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Biomedical subjects

E Barzilay

Publications and source records attributed to E Barzilay.

At least 19 recordsLinked to original sources
PubMed1991

[Treatment of flail chest].

We present our experience in the treatment of 82 patients with flail chest (FC). They were evaluated according to the number of fractured ribs, which apparently correlates with the degree of lung contusion. Treatment methods compared were oxygen mask therapy, epidural analgesia, continuous positive airway pressure (CPAP), intermittent mandatory ventilation (IMV) plus positive end respiratory pressure (PEEP), and high frequency ventilation (HFV) plus PEEP. Oxygen therapy alone was not effective in those with more than 5 fractured ribs, while CPAP was effective in those with up to 10 fractured ribs. No significant difference was found between IMV and HFV. The purpose of respiratory support in FC is to reduce atelectasis and the resulting shunt, and to improve removal of mucus from airways. The patients were discharged without compromise in respiratory function, despite persistence of FC. We conclude that the primary mechanism of respiratory impairment in FC is not the mechanical disturbance, but rather the degree of lung contusion suffered.

Adult↗
PubMed1989

Use of extracorporeal supportive techniques as additional treatment for septic-induced multiple organ failure patients.

We compared retrospectively four similar groups of patients with multiple organ failure (MOF) due to sepsis. All of them were treated initially with conventional therapy, aprotinin as protease inhibitor and vitamin C with allopurinol as possible scavengers of oxygen-free radicals, were also added. After 24 h of no clinical progress, continuous arteriovenous hemofiltration (CAVH), CAVH/dialysis (CAVH/D), and sequential plasmafilter-dialysis with slow continuous hemofiltration (CAVHP/D) were respectively added to groups 2 (n = 14), 3 (n = 6), and 4 (n = 11). Mortality was 87% for group 1, 71% for group 2, 50% for group 3, and 36% for group 4. In the latter we were able to remove possible MOF-inducing mediators from the bloodstream, to give fluids without restriction (even in oliguric patients), and to improve removal of metabolic waste products. It is possible that these extracorporeal supports, associated with conventional therapy, and pharmacologic drugs such as protease inhibitors and possible scavengers of oxygen-free radicals, helped to reduce the mortality rate. We conclude that, although the number of study patients was too small to reach firm conclusions, the good results observed with CAVHP/D suggest clinical trials to assess the efficacy of this technique.

Adult↗
PubMed1989

Superimposed high frequency ventilation with conventional mechanical ventilation.

A 73-year-old man with ARDS-multiple organ failure due to Chlamydia psittaci, was successively supported with conventional respiratory techniques. After 48 hours of no clinical improvement, HFV was superimposed to CMV in order to combine the advantages of each one. Since improvement has been seen in all ventilatory parameters, this method is suggested as another mode of ventilation for patients with refractory hypoxia and hypercarbia who do not respond to conventional respiratory care.

Aged↗
PubMed1989

[Extracorporeal support technics in the treatment of multisystem failure. Our experience].

Mortality rate among patients with septic, oliguric, multiple organ failure is high. Conventional hemodialysis has often detrimental effects on critically ill patients. Continuous arteriovenous hemofiltration (CAVH), continuous arteriovenous hemodialysis (CAVH/D) and continuous arteriovenous hemodialysis associated with sequential plasmapheresis (CAVHP/D) could reduce mortality in septic (hypercatabolic, oliguric) ARDS induced MOF patients. These techniques are simple and can be managed without superspecialized personnel.

Evaluation Studies as Topic↗
PubMed1987

Differential lung ventilation: a review and 2 case reports.

The respiratory parameters of some of the patients with acute respiratory failure deteriorates while using conventional ventilation. These patients suffer unilateral lung disease and the failure to respond favourably to therapy is due to increased intrapulmonary shunt. There is a reflex vasodilation in the injured lung. Functional residual capacity is reduced in the injured lung and the compliance decreases. Gas flow is then deviated to the other lung, thus increases alveolar collapse and decreases regional compliance in the injured lung. These events cause severe hypoxemia. We present here two cases with unilateral lung disease that failed to respond to conventional mechanical ventilation. Asynchronized differential lung ventilation was found to be the therapeutic answer to the problem. We discuss the pathophysiology of unilateral lung injury and the physiology of differential lung ventilation.

