1/33. Pressure limited ventilation with permissive hypoxia and nitric oxide in the treatment of adult respiratory distress syndrome.In the management of adult respiratory distress syndrome pressure limited mechanical ventilation may protect the lungs from overdistention injury. Unacceptable hypoxia may be avoided by adding nitric oxide to the inspiratory gas, and thus make pressure limited ventilation easier to perform. There exists no consensus about an acceptable lower limit of SaO2, and in the present case we gave preference to pressure limitation at the cost of oxygenation. A young woman with severe adult respiratory distress syndrome was set on pressure limited mechanical ventilation with peak pressures of 35-38 cm H2O, PEEP of 10-12 cm H2O, and FiO2 of 0.95 with 20 ppm nitric oxide. SaO2 varied between 75 and 85%, and cardiac output ranged between 5.2 and 7.5 L min-1. oxygen consumption was in the upper normal range, and she did not became acidotic. After 3 days, she started to improve. In conclusion, it seems that hypoxia might be well tolerated as long as the circulation is not compromised. It might prove beneficial to accept some hypoxia to avoid ventilator induced lung damage.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/33. Delivery of an hypoxic gas mixture due to a defective rubber seal of a flowmeter control tube.The delivery of an hypoxic gas mixture to a patient during general anaesthesia is a rare event due to contemporary standards of monitoring, equipment design and alarm features. An incident is described where a split occurred in a rubber seal round the top of a flowmeter control tube. This resulted in a downstream oxygen leak and the delivery of an hypoxic gas mixture to the patient. The bobbin on the oxygen flowmeter did not accurately reflect the amount of oxygen being delivered. A paramagnetic oxygen analyser and a fuel cell oxygen electrode indicated that the inspired oxygen concentration was lower than intended. The anaesthetic machine was exchanged, and the operation continued uneventfully. The faulty anaesthetic machine subsequently passed a formal pressure test by the hospital engineers and also close examination of the flowmeter control valves. The importance of monitoring equipment and the interpretation of the information that they provide is emphasized.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
3/33. airway obstruction in a child with asymptomatic tracheobronchomalacia.PURPOSE: To report a case of airway obstruction with hypoxia during emergence from anesthesia due to unexpected tracheobronchomalacia in a child. CLINICAL FEATURES: In a previously healthy 22-month-old boy with no symptoms or signs of respiratory disease, general anesthesia was induced by inhalation of increasing concentrations of sevoflurane (up to 5%) in oxygen and a laryngeal mask was inserted. Partial airway obstruction persisted during surgery, but obstruction was relieved by positive-pressure ventilation. During emergence from anesthesia, airway obstruction with hypoxia occurred, necessitating tracheal intubation. Emission of carbon dioxide as well as of sevoflurane was reduced and emergence from anesthesia markedly delayed. Fibreoptic tracheoscopy showed marked collapse of the tracheobronchi during expiration, and a diagnosis of tracheobronchomalacia was made. No respiratory complications occurred postoperatively. CONCLUSION: Asymptomatic tracheomalacia should also be suspected in case of airway obstruction during anesthesia in young children.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
4/33. Mechanical ventilation during pregnancy using a helium-oxygen mixture in a patient with respiratory failure due to status asthmaticus.The authors present a 15-year-old with a second trimester intrauterine pregnancy who developed respiratory failure as the result of status asthmaticus and the development of the adult respiratory distress syndrome. Mechanical ventilation was provided with a combination of oxygen and helium to facilitate gas exchange and limit peak inflating pressures. The physiologic basis for helium's potential beneficial effects on gas exchange are reviewed. Previous reports concerning the use of helium during mechanical ventilation as well as the techniques of delivery are discussed.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
