Material in Kapnographie Gebrauchte Eines der Hindernisse für die Nutzung der abgelaufenen CO 2-Überwachung liegt in der Verschiedenheit des Materials durch Notärzte eingesetzt. Zur Klärung dieser Situation ist es wichtig zu unterscheiden, ob der Patient künstlich belüftet ist oder Spontanatmung. Im übrigen haben die verschiedenen Techniken für die Analyse nicht mehr verwendet die Auswirkungen auf klinische Ergebnisse und Effizienz. Diese Aussage steht im Falle der traditionellen Unterscheidung zwischen Nebenstromrauch und Mainstream-Kapnographie. Diese beiden Techniken messen CO 2 mit Infrarot-Wellen, die Seitenstrom-System verwendet eine Absaugpumpe, um CO 2 aus dem Mund, um den Detektor in dem Monitor befindet Verkehr, während die Mainstream-System misst CO 2 direkt in eine kleine Kammer liegt an der Mündung des Patienten und an den Monitor angeschlossen über ein Kabel. Traditionell ist der Nebenstromrauch-System für Patienten spontan atmenden, da das System leichter verwendet, und die Mainstream-System, ein wenig sperriger, ist direkt mit dem Endotrachealtubus in intubierten Patienten verbunden. Technologische Fortschritte in den letzten Jahren haben sich grundlegend die Unterschiede zwischen Mainstream und Nebenstromrauch Systeme reduziert. Die neue Technologie ist auf die Microstream-System, das eine Art &quot;erweiterte Nebenstromrauch System&quot;, in denen CO2 entlang einer dünnen Schlauch vor dem Erreichen der Kammer, wo der Detektor befindet verweist, so dass eine kleinere Übergangszeit zwischen der Mündung und der Detektionskammer und somit ein Kapnographie Kurve, die fast mit dem Durchgang der Luft liegt an der Mündung synchronisiert. Also, lassen Sie uns einen Blick darauf, was unterscheidet die Wahl des Materials, wie in der zweiten Hälfte der Videosequenz: <ul><li> Wenn der Arzt will einen Patienten in Spontanatmung überwachen, um die precocely erkennen Apnoe (während der Sedierung oder nach medizinischen Rausch), dann nur die Form der Kurve ist wichtig, den tatsächlichen Wert der etCO 2 wird weniger wichtig. In diesem Fall kann er Arzt zwischen Nasenbrille oder eine Kombination capnomask Verabreichung von Sauerstoff und CO 2-Aspiration, oder eine dünne CO 2 Ansaugschlauch, die unter einer klassischen Maske platziert werden können wählen. </li><li> Wenn der Arzt will genau analysieren ETCO 2, um die Parameter an ein Beatmungsgerät anzupassen, um die richtige Positionierung eines Endotrachealtubus überprüfen oder die Prognose bei einem Herzstillstand zu bewerten, muss er mit dem Material als für die Verwendung mit angepasst werden Endotrachealtubus (immer hinter dem Filter angeordnet, so Sekrete vom Patienten nicht blockieren das Rohr). </li></ul> Die Kapnographie Curve Ein typisches Kapnographie-Kurve in drei Abläufen ist in Abbildung 1 dargestellt. Die Kurve gewinnt die x-Achse (0-Wert) bei jeder Inspiration, da es praktisch keine CO 2 in Atemluft. <img src="/files/ftp_upload/2508/2508fig1.jpg" alt="Abbildung 1" /> Abbildung 1: alternierende inspiration-Ablauf Unterschiede zwischen PaCO 2 und etCO 2 Es wäre eutopic zu glauben, dass nicht-invasive Überwachung des ausgeatmeten CO 2 kann unter allen Umständen ersetzen die Notwendigkeit für die arterielle Blutgasanalyse (ABG) Maßnahmen, die als Goldstandard für die Messung von PaCO 2 sein. Alles hängt von der Indikationen für die Messung des ausgeatmeten CO 2 und die Patienten kardio-respiratorischen Zustand. Wenn die Anzeige ist die Überwachung der Atemtätigkeit zu Hypoventilation und Apnoe während der Sedierung zu vermeiden, ist eine einfache Analyse der Kurve ausreichend, unabhängig vom Wert der ETCO 2. Auf der anderen Seite, wenn die Angabe auf die ausreichende Belüftung des Hirn-Trauma Patienten ohne Geschichte der Herz-, Atemwegs-Erkrankungen zu überwachen ist, können wir erwarten, dass die ETCO 2-Wert auf die Nähe zu den PaO 2-Wert, obwohl die Notwendigkeit einer genauen PaCO 2-Wert legt zumindest eine ABG-Probe, die erlaubt uns auch bestätigen, dass tatsächlich ETCO 2 nahe PaCO 2 ist im vorliegenden Fall. Schließlich, wenn wir mit dem Fall eines Patienten, die intubiert und belüftet ist wegen Atemnot konfrontiert sind, wird ETCO 2 Werte offenbar nicht eine gute Annäherung an PaCO 2 sein. Der Grund ist einfach: sobald es zu einer Störung in Ventilations-Perfusions-Verhältnis, egal was der Herz-Lungen-Erkrankung vorhanden ist, ein Hindernis für die korrekte Beseitigung von CO 2 durch die Lunge wird erstellt. Als Folge sammelt sich CO 2 in das Blut und naso-bukkalen Elimination reduziert wird, die Schaffung eines PaCO 2 - ETCO 2-Gradienten. Unter diesen Umständen ist es entscheidend, den Wert des PaCO 2 kennen, bevorjede Interpretation der ETCO 2-Wert. Der erste Teil der Videosequenz beschreibt das Verfahren für die Interpretation der Unterschied zwischen PaCO 2 und ETCO 2 folgen. Wir sehen, dass die Maßnahme von ETCO 2 sofort und in eine nicht-invasive Weise erhalten wird, aber in diesem Stadium können nicht zulassen, die Anpassung der Atemschutzmaske ist Parameter. Dies impliziert, dass der PaCO 2, die dann mit dem ETCO 2 kann im Vergleich zu messen. Die PaCO 2-Wert bleibt die Verweisung Wert für die Wertschätzung der Beatmung des Patienten. <ul><li> Wenn PaCO 2 gemessen ist höher als der Sollwert, z. B. 60mmHg statt 40 mmHg, so bedeutet dies, dass der Patient hypoventilated ist. Die Atemschutzmaske ist Parameter können dann angepasst werden, entweder die Atemfrequenz oder das Atemvolumen erhöht, um die Belüftung zu erhöhen und so zu verringern PaCO 2 sein. Das Ziel besteht darin, den ETCO 2 von 20 mmHg, unabhängig von der anfänglichen ETCO 2-Wert. Zum Beispiel kann es möglich sein, dass die ETCO 2-Wert 50 mmHg, wenn der PaCO 2 bei 60mmHg gemessen wird, aufgrund eines PaCO 2-ETCO 2-Gradienten durch die Anwesenheit eines Herz-Kreislauf-Erkrankung der Atemwege erzeugt. Wenn die Anpassung der Atemschutzmaske die Parameter der ETCO 2 aus 50 mmHg auf 30 mmHg drop ermöglicht, können wir sicher annehmen, dass der Patient ausreichend ist mit einem PaCO 2-Wert mit von 60mmHg auf 40mmHg sank belüftet. </li><li> Umgekehrt, wenn der PaCO 2 ist niedriger als der Sollwert, wird der Patient hyperventiliert und damit Atemfrequenz oder Tidalvolumen müssen reduziert, um den Zielwert zu erreichen sein. Wenn PaCO 2 ist 20 mmHg niedriger als der Zielwert, muss man die ETCO 2 von 20 mmHg durch Modifikation des Beatmungsgerätes die Parameter zu erhöhen. </li></ul> Artefakte und Traps in Kapnographie. Wenn die Technik für CO 2-Messung hat sich in Bezug auf Präzision, Reproduzierbarkeit, Reaktionszeit und Kurve Qualität zuverlässig, noch stellt, wie für jeden überwachten Parameter, gewisse Grenzen: <ul><li> Die erste Einschränkung ist wegen des Mangels an richtigem Wissen über die Pathophysiologie der CO 2 durch den Arzt, der dann nur ungern auf die Technik nutzen. Wir hoffen, dass diese Erklärung und die Videosequenzen begleiten wird zur Lösung dieser Einschränkung. </li><li> Im Falle des spontan atmenden Patienten wird die Adjunktion Sauerstofftherapie über die Maske zu verdünnen das abgelaufene CO 2, das deutlich ändern wird Kapnogramm und die ETCO 2 wird sinken. Die Videosequenz zeigt dieses Phänomen. </li><li> Will man für Hypoventilation oder Apnoe Event Monitor an, während prozedurale Sedierung, erwarten wir ETCO 2, in Korrelation zu PaCO 2, parallel zu Hypoventilation des Patienten zu erhöhen. Paradoxerweise, eine Hypoventilation Ereignis bei einem Patienten spontan atmenden ist durch einen Rückgang in ETCO 2 übersetzt, weil der Patient ist dann nur noch atmen mit einem sehr kleinen Tidalvolumen, das entspricht im Wesentlichen dem Totvolumen der tracheo-Bronchal Raum, und wie wir wissen, hat dieser Raum nicht in Gasaustausch teilnehmen und enthält somit nur sehr wenig CO 2. </li><li> Bei der mechanischen Lüftung, ist die Gefahr, dass man vergisst, dass etCO 2 nicht unbedingt PaCO 2 (siehe voriges Kapitel). </li></ul>

