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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Tracheal gas insufflation (TGI) is an adjunct to mechanical ventilation that allows ventilation with small tidal volumes while carbon dioxide (CO2) is satisfactorily cleared. Pioneering studies in healthy animals and in humans suffering respiratory failure showed that the expiratory flushing of proximal dead space decreased minute ventilation with no change in arterial partial pressure of carbon dioxide (PaCO2). Recent work indicates that conventional mechanical ventilation aided by TGI may represent a novel ventilatory strategy that succeeds in limiting both the distending forces acting on the lungs and the PaCO2 elevation of permissive hypercapnia. Furthermore, some studies suggest that weaning aided by TGI may allow a reduction in minute ventilation, PaCO2, physiologic dead space, and the patient's respiratory demands. Clinical use of TGI requires careful monitoring of delivered volumes and pressures to ensure safe clinical application and to evaluate the effect on lung function. Finally, routine use of TGI in intensive care warrants further investigation to solve some technical problems and randomized clinical trials to confirm the beneficial effects in the absence of complications.
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PMID:Clinical studies of tracheal gas insufflation. 1117 44

A 42-year-old woman with hysteromyoma underwent total abdominal hysterectomy under general and epidural anesthesia. Three years before, she had undergone resection of lipoma on her left shoulder under local anesthesia uneventfully. She had no previous history of hypersensitivity. General anesthesia was induced by intravenous injection of fentanyl, propofol, and vecuronium followed by inhalation of nitrous oxide, oxygen, and sevoflurane. Lidocaine and fentanyl were injected through a lumbar epidural catheter. After the start of open laparotomy, there was a sudden onset of hypotension. Administrations of ephedrine and phenylephrine, and volume loading were ineffective. Moreover, she showed profound hypotension, tachycardia, oxygen desaturation, decreased endtidal carbon dioxide and increased airway pressure. She broke out in a sweat with flushing on her chest and upper extremities. Therefore, we interrupted the surgery, checked her arterial blood gas analysis, performed echocardiography, and inserted a pulmonary artery catheter. We made a diagnosis of anaphylactic shock and administered methylprednisolone, albumin, epinephrine, norepinephrine, and dopamine to treat the circulatory collapse. The gynecologists changed their surgical gloves from a powdered-latex type to a powder-free latex type, and the surgery was resumed. She responded well to appropriate emergent therapy and all vasopressor drugs were gradually decreased and eventually stopped. After the end of the surgery, she recovered completely from the signs and symptoms of shock. Later, we found a high level of plasma latex protein-specific IgE antibody and confirmed the events as anaphylactic shock due to latex. We assumed that the anaphylactic shock was powder-induced latex allergy following use of powdered latex gloves in this case. Latex allergy should be suspected if an anaphylactic reaction or shock accompanied by circulatory collapse, respiratory failure, and skin symptoms of unknown origin occurs during surgery. As women more often come into contact with household articles containing latex, we suspect that women are prone to developing sensitivity towards latex. We recommend that powder-free or latex-free surgical gloves should be available not only for patients with a high risk of developing latex allergy, but also for patients indicated for gynecological open laparotomy.
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PMID:[Powder-induced anaphylactic shock following use of powdered latex gloves during gynecological open laparotomy]. 1678 84

Traditionally, nasal oxygen therapy has been delivered at low flows through nasal cannulae. In recent years, nasal cannulae designed to administer heated and humidified air/oxygen mixtures at high flows (up to 60 L/min) have been gaining popularity. These high-flow nasal cannula (HFNC) systems enhance patient comfort and tolerance compared with traditional high-flow oxygenation systems, such as nasal masks and nonrebreathing systems. By delivering higher flow rates, HFNC systems are less apt than traditional oxygenation systems to permit entrainment of room air during patient inspiration. Combined with the flushing of expired air from the upper airway during expiration, these mechanisms assure more reliable delivery of high Fio2 levels. The flushing of upper airway dead space also improves ventilatory efficiency and reduces the work of breathing. HFNC also generates a positive end-expiratory pressure (PEEP), which may counterbalance auto-PEEP, further reducing ventilator work; improve oxygenation; and provide back pressure to enhance airway patency during expiration, permitting more complete emptying. HFNC has been tried for multiple indications, including secretion retention, hypoxemic respiratory failure, and cardiogenic pulmonary edema, to counterbalance auto-PEEP in patients with COPD and as prophylactic therapy or treatment of respiratory failure postsurgery and postextubation. As of yet, very few high-quality studies have been published evaluating these indications, so recommendations regarding clinical applications of HFNC remain tentative.
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PMID:Heated Humidified High-Flow Nasal Oxygen in Adults: Mechanisms of Action and Clinical Implications. 2643 23