Publications by authors named "Berthold Moser"

21 Publications

  • Page 1 of 1

Dimensional compatibility and limitations of tracheal intubation through supraglottic airway devices: a mannequin-based in vitro study.

Can J Anaesth 2021 May 20. Epub 2021 May 20.

Department of Anaesthesiology, University Children's Hospital Zurich, Zürich, Switzerland.

Background: Flexible bronchoscope-guided tracheal intubation through supraglottic airway devices (SGAs) is a well-established element of difficult intubation algorithms. Success can be limited by dimensional incompatibilities between tracheal tubes (TTs) and SGAs.

Methods: In this in vitro study, we tested the feasibility of TT passage through SGAs, removal of SGAs over TTs, and the ability to guide the flexible bronchoscope with 13 TT brands (internal diameter, 6.5-8.0 mm) and ten different SGAs (#4 and #5) in an intubation mannequin.

Results: We tested 1,040 combinations of SGAs and TTs. Tracheal tube passage failed in 155 (30%) combinations of the five tested first-generation SGAs (117 [46%] with SGA #4, 38 [15%] with SGA #5) and in three (0.6%) combinations of the five tested second-generation SGAs (two [0.8%] with SGA #4 and one [0.4%] with SGA #5). The reason for failed passage of a TT through a first-generation SGA consistently was a too-narrow SGA connector. Removal of the SGA over the TT in the 882 remaining combinations was impossible for all sizes of reinforced TTs, except the Parker Reinforced TT, and was possible for all non-reinforced TTs. Only one combination with SGA #4 and 84 combinations with SGA #5 were not ideal to adequately guide the flexible bronchoscope.

Conclusion: Clinically relevant combinations of adult-size TTs and SGAs can be incompatible, rendering flexible bronchoscope-guided tracheal intubation through an SGA impossible. Additional limitations exist regarding removal of the SGA and maneuverability of the flexible bronchoscope.
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http://dx.doi.org/10.1007/s12630-021-01993-5DOI Listing
May 2021

Guided vs. non-guided insertion of Ambu AuraGain™ in edentulous patients.

Anaesthesist 2021 Feb 9. Epub 2021 Feb 9.

Department of Anaesthesiology, Spital Limmattal, Zurich, Switzerland.

Background: Supraglottic airway devices perform more poorly and have lower oropharyngeal leak pressure in edentulous patients than in patients with teeth. The Ambu Aura Gain is a newer second generation supraglottic airway device.

Objective: This randomized clinical trial assessed the oropharyngeal leak pressure in edentulous patients using the Ambu Aura Gain with a gastric tube for insertion guidance and without insertion guidance.

Material And Methods: Patients with ASA (American Society of Anesthesiology) physical status I-III were recruited. Primary outcome was oropharyngeal leak pressure after insertion. Secondary outcome parameters were oropharyngeal leak pressure 15 min and 30 min after insertion, insertion time, insertion attempts and glottis view through flexible fiberscope.

Results: In this study 72 patients aged between 51 and 90 years (mean 73 years) were randomly allocated to the "with guidance" (n = 36) or the "without guidance" group (n = 36). Mean (SD) oropharyngeal leak pressure in "with guidance" and "without guidance" group was 24 cm HO and 24 cm HO (ns), respectively. A difference was found in mean insertion time with guidance versus without guidance group 52 s (45 s) vs. 26 s (15 s) (p < 0.001). No difference was found in any of the other secondary outcome parameters.

Conclusion: A guided insertion technique does not improve oropharyngeal leak pressure of the Ambu AuraGain™ in edentulous patients. As the only difference is an increase in insertion time this technique is of no benefit for this population.
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http://dx.doi.org/10.1007/s00101-021-00914-xDOI Listing
February 2021

Protection Level and Reusability of a Modified Full-Face Snorkel Mask as Alternative Personal Protective Equipment for Healthcare Workers during the COVID-19 Pandemic.

Chem Res Toxicol 2021 01 17;34(1):110-118. Epub 2020 Dec 17.

Institute of Environmental Engineering, Department of Civil, Environmental and Geomatic Engineering, ETH Zurich, Zurich 8093, Switzerland.

