1/14. Horizontal gradient in ventilation distribution due to a localized chest wall abnormality.Horizontal gradients in the distribution of ventilation and of regional vital capacities, as well as a reversed vertical, esophageal pressure gradient, were observed in a patient with a unilateral painful chest wall lesion. The distribution abnormalities disappeared after surgical treatment. These findings suggest that the interdependency between chest wall and lungs, and within the latter, between lobes, is an important factor determining the regional distribution of ventilation and the pleural pressure gradient in man.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/14. Management of tension pneumatocele with high-frequency oscillatory ventilation.We report the successful application of high-frequency oscillatory ventilation in a patient with tension pneumatocele (TP). The proposed check-valve mechanism for the development of pneumatoceles predicts that positive-pressure ventilation could lead to distension of these airspaces and formation of TPs. Therefore, high-frequency ventilation could be more applicable in conditions, such as massive air leak due to bronchopleural fistula, that are difficult to manage by conventional ventilator modes.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/14. The squirting bleb: image and treatment of inspiration-linked leakage of a peritoneopleural fistula.A 25 year old man with known chronic right sided heart failure and ascites due to a congenital heart defect presented with dyspnoea and a massive pleural effusion. thoracoscopy revealed two diaphragmatic blebs. Changes in peritoneal and thoracic pressure during respiration resulted in periodic squirting of a ruptured bleb, illustrating preferential flow of peritoneal fluid into the thorax. The pleural effusion was successfully treated with drainage of ascitic fluid and chemical pleurodesis.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/14. Differential ventilation with low-flow CPAP and CPPV in the treatment of unilateral chest trauma.A case of severe unilateral chest trauma with bronchopleural fistula is presented. Ventilatory therapy consisted of asynchronous independent lung ventilation (AILV). The injured lung was ventilated with intermittent positive pressure ventilation (IPPV) [tidal volume (TV) = 200 ml, f = 25/min, I:E = 0.5, minute volume (MV) = 5.0 l/min, FiO2 = 0.4], and the unaffected lung was ventilated with continuous positive pressure ventilation (CPPV) (TV = 600 ml, f = 12/min, I:E = 0.5, MV = 7.2 l/min, PEEP = 0.5 kPa, FiO2 = 0.4). Adequate gas exchange was obtained (PaO2 = 14.5 /- 2.3 kPa, PaCO2 = 5.5 /- 0.7 kPa), but high air leakage volumes persisted. Thus, differential low-flow CPAP (V = 5.0-7.5 l/min, PEEP = 0.5 kPa, FiO2 = 0.4) of the injured lung and CPPV (TV = 600 ml, f = 12/min, MV = 7.2 l/min, I:E = 0.5, PEEP = 0.5 kPa, FiO2 = 0.4) of the unaffected lung was applied for 36 hours. Further deterioration of pulmonary function was prevented, and the bronchopleural fistula closed after several hours. After another period of AILV the patient was treated with conventional mechanical ventilation, and finally weaned with high-flow CPAP.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/14. The use of combined high-frequency jet ventilation and intermittent positive pressure ventilation in bilateral bronchopleural fistulae.Dissatisfaction with the results of conventional respiratory support has led to the use of high-frequency jet ventilation in desperate clinical situations with severe acute respiratory failure. We report a case of a 77 year old man with bilateral bronchopleural fistulae, who was ventilated with a combination of intermittent positive pressure ventilation and high-frequency jet ventilation. The hemodynamic and respiratory advances of this combination are discussed in an overview of the literature.- - - - - - - - - - ranking = 2.5keywords = pressure (Clic here for more details about this article) |
6/14. Gas flow through a bronchopleural fistula. Measuring the effects of high-frequency jet ventilation and chest-tube suction.high-frequency jet ventilation (HFJV) is FDA-approved for ventilating patients with bronchopleural fistulae (BPF), yet little is known about its effect on the fistula airleak. We quantitated a patient's BPF airleak during both conventional volume-cycled ventilation and HFJV. The effect of chest-tube suction (CTS) on BPF flow was also studied. Despite a significant reduction in peak airway pressure, the HFJV resulted in a 50-70 percent increase in BPF flow. CTS also significantly increased the airleak. HFJV may not always be the preferential method for ventilating patients with BPF and we recommend measuring the fistula airleak when attempting to optimize a patient's ventilatory parameters.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
7/14. A simple technique for managing a bronchopleural fistula while maintaining positive pressure ventilation.The development of a bronchopleural fistula (BPF) is an infrequent, but potentially devastating complication of positive pressure ventilation. A case report is detailed in which a BPF arose in a patient on controlled ventilation with a PEEP of 22 cm H2O. Within 12 hours, fistula flow was continuous and accounted for 75% of the delivered tidal volume. PEEP fell rapidly during expiration; oxygenation steadily deteriorated as the aAO2 fell 0.27 to 0.14. Conventional treatment methods were unsuccessful, and a system was constructed for adding controlled levels of positive pressure ot the pleural space on the side of the BPF. By decreasing the expiratory transpulmonary pressure difference (PEEP minus pleural pressure), the fistula leak was greatly decreased, and PEEP and oxygenation were stabilized. This system can be rapidly constructed at the bedside with equipment routinely available in most hospitals and offers the ability to adjust the expiratory transpulmonary pressure, lung volume, and BPF flow while maintaining positive pressure ventilation with PEEP.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
8/14. Unilateral high frequency jet ventilation. Reduction of leak in bronchopleural fistula.A young alcoholic presented with severe bilateral bronchopneumonia, which required prolonged treatment with intermittent positive pressure ventilation. High airway pressures were necessary for effective gas exchange. A recurrent tension pneumothorax led to a persistent bronchopleural fistula which resulted in hypercarbia and hypoxaemia despite the use of large minute volumes. Surgical resection was not considered feasible because of extensive local infection. Asynchronous independent lung ventilation was instituted, using a double-lumen endobronchial tube. A considerable leak still occurred through the bronchopleural fistula, and it was only when high frequency jet ventilation was substituted to the fistula-containing lung that the leak was virtually abolished, while improving gas exchange. High frequency jet ventilation in bronchopleural fistula is of potential benefit.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/14. Ventilator-induced subpleural air cysts: clinical, radiographic, and pathologic significance.Alveolar rupture from the high airway pressures used in the treatment of adult respiratory distress syndrome may cause interstitial dissection of gas peripherally and the formation of "subpleural air cysts." These thin-walled, rounded air collections are easily detectable radiographically, and their recognition can provide an important early sign of pulmonary barotrauma. This report summarizes the clinical, radiographic, and pathologic features of this lesion in 5 adult patients. We found that tension pneumothorax rapidly occurs after the appearance of these cysts if airway pressures are not reduced or chest tubes are not in place. Secondary infection of the cysts was also common and added significant morbidity to this already compromised group of patients.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/14. The bronchial leak squeak: a new sign for the physical diagnosis of bronchopleurocutaneous fistula.We describe a unique physical diagnostic sign that we have observed in seven patients with bronchopleurocutaneous fistulas. Such patients have a highpitched squeak over the affected chest area during sustained valsalva maneuver. We postulate that turbulence across the bronchial fistula due to high transbronchial pressure gradient during the valsalva maneuver produces the squeaking sound. The pitch of the leak squeak sign is higher in smaller fistulas than in larger fistulas; decreases in intensity and increases in pitch occurred in two patients in whom the bronchial fistula slowly closed. The absence of the leak squeak sound in patients with spontaneous pneumothorax suggests that this sign can be used to differentiate central airways from alveolar air leaks.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
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