DOCSLIB.ORG

24Th International Symposium on Intensive Care and Emergency Medicine Brussels, Belgium, 30 March – 2 April 2004

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
24Th International Symposium on Intensive Care and Emergency Medicine Brussels, Belgium, 30 March – 2 April 2004 Available online http://ccforum.com/supplements/8/S1 Critical Care Volume 8 Suppl 1, 2004 24th International Symposium on Intensive Care and Emergency Medicine Brussels, Belgium, 30 March – 2 April 2004 Published online: 15 March 2004 These abstracts are online at http://ccforum.com/supplements/8/S1 © 2004 BioMed Central Ltd (Print ISSN 1364-8535; Online ISSN 1466-609X) P1 The conditioning of medical gases with hot water humidifiers D Chiumello, M Cressoni, C De Grandis, L Landi, M Racagni Policlinico IRCCS, Milano, Italy Critical Care 2004, 8(Suppl 1):P1 (DOI 10.1186/cc2468) During invasive mechanical ventilation due to the dryness of Table 1 medical gases is necessary to provide an adequate level of conditioning. The hot water humidifiers (HWH) heat the water, thus Results as mean ± SD allowing the water vapor to heat and humidify the medical gases. In the common HWH there is a contact between the medical gases MR 730 and the sterile water, thus increasing the risk of patient’s heated tube Dar HC MR 730 colonization and infection. Recently to avoid the condensation in the inspiratory limb of the ventilator circuit, new heated ventilator Set temperature, 35°C AH (mgH O/l) 26.7 ± 0.3* 37.4 ± 0.6 38.0 ± 0.9 circuits have been developed. In this in vitro study we evaluated 2 RH (%) 83.7 ± 1.0* 97.7 ± 1.4 93.2 ± 1.5 the efficiency (absolute/relative humidity) of three HWH: (1) a common HWH without a heated ventilator circuit (MR 730, Set temperature, 37°C † Fisher&Paykel, New Zeland), (2) the same HWH with a heated AH (mgH2O/l) 34.5 ± 1.6* 38.7 ± 2.2 43.1 ± 1.1 ventilator circuit (Mallinckrodt Dar, Italy) and (3) a new HWH (DAR RH (%) 91.8 ± 3.2 87.7 ± 7.4† 94.6 ± 0.9 HC 2000, Mallinkckrodt Dar, Italy) with a heated ventilator circuit in which the water vapor reaches the medical gases through a *P < 0.05 vs DAR HC and MR 730, †P < 0.05 vs MR 730. gorotex membrane, avoiding any direct contact between the water and gases. At a temperature of 35°C and 37°C the HWH and heated tube were evaluated. settings were maintained constant for all the study period. The measurements were taken after 60 min of continuous use. The absolute humidity (AH) and relative humidity (RH) were measured by a psychometric method. The minute ventilation, tidal At 35°C the output of the MR 730 with a heated tube was volume respiratory rate and oxygen fraction were: 5.8 ± 0.1 l/min, insufficient to provide adequate levels of conditioning, while at 740 ± 258 ml, 7.5 ± 2.6 bpm and 100%, respectively. Ventilator 37°C all the three devices were satisfactory. P2 Use of a bougie during percutaneous tracheostomy M Read University Hospital, Cardiff, UK Critical Care 2004, 8(Suppl 1):P2 (DOI 10.1186/cc2469) Airway techniques for percutaneous tracheostomy include the LMA, A bougie was used during 46. This technique does not use the Combitube, the Microlaryngeal tube and the Perforated Airway bronchoscopic control. A bougie is passed through the tracheal tube Exchanger. Routine bronchoscopy is deemed unnecessary by many, (TT) into the trachea. The TT is withdrawn until the cuff is above the including intensivists in Cardiff. Our audit database stores patient vocal cords. With the cuff fully inflated, the TT is advanced (using the characteristics, techniques and complications, in 700 tracheostomies. bougie as a guide) until the cuff impacts on the vocal cords. A gas- Table 1 aIn one case the seldinger needle also blocked by bougie material. One Complications (type) Number patient was in a hard collar. bIn one case, the seldinger needle Visible cut in bougie 2a perforated the TT cuff and the TT prevented tracheostomy cuff sealing. TT not pulled back far enough 2b In one case, the seldinger wire passed through Murphy eye of TT and Bougie in Murphy eye of TT 1c the dilation process caused the TT to advance into the trachea. The Failure to advance blue rhino 1d second passage of the dilator was done with