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Incidencia, características y evolución del barotrauma durante la ventilación mecánica con apertura pulmonar Incidence, characteristics and outcome of barotrauma during open lung ventilation  [cached]
A. Gil Cano,M.I. Monge García,M. Gracia Romero,J.C. Díaz Monrové
Medicina Intensiva , 2012,
Abstract: Objetivo: Describir la incidencia y principales características clínicas del barotrauma durante la ventilación mecánica con apertura pulmonar. Dise o: Estudio retrospectivo, observacional, descriptivo, en 100 pacientes con insuficiencia respiratoria aguda e infiltrados pulmonares bilaterales. Intervenciones: 1) maniobra de reclutamiento pulmonar (MRP) con presión de ventilación fija e incrementos progresivos de presión positiva al final de la espiración (PEEP), seguida de decrementos escalonados hasta establecer la PEEP de apertura en el valor asociado a la máxima distensibilidad respiratoria; 2) ventilación asistida/controlada por presión ajustada para un volumen tidal de 6-8ml/kg; y 3) radiografía de tórax después de la MRP y diariamente mientras persistió la insuficiencia respiratoria. Resultados: Nueve pacientes, 7 con neumonía y 2 con trauma torácico, desarrollaron barotrauma (2 enfisema subcutáneo y 7 neumotórax), lo cual supuso una incidencia total del 9% y del 16% en aquellos pacientes con lesión pulmonar primaria. En 7 pacientes fue tan solo de un hallazgo radiológico; en los otros dos, se manifestó como un neumotórax bilateral y a tensión, cursando con hipoventilación pulmonar. únicamente en estos dos casos se modificó la estrategia ventilatoria. No hubo diferencias en las presiones ni en los volúmenes respiratorios entre pacientes con o sin barotrauma. La mortalidad fue similar en ambos grupos. Conclusiones: El barotrauma resultó una complicación exclusiva de pacientes con lesión pulmonar primaria, en los que tuvo una incidencia elevada. En la mayoría de las ocasiones fue un hallazgo radiológico sin manifestaciones clínicas, manteniéndose la ventilación con apertura pulmonar. Su aparición no se relacionó con presiones ni volúmenes respiratorios mayores, ni se asoció a mayor mortalidad. Objective: To describe the incidence and main clinical characteristics of barotrauma during open lung ventilation (OLV). Design: A retrospective, observational, descriptive study was made of 100 patients with acute respiratory failure and bilateral pulmonary infiltrates. Interventions: 1) A lung recruitment maneuver (LRM) with fixed ventilation pressure and progressive positive end-expiratory pressure (PEEP) elevations was carried out, followed by stepwise decreases until establishing open-lung PEEP at the value associated to maximum respiratory compliance; 2) assisted/controlled pressure ventilation to achieve a tidal volume of 6-8ml/kg; and 3) chest X-rays after LRM and daily for as long as respiratory failure persisted. Results: Nine patients, 7 with pneumoni
Ventilación de alta frecuencia oscilatoria en barotrauma resultante de un síndrome de dificultad respiratoria aguda Ventilation of oscillatory high frequency in barotrauma caused by acute respiratory distress syndrome
Pablo Cruces Romero,Alejandro Donoso Fuentes,Jorge Valenzuela Vásquez,Franco Díaz Rubio
Revista Cubana de Pediatr?-a , 2008,
Abstract: INTRODUCCIóN. El uso inapropiado de ventilación mecánica en el síndrome de dificultad respiratoria aguda puede amplificar la lesión primaria y complicarse con un escape aéreo persistente, capaz de opacar el pronóstico. La ventilación de alta frecuencia oscilatoria es una modalidad disponible para el rescate de un escape aéreo refractario a ventilación mecánica convencional. Este trabajo tiene como objetivo reportar el efecto de este soporte ventilatorio sobre el intercambio gaseoso y evolución del escape aéreo en pacientes con síndrome de dificultad respiratoria aguda MéTODOS. Se aplicó este soporte ventilatorio a todos los pacientes que ingresaron entre 1999 y 2006 a causa de síndrome de dificultad respiratoria aguda, con barotrauma persistente o recurrente, que alteró el intercambio gaseoso. Se describió el tiempo de persistencia del escape aéreo y la morbilidad y mortalidad para este grupo. RESULTADOS. Se ventilaron 19 pacientes, cuya mediana de edad fue de 17 meses. Antes de comenzar la ventilación, la PaO2/FiO2 fue de 66; el índice de oxigenación de 24 y la PaCO2, de 75 mm Hg. La duración de esta presentó una mediana de 111 h. Se abolió el escape aéreo en un 79 % de los casos y pudo mejorar significativamente el intercambio gaseoso. La sobrevida a los 30 días fue del 89 %. CONCLUSIONES. La ventilación de alta frecuencia es útil en la mayoría