The worldwide outbreak of COVID-19 has drastically increased pressure on medical resources and highlighted the need for rapidly available, large-scale, and low-cost personal protective equipment (PPE). In this work, an alternative full-face mask is adapted from a modified snorkel mask to be used as PPE with two medical-grade filters and a 3D-printed adapter. Since the mask covers the eyes, mouth, and nose, it acts as a full-face shield, providing additional protection to healthcare workers. The SARS-CoV-2 has a size between 60 nm and 140 nm, and airborne viral particles can be carried by larger droplets with sizes up to several millimeters. The minimum filtration efficiency of mechanical and electrostatic filters is usually reached between 30 nm and 300 nm. The filtration efficiency of different medical filters is measured for particles below 300 nm to cover the size of the SARS-CoV-2 and small virus-laden droplets, and determine the minimum efficiency. The filtration performance of the adapted full-face mask is characterized using NaCl particles below 500 nm and different fitting scenarios to determine the minimum protection efficiency. The mask is compared to a commercial respirator and characterized according to the EN 149 standard, demonstrating that the protection fulfills the requirements for the FFP2 level (filtering face-piece 2, stopping at least 94% of airborne particles). The device shows a good resistance to several cycles of decontamination (autoclaving and ethanol immersion), is easy to be produced locally at low cost, and helps to address the shortage in FFP2 masks and face shields by providing adequate protection to healthcare workers against particles <500 nm in size.
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http://dx.doi.org/10.1021/acs.chemrestox.0c00371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771246PMC
January 2021

Simulated dimensional compatibility of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children.

Paediatr Anaesth 2021 Feb 17;31(2):167-177. Epub 2020 Nov 17.

Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland.

Background: Cuffed tracheal tubes have recently been recommended for selective endobronchial intubation to establish single-lung ventilation even in smaller children. This implies that, compared with uncuffed tracheal tubes, the cuffed tracheal tubes selected will be smaller and therefore have a shorter length. We hypothesized that cuffed tracheal tubes might be of insufficient length for selective endobronchial intubation if the tube cuff were fully immersed in the left or right mainstem bronchus.

Methods: The distance from the proximal end of the tracheal tube to the upper border of the cuff in cuffed tracheal tubes and to the upper margin of the Murphy eye in uncuffed tracheal tubes, respectively, was assessed in sizes 3.0-7.0 mm internal diameter. The raw data sets of two previously performed studies obtained from 337 children aged from birth to 16 years, including the distances "teeth to tracheal tube tip" and "tracheal tube tip to carina," were used to calculate age-, weight-, and height-related data for the distance from "teeth to carina." Tracheal tube dimensions were compared with age-related distances from "teeth to carina," applying published recommendations for the selection of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children.

Results: The differences between the length of the age-related tracheal tube and the tracheal tube insertion length required to guarantee full insertion of the tracheal tube cuff or the Murphy eye within the mainstem bronchus ranged from -3.5 to 52.6 mm in cuffed tracheal tubes and from 42.3 to 83.3 mm in uncuffed tracheal tubes.

Conclusions: For many age groups of patients requiring selective endobronchial intubation, the lengths of cuffed tracheal tubes, in contrast to those of uncuffed tracheal tubes, were revealed to be critically short for safe taping outside the oral cavity with the cuff placed completely within the right or left mainstem bronchus.
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http://dx.doi.org/10.1111/pan.14058DOI Listing
February 2021

A randomized trial comparing the Ambu® Aura-i™ and the Ambu® Aura Gain™ laryngeal mask as conduit for tracheal intubation in children.

Minerva Anestesiol 2020 11 4;86(11):1143-1150. Epub 2020 Aug 4.

Department of Anesthesiology and Intensive Care Medicine, Spital Limmattal, Schlieren, Switzerland.

Background: The Ambu Aura Gain is a newer second-generation supraglottic airway device designed for fibreoptic bronchoscopy (FOB)-guided tracheal intubation.

Methods: 57 patients between 18 months and six years of age were randomized to receive either the Ambu Aura-I (N.=29) or the Ambu Aura Gain (N.=28). Primary endpoint was the time for intubation. Secondary endpoints were the time and number of attempts for device insertion, the feasibility of FOB-guided intubation, the oropharyngeal leak pressure (OLP) the fibreoptic grade of laryngeal view and possible complications.

