Chest
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Nineteen patients with ARDS or pneumonia who were ventilated with PcIRV on the Siemens-Elema Servo 900 C were retrospectively reviewed. The PcIRV reduced peak airway pressure, PEEP, increased Paw, and improved ventilation and oxygenation in these patients. When these patients were compared with themselves on prior conventional IPPV, all had a decrease in PIP, an increase in Paw and most had a decrease in VE, with no change in PaCO2 and an increase in PaO2. ⋯ High levels of PIP and PEEP during IPPV have been identified as risk factors in the development of barotrauma and residual parenchymal pulmonary damage. We propose that PcIRV allows for adequate ventilation and oxygenation with decreases in PIP, extrinsically added PEEP and inspired O2 concentration. This mode of ventilation may decrease the morbidity associated with IPPV utilizing high PIP and PEEP.
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Percutaneous cannulation of the internal jugular vein is commonly performed to obtain central venous access. We report the first case of massive hemoptysis occurring during cannulation of the internal jugular vein.
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Mediastinal hematoma resulting from blunt chest trauma can cause compression of the right ventricle and extrapericardial cardiac tamponade. The diagnosis in this instance was aided by conventional two-dimensional echocardiography in addition to hemodynamic measurements. The atypical aspects of this form of cardiac tamponade are discussed.
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Multiple benefits of oxygen therapy for hypoxemic patients with chronic lung disease are well established. Steady flow oxygen therapy is inefficient, wasteful and has a high cost. The Oxymizer pendant improves efficiency of oxygen delivery compared with SF. ⋯ We measured SaO2 while breathing oxygen via SF and the AP with nasal-only breathing and PLB. Results indicate that the AP maintains an increase in SaO2 over SF during nasal-only breathing and a further increase during PLB. We conclude that AP acts as an oxygen conserver during PLB; PLB with the AP achieves greater savings than with nasal-only breathing.
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Suctioning of secretions from the left endobronchial tree is frequently necessary but often difficult in intubated patients. We examined the effectiveness of a catheter designed expressly for this purpose. Special curved tip (Bronchitrac-L) suction catheters were fitted with thin, radiopaque tubing to facilitate x-ray visualization. ⋯ There were no catheter-induced complications in this study. The curved tip catheter is an effective means of suctioning the left bronchial tree in patients with tracheostomy tubes. Its reliability in patients with oral endotracheal tubes is reduced but more effective than current methods.