de los pacientes afectos de este síndrome complicado con barotrauma refractario y constituye una opción terapéutica indiscutible. INTRODUCTION: The inappropriate use of mechanical ventilation in acute respiratory distress syndrome may increase the primary lesion and complicate it with a persistent air leak capable of obscuring the diagnosis. The oscillatory high frequency ventilation is an available modality to rescue a refractory air leak at conventional mechanical ventilation. The aim of this paper is to report the effect of this ventilatory support on gas exchange. and on the evolution of the air leak in patients with acute respiratory distress syndrome. METHODS: The ventilatory support was applied to all the patients admitted between 1999 and 2006 due to acute respiratory distress syndrome, with persistent or recurrent barotrauma that altered the gas exchange. The time of persistence of the air leak, as well as the mortality and morbidity for this group, were described. RESULTS: 19 patients whose average age was 17 months were ventilated. Before starting ventilation, PaO2/FiO2 was 66; oxygenation rate was 24, and PaCO2 was 75 mm Hg. Its mean duration was 111 h. The air leak was eliminated in 79 % of the cas
High Frequency Jet Ventilation during Initial Management, Stabilization, and Transport of Newborn Infants with Congenital Diaphragmatic Hernia: A Case Series  [PDF]
Qianshen Zhang,Jason Macartney,Lita Sampaio,Karel O'Brien
Critical Care Research and Practice , 2013, DOI: 10.1155/2013/937871
Abstract: Objective. To review experience of the transport and stabilization of infants with CDH who were treated with high frequency jet ventilation (HFJV). Study Design. Retrospective chart review was performed of infants with antenatal diagnosis of CDH born between 2004 and 2009, at Mount Sinai Hospital Toronto, Ontario, Canada. Detailed information was abstracted from the charts of all infants who received HFJV. Results. Of the 55 infants, 25 were managed with HFJV at some point during resuscitation and stabilization prior to transport. HFJV was the initial ventilation mode in six cases and nineteen infants were placed on HFJV as rescue therapy. Blood gases procured from the umbilical artery before and/or after the initiation of HFJV. There was a significant difference detected for both PaCO2 ( ) and pH ( ). The pre- and posttransport vital signs remained stable and no transport related deaths or significant complications occurred. Conclusion. HFJV appears to be safe and effective providing high frequency rescue therapy for infants with CDH failing conventional mechanical ventilation. This paper supports the decision to utilize HFJV as it likely contributed to safe transport of many infants that would not otherwise have tolerated transport to a surgical centre. 1. Introduction Congenital diaphragmatic hernia (CDH) is one of the most challenging malformations that neonatologists and pediatric surgeons must manage [1, 2]. In patients with antenatally diagnosed CDH, the prognosis is dependent on both the degree of lung hypoplasia and persistent pulmonary hypertension (PPHN) after their birth [1, 3]. The care of these infants has seen significant evolution, from previous aggressive ventilation and emergent surgical repair to current physiologic stabilization, standardized management protocols, gentle ventilation strategies, and delayed surgical repair, all in less than two decades [2]. Survival of patients with CDH is dependent on early diagnosis and improved resuscitation and transportation of an optimally-supported baby to a major surgical center for repair [3–5]. Infants with CDH may be diagnosed antenatally and deliver at a high risk perinatal center. Most infants with CDH require respiratory support with set limits on ventilatory pressures to avoid lung overdistension and acceptance of adequate rather than optimal PaCO2 and PaO2 [1]. High-frequency ventilation (HFV) allows gas exchange at low volumes thereby decreasing iatrogenic pulmonary barotrauma [6]. To date two modes of HFV has been studied in the care of infants with CDH: high frequency oscillatory
Barotrauma ocular durante mergulho aut?nomo
, Maria Fernanda Abalem de;Rodrigues, Márcio Penha Morterá;Mendon?a, Rafael Cesário de;Sá, Jo?o Carlos Abalém de;
Revista Brasileira de Oftalmologia , 2011, DOI: 10.1590/S0034-72802011000600017
Abstract: report of a case of bilateral ocular barotrauma related to scuba diving, with conjunctival and periocular hemorrhage. some concepts about physics and caution are provided to better understanding the pathophysiology of the barotrauma, so proper orientation regarding prevention might be provided.