bronchoscopic control. Bleeding 1e cCaused no problems. dPatient previous tracheostomy: serial dilator Late complication 2f technique used. eThrombocytopaenic patient. No damage seen on bronchoscopy. fInfected stoma at 5 days, pneumopericardium at 4 days. Critical Care March 2004 Vol 8 Suppl 1 24th International Symposium on Intensive Care and Emergency Medicine seal is maintained by gentle pressure on the TT keeping the cuff neutral cervical position was maintained. In 33 cases the Blue pressing on the vocal cords. During percutaneous tracheostomy the Rhino dilator and in 12 cases the Ultra-Perc (White Rhino) dilator bougie remains in the trachea. When ventilation through the was used. One case was a serial dilator (see later). tracheostomy tube (cuff inflated) is confirmed, the TT and bougie are withdrawn. Throughout the procedure, if ventilation difficulties occur, the TT can be easily re-inserted using the bougie as a guide. Conclusion The bougie for airway control for percutaneous tracheostomy was associated with zero hypoxic episodes in Results Three different bougies were used: types (number used) 46 cases. Minor bougie damage in two cases caused no problems. were Eschmann (29), size 10 Portex disposable (four) and size Other complications seen were either minor or unlikely to be due to 12 Portex disposable (13). Three patients were trauma cases: a the bougie. P3 Percutaneous dilational tracheostomy in critically ill patients: progressive vs single dilatation techniques S Zaky, K Atya Kasr Al-Eini Hospital, Cairo, Egypt Critical Care 2004, 8(Suppl 1):P3 (DOI 10.1186/cc2470) Objectives To report experience with the bedside percutaneous Results Bedside PDT was performed successfully in ICU for all dilatational tracheostomy (PDT) in critically ill patients. To compare 18 patients in a mean time of 17.5 ± 14 min (range 5–60 min). two different methods of PDT, namely progressive and single Single dilatation technique had a significantly lower operative time dilatation techniques. than the multiple dilation group (9.5 ± 6 min vs 27.5 ± 15 min, P < 0.005). Complications were significantly higher in group A Design Prospective observational study. (false passage in one, moderate bleeding in one, minor bleeding in two, conversion of the procedure to open tracheostomy in one Patients Eighteen surgical or medical ICU patients (10 male, mean patient due to isthmus bleeding). On the other hand there was only age 32.8 ± 17 years) in a tertiary university hospital requiring minor bleeding in one patient of group B. tracheostomy for airway control or prolonged mechanical ventilation. Interventions Patients were randomized to receive PDT by either Conclusion PDT is a safe and cost-effective procedure in ICU the multiple progressive dilatation method (group A, eight patients) critically ill patients. The single dilatation method is an even more or single dilatation technique (group B, 10 patients) as described rapidly performed bedside method than the progressive dilation by Ciaglia. method. P4 Percutaneous dilatational tracheostomy — a comparison of three methods: Ciaglia Blue Rhino, PercuTwist and Griggs’ Guidewire Dilation Forceps (GWDF) J Schiefner, K Magnusson, U Zaune, E Vester Evangelisches Krankenhaus, Duesseldorf, Germany Critical Care 2004, 8(Suppl 1):P4 (DOI 10.1186/cc2471) Introduction In contrast to conventional surgical tracheostomy, procedural switch to Blue Rhino. One of these cases led to percutaneous dilational tracheostomy (PDT) in different variants is significant blood loss. Pre-interventional and postinterventional spreading rapidly in intensive care units today. On two intensive values for Hb were 10 ± 1.8 g/dl and 9.9 ± 1.2 g/dl in the Blue care units — cardiological and surgical–anaesthesiological — we Rhino group, 10.4 ± 1.8 g/dl and 10.3 ± 1.9 g/dl in the performed a comparative investigation of three PDT methods in a PercuTwist, and 9.8 ± 0.8 g/dl and 9.57 ± 1.4 g/dl in the GWDF prospective randomized study with an emphasis on clinical utility group (n.s.). Oxygenation remained unchanged early after and safety. intervention with a tendency towards a better PaO2/FiO2 in the GWDF group. Three cases of cartilage fracture were recorded. Methods