At the intensive care unit of Bachmai hospital, in 27 patients with acute pulmonary deficiency syndrome of different causes, who were undergone invasive artificial ventilation, auto-PEEP was assessed. Patients with ARDS had got auto-PEEP of 9,15±4cm Hg, with COPD 12±2,8cm H2O, with asthma crisis 20,4±7,2cm H2O. The use of specific chemotherapies and setting PEEP equal to haft of auto-PEEP to treat the patients with ARDS and COPD had minished the value of auto-PEEP to 4,67±3,7cm H2O in ARDS, 7±2,31 in COPD and 9,71± 1,67 in asthma; blood vapor level was improved also
Respiratory Insufficiency ; Respiration, Artificial ; Intensive Care Units

Acute respiratory distress syndrome (ARDS) is one of the most common severe diseases seen in the clinical setting. With the continuous exploration of ARDS in recent decades, the understanding of ARDS has improved. ARDS is not a simple lung disease but a clinical syndrome with various etiologies and pathophysiological changes. However, in the intensive care unit, ARDS often occurs a few days after primary lung injury or after a few days of treatment for other severe extrapulmonary diseases. Under such conditions, ARDS often progresses rapidly to severe ARDS and is difficult to treat. The occurrence and development of ARDS in these circumstances are thus not related to primary lung injury; the real cause of ARDS may be the "second hit" caused by inappropriate treatment. In view of the limited effective treatments for ARDS, the strategic focus has shifted to identifying potential or high-risk ARDS patients during the early stages of the disease and implementing treatment strategies aimed at reducing ARDS and related organ failure. Future research should focus on the prevention of ARDS.
Humans ; Intensive Care Units ; Respiratory Distress Syndrome/etiology* ; Treatment Outcome

BACKGROUND: Unanticipated admission to the pediatric intensive care unit (PICU) associated with anesthesia may serve as an outcome measure to evaluate the quality of anesthesia care and as education material for residency training. METHODS: We reviewed the unanticipated PICU admissions after anesthesia during 1 year period in order to analyze patient pattern, causes, and specific therapeutic interventions. We also determined whether there were any preventable anesthetic factors responsible for PICU admission. RESULTS: There were 640 admissions to PICU from operating theatres, with 8 unanticipated admissions. Age of the patients ranged from 4 months to 14 years. The unanticipated admissions were distributed to all of the surgical departments. Of 8 unanticipated admissions, only one was considered a preventable feature and had intensive care. CONCLUSIONS: The unanticipated admissions to PICU from the operation theatre were not associated with age or department of surgery. The majority of the causes of unanticipated admission were respiratory problems, which show that the pediatric anesthesiologists have to pay special attention to the respiratory system during anesthesia.
Anesthesia ; Education ; Humans ; Intensive Care Units* ; Critical Care* ; Internship and Residency ; Outcome Assessment (Health Care) ; Respiratory System

China ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Respiration, Artificial ; Respiratory Care Units

BACKGROUND: In sepsis patients, target mean arterial pressures (MAPs) greater than 65 mm Hg are recommended. However, there is no such recommendation for patients receiving mechanical ventilation. We aimed to evaluate the influence of MAP over the first 24 hours after intensive care unit (ICU) admission on the mortality rate at 60 days post-admission in patients showing acute hypoxemic respiratory failure under mechanical ventilation. METHODS: This prospective, multicenter study included 22 ICUs and compared the mortality and clinical outcomes in patients showing acute hypoxemic respiratory failure with high (75-90 mm Hg) and low (65-74.9 mm Hg) MAPs over the first 24 hours of admission to the ICU. RESULTS: Of the 844 patients with acute hypoxemic respiratory failure, 338 had a sustained MAP of 65-90 mm Hg over the first 24 hours of admission to the ICU. At 60 days, the mortality rates in the low (26.2%) and high (24.5%) MAP groups were not significantly different. The ICU days, hospital days, and 60-day mortality rate did not differ between the groups. CONCLUSION: In the first 24 hours of ICU admission, MAP range between 65 and 90 mm Hg in patients with acute hypoxemic respiratory failure under mechanical ventilation may not cause significantly differences in 60-day mortality.
Arterial Pressure* ; Humans ; Intensive Care Units ; Mortality* ; Prospective Studies ; Respiration, Artificial* ; Respiratory Insufficiency* ; Sepsis

