Cases reported "Mediastinal Emphysema"

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1/9. Successful use of high frequency oscillatory ventilation for pneumomediastinum.

    An infant with pneumomediastinum due to mechanical ventilation was successfully treated using high frequency oscillatory ventilation (HFOV). The 3-month-old male had undergone ligation of a patent ductus arteriosus and suffered from barotraumatic pneumomediastinum in the postoperative period. Computed tomography of the chest confirmed the diagnosis. While using conventional mechanical ventilation the respiratory failure worsened. HFOV was instituted and the patient improved. A lower airway pressure by this mode of ventilation provided significant advantages in the patient with an air leak. He was subsequently extubated and discharged home.
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2/9. Spontaneous pneumomediastinum in an 18-year-old black Sudanese high school student.

    Spontaneous pneumomediastinum (SPM) is defined as pneumomediastinum in the absence of an underlying lung disease. It is the second most common cause of chest pain in young, healthy individuals (< 30 years) necessitating hospital visits. It is surpassed in frequency in this setting only by spontaneous pneumothorax. These two conditions may coexist in 18% of patients. The incidence of spontaneous pneumomediastinum varies in different communities and generally is relatively uncommon. Inhalational drug use (cocaine and cannabis) have been associated with a significant number of cases, although cases with no apparent etiologic or incriminating factors are well recognized. Also its recurrence, though uncommon, is worthy of note. It is a benign clinical condition with diverse clinical presentations. physicians' knowledge of the presentation, treatment, and prognosis of SPM will guard against the need for expensive radiologic and laboratory tests. The differential diagnosis of chest pain, shortness of breath, and dysphagia include cardiac, pulmonary, and esophageal diseases. The tendency to pursue these entities may lead to laboratory investigations such as electrocardiograms, arterial blood gases, ventilation/perfusion scans, and contrast radiographic studies of the esophagus.
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3/9. A case of pneumomediastinum in paediatric ARDS: to oscillate or not?

    An 18-month-old was transferred (intubated and ventilated) to our hospital with staphylococcal tracheitis, which progressed to a necrotizing pneumonitis, complicated by surgical emphysema and pneumomediastinum. Maximum conventional ventilation on a Servo 300 failed. Treatment with high frequency oscillatory ventilation (for 10 days) with a permissive hypercarbia and hypoxaemia strategy to limit mean airway pressure facilitated recovery in our patient.
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4/9. Neonatal pneumomediastinum with isolated mitral obstruction.

    While mediastinal air accumulation in the ventilated newborn is usually a benign entity, tension pneumomediastinum can embarrass both respiratory and cardiac function. A case of isolated left ventricular inflow obstruction caused by a pneumomediastinum in a premature infant is described that resolved with high frequency ventilation. The development of pneumomediastinum and haemodynamic compromise in a premature infant warrants echocardiographic examination.
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5/9. Two cases of barotrauma associated with transtracheal jet ventilation.

    Two patients suffered barotrauma whilst undergoing transtracheal jet ventilation (TTJV). In the first, TTJV was provided by a Sanders injector and in the second it was given by a high frequency jet ventilator. barotrauma was a consequence of the expiratory pathway becoming blocked. The mechanism of barotrauma and a method of airway pressure monitoring during TTJV are discussed. It is recommended that meticulous care is taken to ensure an adequate path for expiration when jet ventilation is used.
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6/9. High-frequency oscillatory ventilation (HFOV) in the treatment of neonatal respiratory disturbances: case reports of two infants.