<ol>
	<li>Gravenstein, J. S., Jaffe, M. B., Paulus, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Capnography, Clinical aspects. , (2004).</li><li>Kupnik, D., Skok, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capnometry+in+the+prehospital+setting:+are+we+using+its+potential.">Capnometry in the prehospital setting: are we using its potential.</a> Emerg Med J. 24, 614-617 (2007).</li><li>Delorio, N. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Continuous+end-tidal+carbon+dioxide+monitoring+for+confirmation+of+endotracheal+tube+placement+is+neither+widely+available+nor+consistently+applied+by+emergency+physicians.">Continuous end-tidal carbon dioxide monitoring for confirmation of endotracheal tube placement is neither widely available nor consistently applied by emergency physicians.</a> Emerg Med J. 22, 490-493 (2005).</li><li>Burton, J. H., Harrah, J. D., Germann, C. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+end-tidal+carbon+dioxide+monitoring+detect+respiratory+events+prior+to+current+sedation+monitoring+practices?.">Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?.</a> Acad Emerg Med. 13, 500-504 (2006).</li><li>Fletcher, R., Jonson, B., Cumming, G., Brew, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+concept+of+deadspace+with+special+reference+to+the+single+breath+test+for+carbon+dioxide.">The concept of deadspace with special reference to the single breath test for carbon dioxide.</a> Br J Anaesth. 53, 77-78 (1981).</li></ol>

