Intrathoracic cystic hygroma in an infant with respiratory failure

A 6 month old infant presenting initially with clinical signs of bronchiolitis developed acute symptoms of large airway obstruction and respiratory failure despite treatment of bronchiolitis. Endotracheal intubation and oxygen therapy resulted in immediate and dramatic improvement of respiratory failure. Plain chest radiograph, computerized tomography and surgical biopsy with subsequent histological examination established that the respiratory failure was due to a mediastinal cystic hygroma.(AU)

Nasal non-invasive positive pressure ventilation

This case report is presented to illustrate the advantages of Nasal Non-Invasive Positive Pressure Ventilation (NNIPPV). It is relatively simple, practical, easy to use, and has been proven to be an efficient means of treatment for patients with chronic respiratory failure (CRF), especially hypercanic respiratory failure. The availability of NNIPPV has increased in recent years and has made the concept of domiciliary ventilatory support a practical reality. It has resulted in decreased frequency and duration of hospital admission and hence minimised certain demands on the health service. The use of NNIPPV should be encouraged in developing countries where a shortage of health personnel (especially nurses) and limited health care budgets exists (AU)

Modified plasma exchange in life-threatening Guillain-Barre syndrome - abstract

Modified plasma exchange (MPE), a simpler procedure than a conventional plasmapheresis which uses automated equipment and expensive replacement fluids, has recently been recommended for use in hospitals with limited resources in the management of patients with Guillain-Barre Syndrome (GBS). We have performed MPE in 7 patients with life-threatening respiratory failure due to GBS, using fresh frozen plasma as replacement fluid. In 5 out of 6 patients, in whom MPE was started at the onset of mechanical ventilation, rapid improvement inconsistent with the natural history of the disease was noted. In 2 of these patients, due to severity of illness, more plasma per day than previously recommended was safely removed. In one patient, MPE was started with a peak expiration flow rate of 2.2 litres per minute and assisted ventilation was unnecessary due to rapid improvement. Death occurred in one patient from respiratory complications and was not directly due to MPE. Our study confirms the safety and efficacy of MPE and suggests that more plasma can be safely exhanged by this method than previously recommended (AU)

Newer methods of managing respiratory failure in the newborn - abstract

In spite of the technological advances in neonatal ventilation support over the past two decades, about 30-40 percent of term newborns with severe meconium aspiration syndrome (MAS) and/or persistent pulmonary hypertension of the newborn, succumb in spite of aggressive ventilatory management. The use of Extracorporeal Membrane Oxygenation (ECMO) for infants with severe MAS or PPHN in intractable respiratory failure has significantly changed their outcome. Criteria for placing infants on ECMO included: A) Acute deterioration pa0[2] <50 (AaD02 > 630) x 2 hours or pH <7.15 x 2 hours; or B) Lack of Improvement pa0[2] <60 (AaD0>620) x 8 hours pH <7.2 x 8 hours. Mean ventilation settings prior to initiation of ECMO. Fc0[2] 1.0 Inv 101ñ22.7 PIP 46.8ñq.9 PEEP 4.5ñ1.6 with mean blood gases pH 7.38ñ0.21 Pa0[2] 34.5ñ14.5 Pc0[2] 41.5ñ19.8. Between February 1986 and October 1987, 55 infants were placed on ECMO for a mean time of 84.3ñ47.8 hours. Fifty-three (96.3 percent) infants survived the procedure and were successfully decannulated, 4 infants expired after coming off ECMO support, leaving an overall survival rate of 89.1 percent (AU)

Mortality from thermal injuries at the University Hospital of the West Indies (1972-1976)

Mortality data in 170 patients admitted to the University Hospital of the West Indies with thermal injuries during a five-year period (1972 - 1976) have been reviewed. Sixteen deaths were recorded, giving a mortality rate of 9.4 percent which is higher than those reported in other series. Hypovolaemia and sepsis accounted for over two-thirds of the deaths. Mortality can be reduced by prompt and adequate fluid therapy and by nursing patients with burns in a special isolated unit. It is still important to recognize the futility of over-zealous treatment in certain patients with massive burns in whom 100 percent mortality is expected. (AU)

Cardiorespiratory resuscitation in the prone position in small children

A method of cardiorespiratory resuscitation in the prone position for small children is described. It is especially recommended for use when the resuscitator is alone and has no equipment. No time is lost in securing or maintaining a clear airway. Circulatory and ventilatory assistance is rendered simultaneously and continuously (AU)

Cor pulmonale due to uncommon forms of lung fibrosis

Four cases of lung fibrosis are described in Jamaicans. The cases are of interest because the fibrosis differed in origin. Each terminated with failure of a hypertrophied right heart, the duration of failure being relatively short before death (AU)

Intrathecal Pethidine as sole anaesthetic agent for operative procedures of the lower limb, inguinal area and perineum

Intrathecal pethidine as a sole anaesthetic agent for surgical procedures of the lower limbs, perineum and inguinal areas was investigated and compared with hyperbaric Bupivacaine. A total of 90 patients were randomly divided into groups 1 (bupivacaine) and 2 (pethidine). In group 2, 26 of 46 patients (59 percent) had their procedures successfully with intrathecal pethidine alone and did not require or request any additional sedation or analgesia. This compared to 24 of 44 patients (52.2 percent) in the bupivacaine group. Pethidine had a prolonged postoperative analgesia and was more cost-effective. The incidences of side effects were acceptable. (hypotension 13.6 percent, bradycardia 9.09 percent, nausea and vomiting 11.4 percent, and pruritus 15.9 percent). Pethidine can be used as a sole anaesthetic agent for operative procedures of the lower limbs; side effects are mild and can be treated. (AU)