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Biomedical subjects

A G Galvis

Publications and source records attributed to A G Galvis.

35 records · Page 2Linked to original sources
PubMed1978

Clinical implications of postoperative unilateral phrenic nerve paralysis.

Unilateral phrenic nerve paralysis (PNP) folowed 32 (1.7 percent) of 1,891 consecutive cardiac surgical procedures during an 8 year peroid. Diagnosis was based on radiographic criteria with comparison of preoperative and postoperative chest radiographs and was confirmed in all 21 evaluated by fluoroscopy. Six had persistent radiographic abnormality more than 12 months postoperatively. PNP occurred most frequently in association with Blalock-Taussig shunts. These operations represented 22 percent of this series, and PNP complicated 7 percent of all Blalock-Taussig shunts. PNP was less well tolerated in the 14 infants than in the 18 older children. Eleven infants had serious difficulties during weaning from mechanical ventilatory support. Five infants required tracheostomy, one underwent diaphragmatic plication, and three died. Infants had a mean duration of mechanical ventilation of 24 days and required prolonged intensive care and long-term hospitalization. In comparison, older children had a more benign postoperative course. Diaphragmatic plication should be considered in infants with paradoxical motion of the hemidiaphragm who remain dependent on mechanical ventilatory support for more than 2 weeks postoperatively.

Adolescent↗
PubMed1978

Pulmonary hyperinflation in ventricular septal defect.

Pulmonary hyperinflation (PH) has frequently been seen in patients with ventricular septal defect (VSD). Mean age of patients at the time of cardiac catherization and operation was less in Group II (PHI) than in Group I (normal pulmonary inflation). There is a statistically significant difference in the ratio of mean pulmonary to mean systemic blood flow and the ratio of mean peak pulmonary to mean peak systemic systolic pressures, with the higher values recorded for Group II. There is no statistically significant difference in the pulmonary vascular resistance in the two groups. Thirty-five of the 44 patients with PHI developed normal inflation within a month after surgical correction of VSD. Possible mechanisms of PHI in VSD are discussed. PHI is prolong and perpetuate respiratory distress and can lead to progressive lung disease. PHI is therefore another indication for early surgical correction of VSD.

Adolescent↗
PubMed1976

Continuous dynamic monitoring of pressure and flow patterns during assisted ventilation.

A system for continuous, dynamic monitoring of children requiring ventilatory assistance has been developed and used in a critical care setting. Breath by breath airway pressure changes are measured on a specially adapted meter with high-and low-pressure limit alarms, and are displayed graphically on a bedside oscilloscope. This system has proved to be beneficial in detecting ventilator system malfunction; in adjusting ventilator settings, such as inspiratory/expiratory ratios, end-expiratory pressure, and phase duration and flow ratios; in assessing compliance of a child requiring ventilatory assistance and his capability for spontaneous breathing; and in the early recognition of potentially harmful problems attendant upon assisted ventilation. The system provides additional educational benefit for the I.C.U. personnel, who become more knowledgeable regarding ventilatory problems, and more apt to discover them promptly. The simplicity of the system, compatibility with other I.C.U. monitoring equipment, capability for continuous, dynamic monitoring, and broad scope recommended it for infants and children requiring assisted ventilation.

Child↗
PubMed1975

Pulmonary edema and continuous positive pressure breathing (CPPB).

We have successfully treated severe pulmonary edema of various etiologies and the concomitant hypoxia in 17 infants and children with continuous positive pressure spontaneous breathing. The pressure used was 8 to 14 cm of water above atmospheric pressure. No significant changes occurred in arterial or central venous blood pressure, and no patient developed clinical evidence of peripheral venous engorgement. Pulmonary edema cleared within 24 hours in all cases. We believe this rapid clearing may differentiate pulmonary edema from pneumonia and pulmonary hemorrhage. The pathophysiology and the roentgenologic findings are presented.

Child, Preschool↗
PubMedDate not supplied

An improved technique for prolonged arterial catheterization in infants and children.

Arterial catheterization for blood gas analysis and direct monitoring of blood pressure in infants and children can be attended by a variety of complications, which limit its use to short periods of time. An improved technique, consisting of elimination of stopcocks, the use of a continuous flushing system adapted for infants and children, and meticulous care of the system, was used in 57 children whose ages ranged from the neonatal period to 16 years. The mean duration of cannulation was 5.5 days (range, 1-31 days). All but one of the catheters were functional at the time of discontinuation. There were no thromboembolic phenomena, local or systemic infections or accidental bleeding. We feel that our approach to prolonged arterial cannulation can be an extremely valuable aid in the management of critically ill children.

Adolescent↗
PubMedDate not supplied

Pulmonary edema following relief of acute upper airway obstruction.

Five children, aged one to five years, with severe upper airway obstruction, three of whom had epiglottitis and two of whom had laryngotracheobronchitis, developed acute pulmonary edema after the obstruction had been relieved by placement of an artificial airway. Although major physiologic changes, such as hypoxemia and massive sympathetic discharge, play a significant role in the development of acute pulmonary edema, we have postulated a possible etiological cause for the development of pulmonary edema in these children which involves a series of physiologic events. The generation of very high transpulmonary pressure gradients during inspiration is opposed by a decreased venous return due to the obstruction during exhalation. Airway pressures then fall abruptly with the insertion of the artifial airway, resulting in a sudden increase in venous return to the central circulation and marked increase in the intravascular hydrostatic pressures. The final result of this series of events is the development of pulmonary hyperemia and edema. The prevention of this situation must begin the moment the airway is inserted and involves the application of moderate amounts of continuous positive pressure to the airway, thus allowing time for circulatory adaption to take place.

Airway Obstruction↗