Lijec̆nic̆ki vjesnik
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Lijec̆nic̆ki vjesnik · Nov 1993
[Tracheotomy or intubation, alternatives in the treatment of respiratory insufficiency during infectious diseases in childhood].
Tracheostomy and endotracheal intubation are complementary methods in the management of acute respiratory failure (ARF). One hundred patients (n = 100) were treated at the Intensive Care Unit for Infants and Children, University Hospital of Infectious Diseases "Dr. Fran Mihaljević" Zagreb, from 1987 to 1991. ⋯ Most of our patients developed ARF as a result of inefficient gas transfer, particularly those suffering from central nervous system infection. Nasotracheal intubation appeared to be the method of choice in the treatment of ARF in infancy and childhood, while tracheostomy is only the supplement of substitute when particular indications are present. In most of our patients (83%) those methods contributed to the positive outcome of ARF treatment.
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In an attempt to determine whether the clinical data obtained by primary survey may be used as early outcome predictors in children who had sustained head trauma, children aged 0-14 with clinical diagnoses of coma, contusion, comotio, skull fracture or a combination of these diagnoses or who had been hospitalized for at least 3 days, between 1987 and 1990, were reviewed retrospectively. The outcome was defined by the clinical condition of children 6 months following head trauma using a Glasgow outcome scale (GOS), and was classified: good (good recovery and moderate disability) and poor (severe disability, persistent vegetative state, death). Of 70 children with trauma, 43 patients (61.4%) were separated by this method. ⋯ In this analysis, we have graded motor response according to the GCS criteria, thus it is not excluded that the use of different criteria could demonstrate the importance of motor response as an outcome predictor. In order to ascertain the significance of predictors in early outcome prognosis of head trauma, a relative risk for poor outcome was calculated. Our results showed that the significant predictors in descending order of preference are: pupillary reactivity, pupillary appearance and GCS.(ABSTRACT TRUNCATED AT 250 WORDS)
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The laryngeal mask airway (LMA) was first used at the Department of Orthopedics, School of Medicine, University of Zagreb on May 8, 1991. Two hundred and three patients were undergoing elective orthopedic surgery during the first year of the LMA use. A size-3 mask was used for women and children weighing over 25 kg (55 lbs) and a size-4 mask for men. ⋯ There were no serious complications in terms of laryngo- or bronchospasm, aspiration or insufflation of the stomach. The LMA has been found to be very helpful in solving problems of anesthesia in orthopedic patients. A set of laryngeal mask airways should be an integral part of every anesthetic equipment.
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The development of pulmonary edema after the relief of upper airway obstruction in two patients is described. Pulmonary edema in those patients was the result of increased negative intrapleural and intra-alveolar pressure during forceful inspiration and in the course of upper airway obstruction. ⋯ All patients developing pulmonary edema should be treated with positive pressure ventilation within 24-36 hours. The aim of this study was to alert physicians that besides know factors for the development of cardiogenic and noncardiogenic pulmonary edema there are also other significant mechanisms that cause the accumulation of fluid in pulmonary tissue.