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1.
Medicine (Baltimore) ; 99(1): e18647, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895828

RESUMO

RATIONALE: Influenza is an infection caused by the influenza virus, and its symptoms are mostly mild and self-limiting. However, influenza can cause severe or fatal complications in high-risk patients. Although tracheobronchitis is one of the common complications of influenza, necrotizing tracheobronchitis is very rare. Herein, we describe a case of necrotizing tracheobronchitis causing airway obstruction complicated by pandemic 2009 H1N1 influenza. PATIENT CONCERNS: A 60-year-old man presented with fever and dyspnea. On arrival at the emergency room (ER), the patient received oxygen 4 L/minute via a nasal prolong owing to mild hypoxemia. And invasive mechanical ventilation was needed 5 hours after arrival at the ER due to progressive hypoxemia. DIAGNOSES: Fiberoptic bronchoscopy was performed owing to bloody secretion in the endotracheal tube and revealed diffuse tracheobronchitis with necrotic and hemorrhagic materials obstructing the trachea and bronchus. The pandemic 2009 H1N1 influenza virus was detected from the bronchial washing sample; no other microorganism was detected. INTERVENTION: He received peramivir plus oseltamivir and broad-spectrum antibiotics. OUTCOMES: The bloody secretion continued. He developed cardiac arrest due to airway obstruction on the 6th day of admission. After cardiac arrest, his condition progressed to multi-organ failure, and the patient died on the 10th day of admission. LESSONS: We suggest that necrotizing tracheobronchitis be considered in patients with influenza who present with unexplained hypoxemia.


Assuntos
Obstrução das Vias Respiratórias/virologia , Bronquite/virologia , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/complicações , Doenças da Traqueia/virologia , Brônquios/diagnóstico por imagem , Brônquios/patologia , Bronquite/complicações , Bronquite/diagnóstico por imagem , Bronquite/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Doenças da Traqueia/complicações , Doenças da Traqueia/diagnóstico por imagem , Doenças da Traqueia/patologia
3.
Medicine (Baltimore) ; 98(51): e18339, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860988

RESUMO

Mandibular distraction osteogenesis (MDO) is an effective treatment for tongue-based airway obstruction in infants with severe Pierre Robin sequence (PRS). Most infants receiving MDO require postoperative mechanical ventilation (MV) to assist breathing. Optimal MV time for each individual patient and factors influencing the time must be identified to guide clinical decision-making.A retrospective analysis was performed on 75 infants with PRS receiving MDO from November 2016 to August 2018. Twenty-six were females and 47 were males. Data extracted from the hospital information system included sex, age, weight, history of preterm labor, preoperative pulmonary infection, laryngomalacia/tracheomalacia, laryngoscope exposure classification, anesthesia duration, operation duration, postoperative treatment site, situation of distraction, postoperative complications and MV duration. Statistical analyses were conducted to investigate the potential associations of these factors with MV time.Seventy-three PRS syndrome patients received anesthesia for MDO device procedures were considered eligible for study. Patient sex, history of preterm labor, preoperative pulmonary infection, laryngomalacia/tracheomalacia, laryngoscopy exposure difficulty, postoperative treatment site (neonatal or pediatric intensive care unit), ventilator-associated pneumonia, age, weight, anesthesia duration, and operation duration had no significant influence on postsurgical MV time (P > .05). Amount of distraction at the time of extubation had statistically significant influence on postoperative MV time (P < .05). In addition, scatter plots revealed linear relationships between postoperative MV time and amount of distraction at extubation.According to this analysis, amount of distraction was associated with MV time following MDO for severe PRS and roughly 6 days post-surgery is a generally safe extubation time.


