scholarly journals Cerebral Arterial Air Embolism Associated with Mechanical Ventilation and Deep Tracheal Aspiration

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
S. Gursoy ◽  
C. Duger ◽  
K. Kaygusuz ◽  
I. Ozdemir Kol ◽  
B. Gurelik ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Ct Scan ◽  
Respiratory Activity ◽  
Cerebral Arteries ◽  
Air Embolism ◽  
Mechanical Ventilator ◽  
Pulmonary Barotrauma ◽  
Cranial Ct ◽  
Tracheal Aspiration

Arterial air embolism associated with pulmonary barotrauma has been considered a rare but a well-known complication of mechanical ventilation. A 65-year-old man, who had subarachnoid hemorrhage with Glasgow coma scale of 8, was admitted to intensive care unit and ventilated with the help of mechanical ventilator. Due to the excessive secretions, deep tracheal aspirations were made frequently. GCS decreased from 8–10 to 4-5, and the patient was reevaluated with cranial CT scan. In CT scan, air embolism was detected in the cerebral arteries. The patient deteriorated and spontaneous respiratory activity lost just after the CT investigation. Thirty minutes later cardiac arrest appeared. Despite the resuscitation, the patient died. We suggest that pneumonia and frequent tracheal aspirations are predisposing factors for cerebral vascular air embolism.

scholarly journals Efektivitas Ventilator dalam Proses End of Life dan Tinjauannya Menurut Pandangan Islam

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Yulya Mauliddina ◽  
Ferryal Basbeth ◽  
Muhammad Arsyad
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Medical Record ◽  
Medical Records ◽  
Respiratory Function ◽  
Sampling Techniques ◽  
Mechanical Ventilator ◽  
Probability Sampling

Background: A mechanical ventilator is a device used to help with respiratory function. Its use is indicated for patients with hypoxemia, severe hypercapnia and respiratory failure. Mechanical ventilator is one of the important and widely used aspects for critical patient care in the Intensive Care Unit (ICU). Methods: This research was conducted with non-probability sampling techniques. Non-probability sampling techniques was determined by purposive method, which is to determine the criteria first, then the samples are taken according to predetermined criteria. Results: As much as 98 medical records taken from the Juwita Bekasi Hospital ICU from  2013-2017  showed  that 3 patients showed effective results for ventilator installation and 95 patients showed ineffective results. Conclusion: Based on medical record in Juwita Bekasi Hospital from 2013 to 2017, The mechanical ventilation installation was not effective and only has 1% effectivity.

scholarly journals Fatal Cerebral Air Embolism: A Case Series and Literature Review

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Rashmi Mishra ◽  
Pavithra Reddy ◽  
Misbahuddin Khaja
Keyword(s):  
Ct Scan ◽  
Patent Foramen Ovale ◽  
Cerebral Arteries ◽  
Case Series ◽  
Air Embolism ◽  
Venous Catheter ◽  
Foramen Ovale ◽  
Cerebral Air Embolism ◽  
Orogastric Tube ◽  
Hemodialysis Session

Cerebral air embolism (CAE) is an infrequently reported complication of routine medical procedures. We present two cases of CAE. The first patient was a 55-year-old male presenting with vomiting and loss of consciousness one day after his hemodialysis session. Physical exam was significant for hypotension and hypoxia with no focal neurologic deficits. Computed tomography (CT) scan of head showed gas in cerebral venous circulation. The patient did not undergo any procedures prior to presentation, and his last hemodialysis session was uneventful. Retrograde rise of venous air to the cerebral circulation was the likely mechanism for venous CAE. The second patient was a 46-year-old female presenting with fever, shortness of breath, and hematemesis. She was febrile, tachypneic, and tachycardic and required intubation and mechanical ventilation. An orogastric tube inserted drained 2500 mL of bright red blood. Flexible laryngoscopy and esophagogastroduodenoscopy were performed. She also underwent central venous catheter placement. CT scan of head performed the next day due to absent brain stem reflexes revealed intravascular air within cerebral arteries. A transthoracic echocardiogram with bubble study ruled out patent foramen ovale. The patient had a paradoxical CAE in the absence of a patent foramen ovale.

scholarly journals Retrograde cerebral venous air embolism and the anatomical pathway of air bubbles: a case report

2020 ◽  
Vol 14 (3) ◽  
pp. 210-215
Author(s):  
Berrin EROK ◽  
Kenan KIBICI ◽  
Ali ATCA
Keyword(s):  
Ct Scan ◽  
Air Embolism ◽  
Venous Catheter ◽  
Neurological Deficits ◽  
Air Bubbles ◽  
Jugular Veins ◽  
Venous Air Embolism ◽  
Cranial Ct ◽  
Venous Sinuses ◽  
Dural Venous Sinuses

