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Kroegel C.,Friedrich - Schiller University of Jena | Haidl P.,Fachkrankenhaus Kloster Grafschaft GmbH | Kohlhaufl M.,University of Tübingen | Voshaar T.,Medizinische Klinik III
Pneumologie | Year: 2012

Due to the variability in respect to aetiology, histopathology, lung function, imaging and clinical presentation, as well as overlapping parenchymal processes, bronchiolar disorders are generally difficult to diagnose. Thus, diseases of the small airways should generally be considered in the differential diagnostic approach to respiratory conditions. The diagnostic approach can be devided into several steps: in steps 1 (history and physical examination) and 2 (plain chest radiographs and pulmonary function tests) may point towards a bronchiolar pulmonary process. High-resolution CT (HR-CT) scanning of the chest provides three distinct HR-CT patterns (tree-in-bud sign, ill-defined centrilobular ground-glass nodules and/or pattern of mosaic attenuation, especially visible on expiratory images) which confirm a bronchiolic involvement and help to narrow down a likely diagnosis or more specific bronchiolitic diseases. In inconclusive cases, a histological diagnosis may be required. The paper presents a clinically useful algorithmic approach to diagnosis and differential diagnosis of bronchiolar disorders. © Georg Thieme Verlag KG Stuttgart · New York.


Kroegel C.,Friedrich - Schiller University of Jena | Haidl P.,Fachkrankenhaus Kloster Grafschaft GmbH | Kohlhaufl M.,University of Tübingen | Voshaar T.,Medizinische Klinik III
Pneumologie | Year: 2012

The term bronchiolitis refers to a broad spectrum of common conditions related to the small airways associated with a miscellaneous aetiology, histology, clinical features and course. Due to their variability, bronchiolar disorders are generally difficult to diagnose. History (smoking, collagen vascular disease, inhalational injury, medication usage, and organ transplant) may point towards a bronchiolar process. In addition, signs of systemic and pulmonary infection and evidence of air trapping may provide diagnostic hints. Although clinical presentation, physical examination, pulmonary function tests (obstructive ventilatory defect), and plain chest radiographs may demonstrate abnormalities suggesting small airways involvement, they are often non-specific and rarely diagnostic. In contrast, the high-resolution CT (HR-CT) scanning of the chest provides three distinct HR-CT patterns that assist in the diagnosis and differential diagnosis of bronchiolar conditions: (i) a tree-in-bud pattern, (ii) ill-defined centrilobular ground-glass nodules, and (iii) a mosaic attenuation pattern (best visible on expiratory images). The present paper summarises the current knowledge, the classification, imaging, and the clinical presentation of bronchiolar disorders. © Georg Thieme Verlag KG Stuttgart - New York.


Husemann K.,Robert Bosch GmbH | Haidl P.,Fachkrankenhaus Kloster Grafschaft GmbH | Kroegel C.,Friedrich - Schiller University of Jena | Voshaar T.,Medizinische Klinik III | Kohlhaufl M.,Robert Bosch GmbH
Pneumologie | Year: 2012

In the recent years growing interest has focused on the involvement of the distal airways (internal diameter < 2 mm) in obstructive lung diseases and other pulmonary conditions. Inflammation in the small airways seems to play a major role in severe and uncontrolled asthma as a major determinant of airflow obstruction. Thus, small airways represent an important target for inhalation therapy. Currently there is no accepted single lung function parameter to detect small airway dysfunction. Various invasive and non-invasive techniques have been described. In future, non-invasive lung function testing will gain more importance. Using spirometry or body plethysmography, lung function parameters such as the ratio of forced vital capacity to slow vital capacity (FVC/SVC) and the residual volume (RV) can provide information about air trapping in small airway disease. Recent data show that techniques such as impulse oscillometry, nitrogen washout testing and analysis of exhaled nitric oxide are promising tools to assess involvement of the small airways. Impulse oscillometry is a sensitive method to calculate peripheral airway resistance, nitrogen washout allows one to detect air trapping and inhomogeneous ventilation in the distal lung, and the alveolar nitric oxide concentration represents a marker of peripheral inflammation. Further studies are needed to validate these functional tests or their combination for diagnosis and assessment of treatment response in pulmonary diseases involving small airways. © 2012 Georg Thieme Verlag KG Stuttgart • New York.