Bedeutung von CO 2 für den Organismus Bevor wir abgelaufen CO 2-Überwachung, ist es wichtig zu relativieren die generelle Rolle von CO2 in den menschlichen Körper spielt. Produziert mit einer Rate von etwa 200 ml pro Minute, ist CO 2 nicht nur ein Nebenprodukt des Zellstoffwechsels verschwendet. Wenn unsere medullären Chemorezeptoren die Rolle der Aufrechterhaltung der arteriellen CO2-Partialdruck (PaCO 2) bei 40 mmHg haben, ist es, weil CO ...

expired co2 measurement in intubated or spontaneously breathing patients from the emergency department

Kohlendioxid (CO 2) zusammen mit Sauerstoff (O 2) teilen sich die Rolle als die wichtigsten Gase in den menschlichen Körper. Die Messung des ausgeatmeten CO 2 an der Mündung hat gebeten wachsendem klinischen Interesse bei Ärzten in der Notaufnahme für verschiedene Indikationen: (1) Überwachung et Überwachung des intubierten Patienten, (2) Überprüfung der korrekten Positionierung des Endotrachealtubus, (3 ) Überwachung eines Patienten mit Herzstillstand, (4) zu erreichen Normokapnie in intubiert Kopf Trauma-Patienten, (5) Monitoring Belüftung während der Sedierung. Das Video ermöglicht es Ärzten, sich mit dem Einsatz von Kapnographie vertraut zu machen und den Text bietet einen Überblick über die Theorie und Schulleiter beteiligt. Insbesondere die Bedeutung von CO 2 für den Organismus, die Relevanz der Messung von ausgeatmeten CO 2, werden die Unterschiede zwischen arteriellen und ausgeatmeten CO 2, das Material in Kapnographie mit ihren Artefakten und Fallen verwendet werden, überprüft werden. Da die wichtigsten Zurückhaltung bei der Nutzung der abgelaufenen CO 2-Messung ist wegen des Mangels an richtigem Wissen über die Pathophysiologie der CO 2 durch den Arzt, hoffen wir, dass diese Erklärung und die Videosequenzen begleiten wird zur Lösung dieser Einschränkung.

