Crit Care Resusc
-
We describe two patients with tracheostomies who showed difficulty in weaning from mechanical ventilation, but were eventually weaned after use of a fenestrated tracheostomy tube with a speaking valve. The first patient underwent mechanical ventilation after pulmonary bleeding, while the second needed ventilator support because of tracheomalacia. Both patients needed only slight ventilator support but developed respiratory distress when it was discontinued. ⋯ The valved tube allowed the first patient to control breath-holding, and the second to avoid tracheal collapse. Regaining vocal cord function improved their pulmonary mechanics, which was demonstrated by dramatic improvement of findings on chest x-ray and computed tomography. A fenestrated tracheostomy tube is usually used to improve daily activities of patients with tracheostomies, but might be worth trying for difficult ventilator weaning.
-
Clinical Trial
Rethinking glycaemic control in critical illness--from concept to clinical practice change.
To examine the practical difficulties in managing hyperglycaemia in critical illness and to present recently developed model-based glycaemic management protocols to provide tight control. ⋯ The overall approach of modulating nutrition as well as insulin challenges the current practice of relying on insulin alone to reduce glycaemic levels, which often results in large variability and poor control. The protocol was developed from model-based analysis and proof-of-concept clinical trials, and then generalised to a simple, clinical practice improvement. The results show extremely tight control within safe glycaemic bands.
-
Historical Article
History of mouth-to-mouth rescue breathing. Part 2: the 18th century.
In Britain, the great boost to performing mouth-to-mouth resuscitation for the "suddenly apparently dead" came from William Tossach's 1744 documentation of his own successful case, and then from promotion by John Fothergill and other enthusiasts. Some civic authorities on the Continent were exhorting citizens to employ it from as early as the mid-18th century. The first humane society was founded in Amsterdam in 1767 and initially promoted expired air ventilation (EAV) by the mouth-to-mouth method. ⋯ The need to apply artificial ventilation immediately was not really recognised before John Hunter's recommendation to London's Humane Society in 1776. Charles Kite spelt out clearly the principles of resuscitation in 1787-8, though he gave some priority to warming. It seems that only in the latter part of the 18th century was the importance of airway obstruction recognised, largely due to Edmund Goodwyn.
-
Case Reports
Pulmonary haemorrhage associated with negative-pressure pulmonary oedema: a case report.
Negative-pressure pulmonary oedema caused by upper airway obstruction after tracheal extubation is well recognised, but extensive pulmonary haemorrhage is rare. We report a case of post-extubation, laryngospasm-induced pulmonary oedema with associated pulmonary haemorrhage. The patient required mechanical ventilation with high positive end-expiratory pressure.