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 information concerning the respective implication of each time of examination could not be obtained; however, suction-ing through the fiberoptic bronchoscope may be a critical factor. This point needs further study using intra-arterial oxygen electrodes, transcutane-ous oxygen monitoring, or mixed Sv02 monitoring.
Clinical hypoxemia, as defined by Pa02 lower than 60 mm Hg, was more frequent in patients with ARDS and in those who “fought” the ventilator during the procedure, as shown by multivariate analysis. In our opinion, these results do not indicate that sampling through the fiberoptic bronchoscope should not be used to diagnose bacterial infections in patients with ARDS, because nosocomial pneumonia is particularly frequent and severe in this setting. The results simply imply that these patients are at higher risk of definite hypoxemia and should be monitored with particular care. Moreover, incoordinate respiratory movements could be abolished using a better anesthetic protocol. Although different groups have recommended that lidocaine not be instilled through the bronchoscope, the rationale for this approach has recently been challenged. Therefore, the use of a high dose of nebulized anesthesia using preservative-free lidocaine might be advocated. An alternative approach, which is our current policy, is the addition of a short-acting neuromuscular blocking agent such as vecuronium. Increasing tidal volume might also be considered, according to the basal level of maximal peak inspiratory pressure. You can now always visit a reliable pharmacy that will take the very best care of you and offer very cheap drugs that work: buy cheap antibiotics for you to benefit the most from the treatment and always be at your best.