Pneumologie
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Mechanical ventilation is indicated in acute respiratory failure, especially in so-called pump failure as occurs in status asthmaticus, pneumonia and ARDS due to respiratory muscle fatigue. Using clinical parameters (inspiratory paradox, respiratory alternans), together with blood gas analysis and chest X-ray morphology, the indication can be established on a rational basis. ⋯ Respiratory muscle rest can be assessed by monitoring tracheal pressure time curves. Unconventional methods using very small t idal volumes and very high frequency so far have no clearcut indications, as they are still investigational.
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In three patients with respiratory insufficiency where conventional respiratory methods failed, PEEP, rate of breathing, and total volume were adjusted independently for each lung up to a period of 13 days, using two respirators and a double-lumen tube. In all patients a marked increase in PaO2 was achieved without any noticeable detrimental haemodynamic effects. We conclude that asynchronous independent lung ventilators can be a safe and useful respiratory method in carefully selected patients suffering from predominantly unilateral pulmonary disease in whom conventional respiration methods have failed; that synchronisation of the respiratory circuits is not necessary; and that AILV compared to SILV offers the advantage of greater flexibility and reduced complexity.
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This paper reports on a 45-year-old male patient with tracheobronchomegaly, a very rare pathological picture, which is thought to be associated with autosomal, recessive genetic transmission. Radiological, nuclear-medical and pulmonary function-analytical findings, together with treatment, are presented.
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Comparative Study
[Pulmonary gas exchange in conventional ventilation and high frequency ventilation in severe respiratory insufficiency].
During high frequency jet ventilation (HFJV) adequate alveolar ventilation may be achieved with lower (-35%, p less than 0.0005) central airway pressures than during conventional mechanical ventilation (CMV). Due to increasing ventilation-perfusion inequalities, however, intrapulmonary shunt is then considerably increased (+52%, p less than 0.0005). In disease states with extensive shunting (e.g. ARDS) both ventilation modes can provide sufficient oxygenation only if high PEEP is applied.