Results: No difference was found in the time for intubation, the time for device insertion or the fibreoptic grade of laryngeal view. First-attempt device insertion was successful in all (N.=28) patients with Aura Gain (100%) and in 27 (97%) with Aura-i. In the Aura-i group one insertion failed. A significant difference in successful intubation was seen between the Aura-i and the Aura Gain (79% vs. 100%, respectively, P=0.0011). Also found was a significant difference in the mean OLP (SD) between the Ambu Aura-i and the Ambu Aura Gain (18 [3] vs. 20 [3] cmH2O, respectively; mean difference [MD] 2 cmH2O; P=0.005).

Conclusions: The Ambu Aura Gain served as a reliable device for FOB-guided tracheal intubation. Even if the time for intubation, when intubation was possible did not differ, the Aura-i showed only 79% intubation success, making it a doubtful device for FOB-guided tracheal intubation in cases of emergency and severe hypoxemia in small children.
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http://dx.doi.org/10.23736/S0375-9393.20.14422-5DOI Listing
November 2020

Patient Expectations about Communication in the Perioperative Setting of Elective Knee Surgery - a Questionnaire-based Cross-sectional Study.

Z Orthop Unfall 2020 Oct 18;158(5):490-496. Epub 2019 Sep 18.

Department of Lower Extremity Orthopaedics, Musculoskeletal Centre, Schulthess Clinic, Zurich, Switzerland.

Background: Patient expectations are an issue which is attracting increased interest in outcome research for knee surgery procedures. So far, research into patient expectations has mainly focused on the procedure and postoperative functional improvements. The purpose of this study was to identify patient expectations in the perioperative setting.

Material And Methods: This was a single-center prospective study. A 17-item questionnaire (ordinal answer scale) about patients' perioperative expectations was developed and completed by patients undergoing elective joint-preserving knee surgery. The study covered a period of 3 months and included all patients consecutively undergoing knee surgery. Subgroup analysis was performed for gender, age and type of insurance.

Results: 111 consecutive patients completed the questionnaire on admission. Significant preferences for one answer option were found for 13 out of 17 items. Patients considered it "unimportant" whether or not the physician wore a white coat during the consultation and "very important" that the first medical consultation after the patient was discharged from hospital was with the surgeon who had performed their operation. A concise explanation of the surgical procedure using images, talking to the surgeon the day before surgery and immediately after surgery, having their wound personally inspected by the surgeon, and, finally, the availability of the surgeon by phone were regarded as "important". There were no differences in patient responses between the different subgroups.

Conclusion: Patients expect a high personal commitment and availability of the surgeon during the entire perioperative setting, starting from the first consultation and continuing during follow-up examinations.
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http://dx.doi.org/10.1055/a-0998-8234DOI Listing
October 2020

Ambu® Aura Gain™ versus Ambu® Aura Once™ in children: a randomized, crossover study assessing oropharyngeal leak pressure and fibreoptic position.

Can J Anaesth 2019 01 12;66(1):57-62. Epub 2018 Oct 12.

Department of Anaesthesia and Intensive Care, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.

Purpose: The Ambu® Aura Gain™ is a new second-generation supraglottic airway device that-because of a wider curvature and a wide airway tube-allows fibreoptic intubation. The purpose of this study was to assess the oropharyngeal leak pressure of the Ambu® Aura GainTM compared with the Ambu® Aura Once™.

Methods: In this randomized non-blinded crossover trial with 50 patients aged 18 months to six years (10-20 kg), we compared the Ambu® Aura Gain™ and the Ambu® Aura Once™ for airway maintenance in anesthetized, non-paralyzed participants. Our primary outcome was oropharyngeal leak pressure. Time of insertion, success rates for each device, evaluation of fibreoptic view and ventilation quality during anesthesia, as well as possible complications (e.g., blood staining) were assessed.

