[Noninvasive positive pressure ventilation in postoperative period of tracheal surgery]. / Ventilación con presión positiva no invasiva en el postoperatorio de cirugía traqueal.

OBJECTIVES: Reconstructive surgery of the airway often means prolonged periods of intubation during the post-operatory period, increasing the needs for drugs and favoring the appearance of infectious complications. We present an original system of ventilatory support with non-invasive positive pressure ventilation (NIPPV) using in patients subjected to reconstructive surgery of the airway. PATIENTS AND METHODS: A retrospective study in patients undergoing reconstructive procedures of the airway in the year 2009 was carried out. We exclude those treated endoscopically and those who had vascular rings. The positive pressure mechanism used in the Surgery Critical Care Unit was a design made by the unit based on the circuit devised by Mapleson that provides optimum levels of ventilation without need for connection to a respiratory. We analyze the results, postoperatory intubation time, time dependent on NIPPV and medical treatment received. RESULTS: A total of 7 patients (1 Female and 6 Males) with median age of 1.6 (0.1-7.5) years were included. The diagnoses were: 4 subglottic stenosis, 2 had tracheal stenosis and 1 subcarinal stenosis with involvement of both principal bronchioles. The techniques used were: laryngotracheoplasty with costal cartilage graft (4), tracheoplasty with costal cartilage (1) and sliding tracheoplasty (2) with bilateral bronchoplasty in one of them. The mean time of nasotracheal intubation was 3 days, and mean time of NIPPV was 2.3. No patient required reintubation and none had infectious complications. CONCLUSIONS: Ventilatory support by VPPNI allows effective extubation in these patients, it being possible to maintain a safe airway. Infectious complications, frequent in prolonged intubations, were not observed in any of the cases.

Role of computed tomography and magnetic resonance imaging in aortobronchial fistula diagnosis following aortic coarctation reparative surgery. Report of two cases.

Aortobronchial fistula (ABF) is an uncommon complication of aortic coarctation repair which may occur years after successful coarctation correction. It is invariably fatal if not diagnosed and treated. ABF diagnosis poses a challenge for clinicians and radiologists because of the difficulty in detecting the fistula and the risks associated with some of the diagnostic procedures. Two cases of ABF occurring 1 and 20 years after reparative surgery of aortic coarctation are reported. The advantages and disadvantages of different imaging procedures for the evaluation of patients with suspected ABF are reviewed and the role of computed tomography angiography and magnetic resonance imaging is underlined.

Cardiac tamponade after a systemic-pulmonary shunt complicated by serous leakage.

A newborn baby with complex congenital heart disease had severe persistent pericardial effusion after a systemic-pulmonary shunt. Pericardiocentesis and pericardiotomy could not stop pericardial leakage. At reoperation, topical application of a fibrin glue resulted in resolution of the leak and avoided replacement of the graft.

A new sodium-nitroprusside-infusion controller for the regulation of arterial blood pressure.

Automatic optimization of the infusion rate of sodium nitroprusside (SNP) is achieved by an integrated hardware-software closed-loop controller implemented as a small bedside device. A microprocessor-based blood pressure monitor controls an infusion pump. The shape of the arterial pressure wave is digitally sampled; its analysis incorporates artifact-detection and -rejection routines. The implemented algorithm applies a rule-based closed-loop control that incorporates fuzzy logic. The system models the decision-making ability of the expert, instead of trying to model the patient's physiologic dynamics. Several internal fuzzy-state variables are defined to achieve a clear understanding of mean arterial pressure (MAP) evolution with time. The system performance is very robust, employing, under all possible situations, a sort of "common sense." A clinical trial of the controller was conducted in 60 patients requiring vasodilation therapy for systemic arterial hypertension following cardiac surgery, 20 who had conventional manual control by an experienced nursing staff and 40 who had automated closed-loop control. The first 240 minutes of the postoperative period were closely watched, taking into account 1) the percentage of time during which MAP was within the 10-mmHg wide frame above the target pressure (target gap); 2) the mean difference of pressure values that crossed the boundary of the target gap; 3) the mean SNP-infusion rate. With automatic control, the time mean arterial pressure values were located in the target gap during the first hour amounted to 72.8 +/- 6.7%, vs 51.2 +/- 10.3% in the manual-control group. In the second hour, it was 79.3 +/- 2.5% vs 67.4 +/- 11.7% (p < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

[Hypotension induced by sodium nitroprusside administered via an automatic-adaptive dose regulating system. Experimental development]. / Hipotensión inducida con nitroprusiato sódico mediante un sistema automático-adaptativo de regulación de la dosis. Desarrollo experimental.

