Crit Care Resusc
-
Respiratory complications following cervical spinal cord injury are common and are the leading cause of morbidity and mortality after this type of injury. Impaired mechanics of ventilation, poor cough, increased secretions and bronchospasm predispose to atelectasis, pneumonia and exacerbations of respiratory failure. Prolonged mechanical ventilation and tracheostomy are often required. This review discusses the relevant pathophysiology, various ventilatory strategies and timing of tracheostomy, and examines the evidence surrounding physiotherapeutic and pharmacological treatment options.
-
Randomized Controlled Trial
Increased brain tissue oxygen tension in children with traumatic brain injury using temperature-corrected guided ventilation during prophylactic hypothermia.
To investigate whether ventilatory management using a temperature-corrected (pH-stat) or uncorrected (alpha-stat) blood gas analysis strategy improves brain tissue oxygen tension (PbrO(2)) in children prophylactically treated with moderate hypothermia for traumatic brain injury. ⋯ PbrO(2) may be improved using a pH-stat blood gas management strategy in prophylactic hypothermia for paediatric patients with traumatic brain injury without any clinically relevant increase in ICP.
-
Case Reports
Two cases of toxic methanol ingestion, one leading to brain death: case reports and a brief review.
Two patients were admitted sequentially to a rural emergency department, then transferred to a tertiary intensive care unit, both with serious methanol poisoning from home-brewed alcohol. They were intubated, mechanically ventilated, and treated with intravenous and nasogastric ethanol and continuous venovenous haemodiafiltration. Although quite similar in presentation, metabolic complications and therapy, one patient became brain dead due to severe cerebral oedema, while the other was discharged without any significant complications. Their course highlights the importance of early treatment of non-ethanol alcohol poisoning.