It is often unclear when and how to wean patients from mechanical ventilation. We have devised an evidence-based protocol in which patients undergo a 30-minute trial of spontaneous breathing with a T tube or pressure support of 7 cm H2O. Those who can tolerate the trial are extubated, while those who cannot are reconnected to mechanical ventilation but undergo another trial every day until they...

Tension pneumothorax is not a rare complication of mechanical ventilation, but its occurrence immediately after intubation with a double-lumen endotracheal tube (DLT) is very rare. Subsequent impairment of the respiratory and cardiovascular function can be life threatening if it is not detected early enough and managed properly. Most reported cases of tension pneumothorax during DLT intubation ...

A Brain laryngeal mask was assessed in fifty patients undergoing general anaesthesia who required controlled ventilation. The mask was inserted in all patients without any difficulty and the satisfactory seal obtained enabled ventilation in all patients in a wide range of positions. Airway obstruction occurred in seven patients secondary to downfolding of the epiglottis and this was rectified b...

The application of the independent lung ventilation (ILV) in adults has been described by Carlon and co-workers in 1978 and subsequently by other investigators. In 1983 Hedenstierna and coworkers using a bilumen tube suitable for prolonged intubation, and two Servo Ventilator 900 B (Siemens) adapted for synchronization, treated a wide range of clinical conditions. Following this experience, the...

A 42 year old woman underwent bronchoscopy with procedural propofol sedation. During the procedure, the patient suffered respiratory arrest, and bag-mask ventilation was initiated. During forced mask ventilation, abdominal distention occurred. Even after correct placement of an endotracheal and a nasogastric tube, high inspiratory pressures persisted. The abdominal CT scan revealed a high amoun...

The patient was a 10-yr-old girl who was brought to the operating room to undergo appendectomy. Except for 1 week of abdominal pain and mild nausea but no vomiting, her history was negative. There were no previous anesthetics, environmental or drug allergies, recent upper respiratory infection, or reactive airway disease. No one in her household smoked. She weighed 62 kg and was 138 cm tall. Ex...

A simple non-bronchoscopic bronchoalveolar lavage method was used in 30 patients with the acquired immunodeficiency syndrome undergoing assisted ventilation for respiratory failure. A modified Argyle Levin stomach tube was passed via the endotracheal tube and lavage performed. The lavage was well tolerated and performed quickly and easily, required little training, and had a high degree of sens...

BACKGROUND Video-assisted thoracoscopic surgery (VATS) has emerged as an innovative and popular procedure for the management of postpneumonic empyema in children refractory to a medical response. One-lung ventilation is required during VATS. In this study, we evaluated the efficacy of intraoperative wire-guided endobronchial blockade (WEB) for achieving 1-lung ventilation during a thoracoscopic...

Myasthenia gravis (MG) is an autoimmune disease resulting in destruction of the post-synaptic nicotinic receptors at the neuromuscular junction. Classically, the earliest symptoms of MG are ocular, including ptosis and diplopia. Other less common early symptoms include dysphagia and fatigable chewing. Our case report describes the unusual presentation of MG in a teenager patient and presented f...