Thirty-one patients (age 64 ± 13 [mean ± SD]) were We saw no severe lasting desaturation episodes. We found no enrolled, PDT were performed in three groups, 10 Ciaglia Blue stomal infections and no other life-threatening events. Surgical Rhino (Cook), 10 PercuTwist (Rüsch) — a device employing a intervention was never required. Mortality in all groups was 42% screw with a hydrophilic coating and 11 GWDF — using Griggs’ with no procedure-related deaths. Thirteen patients have been specially designed dilational forceps (Portex). Duration of permanently decanulated. intervention, oxygenation parameters, blood loss and further complications peri-interventionally and postinterventionally were Conclusion The three methods investigated in this study show recorded and compared. comparable feasibility, clinical utility, lack of severe complications and margin of patient safety under the conditions of a secondary Results We found significant differences in the duration of academic teaching hospital. However, the PercuTwist method procedures: Blue Rhino 5.9 ± 3.7 min, PercuTwist 11.7 ± 9.35 min, revealed technical limitations in particular in the presence of a wide GWDF 3.3 ± 1.65 min (P < 0.02). Two PercuTwist procedures tracheo-cutaneous distance. Shortest intervention durations were proved technically difficult — insufficient penetration depth of the achieved using the GWDF. To provide evidence of relevant Percu Twist device and formation of a pre-tracheal via falsa, differences — especially regarding long-term outcome — further successful tracheostoma placement was achieved only after a comparative studies are indispensable. Available online http://ccforum.com/supplements/8/S1 P5 Optimal approach to the tracheostomy technique in critically ill patients with a short fat neck I Dor, M Croitoru, S Krimerman, S Nicola, E Sabo, E Altman Bnai Zion Medical Center, Haifa, Israel Critical Care 2004, 8(Suppl 1):P5 (DOI 10.1186/cc2472) Background and goal of study To examine and to compare our and the PCT patients (mean = 47.3 cm, median = 47 cm, experience with surgical tracheostomy (ST) and percutaneous range = 45–53 cm) (P = 0.9).
Load more

Recommended publications
  • Standards for the Diagnosis and Treatment of Patients with COPD
    Copyright #ERSJournals Ltd 2004 EurRespir J 2004;23: 932– 946 EuropeanRespiratory Journal DOI: 10.1183/09031936.04.00014304 ISSN0903-1936 Printedin UK –allrights reserved ATS/ ERSTASK FORCE Standardsfor the diagnosisand treatment of patientswith COPD: asummaryof the ATS/ERSposition paper B.R. Celli*, W. MacNee*,andcommittee members Committeemembers: A Agusti, A Anzueto, B Berg, A S Buist, P M A Calverley, N Chavannes, T Dillard, B Fahy, A Fein, J Heffner, S Lareau, P Meek, F Martinez, W McNicholas, J Muris, E Austegard, R Pauwels, S Rennard, A Rossi, N Siafakas, B Tiep, J Vestbo, E Wouters, R ZuWallack *P ulmonaryand Critical C are D ivision, St Elizabeth s’ Medical Center, Tufts U niversity School of Medicine, Boston, Massachusetts, USA # Respiratory Medicine ELE GI, Colt R esearch Lab Wilkie Building, CONTEMedical Schoo l, T eviot Place, Edinburgh, UK CONTENTSNTS Background. ............................ 932 Managementof stab eCOPD:surgery in and for Goals and objectives 933 COPD.. ............................... 938 Participants 933 Surgery in COPD 938 Evidence, methodology and validation 933 Surgery for COPD 938 Concept of a "live",modular document 933 Managementof stab e COPD: s eep. ........... 938 Organisation of the document 933 Managementof stab eCOPD:air-trave . 939 De® nitionof COPD. ...................... 933 Exacerbationof COPD: de® nition, eva uation and Diagnosisof COPD. ...................... 933 treatment ............................... 939 Epidemio ogy,risk factors andnatura history De® nition 939 ofCOPD ............................... 934 Assessment 940 Patho ogyand pathophysio ogyin COPD . ....... 934 Indication for hospitalisation 940 C inica assessment, testingand differentia diagnosisof Indications for admission to specialised or intensive COPD.. ............................... 934 care unit 940 Medicalhistory 935 Treatment of exacerbations 940 Physicalsigns 935 Exacerbationof COPD: inpatient oxygen therapy.
