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Query: UMLS:C0040586 (tracheobronchitis)
 449 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A piglet model of acute respiratory failure was used to determine whether necrotizing tracheobronchitis (NTB) produced during high-frequency pneumatic flow interrupter (HFFI) ventilation could be attenuated by prior administration of 2 mg/kg hydrocortisone IV. Fourteen piglets (means age 3.6 days, means wt 1.4 kg) were anesthetized and paralyzed before saline lung lavage. The animals were randomly assigned to either placebo (P) or hydrocortisone (H) group. Continuous HFFI (10 Hz) was interrupted five times per minute by a 1-second deflationary pause. All animals were kept on 1.0 FI02 with ventilators adjusted to maintain adequate arterial blood gases. Airway pressures were similar for both groups. After 8 hours of ventilation the animals were sacrificed and their lungs inflated with formalin to 40 cm H2O. Sections were obtained from trachea, carina, main stem, and peripheral bronchi. A total airway injury (TAIS) was calculated by a pathologist unaware of treatment assignment. There was a significant difference (p less than 0.01, Wilcoxon rank sum) in TAIS scores between P (means 21.3) and H (means 7.8). In five out of seven P animals and in one out of seven H animals, NTB was severe and extended to the hilar bronchi. Although NTB is multifactorial in origin, the prior use of hydrocortisone may decrease the severity and extent of lesions by modifying the inflammatory response to this specific airway injury.
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PMID:Necrotizing tracheobronchitis following high frequency ventilation: effect of hydrocortisone. 212 25

A piglet model of acute respiratory failure was used to determine whether necrotizing tracheobronchitis (NTB) reported during high-frequency pneumatic flow interrupter (HFFI) ventilation could be minimized by a different ventilatory strategy. Twenty-one piglets (mean age 3.8 days, average weight 1.4 kg) were anesthetized with ketamine and given Pavulon prior to saline lung lavage. Femoral vessels were cannulated for measurements of blood pressures, arterial blood gases (ABG), and fluid administration. Airway pressures were measured 5 mm above the endotracheal tube tip. To allow for lung deflation, HFFI (10 Hz) was programmed to pause for 1 sec either 5 (HFFI5) or 12 times per min (HFFI12). Seven animals were assigned to each of the treatment groups and to a conventional mechanical ventilation (CMV) control. All animals were kept on 1.0 FIO2 with ventilators adjusted to maintain ABG (pO2 = 50-100 mmHg and pCO2 = 30-40 mmHg). After 6 h of ventilation, the animals were sacrificed and their lungs inflated with formalin to 40 cm H2O. Sections were obtained from trachea, carina, mainstem, and hilar bronchi. An airway injury score (AIS) was calculated after "blinded" microscopic evaluation. There was no difference in total AIS between CMV (2.4) and HFFI12 (8.6) but a statistically significant difference (p less than 0.05) existed between CMV and HFFI5 (14.1). NTB was limited to the trachea during HFFI12 but extended down to the hilar bronchi during HFFI5. More frequent lung deflations reduce the severity and distribution of NTB during HFFI ventilation.
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PMID:Necrotizing tracheobronchitis following high-frequency ventilation: effect of lung deflation. 322 3

To compare high-frequency jet ventilation (HFJV) with pressure-limited time-cycled conventional ventilation (CV), we randomized 41 infants with clinical and radiographic evidence of respiratory distress syndrome during the first day of life to receive either HFJV or CV. Standardized ventilatory protocols were used for 48 hours, after which CV was administered to both groups. Despite comparable oxygenation (arterial/alveolar oxygen tension ratio), mean airway pressure was lower in the HFJV group (9 +/- 2 vs 13 +/- 2 cm H2O, P less than 0.001), and thus the arterial/alveolar oxygen tension ratio corrected for mean airway pressure was improved in the HFJV group (P less than 0.05). PaCO2 was lower during HFJV (37 +/- 3 vs 42 +/- 3 mm Hg, P less than 0.05) despite a comparable peak inspiratory pressure. The incidence of air leaks, progression of intraventricular hemorrhage, and mortality during the 48-hour period did not differ between the two groups. Bronchoscopies in eight infants given HFJV and five given CV revealed no microscopic evidence of necrotizing tracheobronchitis, but one infant given HFJV had evidence of necrotizing tracheitis at autopsy. We conclude that for 48 hours during the acute stage of respiratory distress syndrome, HFJV can maintain adequate gas exchange at lower mean airway pressure than during CV, without an increase in the incidence of side effects.
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PMID:Randomized trial of high-frequency jet ventilation versus conventional ventilation in respiratory distress syndrome. 354 78

