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Signa Vitae

A Journal In Intensive Care And Emergency Medicine

Tag: ventilation

Emergency one-lung ventilation during oesophagus surgery. A clinical case

Background

One-Lung ventilation could be done in a programme or emerging way in situations that divert the intra-extrathoracic pressures.

 Key words: bronchial injury, ventilation

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Vibration Response Imaging in medical-surgical ICU

Abstract

The new method of monitoring lung function (“vibration response imaging”- VRI) converts vibration energy that appears in the bronchial tree during airflow into an image. The VRI does not use energy that could have a detrimental effect on the cells and organs. The goal of our research was to verify the VRI device in the diagnosis and the localization of various lung pathologies. In our medical-surgical ICU we did a retrospective analysis of the prospective database that included 61 patients. We compare VRI with chest X-ray and CT scan in patients with intrathoracic (the presence of air and fluid in the intrapleural space, pulmonary hypoventilation, atelectasis, contusion and inflammatory lung pathology) or extrathoracic pathology that affect respiratory function.

Intrathoracic pathology was observed in 32 patients and extrathoracic pathology in 29 patients. The use of the VRI device showed earlier disorder of hypoventilation compared to chest X-ray, especially after abdominal surgical procedures, intraabdominal hypertension and various lung pathology as it detected laterobasal pneumothorax earlier.

In our patients VRI has been proven to be a reliable method for detecting regional distribution of ventilation and atelectasis of the lungs of individual parts regardless of pulmonary pathology. VRI is shown as a reliable method for detecting air and fluid in the intrapleural space.

Key words: Vibration response imaging, lung, ventilation

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Dose pre-hospital laryngeal mask airway use has a survival benefit in non-shockable cardiac arrest?

Abstract

Background. Whether pre-hospital laryngeal mask airway (LMA) use poses a survival benefit and should be approved as routine airway management in non-shockable cardiac arrest is of major concern. The present study examined the effectiveness of LMA, in comparison to other pre-hospital airway management on individuals who have experienced non-shockable cardiac arrest.

Methods. Adult patients who experienced non-shockable cardiac arrest with activation of the emergency medical service (EMS) made up our study cohort in Taoyuan, Taiwan. The data were abstracted from EMS records and cardiac arrest registration protocols.

Results. Among the 1912 enrolled patients, most received LMA insertion (72.4%), 108 (5.6%) bag-valve-mask (BVM) ventilation, 376 (19.7%) high-flow oxygen non-rebreather facemask, and only 44 (2.3%) received endotracheal tube intubation (ETI). With regard to survival to discharge, no significant differences in prevalence were evident among the groups: 2.8% of oxygen facial mask, 1.1% of BVM, 2.1% of LMA, and 4.5% of the ETI group survived to discharge (p = 0.314). In comparison to oxygen facial mask use, different types of airway management remained unassociated with survival to discharge after adjusting for variables by logistic regression analysis (BVM: 95% confidence interval [CI], 0.079 – 1.639 [p = 0.186]; LMA: 95% CI, 0.220–2.487 [p = 0.627]; ETI: 95% CI, 0.325–17.820 [p = 0.390]). The results of Hosmer-Lemeshow goodness-of-fit test of logistic regression model revealed good calibration.

Conclusions. Pre-hospital LMA use was not associated with additional survival to discharge compared with facial oxygen mask, BVM, or ETI following non-shockable cardiac arrest.

Key words: emergency medical service, out-of-hospital cardiac arrest, laryngeal mask airway, ventilation, cardiopulmonary resuscitation

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Clinical Applications of Capnography

Abstract

This article gives a short review of the basic definitions of capnography and its use. The introduction gives an overview of the historical development of this procedure. Technical features of the method are presented, followed by several definitions for understanding the basic terms needed to realize the applications of capnography. The last section is a descriptive part that explains the most important clinical applications of capnography, the strengths and limitations of this method. This article distinguishes capnography applications as a single procedure and its benefits as a complimentary procedure.

Key words: capnography, monitoring, ventilation, end-tidal CO2

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