    [Show full text]
  • United States Patent (19) 11 Patent Number: 5,029,579 Trammell (45) Date of Patent: Jul
    United States Patent (19) 11 Patent Number: 5,029,579 Trammell (45) Date of Patent: Jul. 9, 1991 54 HYPERBARIC OXYGENATION 4,452,242 6/1984 Bänziger ......................... 128/205.26 APPARATUS AND METHODS 4,467,798 8/1984 Saxon et al. ... ... 128/205.26 4,474,571 10/1984 Lasley ................................... 604/23 75 Inventor: Wallace E. Trammell, Provo, Utah 4,509,513 4/1985 Lasley ....... ... 128/202.12 4,624,656 1 1/1986 Clark et al. ........................... 604/23 73) Assignee: Ballard Medical Products, Midvale, 4,691,.695 9/1987 Birk et al. ............................. 128/38 Utah Appl. No.: 392,169 FOREIGN PATENT DOCUMENTS 21) 317900 12/1919 Fed. Rep. of Germany ... 128/256 22) Filed: Aug. 10, 1989 1 14443 12/1941 United Kingdom ................ 128/248 Related U.S. Application Data OTHER PUBLICATIONS 63 Continuation of Ser. No. 297,351, Jan. 13, 1989, aban TOPOX Literature. doned, which is a continuation of Ser. No. 61,924, Jun. Oxycure Literature. 15, 1987, abandoned, which is a continuation-in-part of B & F Medical Products, Inc. Literature. Ser. No. 865,762, May 22, 1986, abandoned. Primary Examiner-Richard J. Apley (51) Int. Cl. ............................................... A61H 9/00 Assistant Examiner-Linda C. M. Dvorak (52) U.S. Cl. ................................ 128/205.26; 128/30; Attorney, Agent, or Firm-Lynn G. Foster 128/202.12; 128/205.24; 604/23 (58) Field of Search ...................... 128/202. 12, 205.26, 57 ABSTRACT 128/28, 30, 30.2, 38, 40, 402; 600/21; 604/23, A novel hyperbaric oxygenation apparatus, and related 289, 290, 293,304, 305, 308 methods, the apparatus comprising a chamber in the form of a disposable inflatable bag of impervious inex 56 References Cited pensive synthetic resinous material which can be used at U.S.
    [Show full text]
  • Effect of Assist Negative Pressure Ventilation by Microprocessor
    258 ORIGINAL ARTICLE Thorax: first published as 10.1136/thorax.57.3.258 on 1 March 2002. Downloaded from Effect of assist negative pressure ventilation by microprocessor based iron lung on breathing effort M Gorini, G Villella, R Ginanni, A Augustynen, D Tozzi, A Corrado ............................................................................................................................. Thorax 2002;57:258–262 Background: The lack of patient triggering capability during negative pressure ventilation (NPV) may contribute to poor patient synchrony and induction of upper airway collapse. This study was undertaken to evaluate the performance of a microprocessor based iron lung capable of thermistor trig- gering. Methods: The effects of NPV with thermistor triggering were studied in four normal subjects and six patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) by measuring: (1) the time delay (TDtr) between the onset of inspiratory airflow and the start of assisted breathing; (2) the pressure-time product of the diaphragm (PTPdi); and (3) non-triggering inspiratory efforts (NonTrEf). In patients the effects of negative extrathoracic end expiratory pressure (NEEP) added to NPV were also evaluated. See end of article for Results: With increasing trigger sensitivity the mean (SE) TDtr ranged from 0.29 (0.02) s to 0.21 authors’ affiliations ....................... (0.01) s (mean difference 0.08 s, 95% CI 0.05 to 0.12) in normal subjects and from 0.30 (0.02) s to 0.21 (0.01) s (mean difference 0.09 s, 95% CI 0.06 to 0.12) in patients with COPD; NonTrEf ranged Correspondence to: from 8.2 (1.8)% to 1.2 (0.1)% of the total breaths in normal subjects and from 11.8 (2.2)% to 2.5 Dr M Gorini, Via Ragazzi (0.4)% in patients with COPD.