Results: There were no differences in first and overall insertion attempt rates (Ambu® Aura Once™ 50/50 (100%) vs Ambu® Aura Gain™ 50/50 (100%). Mean (standard deviation) oropharyngeal leak pressure was found to be significantly higher for Ambu® Aura Gain™ than it was for Ambu® Aura Once™ [21 (7) vs 19 (6) cmHO, respectively; mean difference [MD] - 2 cmHO; 95% confidence interval [CI], - 3.8 to - 1.0; P = 0.001]. Mean (SD) insertion time was faster for Ambu® Aura Once™ than for Ambu® Aura Gain™ [8 (3) vs 10 (4) seconds, respectively; MD, - 2 sec; 95% CI, - 2.9 to - 1.2; P < 0.001]. There were no differences in ventilation quality, fibreoptic view, or blood staining.

Conclusion: We conclude that Ambu® Aura Gain™ is a good alternative to the Ambu® Aura Once™ and an efficient device for children in this age group.

Trial Registration: www.clincaltrials.gov (NCT02811042). Registered 23 June 2016.
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http://dx.doi.org/10.1007/s12630-018-1235-7DOI Listing
January 2019

Oropharyngeal leak pressure of the LMA Protector™ vs the LMA Supreme™; a prospective, randomized, controlled clinical trial.

Acta Anaesthesiol Scand 2019 03 19;63(3):322-328. Epub 2018 Sep 19.

Department of Anaesthesia, Schulthess Clinic, Zurich, Switzerland.

Background: Clinical characteristics such as oropharyngeal leak pressure (OLP) and ventilation peak pressure are important factors for successful use of supraglottic airway devices in general anaesthesia. We hypothesized that the LMA Protector™ compared to the LMA Supreme™ may develop a higher OLP, which could be of clinical significance.

Methods: Ninety-six patients were randomized to the LMA Protector™ or LMA Supreme™ groups. We measured oropharyngeal leak pressure within 5 minutes after insertion of the supraglottic airway device with a standardized cuff pressure at 60 cm H O. Secondary parameters, such as insertion time of the supraglottic airway device, the number of attempts inserting the supraglottic airway device and the gastric tube, volume of gastric contents, and maximum airway pressure, as well as pulse oximetry throughout the operation were measured. Further, blood staining after removal of the supraglottic airway device and postoperative airway morbidity 3 hours after surgery were determined.

Results: The mean difference of oropharyngeal leak pressure was 5.2 (95% CI 2.8-7.6), ie, 30.9 (7.4) cmH O for the LMA Protector™ vs 25.6 (4.4) cmH O for the LMA Supreme™ (P < 0.001; mean(SD)). Similarly, there was a mean difference between OLP and maximal ventilation peak pressure 5.6 (95% CI 3.1-8.2) ie 19.6 (7.7) cmH O for the LMA Protector™ vs 14.0 (4.4) cmH O for the LMA Supreme™ (P < 0.001). No difference was found between the groups for other secondary parameters, as well as postoperative airway morbidity.

Conclusion: The LMA Protector™ enabled a higher OLP compared to the LMA Supreme™. This finding may be important for patients requiring a higher peak pressure for sufficient supraglottic airway device ventilation.
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http://dx.doi.org/10.1111/aas.13256DOI Listing
March 2019

Fiberoptic intubation of severely obese patients through supraglottic airway: A prospective, randomized trial of the Ambu AuraGain™ laryngeal mask vs the i-gel™ airway.

Acta Anaesthesiol Scand 2019 02 8;63(2):187-194. Epub 2018 Aug 8.

Department of Anaesthesiology, Schulthess Clinic, Zürich, Switzerland.

Introduction: Airway management in severely obese patients remains a challenging issue for anaesthetists and may lead to life-threatening situations. Supraglottic airway devices, such as the i-gel™ or the AuraGain™, were developed, with the possibility to ventilate the patient or use them as a conduit for endotracheal intubation.

Methods: In our randomized prospective trial, we hypothesized a 10 seconds faster fiberoptic trans-device intubation time through the AuraGain™ laryngeal mask compared to the i-gel™ laryngeal mask in severely obese patients. We randomly assigned 44 patients to the AuraGain or i-gel group and measured trans-device intubation time after 5 minutes of successful ventilation through the device. Secondary parameters relating to the trans-device intubation success, oropharyngeal leak pressure, and parameters regarding insertion of the supraglottic airway devices were measured. Postoperative airway morbidity was determined 5 hours after surgery.

