Archive for the ‘Pulmonary function’ Category - Part 4

Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (15)

In addition, the peak airway pressure recorded on the pressure monitor of the respirator was clearly higher in the “failure-obstructive” group than in the “success-restrictive” group (33 ±4 vs 22 ±6 cm H20, respectively) (p<0.05; unpaired f-test). In Table 4, it can be seen not only that the number of days during which NPPV could […]

Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (14)

Results Considered as a group, all six patients suffered from severe respiratory impairment (mean FEVX <1L) and acute-on-chronic respiratory acidosis (mean FaC02, 9.8 kPa [74 mm Hg]) with a marked gas exchange abnormality (mean P[A-a]02, 11 kPa [82 mm Hg]) (Table 2). In all patients, it was possible to lower the PaC02 to some extent […]

Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (13)

A classic monitoring ICU system was in use in all patients; an indwelling arterial catheter was inserted into the radial artery for continuous recording of arterial blood pressure and frequent blood gas analysis, the Sa02 was continuously monitored via pulse oximeter, and the ECG and respiratory rate were continuously recorded by classic means. A specialized […]

Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (12)

Techniques For NPPV, we used respirators specifically designed for chronic domiciliary nocturnal ventilation, a technique with which we are accustomed (ie, Bennett Companion 2000, Kontron ABT 4100, or Draeger EV 800). All of these ventilators were used in the same way: assist-control mode; without PEEP; and breathing frequency, tidal volume, inspiratory:expiratory time ratio, and “trigger” […]

Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (11)

Case 6 This 60-year-old man had been a heavy smoker for more than 40 years, with very severe chronic airflow obstruction with a “pink-puffer” clinical aspect. Two years previously, he had been intubated and mechanically ventilated for acute respiratory failure, probably due to bronchopulmonary superinfection. The course of mechanical ventilation had been difficult (air trapping) […]

Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (10)

We decided to teach her NPPV, because there was a possibility that delivery should be performed by a cesarean section. Despite 15 days of teaching of NPPV in this strongly motivated and cooperative patient, we were never successful in normalizing PaC02, which remained constantly greater than 6 kPa (45 mm Hg). The delivery’ was uneventful, […]

Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (9)

Fifteen days before admission, a bronchopulmonary infection occurred and, for the first time, ankle edema. The patient was hospitalized with fever, severe dyspnea, drowsiness, and acute-on-chronic severe respiratory acidosis (PaCOs, 10 kPa [75 mm Hg]) with hypoxemia despite controlled oxygenation. Intubation and mechanical ventilation were therefore recommended; however, for unclear reasons the patient and his […]

Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (8)

The impression was that some kind of ventilatory support was necessary, lest potentially lethal respiratory acidosis eventually develop, but that the degree of emergency allowed sufficient time for a trial of NPPV The latter was therefore initiated; initial PaC02 levels of 10.5 kPa (79 mm Hg) decreased rapidly, and 5 h later was at 6.3 […]

Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (7)

We then decided to initiate NPPV: the PaCO* decreased rapidly; and 11 days after the beginning of mechanical ventilation, this technique could be interrupted, with the patient remaining alert and normocapnic. During this period of time, an important diuresis supervened, and the patient lost 12 kg (26 lb) of body weight without any diuretics. Six […]

Nasal Positive Pressure Ventilation in Patients with Acute Respiratory Failure (6)

The patient was discharged from the ICU on the 45th day; without respiratory symptoms and with a VC of 2.8 L. He left the hospital on the 65th day, with mild neurologic symptoms (paresthesia in both arms and legs). One year later, the findings from neurologic examination are normal, and no cardiac or infectious problem […]

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