Incidencia, características y evolución del barotrauma durante la ventilación mecánica con apertura pulmonar
Gil Cano,A.; Monge García,M.I.; Gracia Romero,M.; Díaz Monrové,J.C.;
Medicina Intensiva , 2012,
Abstract: objective: to describe the incidence and main clinical characteristics of barotrauma during open lung ventilation (olv). design: a retrospective, observational, descriptive study was made of 100 patients with acute respiratory failure and bilateral pulmonary infiltrates. interventions: 1) a lung recruitment maneuver (lrm) with fixed ventilation pressure and progressive positive end-expiratory pressure (peep) elevations was carried out, followed by stepwise decreases until establishing open-lung peep at the value associated to maximum respiratory compliance; 2) assisted/controlled pressure ventilation to achieve a tidal volume of 6-8ml/kg; and 3) chest x-rays after lrm and daily for as long as respiratory failure persisted. results: nine patients, 7 with pneumonia and 2 with chest trauma, developed barotrauma (2 subcutaneous emphysemas and 7 cases of pneumothorax), representing an overall incidence of 9% and 16% in patients with primary lung injury. in 7 patients barotrauma was only a radiological finding; in the other 2 patients, it manifested as bilateral and tension pneumothorax, inducing pulmonary hypoventilation without hemodynamic impairment. only in these two cases was the ventilatory strategy modified. there were no differences in the airway pressures or volumes between patients with and without barotrauma. mortality was similar in both groups. conclusions: barotrauma was an exclusive complication of patients with primary lung injury, and the incidence in this group was high. in most cases, there were only radiological findings without clinical significance that did not require the suspension of olv. barotrauma was neither related to high pressures and volumes nor associated with increased mortality.
Rotura gástrica por barotrauma
Saad-Hossne, Rogerio;Prado, Renê Gaberini;Bakoniy Neto, Alexandre;Pereira, Rodrigo Severo de Camargo;Arashiro, Roberta Thiery Godoy;
Revista do Colégio Brasileiro de Cirurgi?es , 2007, DOI: 10.1590/S0100-69912007000200016
Abstract: barogenic rupture of the stomach is a rare complication following cardiopulmonary resuscitation, administration of nasal oxygen by catheter and diving accidents. we report a case of gastric barotrauma following oroesophageal intubation. in most cases, the tears occur along the lesser curvature, what have been already attributed to laplace's formula and, more recently, to morphological features of the stomach.
Ventilación de alta frecuencia oscilatoria en barotrauma resultante de un síndrome de dificultad respiratoria aguda
Cruces Romero,Pablo; Donoso Fuentes,Alejandro; Valenzuela Vásquez,Jorge; Díaz Rubio,Franco;
Revista Cubana de Pediatr?-a , 2008,
Abstract: introduction: the inappropriate use of mechanical ventilation in acute respiratory distress syndrome may increase the primary lesion and complicate it with a persistent air leak capable of obscuring the diagnosis. the oscillatory high frequency ventilation is an available modality to rescue a refractory air leak at conventional mechanical ventilation. the aim of this paper is to report the effect of this ventilatory support on gas exchange. and on the evolution of the air leak in patients with acute respiratory distress syndrome. methods: the ventilatory support was applied to all the patients admitted between 1999 and 2006 due to acute respiratory distress syndrome, with persistent or recurrent barotrauma that altered the gas exchange. the time of persistence of the air leak, as well as the mortality and morbidity for this group, were described. results: 19 patients whose average age was 17 months were ventilated. before starting ventilation, pao2/fio2 was 66; oxygenation rate was 24, and paco2 was 75 mm hg. its mean duration was 111 h. the air leak was eliminated in 79 % of the cases and it significantly improved the gas exchange. survival at 30 days was 89 %. conclusions: high frecuency ventilation is useful in most of the patients presenting this syndrome complicated with refractory barotrauma, and it is an unquestionable therapeutical option.