Assuntos
Obstrução das Vias Respiratórias/terapia , Mandíbula , Osteogênese por Distração , Síndrome de Pierre Robin/complicações , Respiração Artificial , Extubação , Obstrução das Vias Respiratórias/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Tempo
5.
Zhonghua Shao Shang Za Zhi ; 35(11): 811-813, 2019 Nov 20.
Artigo em Chinês | MEDLINE | ID: mdl-31775470

RESUMO

Objective: To explore the effect of tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall in emergency treatment of laryngeal edema in patients with burns. Methods: From November 2000 to August 2018, 22 patients with severe burn or extremely severe burn combined with acute laryngeal edema were rescued in the author's unit, including 18 males and 4 females, aged 17 to 68 years. All patients were complicated with mild inhalation injury or above and more than deep partial-thickness burn to head, face, and neck. From November 2000 to October 2012, simple emergency tracheotomy was performed for 12 cases. From May 2013 to August 2018, tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall was performed for 10 cases. Rescue effect and complication of the two kinds of tracheotomy were recorded. Data were processed with Fisher's exact probability test. Results: Among the 12 patients treated with simple emergency tracheotomy, 5 cases survived and 7 cases died of suffocation during tracheotomy. Among the 10 patients treated with tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall, 9 cases survived and 1 case died of cardiac arrest caused by arrhythmia. There was statistically significant difference in successful rescue effect between the two kinds of tracheotomy (P<0.05). Among the 14 patients who were successfully rescued, symptoms of insomnia and post-traumatic stress disorder occurred in 12 cases, which were relieved after symptomatic treatment for 14 to 45 d without permanent hypoxic brain damage. Conclusions: In case of loss of the condition of preventive tracheotomy, first aid of acute laryngeal edema of burn patient is very difficult. Tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall is simple and rapid with high successful rate and amelioration of hypoxia, which is an ideal plan for laryngeal edema.


Assuntos
Obstrução das Vias Respiratórias , Queimaduras/cirurgia , Tratamento de Emergência , Edema Laríngeo/cirurgia , Traqueotomia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Adulto Jovem
7.
Br Dent J ; 227(9): 783-789, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31705093

RESUMO

Paediatric medical emergencies can be distressing for the child, parent and clinician alike. This paper aims to remind those in primary dental care how to manage these emergencies safely and effectively. Topics covered include paediatric airway management, basic life support, defibrillation, choking, asthma, paediatric emergency drug doses and epilepsy.


Assuntos
Obstrução das Vias Respiratórias , Asma , Serviços Médicos de Emergência , Criança , Assistência Odontológica , Emergências , Humanos , Atenção Primária à Saúde
9.
Medicine (Baltimore) ; 98(42): e17713, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626153

RESUMO

Few data are available regarding factors that impact cricothyrotomy use and outcome in general hospital setting. The aim of the present study was to determine the incidence and outcomes of the patients underwent cricothyrotomy in a "cannot intubate, cannot oxygenate" (CICO) situation at university hospitals in Korea.This was a retrospective review of the electronic medical records of consecutive patients who underwent cricothyrotomy during a CICO situation between March, 2007, and October, 2018, at 2 university hospitals in Korea. Data regarding patient characteristics and outcomes were analyzed using descriptive statistics.During the study period, a total of 10,187 tracheal intubations were attempted and 23 patients received cricothyrotomy. Hospitalwide incidence of cricothyrotomy was 2.3 per 1000 tracheal intubations (0.23%). The majority of cricothyrotomy procedures (22 cases, 95.7%) were performed in the emergency department (ED); 1 cricothyrotomy was attempted in the endoscopy room. In the ED, 5663 intubations were attempted and the incidence of cricothyrotomy was 3.9 per 1000 tracheal intubations (0.39%). Survival rate at hospital discharge was 47.8% (11 of 23 cases). Except for cardiac arrest at admission, survival rate was 62.5% (10 of 16 cases). Successful cricothyrotomy was performed in 17 patients (73.9%) and 9 patients (52.9%) were survived. Among 6 patients of failed cricothyrotomy (26.1%), 2 patients (33.3%) were survived. After failure of cricothyrotomy, various methods of securing airway were established: 3 tracheal intubations, 1 nasotracheal intubation, and 1 tracheostomy.The success rate of cricothyrotomy and survival rate in the CICO situation were not high. After failure of cricothyrotomy, various methods of securing airway were performed.