Results: Mean (SD) intubation time was 55.7 (5.8) seconds for the AuraGain™ vs 54.1 (8.5) for i-gel™ mask (95% CI -2.7 to 5.9; P = 0.474), respectively, on a mean body mass index (BMI) of 39.4 kg/m in the AuraGain™ group vs 38.9 kg/m in i-gel™ group. No difference could be found in the other studied parameters.

Conclusions: Time for intubation through both supraglottic airway devices was similar. Attributed to fast possibility of securing the airway with both supraglottic airway devices, we believe that both, AuraGain™ and i-gel™, can be a good alternative in the airway management in obese patients.
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http://dx.doi.org/10.1111/aas.13242DOI Listing
February 2019

Volume and not pressure controlled inflation of supraglottic device cuff may compromise patient safety.

Minerva Anestesiol 2018 09 15;84(9):1114-1115. Epub 2018 May 15.

Department of Anesthesiology, Schulthess Clinic, Zürich, Switzerland.

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http://dx.doi.org/10.23736/S0375-9393.18.12993-2DOI Listing
September 2018

A prospective, randomized trial of the Ambu AuraGain™ laryngeal mask versus the LMA® protector airway in paralyzed, anesthetized adult men.

Minerva Anestesiol 2018 06 17;84(6):684-692. Epub 2017 Nov 17.

Department of Anesthesiology, Schulthess Clinic, Zürich, Switzerland.

Background: We hypothesize that oropharyngeal leak pressures differ between the LMA® Protector™ and the AuraGain™, two novel supraglottic airway devices offering the possibility of intubation.

Methods: Ninety-eight male patients ASAI-II were randomly assigned to the AuraGainTM or ProtectorTM group. Oropharyngeal leak pressure was measured by incrementing cuff volume in 10 mL steps from 10 mL to 40 mL. The primary outcome was oropharyngeal leak pressure at 40 mL cuff volume. Secondary parameters such as transdevice intubation success, intubation time, the number of intubation attempts, and resistance during advancement of the endotracheal tube were determined.

Results: Mean (SD) oropharyngeal leak pressures at cuff volume of 40 mL was 30.1 (6) cmH2O for the AuraGainTM and 28.2 (7) cmH2O for the LMA ProtectorTM (P=0.142). The mean intracuff pressure for the AuraGainTM was 154 (41) cmH2O and 200 (43) cmH2O for the LMA Protector (P≤0.001). The number of attempts to insert the laryngeal mask was higher for the AuraGainTM group (P=0.002). Intubation time was lower in the AuraGainTM group (15.7 s vs. 18.5 s [ProtectorTM group]; P=0.004), and less resistance in advancing the tracheal tube through the AuraGainTM compared to LMA ProtectorTM device (P<0.001). There were no differences in fiberoptic placement of the endotracheal tube, the number of intubation attempts or postoperative morbidity between the groups.

Conclusions: Because of the higher success rate in first time insertion of the laryngeal mask and the gastric tube, respectively, as well as the lower resistance to insertion of the endotracheal tube we conclude a possible easier handling of the AuraGainTM in anesthetized male patients.
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http://dx.doi.org/10.23736/S0375-9393.17.12254-6DOI Listing
June 2018

In reply: Assessing flexible bronchoscopic intubation through the AuraGain™ laryngeal mask versus a slit Guedel tube.

Can J Anaesth 2018 01 8;65(1):137-138. Epub 2017 Sep 8.

Department of Anaesthesiology, Schulthess Clinic, Zurich, Switzerland.

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http://dx.doi.org/10.1007/s12630-017-0966-1DOI Listing
January 2018

Flexible bronchoscopic intubation through the AuraGain™ laryngeal mask versus a slit Guedel tube: a non-inferiority randomized-controlled trial.

Can J Anaesth 2017 Nov 17;64(11):1119-1128. Epub 2017 Jul 17.

Department of Anaesthesiology, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland.

Purpose: AuraGain, a novel third-generation laryngeal mask, can facilitate insertion of a gastric tube and provide the potential advantage of intubation. Data are lacking on intubation through the AuraGain laryngeal mask.