Siemon K.,Fachkrankenhaus Kloster Grafschaft GmbH | Rosseau S.,Charite Zentrum Fur Ausserklinische Beatmung CABS | Brambring J.,Heimbeatmungsservice Brambring Jaschke GmbH
Atemwegs- und Lungenkrankheiten | Year: 2016

The German Interdisciplinary Society for Ambulatory Ventilation (DIGAB e.V.) is a medico-scientific specialist organization under whose aegis all professional groups involved in the intensive care of ambulatory ventilated patients, are represented. It is a non-profit, politically independent society, registered in accordance to the currently obtaining German laws and regulations. The society came to being in 2010 as a spin-off the former society, The Working Group on Ventilator Weaning and Ambulatory Ventilation (AGH). The co-operation of all those involved including medical doctors and scientists, the affected and self-help organizations, carers and therapists from various disciplines, players in medical technology, the insurance companies and their medical departments, is a vitally important precondition in achieving its various goals not only in the research on chronic ventilatory insufficiency but also in the patient-centered scientific discussion on and the organization of ambulatory ventilation for both children as well as adults. Particular attention is dedicated to the enhancement of quality of life of the patient, medical and nursing support for the affected and their relatives. The other area in which DIGAB is actively involved include the development of guidelines, the qualification and certification of ambulatory ventilation trainers and training institutions, nurses and nursing institutions. Equally important is DIGAB's role in advocacy. DIGAB represents the rights of ambulatory ventilated patients in the society and in politics. © 2016 Dustri-Verlag Dr. Karl Feistle.


Kohler D.,FachkrankenhausKloster Grafschaft GmbH | Dellweg D.,FachkrankenhausKloster Grafschaft GmbH | Kerl J.,FachkrankenhausKloster Grafschaft GmbH
Somnologie | Year: 2011

Sleep deprivation reduces physical fitness and in particular complex motor abilities in healthy people. Static and dynamic lung function parameters are reduced by 5% in chronic obstructive pulmonary disease (COPD). Progressive hypoventilation associated with sleep deprivation, however, is most notable in the presence of existing hypercapnic insufficiency during the day. Affected patients demonstrate enhanced hypoventilation during sleep, which becomes apparent by pronounced hypercapnea and hypoxemia. This association has led to the hypothesis that sleep and sleep disturbances, respectively, have an impact on the hypercapnic insufficiency. Intermittent ventilation compensates hypercapnic insufficiency independent from the duration of ventilation in the same manner, regardless of whether the patient is awake or asleep. This reinforces the hypothesis that the human organism suffering from hypercapnea uses sleep to unload and recompensate the overloaded respiratory muscles, most likely by repletion of glycogen stores. The data in the review suggest that sleep has a positive effect on hypercapnic insufficiency. No specific impact of sleep, however, is seen in hypoxemic insufficiency. © 2011 Springer-Verlag.


Kerl J.,Fachkrankenhaus Kloster Grafschaft GmbH | Dellweg D.,Fachkrankenhaus Kloster Grafschaft GmbH | Kohler D.,Fachkrankenhaus Kloster Grafschaft GmbH
Somnologie | Year: 2012

Background: The analysis and extraction of information from pulse waves is becoming increasingly important in medical diagnostics. We discuss the diagnostic value as well as the limitations of these parameters for sleep laboratory investigations, particularly in the context of cardiovascular risk factor detection in sleep apnea patients. Methods: We describe the methods currently used to determine physiological values from pulse wave morphology. Measurements taken in our sleep laboratory with SOMNOscreen® (SOMNOmedics®, Randersacker) recorders are used to demonstrate the minimum signal (pulse wave and ECG) quality requirements. Results: Direct or indirect pulse wave analysis enables the determination of physiological parameters such as pulse rate, pulse rate variability, pulse wave variability, pulse transit time, pulse wave velocity, systolic and diastolic blood pressure, endothelial function/dysfunction and the degree of atherosclerosis of central arteries, as well as permitting differentiation between obstructive and central apnea and cardiovascular risk assessment. In order to obtain valid data, pulse wave and ECG signals have to meet several morphology criteria. Conclusions: The results are evaluated in the context of routine investigations in the sleep laboratory. Methods that are generally reserved for scientific research are distinguished from those that are already standard practice in - or could easily be integrated into - polysomnography. © 2012 Springer-Verlag Berlin Heidelberg.