Watch this Scientific Journal Video about Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department at JoVE.com

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

Dieses Video beschreibt, wie CO durchführen<sub&gt; 2</sub&gt; Messung in intubiert sowie spontan atmenden Patienten. Die wichtigsten klinischen Angaben beziehen sich auf Notfälle: (1) die Überprüfung angemessene Positionierung eines Endotrachealtubus, (2) zu erreichen Normokapnie in Trauma-Patienten, (3) Überwachung Lüftung im Falle der Sedierung.

Abgelaufene CO 2 Messung bei intubierten oder spontan atmenden Patienten aus der Notaufnahme

Carbon dioxide (CO2) along with oxygen (O2) share the role of being the most important gases in the human body. The measuring of expired CO2 at the mouth ...

expired-co2-measurement-intubated-or-spontaneously-breathing-patients

Research

JoVE Journal

Medicine

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

16.1K Aufrufe.  Universit Catholique de Louvain Cliniques Universitaires Saint-Luc. Dieses Video beschreibt, wie CO durchführen 2 Messung in intubiert sowie spontan atmenden Patienten. Die wichtigsten klinischen Angaben beziehen sich auf Notfälle: (1) die Überprüfung angemessene Positionierung eines Endotrachealtubus, (2) zu erreichen Normokapnie in Trauma-Patienten, (3) Überwachung Lüftung im Falle der Sedierung.

Serie: Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

Scleral Cross-linking Using Riboflavin and Ultraviolet-A Radiation for Prevention of Axial Myopia in a Rabbit Model

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal abnormalities. In addition, pathological myopia is a common irreversible cause of visual impairment and blindness1-3. Our study demonstrates the effect of scleral crosslinking using riboflavin and ultraviolet-A radiation on the development of axial myopia in a rabbit model. The axial length of the eyeball was measured by A-scan ultrasound in New Zealand white rabbits aged 13 days (male and female). The eye then underwent 360&#176; conjunctival peritomy with scleral crosslinking, followed by tarsorrhaphy. Axial elongation was induced in 13 day-old New Zealand rabbits by suturing their right eye eyelids (tarsorrhaphy). The eyes were divided into quadrants, and every quadrant had two scleral irradiation zones, each with an area of 0.2 cm&#178; and a radius of 4 mm. Crosslinking was performed by dropping 0.1% dextran-free riboflavin-5-phosphate onto the irradiation zones 20 sec before ultraviolet-A irradiation and every 20 sec during the 200 sec irradiation time. UVA radiation (370 nm) was applied perpendicular to the sclera at 57 mW/cm&#178; (total UVA light dose, 57 J/cm&#178;). Tarsorrhaphies were removed on day 55, followed by repeated axial length measurements. This study demonstrates that scleral crosslinking with riboflavin and ultraviolet-A radiation effectively prevents occlusion-induced axial elongation in a rabbit model.

We demonstrate the effect of scleral crosslinking with riboflavin and UVA on an axial elongation rabbit eye. Axial elongation was induced in 13 day-old New Zealand rabbits (male and female) by suturing their right eye eyelids (tarsorrhaphy).

Sklerale Vernetzungs Mit Riboflavin und UV-A-Strahlung-für Prävention von Axial Myopie in einem Kaninchenmodell

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal ...

Forschung

Medizin

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or intraosseous routes, but in many patients, particularly in the emergency or critical care settings, these routes are often unavailable or time-consuming to access. A novel device is now available that offers an easy route for administration of medications or fluids via rectal mucosal absorption (also referred to as proctoclysis in the case of fluid administration and subsequent absorption). Although originally intended for the palliative care market, the utility of this device in the emergency setting has recently been described. Specifically, reports of patients being treated for dehydration, alcohol withdrawal, vomiting, fever, myocardial infarction, hyperthyroidism, and cardiac arrest have shown success with administration of a wide variety of medications or fluids (including water, aspirin, lorazepam, ondansetron, acetaminophen, methimazole, and buspirone). Device placement is straightforward, and based on the observation of expected effects from the medication administrations, absorption is rapid. The rapidity of absorption kinetics are further demonstrated in a recent report of the measurement of phenobarbital pharmacokinetics. We describe here the placement and use of this device, and demonstrate methods of pharmacokinetic measurements of medications administered by this method.

