Chest
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Letter Case Reports
Fistula from coronary artery to pulmonary artery after blunt trauma to chest.
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Positive end-expiratory pressure (PEEP) has been extensively utilized in the treatment of severe hypoxemia from noncardiogenic pulmonary edema. The usefulness of therapy with PEEP in the management of lobar atelectasis has not been previously stressed. Recently, we observed four patients with lobar atelectasis who failed to respond to the usual conservative measures of endotracheal suctioning and thoracic physiotherapy. ⋯ Endobronchial obstruction was not found, and despite extensive irrigation and suctioning, the atelectasis failed to resolve. Therapy with PEEP was then added, with pressures of 5 to 15 cm H2O. Serial chest x-ray films disclosed resolution of the atelectasis within 4 1/2 hours in two patients, within 14 hours in one patient, and within 24 hours in the remaining patient.
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Comparative Study
The esophageal obturator airway: a clinical comparison to ventilation with a mask and oropharyngeal airway.
We compared controlled ventilation with the esophageal obturator airway to ventilation with a conventional rubber mask and oropharyngeal airway in ten anesthetized patients. Measurements of exhaled tidal volume, mask-to-face fit (leakage of mask), supraglottic obstruction, and the operator's effort were all inferior using the esophageal obturator airway. ⋯ Placement of the device was difficult in three of ten patients, and two of ten had inadvertent tracheal intubations. Edentulous patients were difficult to impossible to ventilate using the esophageal obturator airway.