    [Show full text]
  • What Are the Respiratory Requirements for the Treatment of COVID-19 Pneumonia?
    What are the respiratory requirements for the treatment of COVID-19 pneumonia? Background What happens in the lungs during COVID-19 pneumonia? Patients may require support of their breathing by having ventilatory assistance for a range of reasons, but patients who are seriously affected by COVID-19 will primarily develop pneumonia which may progress to acute respiratory distress syndrome (ARDS) in which there is extreme inflammation with damage and fluid accumulation within the small gas-exchange sacs of the lung (alveoli).1 These patients require specialised ventilation strategies to prevent hypoxia (oxygen depletion of their tissues) which have been well defined2,3, and which are known to deliver optimum therapy4. How is ventilatory assistance conventionally delivered? Since the first positive pressure devices were introduced in the 1950s, it has become conventional to ventilate the lungs, in a wide variety of disease, by delivering positive pressure ventilatory support, either via a tightly-fitting face mask (CPAP), or through a cuffed endo-tracheal tube using positive pressure ventilators (PPV). These devices have become increasingly sophisticated and a whole generation of anaesthetists/intensivists have become expert in their use. However, before this method was introduced there was a long history of using negative pressure ventilation (NPV) by placing the patient’s body within a chamber with their head outside, with a seal at the neck. The lungs were inflated creating a negative pressure in the chamber or tank (the “iron lung”). NPV mimics and enhances natural respiration. The change from NPV to PPV was not a planned decision related to their relative evidence or efficacy, but occurred because of the convenience of not having to manage a patient inside a large tank, and ironically, a shortage of these large and expensive devices during the polio epidemic during the 1950s.
    [Show full text]
  • Position!Statement:!! Tracheostomy! Management!
    ! ! The!New!Zealand!Speech/language!Therapists’!Association! (NZSTA)! ! ! ! Position!Statement:!! Tracheostomy! Management! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! Copyright!©!2015!The!New!Zealand!Speech;language!Therapists’!Association!! !!!!! ! Disclaimer:!To!the!best!of!The!New!Zealand!Speech;language!Therapists’!Association’s!(‘the!Association’)! knowledge,!this!information!is!valid!at!the!time!of!publication.!The!Association!makes!no!warranty!or! representation!in!relation!to!the!content!or!accuracy!of!the!material!in!this!publication.!The!Association! expressly!disclaims!any!and!all!liability!(including!liability!for!negligence)!in!respect!of!use!of!the! information!provided.!The!Association!recommends!you!seek!independent!professional!advice!prior!to! making!any!decision!involving!matters!outlined!in!this!publication.!! ! ! ! Acknowledgements! ! Working!party! Lucy!Greig!(lead)! Molly!Kallesen! Melissa!Keesing! Anna!Miles! Turid!Peters! Samantha!Scott! Katie!Ward! !! Speech!Pathology!Australia!for!sharing!Speech&Pathology&Australia.&(2013).& Tracheostomy&Management&Clinical&Guideline.&Melbourne:&Speech&Pathology& Australia.&with!members!of!the!New!Zealand!Speech;language!Therapists’! Association.! !! Advisors! Karen!Brewer,!Speech;language!Therapist,!Te!Kupenga!Hauora!Maori,!Faculty!of! Medical!&!Health!Sciences,!The!University!of!Auckland.! ! Erena!Wikaire,!Physiotherapist,!Te!Kupenga!Hauora!Maori,!Faculty!of!Medical!&! Health!Sciences,!The!University!of!Auckland.! ! Reviewers! The!New!Zealand!Speech;language!Therapists’!Association!Executive!Committee!
