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Purpose Facemask ventilation during the induction of general anesthesia in paediatric patients remains a challenge as it may result in hypoxic conditions and gastric insufflation with subsequent regurgitation and aspiration. So far, it is unclear if pressure-controlled or manual facemask ventilation is preferable in children. We hypothesized that pressure-controlled ventilation in apnoeic children results in lower peak airway pressure and flow rates compared to manual ventilation at comparable respiratory rates and tidal volumes. Methods Sixty-two lung-healthy children undergoing scheduled ear-nose-throat surgery were included in the study. After the induction of anesthesia, the patient's lungs were consecutively ventilated via a facemask in either manual or pressure-controlled mode, in randomized order. The primary outcome measure was peak airway pressure. Secondary outcome measures included positive end-expiratory pressure, airway compliance, tidal volume and airway flow. Results Data of 52 patients could be analyzed. Pressure-controlled ventilation resulted in a lower mean and peak inspiratory pressure (both p < 0.001), airway pressure amplitude (p = 0.01) and inspiratory peak flow rate (p = 0.005) compared to manual ventilation. The ratio of inspiration to expiration time was lower in pressure-controlled ventilation compared to manual ventilation (p < 0.001). Conclusion Pressure-controlled facemask ventilation during induction of anesthesia in pediatric patients results in lower airway pressure, and lower flow rates compared to manual ventilation, at comparable tidal and minute volumes., Author(s): Ulrich Goebel [sup.1] [sup.2] , Stefan Schumann [sup.1] [sup.2] , Steffen Wirth [sup.1] [sup.2] Author Affiliations: (Aff1) grid.5963.9, Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, [...]

Purpose To determine the influence of morbid obesity on the incidence of difficult mask ventilation and difficult intubation. Methods Over a 6-year period, all tracheal intubations in the operating room of a large tertiary teaching hospital were analyzed. A modified version of the intubation difficulty scale (mIDS) was used to define easy versus difficult intubation, where a score of two or greater was defined as difficult intubation. Difficult mask ventilation was defined as the use of one or more adjuncts to achieve successful mask ventilation. Results Of 45,447 analyzed cases, 1893 (4.2%) were classified as difficult intubations. Morbidly obese patients were not more likely to have difficult intubation [Odds Ratio (OR) = 1.131, 95% confidence interval (CI): 0.958, 1.334, p = 0.146]. Factors that were associated with difficult intubation included patient age > 46 years, male sex, Mallampati 3-4, thyromental distance < 6 cm, and the presence of intact dentition. Of 37,016 cases in which mask ventilation was attempted, 1069 (2.9%) were difficult. Morbidly obese patients were more likely to have difficult mask ventilation (OR = 3.785, 95% CI: 3.188, 4.493, p 46 years, male sex, Mallampati 3-4, and a history of obstructive sleep apnea. Having intact dentition decreased the likelihood of difficult mask ventilation. Conclusion Morbidly obese patients do not have a higher incidence of difficult intubation compared to non-morbidly obese patients. However, they have a significantly higher incidence of difficult mask ventilation. Other factors that are predictive of both difficult mask ventilation and difficult intubation include age > 46 years, male sex, and Mallampati 3-4., Author(s): Tiffany S. Moon [sup.1] , Pamela E. Fox [sup.1] , Alwin Somasundaram [sup.1] , Abu Minhajuddin [sup.1] , Michael X. Gonzales [sup.1] , Taylor J. Pak [sup.1] , Babatunde [...]

