NIV by nasal mask proved to be feasible and appropriate for the treatment of respiratory failure in hematologic patients who were at high risk of intubation-related complications.
The purpose of this study was to identify EEG changes associated with low-dose propofol infusion producing only sedative effects, and to describe the memory effects of low-dose propofol infusion. Ten healthy volunteers underwent EEG monitoring (at Fz, Cz, Pz and Oz electrode sites) before, during and after propofol 0.5 mg kg-1 i.v. bolus and 75 micrograms kg-1 min-1 as an infusion. Mean serum concentration of propofol during infusion was 0.86 (SD 0.14) micrograms ml-1. The EEG changed significantly during infusion, with increased power in the beta 1 (15-20 Hz), beta 2 (20.5-30 Hz) and delta (1-3.5 Hz) frequencies. Beta 1 and beta 2 power changes were most marked at the Fz and Cz electrodes. Subjects were sedated, but able to complete cognitive tasks. Visual analogue scales of attention and sleepiness were obtained throughout the study and demonstrated a sedative effect during propofol infusion, but were not a significant factor in memory performance or EEG changes. A verbal learning task (Rey Auditory-Verbal Learning Task) administered before, during and after infusion showed a marked reduction in short-term memory capacity and dramatically impaired free recall and recognition during infusion. Nine of 10 subjects had partial amnesia for complex visual scenes presented during infusion, recalling less than 50% of the material. Stronger cueing was required to retrieve information presented during propofol infusion, with an increase in mean retrieval time from 95.4 (41.2) s to 426.8 (83.1) s. EEG and memory effects resolved quickly after the end of infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
Treatment of acute respiratory failure by prolonged non-invasive ventilation in a childPurpose: To evaluate the feasibility and the efficacy of non-invasive ventilation (NIV) by nasal mask in a paediatric patient.Clinical features: A four-year-old girl with acute lymphocytic leukaemia (ALL L~ pre-pre B) complicated by acute respiratory failure was treated with NIV. On admission she exhibited hyperpyrexia (40C), pancytopaenia and severe hypoxia with hypocapnia (PaO 2 = 45 mmHg; PaCO 2 --28.2 mmHg; pH = 7.30; SpO 2 = 76%; ABE = -7.3 mmoI-L -~. V~th NIV, PaO 2 improved (PaO 2 = 78 + 8 mmHg; SpO 2 = 86 + 2; PaCO 2 = 39 -2) throughout the first day. Treatment was continued for six days until the patient was discharged. No complications were recorded.Conclusion: Non-invasive ventilation by nasal mask may represent a choice in the treatment of acute respiratory failure of parenchymal origin in paediatric haematologicat patients.Objectif : I~valuer la faisabilit~ et I'efficacit~ de la ventilation non invasive (VIN) administr6e par masque nasal en p~diatrie.Elements cliniques : Une ~llette de quatre arts atteinte de leuc~mie lymphocytaire aigu~ (ALL L~ pre-pre B) compliqu& d'une insuffisance respiratoire aigu~ a ~t~ trait& par VlN. A I'admission, elle &ait hyperpyrexique et profond~ment hypox~mique avec de I'hypocapnie (PaO 2 = 45 mmHg; PaCO 2 = 28,2 mmHg; pH = 7,30; SPO 2 = 76%; ABE = -7,3 mmoI-L -t. La premiere joum~e, sous VlN, sa condition s'est am~lior& (PaO 2 = 78 mmHg; SPO 2 = 86+2; PaCO 2 = 39_+2). La ventilation a ~t~ continu~e pendant six jours jusqu'au cong~ de la patiente. II n'y a pas eu de complications.Conclusion : La ventilation non invasive par masque nasal peut repr&enter une option th&apeutique valable de I'insuffisance respiratoire aigu~ d'origine parenchymateuse en h~matologie p~diatrique.
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