Methods: Eighty-eight hip or knee surgery patients were enrolled in this parallel randomized-controlled trial. We hypothesized that intubation time using the AuraGain laryngeal mask would be no longer than that for standard flexible bronchoscopic intubation over a slit Guedel tube, with a non-inferiority margin of five seconds. The following data were recorded during a maximum of three intubation attempts: intubation time, number of intubation attempts, degree of resistance to advance the endotracheal tube, and mask placement (i.e., Brimacombe score). Follow-up outcomes, including neck pain, hoarseness, and dysphagia, were also measured two and 24 hr postoperatively. Patients and outcome assessors remained blinded until the last examination.

Results: Mean intubation time was similar between the Guedel tube and AuraGain groups (23.6 sec vs 21.4 sec, respectively). The upper limit of the 95% confidence interval (CI) of the difference in mean intubation time between groups fell below our pre-specified non-inferiority margin; therefore, we found the AuraGain laryngeal mask to be non-inferior to the slit Guedel tube (adjusted group difference, -1.6 sec; 95% CI, -3.7 to 0.5). Successful intubation was achieved in the majority of patients (≥ 95%) in each group on the first attempt. No resistance to insertion of the endotracheal tube was encountered in the majority of patients in each group, and no complications were reported during the 24-hr postoperative period. There was no difference in the Brimacombe score or in the status of postoperative morbidity between the two groups.

Conclusion: We conclude that flexible bronchoscopic intubation through an AuraGain laryngeal mask can be achieved at least as fast as standard bronchoscopic intubation without contributing to additional patient morbidity or postoperative discomfort.

Trial Registration: www.clinicaltrials.gov , NCT 02570269. Registered 23 September 2015.
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http://dx.doi.org/10.1007/s12630-017-0936-7DOI Listing
November 2017

Authorship.

Authors:
Berthold Moser

J Occup Environ Hyg 2013 May;10(5):D62

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http://dx.doi.org/10.1080/15459624.2013.774654DOI Listing
May 2013

Non-invasive ventilation in prehospital settings.

Intern Emerg Med 2013 Aug 13;8(5):453. Epub 2013 Feb 13.

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http://dx.doi.org/10.1007/s11739-013-0909-yDOI Listing
August 2013

High-speed ambient air monitoring of ethylene oxide in sterilization units.

J Occup Environ Hyg 2012 ;9(8):D143-5

Department of Anesthesiology, Cantonal Hospital St. Gallen, Switzerland.

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http://dx.doi.org/10.1080/15459624.2012.692113DOI Listing
October 2012

Changes in injury patterns and severity in a helicopter air-rescue system over a 6-year period.

Wilderness Environ Med 2006 ;17(1):8-14

Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.

Objective: To study the influence of current trends in alpine sports on the frequency and types of injuries handled by a helicopter-based emergency medical system (HEMS) in a wilderness mountain region.

Methods: A retrospective review of medical reports at a single emergency helicopter port (Christophorus-1 air rescue) in Innsbruck, Austria, was conducted for comparison between two 3-year periods (1998-2000 and 2001-2003).

Results: Comparing the two 3-year periods, the proportion of leisure-time injuries leading to HEMS activation increased, whereas the frequency of life-threatening injuries significantly declined (P = .001). There was significant increase in injuries during mountain hiking and rock climbing (P = .002), during swimming (P = .013), and in avalanches (P = .019). Most injuries (70.1%) were recorded for skiers, and 68.3% involved tourists. During the investigation period, the high National Advisory Committee of Aeronautics scores showed a decreasing trend, whereas Glasgow Coma Scale scores and low National Advisory Committee of Aeronautics scores tended to increase (P = .048).

Conclusions: For the HEMS in this study, there has been an increasing number of calls for help from persons involved in outdoor leisure activities. As the number of life-threatening injuries declines, HEMSs more frequently serve as means of rescue rather than as providers of emergency treatment.
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http://dx.doi.org/10.1580/1080-6032(2006)17[8:ciipas]2.0.co;2DOI Listing
June 2006

Gender and age specific differences in exhaled isoprene levels.

