Intensive care medicine
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The development of the flexible, fiberoptic bronchoscope has made bronchoscopic examinations possible in ICU patients undergoing mechanical ventilation. Over the years, the number of such procedures has greatly increased, with both diagnostic and therapeutic objectives, such as performing difficult intubation, management of atelectasis and hemoptysis, diagnosis of nosocomial pneumonia in ventilated patients, and early detection of airway lesions in selected situations, such as high-frequency ventilation. The complication rate can be kept low if the endoscopist has a precise knowledge of the many pathophysiological and technical facets particular to bronchoscopy under these difficult conditions. This article reviews some of these aspects, in the light of our personal experience.
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Intensive care medicine · Jan 1992
Comparative StudyContinuous positive airway pressure by face mask or mechanical ventilation in patients with human immunodeficiency virus infection and severe Pneumocystis carinii pneumonia.
We reviewed the records of 44 patients with AIDS who had 45 episodes of severe Pneumocystis carinii pneumonia (PCP). While 9 patients required intubation and mechanical ventilation (MV) on admission, continuous positive airway pressure (CPAP) by face mask was the initial measure in 36 episodes. There were 25 patients managed with CPAP alone, 23 of whom survived. ⋯ The in-hospital mortality for severe PCP in this study was 33% overall, and reached 65% for mechanically ventilated patients. The 1-year survival was 43% (95% confidence interval, 28%-58%). These data confirm the improved prognosis for patients with AIDS and severe PCP, and suggest that mask CPAP may be an adequate mean of ventilatory support in this setting.
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Intensive care medicine · Jan 1992
Comparative StudyA comparison of continuous positive pressure ventilation, combined high frequency ventilation and airway pressure release ventilation on experimental lung injury.
In pigs with oleic induced lung injury, the effectiveness of combined high frequency ventilation (CHFV, with VDR-Phasitron) and airway pressure release ventilation (APRV) were compared to continuous positive pressure ventilation (CPPV) in a randomized study. The respiratory rate was 15/min, CPAP 8 mmHg and FiO2 0.25. PaCO2 was maintained at 5 kPa. ⋯ There was no difference in the pericardiac pressure between the 3 ventilation modes. The pressure related depressive effects on the cardiovascular function during CHFV and APRV were similar to those during CPPV. Adequate oxygenation and ventilation could be achieved with both CHFV and APRV, but these methods were not superior to CPPV.
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Intensive care medicine · Jan 1992
Increase in lung volume originated by extrinsic PEEP in patients with auto-PEEP. The role of static lung compliance.
The use of extrinsic positive end expiratory pressure (PEEPe) in patients with auto-PEEP (AP) can reduce the respiratory work during weaning from mechanical ventilation. However, the application of PEEPe can produce a certain level of hyperinflation, an undesirable effect which can limit the efficacy of the reduction of respiratory work. The objective of the present study has been to determine if the increase in end expiratory lung volume (EELV) originated by the PEEPe is related to static lung compliance (SLC). ⋯ When PEEPe equal to the AP was applied, the EELV increased by 178 +/- 110 ml (range 45-375 ml, p less than 0.05), and there was a significant correlation with SLC (r = 0.659, p less than 0.05). In conclusion, the application of PEEPe equal to the AP causes a moderate increase in EELV. However, in patients with high pulmonary compliance this increase can be more important and must be taken into account when considering the use of PEEPe during weaning.