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At least 163 records · Page 9Linked to original sources
PubMed1986

Fighting the ventilator--are fast rates an effective alternative to paralysis?

We investigated the effect of increased ventilator rates on the respiratory activity of 17 infants, all actively expiring against the ventilator at conventional rates. Fast rate ventilation was rarely associated with apnoea (3 babies only) and the infant's respiratory efforts even at rates of 120/min had an important effect on tidal exchange. Seven infants altered their respiratory response to breathe in synchrony with the ventilator at 60 breaths/min and 5 maintained this at 120 breaths/min. Nine of the 17 infants continued to actively expire against positive pressure inflation at 60 breaths/min and in two this persisted at 120/min, the remaining 7 infants showed incoordinated breathing at that rate. We conclude that fast rate ventilation appears to have only limited success in suppressing respiratory activity in infants actively expiring against the ventilator.

Apnea↗
PubMed2005

Use of the Montgomery T tube in ventilator-dependent patients.

Tracheal stenosis of ventilator-dependent patient is generally managed via dilation and long trachesostomy tube. This study reports four ventilator patients with tracheal stenosis managed with Montgomery T tube via rigid bronchoscopy. The respiratory symptoms improved in all patients. Three of the patients were weaned from ventilator shortly following treatment.

Adolescent↗
PubMed2004

Joubert-like syndrome unlinked to known candidate loci.

We observed the Joubert syndrome (JS) associated with bilateral morning glory disk anomaly and cystic dysplastic kidneys in three patients from a consanguineous kindred. Homozygosity mapping excluded three JS candidate loci as sites harboring the disease gene. We thus delineate an autosomal recessive disorder, distinct from JS and related conditions.

Adult↗
PubMed2004

The neurologic assessment and treatment of the "difficult to extubate" patient.

Neurologic issues are involved in the patient who is difficult to wean. Assessing the patient and performing a complete neurologic examination are important when developing a successful weaning strategy. The neurologist contributes to this process by providing expertise in the various neurologic conditions and skill in performing a thorough neurologic examination.

Brain Diseases↗
PubMed2004

Pneumothorax associated with long-term non-invasive positive pressure ventilation in Duchenne muscular dystrophy.

Long-term non-invasive positive pressure ventilation (NPPV) is effective for improving the quality of life and survival of neuromuscular patients. This treatment is usually easy to administer and severe complications have rarely been reported. We describe two cases in which the development of pneumothorax was associated with long-term NPPV administered to Duchenne muscular dystrophy patients. Given the wide scale utilization of chronic NPPV, we suggest that care-givers and patients be made aware of this serious complication.

Adult↗
PubMed2006

The physiological basis of respiratory support.

The complex interplay between the characteristics of the respiratory system, its changes as a result of respiratory disease and the effects of mechanical ventilation makes it important to analyse the physiology of the respiratory system in any given clinical situation. Key variables to be considered are the elastic recoil, resistance and time constant of the respiratory system, as well as the characteristics of the respiratory pump. The effects of respiratory support on the intrathoracic organs and lung perfusion must be taken into account. Respiratory support modes can then be tailored to provide maximum benefit and a minimum of negative effects. When the relatively few basic principles that underlie the mechanical behaviour of the respiratory system in most circumstances are kept in mind, the challenge of optimal support seems solvable for most children with respiratory insufficiency.

Airway Resistance↗
PubMed2006

A new tracheal tube and methods to facilitate ventilation and placement in emergency airway management.

The "jet endotracheal tube" (JET) has been designed to facilitate emergency intubation in apnoeic or paralyzed patients with a difficult airway. We investigated the efficiency of jet ventilation to maintain adequate oxygenation and ventilation using the initially designed JET, either with its distal tip positioned above vocal cord and pointed directly at or 45 degrees to the right of the vocal cord opening midline in 10 adult paralyzed pigs. The effectiveness of using end tidal carbon dioxide pressure (PetCO(2)), chest rise and breath sounds to facilitate tracheal placement of the JET blindly in a simulated difficult airway was studied. All complications of using the JET were noted. Jet ventilation with the distal tip of the JET pointed directly at, not 45 degrees to the right of vocal cord opening midline, provides adequate oxygenation and ventilation during intubation. In a simulated difficult airway, PetCO(2), chest rise and breath sounds were all effective methods to assist placement of the JET blindly, and the combination of all three methods works the best. No serious complications were detected with the use of the JET. Our results suggest that a correctly positioned JET guided by monitoring PetCO(2), chest rise and breath sound provides adequate oxygenation and ventilation during intubation in apnoeic pigs, and facilitates the intubation blindly in a simulated difficult airway. No serious complications were observed using the JET in this study. In patients requiring emergency intubation, a JET with PetCO(2) monitoring catheter and the instructions for use may be a useful addition to the airway management devices.

Animals↗
PubMed1998

Experimental pathophysiology of panic.

