Respiratory rate monitoring in ICU patients and healthy volunteers using electrical impedance tomography: a validation study.

Objective. The respiratory rate (RR) is considered one of the most informative vital signals. A well-validated standard for RR measurement in mechanically ventilated patient is capnography; a noninvasive technique for expiratory CO2measurements. Reliable RR measurements in spontaneously breathing patients remains a challenge as continuous mainstream capnography measurements are not available. This study aimed to assess the accuracy of RR measurement using electrical impedance tomography (EIT) in healthy volunteers and intensive care unit (ICU) patients on mechanical ventilation and spontaneously breathing post-extubation. Comparator methods included RR derived from both capnography and bioimpedance electrocardiogram (ECG) measurements.Approach. Twenty healthy volunteers wore an EIT belt and ECG electrodes while breathing through a capnometer within a 10-40 breaths per minute (BPM) range. Nineteen ICU patients underwent similar measurements during pressure support ventilation and spontaneously breathing after extubation from mechanical ventilation. Stable periods with regular breathing and no artefacts were selected, and agreement between measurement methods was assessed using Bland-Altman analysis for repeated measurements.Main result. Bland-Altman analysis revealed a bias less than 0.2 BPM, with tight limits of agreement (LOA) ±1.5 BPM in healthy volunteers and ventilated ICU patients when comparing EIT to capnography. Spontaneously breathing ICU patients had wider LOA (±2.5 BPM) when comparing EIT to ECG bioimpedance, but gold standard comparison was unavailable. RR measurements were stable for 91% of the time for capnography, 68% for EIT, and 64% of the ECG bioimpedance signals. After extubation, the percentage of stable periods decreased to 48% for EIT signals and to 55% for ECG bioimpedance.Significance. In periods of stable breathing, EIT demonstrated excellent RR measurement accuracy in healthy volunteers and ICU patients. However, stability of both EIT and ECG bioimpedance RR measurements declined in spontaneously breathing patients to approximately 50% of the time.

Development of a Web-Based Oxygenation Dashboard for Preterm Neonates: A Quality Improvement Initiative.

BACKGROUND: Preterm neonates are extensively monitored to require strict oxygen target attainment for optimal outcomes. In daily practice, detailed oxygenation data are hardly used and crucial patterns may be missed due to the snapshot presentations and subjective observations. This study aimed to develop a web-based dashboard with both detailed and summarized oxygenation data in real-time and to test its feasibility to support clinical decision making. METHODS: Data from pulse oximeters and ventilators were synchronized and stored to enable real-time and retrospective trend visualizations in a web-based viewer. The dashboard was designed based on interviews with clinicians. A preliminary version was evaluated during daily clinical rounds. The routine evaluation of the respiratory condition of neonates (gestational age < 32 weeks) with respiratory support at the NICU was compared to an assessment with the assistance of the dashboard. RESULTS: The web-based dashboard included data on the oxygen saturation (SpO2), fraction of inspired oxygen (FiO2), SpO2/FiO2 ratio, and area < 80% and > 95% SpO2 curve during time intervals that could be varied. The distribution of SpO2 values was visualized as histograms. In 65% of the patient evaluations (n = 86) the level of hypoxia was assessed differently with the use of the dashboard. In 75% of the patients the dashboard was judged to provide added value for the clinicians in supporting clinical decisions. CONCLUSIONS: A web-based customized oxygenation dashboard for preterm neonates at the NICU was developed and found feasible during evaluation. More clear and objective information was found supportive for clinicians during the daily rounds in tailoring treatment strategies.

[Contribution to therapy of the "prostate syndrome" in aged dogs]. / Beitrag zur Therapie des "Prostata-Syndrome" bei älteren Rüden.

The treatment of the "prostate syndrome" is a great challenge for the practicing veterinarian. In the present paper the therapeutic approach of this syndrome will be evaluated. 58 older dogs showing this syndrome were castrated and received thereafter oral antibiotic therapy. For further additional treatment the dogs were assigned to two groups. The groups were treated as follows: Group one: 41 dogs were treated with retard Gestagen and Flumethason infiltrated into the prostate gland tissue. Group two: 17 dogs were treated with a single subcutaneously applied Gestagen injection. The success of the therapy was judged by decrease the size of the prostate gland to normal size. The first evaluation took place after 2 weeks and the second one after a year following castration and treatment. At the time of the first judgement 95.1% of the dogs in the group one and 70.6% in the group two showed normal prostate gland size. At the time of the second examination, a year after the treatment still 82.8% of the dogs in the group one and only 52.8% in the group two showed normal prostate gland size. These results suggest that the infiltration of the enlarged prostate gland with retard acting Gestagen and Flumethason results in long lasting diminishing of size of the diseased gland.

