Failure of manual respiration

1959 ◽  
Vol 14 (1) ◽  
pp. 84-88 ◽  
Author(s):  
Peter Safar
Keyword(s):  
Airway Obstruction ◽  
Tidal Volume ◽  
Tracheal Tube ◽  
Dead Space ◽  
Upper Airway ◽  
Obese Patients ◽  
Tidal Exchange ◽  
Artificial Airway ◽  
Oropharyngeal Airway ◽  
Oronasal Mask

The tidal volumes moved during performance of the BPAL and CPAL methods in 29 curarized, anesthetized, apneic adults were measured with a spirometer through an oronasal mask (with and without an artificial oropharyngeal airway in place) and through a tracheal tube. With the conventional BPAL method without an artificial airway the average tidal volume was zero, or less than dead space air in 12 of 15 subjects studied. The failure was mainly due to pharyngeal obstruction by the relaxed tongue, occurring when the neck was flexed and the mandible was not supported. An artificial oropharyngeal airway only slightly improved the tidal exchange. A modified BPAL method, which consisted of the head being tilted backward, increased the tidal volume and decreased the incidence of obstruction. With the conventional CPAL method the tidal volumes likewise depended mainly on the position of the head and neck. A modified CPAL method, which consisted of maintaining the head tilted backward by elevating the shoulders, was compared in 10 subjects with the modified BPAL method. The tidal volumes were greater and the incidence of upper airway obstruction was lower with the modified CPAL method. With a tracheal tube in place, tidal volumes of 260–840 ml were moved without signs of airway obstruction. The low values occurred in short and obese patients with reduced lung-thorax compliance. Submitted on August 28, 1958

scholarly journals 1260 High Tidal Volume Non-invasive Ventilation Required to Treat Obesity Hypoventilation

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A479-A480
Author(s):  
Talayeh Rezayat ◽  
Abigail Beggs ◽  
Alon Y Avidan ◽  
Shahrokh Javaheri
Keyword(s):  
Tidal Volume ◽  
Upper Airway ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Invasive Ventilation ◽  
Class Iii ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Patient Reported ◽  
Obesity Hypoventilation

Abstract Introduction Current guidelines recommend CPAP or non-invasive ventilation with tidal volume (VT) <10ml/kg of ideal body weight (IBW) for the treatment of obesity hypoventilation. However, in select patients with significant obesity hypoventilation, this recommendation may not be sufficient to resolve nocturnal hypoventilation. Report of Case A 35 y/o male with hypertension and class III obesity (BMI 58 kg/m2) was referred for evaluation of acute respiratory failure with hypoxia and hypercapnia. ABG demonstrated daytime PCO2 of 71 mmHg. Patient reported sleep fragmentation, snoring, choke awakenings, poor concentration, depression and sleep attacks. PSG demonstrated severe OSA, with an AHI of 154 events/hour, persistent hypoxia and hypercapnia with a SpO2 nadir of 50% and ET-CO2 of 83 mmHg during REM sleep. Respiratory events persisted with CPAP and bilevel, up to a setting of 25/16. Average volume assured pressure support (AVAPS) S/T titration study was performed and resolved sleep apnea at settings of IPAP 24-30, EPAP 4-15, VT 790 (10 mL/kg IBW), 0.5 LPM O2, rate 16. The patient reported having had the best sleep of his life at the end of this study and has since been started on treatment. Conclusion Treatment of OHS should be individualized and may require use of tidal volumes above 10ml/kg for effective treatment. We suggest that in super morbidly obese patients, with extremely noncompliant respiratory system, larger than recommended tidal volume is necessary to ventilate the patient and improve gas exchange. The sustained higher pressures achieved by AVAPS to impose the augmented tidal volume more effectively ameliorate OSA, by keeping the upper airway open. Higher pressures achieved also could elevate FRC, not only increasing oxygen stores, but also contributing to maintenance of open upper airway through its tethering effect. Further physiological studies are needed in super morbidly obese patients comparing low and high tidal volumes.

scholarly journals Tidal volume monitoring during initial resuscitation of extremely prematurely born infants

2019 ◽  
Vol 47 (6) ◽  
pp. 665-670 ◽  
Author(s):  
Katie A. Hunt ◽  
Vadivelam Murthy ◽  
Prashanth Bhat ◽  
Grenville F. Fox ◽  
Morag E. Campbell ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Airway Obstruction ◽  
Tidal Volume ◽  
Preterm Infants ◽  
Respiratory Function ◽  
Upper Airway ◽  
Lung Compliance ◽  
Positive End Expiratory Pressure ◽  
Initial Resuscitation ◽  
Prematurely Born Infants