In this article, we review how the knowledge of the pathophysiology of panic disorder has expanded, with special emphasis on laboratory models using lactate and carbon dioxide challenges. Experiments in the late 1960s revealed that lactate infusion can induce panic attacks. A prominent feature of these attacks is hyperventilation. Because lactate infusion induces a metabolic alkalosis, one would rather expect a compensatory hypoventilation. For years hyperventilation was thought to be causally linked to panic, but it has since been proven to be a symptom rather than a cause of panic attacks. Similarly, it is not hypocapnia but hypercapnia that has proven to be capable of provoking panic attacks. Carbon dioxide challenges are comparable to lactate infusion in the degree to which they meet the criteria for an ideal model of panic disorder. Experiments with carbon dioxide in first-degree relatives of panic disorder patients and in monozygotic twins support the idea of a constitutional predisposition to panic disorder. Of the various other agents that have been used to trigger panic attacks, cholecystokinin seems particularly promising as a valid laboratory model of panic disorder and may provide valuable data regarding the mechanism of panic attacks. The false suffocation alarm theory, proposed by Klein, is an integrative hypothesis that may account for a large number of the laboratory as well as clinical observations.

Carbon Dioxide↗
PubMed2003

Vulnerability to 35% CO2 of panic disorder patients with a history of respiratory disorders.

Patients with panic disorder often report a history of respiratory pathology. Furthermore, panic disorder patients are vulnerable to CO2 challenges. The increased CO2 vulnerability displayed by panic disorder patients may be related to lifetime respiratory pathology. We examined whether panic disorder patients with a history of respiratory disorders are more vulnerable to a 35% CO2 challenge than those without such a history. Ninety-six patients with panic disorder were interviewed about their lifetime respiratory status (asthma, bronchitis and various other respiratory conditions) and underwent the challenge. Immediately before and after the CO2 inhalation, the patients filled out the Visual Analogue Scale for Anxiety (VAS-A) and the Panic Symptom List (PSL). We found no differences between the two panic disorder groups on anxiety (VAS-A), panic symptoms (PSL) or panic attacks after the CO2 challenge. Our results suggest that having a PD is an important factor in CO2 vulnerability independent of a history of respiratory disorders.

Adolescent↗
PubMedDate not supplied

[Assisted ventilation of newborn infants during sleep. Study of factors modifying adaptation to ventilation].

During sleep, of ventilated newborns and young infants, spontaneous respiratory movements may occur, unrelated to the ventilation impulsions. The respiratory pattern is then classified as "active". On the contrary, the respiratory pattern is classified as "passive", when all respiratory movements are related to the ventilation insufflation. The factors which influence the dependence on the ventilator are studied in a group of 20 newborn and young infants. Prematurity, some biological data such as hyperoxia, hypocapnia, seem to favor this dependence. A rapid rate of ventilation (superior to 30/minute) is rarely related to an active respiration; a slow rate of ventilation seems favor this respiratory pattern. It is clear that adaptation to artificial ventilation is better during quiet sleep than during active sleep. Some physiopathological considerations are developed.

Adaptation, Physiological↗
PubMed2001

Reducing the harms caused by cannabis use: the policy debate in Australia.

The debate about cannabis policy in Australia has revolved around the harms that cannabis causes to users and the community, on the one hand, and the harms that are caused by the prohibition of its use, on the other. This paper assesses evidence on: (1) the harms caused to users and the community by cannabis use (derived from the international scientific literature) and (2) the harms that arise from prohibition (as reflected in Australian research). The most probable harms caused by cannabis use include: an increased risk of motor vehicle accidents; respiratory disease; dependence; adverse effects on adolescent development; and the exacerbation of psychosis. The harms of the current prohibition on cannabis use policy are less tangible but probably include: the creation of a large blackmarket; disrespect for a widely broken law; harms to the reputation of the unlucky few cannabis users who are caught and prosecuted; lack of access to cannabis for medical uses; and an inefficient use of law enforcement resources. Cannabis policy unavoidably involves trade offs between competing values that should be made by the political process. Australian cannabis policy has converged on a solution which continues to prohibit cannabis but reduces the severity of penalties for cannabis use by either removing criminal penalties or diverting first time cannabis offenders into treatment and education.

Adolescent↗
PubMed1988

Familial encephalopathy with permanent periodic breathing: 4 cases in 2 unrelated families.

In each of 2 unrelated Algerian families, we observed 2 sisters with a severe static encephalopathy which was detected in the first weeks of life. Anoxia at birth occurred in only one case. This previously unreported familial encephalopathy is characterized by severe mental retardation, hypotrophy, abnormal movements with unprovoked startles, major EEG abnormalities with undifferentiated sleep stages and a very particular periodic breathing pattern that persists during waking and sleep. EEG, polygraphic and video recordings were obtained for all patients. The evolution is chronic and stable. There are no major dysmorphic features. No metabolic or anatomic abnormality was found. Gynecotropy is uncertain and the transmission is likely to be recessive.

Brain Diseases↗