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  • 1
    Electronic Resource
    Electronic Resource
    Pressure control ventilation and minitracheotomy in treating severe flail chest trauma (1995)
    Springer
    Intensive care medicine 21 (1995), S. 1054-1056 
    Details
    ISSN: 1432-1238
    Keywords: Flail chest trauma ; Minitracheotomy ; Acute respiratory failure ; Pressure control ventilation ; Carinal pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate pressure control ventilation (PCV) delivered through a minit-racheotomy in treating severe flail chest trauma. Design Case report. Setting Intensive care unit of a trauma center. Patient A 34-year-old woman affected by flail chest trauma and acute respiratory failure, who was initially treated with tracheal intubation to obtain internal pneumatic stabilization. The patient failed extubation and noninvasive mask treatment (pressure support ventilation plus PEEP) due to poor chestwall mechanics. Interventions Minitracheotomy was performed and ventilation was achieved with high levels of inspiratory pressure (PCV or assisted PCV) to overcome the resistance of the cannula (Mini-Trach II, Portex, ID 4 mm). Esophageal and carinal pressures were monitored. Ventilatory treatment was always performed with the full cooperation of the patient; the patient's glottic function was always intact. Measurements and results The patient was successfully treated with pressure control ventilation delivered through the Mini-Trach. After 7 days of PCV, the patient was switched to assisted PCV. On the 20th day after admission, she was weaned from mechanical ventilation. Conclusions We conclude that a suitable gas exchange and pneumatic stabilization in a flail chest condition can be achieved using minitracheostomic ventilation. At the same time, this treatment could reduce some side effects of traditional tracheal intubation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01700674
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Effects of periodic lung recruitment maneuvers on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome (ARDS) patients (2000)
    Springer
    Intensive care medicine 26 (2000), S. 501-507 
    Details
    ISSN: 1432-1238
    Keywords: Key words Positive end-expiratory pressure ; Mechanical ventilation ; Barotrauma prevention ; Alveolar recruitment ; Acute respiratory distress syndrome (ARDS)
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: We wished to investigate whether volume recruitment maneuvers (VRMs) could improve alveolar recruitment and oxygenation in acute respiratory distress syndrome (ARDS) patients, ventilated at relatively low positive end-expiratory pressure (PEEP). Setting: General intensive care unit (ICU) located in a teaching hospital. Patients: 15 PEEP responder ARDS patients undergoing continuous positive pressure ventilation (CPPV) with sedation and muscle paralysis. Interventions: We identified a low (9.4 ± 3 cmH2O) and a high (16.0 ± 2 cmH2O) level of PEEP associated with target oxygenation values. Using a custom modified mechanical ventilator, we applied in random order three steps lasting 30 min: (1) CPPV at the low PEEP level (CPPV lo); (2) CPPV at the high PEEP level (CPPV hi); (3) CPPV at low PEEP with the superimposition of periodic VRMs (CPPV vrm). VRMs were performed twice a minute by increasing PEEP to the high level for two breaths. Each brace of two breaths was spaced 30 seconds from the preceding one. Measurements and results: We measured gas exchange, hemodynamics, respiratory mechanics, and the end expiratory lung volume (EELV). Compared to CPPVlo, CPPVvrm resulted in higher PaO2 (117.9 ± 40.6 vs 79.4 ± 13.6 mmHg, P 〈 0.01) and EELV (1.50 ± 0.62 vs 1.26 ± 0.50 l, P 〈 0.05), and in lower venous admixture (Qva/Qt) (0.42 ± 0.07 vs 0.48 ± 0.07, P 〈 0.01). During CPPVhi, we observed significantly higher PaO2 (139.3 ± 32.5 mmHg) and lower Qva/Qt (0.37 ± 0.08) compared to CPPVlo (P 〈 0.01) and to CPPVvrm (P 〈 0.05). Conclusions: VRMs can improve oxygenation and alveolar recruitment during CPPV at relatively low PEEP, but are relatively less effective than a continuous high PEEP level.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051196
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
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