Erich Rügheimer

Blood volume determination using hydroxyethyl starch: a rapid and simple intravenous injection method.

OBJECTIVE To develop and evaluate a new method for blood volume measurements using hydroxyethyl starch as a dilution marker. DESIGN Laboratory and clinical investigation. SETTING Neurosurgical operating rooms and anesthesiological laboratories of a university hospital. PATIENTS Twelve patients who underwent a neurosurgical operation. INTERVENTIONS Anesthesia and operations were carried out by physicians who were not involved in the study. In addition, blood samples were drawn from 50 volunteers. MEASUREMENTS AND MAIN RESULTS Blood volume measurements by the hydroxyethyl starch method were validated in vivo by comparison with a conventional carbon monoxide technique. Patients were intravenously injected with hydroxyethyl starch (100 mL) and received simultaneously an injection of carbon monoxide (50 mL) into a closed-circuit ventilation system. Blood samples obtained before and 5 mins after injection were analyzed for carboxyhemoglobin and glucose plasma concentrations after acidic hydrolysis of hydroxyethyl starch. Blood volume was calculated from the difference between glucose concentrations measured after hydrolysis in the plasma, before and after the addition of hydroxyethyl starch. In vitro, the hydroxyethyl starch method had an error and a precision of approximately 2%. In vivo, simultaneous measurements of blood volume using hydroxyethyl starch and carbon monoxide demonstrated a high correlation (r2 = .96, p < .001) between these methods. The mean difference between the two methods relative to their average value was 1.0 +/- 3.5%; the bias was 52.3 mL, and the 95% confidence interval was -64.0 to +168.7 mL. CONCLUSIONS Blood volume determination by the hydroxyethyl starch method is accurate and rapid and may enhance perioperative monitoring of fluid and blood therapy.

Induction of nitric oxide synthase activity in phagocytic cells inhibited by tricyclodecan-9-yl-xanthogenate (D609)

1 The synthesis of nitric oxide (NO) by immune‐stimulated murine phagocytic cells (J774) and the modulation of this synthesis by tricyclodecan‐9‐yl‐xanthogenate (D609), a specific inhibitor of phosphatidylcholine‐specific phospholipase C (PC‐PLC), was investigated. D609 dose‐dependently suppressed production of NO, as measured by the release of nitrite and nitrate, in response to lipopolysac‐charide (LPS) and interferon‐γ (IFN‐γ) in intact cultured cells with an IC50 of approximately 20 μg ml−1. D609 at 40 μg ml−1 completely abrogated immune‐stimulated nitrite production. 2 The inhibitory effects of D609 on nitrite production were time‐dependent and restricted to the first 18 h post‐stimulation. D609 did not inhibit nitrite production in the cytosol of immune‐stimulated phagocytes. 3 These findings indicate that the xanthogenate, D609, is a potent inhibitor of the induction of NO‐synthase activity in immune‐stimulated phagocytes. Furthermore, since D609 has been demonstrated to inhibit PC‐PLC specifically, our findings suggest that the activation of this enzyme by LPS and IFN‐γ is a proximal step in the signal transduction of inducible NO‐synthase in phagocytic cells.

New aspects on respiratory failure

1: The Clinical Aspects of Respiratory Failure as a Result of Biochemical and Immunological Reactions: Endotoxin, Cytokines, and Receptors.- E. coli Sepsis-Induced Pulmonary Injury.- Regulation of the Cellular Immune Response and Interaction with the Endothelium by Changes in Membrane Receptors.- Increased Expression of the Low-Affinity Receptor for IgE (FceRII/CD23) on Rat Alveolar Macrophages.- 2: Cellular Reactions and Interactions: Macrophages and Leukocytes.- The Role of Alveolar and Intravascular Macrophages in Acute Lung Injury: New Methods and New Mechanisms.- Pulmonary Fibrosis: Role of Inflammatory Cells in Local Injury and Fibrosis.- 3: Mediators and Nonspecific Effectors: Eicosanoids, Proteases and Oxygen Radicals.- Eicosanoids and Acute Respiratory Failure - Pathophysiologic and Therapeutic Aspects.- Dietary Modification of the Arachidonic Acid Cascade.- Proteinases as Mediators of the Disturbance of Pulmonary Vascular Permeability in Sepsis, Polytrauma, and ARDS.- The Involvement of Oxygen Radicals and Their Derivatives in ARDS.- 4: Pulmonary Circulation.- Regulation of the Pulmonary Circulation During Lung Injury.- Investigations of the Pathophysiology of the Pulmonary Microcirculation Using In-vivo Microscopy.- Pulmonary Capillary Transit Times in Fully Recruited Networks.- New Drugs for the Treatment of Pulmonary Hypertension Associated with the Adult Respiratory Distress Syndrome.- 5: Gas Exchange.- Effects of Mechanical Ventilation and Cardiac Output upon Perfusion in Hypoxic Lung Areas.- Determination of Lung Water Content and Distribution by Nuclear Magnetic Resonance.- Volumetric Evaluation of Diaphragm Motion.- 6: Mechanics of Breathing and Surfactant.- Inflation and Atelectasis in a Topographical Model of the Lung.- Oscillation Mechanics in Respiratory Monitoring.- The Pulmonary Surfactant System: Its Contribution to Lung Alveolar Stability, Alteration in Acute Respiratory Failure, and Replacement as a Therapeutical Concept.- Effects of Artificial Ventilation on Surfactant Function.- 7: The Respiratory Pump.- Assessment of Dyspnea and Respiratory Muscle Function.- Muscle Fatigue in Acute Respiratory Failure.- Coordination of Respiratory Muscles.- 8: Artificial Ventilation.- Polymorphous Ventilation: A New Ventilation Concept for Distributed Time Constants.- Success of Pressure Support Ventilation and Combined High Frequency Ventilation with Respect to Extravascular Lung Water.- Biphasic Positive Airway Pressure (BIPAP).- Technical Aspects of Patient-Ventilator Interactions.- Learnt Ventilation Processes.- 9: Tissue Oxygenation and Organ Metabolism.- Diagnostic and Therapeutic Possibilities of a Computer-Based Hemodynamic Multisensor System.- Intrathoracic Blood Volume Accurately Reflects Circulating Volume Status in Critically Ill Patients.- Adult Respiratory Distress Syndrome and Metabolic Organ Dysfunction.- 10: Posters.- Generation of Free Oxygen Radicals and Chemotactic Desensitization Following Burn Injury.- A Prospective Evaluation of the Influence of Extrapulmonary Factors on Mechanical Ventilation.- The Relationship of SpO2 93%-95% to Arterial Blood Gases and Pulmonary Function Parameters.

