Chest surgery clinics of North America
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Chest Surg. Clin. N. Am. · May 2002
ReviewExtracorporeal membrane oxygenation for severe respiratory failure.
The use of extracorporeal technology to accomplish gas exchange with or without cardiac support is based on the premise that "lung rest" facilitates repair and avoids the baso- or volutrauma of mechanical ventilator management. Extracorporeal membrane oxygenation (ECMO), a modified form of cardiopulmonary bypass, has been shown to decrease mortality of neonatal, pediatric and adult respiratory failure and is capable of total gas exchange. In neonates, over 20,638 patients have been treated with an overall survival of 77% in a population thought to have 78% mortality.
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This chapter reviews the most updated knowledge regarding mechanical ventilation, its' indications and its' features both diagnostic and therapeutic. Further, the various modes of mechanical ventilation are described. The reader will also gain insight into the pathophysiology of various disease processes and the mode of ventilation that may be the most helpful in their treatment. Weaning is also discussed as well as a relatively new type of ventilation, non-invasive.
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Chest Surg. Clin. N. Am. · May 2002
ReviewAcute respiratory distress syndrome epidemiology and pathophysiology.
Acute respiratory distress syndrome is a devastating syndrome of lung injury following known risk factors, with a persistently high mortality. A consensus conference definition of ARDS has been adopted by clinical researchers, but potential problems remain. ARDS may represent more than one entity, and radiographic and mechanical differences between pulmonary versus extrapulmonary initiated ARDS have been described. ⋯ Surfactant abnormalities contribute to the associated lung dysfunction. A growing body of evidence supports the presence of VILI and a potential mechanism for developing MOSF, and has led to new management strategies. The importances of apoptosis to the repair process, and mechanisms that may lead to persistent fibrosis, such as the activation of the coagulant pathway with fibrin deposition, are increasingly recognized.
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Aspiration of tracheobronchial foreign bodies occurs more commonly in children, but under certain circumstances, it also can occur in adults. The most common symptoms are choking followed by a protracted cough. Physical examination findings include fever, stridor, retractions, and decreased breath sounds. ⋯ The procedure is generally safe and well tolerated. Many patients are managed under general anesthesia, but foreign bodies often can be removed with a flexible bronchoscope with the patient under local anesthesia. Surgery should be performed only as a last resort and rarely is necessary.
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Since the development of the flexible bronchoscope in late 1960s, its use in the management of various pulmonary disorders, especially lung Ca, has expanded tremendously. It is not only of great diagnostic value, with the recent development of various therapeutic modalities such as Nd:YAG laser, tracheobronchial stents, and cryotherapy, but also its value in management of terminal lung Ca has improved dramatically. ⋯ More importantly, because of lack of the training in RB and widespread usage of FB, it is more likely that its role in the various interventional procedures, such as Nd:YAG laser therapy, tracheobronchial stent deployment, brachytherapy, and cryotherapy, will grow exponentially. Because of availability of a variety of therapeutic modalities, such as APC, PDT, and balloons, interventional pulmonologists are well equipped to improve the quality of life of terminally ill patients with cancer and maybe to cure early stage lung Ca.