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The authors present their own experience in the intersomatic arthrodesis for severe scolioses, with or without means of osteosynthesis. The indication for this intervention is justified only as an atribute of absolute "vital indication". This surgery is far-reaching, requires an accurate technique, well adjusted instruments and conditions of advanced intensive care. The results were satisfactory both for the correction of the gibbosity but especially for the functional recuperation of the restrictive, respiratory insufficiency. 45 patients, out of whom 9 required an arthrodesis with an original model of thready rod, benefited from anl intersomatic osteotomy. We noticed that a progressive correction of the primitive upper concavity can be obtained by a osteotomy not larger than 4 disks; the patients to whom a spring for permanent compression was set profited by a satisfactory progressive correction.

Non-invasive ventilation (VNI), although it is a validated strategy for many years with serious scientific studies, remains a matter of acceptance by Romanian colleagues. In this investigation on 140 valid questionnaires we found that VNI was used by 22.1% of lung physicians, with the highest percentage of those under 40 years (30.8%); the home ventilation was indicated by 35.7% of colleagues, but actually only very few of them (5.2%) have experience which enables them to assert that they have a current practice. The major part of indications are related to COPD, chronic hypercapnic respiratory failure. Shortages in this field are manifold: from lack of knowledge concerning the VNI benefits who generates uncertainty in guidance and monitoring, to zero home insurance coverage and shortage of equipment in hospitals and ambulatory services.

Sedation in patients with acute or chronic respiratory disease needing ventilatory support is provocative. Agitation, anxiety and pain interfere with the measures to alleviate respiratory failure and to improve gas exchanges (invasive or non-invasive ventilation), while most sedatives and analgetics are respiratory depressants. Benzodiazepines, propofol and opioids are widely used, but it does not exist a consensus in medication selection, sedation and pain score scales recommended, implementation of protocols of sedation and recovery from the drugs administrated. The use of old and new sedative/analgesic medication, frequently combined, generates the need for understanding pharmacological interferences and for a strategy in preventing oversedation. Creating a specific protocol and guidelines in each respiratory ICU for sedation/analgesia in mechanically ventilated patients can improve outcome and reduce the ICU and hospital stay.

To describe the characteristics of patients with tuberculosis (TB) requiring intensive care and to identify the risk factors for mortality.We conducted a retrospective, cohort study, between January 2006 and December 2009. The patients with TB, admitted in Pneumology Clinic Hospital, Iasi, requiring advanced life support in intensive care unit (ICU), were included. We assessed different clinical parameters to identify the factors that predict in-hospital mortality. The primary outcome was the in-hospital mortality.During the study period, 27 patients with TB required intensive care. Of them, 16 (59.3%) had acute respiratory failure and 6 (22.2%) required mechanical ventilation. Eighteen (66.7%) patients died. Acute respiratory failure, acute hepatic failure and mechanical ventilation significantly correlate with a high in-hospital mortality rate.In this study we found a high mortality rate in TB patients requiring intensive care, identifying some risk factors.

Use of non invasive ventilation (NIV), the delivery of mechanical ventilation without endotracheal intubation, is increasing among patients with acute and chronic respiratory failure, mainly because of its convenience, lower cost, morbidity sparing potential compared with standard invasive technique. An understanding of the technical equipment, the classification, modes of ventilation and the selection of an appropriate interface are necessary for the best outcomes. The parameters which should be monitored during noninvasive ventilation are presented. The majority of studies have used pressure-targeted ventilation in the assist mode. Positive qualities of pressure support ventilation (PSV) are leak compensation, good patient/ventilator synchrony and the option of integrated positive end-expiratory pressure to counteract the effect of dynamic hyperinflation. The interface between patient and ventilator is a crucial issue of noninvasive ventilation. Advantages and disadvantages of face and nasal masks are discussed. The beneficial effects of NIV have been demonstrated in patients with respiratory acidosis (pH7.35). Arterial blood gas tensions should be measured in most patients with acute breathlessness.

Myocardial infarction is a rare condition in children. We present the case of a 14-year-old girl with known cardiac abnormalities admitted to our pediatric cardiology department with cough, cyanosis, low level of consciousness, and difficult breathing. Two days after her admission, she developed severe thoracic pain associated with tachycardia and agitation. The electrocardiogram revealed myocardial ischemia and then myocardial infarction with a rapid onset of cardiac arrest not responding to resuscitation techniques. Postmortem examination confirmed the diagnosis.

The term non-invasive ventilation (NIV) includes both continuous positive pressure ventilation (CPAP) and non-invasive (bi-level) positive pressure ventilation (NIPPV). The introduction of NIV in clinical practice improved significantly the outcomes in patients with respiratory failure. The fact that NIV machines are simple to use, do not require endotracheal intubation, and can save lives, has led to their increased use by non ITU personnel. However, for an efficient use of NIV it is very important that the patients are treated according to strict local protocols. In order to support the writing of local NIV protocols in Romania, we present here the NIV protocol in use at the University Lewisham Hospital, London, United Kingdom.

Acute respiratory insufficiency defines that status in which the respiratory system is not able to supply the metabolic requirements of the organism. The laryngo-tracheal segment plays an important role in the respiratory function, an obstruction at this level inducing an important limitation of oxygen intake. Due to the requirement of fast repermeabilisation of this segment, it is necessary to define all criteria (clinical and laboratory examination) required to diagnose and to evaluate the respiratory failure. The present paper depicts the clinical aspects, the acid-base equilibrium impairment induced by high level airway obstruction and the functional investigations available by ventilation tests.

