Intensive care medicine
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Intensive care medicine · Jan 1984
Variations of regional lung function in acute respiratory failure and during anaesthesia.
Acute respiratory failure and anaesthesia impede ventilation of dependent lung units and perfusion of non-dependent ones, creating considerable ventilation-perfusion (V/Q) mismatch. General PEEP can improve V/Q but it cannot restore it to normal. To improve matching, ventilation must be distributed in proportion to regional blood flow. ⋯ Using this ventilator setting as a rule of thumb in patients with acute, severe, bilateral lung disease, arterial oxygen tension was improved by an average of 45% compared with that during general PEEP, with no reduction in cardiac output. It is concluded that differential ventilation with selective PEEP can offer considerable improvement in gas exchange in acute, bilateral lung disease. However, long-term studies are required before a final evaluation can be made.
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Intensive care medicine · Jan 1984
Case ReportsUpper airway obstruction caused by massive subcutaneous emphysema.
Acute upper airway obstruction is a potentially life-threatening event. The most common causes include foreign body inhalation, thermal injury, inflammation, angioedema and trauma. Airway obstruction caused by submucosal extension of subcutaneous emphysema has only been previously reported once. We report the case of a patient who suffered a respiratory arrest as a result of hypopharyngeal and laryngeal swelling associated with massive subcutaneous emphysema.
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Intensive care medicine · Jan 1984
Case ReportsRecurrent torsade de pointes type ventricular tachycardia in intracranial hemorrhage.
Two out of 72 cases of intracranial hemorrhage-induced polymorphous ventricular tachycardia with typical Torsade de Pointes morphology are presented. Both patients had marked QTc prolongation more than 550 ms. ⋯ Even though polymorphous Torsade de Pointes type ventricular tachycardia is rare during the clinical course of intracranial hemorrhage, attention should be given to the QT interval. QTc prolongation more than 550 ms may carry a high risk of Torsade de Pointes type ventricular tachycardia and ventricular fibrillation.
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Intensive care medicine · Jan 1984
Case ReportsSevere pulmonary interstitial emphysema of the right lung treated by selective intubation of the left main bronchus.
As an alternative to surgical treatment, we have selectively intubated the left main bronchus in children with severe pulmonary interstitial emphysema (PIE) of the right lung. Within 12-24 h the unilateral hyperinflation disappeared. We propose that when conservative treatment of unilateral PIE fails, contralateral SBI should be tried before surgical intervention, leading to loss of functioning tissue, is undertaken.
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Intensive care medicine · Jan 1984
The role of total static lung compliance in the management of severe ARDS unresponsive to conventional treatment.
A group of 36 patients with severe adult respiratory distress syndrome (ARDS) meeting previously established blood gas criteria (mortality rate 90%) became candidates for possible extracorporeal respiratory support [low frequency positive pressure ventilation with extracorporeal CO2 removal (LFPPV-ECCO2R)]. Before connecting the patients to bypass we first switched the patients from conventional mechanical ventilation with positive end expiratory pressure (PEEP) to pressure controlled inverted ratio ventilation (PC-IRV), and then when feasible, to spontaneous breathing with continuous positive airways pressure (CPAP). Forty eight hours after the patients had entered the treatment protocol, only 19 out of the 36 patients in fact required LFPPV-ECCO2R, while 5 were still on PC-IRV, and 12 were on CPAP. ⋯ No patients with a TSLC lower than 25 ml (cm H2O)-1 tolerated either PC-IRV or CPAP, while all patients with a TSLC higher than 30 ml (cm H2O)-1 were successfully treated with CPAP. Borderline patients (TSLC between 25 and 30 ml (cm H2O)-1) had to be treated with PC-IRV for more than 48 h, or were then placed on LFPPV-ECCO2R if Paco2 rose prohibitively. We conclude that TSLC is a most useful measurement in deciding on the best management of patients with severe ARDS, unresponsive to conventional treatment.