Richtlinien zur Blutkomponententherapie bei Blutstillungsstörungen

Die physiologische Blutstillung ist ein komplexer Vorgang und eine aktive Leistung des gesunden Organismus. Neben bestimmten Strukturelementen der Gefase (Muskulatur; Endothelien; subendotheliales, kollagenhaltiges Bindegewebe) sind hieran Thrombozyten sowie die plasmatischen Faktoren der Blutgerinnung und Fibrinolyse einschlieslich der Inhibitoren beider Enzymsysteme beteiligt. Nur das ungestorte Zusammenwirken aller Reaktionspartnergewahrleistet eine effektive und situationsadaquate Hamostase: Das Blut gerinnt lediglich dort, wo es erforderlich ist, z. B. im Bereich von Gewebetraumatisierung und Gefasverletzungen. Im intakten Gefassystem gerinnt es nicht, sondern fliest, sofern ausreichend Stromungsenergie zur Verfugung steht (Ubersicht bei THOMAS (23)).

Zusammenfassung der Diskussion zu Teil 2

Frage: Unbestritten hat die Untersuchung von Ventilations-Perfusions-Beziehungen unsere Kenntnisse en Gasaustausch unter verschiedenen pathologischen Bedingungen wesentlich erweitert. Welche Bedeutung kommt diesen Verfahren in der Klinik zu, v. a. im Hinblick auf therapeutische Entscheidungen?

Zusammenfassung der Diskussion zum Thema: „Pharmakologische Grundlagen“

Welche Besonderheiten der Pharmakokinetik ergeben sich, wenn man die verschiedenen Altersstufen unserer Patienten, mogliche Vorerkrankungen, Veranderungen im Wasser-Elektrolyt-Haushalt sowie im Herz-Kreislauf-System, und hier insbesondere verschiedene Grade des Volumenmangels, berucksichtigt?

Zusammenfassung der Diskussion zum Thema: „Klinik der Verbrennungsbehandlung — Allgemein- und Lokaltherapie“

Soll bei den heute haufigen chemischen Verbrennungen mit fraglichem Inhalationstrauma Kortison routinemasig, systemisch oder per inhalationem gegeben werden?

Zusammenfassung der Diskussion zum Thema: „Therapeutische Besonderheiten und allgemeine Probleme der Verbrennungsbehandlung“

Konnen die berufsgenossenschaftlichen Angaben uber jahrlich etwa 4.000 Tote in Deutschland nach Stromunfallen als allgemein anerkannt angesehen werden?

Zusammenfassung der Diskussion zum Thema: „Organisation, personelle und apparative Ausstattung“

Die Notwendigkeit einer Aufwacheinheit ist unbestritten. Sie ist die einzig logische Losung fur die Verhutung und Bekampfung postoperativer und postnarkotischer Probleme. Sie belast den Patienten als eine Einheit, d. h. sie teilt ihn nicht in eine an-asthesiologische und chirurgische Halfte. Weiterhin vermeidet sie eine nicht immer einfache Trennung in Fruh- und Spatphase nach der Narkose. Sie umgeht die Minderversorgung und -Uberwachung wahrend der Nacht und erleichtert im Einzelfall die Entscheidung, ob ein Patient auf die Normal-, Wach- oder Intensivstation verlegt werden kann bzw. mus.

Zusammenfassung der Diskussion zum Thema: „Pathophysiologische und therapeutische Grundlagen“

Anhand welcher Kriterien last sich der Behandlungserfolg von Brandverletzten messen, und gibt es Hinweise fur entscheidende Fortschritte der Therapie in den letzten Jahren?