Pneumocephalus due to cerebral venous air embolism is an uncommon phenomenon. It results from retrograde progression of low weight air bubbles into dural venous sinuses during manipulation of a venous catheter, more frequently a central venous catheter through the subclavian and the jugular veins. However, it may also occur in relation with a peripheral intravenous catheter as in our case. We report a 91 year old female patient with congestive heart failure who had been examined in our emergency department two days previously due to dyspnea and received diuretic treatment through a peripheral intravenous line. She presented with vomiting and headache without obvious neurological deficits. Non-contrast cranial CT scan revealed wide spread punctate air bubbles inside and outside the cranial vault (pneumocephalus), within the venous system. The pneumocephalus was considered as iatrogenic due to the previous peripheral venous catheterization that resulted in retrograde migration of air bubbles through various venous connections into dural venous sinuses and extracranial veins. Since cerebral venous air embolism is a potentially serious complication of various medical procedures, it should be considered in differential diagnosis of nontraumatic headache and vomiting especially when there is a recent manipulation of venous lines. Cranial CT scan is helpful for early diagnosis.

scholarly journals Use of Inspiratory Strength Training to Wean Six Patients Who Were Ventilator-Dependent

2003 ◽  
Vol 83 (2) ◽  
pp. 171-181 ◽  
Author(s):  
Samuel S Sprague ◽  
Phillip D Hopkins
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Strength Training ◽  
Inspiratory Muscle ◽  
Future Research ◽  
Mechanical Ventilator ◽  
Case Description ◽  
Breathing Patterns ◽  
Breathing Exercises ◽  
Inspiratory Muscle Strength

Abstract Background and Purpose. Patients who are unable to wean from mechanical ventilation (MV) after resolution of critical illness or surgery risk increased morbidity and death and consume a disproportionate amount of intensive care unit resources. Decreased inspiratory muscle strength is often cited as a major factor contributing to prolonged MV. The purpose of this case report is to describe the rationale and application of inspiratory strength training (IST) as an adjunct to lengthen unassisted breathing trials and to ultimately wean patients with chronic mechanical ventilator dependency. Case Description. Six patients who had been ventilator-dependent for 18 to 221 days (mean of 72 days) after surgery and were diagnosed with “failure to wean” performed low-repetition, high-resistance breathing exercises that were coupled with increasing time off the ventilator. Outcomes. All 6 patients were weaned from the ventilator in 9 to 28 days (mean of 17 days). The patients' training pressure increased from a mean of 9.3 cm/H2O to 27.5 cm/H2O, for an increase of 195%. The volitional maximum inspiratory pressure (MIP) increased from a mean of 22.5 cm/H2O to 54 cm/H2O, for a 140% gain in pressure. Discussion. Although it is not clear why the patients appeared to benefit from IST, possible explanations include: (1) addressing inspiratory muscle pump dysfunction, (2) standardization of breathing patterns, 3) routinization of the patients' unassisted breathing trials, and (4) nonspecific training effects. Future research should address these possibilities when attempting to understand the effects of IST in the weaning of patients with chronic ventilator dependency.

scholarly journals Respiratory Modalities in Preventing Reintubation in a Pediatric Intensive Care Unit

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199153
Author(s):  
Ameer Al-Hadidi ◽  
Morta Lapkus ◽  
Patrick Karabon ◽  
Begum Akay ◽  
Paras Khandhar
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Noninvasive Positive Pressure Ventilation ◽  
Pediatric Intensive Care ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Positive Pressure ◽  
P Value

Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, P-value = .0357) and hospital LOS (16.43 vs 10.20 days, P-value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.

scholarly journals 375. COVID 19 infection in a Massachusetts community hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S257-S258
Author(s):  
Raul Davaro ◽  
alwyn rapose
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Essential Hypertension ◽  
Severe Acute Respiratory Syndrome ◽  
High Mortality ◽  
Case Series ◽  
World Health ◽  
Minimal Risk ◽  
The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

scholarly journals Derivation and validation of a search algorithm to retrospectively identify mechanical ventilation initiation in the intensive care unit

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Nathan J Smischney ◽  
Venu M Velagapudi ◽  
James A Onigkeit ◽  
Brian W Pickering ◽  
Vitaly Herasevich ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Search Algorithm

scholarly journals Age, Frailty, Resuscitation and Intensive Care: With Reference to COVID-19

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 36
Author(s):  
David G Smithard ◽  
Nadir Abdelhameed ◽  
Thwe Han ◽  
Angelo Pieris
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Distributive Justice ◽  
Older Age ◽  
Distribution Of Resources ◽  
Utilitarian Approach ◽  
The Individual

Discussion regarding cardiopulmonary resuscitation and admission to an intensive care unit is frequently fraught in the context of older age. It is complicated by the fact that the presence of multiple comorbidities and frailty adversely impact on prognosis. Cardiopulmonary resuscitation and mechanical ventilation are not appropriate for all. Who decides and how? This paper discusses the issues, biases, and potential harms involved in decision-making. The basis of decision making requires fairness in the distribution of resources/healthcare (distributive justice), yet much of the printed guidance has taken a utilitarian approach (getting the most from the resource provided). The challenge is to provide a balance between justice for the individual and population justice.

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