Severe hypoxemia revealing traumatic tricuspid regurgitation with right-to-left intracardiac shunt

A case of traumatic tricuspid regurgitation immediately following chest trauma in an 18-year-old man is reported. The cardiac lesion was revealed by right-to-left shunt due to the reopening of the foramen ovale leading to hypoxemia exacerbated by controlled ventilation. Early surgical repair led to hypoxemia correction.

High-frequency jet ventilation vs continuous positive airway pressure for postoperative respiratory support

In ten patients after recovery from general anesthesia for major vascular surgery, we compared continuous positive airway pressure (CPAP) and high-frequency jet ventilation (HFJV) at the same fractional concentration of oxygen in the inspired gas, both being superimposed on spontaneous breathing. The HFJV was delivered by a ventilator ( Acutronic VS-600) through the lateral lumen of a three-lumen endotracheal tube. Mean airway pressure was increased (3, 8, and 11 mm Hg) by adjusting the driving pressure during HFJV and by the setting of the expiratory valve during CPAP. During HFJV, the frequency (10 Hz) and inspiratory-expiratory ratio (0.25) were kept constant. Control values were measured when patients breathed spontaneously without positive end-expiratory pressure. Cardiac output and transmural filling pressures remained unchanged throughout the study. Neither the arterial oxygen pressure (PaO2) nor intrapulmonary shunt (Qs/Qt) changed significantly during CPAP. The 20- to 30-percent increase in PaO2 and the 5- to 10-percent decrease in Qs/Qt during HFJV when compared to control reflected a slightly but significantly (p less than 0.05) better oxygenation. The increase in arterial carbon dioxide tension was significantly greater during CPAP than during HFJV.

Differential ventilation in unilateral lung disease: effects on respiratory mechanics and gas exchange

Conventional PEEP ventilation has been recently reported to be deleterious in some cases of ARF with unilateral pneumonia. In such respect, two cases of unilateral bacterial pneumonia were intubated with a Carlens tracheal tube. Measurement of tidal volume, static compliance, and functional residual capacity of each lung showed marked inequality. Subsequently, both patients were ventilated with a selective distribution circuit, allowing the introduction of a PEEP valve in the expiratory line of the diseased lung. Evident improvement in blood gases was obtained within 24 hours, as tidal volume, static compliance, and FRC of the diseased lung were markedly improved. In one case equalisation of V/Q ratio was documented using the 81m Kr method. Final recovery was obtained in one case.

[Action of radiation of the head on the capacity for lymphoblastic transformation in the adult rabbit]

The temporary immunological depression previously demonstrated after high level head irradiation of adult rabbits seems to be due to decrease in lymphoblastic transformation capacity connected with encephalon injury.