Faculty of Medicine

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    MANAGING CRITICAL ILL CHILD WITH ACUTE RESPIRATORY FAILURE
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, 2017-04)
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    Ristovski S
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    Children with acute respiratory failure (ARF) present the commonest group of critical ill patients for admission in pediatric intensive care unit (PICU). Respiratory developmental differences between children and adults render this susceptible group to altered response to disease process, various clinical manifestations and interventions for respiratory failure. Appropriate decisions for a proactive and life-saving management of the critically ill child with ARF can be provided recognizing three distinctive clinical profiles: mechanical dysfunction of airways, neuromuscular and breathing dysfunction. Beside this, assessment of many physiologic variables of the respiratory system in children with ARF helps in identification of the development of the respiratory failure and serves as a guide therapy for good outcome. Therapeutic modalities and strategies for respiratory failure in children vary depending on the underlying cause. Interventions include supportive and specific therapy. Maintenance of body temperature is of major importance while fluid therapy, monitoring and assessment are additional necessary measures that are undertaken at first. Supportive therapy include securing the airways, oxygen by mask, nasal cannula or head box, proper positioning, nebulization if indicated, and physiotherapy. Specific measures include oxygen therapy and mechanical ventilatory support. Prognosis and outcome depend on the presence of the disease on admission using a number of scoring system, appropriate follow up and adequate therapeutic treatment.
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    Evaluation of effects of repetitive recruitment maneuvers
    (Academy of Medical Sciences of Bosnia and Herzegovina, 2012)
    Tatjana Trojik
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    Jasmina Radulovska-Chabukovska
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    Margita Lovach-Chepujnoska
    Introduction: acute respiratory failure is manifested clinically as patient with variable degrees of respiratory distress, but characteristically an abnormal arterial blood partial pressure of oxygen or carbon dioxide. The application of mechanical ventilation in this setting can be life saving. Goals: The aim of this study is to evaluate the effects of two recruitment maneuvers not only on oxygenation, but on aeration of the lung as well. For that purpose chest x ray and thoracic computed tomography scan (CT) of the lung were used as safe and objective methods for evaluation the impact of recruitment maneuvers on aeration of the lung. CT scan and chest x ray were performed before recruitment maneuvers as confirmation of diagnose and one day after the last recruitment maneuvers. Material and methods: Sixty patients who met ar DS criteria of the american european consensus conference were included in this study. This study was conducted in iCU in our hospital between november 2009 and December 2011. Patients were orally intubated, sedated with 0, 2-0, 4 μg/kg /min and midazolam 4 mg/h, and ventilated with evita 2 Dura ventilator (Dragger germany). According to the recom-mendation of the Consensus Conference of the american College of Chest physician all patients had an arterial catheter and cen-tral venous catheter. Hemodynamic data were collected from Data Ohmeda monitors. Gas analyses were mesured from blood samples taken from arteria radialis. Partial pressure of oxygen of mixed blood was messured from blood sample taken from v jugularis interior. We used arterial blood colection syringe Bd preset, and blood samples were analyzed with aVl 995HB blood gas analiser. Results: HEMODYNAMIC CHANGES: there wasn't any differences in heart rate, and mean arterial blood pressure before the recruitment five minutes and sixty minutes after the recruitment in both groups. respiratory mechanics: Highest values of the compliance are achived during the recruitment manouver in both groups. There was better improvment in compliance during the e sigh recruitment maneouver, then in Cpap recruitment maneouver. There was improvement in chest X ray in both groups. 93,4% of patients in the Cpap group and 96,7% in e sigh group. CT scan: in Cpap group there were 8 patients with focal changes and 22 patients with diffusse changes. in e sigh group 29 patients had diffuse changes of the lung and one patient had focal changes. We noticed that there was better improvment in aeration in patients with diffuse changes of the lung 96.7% in e sigh group and 73,3% in Cpapgroup. In patient with focal changes there was improvment in 26,7% in e sigh group and 3,3% in Cpap group. We noticed that there was better improvmnet in aeration in patients with diffuse changes than in patients with focal changes. E sigh maneuver had better impact on aeration of the lung then Cpap recruitment maneuver. Conclusion: In our study we proved that e sigh recruitment maneuvers better improved oxygenation in arterial blood than Cpap recruitment maneuver. Repetative e sigh manouvers proved to be essential for arDS patients. They reopened collapsed alveolli and improved aeration of the lung which was confirmed by X ray and CT scan as an objective methods for verification of lung condition.