1/18. Severe aspiration pneumonia after surgery for reconstructed gastric tube cancer treated with extracorporeal life support.A 68-year-old man who had received resection for thoracic esophageal cancer 8 years ago, was operated on for the cancer of the reconstructed gastric tube. On the day of the operation, he accidentally swallowed gastric juice due to an obstruction in the reconstructed gastric tube. He suffered from acute hypoxic respiratory failure which could not be controlled with conventional therapy on postoperative day 1. Therefore, extracorporeal life support was employed at 3.0 L/min. extracorporeal flow for 11 days. Before extracorporeal life support data: PO2/FiO2 = 45, A-aDO2 = 600. During extracorporeal life support, the ventilator setting was pressure control (16 cmH2O) ventilation with a positive end expiratory pressure of 8 cmH2O, respiratory rate of 5 breaths/min., and FiO2 of 0.4. The patient was successfully weaned from extracorporeal life support and extubated on postoperative day 12. After extracorporeal life support data: PO2/FiO2 = 225, A-aDO2 = 465. We report on a successful weaning case from extracorporeal life support and discuss the efficacy these of regarding this patient.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/18. A spoonful of sugar--improving the sensitivity of the glucose oxidase test strip method for detecting subclinical pulmonary aspiration of enteral feed.A 74-year-old woman was admitted to the intensive care unit (ICU) with respiratory failure. Following intubation and mechanical ventilation, nasogastric enteral feeding was begun. The sensitivity of the glucose oxidase strip method for detecting aspiration of enteral feed has been questioned because the glucose levels in commonly used feeds are similar to those of normal tracheal aspirates. In order to increase the glucose concentration of the feed, 10 g of glucose was added to each 500 ml feed carton. Testing oral and tracheal secretions with standard glucose oxidase strips allowed the accurate detection of both pharyngeal regurgitation and tracheal aspiration. An episode of subclinical aspiration was detected and this was associated with a fall in the PaO2/FiO2 ratio. There were no further episodes of aspiration following the introduction of a gastric motility agent, maintaining the patient in the semi-recumbent position and an increase in the positive end expiratory pressure (PEEP).- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/18. Unusual arachnoid cyst of the quadrigeminal cistern in an adult presenting with apneic spells and normal pressure hydrocephalus--case report.A 67-year-old woman was admitted to our clinic with symptoms of normal pressure hydrocephalus, lower cranial nerve pareses, and pyramidal and cerebellar signs associated with respiratory disturbances. Computed tomography (CT) and magnetic resonance imaging revealed a 4.7 x 5.4 cm quadrigeminal arachnoid cyst causing severe compression of the tectum and entire brain stem, aqueduct, and cerebellum, associated with moderate dilation of the third and lateral ventricles. Emergency surgery was undertaken due to sudden loss of consciousness and impaired breathing. The cyst was totally removed by midline suboccipital craniotomy in the prone position. Postoperatively, her symptoms improved except for the ataxia and impaired breathing. She was monitored cautiously for over 15 days. CT at discharge on the 18th postoperative day revealed decreased cyst size to 3.9 x 4.1 cm. Histological examination confirmed the diagnosis of the arachnoid cyst of the quadrigeminal cistern. The patient died of respiratory problems on the 5th day after discharge. Quadrigeminal arachnoid cysts may compress the brain stem and cause severe respiratory disturbances, which can be fatal due to apneic spells. patients should be monitored continuously in the preoperative and postoperative period until the restoration of autonomous ventilation is achieved.- - - - - - - - - - ranking = 2.5keywords = pressure (Clic here for more details about this article) |
4/18. Rocuronium-induced generalized spontaneous movements cause pulmonary aspiration.Rapid-sequence induction with cricoid pressure is a standard procedure for inducing anesthesia in patients with a potentially full stomach. During the induction period, if the patient develops generalized movements of the body, the pressure level of the cricoid may change unexpectedly. As a result, the increase in intragastric pressure may cause gastric regurgitation and consequent pulmonary aspiration. Rocuronium has been widely used as an alternative to succinylcholine during the induction of anesthesia. However, most patients who received rocuronium complained of severe burning pain in their arm during intravenous injection. Even after the administration of the induction agents, rocuronium injection can also cause withdrawal of the hand or other generalized movements of the body. We describe a case of gastric regurgitation with pulmonary aspiration following generalized spontaneous movements associated with rocuronium injection in a girl who received pediatric emergent surgery.- - - - - - - - - - ranking = 1.5keywords = pressure (Clic here for more details about this article) |