Respir Physiol Neurobiol 2006 Dec 28;154(3):478-83. Epub 2006 Feb 28.

Department of Hygiene, Microbiology, and Social Medicine, Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Fritz-Pregl-Strasse 3, A-6020 Innsbruck, Austria.

The analysis of volatile organic compounds (VOC) in the human breath has attracted a considerable amount of clinical and scientific interest during the last decade. In our study, we turned our attention to gender and age specific differences of exhaled volatile compounds, particularly on isoprene which is one of the most abundant organic molecules found in human exhaled air. A total of 126 test persons were enrolled in the study: 66 females and 60 males. Moreover, the participants were classified into six groups with regard to their age. In a standardized setting all of them had to exhale the endexpiratory breath into a sample bag. The volatile compounds at m/z values from 21 to 229 were analyzed by using proton-transfer-reaction-mass-spectrometry. Isoprene (at m/z 69) was found to be highly significantly (p<0.001) elevated in the exhaled air of male subjects. Furthermore, it could be shown that 19-29 years old subjects exhale significantly lower levels of isoprene than older adults (p=0.002). No significant differences between groups were detected for any other measured mass. In conclusion, the present study demonstrates gender and age specific differences of isoprene levels in the exhaled air. These findings may be of potential clinical relevance regarding the multifaceted roles of isoprene, representing both indicator and effector molecule.
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http://dx.doi.org/10.1016/j.resp.2006.01.007DOI Listing
December 2006

Mass spectrometric profile of exhaled breath--field study by PTR-MS.

Respir Physiol Neurobiol 2005 Feb;145(2-3):295-300

Department of Anesthesiology and Critical Care Medicine, Leopold Franzens University, Anichstr. 35, 6020 Innsbruck, Austria.

Recently, increased interest has focused on the diagnostic potential of volatile organic compounds (VOC) exhaled in human breath as this substance group has been conjectured in indoor air quality and disease screening. Proton transfer reaction-mass spectrometry (PTR-MS) has been established as a new tool for a rapid determination of exhaled air profile. However, no investigations have been carried out into the profile of exhaled air as determined by PTR-MS. Therefore, it was the aim of the present study to determine the profile of exhaled breath in a field survey enrolling 344 persons. Analysis was performed using PTR-MS. No significant correlations with age, blood pressure, and body mass index could be observed with any molecular mass. The present study delineates possible reference values for PTR-MS investigations into exhaled air profile. In conclusion, the present study was the first to delineate mass spectrometric characteristics of an average patient sample as possible reference values.
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http://dx.doi.org/10.1016/j.resp.2004.02.002DOI Listing
February 2005

Quantification of recent smoking behaviour using proton transfer reaction-mass spectrometry (PTR-MS).

Wien Klin Wochenschr 2004 Jan;116(1-2):21-5

Department of Anesthesiology and Critical Care Medicine, Clinical Division of General Internal Medicine, Leopold-Franzens University, Innsbruck, Austria.

Smoking is the most important single risk factor in current public health. Surveillance of exposure to tobacco smoke may be accomplished using environmental monitoring or in-vivo tests for smoking biomarkers. Acetonitrile exhaled in human breath has been described as a potential marker mirroring recent smoking behavior. The aim of this study was to determine exhaled acetonitrile levels in a sample of 268 volunteers (48 smokers, 220 non-smokers) attending a local health fair. Breath specimens were collected into inert sample bags, with parallel collection of ambient air. Subsequently, all samples were analysed using proton transfer reaction-mass spectrometry (PTR-MS). Smokers had elevated levels of exhaled acetonitrile compared with non-smokers (p<0.001). Analysis using the receiver-operating-characteristic curve demonstrated that smoking can be predicted with a sensitivity of 79% and a specificity of 91%, using a cut-off concentration of 20.31 parts per billion of acetonitrile. This first field survey of exhaled acetonitrile in a large group of test persons demonstrates the feasibility of a rapid and non-invasive test for recent exposure to tobacco. We conclude that analysis of exhaled-breath acetonitrile may serve as a method of determining recent active smoking behaviour.
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http://dx.doi.org/10.1007/BF03040419DOI Listing
January 2004