Abstract Background Airway obstruction can occur during facemask (FM) resuscitation of preterm infants at birth. Intubation bypasses any upper airway obstruction. Thus, it would be expected that the occurrence of low expiratory tidal volumes (VTes) would be less in infants resuscitated via an endotracheal tube (ETT) rather than via an FM. Our aim was to test this hypothesis. Methods Analysis was undertaken of respiratory function monitoring traces made during initial resuscitation in the delivery suite to determine the peak inflating pressure (PIP), positive end expiratory pressure (PEEP), the VTe and maximum exhaled carbon dioxide (ETCO2) levels and the number of inflations with a low VTe (less than 2.2 mL/kg). Results Eighteen infants were resuscitated via an ETT and 11 via an FM, all born at less than 29 weeks of gestation. Similar inflation pressures were used in both groups (17.2 vs. 18.8 cmH2O, P = 0.67). The proportion of infants with a low median VTe (P = 0.6) and the proportion of inflations with a low VTe were similar in the groups (P = 0.10), as was the lung compliance (P = 0.67). Infants with the lowest VTe had the stiffest lungs (P < 0.001). Conclusion Respiratory function monitoring during initial resuscitation can objectively identify infants who may require escalation of inflation pressures.

Tracheostomy and respiratory dead space in emphysema

1964 ◽  
Vol 19 (1) ◽  
pp. 92-96 ◽  
Author(s):  
Herman F. Froeb ◽  
Byong M. Kim
Keyword(s):  
Airway Obstruction ◽  
Dead Space ◽  
Arterial Oxygen Saturation ◽  
Upper Airway ◽  
Alveolar Ventilation ◽  
Upper Airway Obstruction ◽  
Arterial Oxygen ◽  
Lower Airway ◽  
Arterial Blood ◽  
Lower Airway Obstruction

Acute experimentation to judge the effects of reduction of dead space with tracheostomy breathing was performed on four subjects with lower airway obstruction (bronchitis and emphysema) and on two subjects with upper airway obstruction (carcinoma of the larynx and tracheal stenosis). With tracheostomy breathing, the reduction in dead space led to a decrease in minute ventilation except in the two patients with upper airway obstruction. Alveolar ventilation decreased except when alveolar hypoventilation was present to start with. There was no change or an increase in Pacoco2 and H+ in the subjects with lower airway obstruction and small increases in arterial oxygen saturation and Paoo2 occurred. A decrease in Pacoco2 and H+ occurred in one of two patients with upper airway obstruction. Reduction of dead space per se with tracheostomy breathing brings about small changes in alveolar ventilation and gas exchange in the lungs of patients with chronic bronchitis and emphysema. Note:(With the Technical Assistance of Roy Engstrom, Mabel Pearson, and Tom Purcell) physiological dead space and tracheostomy; arterial blood gases with tracheostomy breathing; tracheostomy versus mouth breathing; emphysema and tracheostomy breathing Submitted on February 11, 1963

scholarly journals Double Barrel Nasal Trumpets to Prevent Upper Airway Obstruction after Nasal and Non-Nasal Surgery

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Macario Camacho ◽  
Justin M. Wei ◽  
Lauren K. Reckley ◽  
Sungjin A. Song
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Nasal Surgery ◽  
Upper Airways ◽  
Obstructive Sleep

Objectives. During anesthesia emergence, patients are extubated and the upper airway can become vulnerable to obstruction. Nasal trumpets can help prevent obstruction. However, we have found no manuscript describing how to place nasal trumpets after nasal surgery (septoplasties or septorhinoplasties), likely because (1) the lack of space with nasal splints in place and (2) surgeons may fear that removing the trumpets could displace the splints. The objective of this manuscript is to describe how to place nasal trumpets even with nasal splints in place. Materials and Methods. The authors describe techniques (Double Barrel Technique and Modified Double Barrel Technique) that were developed over three years ago and have been used in patients with obstructive sleep apnea (OSA) and other patients who had collapsible or narrow upper airways (i.e., morbidly obese patients). Results. The technique described in the manuscript provides a method for placing one long and one short nasal trumpet in a manner that helps prevent postoperative upper airway obstruction. The modified version describes a method for placing nasal trumpets even when there are nasal splints in place. Over one-hundred patients have had nasal trumpets placed without postoperative oxygen desaturations. Conclusions. The Double Barrel Technique allows for a safe emergence from anesthesia in patients predisposed to upper airway obstruction (such as in obstructive sleep apnea and morbidly obese patients). To our knowledge, the Modified Double Barrel Technique is the first description for the use of nasal trumpets in patients who had nasal surgery and who have nasal splints in place.