5/18. Management and long-term follow-up of patients with types III and IV laryngotracheoesophageal clefts.BACKGROUND: Laryngotracheoesophageal cleft (LTEC) is a rare congenital anomaly that occurs when the trachea and esophagus fail to separate during fetal development. The 2 most severe forms of LTEC are type III, with extension of the cleft from the larynx to the carina, and type IV, with extension of the cleft into one or both mainstem bronchi. methods: Over the past 25 years, we have accumulated an experience caring for 9 patients with severe LTEC, including 4 with type III and 5 with type IV. RESULTS: morbidity and mortality from severe LTEC often result from aspiration and chronic lung disease. patients with types III (1/4) and IV (5/5) LTEC have an extremely high incidence of microgastria with a shortened esophagus for which fundoplication is ineffective. Because gastric feeding often does not initially increase stomach volume and may cause severe aspiration, we suggest early gastric division with later reconstruction of intestinal continuity in patients with microgastria. Postoperative tracheoesophageal fistulas have occurred in 6 of 9 patients. CONCLUSIONS: Generous interposition of vascularized tissue with a multiple-layer closure has helped to prevent further recurrences. Postoperative tracheomalacia may be managed with continuous positive airway pressure and may require customized endotracheal tubes. Evaluation of respiratory and digestive function, school performance, and quality of life for the surviving patients is described.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
6/18. Neurogenic pulmonary edema: case reports and review.Neurogenic pulmonary edema (NPE) is a relatively common though often subclinical complication of a variety of central nervous system insults (trauma, hemorrhage, seizures, etc.) in children and adults. The syndrome probably results from massive centrally mediated sympathetic discharge and generalized vasoconstriction, and often presents in the emergency department (ED). The symptoms are likely to be mistaken for aspiration pneumonia. Treatment consists of ventilatory support, including positive end-expiratory pressure, and aggressive measures to reduce intracranial pressure. We present four cases of NPE and review its recognition and emergent management.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/18. Pulmonary "cyclosporinoma" mimicking infection after heart transplantation.Tissue from a transthoracic needle biopsy, which was performed as part of the investigation of an undiagnosed left upper lobe opacity in a patient after orthotopic heart transplantation, revealed numerous macrophages loaded with oil globules. No causative organisms were present. High-pressure liquid chromatography showed a similar profile to the oil in which cyclosporine is suspended. The lesion appears to have been caused by aspiration of cyclosporine.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
8/18. Short-term asynchronous ventilation and differential positive end-expiratory pressure in the treatment of aspiration pneumonia. A case report.Synchronous and asynchronous differential lung ventilation, with or without the application of selective positive end-expiratory pressure (PEEP), has been described. Short-term asynchronous ventilation with differential PEEP as a treatment modality for unilateral lung disease has not been well documented. We report on a 43-year-old accident victim with multiple trauma who developed a severe left-sided aspiration pneumonia which failed to respond to conventional therapy including the application of PEEP. A left-sided double-lumen endotracheal tube was passed and 15 cm and 5 cm H2O PEEP was applied to the left and right lungs respectively. Asynchronous ventilation using two Ambu bags coupled with vigorous physiotherapy and endobronchial suctioning for 40 minutes resulted in a dramatic improvement in both the appearance on chest radiography and arterial blood gas values.- - - - - - - - - - ranking = 2.5keywords = pressure (Clic here for more details about this article) |
9/18. Aspiration in caesarean section successfully treated with high continuous positive airway pressure (CPAP).A case of aspiration pneumonitis during Caesarean section is described. The patient was treated with high-level continuous positive airway pressure (CPAP) resulting in marked improvement and discharge from the intensive care Unit 44 hours after the aspiration had occurred.- - - - - - - - - - ranking = 2.5keywords = pressure (Clic here for more details about this article) |
10/18. tolazoline and dopamine therapy in neonatal hypoxia and pulmonary vasospasm.Severe hypoxia unresponsive to maximum ventilatory support occurs both in idiopathic respiratory distress syndrome and meconium aspiration. We recently encountered a 980 g female infant with respiratory distress syndrome and 3 300 g female infant with meconium aspiration and persistant fetal circulation whose clinical course necessitated the use of tolazoline and dopamine to reduce pulmonary and to stabilize systemic pressures. The infant with respiratory distress syndrome responded with a PaO2 increase of 2.7 kPa while the infant with persistant fetal circulation and meconium aspiration showed a 51.6 kPa rise. Combined pharmacologic therapy may have a role in improving oxygenation status in severely hypoxemic infants receiving maximum support.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
| | Next -> |