    [Show full text]
  • Respiratory Failure Diagnosis Coding
    RESPIRATORY FAILURE DIAGNOSIS CODING Action Plans are designed to cover topic areas that impact coding, have been the frequent source of errors by coders and usually affect DRG assignments. They are meant to expand your learning, clinical and coding knowledge base. INTRODUCTION Please refer to the reading assignments below. You may wish to print this document. You can use your encoder to read the Coding Clinics and/or bookmark those you find helpful. Be sure to read all of the information provided in the links. You are required to take a quiz after reading the assigned documents, clinical information and the Coding Clinic information below. The quiz will test you on clinical information, coding scenarios and sequencing rules. Watch this video on basics of “What is respiration?” https://www.youtube.com/watch?v=hc1YtXc_84A (3:28) WHAT IS RESPIRATORY FAILURE? Acute respiratory failure (ARF) is a respiratory dysfunction resulting in abnormalities of tissue oxygenation or carbon dioxide elimination that is severe enough to threaten and impair vital organ functions. There are many causes of acute respiratory failure to include acute exacerbation of COPD, CHF, asthma, pneumonia, pneumothorax, pulmonary embolus, trauma to the chest, drug or alcohol overdose, myocardial infarction and neuromuscular disorders. The photo on the next page can be accessed at the link. This link also has complete information on respiratory failure. Please read the information contained on this website link by NIH. 1 http://www.nhlbi.nih.gov/health/health-topics/topics/rf/causes.html
    [Show full text]
  • The Following Information Was Take From
    The following excerpt has been taken from the Christopher & Dana Reeve Foundation Paralysis Resource Center website. http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.4453421/k.9F9F/Respiratory .htm Respiratory, Ventilator and Trach Resources As we breathe, oxygen in the air is brought into the lungs and into close contact with the blood, which absorbs it and carries it to all parts of the body. At the same time, the blood gives up carbon dioxide, which is carried out of the lungs with air breathed out. Lungs are not affected by paralysis. However, the muscles of the chest, abdomen, and diaphragm can be affected. As the various breathing muscles contract, they allow the lungs to expand, which changes the pressure inside the chest so that air rushes into the lungs. This is inhaling – which requires muscle strength. As those same muscles relax, the air flows back out of your lungs, and you exhale. If paralysis occurs at the C-3 level or higher, the phrenic nerve is no longer stimulated and therefore the diaphragm does not function. This means mechanical assistance -- usually a ventilator – will be needed to breathe. Persons with paralysis at the mid-thoracic level and higher will have trouble taking a deep breath and exhaling forcefully. Because they don’t have use of abdominal or intercostal muscles, these people have also lost the ability to forcefully cough. This can lead to lung congestion and respiratory infections. Moreover, secretions can act as glue, causing the sides of your airways to stick together and not inflate properly. This is called atelectasis, or a collapse of part of the lung.