Severe Croup: The Child With Fever and Upper Airway Obstruction

1986 ◽  
Vol 7 (8) ◽  
pp. 227-233
Author(s):  
Jane Donohue Battaglia
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Infection ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Toxin Production ◽  
Airway Intervention ◽  
Artificial Airway ◽  
Bacterial Tracheitis ◽  
Viral Croup ◽  
Bacterial Superinfection

Infectious causes of airway obstruction can be distinguished by anatomic location and causative agent. Epiglottitis, the most common supraglottic obstruction, is bacterial in origin. An artificial airway and antibiotic therapy are mandatory. Spasmodic croup is a mild, transitory subglottic swelling which responds to mist and sometimes antihistamine therapy. Laryngotracheitis, or viral croup, affects the subglottic airway with fluctuating severity and is treated with mist, racemic epinephrine, oxygen, and sometimes steroids. Obstruction may be so severe that intubation or tracheostomy is needed. Laryngotracheobronohitis is the downward extension of viral croup, frequently accompanied by bacterial superinfection. Antibiotics may be needed, and airway intervention is more likely to be indicated than it is for uncomplicated viral croup. Bacterial tracheitis is a primary bacterial infection which causes thick secretions and membrane formation. Antibiotic therapy and sometimes airway intervention are needed. Diphtheria is a bacterial infection with toxin production, the treatment of which always includes both antitoxin and antibiotic and, sometimes, an artificial airway.

Pulmonary Edema following Relief of Acute Upper Airway Obstruction

1980 ◽  
Vol 89 (2) ◽  
pp. 124-128 ◽  
Author(s):  
Antonio G. Galvis ◽  
Sylvan E. Stool ◽  
Charles D. Bluestone
Keyword(s):  
Airway Obstruction ◽  
Pulmonary Edema ◽  
Venous Return ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Acute Pulmonary Edema ◽  
Positive Pressure ◽  
Sudden Increase ◽  
Artificial Airway ◽  
Continuous Positive Pressure

Five children, aged one to five years, with severe upper airway obstruction, three of whom had epiglottitis and two of whom had laryngotracheobronchitis, developed acute pulmonary edema after the obstruction had been relieved by placement of an artificial airway. Although major physiologic changes, such as hypoxemia and massive sympathetic discharge, play a significant role in the development of acute pulmonary edema, we have postulated a possible etiological cause for the development of pulmonary edema in these children which involves a series of physiologic events. The generation of very high transpulmonary pressure gradients during inspiration is opposed by a decreased venous return due to the obstruction during exhalation. Airway pressures then fall abruptly with the insertion of the artificial airway, resulting in a sudden increase in venous return to the central circulation and marked increase in the intravascular hydrostatic pressures. The final result of this series of events is the development of pulmonary hyperemia and edema. The prevention of this situation must begin the moment the airway is inserted and involves the application of moderate amounts of continuous positive pressure to the airway, thus allowing time for circulatory adaption to take place.

scholarly journals Use of a Tracheal Tube as a Nasally Inserted Supraglottic Airway in a Case of Near-Fatal Airway Obstruction Caused by Epiglottitis

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Masayuki Ozaki ◽  
Koji Murashima
Keyword(s):  
Airway Management ◽  
Airway Obstruction ◽  
Tracheal Tube ◽  
Mental Status ◽  
Supine Position ◽  
Upper Airway ◽  
Supraglottic Airway ◽  
Airway Patency ◽  
Sitting Posture ◽  
Airway Narrowing

Airway management is critical during near-fatal obstruction of the upper airway in epiglottitis; however, this is challenging because of the sitting posture and agitated mental status of the patient. Moreover, there is currently no established protocol for safe airway management in patients with epiglottitis. Here, we describe the use of a conventional tracheal tube as a nasolaryngeal airway to maintain airway patency at the site of airway narrowing in the supine position, which enabled alleviation of imminent airway obstruction in a patient with epiglottitis. For definitive airway establishment, tracheostomy was then safely performed in the supine position.

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