    The technique of high-frequency oscillatory ventilation (HFOV) was successfully used in a preterm infant with severe hyaline membrane disease and in a term neonate presenting with intrauterine pneumonia and associated severe pneumomediastinum. None of the infants could adequately be ventilated by conventional ventilation; both of them deteriorated owing to severe hypoxaemia and hypercapnia. In the preterm infant with HMD a rapid and progressive improvement of oxygenation had been observed immediately after the beginning of HFOV, and he was successfully weaned off the ventilator after 71 hours on HFOV. His recovery was uncomplicated and definitive. In the term neonate presenting with IUP and associated severe PM, an improvement in oxygenation was detected, whereas the retention of paCO2 remained unaltered. On leaving the MAP unchanged but doubling the flow rate, paCO2 and arterial pH also normalised. No sign of PM was seen on the X-ray picture 17.5 hours after the start of HFOV. This patient was weaned off the ventilator after 29 hours on HFOV and his recovery was also uncomplicated. It is believed that recovery of the PM was secondary to the low MAP and to the higher arterial pO2 levels, and that HFOV may also have a direct role in the treatment of preexisting air leaks and perhaps also in their prevention. In our patients HFOV resulted in a definitive recovery, while no improvement had occurred on using conventional ventilation. To determine the exact mechanism of action, the clear cut fields of indications and the possible side effects of HFOV, further investigations are needed.
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ranking = 0.0043525650770517
keywords = frequency
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7/9. Complications of Venturi jet ventilation during microlaryngeal surgery.

    Microlaryngoscopy for the diagnosis and treatment of laryngeal pathology is a commonly performed procedure in otolaryngology. The use of this technique continues to increase in frequency due to the availability of laser surgery for the management of laryngeal disease. Ventilation during microlaryngoscopy, however, poses a problem as the airway must be shared by the anesthesiologist and the otolaryngologist. Although many techniques of ventilation during microlaryngoscopy are used, the use of high-pressure Venturi jet ventilation, especially during laser surgery, is most frequent. Complications during high-pressure Venturi jet ventilation are uncommon but may occur suddenly and present the surgeon with a life-threatening emergency. hypoventilation, pneumomediastinum, pneumothorax, severe abdominal distention, and death (directly attributable to various methods of jet ventilation) have been described.
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keywords = frequency
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8/9. High frequency positive pressure ventilation (HFPPV) in a newborn infant with ruptured lungs.

    A 4.2-kg full-term male infant underwent treatment of acute respiratory distress as a result of gross bilateral pneumothoraces, pneumomediastinum and interstitial emphysema. When a trial of continuous positive airway pressure failed conventional intermittent positive pressure ventilation was instituted, but this also failed to achieve satisfactory ventilation at a respiratory frequency of 60 b.p.m. while producing peak airway pressures of 30 cmH2O. High frequency positive pressure ventilation was instituted with a Siemens 900C ventilator delivering a minute volume of 3 litre min-1 at a respiratory frequency of 72 b.p.m., while registering peak airway pressures in the range of 20-23 cm H2O. During the first 30 min of this regimen the patient's condition improved such that FIO2 was decreased to 0.6. Six hours later FIO2 was decreased to 0.55 and the inspired minute volume to 2.8 litre min-1 with a further decrease in peak airway pressure. The infant was maintained on high frequency positive pressure ventilation for a total of 42 h, and following weaning made an uneventful recovery. In another newborn infant, weight 1.9 kg, the measurement of airway pressure at the distal end of the tracheal tube and gas flow in the inspiratory limb of the respiratory circuit established that the tracheal peak airway pressure was 10 cm H2O less that the pressure registered on the ventilator. The 900C ventilator produced a pattern of high frequency low pressure ventilation, with sustained PEEP, which closely resembles the defined pattern of HFPPV.
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keywords = high frequency, frequency
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9/9. Pulmonary interstitial emphysema treated by selective bronchial obstruction and high-frequency oscillatory ventilation.

    A 30-week preterm infant ventilated for respiratory distress syndrome developed severe right-sided pulmonary interstitial emphysema, pneumomediastinum, and subcutaneous emphysema involving the neck. Selective bronchial obstruction and high-frequency oscillatory ventilation showed dramatic improvement in the clinical and radiographic condition of the infant.
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ranking = 0.0043525650770517
keywords = frequency
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