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pneumothorax peep

Patricio González-Pizarro, Javier García-Fernández, Susana Canfrán, Fernando Gilsanz
BACKGROUND: Causing pneumothorax is one of the main concerns of lung recruitment maneuvers in pediatric patients, especially newborns. Therefore, these maneuvers are not performed routinely during anesthesia. Our objective was to determine the pressures that cause pneumothorax in healthy newborns by a prospective experimental study of 10 newborn piglets (<48 h old) with healthy lungs under general anesthesia. METHODS: The primary outcome was peak inspiratory pressure (PIP) causing pneumothorax...
February 2016: Respiratory Care
Marco Giani, Vittorio Scaravilli, Sebastiano Maria Colombo, Andrea Confalonieri, Rosambra Leo, Elena Maggioni, Leonello Avalli, Alessia Vargiolu, Giuseppe Citerio
PURPOSE: To evaluate the feasibility and efficacy of an apnea test (AT) technique that combines the application of positive end expiratory pressure (PEEP) with subsequent pulmonary recruitment in a large cohort of brain-dead patients. METHODS: This study was a retrospective analysis of prospectively collected data on brain-dead patients admitted to our institution (Hospital San Gerardo, Monza, Italy) between January 2010 and December 2014. The rate of aborted apnea tests (ATs), occurrence of complications (i...
January 2016: Intensive Care Medicine
Sundeep R Bhat, David A Johnson, Jessica E Pierog, Brita E Zaia, Sarah R Williams, Laleh Gharahbaghian
INTRODUCTION: In the United States, there are limited studies regarding use of prehospital ultrasound (US) by emergency medical service (EMS) providers. Field diagnosis of life-threatening conditions using US could be of great utility. This study assesses the ability of EMS providers and students to accurately interpret heart and lung US images. METHODS: We tested certified emergency medical technicians (EMT-B) and paramedics (EMT-P) as well as EMT-B and EMT-P students enrolled in prehospital training programs within two California counties...
July 2015: Western Journal of Emergency Medicine
Nissar Shaikh, Abdel Salam Saif, Mohammed Nayeemuddin, Ousama Kokash
Patent foramen ovale (PFO) is defined as a valve-like opening at the level of foramen ovale or between septum primum and secundum without evidence of the anatomical defect. Paradoxical embolism (PDE) is an embolus passing through a defect PFO leading to end-organ dysfunction. PDE in septic shock is not yet reported in the literature. A 49-year male presented to the emergency department with shortness of breath since one day and pain in the left side of the chest. Chest x0 -ray revealed middle-left lobe pneumonia with pleural effusion; he was started on Co-amoxiclav, and admitted to the ward...
January 2012: Anesthesia, Essays and Researches
John T Denny, Andrew Burr, James Tse, Julia E Denny, Darrick Chyu, Shaul Cohen, Arpit N Patel
Prompted by our experience with complications occurring with apnea testing (AT), we discuss complications reported in the literature. AT is an integral part of brain death assessment. Many complications of AT have been described, including hypoxemia, arterial hypotension, tension pneumothorax and cardiac arrest. We conclude that a commonly used technique in conducting AT can create auto-positive end expiratory pressure (PEEP) and contributes to many complications. The mechanism of occult auto-PEEP in AT is discussed...
June 2015: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Linda E Sousse, David N Herndon, Clark R Andersen, Arham Ali, Nicole C Benjamin, Thomas Granchi, Oscar E Suman, Ronald P Mlcak
BACKGROUND: Inhalation injury, which is among the causes of acute lung injury and acute respiratory distress syndrome (ARDS), continues to represent a significant source of mortality in burned patients. Inhalation injury often requires mechanical ventilation, but the ideal tidal volume strategy is not clearly defined in burned pediatric patients. The aim of this study was to determine the effects of low and high tidal volume on the number of ventilator days, ventilation pressures, and incidence of atelectasis, pneumonia, and ARDS in pediatric burned patients with inhalation injury within 1 year post burn injury...
April 2015: Journal of the American College of Surgeons
Satoshi Ideno, Eiki Hatori, Junzo Takeda, Hiroshi Morisaki
The Hermansky-Pudlak syndrome (HPS) is a rare set of disorders characterized by oculocutaneous albinism, bleeding diathesis, and pulmonary fibrosis, with the latter 2 conditions presenting major challenges in anesthetic management. We report a 53-year-old woman with pulmonary fibrosis secondary to HPS who underwent video-assisted bullectomy to treat recurrent pneumothorax. Preoperative bleeding time and platelet count were within normal limits, but the surgeons had difficulty with continuous oozing from the incision site; the surgical blood loss was 270 mL, which was a relatively large amount for this surgery...