Acute Disease↗
PubMed1987

Traumatic respiratory insufficiency: comparison of conventional mechanical ventilation to high-frequency positive pressure with low-rate ventilation.

Eleven patients suffering severe traumatic respiratory insufficiency were mechanically ventilated using a new system which combined high-frequency positive-pressure ventilation (HFPPV) with low-rate conventional mechanical ventilation (LRCMV). Ten similar patients were ventilated by conventional mechanical ventilation (CMV) with PEEP. HFPPV patients were fully conscious and cooperative during ventilation and did not need sedatives or muscle relaxants. Arterial oxygenation was significantly (p less than .005) better in HFPPV than CMV patients (89.91 +/- 10.24 vs. 78.43 +/- 11.13 torr, respectively), and pulmonary shunt was also better in the HFPPV group (13.1 +/- 4.7% vs. 20.4 +/- 6.4%, p less than .01). Moreover, inspired oxygen concentrations were lower (PaO2/FIO2 197.8 +/- 51.3 in the HFPPV group vs. 130 +/- 46.6 in the CMV group, p less than .005) and the time required for mechanical ventilation was shorter (4.2 +/- 0.91 vs. 6.1 +/- 0.8 days, p less than .1). All HFPPV patients immediately began breathing spontaneously when they were disconnected from the ventilator. We suggest this method as a better ventilatory mode for patients suffering traumatic respiratory insufficiency.

Adult↗
PubMed1986

Hemofiltration in septic ARDS. The artificial kidney as an artificial endocrine lung.

Twenty-four patients with high microvascular permeability pulmonary edema were initially treated by means of conventional supportive therapy for 1-12 days. Continued deterioration was treated by predilutional hemofiltration and induced a dramatic improvement in 22/24 patients. Survival was 92%. Sieving coefficients for autacoids and middle molecular weight vasoactive peptides involved in the development of high microvascular permeability pulmonary edema were higher than 0.88 indicating that clearing from blood of these peptides during one pass through the hemofilter is similar to that obtained during one pass through the pulmonary normal microvasculature. Hemofiltration seems to be a significant breakthrough in the treatment of ARDS secondary to severe sepsis.

Acute Kidney Injury↗
PubMed1986

Obstructive renal failure and pleural effusion caused by the gravid uterus.

Acute renal failure due to ureteral obstruction by the gravid uterus is considered to be a rare complication of late pregnancy. Pleural effusion caused by urinary tract obstruction is also extremely uncommon. This presentation reports what is believed to be the first case in which both these complications appeared at the same time in a pregnant patient.

Acute Kidney Injury↗
PubMed1985

[Non-cardiac pulmonary edema: an enigma today].

Pulmonary oedema is caused by an excessive accumulation of interstitial fluid in the lungs: in the case of left ventricular failure, oedema arises due to an increase in capillary hydrostatic pressure. Non-cardiac oedema, on the other hand, is brought about by a change in alveolar capillary membrane permeability. Although the causes are different, namely respiratory distress syndrome in adults, altitude-induced pulmonary oedema, oxygen toxicity, medication, metabolic changes, etc., the result is the same, i.e. damage to the alveolar capillary membrane. This damage appears to be brought about by two factors: complement activation and damage to the blood clotting mechanism. The difference between cardiac and non-cardiac pulmonary oedema is difficult to gauge. If pulmonary cone pressure is normal or low, and if the oedematous fluid/plasma protein ratio is greater than 0.7, the oedema is non-cardiac in origin. Treatment is carried out with the aim of repairing the alveolar capillary membrane and preventing extension of the damage. Respiratory insufficiency is treated by a mechanical respirator, applying positive pressure at the end of expiration. Fluid administration is adjusted according to pulmonary cone pressure levels. Opinions are still divided over whether to administer crystalline or colloidal solutions, steroids or protease inhibitors.

Adrenal Cortex Hormones↗
PubMed1985

[Non-cardiac pulmonary edema in a patient with recent cardiac pulmonary edema].

