation de ces langues s'insère dans les problématiques ici abordées: deux langues littéraires pour une dénomination (erza/mokcha, komi/permiak, mais la polémique sur le mari des plaines et le mari des montagnes est fortement développée par deux études illustrant bien les problèmes rencontrés : vieillissement des locuteurs, zones de transition multilingues. Le recueil est introduit par un essai de l'écrivain et chercheur oudmourte Aleksej Arzamazov