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Endotracheal intubation using fiberoptic bronchoscopy
J. Chaves Caminha, Álvaro Moreira Silva, Fernando Rua
Summary:
Objective: to evaluate the use of fiberoptic bronchoscopy
for endotracheal intubation.
Methods: Retrospective evaluation of all cases of
endotracheal intubation using fiberoptic bronchoscopy, at
Hospital Geral de Stº. António, during 1994. Results:
During the one year study-period, 19 fiberoptic
bronchoscopy endotracheal intubations were performed; in
the same period there were about 10,000 patients who
received na endotracheal tube. The most frequent
indication for fiberoptic intubation 86 patients) was
cervical spine trauma; three patients had major facial
trauma. Patients were 20 to 91 years old (mean 48); there
were 15 males and 4 females. When attempted, fiberoptic
bronchoscopy was always accomplished. The nasal approach
was preferred and used successfully in all cases. There
were no complications.
Conclusions: Endotracheal intubation can be safely and
efficiently performed with fiberotic bronchoscopy. In our
institution this technique has been employed sparsely.
Fiberoptic bronchoscopy is very useful for endotracheal
intubation and should become more available.
KEY WORDS: Fiberoptic Bronchoscopy, Endotracheal
intubation.
Continuos Monitoring of Jugular Venous bulb Oxygenation in head trauma
Paulo Martins, Armindo Rebelo, Jorge Pimentel
Summary:
Recent studies have shown the importance of secundary
hipoxic-ischemic lesions, i the fatal outcome of severe
head trauma.
Monitoring of hemodynamics and cerebral metabolism by
measuring the jugular venous oxygen saturation (SjvO2)
and the arteriovenous oxygen (AVDO2) allows the early
detection of alterations in the cerebral metabolismor
perfusion.
We studied ten patients with severe head trauma, in coma
(GCS 4 and 5) who had continuous monitoring of SjvO2 and
ICP. Three of them had jugular venous desaturation with
hipooerfusion by a rise in ICP or vasospasm.
Very often the catheter tip moves away from the jugular
bulb and must be repositioned several times.
Besides some limitations, the continuous monitoring of
SjvO2 allows early detection of hipoperfusion episodes,
and the rationalisation of therapeutic manouvers,
improving the final outcome of severe head injures
patients.
KEY WORDS: Head trauma; Jugular venous bulb oxygenation;
Cerebral metabolic rate of oxygen; Arteriovenous oxygen
difference.
Severity Score System used to compare two different mixed case ICU at Hospital S. João
Cristina Granja, João Pina, Fernando Abelha
Summary:
Using APACHE II and TISS data the authors discuss the
results of one year work at two different mixed case
intensive care units at the Hospital de S. João. Actual
mortality was higher than the predicted from the APACHE
II for both ICU; however, the differences were not
statistically significant. According to the number of
beds, efficiency was very low because of the high length
of stay in both ICU. However the shorter lengthof stay in
one of the ICU could be related to its higher level of
invasiveness, since this did not produce any difference
in mortality. Adjacent care areas influenced length of
stay because of the most frequent kind of patients the
ICU admitted and the level of pressure they put on the
turn over of the ICU. The nurse patient ratio pointsto na
higher level of care than the predicted using the TISS
scores. The reasons for this discrepancy are, probably,
based on the scarse number of qualified auxiliary
personnel, implying a lower level in the nurse´s
activities with lower TISS scores and also because of
unsatisfactory conditions at the wards delaying discharge
of patients, mainly at the weekend. Finally, the authors
mention the significant workload in collecting and
analyse severity scoring data which means that it is
increasingly necessary to get the highest possible profit
of this tool in the management of intensive care
ub«nits.
KEY WORDS: Intensive Care, severity Score Systems,
Intensive Care Management
Hemodynamic support with intra-aortic ballon Counterpulsation
Pedro Pinto Cardoso, Fernando Matias
Summary:
Intraaortic ballon counterpulsation has been used to
provide circulatory assistance to patients with cardiac
failure. It is available in almost all intensive care
units, specially those designed to care for patients
after cardiac surgery. Its use in cardiac catheterization
laboratories has been growing to support high risk
patients before they are submitted to diagnostic and
therapeutic procedures or as a bridge to cardiac surgery,
should complications occur.
The mechanisms of action and the effects in sub-groups of
patients have been widely investigated.
The authors review the literature, adressing to
phisiological mechanisms and hemodynamics effects of
logical ballon pumping, technique of insertion, use and
discontinuance, timing in order to obtain maximum benefit
and problems resulting from malfunctionning. The
indications, contraindications and complications of
intraaortic ballon pumping are also reviewed.
KEY WORDS: Intraaortic ballon conterpulsation;
circulatory assistance devices.
Head Trauma: a retrospective Analysis
M. Pontes, R. Lima, V. Alves, L. Carreira, E. Gonçalves, J. Moreira, O. Cunha
Summary: The authors retrospectively analised nineteen cases of head injury children, admited during 1994, in the Neonatal and Pediatric Intensive Care Unit of HGSA. In 58% of the cases, the origin of injury was related with motor vehicle. There were no other major traumatic injuries in 58% of cases. We analised the therapy procedures and also the complications and sequels, making a correlation between the Glasgow Coma Score on the admission with the nature of sequels. We also correlate the results of the first CT scan and the nature of sequels. The main prognosis data are based on the first CT scan and the value of the Glasgow Coma Score at admission. KEY WORDS: Head injury/Children.
Case Report: Main Brochus Obstrution due to tumoral herpetic lesion in a multiple trauma injuried patient
Pedro José Pimenta Vasconcelos, Vitor Ribeiro Lopes, Nelson Diogo, António Raimundo Santos Rezende
Summary:
The authors present a case of pulmonary atelectasis,
secondary to main bronchus obstrution, due to a single
tumoral herpetic lesion on the lung in a previously
healthy patient presenting multiple traumatic injuries.
Case Report: Severe Tetanus in drug addicts
V. Lopes, P. Vasconcelos, A. Rezende
Summary:
We describe 4 cases of severe Tetanus in drug addicts,
with important signs of Autonomous Nervous system
dysfunction, requiring prolonged stay in ICU. We report
the main therapy used.
| Creation date: 9
July 1997 Last update: 9 July 1997 |
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