Pneumologie
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Mechanical ventilation is indicated in acute respiratory failure, especially in so-called pump failure as occurs in status asthmaticus, pneumonia and ARDS due to respiratory muscle fatigue. Using clinical parameters (inspiratory paradox, respiratory alternans), together with blood gas analysis and chest X-ray morphology, the indication can be established on a rational basis. ⋯ Respiratory muscle rest can be assessed by monitoring tracheal pressure time curves. Unconventional methods using very small t idal volumes and very high frequency so far have no clearcut indications, as they are still investigational.
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In three patients with respiratory insufficiency where conventional respiratory methods failed, PEEP, rate of breathing, and total volume were adjusted independently for each lung up to a period of 13 days, using two respirators and a double-lumen tube. In all patients a marked increase in PaO2 was achieved without any noticeable detrimental haemodynamic effects. We conclude that asynchronous independent lung ventilators can be a safe and useful respiratory method in carefully selected patients suffering from predominantly unilateral pulmonary disease in whom conventional respiration methods have failed; that synchronisation of the respiratory circuits is not necessary; and that AILV compared to SILV offers the advantage of greater flexibility and reduced complexity.
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Comparative Study
[Pulmonary gas exchange in conventional ventilation and high frequency ventilation in severe respiratory insufficiency].
During high frequency jet ventilation (HFJV) adequate alveolar ventilation may be achieved with lower (-35%, p less than 0.0005) central airway pressures than during conventional mechanical ventilation (CMV). Due to increasing ventilation-perfusion inequalities, however, intrapulmonary shunt is then considerably increased (+52%, p less than 0.0005). In disease states with extensive shunting (e.g. ARDS) both ventilation modes can provide sufficient oxygenation only if high PEEP is applied.
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This paper reports on a 45-year-old male patient with tracheobronchomegaly, a very rare pathological picture, which is thought to be associated with autosomal, recessive genetic transmission. Radiological, nuclear-medical and pulmonary function-analytical findings, together with treatment, are presented.
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Immediate postoperative extubation of patients submitted to chest surgery is possible in almost all cases. The intensive care unit responsible for these patients should have good facilities for bronchoscopy, and the indication for this procedure should be made, postoperatively, on a broad basis. The introduction of peri-operative antibiotic prophylaxis has led to a substantial decline in disturbances of wound healing. Due to the use of autologous blood transfusion, the need for homologous blood transfusions has been reduced significantly.