May 2015: Journal of Clinical Anesthesia
Pierpaolo Terragni, Vito Marco Ranieri, Luca Brazzi
PURPOSE OF REVIEW: To discuss the mechanisms of ventilator-induced lung injury and the pro and cons of the different approaches proposed by literature to minimize its impact in patients with acute respiratory distress syndrome. RECENT FINDINGS: Mechanical ventilation is indispensable to manage respiratory failure. The evolution of knowledge of the physiological principles and of the clinical implementation of mechanical ventilation is characterized by the shift of interest from its capability to restore 'normal gas exchange' to its capability of causing further lung damage and multisystem organ failure...
February 2015: Current Opinion in Critical Care
Walter James, Lisa Brath, Orlando Debesa
SESSION TITLE: Infectious Disease Cases IISESSION TYPE: Affiliate Case Report SlidePRESENTED ON: Wednesday, October 29, 2014 at 11:00 AM - 12:15 PMINTRODUCTION: Acute Respiratory Distress Syndrome (ARDS) is a disease with significant morbidity, mortality and cost. Pulmonary tuberculosis(TB) causing ARDS is rare. This case report describes a unique case of ARDS secondary to Pulmonary TB that was successfully managed with extracorporeal membrane oxygenation (ECMO). CASE PRESENTATION: A 31 year-old Liberian male was transferred with progressive respiratory failure requiring mechanical ventilation...
October 1, 2014: Chest
Canan Bor, Kubilay Demirağ, Mehmet Uyar, Ilkin Cankayalı, Ali Reşat Moral
The pregnant patients are prone to influenza A (H1N1) virus infection, which may rapidly progress to lower respiratory tract infection and subsequent respiratory failure and acute respiratory distress syndrome (ARDS). Pneumothorax might develop in ARDS under mechanical ventilation. But post-ARDS pneumothorax in spontaneously breathing patient has not been reported in the literature. We report a 31-year old pregnant woman infected with influenza A (H1N1) virus and progressed to ARDS. Mechanical ventilation with high PEEP improved patient's gas exchange parameters within 3 weeks...
March 2013: Balkan Medical Journal
Benjamin Kasenda, Willi Sauerbrei, Patrick Royston, Matthias Briel
BACKGROUND: Categorizing an inherently continuous predictor in prognostic analyses raises several critical methodological issues: dependence of the statistical significance on the number and position of the chosen cut-point(s), loss of statistical power, and faulty interpretation of the results if a non-linear association is incorrectly assumed to be linear. This also applies to a therapeutic context where investigators of randomized clinical trials (RCTs) are interested in interactions between treatment assignment and one or more continuous predictors...
May 20, 2014: Systematic Reviews
Pritish Bawa, Kultida Soontarapornchai, Agnes Perenyi, Rachelle Goldfisher, John Amodio
Pulmonary interstitial emphysema (PIE) is not an uncommon finding in premature infants with respiratory distress who need respiratory support by mechanical ventilation. PIE has been reported in a few cases of neonates in whom either no treatment other than room air was given or they were given continuous positive end-expiratory pressure (CPAP) support. We present a case of a premature neonate who presented with respiratory distress, in whom PIE and spontaneous pneumothorax (PTX) developed while on CPAP therapy only...
2014: Case Reports in Pediatrics
Cağlar Odek, Tanıl Kendirli, Ayhan Yaman, Bilge Aldemir-Kocabaş, Erdal Ince
Respiratory syncytial virus (RSV) is the leading cause of viral respiratory tract infections in infants and young children. Although the course of RSV infection is usually benign, a small proportion of infants require mechanical ventilation for respiratory failure. We describe an eight-month-old previously healthy female who developed bilateral pneumothorax and acute respiratory distress syndrome (ARDS) secondary to RSV infection. Because of the severe hypoxemia, three doses of surfactant were administered and prone positioning was implemented for nine days...
