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      Cardiac Tamponade due to Pneumopericardium


      , ,


      S. Karger AG

      Pneumopericardium, Cardiac tamponade, Barotraumas

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          We describe a newborn with acute respiratory distress syndrome, subjected to mechanical ventilatory assistance with high level of peak inspiratory pressure (PIP) and positive end expiratory pressure (PEEP), who developed cardiac tamponade due to pneumopericardium. Tension pneumopericardium produces the same physiological derangement as cardiac tamponade secondary to accumulated blood or other fluids. This life-threatening complication demands immediate diagnosis and treatment.

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          Most cited references 5

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          Incidence of pulmonary barotrauma in a medical ICU.

           H Baier,  G Petersen (1983)
          One hundred seventy-one patients admitted to a Medical ICU and who received treatment for respiratory failure with mechanical ventilation were studied for the development of pulmonary barotrauma (PBT) as manifested by pneumomediastinum, subcutaneous emphysema, or pneumothorax. Fourteen patients (8%; group A) developed this complication; they were younger, had higher maximal peak inspiratory airway pressures (PIP); and higher levels of maximal PEEP. We conclude that for medical patients treated for respiratory failure with mechanical ventilation, the incidence of PBT is 8% and that younger age, higher levels of PIP and PEEP seem to pose an increased risk for developing PBT.
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            High level positive end expiratory pressure (PEEP) in acute respiratory insufficiency.

            Twenty-eight patients developed severe, progressive acute respiratory insufficiency despite aggressive application of conventional respiratory therapy. Application of increased PEEP (18 torr or greater) resulted in a significant decrease in QA/QT. Selection of the optimal levle of PEEP for each patient required serial determinations of QA/QT and measurement of cardiovascular response. The overall survival rate was 61 percent. Acute respiratory insufficiency was a proximate cause of death in only one patient. Four of the patients (14 percent) developed a pneumothorax following institution of high PEEP therapy. Cardiac output was not affected adversely at any level of PEEP up to 32 torr (44 cm H2O). We conclude that high levels of PEEP can be therapeutic for patients with refractory respiratory failure when combined with intermittent mandatory ventilation and careful cardiovascular monitoring. As with any therapy, the optimum dose should be tailored to each patient according to his needs and response.
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              The anatomy and applied anatomy of the mediastinal fascia.


                Author and article information

                S. Karger AG
                November 2005
                24 November 2005
                : 105
                : 1
                : 34-36
                Critical Care Units of the Instituto Médico La Floresta and The University Hospital of Caracas, and Laboratory of Interventional Cardiology, Caracas, Venezuela
                88450 Cardiology 2006;105:34–36
                © 2006 S. Karger AG, Basel

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                Page count
                Figures: 1, References: 12, Pages: 3
                Original Research


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