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Congenital Laryngeal Disease
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Treatment is difficult and may involve pressure ventilation – continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) – until there is spontaneous improvement. A tracheostomy may be needed to facilitate ventilation or to bypass a malacic segment. Some cases respond to ‘aortopexy’, where the aorta is hitched forward and anchored to the sternum, thus pulling the mediastinal structures, including the trachea, with it and opening the lumen.
Congestive Heart Failure
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Treatment of pulmonary edema begins with 100% oxygen administered via a nonrebreather mask. The patient is kept in an upright position. Furosemide is given by IV or continuous infusion. Nitroglycerin is administered sublingually, followed by an IV drip that is titrated upwards every 5 minutes as needed. Intravenous morphine has been used for severe anxiety and to reduce the breathing difficulties, but today is used mostly palliatively since studies have shown it is linked to worsened outcomes. If there is significant hypoxia, noninvasive ventilatory assistance is given by using bilevel positive airway pressure. Tracheal intubation and mechanical ventilation are needed if there is carbon dioxide retention or the patient is nonalert or not fully conscious.
Perioperative cardiovascular evaluation and treatment of elderly patients undergoing noncardiac surgery
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Dipika Gopal, Monika Sanghavi, Lee A. Fleisher
It is believed by some authorities that approximately one in five American adults have at least mild obstructive sleep apnea (OSA). This figure is likely to increase as the population becomes older and more obese. In the perioperative period, adult patients with OSA, even if asymptomatic, present special challenges that must be addressed to minimize risk of morbidity and mortality. Most experts agree that, in the absence of a sleep study, a presumptive diagnosis of OSA may be made based on consideration of the following criteria: increased body mass index, increased neck circumference, snoring, daytime hypersomnolence, and tonsillar hypertrophy. Preoperative initiation of continuous positive airway pressure should be considered particularly if OSA is severe. Patients with increased perioperative risk from OSA should be extubated when fully awake and in the semi-upright position after full reversal of neuromuscular blockade. Bilevel positive airway pressure use immediately after extubation can be considered in those at high risk for reintubation (23).
An update on Alpers-Huttenlocher syndrome: pathophysiology of disease and rational treatment designs
Published in Expert Opinion on Orphan Drugs, 2018
Management of the airway and respiratory needs of a patient with AHS is challenging. As the disease progresses, family involvement concerning the intensity of respiratory intervention can become an emotional issue. Airway management ranges from partial external treatments such as bilevel-positive airway pressure to full ventilator support with tracheostomy. The progression of the disease can be due to the loss of central respiratory drive, as a result of cortical injury and progressive myopathy leading to obstructive apnea. The resulting hypoventilation and hypercarbia can exacerbate the already ongoing encephalopathy. Poor sleep with frequent awakenings can influence inattention, irritability, and memory loss. The use of respiratory support needs to be managed by sleep specialists, and discussions with family and other providers to determine the level and intensity of intervention required.
Mask interface for continuous positive airway pressure therapy: selection and design considerations
Published in Expert Review of Medical Devices, 2018
Zhichao Ma, Michael Drinnan, Philip Hyde, Javier Munguia
PAP therapy has been used to treat OSA syndrome as an effective clinical approach. There are a wide range of PAP devices such as continuous positive airway pressure (CPAP), auto-adjusting CPAP, bi-level PAP, adaptive servo ventilation, and volume-assured pressure support [13]. Bilevel Positive Airway Pressure (BiPAP) and CPAP are two typical forms, which are commonly used for treating moderate or severe OSA syndrome and both rely on supplying pressurized air to the patient’s airways via a mask. BiPAP can offer different levels of air pressure during inspiration and expiration; typically, higher air pressure is supplied during inspiration and lower pressure is supplied during expiration as opposed to CPAP which delivers a constant single pressure level. The CPAP system comprises a pump, a flexible hose, a facial mask, and a headgear. Figure 3 shows a basic connection between CPAP device and patients [14,15]. The pump is used to pressurize the air beyond atmospheric pressure, at a level that is comfortably tolerated by the wearer [16] opening the blocked airway via a pressurized airflow (Figure 4).
Pneumonia with pleural empyema caused by Salmonella Typhi in an immunocompetent child living in a non-endemic country
Published in Paediatrics and International Child Health, 2018
Gwénaëlle Duhil de Bénazé, Emilie Desselas, Véronique Houdouin, Patricia Mariani-Kurkdjian, Ahmed Kheniche, Stéphane Dauger, Géraldine Poncelet, Jean Gaschignard, Michaël Levy
Her respiratory distress worsened and she was transferred to the intensive care unit, Robert Debré Hospital (Paris, France). Non-invasive ventilation with oxygen was undertaken using bilevel positive airway pressure through a facial mask. Transthoracic echocardiography was normal. Culture of the pleural fluid demonstrated S. enterica serotype Typhi and repeated blood (five) and stool cultures (two) were negative. The salmonella was sensitive to chloramphenicol, amoxicillin, co-trimoxazole, cefotaxime/ceftriaxone, ciprofloxacin, nalidixic acid and azithromycin (agar diffusion test). The antibiotic regimen was switched to intravenous ceftriaxone 50 mg/kg/day and ciprofloxacin 30 mg/kg/day for 15 days followed by 4 weeks of oral ciprofloxacin 30 mg/kg/day.