Pressure Controlled Ventilation(PCV) in a Patient with Status Asthmaticus / 대한마취과학회지

High peak inspiratory pressure during control-mode ventilation (CMV) with volume cycled ventilator is associated with increased risk of barotrauma. Pressure controlled ventilation can reduce peak inspiratory pressure and barotrauma, and provide for adequate gas exchange. We present a case of the patient of status asthmaticus in whom we used pressure controll ventilation of lower inspiratory pressure (initially 45 cmH2O) with good outcome during midazolam infusion. At the admission to the ICU, the peak inspiratory pressure was 80 cmH2O with control- mode ventilation of volume cycled ventilator and respiratory acidosis developed (pH: 7.20, PaCO2: 64.1 mmHg). After changing the volume control mode to pressure controlled mode, the peak inspiratory pressure could be reduced from 80 cmH2O to 45 cmH2O with improvement of respiratory acidosis. From our experience, we recommend the application of pressure control ventilation safely to the patients in whom peak inspiratory pressure is high enough to induce barotrauma, if expired tidal volume is monitored.

Midazolam Infusion for Sedation in the ICU Patients / 대한마취과학회지

Problems related to agitation in the ICU patients include cardiorespiratory instability, ina bility to cooperate with nursing care, failure to maintain op timal positioning in bed, dis- ruption of life sustaining tubes and catheters, and injuries to patients and hospital person- nel. Thus, the ability to provide safe, controllable, and reversible sedation can be important in the care of critically ill patients. Midazolam is a water soluble imidazobenzodiazepine with a rapid onset of ac tion and short elimination half life compared with diazepam or lorazepam. We evaluated the use of midazolam by continuous infusion for prolonged sedation of critically ill adult patients. The results were as follows ; 1) Midazolam infusion effectively controlled severe agitation in all patients. 2) No episodes of cardiovascular depression due to midazolam occur red during the study period. 3) In one patient, tolerance was developed 6 days after infusion. 4) Mean time to alertness was 2.23 hours. 5) In a renal failure patient, there was no significant prolongation of time to alertness. These results suggest that midazolam infusion provides safe, controllable, and reversible sedation in the care of critically ill patients.