5/33. Anterior ischemic optic neuropathy after a trans-Atlantic airplane journey.PURPOSE: To report a case of anterior ischemic optic neuropathy after a trans-Atlantic airplane journey. DESIGN: An observational case report. methods: A 48-year-old healthy man presented with severe visual loss in his left eye within 12 hours after a 15-hour-long trans-Atlantic airplane flight. The patient underwent slit-lamp examination, funduscopy, fluorescein angiography, automated perimetry, and various blood examinations. RESULTS: visual acuity was LE: 20/30, and a mild left eye relative afferent pupillary defect was noted. Funduscopic evaluation revealed an edematous optic disk in the left eye with a para-diskal retinal hemorrhage. fluorescein angiography revealed a leaking optic disk, and perimetry showed an inferior hemi-field scotoma. Anterior ischemic optic neuropathy was diagnosed. CONCLUSION: Prolonged airplane travel may compromise vision either by a thromboembolic mechanism caused by prolonged immobilization or by a vasospasm mechanism induced by the low oxygen pressure during the flight.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
6/33. Bilateral vocal cord dysfunction complicating short-term intubation and the utility of heliox.Bilateral vocal cord paralysis is an extremely rare complication of short-term endotracheal intubation. Its etiology following intubation is likely due to recurrent laryngeal nerve injury on intubation. The anterior ramus of the recurrent laryngeal nerve is especially susceptible to pressure injury in intubated patients. Heliox is reported as a successful means of decreasing the work of breathing in upper airway obstruction via decreases in airway resistance. Two cases of bilateral vocal cord dysfunction following short-term intubation are reported. The first case of bilateral vocal cord paresis treated with Heliox is described.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
7/33. Transtracheal ventilation.Effective percutaneous oxygenation and ventilation can be achieved through the use of transtracheal catheters. A graphic study of pressure-flow requirements through different-sized catheters can serve as a guide for the caliber and driving pressure requirement to obtain optimal oxygen flow.- - - - - - - - - - ranking = 0.4keywords = pressure (Clic here for more details about this article) |
8/33. Use of prone ventilation in neurogenic pulmonary oedema.We present a case of neurogenic pulmonary oedema (NPO) due to subarachnoid haemorrhage that resulted in hypoxia refractory to conventional mechanical ventilation. Prone positioning was employed, resulting in rapid and sustained improvement in oxygenation. We discuss the pathogenesis of NPO and the mechanism of action of prone ventilation. Prone ventilation may be of value in the management of NPO, both in treating life-threatening hypoxia and in optimizing neurological recovery. Further data are required on its effect on intracranial pressure after subarachnoid haemorrhage.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
9/33. Improving oxygenation when conventional ventilation fails: a case study.Long periods of significant hypoxia do not disqualify a patient from becoming an organ donor. As the management of organ donor patients becomes more complex, recovery coordinators often have to change their thinking and resort to nonconventional means of management. This case study presents a hypoxic donor and how using pressure-control inverse ratio ventilation improved oxygenation in this donor. Before changing ventilator modes, the transplant surgeons were concerned about the long periods of hypoxia the patient had experienced during her hospitalization. After making the change, improving oxygenation, and demonstrating an improved oxygen state, 4 organs were recovered and subsequently transplanted. All the recovered organs functioned immediately after transplantation without any signs of poor performance. Although this treatment modality is not available at every institution, it can be used to improve oxygenation problems in organ donors.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
10/33. Transient platypnea-orthodeoxia-like syndrome induced by propafenone overdose in a young woman with Ebstein's anomaly.In this report we describe the case of a 37-year-old white woman with Ebstein's anomaly, who developed a rare syndrome called platypnea-orthodeoxia, characterized by massive right-to-left interatrial shunting with transient profound hypoxia and cyanosis. This shunt of blood via a patent foramen ovale occurred in the presence of a normal pulmonary artery pressure, and was probably precipitated by a propafenone overdose. This drug caused biventricular dysfunction, due to its negative inotropic effect, and hypotension, due to its peripheral vasodilatory effect. These effects gave rise to an increase in the right atrial pressure and a decrease in the left one with a consequent stretching of the foramen ovale and the creation of massive right-to-left shunting. In our case this interatrial shunt was very accurately detected at bubble contrast echocardiography.- - - - - - - - - - ranking = 0.4keywords = pressure (Clic here for more details about this article) |
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