Assuntos
Manuseio das Vias Aéreas/métodos , Obstrução das Vias Respiratórias/cirurgia , Cartilagem Cricoide/cirurgia , Sistema de Registros , Cartilagem Tireóidea/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/mortalidade , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Intubação Intratraqueal/métodos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Adulto Jovem
10.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(10): 748-753, 2019 Oct 07.
Artigo em Chinês | MEDLINE | ID: mdl-31606987

RESUMO

Objective: To study the correlation between the standardized palatal sensory threshold and airway obstruction and hypoxia during sleep, and to infer its role in the pathogenesis of OSAHS. Methods: From August 2016 to May 2017, 92 OSAHS patients as experimental group and 48 non-OSAHS volunteers as control group were recruited in Department of Otorhinolaryngology Head and Neck Surgery, Changhai Hospital Affiliated to the Naval Medical University. The tactile sense was measured by Smmes-Weinstein Monofilaments in the middle of uvula and both side of hard palate,then the threshold of the uvula minus, the average threshold of the hard palate as the standardized palatal sensory threshold(SPST). The control point of both groups was located in the central underlip. Mann-Whitney U test for comparing two independent samplesand partial correlation analysis. Results: There was no difference in tactile threshold of underlip between the experimental group and the control group(0.020[0.008,0.020] g/mm(2) vs. [0.020(0.008,0.020] g/mm(2), Z=293.0, P=0.221); the tactile sense of the experimental group was larger than that of the control group in thehardpalate(0.040[0.140,0.055] g/mm(2) vs. 0.138[0.064,0.400] g/mm(2), Z=4.5, P=0.000), soft palate(0.400[0.280,0.400] g/mm(2) vs. 1.400[1.000,4.000] g/mm(2), Z=0, P=0.000) and SPST(0.355[0.125,0.373] g/mm(2) vs. 1.285[0.896,3.025] g/mm(2), Z=0, P=0.000). The SPST was positive correlation with apnea hypopneaindex(AHI)(r=0.835, P=0.000) and negative correlation with the nadir oxyhemoglobin saturation (r=-0.636, P=0.000). Conclusion: The greater the standardized palatal sensory threshold, the worse the condition of OSAHS, the lower, the lowest blood oxygen at night, and the impaired upper airway sensory function plays an important role in the pathogenesis of OSAHS.


Assuntos
Obstrução das Vias Respiratórias/fisiopatologia , Hipóxia/fisiopatologia , Palato Duro/fisiopatologia , Limiar Sensorial , Apneia Obstrutiva do Sono/fisiopatologia , Úvula/fisiopatologia , Obstrução das Vias Respiratórias/complicações , Humanos , Apneia Obstrutiva do Sono/etiologia , Tato , Percepção do Tato
11.
Niger J Clin Pract ; 22(10): 1459-1461, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607740

RESUMO

Tracheobronchomalacia is a rare condition in the pediatric age group which may be life-threatening when it occurs. The common form of tracheomalacia is congenital, presenting with wheezing and cough. We report a case of a 65-day-old baby who was treated with non-invasive mechanical ventilation due to respiratory distress since the day of birth. Tracheomalacia was diagnosed based on the physical examination and the thorax computerized tomography (CT) findings. Patient was initially treated with noninvasive positive pressure ventilation and thereafter, fitted with a tracheobronchial conical fully-covered self-expandable nitinol stent. After stent insertion and the respiratory situation of the patient improved, ventilatory weaning and extubation were possible. A careful selection of suitable patients, appropriate stent type and the site, where it has to be placed is mandatory for successful airway stenting. Also, children must be adequately followed-up to prevent the possible life-threatening complications after stent insertion.


Assuntos
Obstrução das Vias Respiratórias/terapia , Stents , Traqueomalácia/terapia , Obstrução das Vias Respiratórias/congênito , Obstrução das Vias Respiratórias/diagnóstico , Ligas , Feminino , Humanos , Lactente , Stents/efeitos adversos , Tomografia Computadorizada por Raios X , Traqueomalácia/congênito , Traqueomalácia/diagnóstico , Resultado do Tratamento
12.
Orv Hetil ; 160(42): 1655-1662, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31608689