This study presents a novel device that offers an easy route to quickly provide medications and fluids in patients with limited or difficult IV access. This small-diameter device is placed in the distal third of the rectum, allowing for ongoing medication and fluids administration.

Ein neuer Ansatz für die Verabreichung von Medikamenten und Flüssigkeiten in Notfallszenarien und Einstellungen

The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or ...

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can be&#160;achieved by either&#160;thrombolysis with recombinant tissue-plasminogen activator (rt-PA), the standard therapy for stroke patients who present within the first hours of symptom onset without contraindications, or by an endovascular approach, if a proximal brain vessel occlusion is detected. As the efficacy of both therapies declines over time, every minute saved along the way will improve the patient&#39;s outcome.
This critical situation requires thorough work and precise communication with the patient, the family and colleagues from different professions to acquire all relevant information and reach the right decision while carefully monitoring the patient. This is a high fidelity situation. In nonmedical high-fidelity environments such as aviation, Crew Resource Management (CRM) is used to enhance safety and team efficiency.
This guide shows how a Stroke Team algorithm, which is transferable to other hospital settings, was established and how regular simulation-based trainings were performed. It requires determination and endurance to maintain these time-consuming simulation trainings on a regular basis over the course of time. However, the resulting improvement of team spirit and excellent door-to-needle times will benefit both the patients and the work environment in any hospital.
A dedicated Stroke Team of 7 persons who are notified 24/7 by a collective call via speed dial and run a binding algorithm that takes approximately 20 min, was established. To train everybody involved in this algorithm, a simulation-based team training for all new Stroke Team members was conceived and conducted at monthly intervals. This led to a relevant and sustained reduction of the mean door-to-needle time to 25 min, and enhanced the feeling of stroke readiness especially in junior doctors and nurses.

Every min counts in acute stroke care. This guide shows how to establish a Stroke Team algorithm and enhance its performance with regular simulation training. The principles of Crew Resource Management (CRM) facilitate a straight workflow, reduce door-to-needle times and increase staff satisfaction.

Einrichten eines Stroke-Team-Algorithmus und Durchführung von Simulationsbasierte Ausbildung in der Notaufnahme - Praktischer Leitfaden

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of a robotic system. In traditional robotic training for surgeons, a brief web based overview of performing an emergency undocking is provided during initial introductory training to the robotics system. During such a process, there is no training in delineation of interdisciplinary roles for operating room (OR) personnel. The training presented here uses formative simulation and debriefing followed by a lecture. For the simulation, a modified gynecologic simulator is draped in a steep trendelenburg position consistent with most gynecologic laparoscopic surgery. The training torso is modified using tubing hooked to pressure bags of red food colored IV fluid used to simulate a catastrophic vessel injury on demand. Positioned throughout the operating room setting is an interprofessional team consisting of embedded standardized persons (ESPs) to fulfill the roles of a circulating nurse, scrub nurse, anesthesiologist, and bedside assist surgeon. Robotic surgeons are presented a case scenario necessitating emergency undocking, and given control of the robotic instruments. The scenario is terminated following either successful completion of an emergency undock, or at five minutes due to the emergent nature of the case. A debriefing session with hands on training of the steps to emergency undocking, necessary equipment, troubleshooting techniques, and operating room personnel roles follows the simulation. The learners are presented with a short lecture reemphasizing the material presented in the debriefing for their own self-study. This training results in improved time accessing the patient, improved knowledge, confidence, and completion of critical actions, and can be replicated in most institutions. All robotic surgeons should be able to demonstrate competence in this crucial intervention. A limitation of the curriculum is ability to access the in-situ environment for training purposes.

This training platform is designed to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of the robotic system. Training includes the utilization of the technology and equipment to perform an emergency undocking, as well as delineation of roles for such a scenario.

