Insuflación de gas traqueal y protección pulmonar en paciente críticamente enfermo con SARS-CoV-2 / Tracheal gas insufflation plus lung protect in critical ill SARS-CoV-2 patient / Insuflação de gás traqueal e proteção pulmonar em paciente crítico com SARS-CoV-2

Resumen: Las alteraciones estructurales que a nivel pulmonar genera la COVID-19 son muy graves cuando se desarrolla SARS-CoV-2 resultando ser determinantes en el desenlace de los pacientes. La carga de enfermedad aportada por la ventilación mecánica invasiva impuesta a este grupo de pacientes desencadena en un porcentaje muy alto la mortalidad conocida. Presentamos una serie de casos de pacientes con SARS-CoV-2 que, frente al fracaso de cánula de alto flujo, de la ventilación mecánica no invasiva y de la posición prono, requirieron estrategia de rescate con insuflación de gas traqueal más ultraprotección pulmonar con resultados favorables.

Abstract: The pulmonary structural alterations by COVID-19 are very serious when SARS-CoV-2 develops, resulting in determinants in the outcome of patients. The burden of disease provided by invasive mechanical ventilation imposed on this group of patients triggers a very high percentage of known mortality. We present a series of cases of patients with SARS-CoV-2 who faced with the failure of high flow cannula, non-invasive mechanical ventilation and prone position required rescue strategy with tracheal gas insufflation plus ultra lung protection with favorable results.

Resumo: As alterações estruturais que o COVID-19 gera a nível pulmonar são muito graves quando se desenvolve o SARS-CoV-2, revelando-se decisivas na evolução dos doentes. A carga de doença imposta causada pela ventilação mecânica invasiva a esse grupo de pacientes desencadeia em um percentual muito elevado a mortalidade conhecida. Apresentamos uma série de casos de pacientes com SARS-CoV-2 que, devido à falha da cânula de alto fluxo, ventilação mecânica não invasiva e posição prona, necessitaram de estratégia de resgate com insuflação de gás traqueal mais proteção ultrapulmonar com resultados favoráveis.

High-flow nasal oxygenation for anesthetic management / 대한마취과학회지

High-flow nasal oxygenation (HFNO) is a promising new technique for anesthesiologists. The use of HFNO during the induction of anesthesia and during upper airway surgeries has been initiated, and its applications have been rapidly growing ever since. The advantages of this technique include its easy set-up, high tolerability, and its abilities to produce positive airway pressure and a high fraction of inspired oxygen and to influence the clearance of carbon dioxide to some extent. HFNO, via a nasal cannula, can provide oxygen both to patients who can breathe spontaneously and to those who are apneic; further, this technique does not interfere with bag-mask ventilation, attempts at laryngoscopy for tracheal intubation, and surgical procedures conducted in the airway. In this review, we describe the techniques associated with HFNO and the advantages and disadvantages of HFNO based on the current state of knowledge.

ROHHAD Syndrome: The Girl who Forgets to Breathe.

Background: ROHHAD syndrome is an exceedingly rare cause of central hypoventilation. Case characteristics: A 7-year-old girl with ROHHAD syndrome who had central hypoventilation, rapid weight gain, multiple cardiac arrests and hyperprolactinemia. Outcome: She required prolonged and repeated ventilation, and finally died due to complications of ventilation. Message: ROHHAD Syndrome should be suspected in any child who presents with obesity, behavioral changes or autonomic instability following a neural crest tumor.

Long-term oxygen therapy in patients with chronic respiratory failure in one university hospital / 결핵및호흡기질환

BACKGROUND: Although home oxygen therapy in hypoxemic patients with chronic lung disease has been increasing over the decade in Korea, the present state has not been known well. This study was done to know the situation of home oxygen therapy in a Korean university hospital. METHODS: Between January 1, 2000 and August 31, 2003, 86 patients prescribed home oxygen therapy by the pulmonary physicians of Asan Medical Center were investigated using their medical record and questionnaire. RESULTS: Patients (52 men, mean age of 61 years) with home oxygen therapy were increasing by every year. Underlying diseases were COPD (n=29), tuberculous destroyed lung (n=18), bronchiectasis (n=15), ILD (n=12), and others. Baseline FEV1/FVC, FVC, and FEV1 of patients were 58.4+/-25.2%, 54.5+/-17.1% of predicted, and 41.7+/-20.6% of pred. Mean oxygen flow was 1.5 L/min and mean duration per day was 14.5 hours. During therapy, mean PaO2 values have increased from 51.2 to 77.7 mm Hg and PaCO2 values have increased from 47.5 to 49.6 mm Hg. Only 16.5% of the subjects were monitored by visiting nurses or pulse oximeter. Three year survival rate was 56.6% and hypercapnic patients showed better prognosis. CONCLUSION: The patients with home oxygen therapy were increasing yearly and a part of them were monitored. The hypercapnea respiratory failure patients would have better prognosis.

Non-invasive Mechanical Ventilator Care for the Patients with Advanced Neuromuscular Disease

OBJECTIVE: The usage of mechanical ventilator has been an issue in advanced stage of most neuromuscular diseases. The patients experience hypoventilation symptoms and usually die from pulmonary complications at last. Besides traditional invasive mechanical ventilation, non-invasive intermittent positive pressure ventilation (NIPPV) has provided an alternative treatment option. We evaluated the effects of NIPPV. METHOD: We applied NIPPV method to the patients with advanced neuromuscular disease who were hospitalized due to ventilatory failure, who visit our outpatient clinic due to hypercapnic symptoms, or who showed hypercapnia on a routine follow-up. To evaluate ventilatory status, blood gas tensions were analyzed by the arterial blood gas analysis and/or pulse-oxymeter and capnometer. Overnight pulse-oxymeter monitorings were done whenever necessary. RESULTS: Thirty patients were managed with NIPPV successfully. In five cases, invasive IPPV with tracheostomy at admission was switched to NIPPV. Three patients who had been intubated to receive IPPV were transferred to NIPPV without being tracheostomized. CONCLUSION: NIPPV can be used safely and effectively as an alternative method of ventilatory support for the patients with advanced neuromuscular disease who show ventilatory failure. It would relieve symptoms and signs of hypoventilation and prevent the acute respiratory muscle decompensation, if applied before overt ventilatory failure.

Severe Hypercapnia Occurred by Anesthetized Child with Treated Bronchitis during an Operation for Bilateral Hutch's Diverticulum of Bladder: A case report / 대한마취과학회지

A 23-month-old male patient with treated bronchitis underwent a surgery for the repair of bilateral Hutch's diverticulum of bladder under general anesthesia. He treated bronchitis during 2 weeks since 3 weeks before operation. Arriving operating room, he had mild coughing with sputum. During anesthesia, he was well ventilated but endotracheal secretion was profuse. At ABGA of 2 hours after starting anesthesia, severe hypercapnea(PaCO2: 190.2 mmHg) and severe acidosis(PH: 6.746) were checked. Active treatment was done by suction of endotracheal secretion, hyperventilation, PEEP(5~10 cmH2O), increasing fresh gas flow rate(3.6 L/min --> 7 L/min), and administration of sodium bicarbonate, orciprenaline sulfate and methyl- prednisolone. After 3 hours of treatment, ABGA was normalized and symptoms including wheezing were relieved.