RESUMEN
Between 1986 and 1996, 16 infants and children less than 11 years of age (m = 11, f = 5) underwent resections for acquired or congenital tracheobronchial stenoses. During this period, various techniques of total intravenous anaesthesia (TIVA) were employed (midazolam, fentanyl, pancuronium; propofol, fentanyl, pancuronium). During the phase of dividing the airways, high-frequency-jet ventilation (HFJV) into the trachea or the main bronchi by 8-12Fr catheter(s) was applied for 10-75 min with driving pressures between 0.3-1.8 bar, frequencies between 100-200/min, I:E ratio between 1:4-1:1, and FjetO2 1.0. Catheter position was controlled visually, gas exchange was monitored by pulse oximetry and blood gas analysis. There were two incidents of transient hypoxaemia (paO2 less than 60 mmHg), and 4 cases of hypercapnia (paCO2 more than 45 mmHg). No complications due to the HFJV-catheter technique, such as barotrauma or aspiration were seen. All children were kept postoperatively on a ventilator due to swelling of the airway anastomosis. In 5 children ventilator treatment exceeded 7 days, 3 children were discharged tracheostomised. These observations serve to confirm that HFJV is capable of maintaining gas exchange during tracheal resection in infants and children, if the following prerequisites are met: 1. Tracheobronchial pathology suitable for poststenotic placement of jet catheter. 2. No respiratory impairment by parenchymal pathology. 3. Monitoring by continuous visual control of respiratory mechanics, pulse oximetry and blood gas analysis. Cardiopulmonary bypass should be applied if airway pathology precludes safe placement of jet catheters, or in the presence of parenchymal respiratory failure.
Asunto(s)
Anestesia General , Anestesia Intravenosa , Ventilación con Chorro de Alta Frecuencia , Estenosis Traqueal/cirugía , Análisis de los Gases de la Sangre , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Monitoreo Intraoperatorio , Complicaciones Posoperatorias/fisiopatología , Intercambio Gaseoso Pulmonar/fisiología , Estenosis Traqueal/congénito , Estenosis Traqueal/fisiopatologíaAsunto(s)
Anestesia General/instrumentación , Respiración Artificial/instrumentación , Enfermedades Torácicas/cirugía , Neoplasias Torácicas/cirugía , Broncoscopios , Dióxido de Carbono/sangre , Ventilación con Chorro de Alta Frecuencia/instrumentación , Humanos , Oxígeno/sangre , Respiración con Presión Positiva/instrumentación , Atelectasia Pulmonar/fisiopatología , Atelectasia Pulmonar/prevención & control , Intercambio Gaseoso Pulmonar/fisiología , Enfermedades Torácicas/fisiopatología , Neoplasias Torácicas/fisiopatologíaRESUMEN
From 1986 to 1988 84 patients with tuberculosis were treated in the Intensive Care Unit of the Thorax Clinic Heidelberg (2.8% of total admissions). Only 18% (n = 15) of the cases were referred in the course of conservative treatment while 82% (n = 69) were admitted after thoracic surgery. In 49 of these patients (71%) the diagnosis of tuberculosis could be confirmed only postoperatively by histological examination. This diagnosis should be considered in any ICU patient belonging to the typical groups at risk or showing clinical signs of tuberculosis, e.g. weight loss, chronic productive cough and fever. For the confirmation of the diagnosis both microscopic examination and mycobacterial cultures are necessary. In cases of open tuberculosis in which mycobacteria are identified in sputum, urine or fistula secretion, the most important step of infection prophylaxis is the isolation of these patients (single rooms) and the prevention of airborne transmission by using face masks and protective gowns.
Asunto(s)
Infección Hospitalaria/diagnóstico , Infecciones Oportunistas/diagnóstico , Tuberculosis Pulmonar/diagnóstico , Antituberculosos/uso terapéutico , Quimioterapia Combinada , Humanos , Unidades de Cuidados Intensivos , Neumonectomía , Complicaciones Posoperatorias/diagnóstico , Insuficiencia Respiratoria/diagnóstico , Factores de Riesgo , Tuberculosis Pulmonar/cirugíaRESUMEN
We report on a 27-year-old female developing acute thoracic inlet obstruction by bilateral pulmonary cysts which arose from pulmonary lymphangioleiomyomatosis and increased with respiratory treatment. Bilateral synchronous bullectomy via median sternotomy was necessary to resolve the life-threatening condition. The most frequent differential diagnoses are tension pneumothorax and pericardial tamponade. Although this case of thoracic inlet obstruction was caused by a rare disease it may serve to recall the therapeutic problems encountered in bullous pulmonary lesions under tension, especially regarding acute volume expansion due to one-way valve mechanism during respiratory treatment or general anaesthesia.