RESUMO
Tracheostomy is performed in about a quarter of ICU patients requiring prolonged mechanical ventilation, weaning from assisted ventilation, airway suction and airway protection. Tracheostomy improves patient comfort compared with standard intubation. Tracheostomy performed early upon ICU admission has not shown survival benefits. Percutaneous dilatational techniques are commonly used because the procedure can be performed at the bedside. Surgical tracheostomy is often reserved for cases with abnormal anatomy or failed percutaneous tracheostomy. It is not known which of the percutaneous techniques is safer in terms of perioperative complications. Ultrasound scanning of the neck and routine endoscopy during the procedure appear to reduce early complications. Decannulation is often delayed and an intensivist-led follow-up may facilitate timely removal of tracheostomy tubes in step down areas or wards.
Assuntos
Estado Terminal/terapia , Traqueostomia/métodos , Humanos , Respiração Artificial/métodos , Respiração Artificial/normas , Fatores de Tempo , Traqueostomia/normas , Resultado do TratamentoAssuntos
Broncoscopia/métodos , Esofagectomia/métodos , Hipóxia/prevenção & controle , Respiração Artificial/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Broncoscopia/efeitos adversos , Estudos de Coortes , Esofagectomia/efeitos adversos , Feminino , Tecnologia de Fibra Óptica , Humanos , Hipóxia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
OBJECTIVE: To report the use of pumpless extracorporeal carbon dioxide removal in two cases of acute severe asthma. DESIGN: Case reports. SETTING: Adult general intensive care unit, Leeds General Infirmary, Leeds, UK. PATIENTS: A 74-yr-old male and 52-yr-old female with life-threatening asthma developed progressive hypercapnia and severe acidosis that proved nonresponsive to all other therapies. INTERVENTION: Initiation of extracorporeal arteriovenous carbon dioxide removal using the Novalung device (Novalung GmbH, Lotzenäcker 3, D-72379 Hechingen, Germany). MAIN RESULTS: The addition of extracorporeal carbon dioxide removal to mechanical ventilation corrected hypercapnia and acidosis, allowing reduction of other supportive measures. In both cases, adequate gas exchange was maintained until their underlying condition improved sufficiently for device removal. The two patients were subsequently weaned from mechanical ventilation and made a full recovery. CONCLUSIONS: Extracorporeal carbon dioxide removal proved to be a valuable adjunct to mechanical ventilation and other medical treatment.