Cases reported "Pneumonia, Aspiration"

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1/5. hypercapnia related to a faulty adult co-axial breathing circuit.

    IMPLICATIONS: This report describes the appearance of CO2 on the capnograph during inspiration, which was linked to disconnection of the inner tube of a coaxial circuit extension piece. The increased use of coaxial breathing systems for adults makes inner tubes disconnections an important consideration when the CO2 appears during inspiration.
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2/5. Unusual arachnoid cyst of the quadrigeminal cistern in an adult presenting with apneic spells and normal pressure hydrocephalus--case report.

    A 67-year-old woman was admitted to our clinic with symptoms of normal pressure hydrocephalus, lower cranial nerve pareses, and pyramidal and cerebellar signs associated with respiratory disturbances. Computed tomography (CT) and magnetic resonance imaging revealed a 4.7 x 5.4 cm quadrigeminal arachnoid cyst causing severe compression of the tectum and entire brain stem, aqueduct, and cerebellum, associated with moderate dilation of the third and lateral ventricles. Emergency surgery was undertaken due to sudden loss of consciousness and impaired breathing. The cyst was totally removed by midline suboccipital craniotomy in the prone position. Postoperatively, her symptoms improved except for the ataxia and impaired breathing. She was monitored cautiously for over 15 days. CT at discharge on the 18th postoperative day revealed decreased cyst size to 3.9 x 4.1 cm. Histological examination confirmed the diagnosis of the arachnoid cyst of the quadrigeminal cistern. The patient died of respiratory problems on the 5th day after discharge. Quadrigeminal arachnoid cysts may compress the brain stem and cause severe respiratory disturbances, which can be fatal due to apneic spells. patients should be monitored continuously in the preoperative and postoperative period until the restoration of autonomous ventilation is achieved.
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3/5. Aspiration pneumonia and coma--an unusual presentation of dystrophic myotonia.

    A 30-year-old female patient presented in a comatose state with clinical and radiographic signs of aspiration pneumonia 16 hours following elective surgery. Subsequent clinical assessment and investigations revealed the characteristic facies, proximal muscle weakness, lenticular opacities, pulmonary function defects, arterial desaturation and abnormal breathing during rapid eye movement (REM) sleep often associated with myotonia dystrophica. Although these characteristic features were evident on clinical examination postoperatively they were not noted in the preoperative assessment. The aspiration pneumonia and coma were unusual presenting features of this disease. Unsuspected myotonia dystrophica should be considered in the differential diagnosis of unexplained respiratory depression, aspiration or comatose state following surgery. Recognition of the disorder during the preoperative assessment is the key to avoiding complications during the perioperative management of such patients.
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keywords = breathing
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4/5. Respiratory complications in patients with myelodysplasia and arnold-chiari malformation.

    Respiratory complications in four patients with myelodysplasia and the arnold-chiari malformation included abnormal control of breathing, upper-airway dysfunction, aspiration pneumonia, and cor pulmonale. Early and prolonged ventilatory support resulted in a favorable outcome in three of four patients.
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5/5. How to modify a volume-cycled home ventilator to satisfy a child's need for pressure-limiting and continuous positive airway pressure during spontaneous breathing.

    Piston driven volume-cycled home ventilators increase work of breathing in the synchronized intermittent mandatory ventilation mode. A 2-year-old trisomy 21 patient with chronic lung disease due to recurrent aspiration pneumonia required a ventilator rate of 6-8 breaths per minute awake and 15 asleep, with peak pressure of 32 cm H2O and positive end-expiratory pressure (PEEP) of 10 cm H2O. Two circuits were designed to facilitate breathing and respiratory mechanics of his spontaneous breaths on both were compared. A spring valve on the inspiratory line pressure-limited ventilation and at the end of the expiratory line provided PEEP in both systems. The reservoir system had a 2-liter bag on the inspiratory limb of the circuit, and two one-way valves at the patient connector to direct inspiratory and expiratory flow. The continuous positive airway pressure (CPAP) system provided continuous flow with a CPAP device set to deliver a pressure 2 cmH2O higher than the PEEP valve. On the CPAP system, compared to the reservoir system, dynamic compliance was greater [1.52 (0.14 SD) ml/cm H2O/kg vs. 0.39 (0.02), p < 0.001] and resistance less [8.15 (1.26) cm H2O/l/s vs. 45.86 (0.87), p < 0.001] as measured with a PeDS machine. This is an innovative use of a CPAP device.
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