RESUMO

Introduction: Most modern thoracic operations are performed with single-lung ventilation balancing between convenient surgical approach and adequate gas exchange. The technical limitations include difficult airways or insufficient parenchyma for the intraoperative single-lung ventilation. Earlier, cardiopulmonary bypass was the only solution, however, today the extracorporeal membrane oxygenation is in the forefront. Aim: We retrospectively analysed our elective operations by use of venovenous ECMO to assess the indication, safety, perioperative morbidity and mortality. Patients and method: 12 patients were operated using venovenous (VV-) ECMO between 28 April 2014 and 30 April 2018 in the National Institute of Oncology. The main clinicopathological characteristics, data regarding the operation, the use of ECMO and survival were collected. Results: The mean age was 45 years, 2 patients had benign and 10 had malignant diseases. Extreme tracheal stricture was the indication for ECMO in 3 cases, while 4 patients had previous lung resection and lacked enough parenchyma for single-lung ventilation. 5 patients had both airway and parenchymal insufficiency. The average time of apnoea was 142 minutes without interruption in any of the cases. We did not experience any ECMO-related complication. We had no intraoperative death and 30-day mortality was 8.33%. Conclusion: In case of technical inoperability, when there is no airway or insufficient parenchyma for gas exchange, but pulmonary vascular bed is enough and there is no need for great-vessel resection, VV-ECMO can safely replace the complete gas exchange without further risk of bleeding. The use of VV-ECMO did not increase the perioperative morbidity and mortality. Previously inoperable patients can be operated with VV-ECMO. Orv Hetil. 2019; 160(42): 1655-1662.


Assuntos
Obstrução das Vias Respiratórias/terapia , Oxigenação por Membrana Extracorpórea/métodos , Cirurgia Torácica/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Adulto , Idoso , Obstrução das Vias Respiratórias/etiologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Feminino , Humanos , Hungria , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Resultado do Tratamento
14.
J Orthod ; 46(4): 367-373, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31597511

RESUMO

OBJECTIVE: To present the application of the pre-epiglottic baton plate (PEBP) in infants with Pierre Robin sequence (PRS) in the Southern Chinese population (Hong Kong) and to present the diagnosis and management protocol of these infants in our centre. DESIGN: Retrospective case series of three patients with PRS. SETTING: Neonatal Intensive Care Unit in Kwong Wah Hospital and Craniofacial Orthodontic Centre in United Christian Hospital, Hong Kong. PARTICIPANTS: Three new-born infants (two girls, one boy) with PRS and upper airway obstruction due to glossoptosis. METHODS: A protocol for the diagnosis and management of these infants in the Southern Chinese population (Hong Kong) was presented. The three patients received nasal high-flow oxygen and/or continuous positive airway pressure (CPAP) as first-line respiratory support, followed by PEBP for 3-5 months. A two-stage approach was undertaken to ensure accurate positioning of the PEBP. RESULTS: All three infants had improvement in clinical signs, symptoms and polysomnography upon discharge. PEBP and other respiratory aids were weaned off at 3-6 months. CONCLUSIONS: The PEBP, combined with other respiratory support, is a useful modality in the treatment of obstructive sleep apnoea in infants with PRS.


Assuntos
Obstrução das Vias Respiratórias , Síndrome de Pierre Robin , Apneia Obstrutiva do Sono , Feminino , Hong Kong , Humanos , Lactente , Masculino , Polissonografia , Estudos Retrospectivos
15.
Artigo em Alemão | MEDLINE | ID: mdl-31639859

RESUMO

Aspiration during anesthesia induction is no triviality, but can lead to serious complications and mortality. The classic technique of rapid sequence induction (RSI) is a fundamental form of anesthesia induction in non-fasting patients to prevent pulmonary aspiration of gastric contents.Pregnant women and children pose a special challenge due to their hypoxia risk; the classical RSI concept "induction - apnea - (cricoid pressure -) intubation" can lead to hypoxia and therefore must be modified in favor of a controlled technique with preservation of oxygenation in this patient group. A controlled procedure with continuous oxygenation as far as possible should be used.The preparation of an RSI involves the careful selection of medicines, equipment and monitoring. An important quality criterion of RSI is the atraumatic airway management in deep anesthesia with profound muscle relaxation without resistance (coughing, choking, pressing) of the patient.


Assuntos
Obstrução das Vias Respiratórias , Anestesia Geral , Jejum , Intubação Intratraqueal , Manuseio das Vias Aéreas , Criança , Feminino , Humanos , Gravidez , Pressão
16.
Rev Med Suisse ; 15(665): 1765-1768, 2019 Oct 02.
Artigo em Francês | MEDLINE | ID: mdl-31580021

RESUMO

Congenital tracheal stenosis is a rare malformation of the fibrino-cartilaginous tracheal skeleton, frequently associated with cardiac malformations. The symptoms and the age of presentation varie according to the severity of the stenosis. There is a risk of airway obstruction. The diagnosis is based on endoscopy and surgery is usually required.


