Interesting article by P Phipps and C S Garrard (Intensive Care Unit, John Radcliffe Hospital, Oxford OX3 9DU, UK) regarding the treatment and managemnet of acute asthma. Management of the patient before intubation, during and post intubation are discussed
You can find the link Here
Guillain-Barré Syndrome is the leading cause of nontraumatic acute paralysis in industrialized countries. About 30% of patients have RESPIRATORY failure requiring intensive care unit (ICU) admission and invasive mechanical ventilation. Progressive weakness of both the inspiratory and the expiratory muscles is the mechanism leading to respiratory failure. Aspiration pneumonia and atelectasis are common consequences of the bulbar muscle weakness and ineffective cough.
From the Department of Neurology at the Mayo Clinic, there appears to be diagnostic and clinical techniques in deciding when/if a patient requires admission to the I.C.U.
In the study ( from Vol. 58 No. 6, June 2001 Archives of Neurology) 114 patients with GBS who were admitted to the Intensive Care unit were studied.
In summery the results they found were the following:
Those requiring mechanical ventilation were found to have bilateral facial weakness, or dysautonomia, and bulbar dysfunction. Spirometry values indicated concern with VC <20 ml/kg, MIP ,30 cmH20 and a maximum expiratory pressure of <40 cmH20.
Ventilating patients in the Cardiac Surgery Intensive Care Unit is typically straight forward. Moderate tidal volumes with an elevated Fi02, followed by a wean to pressure support ventilation once level of consciousness returns.
Typically this occurs within 4-6 hours upon the patients arrival into the CSICU.
However, there are situations where more aggressive ventilation strategies are required such as increased blood loss from mediastinal chest tubes (?peep), refractory hypoxemia from postoperative pulmonary dysfunction (PPD) (?peep and Fi02, PC ventilation, addition of NO, etc.), ?BP and circulation, etc.
There is a very good article in AMERICAN JOURNAL OF CRITICAL CARE, September 2004, Volume 13, No. 5 which helps explain its occurrence.
Please see tables 1 and 2 in this article for plausible explanations.
Read the full article here.
