[Endoscopic placement of an intratracheal oxygen catheter--description of a new method]. / Endoskopische Applikation eines intratrachealen Sauerstoffkatheters--Beschreibung einer neuen Methode.

BACKGROUND: In patients with disturbed gas-exchange intratracheal oxygen insufflation improves oxygenation and reduces the minute ventilation. Until now the intratracheal oxygen insufflation was performed using a tracheostomy or a percutaneous transtracheal technique. We studied the acceptance and efficacy of the intratracheal oxygen insufflation using a bronchoscopic technique of intratracheal catheter placement. PATIENTS AND METHODS: Five COPD-patients (4 men, 55.2 +/- 10.3 years; FEV1: 0.9 +/- 0.31 = 30.3 +/- 5.5% debit, pO2: 56.2 +/- 10.3 mmHg, pCO2 +/- 43.1 +/- 4.8 mmHg). Procedure of catheter placement: Through a nasally passed bronchoscope a guide wire was inserted into the proximal part of one bronchus. When positioned at the point 2 to 3 cm proximal to the carina, the bronchoscope was marked with plaster at the nasal ostium in order to measure this distance. After removing the endoscope, the oxygen catheter was inserted proximal to the carina using the guide wire. Before and during the intratracheal oxygen insufflation (flow: 3 l/min) minute ventilation, tidal volume, breathing frequence, blood gases and the subjective scores (using a visual analogue scale) were measured. RESULTS: Apart from one patient with a tolerable spontaneous declining urge to cough irritation the catheter was tolerated well during the study. Whereas pCO2 remained stable during the ITO2 (before ITO2: 43.1 +/- 4.8 mmHg; after 1 hour ITO2: 44.3 +/- 4.8 mmHg), the oxygenation improved (pO2: 56.2 +/- 10.3; 81.4 +/- 19.6 mmHg) and the minute ventilation decreased (7.5 +/- 1.8; 5.4 +/- 1.3 l/min) by approximately 28%. CONCLUSION: The bronchoscopic application of the intratracheal oxygen catheter was characterized by high acceptance, low invasiveness and immediate function. Furthermore, the minute ventilation and work of breathing respectively decreased to a relevant degree.

Endoscopic placement of a tracheal oxygen catheter: a new technique.

OBJECTIVE: In patients with chronic obstructive pulmonary disease (COPD), intratracheal oxygen insufflation (ITO) is an established therapeutic approach. We developed a new endoscopic technique of intratracheal catheter placement. The aim of this pilot study was to demonstrate its short-term feasibility in acutely extubated patients with moderate to severe COPD who require oxygen therapy. DESIGN: A guide wire was inserted through a nasally passed bronchoscope and was positioned such that its tip was placed intratracheally. Using a "Seldinger technique", the tracheal catheter was then inserted over the wire to a point 2-3 cm proximal to the carina and positioned under direct vision from the bronchoscope inserted through the contralateral nose. After catheter insertion, the guide wire was removed. The patients scored catheter-associated local discomfort using a visual analogue scale. In a randomly assigned, crossover design, the effectiveness of the endoscopically (e) inserted ITO catheter was assessed by measuring the capillary blood gases, respiratory rate (RR), tidal volume (Vt) and minute ventilation (MV) after 1 h breathing room air without eITO and 1 h after eITO (flow: 3 l/min). MEASUREMENTS AND RESULTS: The eITO catheter was placed in all patients without complications and with only minimal discomfort in two patients (spontaneously reversible cough). Compared to breathing room air, capillary O2 pressure increased (from 54.7 +/- 9.4 to 82.8 +/- 21.8 mmHg) whereas Vt (from 458.7 +/- 86.8 to 358.3 +/- 75.1 ml) and MV (from 7.7 +/- 1.5 to 5.5 +/- 1.1 l/ min) decreased significantly (each p < 0.0001) with eITO in all patients. The capillary CO2 pressure and RR did not change. CONCLUSIONS: Acutely extubated patients in whom oxygen therapy is indicated may profit from eITO. This new technique works immediately and is thus an effective short-term intervention of potential value in the intensive care unit.

Influence of various fatty acids on tumour growth in total parenteral nutrition.

The aim of parenteral nutrition in tumour patients is to offer an alternative nutritional support to the patient without accelerating the growth of the tumour. For this purpose we fed a total of 100 rats, divided into five groups of 20 animals each (10 with and 10 without tumours), for a total period of 15 days with various nutritional regimes. Group 1 received glucose, group 2 long-chain triglycerides, group 3 medium-chain triglycerides (MCT), group 4 omega-3 fatty acids, and group 5 an oral diet. On the 10th day the Yoshida sarcoma in its ascites form was implanted into the tumour-bearing rats. In animals receiving MCT or omega-3 fatty acids tumour growth was considerably smaller than in the other groups (group 1 vs. groups 3 and 4; p < 0.05). Unfavourable effects of the administration of these fatty acids on the general condition of the animals were not observed [muscle nitrogen content (mg/kg body weight): MCT = 82.3, omega-3 fatty acids = 65.25]. The impulse cytophotometric measurements did not demonstrate any influence on the pattern of cell division (p > 0.05). We think that modulation of the immune system by feeding with MCT or omega-3 fatty acids was responsible for the reduced tumour growth in relation to the other groups. The extrapolation of these results to the clinical situation, however, may not be possible.