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2002 Patients' recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit Crit Care Med 30 746 752

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Creating of indoor environment in the work area in industrial buildings should be based on cooperation between heating and ventilation. However, practice shows that this is not truth in many cases. Both professions are many times designed separately. Result is their noncooperation leading to a mutual obstruction in terms of disposal location or functional operation of the systems. Creating a heating and ventilation system, which would both be designed in accordance with applicable legislation and it would create an optimal indoor environment for people in working area, to find solution in combination of radiant heating with ventilation air recovery unit.

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Orvosi Hetilap
Authors: Tamás Végh, István László, Marianna Juhász, Mariann Berhés, Ákos Fábián, György Koszta, Csilla Molnár, and Béla Fülesdi

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2019 decemberében egy új típusú pneumoniajárvány kitöréséről számoltak be a kínai Wuhan városából, melynek kórokozója egy új koronavírus volt. A kezdetben állatról emberre terjedő betegség később emberről emberre is terjedt, világjárványt okozva. A vírus okozta betegség (COVID–19) a tünetmentestől az enyhe tünetekkel járón keresztül a súlyos, légzési elégtelenséggel, intenzív osztályos ellátást igénylő spektrumon keresztül változatos formában megjelenhet. Ez utóbbi betegcsoport ellátása jelentős terhet ró az egészségügyre. Ezen összefoglaló célja az intenzív ellátást és légzéstámogatást/gépi lélegeztetést igénylő betegek ellátásának gyakorlati aspektusait hivatott bemutatni. Orv Hetil. 2020; 161(17): 678–684.

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. Howard & T.S. Carey (2006) ‘The Changing Epidemiology of Mechanical Ventilation: A Population-Based Study’, Journal of Intensive Care Medicine 21, 173–82. Carey T.S. The Changing

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mtsai: Mortality is directly related to the duration of mechanical ventilation before the initiation of extracorporeal life support for severe respiratory failure. Crit. Care Med., 1997, 25 , 28

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≥2 mmol/L ( p  < 0.001) and in higher percent required mechanical ventilation ( p  < 0.001) as well as massive transfusion ( p  = 0.011) and emergency surgery ( p  = 0.034) on admission. Patients with BSI evinced more severe medical condition on

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Thymoma has been associated with a variety of autoimmune disorders. We report a case of myasthenia gravis and pancytopenia in a 53-year-old man with lymphoepithelial thymoma and interstitial lung disease. Preoperative examination revealed neither hematologic abnormality nor myasthenia gravis. The patient had enteritis prior to thymomectomy, sternal infection in the first month of operation, and urinary infection at the third month. About three months after thymomectomy, he required mechanical ventilation support due to myasthenia gravis-related respiratory failure. One month later, a rapidly progressing pancytopenia developed. The patient died within two weeks of overwhelming septicemia unresponsive to treatment with antibiotics and steroids. The possible onset of myasthenia gravis or pancytopenia after thymomectomy should be kept in mind during follow-up. Recurrent infections in the early stages of thymomectomy may suggest a lethal onset of pancytopenia.

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Orvosi Hetilap
Authors: Ádám Perényi, Balázs Sztanó, Zsolt Bella, Ilona Szegesdi, Miklós Csanády, Éva Kelemen, Barna Babik, and László Rovó

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A jelenleg is zajló SARS-CoV-2 okozta pandémia miatt a betegek 6%-ában tartós gépi lélegeztetést igénylő légzési elégtelenség alakul ki. A későbbi felső légúti szűkület létrejöttének veszélye miatt „békeidőben” korai tracheotomia jönne szóba. A jelen helyzetben azonban a fokozott aeroszolképződéssel járó beavatkozások kerülendők, ezért a javallatok újragondolására van szükség. A nemzetközi ajánlások alapján alakítottuk ki saját eljárásrendünket. Orv Hetil. 2020; 161(19): 767–770.

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Orvosi Hetilap
Authors: András Lorx, Dóra Bartusek, György Losonczy, and János Gál

.: Noninvaisve vs conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med., 2002, 28 , 1701

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Abstract

Introduction: The 2009 pandemic 2009 H1N1 (pH1N1) influenza A virus shows a markedly different disease pattern than seasonal strains, causing critical illness in relatively young, female, pregnant individuals as well as in comorbid patients. Materials and methods: The Department of Anesthesiology and Intensive Therapy of Semmelweis University served as a regional influenza center for the adult critically ill during the winter of pH1N1 outbreak. We analyzed data collected from 26 suspected pH1N1 critically ill patients treated in our unit during this period. Results: Sixteen cases were confirmed as pH1N1 infection with RT-PCR, while the other 10 patients with influenza like illness showed tendency to a different age and comorbidity, as well as outcome characteristics, suggesting a different pathogenesis. Confirmed pH1N1 patients showed a mean age of 50.5 years (median: 44; range: 20–85), with female predominancy (69%). Comorbidity was present in 69% of cases (chronic heart conditions, chronic pulmonary disease, previous history of malignancy present in 31; 25 and 19%, respectively). Twenty-five percent of the patients were pregnant women. Nineteen percent of the cases received previous pH1N1 vaccination. But two patients were later readmitted for worsening chronic conditions that led to death, which resulted in a total mortality rate of 31%. Mean APACHE II and SOFA scores on admittance were 12.2 and 5.3, respectively. Average length of treatment was 11.5 days (median: 6.5; range 2–50 days). All patients received ventilatory assistance, 69% of patients received invasive, while 31% of patients received non-invasive ventilatory assistance. The average number of days of invasive ventilation was 10.5 days (median: 5.5; range: 2–45). Forty-five percent of ventilated patients required rescue ARDS therapy. Complications included hemodynamic instability (56%); acute renal failure (13%) and pneumothorax (13%). Superinfection with other microbes were observed in 56% of the patients. Conclusions: In our study, pH1N1 infected critically ill patients had a wide age range, but were more commonly female, pregnant, or had a previously described underlying disease. Mortality, length of treatment, need for invasive mechanical ventilation, length of mechanical ventilation, major complication rates were similar to those previously described. A previously not reported relatively high occurrence of pneumothorax was noted, which is possibly a long-term complication of severe viral pneumonitis.

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