Core Topics in Mechanical Ventilation
Lluis Blanch
Critical Care , 2009, DOI: 10.1186/cc7951
Abstract: The contents of Core Topics in Mechanical Ventilation edited by Ian Mackenzie can be separated into two general parts. Several chapters cover general respiratory physiology, which is essential to understand how mechanical ventilation works and interacts with cardio-respiratory performance. It is worth mentioning the good contributions on the physiology of gas exchange, carbon dioxide balance and cardio-respiratory interactions. Some chapters are dedicated to adjuncts of mechanical ventilation, including both general and custom adjuncts used in mechanically ventilated patients. Of note are the chapters dedicated to the effects and administration of oxygen and heliox, and to sedation, analgesia, paralysis and nutrition.The second part is devoted to mechanical ventilation. The reader can find recommendations about how to set the ventilator in several clinical scenarios such as asthma, chronic obstructive pulmonary disease, and chest, burn and blast injuries. One specific chapter is devoted to adverse effects and complications of mechanical ventilation. This chapter deals in a very comprehensive manner with management of the difficult airway, unplanned extubation and how to minimize and manage ventilation-induced lung injury (barotrauma, volutrauma, and atelectrauma), among others. The management of acute lung injury and acute respiratory distress syndrome are not covered in dedicated chapters, but major principles are included as paragraphs in distinct parts of the book. The same is the case for non-invasive mechanical ventilation, which nowadays can be considered an independent discipline that extends beyond anesthesia and intensive care departments. Three chapters deserve mention for their particular relevance: Management of the artificial airway, Modes of mechanical ventilation, and Mechanical ventilation for transport. These chapters are extensive and comprehensive and include technical documentation as well as tables and figures that are self-explanatory. I am als
Ventilación de alta frecuencia en neonatología: a quiénes y cómo ventilar High frequency ventilation in neonatology: who should be ventilated and how
Fernando Domínguez Dieppa
Revista Cubana de Pediatr?-a , 2005,
Abstract: En Cuba, desde inicios del presente siglo, los recién nacidos comenzaron a ventilarse con un método de asistencia respiratoria aún relativamente novedoso, que se denomina ventilación de alta frecuencia. Es el objetivo fundamental de esta revisión precisar sus indicaciones, contraindicaciones, orientar como utilizarla y se alar algunas de sus complicaciones. La ventilación de alta frecuencia es ya una estrategia alternativa muy útil en la asistencia respiratoria neonatal In Cuba, since the beginning of the present century, the newborn infants started to be ventilated by a method of respiratory assistance called high frequency ventilation, which is still relatively new. The main objective of this review is to determine its indications and contraindications, to explain how to use it and to make reference to some of its complications. High frequency ventilation is a very useful alternative strategy in neonatal respiratory assistance.
Monitoreo de presión intracraneana: infección y otras complicaciones con el uso de K-30 subdural y fibra óptica intraparenquimatosa
Javier L. Gardella,Martín Guevara,Cynthia Purves,Carolina Moughty Cueto
Revista Argentina de Neurocirugía , 2006,
Abstract: Objetivo. Evaluar las complicaciones en la utilización de trasductores de presión intracraneana (PIC) K-30 subdurales (KS) y fibrasópticas intraparenquimatosas (FO). Método. En un estudio estadístico descriptivo y retrospectivo se revisaron las historias clínicas de los pacientes que ingresaron a Terapia Intensiva del Hospital "Juan A Fernández" (junio 1993 - febrero 2003) y requirieron monitoreo de PIC. Los datos fueron procesados con el programa STATA 6.0. Resultados. Se efectuaron 252 monitoreos en 191 pacientes; 71 monitores fueron FO y 181 fueron SK; 188 fueron catéteres únicos y 64 recambios. Los motivos de recambio fueron: arrancamiento, error de lectura, deterioro neurológico y colocación > 5 días. El arrancamiento ocurrió en 13 casos (12 KS y 1 FO); error de lectura o falla técnica en 33 casos (20 KS y 13 FO); fístula de LCR en 9 casos (7 KS y 2 FO). Sólo en un caso de los que presentaron fístula se constató cultivo de LCR positivo. (En 6 casos el recambio se debió a deterioro neurológico. Recambio por monitoreo > 5 días ocurrió en 12). Período de monitorización: 1-15 días. La permanencia del monitor en pacientes con catéteres sin infección fue de 3,62 días y en pacientes con infección: 4,67 días. En 29 casos se comprobó infección (10 FO y 19 KS). No fue significativa la diferencia entre edad, sexo, Glasgow al ingreso y cirugía a cielo abierto cuando se lo relacionó con infección y tipo de monitor. Fue significativa la incidencia de infección en los pacientes reoperados. Conclusión. Técnicamente el monitoreo PIC con KS subdural demostró ser un método confiable. La incidencia de complicaciones, en particular la infecciosa, con sistema KS fue similar a las observadas con FO. Objective: To evaluate the complications between to types of intracranial pressure monitoring devices: subdural K-30 (SK) and intraparenchymal fiber optic (FO). Method: In this descriptive retrospective study we reviewed the clinical records of those patients who were admitted to the Intensive Care Unit of the Hospital "Juan A. Fernández" (June 1993-February 2003) and required intracranial pressure monitoring. We processed the data with the STATA 6.0 programme. Results: We inserted 252 monitors in 191 patients: 71 FO and 181 SK; 188 were primary and 64 were secondary procedures. The causes of removal were: dislocation of the device, technical failure, neurological deterioration and permanence longer than 5 days. Dislocation occurred in 13 cases (12 SK, 1 FO), technical failure was observed in 33 cases (20 SK, 13 FO). We observed cerebrospinal fluid fistula (CSF) in 9 cases (
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