1/3. halothane, an effective infrequently used drug, in the treatment of pediatric status asthmaticus: a case report.Asthma is the most common chronic disease of childhood. Despite a better understanding of the disease process and its management, status asthmaticus continues to be a life-threatening event. The use of volatile inhaled anesthetics is infrequently reported as adjunctive therapy to conventional treatment of this condition. We report the use of halothane in a mechanically ventilated pediatric patient with life-threatening status asthmaticus who was admitted to the pediatric intensive care unit (PICU) after failing to respond to standard medical therapy and noninvasive positive pressure ventilation. A 12-year-old African American male was seen in the emergency department and treated with intravenous corticosteroids, beta-agonist therapy. He deteriorated rapidly and required endotracheal intubation and mechanical ventilation. Two hours later, the patient developed an acute, severe respiratory acidosis (pH=6.97, PaCO2=171, PaO2=162, BE=1.7). halothane was started at 2% by using the Siemens Servo 900C anesthesia ventilator. Improvement in both arterial blood gases and exhaled tidal volume were noted 30 minutes after initiation of the anesthetic gas. The patient remained on halothane for a total of 36 hours. No adverse effects associated with the use of halothane were noted. The patient was extubated to BiPAP 16/6, FiO2=0.30 at 68 hours and was discharged home 5 days later.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/3. How far can we go with permissive hypercapnia? A case presentation and some biased comments with emphasis on maintaining normal haemoglobin level.The respiratory management strategy of small tidal volume with permissive hypercapnia has been adopted to avoid further aggravation of lung injury due to high airway pressure with some impressive success (1). No consensus, however, has been established in terms of the rate of increase in PaCO2 and its upper limit. Recently, our colleague in the intensive care unit experienced a severe case of ARDS successfully treated with the above strategy despite of the fact that during the course of treatment, the highest PaCO2 reached 177 mmHg and the lowest pH, 7.03 (2). The fact that PaCO2 may reach a very high level in the clinical setting and the well-known role of haemoglobin (Hb) in buffering CO2 led us to study effects of different Hb levels on pH and haemodynamic changes in response to acute CO2 loading in the blood. We will summarize the case report first with permission of authors (the case report was published in Japanese) (2) and then discuss the studies conducted in our animal laboratory.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/3. Tension pneumopericardium following tracheoplasty for congenital tracheal stenosis.Tension pneumopericardium is a rare complication of mechanical ventilation following tracheoplasty for congenital tracheal stenosis. This case report describes fatal tension pneumopericardium in a three-month-old male infant some 24 hours following tracheoplasty for this condition. Because of persisting stenosis of the left main bronchus, ventilation pressures of PIP 23 cm H2O and PEEP 5 cm, progressing to PIP 28 cm and PEEP 7 cm were needed to maintain adequate respiratory exchange. Partial relief of the pneumopericardium was achieved by vigorous cardiac massage, but three days later the infant died of massive airway haemorrhage.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |