Anästhesie, Intensivtherapie, Notfallmedizin
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Anasth Intensivther Notfallmed · Aug 1983
Review[Effect of high-frequency ventilation on the pulmonary clearance system].
Four types of ventilation with high frequencies offer new therapeutical possibilities of treating severe pulmonary diseases. The first aim in using these techniques is to normalize or to maintain a stable gas exchange. Secondly, the improvement of mucociliary transport function and the counterpulsation effect on the capillaries and lymph vessels may have an interesting influence on pulmonary secretion clearance. These methods will represent essential progress in mechanical ventilation and respiratory physiotherapy, if they gain clinical perfection.
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This investigation is based on 140 autopsy protocols of unsuccessful resuscitation procedures (Resuscitation Center of the Army Hospital, Hamburg); injections and closed-chest cardiac massage had been performed in every case. - Most of the patients had collapsed because of cardiac shock; patients with thoracic or abdominal injury were excluded from this study. In individual cases only, the following severe complications originated from the resuscitation procedures: fracture of a chest vertebra, serial fractures of ribs resulting in an unstable thorax, bilateral haemothorax, tension pneumothorax, rupture of kidney and of spleen (but not of liver). In one case the lesions caused by the resuscitation measures must be considered as responsible for the lethal outcome. ⋯ The number of fractured ribs ranged up to 16, mainly 3-8 ribs were fractured. Fractures of rib No. 1 and 8-12 were very rare. The fractures were located between the parasternal and axillary lines.--In a comparative study the site of rib fractures after heavy blunt thoracic injuries was preferably found in the dorsal region.