Notfall Abdocken im Roboter-Chirurgie: eine Simulation Curriculum

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

Setup and Execution Of the Blindfolded Code Training Exercise

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to improve resident physician communication and leadership strategies in high-acuity situations. The blindfolded code training exercise removes visual stimuli from the team leader, forcing the team leader to effectively utilize closed-loop communication. The simple act of blindfolding the team leader creates a learning environment where the leader must utilize a conceptual framework and critical thinking strategies to organize the team and manage the resuscitation. An advantage to this teaching technique is that it does not require any special simulation equipment, making it a low-cost approach. The blindfolded code training exercise can be applied to the management of any critically ill patient where the primary objective is to focus on developing communication skills in acute resuscitations. The purpose of the description of the blindfolded code training exercise is to provide guidance on how to perform this innovative teaching technique to force effective closed-loop communication.

The blindfolded code training exercise, which blindfolds the team leader in a code resuscitation simulation, is an advanced teaching technique to improve closed-loop communication, organizational skills, and critical thinking.&#160;

Installation und Ausführung der mit verbundenen Augen Code Training Übung

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to ...

CO2-Lasertonsillotomy Under Local Anesthesia in Adults

Tonsil-related complaints are very common among the adult population. Tonsillectomy under general anesthesia is currently the most performed surgical treatment in adults for such complaints. Unfortunately, tonsillectomy is an invasive treatment associated with a high complication rate and a long recovery time. Complications and a long recovery time are mostly related to removing the vascular and densely innervated capsule of the tonsils. Recently, CO2-lasertonsillotomy under local anesthesia has been demonstrated to be a viable alternative treatment for tonsil-related disease with a significantly shorter and less painful recovery period. The milder side-effect profile of CO2-lasertonsillotomy is likely related to leaving the tonsil capsule intact. The aim of the current report is to present a concise protocol detailing the execution of CO2-lasertonsillotomy under local anesthesia. This intervention has been performed successfully in our hospital in more than 1,000 patients and has been found to be safe and to be associated with a steep learning curve.

CO2-Lasertonsillotomy Under Local Anesthesia in Adults

CO2-lasertonsillotomy under local anesthesia is an interesting alternative treatment method for tonsillectomy under general anesthesia for tonsil-related complaints in adults. This report presents a step-by-step protocol detailing the execution of CO2-lasertonsillotomy under local anesthesia.

CO2-Lasertonsillotomie unter örtlicher Anästhesie bei Erwachsenen

Tonsil-related complaints are very common among the adult population. Tonsillectomy under general anesthesia is currently the most performed surgical ...

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most frequent type of cardiac ablation procedure performed. Although generally safe, collateral injury to surrounding structures, particularly the esophagus, remains a concern. Cooling or warming the esophagus to counteract the heat from RF ablation, or the cold from cryoablation, is a method that is used to reduce thermal esophageal injury, and there are increasing data to support this approach. This protocol describes the use of a commercially available esophageal temperature management device to cool or warm the esophagus to reduce esophageal injury during left atrial ablation. The temperature management device is powered by standard water-blanket heat exchangers, and is shaped like a standard orogastric tube placed for gastric suctioning and decompression. Water circulates through the device in a closed-loop circuit, transferring heat across the silicone walls of the device, through the esophageal wall. Placement of the device is analogous to the placement of a typical orogastric tube, and temperature is adjusted via the external heat-exchanger console.

The goal of this protocol is to describe the use of esophageal temperature modulation to counteract esophageal thermal injury from left atrial ablation for the treatment of atrial fibrillation.

Kühlung oder Erwärmung der Speiseröhre zur Verringerung der Ösophagus-Verletzung während der linken Atrial-Ablation bei der Behandlung von Vorhofflimmern

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most ...

Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis

Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in clinical settings including cardiovascular and brain surgery, neonatal monitoring and prehospital medicine. The NIRS monitoring devices are real-time and noninvasive, and have mainly been used for evaluating cerebral oxygenation in critically ill patients during an operation or intensive care. Thus far, the use of NIRS monitoring in patients with chronic kidney disease (CKD) including hemodialysis (HD) has been limited; therefore, we investigated rSO2 values in some organs during HD. We monitored rSO2 values using a NIRS device transmitting near-infrared light at 2 wavelengths of attachment. The HD patients were placed in a supine position, with rSO2 measurement sensors attached to the foreheads, the right hypochondrium and the lower legs to evaluate rSO2 in the brain, liver and lower leg muscles, respectively. NIRS monitoring could be a new approach to clarify changes in organ oxygenation during HD or factors affecting tissue oxygenation in CKD patients. This article describes a protocol to measure tissue oxygenation represented by rSO2 as applied in HD patients.