Thrombolytic therapy is usually reserved for patients with clinically serious or massive pulmonary embolism. In desperated cases, however, pulmonary embolectomy is recommended despite its high mortality rate. We experienced acute respiraory failure after embolectomy performed under cardiopulmonary bypass in patient with chronic massive pulmonary embolism. The patient recovered sucessfully with postoperative management in the intensive care unit.
Cardiopulmonary Bypass ; Embolectomy* ; Humans ; Intensive Care Units ; Mortality ; Pulmonary Embolism* ; Respiratory Insufficiency* ; Thrombolytic Therapy

BACKGROUND: In emergency rooms or intensive care units, we have shown delivery of higher fractions of oxygen promptly for respiratory or cardiac arrest patients by using resuscitating instruments, especially the resuscitator bag. Previously we studied the variables affecting the fraction of delivered oxygen (FDO2) under varying ventilating techniques and conditions. In this paper, using corrugated tubes as substitute for reservoir bag, we measured FDO2 and compared two. METHODS: We designed a special wooden box, which held the Laerdal resuscitator bag. We measured the FDO2 with or without reservoir bags and corrugated tubes at various tidal volumes, respiration rates and oxygen flows. RESULTS: With a 500 ml corrugated tube, FDO2 were higher than with a 250 ml corrugted tube but lower than with a reservoir bag. CONCLUSIONS: Corrugated tube is less effective to deliver high fractions of oxygen than the reservior bag, but it is acceptable to use corrugated tube as a substitute for a reservior bag than not to use it at all.
Emergency Service, Hospital ; Heart Arrest ; Humans ; Intensive Care Units ; Oxygen* ; Respiratory Rate ; Tidal Volume

Dexmedetomidine is a highly selective α2-adrenoceptor agonist with a vast array of properties, making it suitable for sedation in numerous clinical scenarios. Its use was previously restricted to the sedation of intensive care unit patients. However, its use in pediatric dental sedation has been gaining momentum, owing to its high suitability when compared with conventional pediatric sedatives. Its properties range from sedation to anxiolysis to analgesia, due to its sympatholytic properties and minimal respiratory depression ability. Because dexmedetomidine is an efficacious and safe drug, it is gaining importance in pediatric sedation. Thus, the aim of this review is to highlight the properties of dexmedetomidine, its administration routes, its advantages over the commonly used pediatric sedatives, and especially its role as an alternative pediatric sedative.
Analgesia ; Dexmedetomidine ; Humans ; Hypnotics and Sedatives ; Intensive Care Units ; Midazolam ; Respiratory Insufficiency

OBJECTIVES: To study the value of Silverman-Anderson score versus Downes score in predicting respiratory failure in full-term neonates. METHODS: The convenience sampling method was used to select the full-term neonates with lung diseases who were hospitalized in the neonatal intensive care unit from July 2020 to July 2021. According to the diagnostic criteria for neonatal respiratory failure, they were divided into a respiratory failure group (65 neonates) and a non-respiratory failure group (363 neonates). Silverman-Anderson score and Downes score were used for evaluation. The receiver operating characteristic analysis was used to compare the value of the two noninvasive scores in predicting respiratory failure in full-term neonates. RESULTS: Among the 428 full-term neonates, 65 (15.2%) had respiratory failure. The Silverman-Anderson score had a significantly shorter average time spent on evaluation than the Downes score [(90±8) seconds vs (150±13) seconds; P<0.001]. The respiratory failure group had significantly higher points in both the Silverman-Anderson and Downes scores than the non-respiratory failure group (P<0.001). The Silverman-Anderson score had an AUC of 0.876 for predicting respiratory failure, with a sensitivity of 0.908, a specificity of 0.694, and a Youden index of 0.602 at the optimal cut-off value of 4.50 points. The Downes score had an AUC of 0.918 for predicting respiratory failure, with a sensitivity of 0.723, a specificity of 0.953, and a Youden index of 0.676 at the optimal cut-off value of 6.00 points. The Downes score had significantly higher AUC for predicting respiratory failure than the Silverman-Anderson score (P=0.026). CONCLUSIONS Both Silverman-Anderson and Downes scores can predict the risk of respiratory failure in full-term neonates. The Silverman-Anderson score requires a shorter time for evaluation, while the Downes score has higher prediction efficiency. It is recommended to use Downes score with higher prediction efficiency in general evaluation, and the Silverman-Anderson score requiring a shorter time for evaluation can be used in emergency.
Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Prognosis ; ROC Curve ; Respiratory Insufficiency/etiology* ; Risk Factors

Child ; Humans ; Infant, Newborn ; Consensus ; Respiratory Distress Syndrome/therapy* ; Respiratory Distress Syndrome, Newborn ; Respiration, Artificial ; Intensive Care Units, Pediatric