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Acquired Laryngotracheal Disease
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Premature babies, often with multiple significant and life-threatening medical issues, are now routinely managed on highly specialised neonatal and paediatric intensive care units (PICUs) with excellent survival prospects. Many require assisted ventilation, typically with the help of an indwelling ET tube, sometimes for long periods. As this practice became commonplace from the 1960s onwards, it became apparent that a number of children developed scarring and stenosis of the airway, presumably as a direct consequence of prolonged or traumatic intubation. Trauma at the level of the cords caused glottic webs; trauma further down caused SGS. Tracheostomy was the inevitable consequence until surgical techniques to reconstruct the airway became widely available.
Pulmonary Oedema, Lymphangitis Carcinomatosa and ARDS.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Pleural effusions are relatively uncommon, and the heart is often of normal size. Some patients recover completely, whilst others develop diffuse fibrosis (sometimes within one to two weeks), and when this occurs only slowly recover after several weeks or months. About half of the cases are fatal, particularly if secondary infection, diffuse intra-vascular coagulation, coma or multisystem failure occur. Assisted ventilation is often used to maintain blood oxygenation, as well as general supportive therapy. The assisted ventilation may lead to bullous formation and pneumothoraces, the latter often being difficult to recognise on radiographs taken in supine or semi-recumbent positions (see ps. 14.22 - 23); 'shoot-through' lateral views and/or CT may be required to show them (see above).
Medicines in neonates
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Kuzemko and Paala introduced the methylxanthines into the management of apnoeic premature infants in the early 1970s [2]. Others have shown theophylline and caffeine to both be effective [3–6]. Severe apnoeic spells were significantly decreased [7] or completely controlled [8]. There was also a decrease in the total duration of hypoxaemia and of hyperoxaemia [5], as fewer interventions with oxygen for apnoeic spells were required. Controlled studies have demonstrated a reduction in the need for assisted ventilation and in the cardio-respiratory alterations [10,11]. No extensive placebo controlled trials on methylxanthine efficacy have been performed since these initial studies.
Personalized medicine targeting different ARDS phenotypes: The future of pharmacotherapy for ARDS?
Published in Expert Review of Respiratory Medicine, 2023
Florian Blanchard, Arthur James, Mona Assefi, Natacha Kapandji, Jean-Michel Constantin
This is obvious to say that, for years and years, ARDS patients have been deeply sedated and often paralyzed by NMBA. A multimodal patient-centered approach, including effective early analgesia, optimal sedation, and delirium/agitation-free emergence, is imperative for all adults in the ICU and should also be considered for patients with ARDS [106]. To manage both neurological and respiratory issues, assisted ventilation should be promoted and respiratory drive controlled, because early spontaneous breathing can be beneficial or deleterious, depending on the strength of spontaneous activity, severity of lung injury, and the patient’s global inflammatory status [107]. Future studies are needed to determine ventilator/sedation strategies that minimize injury but still maintain some diaphragm activity. No data are available at the time we finish this review, but phenotyping ARDS according to, at least, inflammation, is likely the key to move from patients being deeply sedated to light sedation with spontaneous breathing, and therefore the way to increase long-term outcomes.
How to recognize patients at risk of self-inflicted lung injury
Published in Expert Review of Respiratory Medicine, 2022
Tommaso Pettenuzzo, Nicolò Sella, Francesco Zarantonello, Alessandro De Cassai, Federico Geraldini, Paolo Persona, Elisa Pistollato, Annalisa Boscolo, Paolo Navalesi
Recognizing patients at risk of P-SILI is clinically relevant. Indeed, if a preexisting lung damage is worsened by an excessive patient’s inspiratory effort, then strategies aiming at preventing the detrimental effects of high respiratory drive and breathing effort might improve patients’ outcome. Clinicians must carefully assess the balance between risks and benefits of controlled mechanical ventilation, as compared to spontaneous breathing with or without assisted ventilation. In addition, in patients at risk for P-SILI, lung-protective mechanical ventilation could be considered not just supportive, but rather prophylactic or even therapeutic [1]. Worth mentioning, however, despite the increasing experimental and clinical data on which the concept of P-SILI is based [3–10], no study has insofar clearly demonstrated the efficacy of any preventative or therapeutic strategy for the management of P-SILI.
Pheochromocytoma with Acute Non-cardiac Pulmonary Edema: A Report of One Case and the Review of Literature
Published in Cancer Investigation, 2021
Yuan Liu, Ning Wang, Shi Li, Ling Jiang, Chunfang Liu, Jian Xu, Huadong He
Non-invasive ventilator-assisted ventilation was given. 0.9% sodium chloride (500 ml) was given intravenously to correct shock. Moxifloxacin sodium chloride (0.4 g, intravenous drip, once a day) was given to resist infection, oseltamivir (75 mg, oral, twice a day) was given to resist virus, methylprednisolone sodium succinate (40 mg, intravenous drip, once a day) was given to relieve lung inflammation, and ambroxol (30 mg, intravenous drip, twice a day) was given to eliminate phlegm. Reduced glutathione (2.4 g, intravenous drip, once a day) was given to protect the liver. After the above symptomatic treatment, the patient's condition gradually stabilized. Reexamination showed that myocardial enzymes, troponin, brain natriuretic peptide (BNP) and blood routine were generally normal. After 4 days of admission, pulmonary CT showed that the pulmonary lesions were obviously improved (Figure 3).