Assuntos
Constrição Patológica/congênito , Constrição Patológica/cirurgia , Traqueia/anormalidades , Obstrução das Vias Respiratórias , Constrição Patológica/diagnóstico , Humanos , Traqueia/cirurgia , Estenose Traqueal/congênito , Estenose Traqueal/diagnóstico , Estenose Traqueal/cirurgia
17.
Cir. pediátr ; 32(4): 172-176, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184104

RESUMO

Objetivos. Validar el score clínico de Valdivieso y cols. en el manejo de los pacientes con sospecha de aspiración de cuerpo extraño en un hospital de tercer nivel. Dicho score plantea escenarios diferentes según la puntuación obtenida: broncoscopia, TAC, observación o alta. Material y métodos. Estudio retrospectivo de los pacientes a los que se realizó una broncoscopia por sospecha de cuerpo extraño entre noviembre de 2015 y noviembre de 2018. Se recogieron las variables propuestas por el score (atragantamiento presenciado, estridor, sibilancias, hipoventilación unilateral, radiografía alterada y cuerpo extraño de riesgo) y su puntuación para cada paciente, analizando el rendimiento de la prueba mediante la curva COR (característica operativa del receptor). Resultados. Se realizó broncoscopia en 81 pacientes con una edad media de 2,1 años (7 meses-11 años), encontrando cuerpo extraño en el 33,3%. El área bajo la curva COR del score fue de 0,803 (0,695-0,911). En 6 (22,2%) pacientes con cuerpo extraño confirmado el score indicaba inicialmente observación en 5 casos y alta en 1. Excluyendo a los 49 pacientes con atragantamiento con fruto seco o con auscultación alterada unilateral, a los que en nuestro medio se indica directamente broncoscopia, el score clasificó correctamente a los 32 pacientes restantes, lo que hubiese reducido el porcentaje de broncoscopias "blancas" en un 21%. Conclusiones. El score presenta en nuestra muestra un alto rendimiento diagnóstico pero una tasa de falsos negativos no despreciable. En cambio, tiene una especial utilidad en los pacientes que no presentan atragantamiento con fruto seco y/o auscultación alterada unilateral, permitiendo reducir broncoscopias blancas


Objective. To validate the clinical score of Valdivieso et al. in the management of patients with suspected foreign body aspiration in a tertiary hospital. This score raises different scenarios according to the result: bronchoscopy, CT, observation or discharge. Material and methods. Retrospective study of patients who under-went a bronchoscopy due to suspected tracheobronchial foreign body between November-2015 and November-2018. The variables proposed by the score were collected (choking, stridor, wheezing, unilateral hypoventilation, altered chest X-ray and high-risk foreign body) and the score was calculated for each patient, analyzing the performance of the test using the ROC (Receiver Operating Characteristic) curve. Results. Bronchoscopy was performed in 81 patients with a mean age of 2.1 years (7 months-11 years), finding foreign body in 33.3%. The area under the ROC curve of the score was 0.803 (0.695-0.911). In 6 (22.2%) patients with confirmed foreign body the score initially indicated observation in 5 cases and discharge in 1. Excluding the 49 patients with unilateral altered auscultation or when there was a nut suspected, which in our environment are clear indications for bronchoscopy, the score correctly classified the remaining 32 patients, which would have reduced the rate of normal bronchoscopies from 66% to 45%. Conclusions. The score in our sample presents a high diagnostic power but a non-negligible false negative rate. It has a special utility in patients who do not have unilateral altered auscultation and/or choking with nuts, allowing to reduce the rate of normal bronchoscopies


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Broncoscopia/métodos , Corpos Estranhos/diagnóstico por imagem , Aspiração Respiratória/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Corpos Estranhos/complicações , Aspiração Respiratória/complicações , Sons Respiratórios/etiologia , Estudos Retrospectivos
18.
Georgian Med News ; (292-293): 68-71, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31560666