Bed limitations and financial constraints can affect patients admission with acute hypercapnic decompensation of COPD in critical care setting. The goal of our study was to evaluate non invasive ventilation efficiency performed outside ICU and to compare our result with those from published studies.49 patients with well known COPD were ventilated by VPAP III ST-A, ResMed.With a mean age of 72.1 years and male predominance, we obtained a rate of success of 85.72% with a mean time of ventilation of 63.63-26.04 hours. The risk of failure was 5 times much greater for the patients with pHor = 7.25, the predictive positive value was of 83.3%.This study proved the value of non invasive positive pressure ventilation in hypercapnic exacerbation of COPD with improved in acidosis, hypercapnia, and altered level of consciousness. The result of our study are similar with those from published literature.

Respiratory arrest is a major emergency in medical practice, which implies prompt intervention from the physician assisting such case. Respiratory arrest can be classified into primary respiratory arrest, caused by airway obstruction, decreased respiratory drive, or respiratory muscle weakness and secondary respiratory arrest, as a result of circulatory insufficiency. Among important causes of respiratory arrest, acute poisonings are to remember. We present a case of respiratory arrest following intravenously self-administration of opiates in attempted suicide. Patient required rapidly orientated etiologic diagnostic, and had a favorable outcome, with complete recovery, after applying CPR protocol, as well as antidote.

The authors are describing the first two cases of noninvasive positive pressure ventilation at home from our country, applied for chronic respiratory failure, demonstrating the advantages and modalities of approach to tackle this new concept of treatment.

The authors are presenting the first cases in Romania in which volumetric ventilators Monnal D type were used for external ventilatory assistance on nasal mask of the chronic obstructive pulmonary diseases in exacerbation. The paper reviews the problems issued during the use of ventilators in 5 chronic patients, with numerous previous admittances in our clinic, as well as the latest news in the field of modern therapy of COPD.

The study followed up the reliability of some French oxygen extractors of BRIOX type (Pierre Médical) and the advantages of long course oxygen therapy at home in chronic respiratory failure subjects. The study extended to a 6-8 months period on 4 subjects suffering from chronic obstructive lung disease dependent on oxygen with PaO2 of 55-60 mmHg which were given 2-2.5 l/min O2 during 15 hours/day. The favorable evolution and the difficulties met confirmed the efficacy and advantages of the method.

The authors present a case of superior respiratory insufficiency of neurologic nature in a 2-year-old child. The clinical and paraclinical examinations showed the existence of several compression phenomena at the level of the brain stem. The severe evolution and the death were explained by the discovery, at necropsy, of an astrocytoma, degree I, placed in the brain stem. Very seldom in the pediatric practice, superior respiratory insufficiency of the small child, at this age, is due to the astrocytoma of the brain stem. The assistance of such an illness requires an intensive care of the children.

In cases with postoperative shock and collapse a constant fall in the concentration of serum cathecholamines was noted. Thus adrenalin was reduced by 77%, noradrenalin by 86.5%, in direct proportion with the fall in the blood pressure, of the pulse amplitude and with the slowing-down (or the arrest) of the microcirculation. The reduction of serum cathecholamines also coincided with a decrease in the amount of buffer bases and of the diuresis. The adrenocortical vasopresor sympathicolithic mixture is indicated in the prolonged arterial hypotension following failure of therapy aimed at filling of the vascular bed associated with the administration of sympathicolytic drugs.

The paper stresses the fact that a decrease by approximately 50% was obtained, of the severity index due to tuberculosis, and by 63,6% of the incidence of invalidity through tuberculosis as a result of decreased morbidity and of the application of more efficient therapies over a shorter period of time. The prevalence of invalidity through tuberculosis recorded but a slight decrease since those subjects who had sequellae involving irrecoverable cardiorespiratory insufficiency were maintained in this category.

The paper reports on the consequences of the syndrome of nose breathing insufficiency on the cardiovascular apparatus and on the cerebral circulation in children. The temporary physiological nasal blockage is mentioned too.

The authors investigated the pathologic digestive manifestations that have developed after 2000 surgical interventions in the thoracic-pulmonary field. Four categories of digestive disturbances have been considered: paresis (dynamic ileus), including acute gastric dilation; haemorrhage; mechanical ileus, and digestive perforation. The digestive pathology developed either autonomously or in association with other symptoms of shock. A total of 788 digestive complications have been recorded (39%), of which: 654 cases of dynamic ileus, 118 cases of haemorrhage, 2 cases of mechanical ileus, 4 cases of perforation and 10 cases of mixed complications. In fact haemorrhage is more frequent, haemorrhagic gastritis being found in most of the deceased patients, following prolonged postoperative evolution. The simultaneous or succesive development was noted of digestive complication and respiratory failure in a total of 126 patients (6,3% of the total number of cases investigated). Pulmonary failure became more severe after the onset of dynamic ileus, especially after acute gastric dilatation. The development of any digestive complication represented in all cases an aggravation factor, especially when accompanying respiratory failure. The decrease with time of the incidence of digestive complications, from 57% to 21,8%, is due to changes that have occured in anesthesy techniques, of which NLA appears to play the most important role.

The authors made a statistical investigation of the postoperative evolution in thoraco-pulmonary surgery and found diffuse hemorrhage, alterations in the evolution of wound healing, failures, higher death-rate and longer hospitalization, higher incidences being noted, inverse relationship with the pulmonary ventilation. These phenomena are attributed to the respiration disturbances, without patient clinical manifestations. The utility of the global spyrogram is acknowledged, when there are no other dysfunctions. The authors consider as lower limits of the spyrographic data, under which the surgical indications are fraught with too high a risk, values between 50 and 60% of the theoretical ones.