A new miniaturized system for extracorporeal membrane oxygenation in adult respiratory failure

Introduction Mortality of severe acute respiratory distress syndrome in adults is still unacceptably high. Extracorporeal membrane oxygenation (ECMO) could represent an important treatment option, if complications were reduced by new technical developments. Methods Efficiency, side effects and outcome of treatment with a new miniaturized device for veno-venous extracorporeal gas transfer were analysed in 60 consecutive patients with life-threatening respiratory failure. Results A rapid increase of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO(2)/FiO(2)) from 64 (48 to 86) mmHg to 120 (84 to 171) mmHg and a decrease of PaCO(2) from 63 (50 to 80) mmHg to 33 (29 to 39) mmHg were observed after start of the extracorporeal support (P < 0.001). Gas exchange capacity of the device averaged 155 (116 to 182) mL/min for oxygen and 210 (164 to 251) mL/min for carbon dioxide. Ventilatory parameters were reduced to a highly protective mode, allowing a fast reduction of tidal volume from 495 (401 to 570) mL to 336 (292 to 404) mL (P < 0.001) and of peak inspiratory pressure from 36 (32 to 40) cmH(2)O to 31 (28 to 35) cmH(2)O (P < 0.001). Transfusion requirements averaged 0.8 (0.4 to 1.8) units of red blood cells per day. Sixty-two percent of patients were weaned from the extracorporeal system, and 45% survived to discharge. Conclusions Veno-venous extracorporeal membrane oxygenation with a new miniaturized device supports gas transfer effectively, allows for highly protective ventilation and is very reliable. Modern ECMO technology extends treatment opportunities in severe lung failure

The Role of the Intestinal Microbiome in Chronic Psychosocial Stress-Induced Pathologies in Male Mice

Chronic psychosocial stress is a risk factor for the development of physical and mental disorders accompanied or driven by an activated immune system. Given that chronic stress-induced systemic immune activation is lacking in germ-free and antibiotics-treated mice, a causal role of the gut microbiome in the development of stress-related disorders is likely. To address this hypothesis in the current study we employed the chronic subordinate colony housing (CSC, 19 days) paradigm, a pre-clinically validated mouse model for chronic psychosocial stress, known to alter the gut microbial signature and to induce systemic low-grade inflammation, as well as physical and mental abnormalities. In detail, we investigated if (i) CSC-induced alterations can be prevented by repeated transplantation of feces (FT) from non-stressed single-housed control (SHC) mice during CSC exposure, and (ii) if the transplantation of a “stressed” CSC microbiome is able to induce CSC effects in SHC mice. Therefore, we repeatedly infused SHC and CSC recipient mice rectally with SHC donor feces at days 4 and 11 of the CSC paradigm and assessed anxiety-related behavior on day 19 as well as physiological, immunological, and bone parameters on day 20. Furthermore, SHC and CSC recipient mice were infused with CSC donor feces at respective days. To exclude effects of rectal infusions per se, another set of SHC and CSC mice was infused with saline, respectively. Our results showed that transplantation of SHC feces had mild stress-protective effects, indicated by an amelioration of CSC-induced thymus atrophy, anxiety, systemic low-grade inflammation, and alterations in bone homeostasis. Moreover, transplantation of CSC feces slightly aggravated CSC-induced systemic low-grade inflammation and alterations in bone homeostasis in SHC and/or CSC animals. In conclusion, our data provide evidence for a role of the host’s microbiome in many, but not all, adverse consequences of chronic psychosocial stress. Moreover, our data are consistent with the hypothesis that transplantation of healthy feces might be a useful tool to prevent/treat different adverse outcomes of chronic stress. Finally, our data suggests that stress effects can be transferred to a certain extend via FT, proposing therapeutic approaches using FT to carefully screen fecal donors for their stress/trauma history

Закономерности микроструктурных изменений в титановом сплаве ВТ6 при деформации и наводороживании

Объектом исследования являются образцы титанового сплава марки ВТ6 прокатанные до различных степеней деформации методом механической прокатки. Исследование дефектной структуры проводилось с использованием методов позитронной спектроскопии, которые могут определять тип и концентрацию дефектов, а также химическое окружение данных дефектов. Однако, для получения количественной и качественной оценки количества дефектов методами позитронной спектроскопии необходима дополнительная информация о базовых дефектах и их влиянии на характеристики позитронной аннигиляции. Целью работы является анализ структурных изменений в титановом сплаве ВТ6 в зависимости от степени холоднокатаной пластической деформации и после наводороживания.The object of the study are samples of titanium alloy grade VT6 rolled to various degrees of deformation by mechanical rolling. The study of the defect structure was carried out using positron spectroscopy methods, which can determine the type and concentration of defects, as well as the chemical environment of these defects. However, to obtain a quantitative and qualitative assessment of the number of defects by the methods of positron spectroscopy, additional information is needed about the basic defects and their effect on the positron annihilation characteristics. The aim of the work is to analyze the structural changes in titanium alloy VT6, depending on the degree of cold-rolled plastic deformation and after hydrogenation