[Consequence of frequent moving among stalls on the economics of swine fattening]. / Auswirkungen mehrmaligen Umstallens auf die Wirtschaftlichkeit in der Schweinemast.

In an industrial pig productions unit the weaned piglets of 20 sows were assigned to two Groups. The Groups were treated as follows: Group one (99 piglets of 10 sows): the pigs were kept in the same pen of the unit from birth until slaughter and received no prophylactic medication. If illness occurred, only the individual pig was treated. Group two (102 piglets of 10 sows): according to standard operating procedures on this farm, the pigs assigned to Group two were moved during the growing-fattening period three times, having received after moving into Flat-Deck and into the growing-fattening house for one week prophylactic antibiotic treatment. If illness occurred, only the individual pig was treated. The following Parameter were evaluated: A: Mortality B: Food Conversion C: Medicine expenses D: Stress related diseases E: Infectious diseases F: Age at slaughter at 100 kg live weight G: Revenue differences between the Groups The Group one showed regarding all investigated Parameters, when compared to the Group two, markedly better results and 15.58 Deutsche Mark cheeper production cost per pig. These result shows, that moving pigs among houses markedly influences the economics in fattening units.

[Management of E. coli dependent factorial diseases in weaning piglets]. / Management der E. coli-bedingten Faktorenkrankheiten nach dem Absetzen der Ferkel.

The most important postweaning factorial diseases are at least partly caused by E. coli. The term postweaning coli complex can be subcategorized into the following manifestations: postweaning diarrhoea, edema disease, postweaning wasting and hemorrhagic gastroenteritis. In the presented study the effect of prophylactic zootechnique alone and zoo- and biotechnique in combination was evaluated during the first weeks postweaning. The results showed that combined zoo- and biotechnique is superior to simple zootechnique regarding food conversion (1.41 kg versus 1.73 kg), average daily weight gain (390 g versus 325 g) and postweaning piglet mortality (3.1% versus 4.9%). It is the opinion of the authors that combined postweaning zoo- and biotechnique should be performed in such pig production units where ETEC and/or SLTEC are present.

[The effect of timing of labor induction on the occurrence of congenital myofibrillar hypoplasia--short clinical report]. / Der Einfluss des Zeitpunktes der Partusinduktion auf das Auftreten der kongenitalen myofibrillären Hypoplasie--Kurzbericht aus der Praxis.

In an intensive pig production unit with routinely performed prostaglandin partus induction four groups of sows were formed shortly before parturition. The animals received 3 mg alfaprostol as a single intramuscular injection each. The sows of group 1 on the 112th, those of group 2 on the 113th and the animals of group 3 on the 114th day of pregnancy. Group 4 sows were not treated and formed the control group. We evaluated the number of live born piglets and the number of piglets born with congenital myofibrillar hypoplasia. The results showed no significant difference regarding live born piglets. As regards congenital myofibrillar hypoplasia the sows with early partus induction (group 1) showed significant higher incidence when compared to the other groups. It is likely that in cases of partus induction before the 113th day of pregnancy the fetus is still insufficiently protected by natural maturation, adaptation and tolerance ability against such congenital condition as CMH. Therefore it is the opinion of the authors that partus induction before the 113th day of pregnancy should not be performed.

[Pathological changes in the urogenital tract and mammae of culled sows from an industrial pig production unit]. / Pathogene Befunde aus dem Urogenitaltrakt ausgemerzter Muttersauen aus einem Grossbestand.

In an industrial pig production unit 101 sows were culled because of reproduction failure. All the sows had a previous history of MMA, PHS, SUGD. All the sows were crosses of the two breeds Large White and Landrace. 101 sows were examined postmortem for pathologic changes. Changes were found in the kidney (38.6%), pyelum (49.5%), ureter (52.5%), bladder (100%), urethra (100%), uterus (50.5%), cervix (31.7%), vagina (28.7%), ovaries (51.5%), mammary gland (100%). Since 100% of the pathologic findings happened simultaneously in the urinary tract as well as in the mammary gland and just over 50% of the investigated cases had pathologic changes in the genital organs as well, the results suggest that MMA, PHS, and SUGD must be regarded as different manifestations of the same pathological entity of the urogenital organs of the sow. The authors introduce the term SUGD to denominate the conflicting terminology around the periparturient reproductive failure syndrome complex.

[The peripartal disease complex of the sow in the industrial swine breeding facility. 4. The effect of prophylactic oral medication on the occurrence of the peripartal disease complex of the sow with the symptoms of urinary tract infection and vaginal-vulvar discharge]. / Bericht über den peripartalen Krankheitskomplex der Muttersau in der industriellen Schweinezucht. 4. Mitteilung: Die Auswirkungen der prophylaktischen oralen Medikamentengabe auf das Auftreten des peripartalen Krankheitskomplexes der Muttersau mit der Anamnese von urinary tract infection (UTI) und vaginal-vulvalem Ausfluss (vaginal-vulvar discharge [VD]).

