Full Description
Surgical intervention and anaesthetics, including patient positioning and mechanical ventilation, change the mechanics of breathing and gas exchange in patients and often lead to post-operative bronchopulmonary complications. As numerous investigations have shown, the risk of developing complications can be up to six times greater in patients with pre-existing pulmonary pathology than in patients without this risk potential. The patients at greatest risk are those with severe post-traumatic or haemorrhagic shock, sepsis and prior burns, or a rejection crisis following transplantation. Such patients may develop ARDS, which is still associated with a high mortality rate. Thus respiratory insufficiency is, and will remain, a central problem for the anaesthetist both during the anaesthetic and in the postoperative phase. This volume presents an interdisciplinary synopsis of new aspects concerning the pathophysiology, diagnostic evaluation and treatment of respiratory insufficiency. It provides the physician with a particular interest in anaesthesia and intensive care medicine with an overview of the present state of our knowledge in terms of its therapeutic usefulness.
It also indicates the direction further developments can be expected to take in the optimal treatment of severely ill patients with respiratory insufficiency.
Contents
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.
