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At least 73 records · Page 4Linked to original sources
PubMed1978

Systemic air embolism secondary to respiratory therapy in the neonate: six cases including one survivor.

Systemic air embolism has been described as a complication of respiratory therapy using positive pressure ventilation. This is usually a dire, if not fatal occurrence. The incidence of this severe complication will likely increase with the advent of more vigorous and aggressive respiratory therapy of the respiratory distress syndrome in neonates. It is important for both the clinician and the radiologist to be aware of this entity, its etiology, and its probable increasing frequency. This paper reports six cases of systemic air embolism, including one patient who revealed no clinical symptomatology, and in whom the diagnosis was made by radiographic findings only. This is the largest series yet reported and includes, to my knowledge, the first reported neonate to survive this complication.

Embolism, Air↗
PubMed1979

Effect of mechanical ventilation and positive end-expiratory pressure (PEEP) on chest radiograph.

The effect of differing ventilator settings and positive end-expiratory pressure (PEEP) on the chest radiograph was studied in 12 patients with acute respiratory failure. Changing ventilator settings produced dramatic variations in the appearance of pulmonary infiltrates in technically identical radiographs exposed over a 10-15 min period. PEEP had the greatest effect on radiographic appearance. In seven patients, the diagnosis or estimation of severity of pulmonary infiltrates would have been altered if only the film during PEEP had been available. Knowledge of ventilator settings is vital in evaluating the severity of infiltration and radiographic diagnosis in patients with acute respiratory failure.

Humans↗
PubMed1979

[The role of anaesthesiology in intensive care (author's transl)].

The German Society of Anaesthesia and Resuscitation was founded in 1953. The change of name to "German Society of Anaesthesia and Intensive Care" in 1977 reflects the development that this specialty has undergone since 1953; it is also an indication of the claim of anaesthesia to play a part in the care of the critically ill surgical patient. To the questions: what is the basis for this claim, what can anaesthesia contribute towards the care of these cases, where is the dividing line between anaesthesia and the other disciplines concerned in intensive care, what effect has intensive care work on the training of the anaesthetist, the answers are as follows: the concern of the anaesthetist is the care of the patient whose vital functions are impaired by surgery, anaesthesia or disease; he has therefore acquired techniques and means to maintain and assist these vital functions. His work in the intensive care ward is thus often no more than a continuation of the work he is doing in the operating theatre. This does not mean that he should replace the clinician of the traditional specialties working in the intensive care unit; rather that he should function as a co-ordinator as regards the type and course of treatment and nursing. For the anaesthetist there is the advantage that he can enlarge and consolidate the skill and knowledge acquired in the operating theatre, deepen his understanding of pathophysiological conditions and gain experience and assurance in evaluation of a variety of clinical situations. By becoming competent in diverse fields (at a time when the general trend is for ever more specialization) he will contribute towards raising the status of the anaesthetist who is still apt to be regarded as merely a technician.

Anesthesia↗
PubMed1979

The effect of focal twitching on the intracranial pressure during paralysis and mechanical ventilation.

Three patients with head injuries developed minor facial twitching while their intracranial, intrathoracic and systemic arterial pressures were being monitored and they were on mechanical ventilation. These twitches were disclosed by the coincided great and damaging increases in the intracranial pressure, while the intrathoracic and arterial pressures were virtually unchanged. The intracranial hypertension was attributed to cerebral vasodilatation which was presumed to be due to the accumulation of cerebral metabolites since other causative factors such as systemic hypertension and hypoxia were under control. Cerebral elastance modulated the rise in intracranial pressure.

Acid-Base Equilibrium↗
PubMedDate not supplied

[Value of ventilatory assistance through the mouth in readaptation of patients with chronic respiratory insufficiency. Report of 20 cases (author's transl)].

Twenty patients with severe and chronic respiratory insufficiency (SaO2 less than or equal to 80% - PaCO2 greater than or equal to 50 mmHg) were treated with intermittent ventilatory assistance. They used volumetric apparatus 2 to 8 hours a day, during at least 6 months (22 months +/- 13). Respiratory status never improved strikingly, on the contrary most of the time it worsened and patients needed other ventilatory technics and/or died (11 of 20). This technic of ventilatory assistance does not seem to really change the prognosis of these patients in a severe and chronic state.

Carbon Dioxide↗
PubMedDate not supplied

[Immediate effects and conditions of effectiveness of a session of mechanical assisted ventilation (M.A.V.) in severe respiratory insufficiency (PaCO2 greater than 50 mmHg) out of intensive care conditions (author's transl)].

Effectiveness and haemodynamic tolerance of M.A.V. in conscious patients with a severe respiratory insufficiency is mainly due to the proper adaptation to ventilator with low frequency and adequate V.T. Thus M.A.V. is an eventual complement to directed ventilation exercises which in addition reduce the "rebound" of hypoxia and hypercapnia after a M.A.V. session. A proper adaptation ensures haemodynamic tolerance. Expiratory time should be sufficient in such obstructive patients. A post inspiratory pause can improve V.C.O2. Nevertheless, it should not shorten inspiratory time to less than one second and for each patient the best ventilatory profile should be properly established taking into account blood gases, circulatory, expired CO2 and clinical monitoring.

Carbon Dioxide↗
PubMedDate not supplied

[A control trial of home I.P.P.B. therapy in patients with chronic obstructive respiratory insufficiency. Protocol and state of the study (author's transl)].

Because a previous retrospective study did not allow any conclusion as to the efficacy of home IPPB therapy in patients with chronic airflow obstruction, a control trial has been started. The protocol includes definition of patients, modalities of treatment, criteria for evaluation. Among criteria for a patient to enter the trial is a chronic hypercapnia (with PaCO2 greater than or equal to 48 mmHg) observed over a preliminary period of 4 months. At the end of this period patients are allocated at random into two groups with and without IPPB at home (at least 1 to 2 hours daily through a mouthpiece); medical prescriptions are same in the 2 groups so as surveillance which is planned for 2 years. Evaluation should be based upon 5 predetermined criteria. This trial is in progress.

Activities of Daily Living↗
PubMed1976

[General anesthesia and bronchoscopy].

High frequency, positive pressure ventilation during anesthesia for bronchoscopy, uses the intermittent delivery of oxygen and an anesthetic gas mixture thus avoiding the risks of hypoxia, retention of carbon dioxide and concomitant acidosis. This technique may be used with low pressures in the airways (8 to 10 cm of water during insufflation).

Anesthesia, Inhalation↗
PubMedDate not supplied

The effect of different endotracheal suction procedures on arterial blood gases in a controlled experimental model.

In an anesthetized hypoxemic animal model, 15 seconds of endotracheal suctioning, using a suction pressure of --170 mm. Hg and endotracheal tube to suction catheter ratio of 1.87 to 1, produced a 13 mm. Hg fall in arterial oxygen tension. Oxygen tension did not return to control level even at 5 minutes after suctioning. Giving 100 per cent oxygen before suctioning prevented suction-induced hypoxemia during and immediately after suctioning, but at 5 minutes after suctioning, oxygen tension fell below control levels. Mechanical lung hyperinflation with room air after suctioning quickly raised arterial oxygen tension above control levels. When mechanical ventilation using 100 per cent oxygen was maintained before, during, and after the suction procedure, arterial oxygen tension remained elevated at all times.

Animals↗