Byline: Onnen Moerer (1,2), Jennifer Beck (3), Lukas Brander (1,4), Roberta Costa (5), Michael Quintel (2), Arthur S. Slutsky (1,6,8), Fabrice Brunet (6,7), Christer Sinderby (6,7,8) Keywords: Non-invasive ventilation (NIV); Helmet; Neurally triggered ventilatory assist; Neural control; Pressure support ventilation; Trigger Abstract: Objective Patient--ventilator synchrony during non-invasive pressure support ventilation with the helmet device is often compromised when conventional pneumatic triggering and cycling-off were used. A possible solution to this shortcoming is to replace the pneumatic triggering with neural triggering and cycling-off--using the diaphragm electrical activity (EA.sub.di). This signal is insensitive to leaks and to the compliance of the ventilator circuit. Design Randomized, single-blinded, experimental study. Setting University Hospital. Participants and subjects Seven healthy human volunteers. Interventions Pneumatic triggering and cycling-off were compared to neural triggering and cycling-off during NIV delivered with the helmet. Measurements and results Triggering and cycling-off delays, wasted efforts, and breathing comfort were determined during restricted breathing efforts ( Conclusions The present study demonstrates in healthy subjects that subject--ventilator synchrony, trigger effort, and breathing comfort with a helmet interface are considerably less impaired during increasing levels of PSV and respiratory rates with neural triggering and cycling-off, compared to conventional pneumatic triggering and cycling-off. Author Affiliation: (1) Interdepartmental Division of Critical Care, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (2) Department of Anaesthesiology, Emergency and Critical Care Medicine, University of Gottingen, Gottingen, Germany (3) Neonatal Intensive Care Unit, Department of Pediatrics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (4) Department of Intensive Care Medicine, University Hospital, Inselspital, Bern, Switzerland (5) Department of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, Rome, Italy (6) Department of Critical Care Medicine, St. Michael's Hospital, University of Toronto, 30 Bond Street, Room 4-072, Queen wing, Toronto, ON, M5B 1W8, Canada (7) Department of Medicine, University of Toronto, Toronto, ON, Canada (8) Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada Article History: Registration Date: 13/05/2008 Received Date: 21/12/2007 Accepted Date: 16/04/2008 Online Date: 30/05/2008 Article note: This article is discussed in the editorial available at: doi: 10.1007/s00134-008-1164-y. Electronic supplementary material The online version of this article (doi: 10.1007/s00134-008-1163-z) contains supplementary material, which is available to authorized users.

Byline: Fabrizio Racca (1), Lorenzo Appendini (2), Cesare Gregoretti (3), Ilaria Varese (1), Giacomo Berta (1), Ferdinando Vittone (1), Gabriela Ferreyra (1), Elisa Stra (1), V. Marco Ranieri (1) Keywords: Noninvasive ventilation; Pressure support ventilation; Continuous positive airway pressure; Carbon dioxide rebreathing; Helmet; Air leaks Abstract: Objective We examined whether additional helmet flow obtained by a single-circuit and a modified plateau valve applied at the helmet expiratory port (open-circuit ventilators) improves CO.sub.2 wash-out by increasing helmet airflow. Design and setting Randomized physiological study in a university research laboratory. Participants Ten healthy volunteers. Interventions Helmet continuous positive airway pressure and pressure support ventilation delivered by an ICU ventilator (closed-circuit ventilator) and two open-circuit ventilators equipped with a plateau valve placed either at the inspiratory or at the helmet expiratory port. Measurements and results We measured helmet air leaks, breathing pattern, helmet minute ventilation ( .sub.Eh), minute ventilation washing the helmet ( .sub.Ewh), CO.sub.2 wash-out, and ventilator inspiratory assistance. Air leaks were small and similar in all conditions. Breathing pattern was similar among the different ventilators. Inspiratory and end-tidal CO.sub.2 were lower, while .sub.Eh and .sub.Ewh were higher only using open-circuit ventilators with the plateau valve placed at the helmet expiratory port. This occurred notwithstanding these ventilators delivered a lower inspiratory assistance. Conclusions Additional helmet flow provided by open-circuit ventilators can lower helmet CO.sub.2 rebreathing. However, inspiratory pressure assistance significantly decreases using open-circuit ventilators, still casting doubts on the choice of the optimal helmet ventilation setup. Author Affiliation: (1) Dipartimento di Anestesia e Rianimazione, Universita di Torino, Ospedale S. Giovanni Battista-Molinette, Turin, Italy (2) Divisione di Pneumologia, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Via Revislate, n. 13, 28010, Veruno, Italy (3) Servizio di Anestesia e Rianimazione, Azienda Ospedaliera CTO-CRF-Maria Adelaide, Turin, Italy Article History: Registration Date: 27/03/2008 Received Date: 25/09/2007 Accepted Date: 24/03/2008 Online Date: 06/05/2008 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s00134-008-1120-x) contains supplementary material, which is available to authorized users.

