Respiratory system compliance decreases after cardiopulmonary resuscitation and stomach inflation: impact of large and small tidal volumes on calculated peak airway pressure

The differential diagnosis for apnea in newborns and infants is extensive and includes, but is not limited to, central nervous, gastrointestinal, metabolic, and respiratory system disorders.1 Frequently no cause is found for the apnea. We present a case in which an unusual cause was found and only after many months. CASE REPORT S. K. was a healthy infant with a normal birth history and no significant problems until the age of 13 months when, while playing with his mother, he suddenly collapsed, becoming apneic and cyanotic. Cardiopulmonary resuscitation was administered for 10 minutes before the child began to breathe spontaneously.

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Thoracic sympathetic block reduces respiratory system compliance

Sao Paulo Medical Journal ◽

10.1590/s1516-31802007000100003 ◽

2007 ◽

Vol 125 (1) ◽

pp. 9-14 ◽

Cited By ~ 5

Author(s):

Fábio Ely Martins Benseñor ◽

Joaquim Edson Vieira ◽

José Otávio Costa Auler Júnior

Keyword(s):

Chest Wall ◽

Respiratory System ◽

Lung Resection ◽

Lung Compliance ◽

Airway Hyperreactivity ◽

Sympathetic Block ◽

Respiratory System Compliance ◽

Double Blind ◽

Thoracic Epidural ◽

Student’S T

CONTEXT AND OBJECTIVE: Thoracic epidural anesthesia (TEA) following thoracic surgery presents known analgesic and respiratory benefits. However, intraoperative thoracic sympathetic block may trigger airway hyperreactivity. This study weighed up these beneficial and undesirable effects on intraoperative respiratory mechanics. DESIGN AND SETTING: Randomized, double-blind clinical study at a tertiary public hospital. METHODS: Nineteen patients scheduled for partial lung resection were distributed using a random number table into groups receiving active TEA (15 ml 0.5% bupivacaine, n = 9) or placebo (15 ml 0.9% saline, n = 10) solutions that also contained 1:200,000 epinephrine and 2 mg morphine. Under general anesthesia, flows and airway and esophageal pressures were recorded. Pressure-volume curves, lower inflection points (LIP), resistance and compliance at 10 ml/kg tidal volume were established for respiratory system, chest wall and lungs. Student’s t test was performed, including confidence intervals (CI). RESULTS: Bupivacaine rose 5 ± 1 dermatomes upwards and 6 ± 1 downwards. LIP was higher in the bupivacaine group (6.2 ± 2.3 versus 3.6 ± 0.6 cmH2O, p = 0.016, CI = -3.4 to -1.8). Respiratory system and lung compliance were higher in the placebo group (respectively 73.3 ± 10.6 versus 51.9 ± 15.5, p = 0.003, CI = 19.1 to 23.7; 127.2 ± 31.7 versus 70.2 ± 23.1 ml/cmH2O, p < 0.001, CI = 61 to 53). Resistance and chest wall compliance showed no difference. CONCLUSION: TEA decreased respiratory system compliance by reducing its lung component. Resistance was unaffected. Under TEA, positive end-expiratory pressure and recruitment maneuvers are advisable.

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Manual hyperinflation and the role of physical therapy in intensive care and emergency units

Fisioterapia em Movimento ◽

10.1590/1980-5918.030.s01.ao23 ◽

2017 ◽

Vol 30 (suppl 1) ◽

pp. 241-248

Author(s):

Rafael Vinícius Santos Cruz ◽

Fabiana do Socorro da Silva Dias de Andrade ◽

Pollyanna Dórea Gonzaga de Menezes ◽

Bruno Oliveira Gonçalves ◽

Robson da Silva Almeida ◽

...

Keyword(s):

Intensive Care ◽

Physical Therapy ◽

Airway Pressure ◽

Physical Therapists ◽

High Peak ◽

Peak Airway Pressure ◽

Routine Practice ◽

Perceived Benefits ◽

Therapy Technique ◽

Emergency Units

Abstract Introduction: Although manual hyperinflation (MHI) is a physical therapy technique commonly used in intensive care and emergency units, there is little consensus about its use. Objective: To investigate the knowledge of physical therapists working in intensive care and emergency units about manual hyperinflation. Methods: Data were collected through self-administered questionnaires on manual hyperinflation. Data collection took place between September 2014 and January 2015, in Itabuna and Ilhéus, Bahia, Brazil. Results: The study sample was composed of 32 physical therapists who had between 4 months and 10 years working experience. All respondents affirmed that they used the technique in their professional practice. However, only 34.4% reported it to be a routine practice. 90.6% stated that the most common patient position during manual hyperinflation is “supine”. Participants were almost unanimous (93.8%) in citing secretion removal and cough stimulation as perceived benefits of MHI. High peak airway pressure was identified as being a precaution to treatment with MHI by 84.4% of participants, whilst 100% of the sample agreed that an undrained pneumothorax was a contraindication to MHI. Conclusion: The most common answers to the questionnaire were: supine position during MHI; secretion removal and cough stimulation as perceived benefits; high peak airway pressure as a precaution; and an undrained pneumothorax as a contraindication.