    [Show full text]
  • Volume 46 Contents
    VOLUME 46 CONTENTS No 1 JANUARY 1991 Page Original articles 1 Risk of tuberculosis in immigrant Asians: culturally acquired immunodeficiency? P J Finch, F J C Millard, J D Maxwell 6 Effect of negative pressure ventilation on arterial blood gas pressures and inspiratory muscle strength during an exacerbation of chronic obstructive lung disease J M Montserrat, J A Martos, A Alarcon, R Celis, V Plaza, Thorax: first published as on 1 January 1991. Downloaded from C Picado 9 The protective effect of a beta2 agonist against excessive airway narrowing in response to bronchoconstrictor stimuli in asthma and chronic obstructive lung disease E H Bel, A H Zwinderman, M C Timmers, i H Dijkman, P J Sterk 15 Corticosteroid treatment as a risk factor for invasive aspergillosis in patients with lung disease L B Palmer, H E Greenberg, M J Schiff 21 Continuous extrapleural intercostal nerve block after pleurectomy E J Mozell, S Sabanathan, A J Mearns, P J Bickford-Smith, M R Majid, C Zografos 25 Erythropoietin concentrations in obstructive sleep apnoea J M Goldman, R M Ireland, M Berthon-Jones, R R Grunstein, C E Sullivan, J C Biggs 28 Effects ofhypercapnia and hypocapnia on respiratory resistance in normal and asthmatic subjects F J J van den Elshout, C L A van Herwaarden, H Th M Folgering 33 Abnormal lung function associated with asbestos disease of the pleura, the lung, and both: a comparative analysis K H Kilburn, R H Warsaw 39 Cysteine and glutathione concentrations in plasma and bronchoalveolar lavage fluid after treatment with N-acetylcysteine M
    [Show full text]
  • (HIMS) : an International Study of Incidents Occuring in Hyperbaric Medicine Units
    (IIIMS): An The Hyperbaric Incident Monitoring study International Study of Incidents Occurring in Hyperbaric Medicine Units Christy Joan Pirone BSN, Rfl Master of clinical science infulf;.ltment of the requirementfor the Degree of Thesis submitted to the University of Adetaide Adelaide UniversitY Department of Ctinical Nursing October 2000 GONTENTS Page Abstract Summary of Thesis vlll Declaration 1X Dedication x Acknowledgments xl List of Tables xiv List of Figures xv List of Abbreviations xvi 1 Introduction 2 The Research Questions 2 Aims 2 Obiectives J Overview of the thesis structure Chapter 1 Incident Monitoring In llealth Care 5 5 1.1 Scope and Significance of the Clinical Problem 7 l'2tncidentReportinginHealthcare:ReviewoftheLiterature 7 1.2.a Overviø,t¡ and Methodologl of the Revietv I 1.2.b Evolution snd methods of incident reporting 13 1.2.c IncidentAnalYsis 1l Chapter 2 History of SafetY in Clinical Hyperbaric Medicine t7 22 2.1 Hyperbaric Specific National StandardJGuidelines 22 2.2 Training Chapter 3 Review of the Literature: Incidents and safety in 27 Hyperbaric Medical Practice 28 3.1 MethodologYofthereview 29 3.2 Review of Incident Monitoring in Hyperbaric 31 3.2.a Findings of Incident Reporting in Iþperbaric 33 3.3 Incident literature review by type of incident 34 3.4 Fire úrcidents 36 3.5 Pressure Incidcnts 38 3.6 Hyperbaric StaffSafetY 38 3.6.a Fitness to dive 43 3.6.b Incidents Affecting Stqf Safety DecomPres s ion Illne s s (DC I) Barotrauma Pressure related iniuries OrygentoxicitY Mus c ulo s læl e t al Effe ct s
    [Show full text]
  • Medical Ventilator 1 Medical Ventilator
    Medical ventilator 1 Medical ventilator A medical ventilator may be defined as any machine designed to mechanically move breatheable air into and out of the lungs, to provide the mechanism of breathing for a patient who is physically unable to breathe, or breathing insufficiently. See also mechanical ventilation. While modern ventilators are generally thought of as computerized machines, patients can be ventilated indefinitely with a bag valve mask, a simple hand-operated machine. After Hurricane Katrina, dedicated staff "bagged" patients in New Orleans hospitals for days with simple bag valve masks. Ventilators are chiefly used in intensive care medicine, home care, and emergency medicine (as standalone units) and in anesthesia (as a component of an anesthesia machine). The Bird VIP Infant ventilator Function In its simplest form, a modern positive pressure ventilator consists of a compressible air reservoir or turbine, air and oxygen supplies, a set of valves and tubes, and a disposable or reusable "patient circuit". The air reservoir is pneumatically compressed several times a minute to deliver room-air, or in most cases, an air/oxygen mixture to the patient. If a turbine is used, the turbine pushes air through the ventilator, with a flow valve adjusting pressure to meet patient-specific parameters. When overpressure is released, the patient will exhale passively due to the lungs' elasticity, the exhaled air being released usually through a one-way valve within the patient circuit called the patient manifold. The oxygen content of the inspired gas can be set from 21 percent (ambient air) to 100 percent (pure oxygen). Pressure and flow characteristics can be set mechanically or electronically.
