Intensive care medicine
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Intensive care medicine · Jan 1986
Clinical applications of independent lung ventilation with unilateral high-frequency jet ventilation (ILV-UHFJV).
Six patients with unilateral acute lung injury (ALI) were treated with a new form of ventilatory support: independent lung ventilation with unilateral high-frequency jet ventilation (ILV-UHFJV). The first three patients suffered from unilateral ALI complicated by a bronchopleural fistula (BPF); they were at first ventilated with HFJV, but remained unresponsive to treatment, showing a progressive impairment of the ventilation/perfusion ratio with a deterioration in clinical condition. ⋯ Subsequently, three more patients were treated; their respiratory failure was due to a unilateral ALI without BPF, unresponsive to either HFJV or CPPV. Once again, ILV-UHFJV was followed by a dramatic improvement in respiratory function; the haemodynamics remained unchanged and it was also possible to demonstrate a rapid improvement in individual and overall lung function.
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Intensive care medicine · Jan 1986
Case ReportsProlonged high-frequency jet ventilation in a patient with bronchopleural fistula. An alternative mode of ventilation.
We report a case of bronchopleural fistula (BPF) in a patient submitted to conventional mechanical ventilation in which high frequency jet ventilation (HFJV) was applied during five consecutive days. Gas exchange was adequate, the bronchial secretions could easily be cleared and the patient adapted comfortably to HFJV. In spite of PEEP levels between 4 and 8 mm Hg, the leak through the BPF ceased completely.
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Analgesia and sedation for patients in intensive care units (ICU) who require mechanical ventilation are most commonly provided by intermittent i.v. injections of opiates and benzodiazepines. However, the technique has a number of disadvantages. Also, in many cases these drugs are inadequate, even in large doses, and muscle relaxants may be necessary for patient respirator coordination. ⋯ In patients with multiple trauma and in patients where frequent assessment of the level of consciousness is important this technique is superior to parenteral analgesic sedative combinations. Intrathecal morphine may be indicated in patients in a compromised position. The daily analgesic requirement can be reduced by about 10-100 times by the use of epidural and intrathecal morphine respectively.
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Intensive care medicine · Jan 1985
Case ReportsPulmonary complications following endotracheal intubation for anesthesia in breech extraction.
A 28-year-old, healthy pregnant patient developed bilateral pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumoretroperitoneum and pneumoperitoneum following endotracheal intubation and manual ventilation during general anesthesia for breech extraction. It is likely that positive-pressure ventilation was the cause for this very rare combination of complications. Early recognition and treatment may prevent such a catastrophe.