RESUMEN
Intensive respiratory care service has come a long way from the beginning in Scandinavia in early 1952. Intensive care service (IRCU) was started at our institute in 1983 as tetanus and respiratory care ward which has developed into Department of respiratory diseases over years. We are reporting our experience of 886 cases of acute respiratory failure (ARF) treated from Jan, 1983 upto April 1990.
Asunto(s)
Síndrome de Dificultad Respiratoria/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Cuidados Críticos , Humanos , India , Unidades de Cuidados Intensivos , Persona de Mediana Edad , Síndrome de Dificultad Respiratoria/terapiaRESUMEN
A 30-year old with rhabdomyolysis and acute renal failure is presented. The attack followed a minor operation under general anaesthesia during which succinylcholine was administered as muscle relaxant. The fasciculations which occurred immediately after injection of succinylcholine may possibly have precipitated rhabdomyolysis.
Asunto(s)
Lesión Renal Aguda/inducido químicamente , Anestesia General , Rabdomiólisis/inducido químicamente , Succinilcolina/efectos adversos , Timpanoplastia , Adulto , Humanos , Masculino , Rabdomiólisis/diagnóstico , Succinilcolina/administración & dosificaciónAsunto(s)
Batroxobina/administración & dosificación , Broncoscopios , Hemoptisis/terapia , Adulto , HumanosRESUMEN
Between Jan. 1983 and Dec. 1986, 288 patients with acute respiratory failure of varied aetiologies were admitted to tetanus and respiratory care ward. One hundred and twenty patients (41.66%) had primary respiratory diseases, 107 (37.15%) of poisoning, 24 (8.3%) had neuromuscular diseases and 37 (12.48%) had miscellaneous disorders. Ventilatory support was given for more than 6 hours to 118 patients. The overall survival was 61.81% and on ventilator 38.13%. The mortality was high with ARDS (100%), miscellaneous (100%) pneumonia with septicaemia (75%) and COAD (54.28%). Patient with COAD had high mortality with acidosis (pH less than 7.1, P less than 0.01), hypotension (systolic BP less than 90 mm of Hg, p less than 0.05) and oliguria (urine out put less than 400 ml/24 hours, p less than 0.05). Organophosphorus compound was the commonest poison (89.75%) and patients who had moderate to severe hypoxia (pO2 less than 60 mm of Hg), hypotension and an interval of more than 4 hours between the consumption of poison and admission (all P less than 0.05) expired; 68.18% expired within the first 72 hours. All the patients with primary neuromuscular paralysis and bronchial asthma survived. Hospital acquired infections (160 patients), retained secretions (108 patients) and hypotension (64 patients) were the commonest complications seen in the 288 patients. Staphylococcus aureus (32.14%) was the commonest organism isolated. Financial constraints, drug shortages and frequent failure of machines were other major problems in the intensive respiratory care unit.
Asunto(s)
Insuficiencia Respiratoria/terapia , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cuidados Críticos/métodos , Infección Hospitalaria/prevención & control , Estudios de Evaluación como Asunto , Humanos , India , Unidades de Cuidados Intensivos/organización & administración , Persona de Mediana Edad , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/mortalidad , Estudios RetrospectivosRESUMEN
Fourteen cases, 5 with pre-existing COAD, exposed to up to 30 p.p.m. chlorine gas in an accidental leakage, were followed up clinically, radiologically and by spirometry at 2 weeks, 4 weeks, 8 weeks and 6 months. All the patients were asymptomatic by 2 weeks and did not reveal any radiological abnormality. The FVC, FEV1 and FVC observed/predicted improved at 4 weeks (p less than 0.05, p less than 0.05, p less than 0.01) and the improvement in FEF0.25-0.75 reached statistical significance (p less than 0.05) at 6 months. The mean improvement in FVC was 0.84 l and FEV1 was 0.6 l at 4 weeks. The 5 patients with pre-existing COAD did not show any evidence of additional lung damage. The observations have been consistent with acute tracheobronchitis with trends towards complete recovery.