Application and Technical Principles of Catheter High-Frequency Jet Ventilation.

The aim of this publication is to analyze the topic of high-frequency jet ventilation (HFJV), namely catheter HFJV (C-HFJV), from a mathematical-physical as well as a clinical point of view. There are known issues with applying anesthesia and artificial lung ventilation (ALV) during surgical procedures in the upper airways, e.g., during bronchoscopy or tracheostomy. The principles, advantages, and disadvantages of HFJV are discussed in context with basic physical principles to clarify the proper use of this method. The basic technical principles of catheter construction, as well as its functional properties from a biophysical point of view, are introduced. Also, the placement of the catheter in the airways, the set-up of the HFJV ventilator, and the indications as well as the risks and contraindications of the use of C-HFJV are analyzed. This leads to the explanation of potentially optimal techniques for C-HFJV applications. In this article, we present the positive effects of C-HFJV even with complications such as bacterial or viral pneumonia, including COVID-19. In conclusion, we offer recommendations for clinical practice obtained from a literature review and from our rich clinical experience.

Point-of-Care Ultrasound Diagnosis of Acute High Altitude Illness: A Case Report.

With the advent of high-quality portable ultrasound machines, point-of-care ultrasound (POCUS) has gained interest as a promising diagnostic tool for patients with high altitude illness. Although POCUS is used successfully in hospital environments to detect interstitial pulmonary edema and increased intracranial pressure, the relationship between specific sonographic criteria and high altitude illness is still unclear. We report the case of a healthy 32-y-old male who developed acute respiratory distress and neurologic impairment at 4321 m while participating in a high altitude medical research expedition. We discuss the potential of POCUS to diagnose acute high altitude illness by lung ultrasound, optic nerve sheath diameter measurement, and echocardiography. Ultrasound in combination with clinical findings helped us to exclude relevant differential diagnoses, start on-site treatment, and organize an evacuation. We used serial clinical and ultrasound examinations to assess the patient over time. Although its role in high altitude medicine needs further investigation, we believe that POCUS can be a valuable tool to aid clinical decision-making in remote, high altitude environments.

Point-of-Care Ultrasound Diagnosis of Community-Acquired Pneumonia in a High-Altitude, Resource-Poor Setting.

Objective: Point-of-care ultrasound (POCUS) for the evaluation of patients with suspected high-altitude pulmonary edema can be a useful tool in remote, high-altitude areas. The same technique can also yield high differential diagnostic accuracy for other relevant causes of acute respiratory distress at high altitude. With the recent development of high-quality, hand-held ultrasound devices, POCUS can be used with increasing reliability in such environments. We present a case of severe respiratory disease in a young, otherwise healthy patient during a trek at high altitude in the Khumbu valley of Nepal. Methods: By using POCUS, we were able to exclude several important differential diagnoses and diagnose the patient with community-acquired pneumonia. Results: Our findings allowed us to start early on-site treatment and positively influenced shared decision-making with the patient, which led to a helicopter evacuation. Conclusions: This case illustrates that POCUS can be a valuable tool in remote, high-altitude regions and could allow healthcare providers to diagnose and follow-up with patients exhibiting acute respiratory symptoms when other radiological imaging modalities are not available.

Impact of a prehospital discrimination between trauma patients with or without early acute coagulopathy of trauma and the need for damage control resuscitation: rationale and design of a multicenter randomized phase II trial.

BACKGROUND: The evidence of the Trauma Induced Coagulopathy Clinical Score (TICCS) accuracy has been evaluated in several studies but the potential effect of its use on patient outcomes needs to be evaluated. The primary objective of this study is to evaluate the impact on mortality of a prehospital discrimination between trauma patients with or without a potential need for damage control resuscitation. METHODS: The trial will be designed as randomized phase II clinical trial with comparison of the experimental protocol against the standard of care. The TICCS will be calculated on the site of injury for the patients of the intervention group and treatment will be guided by the TICCS value. Seven days mortality, 30 days mortality, global use of blood products and global hospital length-of-stay will be compared. DISCUSSION: Many data suggest that a very early flagging of trauma patients in need for DCR would be beneficial but this need to be proved. Do we improve our quality of care by an earlier diagnosis? Does a prehospital discrimination between trauma patients with or without a potential need for DCR has a positive impact?

Air versus ground transport of patients with acute myocardial infarction: experience in a rural-based helicopter medical service.

AIMS: Primary prehospital Helicopter Emergency Medical Service (HEMS) interventions may play a role in timely reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI). We designed a prospective study involving patients with acute myocardial infarction aimed at the evaluation of the potential benefit of such primary HEMS interventions as compared with classical Emergency Medical Services ground transport. METHODS AND RESULTS: This prospective study was conducted from 1 July 2007 to 15 June 2012. Successive patients with STEMI eligible for percutaneous coronary intervention were included. Simulated ground-based access times were computed using a digital cartographic program, allowing the estimation of healthcare system delay from call to admission to the catheterization laboratory.During the study period, 4485 patients benefited from HEMS activations. Of these patients, 342 (8%) suffering from STEMI were transferred for primary percutaneous coronary intervention. The median primary response time was 11 min (interquartile range: 8-14 min) using the helicopter and 32 min (25-44 min) using road transport. The median transport time was 12 min (9-15 min) using HEMS and 50 min (36-56 min) by road. The median system delay using HEMS was 52 min (45-60 min), whereas this time was 110 min (95-126 min) by road. Finally, the system delay median gain was 60 min (47-72 min). CONCLUSION: Using HEMS in a rural region allows STEMI patients to benefit from appropriate rescue care with delays similar to those seen in urban settings.