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Biomedical subjects

B H Hoff

Publications and source records attributed to B H Hoff.

6 recordsLinked to original sources

Use of positive airway pressure without endotracheal intubation.

Continuous positive airway pressure (CPAP) and expiratory positive airway pressure (E-PAP) may be used safely without endotracheal intubation in patients with acute respiratory failure when strict selection criteria are adhered to. The therapy should be titrated to reduce intrapulmonary shunting, improve PaO2, and reduce FIO2. Other considerations include balancing oxygen consumption against cardiac output and oxygen transport. Absolute or relative indications for abandoning the technique and using endotracheal intubation with mechanical ventilatory support include unrelenting hypoxia, patient exhaustion, rising PaCO2, development of metabolic acidosis, presence of ventricular arrhythmias, and inability to protect the airway.

Acute Disease

Multisystem failure: a review with special reference to drowning.

Near-drowning represents an insult that can affect all organ systems. A common pathway for injury is hypoxemia, acidosis, and hypoperfusion. Pulmonary insufficiency and CNS dysfunction are major causes of morbidity and mortality. Variations in vascular volume, heart failure, renal failure, coagulation disorders, and electrolyte disturbances may also be present. Patients should be observed for multisystem failure and therapy tailored to the particular needs of each victim.

Acidosis

Heat stroke.

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Body Temperature

Multiple organ failure after near-hanging. A case report.

Near-hanging and strangulation injuries can result in multiorgan failure. A 13-year-old male sustained an ischemic anoxic cerebral injury that was followed by an encephalopathy lasting approximately 30 hours and pulmonary edema lasting more than 48 hours. The patient was treated with continuous positive pressure ventilation followed by spontaneous breathing with continuous positive airway pressure by a mask; shock was reversed. The loss of cardiovascular competency and pulmonary insufficiency are problems frequently encountered in the patient who has sustained an hypoxic insult. Cerebral injury can result from hypoxemia related to tracheal compression, aspiration, and pulmonary edema; cerebral vascular engorgement secondary to venous compression; and ischemic anoxia related to arterial compression. Cerebral changes continue after circulatory and pulmonary competence has been restored. Multiorgan monitoring and control including intracranial pressure monitoring may be required to guide therapy. Respiratory distress syndrome may develop secondary to multiple factors including autonomic reflexes triggered by cerebral hypoxia and edema.

Adolescent