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      Cardiac Tamponade due to Pneumopericardium

      , ,

      Cardiology

      S. Karger AG

      Pneumopericardium, Cardiac tamponade, Barotraumas

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          Abstract

          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.

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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2006
                November 2005
                24 November 2005
                : 105
                : 1
                : 34-36
                Affiliations
                Critical Care Units of the Instituto Médico La Floresta and The University Hospital of Caracas, and Laboratory of Interventional Cardiology, Caracas, Venezuela
                Article
                88450 Cardiology 2006;105:34–36
                10.1159/000088450
                16179824
                © 2006 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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

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