Cardiac arrest as a possible sequela of critical airway management and intubation.

Immediate cardiac arrest may occur as a result of the physiological consequences of critical airway management, which may include one or all of the following: (1) sedation and/or paralysis, (2) tracheal intubation, and (3) positive pressure ventilation. Two patients are reported, both with myocarditis, who developed cardiac arrest within minutes of simple intubations. Their arrests were not related to technical difficulties of critical airway management. Any disease process that creates a preload-dependent cardiovascular system also creates a situation wherein critical airway management may cause cardiac decompensation. All medications administered to sedate patients and facilitate intubation, as well as mechanical ventilation itself, can cause a decrease in preload. This may be a significant mechanism through which immediate decompensation occurs. Potential conditions that cause preload-dependent cardiovascular systems, as well as alternate therapeutic considerations, are outlined. In these patients intubations should not be delayed, but should be done with extreme caution in anticipation of possible cardiac arrest.

Inverse ratio ventilation in a 6-year-old with severe post-traumatic adult respiratory distress syndrome.

We successfully employed inverse ratio ventilation on a 6-year-old multiple trauma victim with severe adult respiratory distress syndrome after conventional ventilation modes using volume ventilation with high positive peak inspiratory pressure and PEEP had failed to improve oxygenation.