September 2013: Turkish Journal of Pediatrics
Nektaria Xirouchaki, Eumorfia Kondili, George Prinianakis, Polychronis Malliotakis, Dimitrios Georgopoulos
PURPOSE: To assess the impact of lung ultrasound (LU) on clinical decision making in mechanically ventilated critically ill patients. METHODS: One hundred and eighty-nine patients took part in this prospective study. The patients were enrolled in the study when LU was requested by the primary physician for (1) unexplained deterioration of arterial blood gases and (2) a suspected pathologic entity [pneumothorax, significant pleural effusion (including parapneumonic effusion, empyema, or hemothorax), unilateral atelectasis (lobar or total), pneumonia and diffuse interstitial syndrome (pulmonary edema)]...
January 2014: Intensive Care Medicine
Y-E Jang, J-H Lee, Y-H Park, H-J Byon, H-S Kim, C-S Kim, J-T Kim
We evaluated the effect of lung deflation on the relative position of the pleura compared with a reference line during supra- and infraclavicular approaches to the right subclavian vein. The reference line was drawn relative to the predicted pathway of the needle. The distances between the pleura and the reference line for supra- and infraclavicular approaches were measured during inspiration and expiration in 41 infants. Measurements were repeated with the application of 5 cmH2O positive end-expiratory pressure (PEEP) and in the Trendelenburg position...
October 2013: Anaesthesia
D Myšíková, J Simonek, A Stolz, R Lischke
Reexpansion pulmonary oedema is a rare but possibly lethal complication of thoracic drainage for pneumothorax. Morbidity and mortality of this complication remains high (up to 20% of lethal cases) and as such deserves our attention. We report a case of ipsilateral left-sided pulmonary oedema following chest tube insertion in a 42-year-old male patient with spontaneous pneumothorax. Pneumothorax can be expected to last for up to 3 weeks (from the first presentation of sudden dyspnoea and chest pain). The pathophysiology of this lung affection has not yet been completely elucidated; the crucial role is probably played by damage to the endothelium which is followed by increased endothelial permeability during ischemia-reperfusion injury in a rapidly reexpanding lung...
June 2013: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Yun-lin Song, Ying Li, Ye-wei Zhu, Qing-li Dou, Aierken Aierken, Rui-feng Chai, Xiang-you Yu
OBJECTIVE: To evaluate the efficacy and safety of automatic variable flow rate (AutoFlow) for volume control ventilation through monitoring the number of ventilator alarm. METHODS: Forty-eight adult patients receiving the Drager Evita 4 ventilator with an expectation of more than 2 days duration were divided into two groups by randomly digital methods, each n=24. The patients in control group were received routinely mode with synchronized intermittent mandatory ventilation (SIMV), and the others in observation group were given SIMV and assist with AutoFlow...
June 2013: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Mark Cipolle, Michael Rhodes, Glen Tinkoff
Although most thoracic trauma may be treated non-operatively, major thoracic trauma accounts for 25% of trauma deaths. Except for provision of a definitive airway and/or relief of a tension pneumothorax with a needle decompression, the vast majority of thoracic trauma is best served with "load and go," high-flow oxygen, placement of an IV line and administration of crystalloid solutions as the clinical scenario would indicate. Understanding the mechanism of injury is helpful in establishing both prehospital and in-hospital management priorities...
September 2012: JEMS: a Journal of Emergency Medical Services
Mei-Jy Jeng, Yu-Sheng Lee, Pei-Chen Tsao, Wen-Jue Soong
Air leak syndrome includes pulmonary interstitial emphysema, pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, subcutaneous emphysema, and systemic air embolism. The most common cause of air leak syndrome in neonates is inadequate mechanical ventilation of the fragile and immature lungs. The incidence of air leaks in newborns is inversely related to the birth weight of the infants, especially in very-low-birth-weight and meconium-aspirated infants. When the air leak is asymptomatic and the infant is not mechanically ventilated, there is usually no specific treatment...
November 2012: Journal of the Chinese Medical Association: JCMA
Peter Slinger, Bruce Kilpatrick
Patients are at risk for several types of lung injury in the perioperative period. These injuries include atelectasis, pneumonia, pneumothorax, bronchopleural fistula, acute lung injury, and acute respiratory distress syndrome. Anesthetic management can cause, exacerbate, or ameliorate most of these injuries. Lung-protective ventilation strategies using more physiologic tidal volumes and appropriate levels of positive end-expiratory pressure can decrease the extent of this injury. This review discusses the effects of mechanical ventilation and its role in ventilator-induced lung injury with specific reference to cardiothoracic anesthesia...
December 2012: Anesthesiology Clinics
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