In an industrial pig production unit 20 sows were selected at random. All the sows had a puerperal disease in their anamnesis. The sows were divided in two groups consisting of ten sows each. Group 1 received Ampicillin per os (3 g per sow and day) four days a.p. and four days p.p. The majority of the sows showed a significant E. coli bacteriuria and non of the sows showed a significant Enterococcus bacteriuria prior to treatment. The development of puerperal disease was registered. The treated group showed less occurrence of disease compared to the control. Group 1 revealed significant (p < 0.05) less early postnatal losses than the untreated control. Group 1 showed better four weeks weaning weights as well. It is the authors opinion that sows having significant bacteriuria a.p. should be treated a.p. and p.p. before periparturient disease occurs.

[The peripartal disease complex of the mother sow in the industrial swine facility. 3. Slaughter findings of old sows with anamnesis of peripartal diseases]. / Bericht über den peripartalen Krankheitskomplex der Muttersau in der industriellen Schweinezucht. 3. Mitteilung: Schlachtbefunde von Altsauen mit der Anamnese von peripartalen Erkrankungen.

In an industrial pig production unit ten sows were selected at random. All the sows had a puerperal disease in their anamnesis. The sows were slaughtered after weaning and subjected to pathological examination. The mammary glands, uteri and bladder of ten slaughtered sows were examined for gross pathological alterations. All the sows showed symptoms of chronic mastitis (abscess, granuloma, fibrosis or cysts). Four of the examined uteri showed pathological alterations. Nine out of the ten bladders examined revealed pathological findings.

[The peripartum disease complex of the sow in commercial swine breeding. 2. The effect of prepartum bacteriuria on the peripartum and postpartum occurrence of puerperal diseases in the sow with anamnesis of urinary tract infection and vaginal-vulvar discharge]. / Bericht über den peripartalen Krankheitskomplex der Muttersau in der industriellen Schweinezucht. 2. Mitteilung: Der Einfluss der präpartalen Bakteriurie auf das peri- bzw. postpartale Auftreten von Puerperalerkrankungen bei der Muttersau mit der Anamnese von urinary tract infection (UTI) und vaginal-vulvar discharge (VD).

In an industrial pig production unit ten sows were selected at random. All the sows had puerperal disease in their anamnesis and all of them revealed at the time of selection--during their late pregnancy--urinary tract infection (UTI) and vaginal-vulvar discharge (VD) and most of them had significant bacteriuria a.p. All the sows were evaluated using Bilkei's MMA early detection system. The majority of the sows which have had significant bacteriuria a.p. developed a puerperal disease.

[The peripartum disease complex of the sow in industrial swine breeds. 1. Peripartum course of bacteriuria of sows with vaginal-vulvar discharge in a modern swine breeding facility]. / Bericht über den peripartalen Krankheitskomplex der Muttersau in der industriellen Schweinezucht. 1. Mitteilung: Peripartaler Verlauf der Bakteriurie der Sauen mit vaginal-vulvalem Ausfluss in einem modernen Schweinezuchtbetrieb.

In an industrial pig production unit ten sows were selected at random. All the sows had puerperal disease in their anamnesis and all of them revealed at the time of selection--during their late pregnancy--Urinary Tract Infection (UT)I and vaginal-vulvar discharge (VD). Mid-stream early morning urine samples were collected during four days ante partum and during four days post partum. The samples were semiquantitatively examined for E. coli and gram positive cocci. Three sows showed ante partum non significant bacteriuria which turned into significant bacteriuria post partum. The majority of the reminding sows revealed a significant bacteriuria during the whole period of examination.

[Improvement of the rate of conception by the use of PGF2 alpha in the sow one day before weaning]. / Verbesserung der Konzeptionsrate mit Applikation von PG F2 alpha bei der Muttersau ein Tag vor dem Absetzen.

The authors investigated the influence of PGF 2 alpha on rate of conception in a single large pig production unit. Two groups of sows were selected at random before weaning, forming an experimental and a control group. The groups were treated as follows: Group 1 (experimental group) received a single intramuscular dose of 3 mg Alfaprostol one day before weaning. Group 2 (control group) received a single intramuscular dose of 2 ml physiologic saline intramuscular one day before weaning. The results are evaluated on the basis of parameter "return to estrus". The experimental group showed significant less (p < 0.05) sows returning to estrus than the control. This evidence suggests that the reason of unsatisfactory breeding performance after PG F2 alpha application may be the result of other influencing factors.