Qualitätsmanagement: Implementierung des „In-Hospital“-Notfallprotokolls in die klinische Praxis

Outcome after in-hospital resuscitation with survival rates between 14-17% still remains poor. Structured documentation of in-hospital cardiac arrest especially in Germany is rare and inhomogeneous. Documentation of in-hospital emergency situations (I-ES) may help to develop organizational structures, to collect information of treatment after resuscitation and therefore, improve patient's outcome. The aim of this study was to evaluate the documentation quality and user's acceptance after the implementation of an in-house emergency (IHE) protocol used by the authors' internal medicine emergency team (ET). Analysis of IHE protocols and discharge letters of 65 patients between August 2004 and December 2007 at a university medical center. The IHE protocol was used in 65% of all emergency calls with a completion rate of 80% of all available documentation categories. Especially documentation of drugs given, their dosage and the general course of action was incomplete. In 25% the discharge letters did not contain information about the I-ES. Implementation of the authors' IHE protocol, designed in close accordance with the DIVI (German Interdisciplinary Association of Intensive Care and Emergency Medicine) out-of-hospital emergency protocol, helps to collect important data in I-ES. Usage of the protocol resulted in better documentation of emergency situations in contrast to the information found in discharge letters alone. Nevertheless, documentation of I-ES still needs to be improved, especially concerning the completeness of records

Bedeutung der Abdomen-Sonografie zur Infektfokussuche in der Notaufnahme

Introduction A very high number of patients presenting in emergency departments suffer from an unknown infection or rather fever. If diagnostic imaging is necessary ultrasound can be performed. Whether ultrasound is superior to medical history and clinical examination considering the significantly enhanced technology in recent years and hence has to be performed in patients without abdominal symptoms with non-obvious focus cannot be answered by review of the literature. The objective of this study was to evaluate the relevance of abdominal ultrasound in the determination of the site of infection and to analyse whether an abdominal ultrasound for the identification of the source of infection is dispensable in patients in whom history and clinical examination do not indicate an abdominal focus. Methods All patients undergoing an ultrasound between 2013/04 and 2013/07 in the emergency department of the university hospital of Regensburg were retrospectively analysed. 500 abdominal ultrasound examinations were performed for identifying an abdominal site of infection. These cases were analysed whether medical history and clinical examination were indicating an abdominal focus. Furthermore, on the basis of patient record and medical report the result of the performed ultrasound, final diagnosis, clinical parameters (lab results, fever) were retrospectively analysed. Results Based on the medical report in 208 (41.6 %) of the 500 reviewed cases there has been an abdominal focus. In 122 of these patients (59.0 %) abdominal ultrasound identified the abdominal focus correctly. In 206 patients (99.0 %) medical history and in 152 patients (73.1 %) clinical examination indicated an abdominal focus. A subgroup analysis regarding immunocompromised patients revealed that in 25 of 38 patients (65.8 %) an abdominal focus was determined via abdominal ultrasound. In patients with unremarkable medical history and clinical examination (23 examinations) no abdominal focus could be found via abdominal ultrasound. Discussion An urgent examination of the abdomen via ultrasound is dispensable in patients in whom history (provided complete history) and clinical examination (i.e. particularly no immunosuppression) do not indicate an abdominal focus

Pharmacokinetics of meropenem during intermittent and continuous intravenous application in patients treated by continuous renal replacement therapy

Objective: The clinical effect of beta-lactam antibiotics depends on the time of drug concentration above the minimal inhibitory concentration ( MIC) for a susceptible bacterium. Continuous infusion ( CI) of ss-lactams such as meropenem may therefore be a more rational approach than intermittent bolus injections ( IB). The aim of this study was to test whether CI of meropenem achieves effective drug concentrations comparable to IB in patients treated by continuous renal replacement therapy ( CRRT). Design: Prospective, randomised cross-over study. Setting: Twelve-bed medical intensive care unit ( ICU). Patients and interventions: Six ICU patients were randomised to receive either meropenem 1 g IB every 12 h or a 0.5 g i.v. loading dose followed by 2g i.v. CI over 24h. After 2 days, regimens were crossed over. Meropenem pharmacokinetics were determined on days 2 and 4. Measurements and results: Peak serum concentration [ median ( 25% and 75% quartiles)] after short infusion of 1 g meropenem were 62.8 ( 51.4; 85.0) mg/l, trough levels at 12 h were 8.1 (4.5; 18.7) mg/l, and serum half-life was 5.3 (5.1; 7.0) h. Steady-state concentrations during CI were 18.6 (13.3; 24.5) mg/l. The AUCs during either treatment were comparable and determined as 233 ( 202; 254) mg/l*h ( IB) and 227 ( 182; 283) mg/l*h ( CI), respectively. Four hours after IB, drug concentrations dropped below CI steady-state concentrations. Conclusion: Appropriate antibacterial concentrations of meropenem in patients with CRRT are easily achievable with CI. CI may be an effective alternative dosing regimen to IB. A prospective comparison of the clinical efficacy of the two dosage regimens is warranted