RESUMO

The aim of our study was a comparative description of the state of bronchial sensitivity to nonspecific stimuli in respiratory asymptomatic children and children with bronchial asthma. We investigated a total of 242 children aged between 7 and 14 years. The group of respiratory asymptomatic children included 100 examined and 142 had an established diagnosis of atopic bronchial asthma at the I, II, and III stages in the phase of remission. The study was conducted in accordance with the principles of bioethics. In order to investigate the nature of the reaction, bronchoprovocation test with the acetylcholine (bronchoconstrictor) was conducted in children. The test involved monitoring the state of bronchial patency under the effect of increasing concentrations of the stimulus. The acetylcholine test showed that the state of nonspecific bronchial hypersensitivity was expressed in the most of patients with asthma and in 5% of respiratory asymptomatic children. Comparison of the results of the nonspecific bronchial sensitivity and diagnosed airway obstruction did not reveal the relationship between these characteristics. The findings suggest that the presence of nonspecific bronchial hypersensitivity is a congenital and not an acquired phenomenon.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Asma/fisiopatologia , Brônquios/fisiopatologia , Hiper-Reatividade Brônquica/fisiopatologia , Hipersensibilidade Imediata/complicações , Adolescente , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/fisiopatologia , Asma/etiologia , Hiper-Reatividade Brônquica/diagnóstico , Testes de Provocação Brônquica , Criança , Humanos
19.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 37(4): 450-452, 2019 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-31512843

RESUMO

Negative pressure pulmonary edema is a rare complication of general anesthesia. This paper presents a case of acute negative pressure pulmonary edema that occurred during general anesthesia resuscitation. The patient is a young male that underwent bimaxillary surgery under general anesthesia. Laryngospasm spasm ensued after extubation. The treatment for laryngeal spasm retained the smoothness of the nasopharyngal airway, and the pulse oxygen saturation rapidly decreased after anesthesia resuscitation. Pink foam sputum was sucked out from the cavity due to respiratory shortness from mouth and nose. Highly concentrated oxygen was immediately given to assist ventilation and as a symptomatic support (diuretics, hormones), and the condition evidently improved. The diagnosis and treatment of this case suggest that when acute pulmonary edema occurs during general anesthesia resuscitation, negative pressure pulmonary edema should be highly suspected. The first line of treatment is to relieve respiratory tract obstruction. Supplying highly concentrated oxygen to assist positive pressure ventilation is an effective treatment to alleviate pulmonary edema.


Assuntos
Obstrução das Vias Respiratórias , Laringismo , Edema Pulmonar , Anestesia Geral , Humanos , Masculino , Resultado do Tratamento
20.
J Craniomaxillofac Surg ; 47(11): 1699-1705, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31477439

RESUMO

Various treatments, many of them considerably invasive, are currently applied to infants with Robin sequence (RS) and accompanying upper airway obstruction (UAO). We present a narrative review of our data on the Tübingen palatal plate (TPP) which show the following: a) in a randomized trial, the TPP was superior to a sham procedure in alleviating UAO; b) children treated with the TPP in infancy showed an intellectual development within the reference range; c) prone positioning is no alternative, as it is ineffective and associated with an increased risk of sudden death; d) the TPP reduces the mixed-obstructive apnea index to near-normal values, both in isolated and most (83%) syndromic RS, e) of 443 infants (129 syndromic) treated with the TPP in our center, 23 (5%) ultimately received a tracheostomy (all with syndromic RS), f) recent data suggest that the TPP may induce mandibular catch-up growth, g) the TPP may also help to reduce respiratory complications following cleft closure in RS, and h) TPP treatment is applied by various centers around the world, although it is unclear if its effectiveness is invariably controlled by endoscopy and sleep studies, although both are necessary. Given these data from peer-reviewed studies, it may be questioned whether the "First do no harm" principle is always adhered to when subjecting RS infants to more invasive procedures such as mandibular distraction osteogenesis or tongue-lip adhesion.


Assuntos
Obstrução das Vias Respiratórias/terapia , Osteogênese por Distração , Síndrome de Pierre Robin/terapia , Apneia Obstrutiva do Sono/terapia , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Criança , Humanos , Lactente , Mandíbula/crescimento & desenvolvimento , Mandíbula/patologia , Síndrome de Pierre Robin/complicações , Síndrome de Pierre Robin/diagnóstico , Síndrome de Pierre Robin/genética , Polissonografia , Estudos Retrospectivos , Apneia Obstrutiva do Sono/diagnóstico , Resultado do Tratamento
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