We present a protocol to measure regional oxygen saturation (rSO2) in hemodialysis (HD) patients by using a near-infrared spectroscopy monitor. The rSO2 value is an index of tissue oxygenation. This noninvasive and real-time monitoring could be useful for confirming changes in organ oxygenation during HD.

Messung der Gewebeoxygenierung mittels Nahinfrarotspektroskopie bei Patienten, die sich einer Hämodialyse unterziehen

Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in ...

A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects

Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if administered at high concentration. Inhaled NO gas is routinely used to increase systemic oxygenation in different disease conditions. The administration of high concentrations of NO also exerts a virucidal effect in vitro. Owing to its favorable pharmacodynamic and safety profiles, the familiarity in its use by critical care providers, and the potential for a direct virucidal effect, NO is clinically used in patients with coronavirus disease-2019 (COVID-19). Nevertheless, no device is currently available to easily administer inhaled NO at concentrations higher than 80 parts per million (ppm) at various inspired oxygen fractions, without the need for dedicated, heavy, and costly equipment. The development of a reliable, safe, inexpensive, lightweight, and ventilator-free solution is crucial, particularly for the early treatment of non-intubated patients outside of the intensive care unit (ICU) and in a limited-resource scenario. To overcome such a barrier, a simple system for the non-invasive NO gas administration up to 250 ppm was developed using standard consumables and a scavenging chamber. The method has been proven safe and reliable in delivering a specified NO concentration while limiting nitrogen dioxide levels. This paper aims to provide clinicians and researchers with the necessary information on how to assemble or adapt such a system for research purposes or clinical use in COVID-19 or other diseases in which NO administration might be beneficial.

This simple and highly adaptable system device for the inhalation of high-concentration nitric oxide (NO) gas does not require mechanical ventilators, positive pressure, or high gas flows. Standard medical consumables and a snug-fitting mask are used to safely deliver NO gas to spontaneously breathing subjects.

Ein neuartiges Inhalationsmaskensystem zur Abgabe hoher Konzentrationen von Stickoxidgas bei spontan atmenden Probanden

Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if ...

Vorhersage der Prognose bei akuter Herzinsuffizienz mit Hilfe des Phasenwinkels und der BIVA Z-Scores

Clinical Application of Phase Angle and BIVA Z-Score Analyses in Patients Admitted to an Emergency Department with Acute Heart Failure

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, such as increased body fluid congestion or systemic congestion. This condition is one of the most common reasons for hospital admission and has been associated with poor outcomes. The phase angle indirectly measures intracellular status, cellular integrity, vitality, and the distribution of spaces between intracellular and extracellular body water. This parameter has been found to be a predictor of health status and an indicator of survival and other clinical outcomes. In addition, phase angle values of &lt;4.8&#176; upon admission were associated with higher mortality in patients with acute heart failure. However, low phase angle values may be due to alterations-such as the shifting of fluids from an intracellular body water (ICW) compartment to an ECW (extracellular body water) compartment and a concurrent decrease in body-cell mass (which can reflect malnutrition)-that are present in heart failure. Thus, a low phase angle may be due to overhydration and/or malnutrition. BIVA provides additional information about the body-cell mass and congestion status with a graphical vector (R-Xc graph). In addition, a BIVA Z-score analysis (the number of standard deviations from the mean value of the reference group) that has the same pattern as that of the ellipses for the percentiles on the original R-Xc graph can be used to detect changes in soft-tissue mass or tissue hydration and can help researchers compare changes in different study populations. This protocol explains how to obtain and interpret phase angle values and BIVA Z-score analyses, their clinical applicability, and their usefulness as a predictive marker for the prognosis of a 90-day event in patients admitted to an emergency department with acute heart failure.

Autor im Rampenlicht: Enthüllung prognostischer Indikatoren bei Herzinsuffizienz - Die Rolle der Phasenwinkel- und bioelektrischen Impedanzanalyse 

In this protocol, we explain how to obtain and interpret phase angle values and bioelectrical impedance vectorial analysis (BIVA) Z-score obtained by bioelectrical impedance in patients with acute heart failure admitted to the Emergency Department and their clinical applicability as a predictive marker for the prognosis of a 90-day event.

Klinische Anwendung von Phasenwinkel- und BIVA-Z-Score-Analysen bei Patienten, die mit akuter Herzinsuffizienz in eine Notaufnahme eingewiesen wurden

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, ...