    [Show full text]
  • Severe Airway Complications Are Described
    Respiratory Medicine Case Reports 15 (2015) 33e35 Contents lists available at ScienceDirect Respiratory Medicine Case Reports journal homepage: www.elsevier.com/locate/rmcr Case report Syndrome of iron pill inhalation in four patients with accidental tablet aspiration: Severe airway complications are described * U. Caterino , P. Battistoni, S. Batzella, R. Dello Iacono, G. Lucantoni, G. Galluccio Center for Thoracic Endoscopy, S. Camillo Forlanini Hospital, Rome, Italy abstract Keywords: Iron pill inhalation represents a uncommon cause of syntomatic endobronchial foreign bodies. Unlike Aspiration foreign body, the direct contact of iron tablet onto the bronchial mucosa results in severe bronchial Bronchial necrosis damage in addition to obstruction and local irritation. Four patients with Iron Pill Inhalation Syndrome Ferrous sulphate are described. All but one patient developed irreversible bronchial stenosis as late post inflammatory complication. Bronchoscopic features and clinical evolution are described in order to reduce the risk of severe side-effects in patients highly suspected for iron pill aspiration. © 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Introduction asthma. While the chest X-ray was normal, spirometry revealed obstruction of the small and moderate airways. Despite steroid In patients with swallowing disorders and history of martial treatment, the symptoms continued for months and the patient therapy, the onset of cough, dyspnoea and recurrent pneumonias was addressed to our endoscopy unit for further evaluation. She are mandatory indication for bronchoscopic examination [1e7]. underwent a chest HRCT scan revealing a pulmonary consolidation Accidental iron pill-inhalation represents an acute broncho- of right lower lobe and partial right middle lobe atelectasis.
    [Show full text]
  • Negative Pressure Ventilation in the Treatment of Acute Respiratory Failure: an Old Noninvasive Technique Reconsidered
    Eur Respir J, 1996, 9, 1531–1544 Copyright ERS Journals Ltd 1996 DOI: 10.1183/09031936.96.09071531 European Respiratory Journal Printed in UK - all rights reserved ISSN 0903 - 1936 SERIES: 'CLINICAL PHYSIOLOGY IN RESPIRATORY INTENSIVE CARE' Edited by A. Rossi and C. Roussos Negative pressure ventilation in the treatment of acute respiratory failure: an old noninvasive technique reconsidered A. Corrado, M. Gorini, G. Villella, E. De Paola Negative pressure ventilation in the treatment of acute respiratory failure: an old non- Unità di Terapia Intensiva Respiratoria, invasive technique reconsidered. A. Corrado, M. Gorini, G. Villella, E. De Paola. ©ERS Villa d'Ognissanti, Azienda Ospedaliera di Journals Ltd 1996. Careggi, Firenze, Italy. ABSTRACT: Noninvasive mechanical ventilatory techniques include the use of nega- Correspondence: A. Corrado tive and positive pressure ventilators. Negative pressure ventilators, such as the "iron Unità di Terapia Intensiva Respiratoria lung", support ventilation by exposing the surface of the chest wall to subatmos- Villa d'Ognissanti pheric pressure during inspiration; whereas, expiration occurs when the pressure Viale Pieraccini, 24 around the chest wall increases and becomes atmospheric or greater than atmos- 50139 Firenze pheric. Italy. In this review, after a description of the more advanced models of tank ventila- tors and the physiological effects of negative pressure ventilation (NPV), we sum- Keywords: Acute respiratory failure marize the recent application of this old technique in the treatment of acute respiratory chronic obstructive pulmonary disease failure (ARF). Several uncontrolled studies suggest that NPV may have a potential iron lung negative pressure ventilation therapeutic role in the treatment of acute on chronic respiratory failure in patients neuromuscular disorders with chronic obstructive pulmonary disease and restrictive thoracic disorders, reduc- paediatric diseases ing the need for endotracheal intubation.
    [Show full text]