Sodium nitroprusside (NPS) is a potent vasodilator which is frequently administered for the control of arterial blood pressure and peripheral resistances. Manual regulation of the dose is difficult and requires a permanent surveillance of patients under treatment. Several attempts have been made to develop an automatized system able to safely control the dose of the drug in clinical practice. However, since now the results have not been completely satisfactory. The aim of our study was to develop of a new automatic-adaptative system able to continuously control the dose of NPS. The system consists of a high precision infusion pump controlled by a microprocessor. Arterial blood pressure is continuously monitorized and according to its values NPS is automatically regulated to maintain blood pressure within a preselected range. A control "fuzzy logic" algorithm was used. We have assessed the efficacy, adaptability, and safeness of the system. The system was tested in 15 mongrel dogs. The protocol was divided into two parts. During the first part a 25% to 30% reduction in blood pressure from baseline values lasting for a period of 4 hours was attempted. The second part was devoted to test the adaptability of the control unit during induced unstable hemodynamic situations. Group I dogs were subjected to volume overload. Group II were treated with noradrenaline to increase blood pressure, and group III underwent a venous bleeding to produce arterial hypotension. Control of arterial blood pressure was achieved after a minimum of 5 min and a maximum of 19 min (mean values = 13.3 min).(ABSTRACT TRUNCATED AT 250 WORDS)

[Neonatal tracheomalacia. Study of 3 cases treated with aortopexy+]. / Traqueomalacia neonatal. Estudio de tres casos tratados con aortopexia.

Neonatal tracheomalacia is a disease in which there is a softening of the tracheal wall with lost of this consistency. This cause expiratory collapse cough and respiratory difficulty it is generally associated with Esophageal atresia and Vascular Rings. Exceptionally is a primary disease. In this paper we present three cases of neonatal tracheomalacia treated by aortopexy who is at the moment the best treatment that we have in severe cases. Soft cases will remit with conservative treatment.

Ventilación con presión positiva no invasiva en el postoperatorio de cirugía traqueal / Noninvasive positive pressure ventilation in postoperative period of tracheal surgery

Objetivos. La cirugía reconstructiva de la vía aérea conlleva con frecuencia periodos de intubación prolongados durante el postoperatorio, aumentando las necesidades de fármacos y favoreciendo la aparición de complicaciones infecciosas. Presentamos un original sistema de soporte ventilatorio con presión positiva no invasiva (VPPNI) empleado en pacientes sometidos a cirugía reconstructiva de la vía aérea. Pacientes y métodos. Estudio retrospectivo en pacientes sometidos a procedimientos reconstructivos de la vía aérea en el año 2009.Excluimos aquellos tratados endoscópicamte y los que presentaron anillos vasculares. El mecanismo de presión positiva empleado en la Unidad de Cuidados Críticos Quirúrgicos fue un diseño propio a partir del (..) (AU)

Objectives. Reconstructive surgery of the airway often means prolonged periods of intubation during the post-operatory period, increasing the needs for drugs and favoring the appearance of infectious complications. We present an original system of ventilatory support with non-invasive positive pressure ventilation (NIPPV) using in patients subjected to reconstructive surgery of the airway. Patients and methods. A retrospective study in patients undergoing reconstructive procedures of the airway in the year 2009 was carried out. We exclude those treated endoscopically and those who had vascular rings. The positive pressure mechanism used in the Surgery Critical Care Unit was a design made by the unit based on the circuit (..) (AU)