[Development of a s-IMV-technique for Bird apparatus (author's transl)]. / Entwicklung einer s-IMV-Technik für Birdgeräte.

We have developed our IMV-technique described previously to a s-IMV-technique. The principle of this s-IMV-technique is the following: it is necessary to equip two Bird Mark 7 machines with a special system of tubes. Then, an additional inspiratory volume is exactly given with the inspiration, triggered by the patient. for this purpose we constructed an electronic set which is able to recognize the spontaneous breathing of the patient by means of a thermistor and a bedside monitor. Then, more frequency variable inspiration volumes are applied exactly with the breathing of the patient. The adaptation of this apparatus to the patient is reached by impressing of a red stylus (on the left side of the Bird) by an electromagnet according to the inspiration of the patient. With this method it is possible to vary the treatment of patients with respiratory insufficiency, for instance, controlled artificial respiration, s-IMV up to spontaneous breathing. The F.I.O2 of the inspired gas can be chosen and lies between 9,21 and 1,0. CPAP and PEEP are possible.

[First results of emergency treatment in massive fulminant lung embolism by means of a rapidly injected streptokinase in a high initial dose (author's transl)]. / Erste Ergebnisse der Notfallbehandlung bei massiver, fulminanter Lungenembolie mit einer rasch injizierten hohen Initialdosis von Streptokinase.

Five cases of patients with massive fulminant lung embolism are reported who were successfully reanimated in spite of one or several cardiac arrests by bolus injection of 750,000 to 1,000,000 I.U. streptokinase applicated intraveneously within a few seconds up to about 3 min. The effect of this rapidly injected high initial dose of streptokinase on the embolus in the A. pulmonalis and on the disturbed microcirculation in prefinale states of shock is discussed. In consequence of the aggressive therapy with streptokinase severe haemorrhagic complications occurred in all cases reported. As the patients would not have survived the massive fulminant lung embolism without this therapy it is concluded that in certain cases of fulminant lung embolism the bolus injection of streptokinase should be tried besides other measures of reanimation as a ultima ratio in spite of a contraindicated lysis. We think that this aggresive therapy is indicated for patients with massive fulminant lung embolism who were treated in a conventional way without success, who could not be operated or who had already suffered from a cardiac arrest. It is suggested to treat a massive fulminant lung embolism not only with conventional measures of reanimation but also with rapid i.v.-injection of 750,000 to 1,000,000 I.U. of streptokinase.

[A simple self prepared IMV system using original parts of Bird including alternative ventilation under CPAP and PEEP (author's transl)]. / Einfaches, aus BIRD-Originalteilen selbst herstellbares IMV-System mit alternativer Anwendung von CPAP und PEEP.

A simple self prepared IMV system (intermittant mandatory ventilation system) is described. Only original parts of Bird are used. The system is in fact a combination of the original Bird-PEEP-system with the CPAP-system described by us [1]. The function, mounting and working of the IMV system is described. With this combined system it is now possible to apply different forms of assisted or nonassisted ventilation (CPAP, PEEP, IMV) utilizing the same system making by minor modifications. The FIO2 can be exactly regulated. It is possible to pass continuously from totally controlled ventilation to full spontaneous breathing with or without CPAP. Since original parts of Bird-gears are used in many intensive care units, new developments in artificial ventilation such as IMV can be realized without great expenses. The functioning of this system is demonstrated by several cases including the documentation of recorded changes of arterial oxigenation.

Transitory heart pacemaker for the prophylaxis of hypoxic cardiac standstill in cases of severe pulmonary insufficiency.

Patients with hypoxia due to severe pulmonary insufficiency show a tendency towards hypoxic cardiac arrest. Asystole can occur in patients during therapeutic and nursing measures such as endotracheal suction. Experience indicates that the hypoxic cardiac arrest is difficult to resuscitate. External heart massage also shows a variety of complications. We propose the appropriately timed and prophylactic use of a transitory heart pacemaker for patients with a tendency towards hypoxic cardiac arrest. Our results show that a transitory heart pacemaker is capable of producing heart contractions even in cases of the severest hypoxia, in which otherwise cardiac arrest already would have occurred. The subclavian vein is punctured, and the electrode is pushed into the right ventricle. The electrode tip is positioned accurately by means of X-ray examination, and also by monitoring the threshold of the stimulating current. We consider that the proposed method should be used in patients who would have an increased chance of survival as a result of the additional measure of using a transitory heart pacemaker in cases of pulmonary hypoxia. It would not be indicated in patients with unfavourable prognoses due to progressive changes in the lungs.

[Easy alteration of the PEEP-system to CPAP by using exclusively original bird parts (author's transl)]. / Einfacher Umbau eines PEEP-Systems auf CPAP unter ausschliesslicher Verwendung von BIRD-Originalteilen.

In various situations breathing with positive-end expiratory pressure (PEEP) and spontaneous respiration with continously positive airway pressure (CPAP) is of advantage to the patient. Not all intensive care units are equipped with the modern apparatus that makes possible alternative application of PEEP and CPAP. We have developed a system using a BIRD Mark 7 or 8 that allows alteration of PEEP to CPAP by only few manipulations. As a safety measure we exclusively apply original parts of the same firm (BIRD). The system allows exact adjustment and controllable application of a continuous positive airway pressure, exact proportion of oxygen in the inspired gas, moistening of the in spired air and nebulization of medicaments. If the patient should show inadequate ventitation after a certain times then artificial respiration with the PEEP system is quickly possible with only a few manipulations.

[Rapid intravenous injection of streptokinase in a high initial dose for therapy of a fulminant pulmonary embolism (author's transl)]. / Rasche i.v.-Injektion einer hohen Initialdosis Streptokinase zur Therapie der fulminanten Lungenembolie

As a result of the case described the administration of streptokinase in a high initial dosage of about 750,000-1,000,000 U within a few minutes appears to be effective in serious lethal pulmonary embolism. In spite of hypoxic cardiac arrest a 35-year-old female patient was reanimated successfully 20 minutes after the occurrence of pulmonary embolism on the 10th day after caesarian section. The development indicated that the high dosage of streptokinase led to lysis of the embolus and thus to perfusion of the lungs. In spite of complications haemothorax 4,000 ml, uterine haemorrhage the fibrinolytic and later the anticoagulante therapy was continued until lysis of the embolus was assumed as judged by the condition of the patient. To prevent a renewed cardiac arrest a temporary pacemaker was applied. The patient survived without evidence of a cerebral lesion. This paper wants to advocate the administration of streptokinase in "exorbitant" dosage in hopeless cases of serious pulmonary embolism of which a high percentage die. It is essential that the injection be made within a few minutes and must not be extended over the normally recommended period of time.

[Studies on placental blood flow under drug induced hypertension (animal experiments) (author's transl)]. / Das Verhalten der Plazentadurchblutung unter medikamentös erzeugter Hypertonie im Tierversuch

Placental blood-flow rates in rabbits were measured by the indirect method of local apparent conductivity. In our experiments, hypertension was produced by injection or infusion of hypertensive drugs. As a result of hypertension we observed a marked decrease in placental blood flow. Vasoconstriction seems to be the pathophysiologic mechanism causing the reduced blood flow rate. Accordingly, the placenta may not be considered as a "priviledged organ" in circulatory regulations. In our experiments, placental ischemia subsequently to ligatures did not produce hypertension so that the production of a placental pressor-substance could not be demonstrated. If we assume a circulus vitiosus hypertension-placental ischemia-hypertension, the hypertension seems to be the primary cause.