Archive for the 'Fiberoptic Bronchoscopy' Category

25 Sep

Evaluation of Cardiopulmonary Risk under Midazolam Sedation: Results (Part 3)

No relation could be established (F<0.5) for the size of the tracheal tube, baseline minute ventilation, baseline PaC02, decrease in minute ventilation, number of pop-off cycles, and number of triggered cycles. The baseline Pa02, use of PEEP, and change in PaC02 were factors independently related to the degree of relative hypoxemia as determined by using the […]

15 Sep

Evaluation of Cardiopulmonary Risk under Midazolam Sedation: Discussion (Part 4)

Major arrhythmias were noticed in 5 percent of the patients, which agrees with a number of studies in spontaneously breathing patients, but is lower than the 40 percent rate observed by Katz et al. In the latter report, arrhythmias were frequently associated with a period of major oxygen desaturation of up to 44 percent. Such […]

14 Sep

Evaluation of Cardiopulmonary Risk under Midazolam Sedation: Discussion (Part 3)

As a group, ventilated patients did not demonstrate major blood pressure variations or tachycardia. The mean decrease in systolic blood pressure below baseline values was 10 percent, which was related to sedation, and not to the bronchoscopic procedure. In normal humans, midazolam at a dose of 0.15 mg/kg IV produces a similar response, associated with […]

13 Sep

Evaluation of Cardiopulmonary Risk under Midazolam Sedation: Discussion (Part 2)

This decrease in minute ventilation was observed despite the use of a special adapter. Contrary to the results of Lindholm et al, we were unable to find a relation between the size of the tracheal tube and the degree of hypoxemia (F<0.5). Because of the short duration (120 seconds) of the procedure in our study, detailed […]

12 Sep

Evaluation of Cardiopulmonary Risk under Midazolam Sedation: Discussion (Part 1)

Fiberoptic bronchoscopy is generally regarded as safe, based on surveys of endoscopists. Such studies provide important data for alert patients undergoing diagnostic investigation but fail to adequately identify factors that may increase the risk of endoscopy in ventilated patients. As we approach an era where bronchoscopy may supersede bronchial aspiration as a sampling procedure for […]

11 Sep

Evaluation of Cardiopulmonary Risk under Midazolam Sedation: Results (Part 5)

Risk Factors Fourteen patients developed clinical hypoxemia as defined by PaO2 lower than 60 mm Hg on FIO2 adjusted to 0.8. Distribution of the variables associated with such hypoxemia is shown in Tables 2 and 3. Using univariate analysis, ten factors could be identified. After stepwise logistic regression analysis, two independent variables were significantly associated […]

10 Sep

Evaluation of Cardiopulmonary Risk under Midazolam Sedation: Results (Part 4)

Hemodynamic Monitoring Variations of heart rate and systolic blood pressure are indicated in Figure 3. The heart rate increased slightly at the end of the procedure, with an average of 103 beats per minute, but wide interindividual variations were observed (range, 30 to 170 beats per minute). Major arrhythmias were observed in six patients (tachyarrhythmia […]

08 Sep

Evaluation of Cardiopulmonary Risk under Midazolam Sedation: Results (Part 2)

The magnitude of alterations in pH and PaC02 was relatively slight. Only three patients had a PaC02 greater than 60 mm Hg at the end of bronchoscopy. Development of ARDS was not associated with a higher PaC02 at the end of the procedure. When patients were analyzed according to their PEEP level, the mean PaC02 […]

07 Sep

Evaluation of Cardiopulmonary Risk under Midazolam Sedation: Results (Part 1)

Clinical characteristics of the 107 patients are summarized in Table 1. The patients had been admitted to the ICU for a variety of problems, including postoperative respiratory failure (31 cases; 29 percent), respiratory insufficiency associated with chronic obstructive pulmonary disease (24 cases; 22 percent), acute pulmonary disease (16 cases; 15 percent), neurologic emergencies (14 cases; […]

06 Sep

Evaluation of Cardiopulmonary Risk under Midazolam Sedation: Materials and Methods (Part 3)

Protocol Arterial blood gas levels, heart rate, blood pressure, and central hemodynamic data were measured in the following order: prior to preoperative medication; five minutes after IV premedication;  at the end of the procedure, with the fiberoptic bronchoscope still in place; 15 minutes after removing the endoscope; and two hours after examination. Ventilator settings were […]

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