Siemon K.,Fachkrankenhaus Kloster Grafschaft GmbH | Dellweg D.,Fachkrankenhaus Kloster Grafschaft GmbH | Barchfeld T.,Fachkrankenhaus Kloster Grafschaft GmbH | Wenzel M.,Fachkrankenhaus Kloster Grafschaft GmbH | Kohler D.,Fachkrankenhaus Kloster Grafschaft GmbH
Pneumologe | Year: 2010

The variety of respirators and artificial respiration modes has almost become difficult to grasp, and attempts for a nomenclature remain incomplete. The principal modes are volume-targeted and pressure-limited ventilation. Pressure-limited ventilation has replaced volume-controlled ventilation, and both are complementary in so-called hybrid modes. Self-learning controlled ventilation modes extend the field of assisted, assisted-controlled, and controlled ventilation. The choice of a suitable ventilator system and the optimum settings requires a basic understanding of the underlying disease, which determines the different settings and parameters. Individual settings for increases and decreases in pressure can promote efficiency and compliance. The choice of accessories (tube, mask), including optimum humidification, also influences the ventilation quality. © 2010 Springer Medizin Verlag.


Background: Guidelines for the initiation of mechanical ventilation (MV) therapy recommend polysomnographic (PSG) and polygraphic (PG) recordings for diagnosis and control of MV efficiency. Flow signals can be heavily modified under MV therapy and are not comparable with diagnostic measurements. This article describes the interpretation of signals from PSG/PG measurements in the context of MV therapy. Methods: Examples of PSG/PG-controlled MV therapy from the years 2000–2016 were used for this study. The interpretation of these PSG/PG signals in the context of investigating patient–ventilator synchronisation and ventilating quality is shown. Furthermore, the usefulness of incorporating internal ventilator signals, as well as long-term CO2 measurements, into the PSG/PG recording is explained. Results: Shape modification of flow signals in ventilator systems, detection of respiratory events, detection of patient–ventilator synchrony/asynchrony during controlled ventilation, quality of trigger sensitivity during assisted ventilation, intended and unintended leakage, as well as the assessment of automated features like auto-IPAP and auto-EPAP, are demonstrated through examples. Conclusions: A prerequisite for good sleep quality during night-time MV is an undisturbed patient–ventilator interaction. The different types of patient–ventilator asynchronies related to the ventilator mode (controlled/assisted) can by quickly identified with PSG/PG recordings. With additional internal signals from the ventilator itself (especially leakage and breathing volume), as well as with long-term CO2 measurements, rapid and high-quality MV initiation and control is possible. © 2016, Springer-Verlag Berlin Heidelberg.


Heyse D.,Fachkrankenhaus Kloster Grafschaft GmbH | Kerl J.,Fachkrankenhaus Kloster Grafschaft GmbH | Dellweg D.,Fachkrankenhaus Kloster Grafschaft GmbH
Atemwegs- und Lungenkrankheiten | Year: 2016

Technical devices for artificial mechanical positive pressure ventilation are in use since the 16th century. Ventilation by alternating positive and negative pressure was first published in the 18th century. Negative pressure ventilation was first described in the early 19th century and has become standard in artificial ventilation for more than 100 years, especially by means of "iron lungs". Towards the end of the polio epidemics in the 1950's newly developed positive pressure ventilators were spread worldwide. Until the early 1980's volume controlled ventilation was predominantly used but was more and more replaced by turbine ventilators developed for pressure controlled ventilation. The advantage of the technical solution for mask leakage compensation during noninvasive ventilation together with continuous size reduction of ventilators established these systems as a standard for home mechanical ventilation. © 2016 Dustri-Verlag Dr. Karl Feistle.

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