Swiss medical weekly
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Swiss medical weekly · May 1996
Review[Ventilation in the prone position in acute respiratory distress syndrome (ARDS)].
Prone position mechanical ventilation (PPV) secures an improvement in gas exchange in approximately two-thirds of ARDS patients. Recent experimental and clinical data suggest that PPV acts mainly by recruiting alveoli situated in the dorsal dependent regions which are collapsed under the superimposed weight of the overlying edema-laden lungs. The purpose of this article is to provide an overview of the basic pathophysiological mechanisms underlying PPV as well as to underscore the promising clinical results so far obtained with this technique. In spite of these results the place of PPV among the other ventilatory and pharmacological approaches in the supportive treatment of ARDS, and the possible beneficial or deleterious consequences of associating PPV with one or more of these therapeutic modalities, remains to be determined.
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Zolpidem (Stilnox), an imidazopyridine derivative, is a strong sedative with minor myorelaxant and anticonvulsant properties which exhibits high-affinity binding at a benzodiazepine-receptor subtype. Although the structure of zolpidem differs from the benzodiazepines, the acute toxicity of zolpidem has generally been compared to triazolam (Halcion) and midazolam (Dormicum). 5 years after introduction of zolpidem to the Swiss market we have therefore retrospectively analyzed 91 well documented cases of acute zolpidem intoxication reported to the Swiss Toxicological Information Center. Furthermore, 54 single-drug poisonings with zolpidem were compared with 53 triazolam and 55 midazolam intoxications observed over the same time period. 0.01-0.02 g of zolpidem is the recommended therapeutic dose. ⋯ In conclusion, our results indicate that zolpidem single-drug poisonings are generally benign and require no specific therapeutic measures. In combined intoxications, however, patients may develop coma at relatively low zolpidem doses and should therefore be monitored for approximately 24 hours. If necessary, disturbances of consciousness can be successfully treated with flumazenil.