Pulmonary oedema may be cardiac or non-cardiac in origin: these two forms are clinically indistinguishable and their treatments are completely different. A case of pulmonary oedema is reported. This was believed to be of cardiac origin but did not respond to conventional treatment with diuretics and positive fibrotropic drugs. Insertion of a Swan-Ganz catheter revealed low capillary wedge on pressure. This, in turn, indicates that pulmonary oedema is non-cardiac in origin. The administration of liquids and cortisones led to a rapid improvement in the patient's condition. It is concluded that, whenever conventional treatment of pulmonary oedema fails, the possibility of non-cardiac oedema should be considered. In order to check this, capillary wedge pressure is measured.

Blood Gas Analysis↗
PubMed1985

Hemofiltration in severe septic adult respiratory distress syndrome associated with varicella.

One case of severe varicella pneumonia with high microvascular permeability pulmonary edema and signs of multiple system organ disfunction was successfully treated by means of hemofiltration. The patient was discharged from the Intensive Care Unit 6 days after admission. Peptides showing molecular weight ranging between 600 (prostaglandins) and 4000 (B-endorphin) daltons were cleared from blood at the same rate as urea. Hemofiltration appears to be a valuable tool for treating septic ARDS.

Adult↗
PubMed1985

Hemofiltration in severe high microvascular permeability pulmonary edema secondary to rickettsial spotted fever.

Two patients, affected by spotted fever, developed low pulmonary capillary wedge pressure (PCWP) pulmonary edema with severe hypoxemia. Conventional specific and supportive therapy, including mechanical ventilation, failed to induce significant respiratory and hemodynamic improvement which was dramatically reached by means of hemofiltration. Removal of circulating middle molecular weight peptides by the convective mass transfer, characteristic of hemofiltration, offers a new and effective therapeutic approach for the adult respiratory distress syndrome secondary to rickettsial diseases.

Adult↗
PubMed1984

Combined use of HFPPV with low-rate ventilation in traumatic respiratory insufficiency.

Two patients with chest injuries, flail chest and respiratory failure were mechanically ventilated by a system composed of 2 Bennett respirators and an independent source of gas. This system provides high-frequency positive pressure ventilation (HFPPV), low-frequency conventional mechanical ventilation (LFCMV) and high inspiratory flow of fresh gas (HIF), through the independent source. This system made use of the advantages of HFPPV and also solved the problem of possible CO2 retention. Using this system we could ventilate the patients while they were fully conscious and cooperative, thus eliminating the need for sedatives and muscle relaxants. Time of mechanical ventilation was shortened since the internal pneumatic fixation was very good and made it possible for the fractured ribs to unite rapidly. Restoration of spontaneous breathing was immediate after disconnection from the ventilator. We suggest this method as another mode of ventilation for patients with flail chest and respiratory failure.

Aged↗
PubMed1984

Sequential hemofiltration in nonoliguric high capillary permeability pulmonary edema of severe sepsis: preliminary report.

Five patients with nonoliguric adult respiratory distress syndrome (ARDS) secondary to severe sepsis showed improved blood oxygenation after up to 36 h of conventional therapy and mechanical ventilation with optimal positive end-expiratory pressure. However, metabolic acidosis was unchanged, and blood urea had increased. Some patients showed hemodynamic signs of incipient heart failure. After sequential hemofiltration, the altered physiologic shunt and blood pH returned to normal. Chest x-rays showed clearing of interstitial pulmonary edema. Patients recovered from ARDS in spite of fluid accumulation. Mechanical ventilation was stopped up to 8.5 h after the last hemofiltration. We postulate that convective ultrafiltration clears the blood of circulating low- and middle-weight vasoactive molecules implicated in the development of high microvascular permeability acute pulmonary edema secondary to sepsis.

Adult↗
PubMed1984

Freshwater near-drowning: our experience in life-supportive treatment.

Eight freshwater near-drowning victims were treated in the General Intensive Care Unit. The most prominent findings upon arrival were respiratory failure, hypoxemia and coma. Routine treatment, including mechanical ventilation and brain resuscitation, was initiated in all patients. Six patients were discharged fully recovered from the unit on the 3rd to 6th day; one patient who recovered fully but had amnesia was discharged after 8 months; and one patient remained decerebrated and died 5 months later. A more aggressive treatment of near-drowning victims is justified and recommended.

Adolescent↗