Byline: Francesco Mojoli (1,2), Giorgio A. Iotti (3), Maddalena Gerletti (1), Carlo Lucarini (1), Antonio Braschi (1,2) Keywords: Non-invasive ventilation; Helmet; Carbon dioxide; Rebreathing; Monitoring; Physical model Abstract: Objective To define how to monitor and limit CO.sub.2 rebreathing during helmet ventilation. Design Physical model study. Setting Laboratory in a university teaching hospital. Interventions We applied pressure-control ventilation to a helmet mounted on a physical model. In series 1 we increased CO.sub.2 production (V'CO.sub.2) from 100 to 550a-ml/min and compared mean inhaled CO.sub.2 (iCO.sub.2,mean) with end-inspiratory CO.sub.2 at airway opening (eiCO.sub.2), end-tidal CO.sub.2 at Y-piece (yCO.sub.2) and mean CO.sub.2 inside the helmet (hCO.sub.2). In series 2 we observed, at constant V'CO.sub.2, effects on CO.sub.2 rebreathing of inspiratory pressure, respiratory mechanics, the inflation of cushions inside the helmet and the addition of a flow-by. Measurements and results In series 1, iCO.sub.2,mean linearly related to V'CO.sub.2. The best estimate of CO.sub.2 rebreathing was provided by hCO.sub.2: differences between iCO.sub.2,mean and hCO.sub.2, yCO.sub.2 and eiCO.sub.2 were 0.0a-+-a-0.1, 0.4a-+-a-0.2 and -1.3a-+-a-0.5%. In series 2, hCO.sub.2 inversely related to the total ventilation (MVtotal) delivered to the helmet--patient unit. The increase in inspiratory pressure significantly increased MVtotal and lowered hCO.sub.2. The low lung compliance halved the patient:helmet ventilation ratio but led to minor changes in MVtotal and hCO.sub.2. Cushion inflation, although it decreased the helmet's internal volume by 33%, did not affect rebreathing. A 8-l/min flow-by effectively decreased hCO.sub.2. Conclusions During helmet ventilation, rebreathing can be assessed by measuring hCO.sub.2 or yCO.sub.2, but not eiCO.sub.2. It is directly related to V'CO.sub.2, inversely related to MVtotal and can be lowered by increasing inspiratory pressure or adding a flow-by. Author Affiliation: (1) Servizio di Anestesia e Rianimazione I, Fondazione IRCCS Policlinico S. Matteo, Piazzale Golgi 2, Pavia, Italy (2) Cattedra di Anestesiologia e Rianimazione, Universita degli Studi di Pavia, Pavia, Italy (3) Servizio di Anestesia e Rianimazione II, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy Article History: Registration Date: 25/03/2008 Received Date: 06/11/2007 Accepted Date: 15/03/2008 Online Date: 18/04/2008

Problem Hypoxaemia in children with severe or very severe pneumonia is a reliable predictor of mortality, yet oxygen was not available in most paediatric wards in Malawi. Approach The Child Lung Health Programme in Malawi made oxygen available by supplying oxygen concentrators and essential supplies to 22 district and 3 regional hospitals&apos; paediatric wards. Five key steps were taken to introduce concentrators: (1) develop a curriculum and training materials; (2) train staff on use and maintenance; (3) retrain electromedical departments on maintenance and repair; (4) conduct training once concentrators arrived in the country; and (5) distribute concentrators once staff had been trained. Local setting The paediatric wards in 3 regional and 22 government district hospitals and 3 regional electromedical engineering departments in Malawi. Relevant changes Main changes were: (1) provision of a source of oxygen in every paediatric ward in all district hospitals; (2) training of electrical engineering and health personnel in the use, maintenance and repair of oxygen concentrators; and (3) setting-up of high-dependency rooms or areas for severely ill children where oxygen is administered. Lessons learned It is feasible to implement an oxygen system using concentrators throughout a low-income country. Oxygen delivery requires trained staff with necessary equipment and supplies. Regular maintenance and supervision are essential to ensure optimal utilization. Problematique Chez l&apos;enfant atteint d&apos;une pneumonie tres grave ou severe, l&apos;hypoxemie annonce de maniere fiable une evolution mortelle. Pourtant, la plupart des services pediatriques du Malawi ne disposaient pas d&apos;oxygene. Demarche Le Programme Sante pulmonaire de l&apos;enfant au Malawi a mis l&apos;oxygene a la disposition de 22 services pediatriques hospitaliers de district et de 3 services pediatriques d&apos;hopitaux regionaux, en leur fournissant des concentrateurs d&apos;oxygene et les fournitures indispensables, L&apos;introduction de ces concentrateurs s&apos;est faite en cinq etapes cles : 1) mise au point d&apos;un programme et de supports de formation ; 2) formation du personnel a l&apos;utilisation et a la maintenance de ces appareils; 3) recyclage des departements d&apos;electronique