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2. Effect of decreased inspiratory times on tidal volume

Author

Herff, H., Bowden, K., Paal, P., Mitterlechner, T., von Goedecke, A., Lindner, K.H., and Wenzel, V.

Abstract

Abstract: Background: During cardiopulmonary resuscitation (CPR) with a chest compression rate of 60–100/min the time for secure undisturbed ventilation in the chest decompression phase is only 0.3–0.5 s and it is unclear which tidal volumes could be delivered in such a short time. Objectives: Attempts were made to assess the tidal volumes that can be insufflated in such a short time window. Methods: In a bench model tidal volumes were compared in simulated non-intubated and intubated patients employing an adult self-inflating bag-valve with inspiratory times of 0.25, 0.3, and 0.5 s. Respiratory system compliance values were 60 mL/cmH2O being representative for respiratory system conditions shortly after onset of cardiac arrest and 20 mL/cmH2O being representative for conditions after prolonged cardiac arrest. Results: With a respiratory system compliance of 60 mL/cmH2O, tidal volumes (mean±SD) in non-intubated versus intubated patients were 144±13 mL versus 196±23 mL in 0.25 s (p<0.01), 178±10 versus 270±14 mL in 0.3 s (p<0.01), and 310±12 mL versus 466±20 mL in 0.5 s (p<0.01). With a respiratory system compliance of 20 mL/cmH2O, tidal volumes in non-intubated patient versus intubated patients were 128±10 mL versus 186±20 mL in 0.25 s (p<0.01), 158±17 versus 250±14 mL in 0.3 s (p<0.01) and 230±21 mL versus 395±20 mL in 0.5 s (p<0.01). Conclusions: Ventilation windows of 0.25, 0.3, and 0.5 s were too short to provide adequate tidal volumes in a simulated non-intubated cardiac arrest patient. In a simulated intubated cardiac arrest patient, ventilation windows of at least 0.5 s were necessary to provide adequate tidal volumes.

Published
2024
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25. Peripheral Nerve Stimulation for Trigeminal Neuropathic Pain

Author

Stidd, D. A., Wuollet, A., Bowden, K., Theodore Price, Patwardhan, A., Barker, S., Weinand, M. E., Annabi, J., and Annabi, E.

Subjects
Adult, Male, organic chemicals, chemical and pharmacologic phenomena, Electric Stimulation Therapy, Middle Aged, Trigeminal Neuralgia, Herpes Zoster, Article, Eye Enucleation, Postoperative Complications, Humans, Trigeminal Nerve Injuries, Aged
Abstract

Facial pain is a complex disease with a number of possible etiologies. Trigeminal neuropathic pain (TNP) is defined as pain caused by a lesion or disease of the trigeminal branch of the peripheral nervous system resulting in chronic facial pain over the distribution of the injured nerve. First line treatment of TNP includes management with anticonvulsant medication (carbamazepine, phenytoin, gabapentin, etc.), baclofen, and analgesics. TNP, however, can be a condition difficult to adequately treat with medical management alone. Patients with TNP can suffer from significant morbidity as a result of inadequate treatment or the side effects of pharmacologic therapy. TNP refractory to medical management can be considered for treatment with a growing number of invasive procedures. Peripheral nerve stimulation (PNS) is a minimally invasive option that has been shown to effectively treat medically intractable TNP. We present a case series of common causes of TNP successfully treated with PNS with up to a 2 year follow-up. Only one patient required implantation of new electrode leads secondary to electrode migration. The patients in this case series continue to have significant symptomatic relief, demonstrating PNS as an effective treatment option for intractable TNP. Though there are no randomized trials, peripheral neuromodulation has been shown to be an effective means of treating TNP refractory to medical management in a growing number of case series. PNS is a safe procedure that can be performed even on patients that are not optimal surgical candidates and should be considered for patients suffering from TNP that have failed medical management.

Published
2012

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