Four patients with cardiorespiratory failure caused by secondary kyphoscoliosis were studied. Polycythemia, cor pulmonale, restrictive lung pattern (functional residual capacity (FRC), 17 to 27% predicted; vital capacity (VC), 11 to 23% predicted), and abnormal arterial blood gases, primarily hypoventilation (PaO2, 31 to 44 mm Hg; PaCO2, 52 to 73 mm Hg), were seen in all. Supplementary oxygen, digoxin, diuretics, 15 min of intermittent positive-pressure breathing with inspired pressure (PI) 25 cm H2O 4 times daily, and tracheostomy failed to produce improvement. However, 12 h of nighttime ventilation (NTV) with PI 28 to 35 cm H2O through a permanent tracheostomy proved effective. Within 72 h, dyspnea at rest, restless sleep, and frequent waking resolved. Within 8 to 22 days, the PaO2 was approximately 58 mmHg and the PaCO2 was approximately 41 mm Hg while breathing 21% oxygen spontaneously during the day. The right heart failure resolved within 2 to 7 wk, and the hemoglobin count decreased to approximately 165 g/L within 2 to 6 months. There was a mean increase of 700 ml (72%) in functional residual capacity and 430 ml (49%) in vital capacity. The patients were discharged 2 days to 5 wk after NTV commenced. Daytime activity increased, approaching a normal life style. The improvement was sustained over a mean follow-up period of 3.4 yr. Problems included recurrent episodes of tracheobronchitis, mild self-limiting hemoptysis, and speech modification. Nighttime ventilation may be an effective alternative for long-term treatment of cardiorespiratory failure caused by secondary kyphoscoliosis.
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PMID:Nighttime ventilation improves respiratory failure in secondary kyphoscoliosis. 669 24

Smoke inhalation injury is a complex of disease processes best understood and treated when defined in terms of the time period after injury. The early phase (0 to 36 hrs) is characterized by diagnosis and treatment of carbon monoxide and cyanide toxicity and by management of early airways edema, bronchorrhea, and bronchoconstriction with aggressive pulmonary toilet. Between 1 and 5 days, the major characteristic is airways mucosal slough, tracheobronchitis, and increasing lung water and impaired gas exchange. Pulmonary toilet and infection control, as well as close management of fluid shifts, is the major treatment. With onset of the inflammation-infection phase, the risk of nosocomial pneumonia increases markedly, as does the impairment in lung function as a result of marked increase in oxygen consumption and CO2 production. Nutrition, stress modification, avoidance of muscle fatigue, and control of infection are the key treatment modalities.
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PMID:Smoke inhalation injury. 792 21

By pediatricians the high frequency oscillatory ventilation (HFOV) is used almost only in the neonatal period. We report on the administration of HFOV in infants with pulmonary insufficiency after failure of conventional ventilatory support. 6 infants (aged 2-7 months, all former preterm babies) were referred to our hospital due to severe pneumonia after unsuccessful conservative management. Indications for HFOV were hypoxia (mean paO2 41.8 mm Hg with FiO2 = 0.95 and mean airway pressure = 16.6 cm H2O) and/or air leak syndrome. In all cases a sufficient oxygenation could be achieved by HFOV, followed then by stepwise reduction of FiO2 and MAP. The air leaks receded. After 12-178 h on HFOV a successful switchback to conventional ventilatory support (at FiO2 = 0.48 and MAP < 12 cm H2O) was possible, all infants were extubated 6-15 days later. Possible risks of HFOV are air leaks, a necrotizing tracheobronchitis and hemodynamic changes due to compression of the heart and great vessels. With the at the moment in Germany available oscillatory ventilators HFOV as a rescue therapy must be limited for infants with a body weight below 5-6 kg.
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PMID:[High frequency oscillatory ventilation of infants with severe respiratory disorders: possibilities, risks and limits]. 805 9

We determined the effect of a graded increase in lung exposure to a toxic smoke by increasing smoke tidal volume (VT) or the number of smoke breaths. Sheep were anesthetized and then insufflated with cooled cotton toweling smoke; VT was 5, 10, or 20 ml/kg, and smoke breaths were varied from 12 to 48. The smoke had a uniform particle size (3 +/- 0.4 microns diam). Peak carboxyhemoglobin levels varied from 8 +/- 2 to 45 +/- 4% in the lowest to highest exposure groups, respectively. Animals were monitored unanesthetized for 24 h, and then they were killed. Oxygenation (ratio of arterial PO2 to fraction of inspire O2) decreased from 480 +/- 21 to 200 Torr, and compliance decreased by approximately 50% in the highest smoke exposure groups, whereas only a modest decrease in oxygenation and no compliance changes were seen with lesser exposures. A moderate tracheobronchitis, some atelectasis, and no alveolar edema were noted in the lower smoke exposure groups, whereas severe tracheobronchitis, airway edema, and alveolar atelectasis were observed in the highest exposure group. Only modest alveolar flooding was noted. Impaired oxygenation and anatomic injury correlated best with the total smoke delivered (r = 0.59). Increasing VT from 5 to 20 ml/kg did not increase airway or alveolar injury if the total smoke mass delivered was maintained constant. The degree of impaired oxygenation did not correlate with measured lung water (r = 0.27) or lung lymph flow (r = 0.31).
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PMID:Effect of increasing the tidal volume of smoke breaths on smoke-induced lung dysfunction. 817 19

