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2.
Respir Med Case Rep ; 19: 83-5, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27547723

RESUMO

Yokkaichi asthma was one of the most common environmental pollution diseases in Japan in the 1960s and 1970s. The problem of air pollution in Yokkaichi was solved in the 1970s. However, mortality and life expectancy were still affected by the late effects of air pollution in patients with Yokkaichi asthma even in the 2000s. In this case report, we described the experience of successful treatment of a patient with severe asthmatic status due to Yokkaichi asthma. A 40s-year-old man, who was officially certified as a patient with Yokkaichi asthma from his infancy, was admitted to hospital due to acute exacerbation of asthma. Mechanical ventilation, intravenous administration of aminophylline and dexamethasone, enteral administration of montelukast, and a transdermal patch of tulobuterol were started. However, because of the lack of improvement in clinical status, inhalation of procaterol using vibrating mesh nebulizer systems was started. Inhalation of procaterol was used three times a day. After using the vibrating mesh nebulizer, respiratory system compliance and hypercapnia rapidly improved. Bilateral expiratory wheezing was diminished. Weaning from mechanical ventilation was initiated, and on the eighth day of mechanical ventilation, the patient was extubated. Although intractable respiratory failure with decreased respiratory system compliance resulting from the late effects of air pollution and a long-time asthmatic inflammatory condition was observed, the use of a vibrating mesh nebulizer for the inhaled administration of procaterol was useful to relieve severe bronchospasm due to Yokkaichi asthma.

3.
Masui ; 63(1): 84-7, 2014 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-24558938

RESUMO

A 5-year-old girl was admitted to our hospital after resuscitation from cardiac arrest due to near-drowning accident in a river. On admission, Glasgow Coma Scale score was 7; arterial blood pressure was 113/73 mm Hg; heart rate was 157 beats x min(-1), and percutaneous oxygen saturation was 99% on 10 l x min(-1) of oxygen. The patient was intubated with a 5.0 mm internal diameter endotracheal tube, and therapeutic hypothermia was started for neural protection. Hypothermia in the target temperature of 34 degrees C was maintained for 24 hours using Arctic Sun System. Although the patient had been sedated with fentanyl 0.6-1.2 microg x kg(-1) x hr(-1), midazolam 0.2-0.4 mg x kg(-1) x hr(-1) and dexmedetomidine 0.6-1.0 mirog x kg(-1) x hr(-1), agitation increased during the rewarming period following hypothermia. To avoid accidental extubation, we used Anchor Fast as a device for securing oral endotracheal tube. Anchor Fast kept the tube position properly even though the patient was turned or moved. Seventy-two hours later, she was rewarmed and extubated as scheduled. Ten days after admission, she was discharged without any neurological deficits.


Assuntos
Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Hipotermia Induzida/métodos , Intubação Intratraqueal/instrumentação , Afogamento Iminente/complicações , Pré-Escolar , Feminino , Humanos , Intubação Intratraqueal/métodos , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/prevenção & controle , Ressuscitação , Resultado do Tratamento
4.
Masui ; 62(8): 939-41, 2013 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-23984568

RESUMO

A 63-year-old female with obesity (body mass index of 32.0 kg x m(-2)) was scheduled for total abdominal hysterectomy under combined epidural general anesthesia. The surgical procedure was completed without any troubles. Immediately after tracheal extubation, however, the patient developed acute respiratory distress, and the percutaneous oxygen saturation (Spo2) decreased from 97 to 44% for 1 minute. When the patient was admitted to our intensive care unit due to hypoxia, arterial blood gas values showed pH 7.37, Paco2 40.4 mmHg, Pao2 67.5 mmHg, and Spo2 94% on 5 l x min(-1) of oxygen via face mask. Her respiratory rate was 23 breaths x min(-1). We used a nasal high-flow humidified oxygen system (Optiflow) to improve oxygenation. We set the initial flow rate at 35 l x min(-1) with 50% oxygen. One hour after initiating the nasal high-flow system, the patient's respiratory rate fell to 18 breaths x min(-1), and Spo2 rose up to 98%. Arterial blood gas showed improved Pao2 of 98.0 mmHg. Nasal high-flow therapy was useful to avoid intubation in a patient with postanesthetic respiratory failure.


Assuntos
Extubação , Hipóxia/terapia , Oxigenoterapia/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade
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