Airway closure, functional residual capacity (FRC) and transpulmonary pressure-volume curves were assessed for each lung separately in the anaesthetized subject by means of a double lumen tracheal catheter. In the supine position airway closure occurred synchronously in the two lungs and 0.2-0.31 above FRC. The pressure- volume curves in both lungs were rather similar and critical closing pressure (CP) was approximately 3 cmH2O in each lung. In the left lateral posture, FRC was increased in the non-dependent and reduced in the dependent lung, while closing capacity (CC) remained unaltered. Airway closure was asynchronous and discontinuous between the two lungs. This was caused by the non-linear transpulmonary pressure-volume curve in the lungs, in conjunction with the vertical pleural pressure gradient. An interpulmonary "pendelluft" phenomenon was observed in the left lateral posture, increasing inhomogeneity of ventilation. It may depend on regional differences in compliance.
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Cureus
December 2024
Pediatric Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, USA.
Subcutaneous emphysema results from air or gas being forced into the fascial spaces of subcutaneous tissue. Once the air or gas has entered the fascial spaces, it travels along connective tissue causing a mass effect and swelling. This rare complication usually presents with mild severity during the immediate postoperative period following surgical procedures of the head or neck regions and self-resolves with conservative treatment.
View Article and Find Full Text PDFSemin Respir Crit Care Med
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Respiratory Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
Pulmonary embolism (PE) and obstructive sleep apnea (OSA) remain a major health issue worldwide with potential overlapping pathophysiological mechanisms. PE, the most severe form of venous thromboembolism, is associated with high morbidity and mortality, presenting challenges in management and prevention, especially in high-risk populations. OSA is a prevalent condition characterized by repeated episodes of upper airway closure resulting in intermittent hypoxia and sleep fragmentation.
View Article and Find Full Text PDFEmerg Med J
January 2025
Department of Anesthesiology & Trauma Center / HEMS Lifeliner 1, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
Thoracostomies, and subsequent placements of chest tubes (CTs), are a standard procedure in several domains of medicine. In emergency medicine, thoracostomies are indicated to release a relevant hemothorax or pneumothorax, particularly a life-threatening tension pneumothorax. In many cases, an initial finger-assisted thoracostomy is followed by placement of a CT to ensure continuous decompression of blood and air.
View Article and Find Full Text PDFJ Clin Med
December 2024
Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80131 Naples, Italy.
A tracheoesophageal fistula (TEF) represents a condition characterized by abnormal communication between the gastrointestinal tract and the airways. Although the current gold-standard treatment is surgery, pre-existing clinical conditions may represent contraindications. We therefore propose a bronchoscopic approach through rigid bronchoscopy without tracheostomy for total repair in patients suffering from benign tracheoesophageal fistulas.
View Article and Find Full Text PDFJ Thorac Dis
November 2024
Department of Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Mechanical ventilation, essential for critically ill patients, contrasts with natural respiration, primarily due to differences in pleural pressure ( ). Natural inspiration decreases , pulling the lungs away from the thoracic wall, whereas positive pressure inspiration increases , pushing the lungs against the thoracic wall. This shift has several consequences.
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