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The correlation of respiratory system compliance and mortality in COVID-19 acute respiratory distress syndrome: do phenotypes really exist?

Journal of Lung Pulmonary & Respiratory Research ◽

10.15406/jlprr.2021.08.00253 ◽

2021 ◽

Vol 8 (2) ◽

pp. 67-74

Author(s):

Rachel L. Choron ◽

Stephen A. Iacono ◽

Alexander Cong ◽

Christopher G. Bargoud ◽

Amanda L. Teichman ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory System ◽

Management Strategies ◽

Respiratory System Compliance ◽

Risk Of Death ◽

Mortality Difference ◽

Ventilator Management ◽

Observational Cohort ◽

Multivariable Regression ◽

The Mean

Background: Recent literature suggests respiratory system compliance (Crs) based phenotypes exist among COVID-19 ARDS patients. We sought to determine whether these phenotypes exist and whether Crs predicts mortality. Methods: A retrospective observational cohort study of 111 COVID-19 ARDS patients admitted March 11-July 8, 2020. Crs was averaged for the first 72-hours of mechanical ventilation. Crs<30ml/cmH2O was defined as poor Crs(phenotype-H) whereas Crs≥30ml/cmH2O as preserved Crs(phenotype-L). Results: 111 COVID-19 ARDS patients were included, 40 phenotype-H and 71 phenotype-L. Both the mean PaO2/FiO2 ratio for the first 72-hours of mechanical ventilation and the PaO2/FiO2 ratio hospital nadir were lower in phenotype-H than L(115[IQR87] vs 165[87], p=0.016), (63[32] vs 75[59], p=0.026). There were no difference in characteristics, diagnostic studies, or complications between groups. Twenty-seven (67.5%) phenotype-H patients died vs 37(52.1%) phenotype-L(p=0.115). Multivariable regression did not reveal a mortality difference between phenotypes; however, a 2-fold mortality increase was noted in Crs<20 vs >50ml/cmH2O when analyzing ordinal Crs groups. Moving up one group level (ex. Crs30-39.9ml/cmH2O to 40-49.9ml/cmH2O), was marginally associated with 14% lower risk of death(RR=0.86, 95%CI 0.72, 1.01, p=0.065). This attenuated (RR=0.94, 95%CI 0.80, 1.11) when adjusting for pH nadir and PaO2/FiO2 ratio nadir. Conclusion: We identified a spectrum of Crs in COVID-19 ARDS similar to Crs distribution in non-COVID-19 ARDS. While we identified increasing mortality as Crs decreased, there was no specific threshold marking significantly different mortality based on phenotype. We therefore would not define COVID-19 ARDS patients by phenotypes-H or L and would not stray from traditional ARDS ventilator management strategies.

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Massive Subcutaneous Emphysema during Laparoscopic Cholecystectomy

TAJ Journal of Teachers Association ◽

10.3329/taj.v21i1.3225 ◽

1970 ◽

Vol 21 (1) ◽

pp. 77-79

Author(s):

ASM Moosa ◽

M Baharul Islam ◽

Shahina Akther ◽

M Latifur Rahman ◽

Nazim Uddin Ahmed

Keyword(s):

Carbon Dioxide ◽

Laparoscopic Cholecystectomy ◽

Partial Pressure ◽

Subcutaneous Emphysema ◽

Airway Pressure ◽

Surgical Techniques ◽

Lung Ventilation ◽

Peak Airway Pressure ◽

Sudden Increase ◽

Partial Pressure Of Oxygen

Laparoscopic surgical techniques are increasingly being applied to treat cholelithiasis and other indications of gallbladder diseases. These procedures however are not without potential morbidity. Herein we describe two patients treated with laparoscopic cholecystectomy; those cases were complicated with subcutaneous emphysema and hypercarbia per-operatively. After discontinuation of pneumoperitoneum, saturation of partial pressure of oxygen (SpO2) gradually increased with improvement of the neck subcutaneous emphysema, at the same time the lung ventilation also improved. Our findings show that we have to stop pneumoperitoneum or decrease partial pressure of end carbon dioxide level immediately, when we find a sudden increase of the peak airway pressure or decrease SpO2 with subcutaneous emphysema during laparoscopic cholecystectomy. doi: 10.3329/taj.v21i1.3225 TAJ 2008; 21(1): 77-79

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