Intérêt de la mesure transcutanée des gaz du sang au cours des fibroscopies bronchiques en réanimation

Manchón, Josep Navarro; Ferber, Christian von; Roche, Florentina Pina; Lopez, Michel; Gallet, Michel

doi:10.1016/s0750-7658(88)80011-x

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…The delay before normalization of gas exchange varies from about 15 rain for normal lungs to several hours in severe parenchymal disease [13]. These findings have led to the continuous monitoring of arterial oxygenation during and up to 1-2 h after bronchoscopy [17,19]. It is beyond the scope of this article to compare the various techniques available.…”

Section: ) Gas Exchange and Hemodynamic Alterationsmentioning

confidence: 99%

“…Suffice it to say that the method of choice at the present time seems to be pulse oximetry, which allows on-line monitoring of the O2 saturation of h~emoglobin by spectrophotometry [20]. It offers more flexibility in its use than transcutaneous PO2 (PtcOa) [17,19], which requires heating the skin, and offers less reliability in low cardiac output states [20]. In unstable or hypercapnic patients, measurement of the end-tidal expired PCO2 (PetCO2) at the endotracheal tube opening allows a breath-by breath analysis of changes in the ventilatory status [20].…”

Section: ) Gas Exchange and Hemodynamic Alterationsmentioning

confidence: 99%

“…In terms of complications, bleeding and pneumothorax are more frequent with PSB [77]. BAL causes moderate transient hypoxemia, prompting continuous monitoring of gas exchange and an increase the FiO 2 to 1.0 during the procedure [17,19,68].…”

Section: ) Diagnosis Of Nosocomial Pneumoniamentioning

confidence: 99%

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Bronchoscopy in the intensive care unit

Jolliet¹,

Chevrolet²

1992

Intensive Care Med

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The development of the flexible, fiberoptic bronchoscope has made bronchoscopic examinations possible in ICU patients undergoing mechanical ventilation. Over the years, the number of such procedures has greatly increased, with both diagnostic and therapeutic objectives, such as performing difficult intubation, management of atelectasis and hemoptysis, diagnosis of nosocomial pneumonia in ventilated patients, and early detection of airway lesions in selected situations, such as high-frequency ventilation. The complication rate can be kept low if the endoscopist has a precise knowledge of the many pathophysiological and technical facets particular to bronchoscopy under these difficult conditions. This article reviews some of these aspects, in the light of our personal experience.

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Section: ) Gas Exchange and Hemodynamic Alterationsmentioning

confidence: 99%

Section: ) Gas Exchange and Hemodynamic Alterationsmentioning

confidence: 99%

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Bronchoscopy in the intensive care unit

Jolliet¹,

Chevrolet²

1992

Intensive Care Med

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Fibroscopie bronchique sous ventilation non invasive chez des patients atteints de bronchopathie chronique obstructive avec hypoxémie et hypercapnie

Conceiçao¹,

Genco²,

Favier³

et al. 2000

Annales Françaises d'Anesthésie et de Réanimation

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Naltrexone improves blood gas patterns in obstructive sleep apnoea syndrome through its influence on sleep

Ferber

Duclaux

Mouret³

1993

Journal of Sleep Research

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Endogenous opiates have been shown to depress ventilation, and could therefore play a role in sleep apnoea syndrome (SAS). Hence, opiate antagonists have been used to treat SAS. The improvement they seem to give in blood-gas monitoring could derive either from a direct blocking of endorphins that inhibit respiration or else, indirectly, through an influence on sleep patterns. The present study used a double blind cross-over protocol to investigate the relationships between the effects on blood-gas and on sleep patterns of the oral opiate antagonist naltrexone in obstructive SAS. Sleep patterns and transcutaneous blood gas (tcPO2 and tcPCO2) were recorded in parallel. Control recordings, without treatment, were carried out over two nights, followed by two nights of recording after administration either of naltrexone followed by a placebo or of a placebo followed by naltrexone. The number of obstructive apnoea and hypopnoea events per hour of sleep (Apnoea-Hypopnoea Index: AHI), of hypoxic events (defined as a tcPO2 fall of at least 10, 15 or 20 mm Hg) and of hypercapnic events (defined as a tcPCO2 increase of at least 5 mm Hg) were counted. A Metabolic Suffering Index (MSI) was calculated, defined as the product of the number, duration and magnitude of hypoxic and hypercapnic events. Compared to placebo, naltrexone resulted in significant improvements in blood-gas patterns for the duration and MSI of hypoxic events and for the number, duration and MSI of hypercapnic events. Likewise, compared to placebo, naltrexone induced significant decreases in total sleep time, slow-wave sleep and rapid eye movement (REM) sleep, and, on the other hand, significant increases in total wake time and in the number of wakenings per hour of sleep (Nw h-1). Certain naltrexone-linked blood-gas improvements were closely correlated with certain of the sleep pattern changes: the decrease in number and duration of hypoxic events correlated with REM-time decrease and the decrease in number and duration of hypercapnic events correlated with the increase in Nwh-1. These findings suggest that the improvement in blood-gas patterns induced by naltrexone in SAS may be mediated by sleep pattern effects: i.e. a decrease in REM-time and an increase in intra-sleep wakening.

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Intérêt de la mesure transcutanée des gaz du sang au cours des fibroscopies bronchiques en réanimation

Cited by 3 publications

References 5 publications

Bronchoscopy in the intensive care unit

Bronchoscopy in the intensive care unit

Fibroscopie bronchique sous ventilation non invasive chez des patients atteints de bronchopathie chronique obstructive avec hypoxémie et hypercapnie

Naltrexone improves blood gas patterns in obstructive sleep apnoea syndrome through its influence on sleep

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