Hybrid intratracheal pulmonary ventilation (h-ITPV) is a continuous flow ventilatory technique that uses a "reverse thruster" catheter to redirect the flow of gas away from the carina. We report here the use of h-ITPV in a pediatric patient with acute sickle cell chest syndrome who required venoarterial ECMO support because of refractory hypoxemic respiratory failure. Her ECMO course was complicated by air leaks, coagulopathy, cardiac tamponade, and necrotizing tracheobronchitis. She could be weaned from ECMO only by maintaining high pressure conventional ventilatory support. To prevent ventilator induced barotrauma, we initiated h-ITPV and weaned her from ECMO bypass. After 12 days of h-ITPV, with tidal volumes of 2-3 ml/kg at carinal peak inspiratory pressures of 25-30 cm H2O, the air leaks ceased and h-ITPV was discontinued. Dead space ventilation fraction (VD/VT) as low as 0.29 was achieved with this technique. Post-h-ITPV bronchoscopy displayed a dramatic resolution of the necrotizing tracheobronchitis. The patient survived and was discharged from the hospital. We conclude that the use of hybrid ITPV may facilitate weaning from ECMO to low pressure conventional ventilation and prevent the development of pulmonary barotrauma.
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PMID:Rescue from pediatric ECMO with prolonged hybrid intratracheal pulmonary ventilation. A technique for reducing dead space ventilation and preventing ventilator induced lung injury. 826 24

In the course of developing a model of inhalation injury, the relationship between the severity of pulmonary injury and specific techniques and doses of smoke exposure was examined in pairs of rabbits simultaneously exposed to smoke. In group I (5 pairs), one animal in each pair was exposed to smoke with a breath hold (BH) at the end of each exposure; the second animal received an exposure producing the same level of carboxyhemoglobin without BH. In group II (6 pairs), both animals were exposed to 25 units of smoke simultaneously, with BH. In group III (3 pairs), one animal received a 20-unit exposure and the other a 25-unit exposure, both with BH. In group IV, 9 animals received 25-unit exposures with BH and were observed for 4 days. Groups V and VI served as controls. Smoke exposure with BH regularly produced severe injury in terms of decreased PaO2 and histopathologic changes, while exposure without BH did not, despite high levels of carboxyhemoglobin after smoke inhalation. The mean differences in percent residual PaO2 (PaO2 at 48 hours x 100/pre-injury PaO2) and in extravascular lung water (EVLW) at 48 hours within pairs of animals receiving 25 units with BH were 12.3% +/- 5.33%, and 0.271 +/- 0.157 mL/g, respectively. Histologic findings such as necrotic tracheobronchitis with pseudomembrane were consistently present. No differences were observed between animals receiving exposure of 20 and 25 units. During the 4 days of observation, three animals in group IV died. PaO2 was lowest on the second day and rose thereafter in all surviving animals except in one that had massive pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A rabbit model of inhalation injury. 848 84

Basidiobolus ranarum is a saprophytic fungus in the environment that also is a part of the endogenous microflora in the gastrointestinal tract of several vertebrates. These organisms may penetrate skin or muscosa of humans and other animals, causing granulomatous inflammation. Two dogs infected with B. ranarum had prolonged or repeated exposure to water or soil in their environment. One dog had progressive subcutaneous infection of all the limbs, and the other dog had recurrent coughing and dyspnea caused by tracheobronchitis. In both dogs, secondary bacterial infection of the lesions was evident. Treatment of the dog with subcutaneous infection involved cutaneous dressings and sequential use of enrofloxacin and itraconazole; however, this resulted in suspected liver damage without clinical improvement. Subsequent treatment with potassium iodide and a lipid formulation of amphotericin B was also unsuccessful, and the dog was euthanatized. The other dog was treated alternately with enrofloxacin and itraconazole. When the clinical signs and infection returned, combination treatment with both drugs was more effective; however, the dog developed liver damage. Subsequent treatment with enrofloxacin on an intermittent basis controlled the dog's coughing during a 3-year period.
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PMID:Infection with Basidiobolus ranarum in two dogs. 1218 3


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