PubMed Health⌕ Search

Biomedical subjects

P B Hazard

Publications and source records attributed to P B Hazard.

14 recordsLinked to original sources
PubMed1999

Posterior tracheal wall perforation during percutaneous dilational tracheostomy: an investigation into its mechanism and prevention.

OBJECTIVES: Part 1: To describe the complication of posterior tracheal wall injury and perforation associated with the percutaneous dilational tracheostomy (PDT). Part 2: To determine the mechanism of posterior tracheal wall injury during PDT. DESIGN: Prospective observational study. SUBJECTS: Part 1: Medical-surgical ICU patients requiring tracheostomy. Part 2: Swine and cadaver models. INTERVENTIONS: Part 1: Consecutive medical-surgical ICU patients undergoing tracheostomy tube insertion via the percutaneous dilation technique with bronchoscopic guidance were enrolled in the study. Demographic data and complications were recorded. Part 2: Tracheostomy tubes were inserted via the percutaneous dilational technique in the swine model with concomitant bronchoscopic video recording from the proximal and distal airways. Tracheostomy tubes were inserted via the percutaneous dilational technique in the cadaver model followed by anatomic inspection of the airway. RESULTS: Part 1: Seven (29%) of 24 medical-surgical ICU patients sustained complications associated with PDT. Three patients (12.5%) sustained posterior tracheal wall perforations followed by the development of tension pneumothoraces. Part 2: The swine model demonstrated that posterior tracheal wall perforation may occur during PDT when the guiding catheter is withdrawn into the dilating catheters. Five-centimeter posterior tracheal wall mucosal lacerations occurred when the guidewire and the guiding catheter were not properly stabilized during PDT. CONCLUSION: Percutaneous dilational tracheostomy was associated with a 29% complication rate in this observational study. Of concern was the high rate (12.5%) of posterior tracheal wall perforation. The swine and cadaver models suggest that posterior tracheal wall injury or perforation may occur if the guidewire and guiding catheter are not properly stabilized. To avoid posterior tracheal wall injury, the guidewire and guiding catheter should be firmly stabilized during PDT.

Animals↗
PubMed1993

Safety of thoracentesis in mechanically ventilated patients.

As practicing intensivists, we frequently diagnose pleural effusions in mechanically ventilated patients and routinely perform thoracentesis even when the patient is on positive end-expiratory pressure (PEEP). In light of a recent report, we have reviewed our experience. It is of interest that all thoracenteses were performed with patients in the lateral decubitus position.

Adult↗
PubMed1988

Bedside percutaneous tracheostomy: experience with 55 elective procedures.

Over a 24-month period, tracheostomy was performed in 55 patients using a percutaneous, wire-guided, dilatational technique. All such procedures were undertaken at the patient's bedside in the intensive care unit, with the patient under local anesthesia and mechanically ventilated through an oral endotracheal tube. A variety of wire-guides, dilators, and tracheal tubes were used as experience and proficiency were gained with the approach, and eventually, a simple modification of a standard low-pressure cuffed endotracheal tube was found to facilitate the procedure. The percutaneous method was found to be rapid and simple, to leave almost no cosmetic deformity, and to be almost totally free from infectious complications. This technique should be considered for routine use in critically ill, ventilator-dependent patients.

Adolescent↗
PubMed1987

Treatment of multifocal atrial tachycardia with metoprolol.

We used metoprolol orally or iv in 25 patients with multifocal atrial tachycardia that was complicating severe cardiopulmonary illness, and we observed its effect on heart rate and rhythm, BP, and arterial blood gases. All patients showed a dramatic slowing of heart rate, averaging 54.0 +/- 4.0 beat/min (p less than .001), with only small and transient fall in BP. Seventeen (68%) patients experienced conversion to sinus rhythm, 11 immediately, and six more within 3 h. Time to response averaged 5.1 h with the oral form but was less than 10 min when the drug was given iv. The mean oral dose required was 32.5 mg, and the mean iv dose was 6.5 mg. No patient experienced clinically apparent hemodynamic or respiratory deterioration as a result of metoprolol administration. While arterial pH and PaCO2 were unaltered by metoprolol, mean PaO2 increased by 12.2 +/- 5.8 torr (p less than .05), the increase being greatest in patients with more severe gas-exchange derangement. We conclude that metoprolol is effective in the management of multifocal atrial tachycardia.

Administration, Oral↗
PubMed1987

Verapamil in multifocal atrial tachycardia. Hemodynamic and respiratory changes.

The hemodynamic and gas exchange alterations resulting from treatment of multifocal atrial tachycardia (MAT) with intravenous verapamil were monitored in 13 critically ill patients. Administration of verapamil (mean dose 12.9 +/- 1.0 mg) produced immediate if usually transient reduction in heart rate. Stroke volume index rose, but no significant changes in cardiac index, blood pressure, or pulmonary artery or capillary wedge pressures were demonstrated. Verapamil appeared to increase pulmonary venous admixture. Oxygen transport, however, did not decrease significantly. Verapamil is generally beneficial in the treatment of MAT, but its utility may be limited in many patients by its tendency to aggravate pre-existing arterial hypoxemia.

Aged↗
PubMed1987

Flail chest injury in a patient with surgical absence of the sternum.

Although pulmonary disability is usually minimal following total sternectomy, the potential for remote complications exists. We present a case of severe respiratory failure resulting from simple rib fractures occurring two years after sternectomy for sternal osteomyelitis. Respiratory failure resulted from flail chest due to the combination of acute rib fracture and the lack of anterior fixation of the thoracic cage.

Aged↗
PubMed1981

Transvenous cardiac pacing in cardiopulmonary resuscitation.

Despite widespread application of cardiac pacing to a wide variety of circumstances with minimal morbidity are remarkable success, the possible role of transvenous pacing in the acute setting of cardiac resuscitation has not been adequately evaluated. The authors report their experience with the use of transvenous pacemakers in 26 patients undergoing cardiopulmonary resuscitation (CPR). Although electrical activity was induced by pacing in nearly one-third of those whose primary disturbance was asystole, electromechanical dissociation followed and survival was not improved. Of patients in whom complete heart block or other bradycardia occurred during CPR, and in whom the rhythm disturbance was unresponsive to conventional pharmacological therapy, capture was possible in 77%, and successful resuscitation in one-third. Complications were minimal. It is concluded that transvenous cardiac pacing is beneficial in acute bradycardia developing during CPR, but no benefit in asystole was demonstrated.

Cardiac Pacing, Artificial↗
PubMedDate not supplied

Calculation of sodium bicarbonate requirement in metabolic acidosis.

Despite the host of complications which may be associated with intravenous sodium bicarbonate infusion, the use of this agent is a frequent necessity in patients with metabolic acidosis. No satisfactory formula for calculating bicarbonate dose had previously been described, although such an approach might be expected to reduce the incidence of these complications. The authors have devised a simple formula for bedside calculation of bicarbonate requirement in metabolic acidosis, designed to elevate th pH to the region about 7.30, and report their experience with the use of this formula in 13 instances. In all but one, the post-infusion pH was between 7.25 and 7.37, with a mean of 7.30 +/- 0.04 and no instances of serious overtitration. It is concluded that the formula is useful as a pragmatic aid in the management of patients with metabolic acidosis.

Acid-Base Imbalance↗