medicale pour qu&apos;ils puissent effectuer la maintenance et les reparations; 4) dispensation d&apos;une formation une fois les concentrateurs arrives dans le pays ; et 5) distribution des concentrateurs une fois le personnel forme. Contexte local Les services pediatriques de 3 hopitaux regionaux et de 22 hopitaux publics de district et 3 departements regionaux de genie electronique medical du Malawi. Modifications pertinentes Les principaux changements ciapres ont ete apportes : 1) fourniture d&apos;une source d&apos;oxygene dans chaque service pediatrique de l&apos;ensemble des hopitaux de district ; 2) formation du personnel sanitaire et specialise en electronique medicale a l&apos;utilisation, a la maintenance et a la reparation des concentrateurs d&apos;oxygene ; et 3) mise en place de salles ou de zones pour patients tres dependants ou l&apos;on administre de l&apos;oxygene aux enfants gravement malades. Enseignements tires La mise en oevre d&apos;un systeme d&apos;approvisionnement en oxygene utilisant des concentrateurs est faisable dans un pays a faible revenu. La delivrance de l&apos;oxygene necessite du personnel forme, ainsi des equipements et des fournitures. Une maintenance et une supervision regulieres sont essentielles pour garantir une utilisation optimale. Problema La aparicion de hipoxemia en les ninos con neumonia grave o muy grave es un factor predictivo fiable de la mortalidad. Pese a ello, la mayoria de las salas de pediatria de Malawi carecian de oxigeno. Enfoque El Programa de Salud Pulmonar Infantil de Malawi suministro oxigeno facilitando concentradores y suministros esenciales a las salas de pediatria de 22 hospitales de distrito y 3 hospitales regionales. Se tomaron cinco medidas clave para introducir les concentradores: 1) desarrollo de un programa de estudios y de material didactico; 2) formacion del personal sobre su use y mantenimiento; 3) actualizacion profesional de los departamentos de electromedicina en materia de mantenimiento y reparacion; 4) actividades de capacitacion una vez llegados les concentradores al pais; y 5) distribucion de les concentradores tras haber formado al personal. Contexto local Las salas de pediatria de 3 hospitales regionales y 22 hospitales de distrito publicos, y 3 departamentos regionales de ingenieria en electromedicina de Malawi. Cambios destacables Les cambios principales fueron les siguientes: 1) instalacion de una fuente de oxigeno en cada una de las salas de pediatria de todos les hospitales de distrito; 2) capacitacion del personal de electroingenieria y salud en el use, mantenimiento y reparacion de los concentradores de oxigeno; y 3) acondicionamiento de habitaciones o zonas reservadas a grandes dependientes para los ninos gravemente enfermos, incluida la instalacion de sistemas de administracion de oxigeno. Ensenanzas extraidas Es posible implantarall forma generalizada un sistema de suministro de oxigeno a base de concentradores en los paises de ingresos bajos. La administracion de oxigeno requiere personal especialmente preparado y dotado del equipo y suministros necesarios, y unas actividades regulares de mantenimiento y supervision son fundamentales para que se haga un uso optimo del material. [TEXT NOT REPRODUCIBLE IN ASCII], Background Hypoxaemia in children with severe or very severe pneumonia is a reliable predictor of mortality, increasing the risk of dying fivefold. (1,2) Hospitals throughout the developing world have very [...]

This study examined the effects of an external nasal dilator (END) on sedentary and aerobically trained women using the blood lactate threshold as a measure of aerobic performance. Three groups of women (sedentary, pre-season, in-season) participated in the study: nine sedentary college students (age 19 [+ or -] 1.0 y), eight pre-season college athletes (age 20 [+ or -] 2.3 y), and six in-season college rowers (age 20 [+ or -] 1.7 y). A two-way repeated-measures design was used with subjects in each group being exposed to both conditions (with END and without END). The first two groups performed two incremental exercise tests in random order on a cycle ergometer, and the third group performed the tests on a rowing ergometer. Participants in each group wore an END strip for only one of the tests. Venous blood was collected at rest, during the final 30 seconds of each stage, and 1 and 3 minutes into the recovery period for the determination of blood lactate concentration and identification of the blood lactate threshold. No significant differences (P = 0.05) were found in blood lactate concentration at the lactate threshold between conditions for either group (sedentary: with END 2.51 [+ or -] 1.18 mmol * [L.sup.-1], without END 2.56 [+ or -] 0.84 mmol * [L.sup.-1]; preseason: with END 2.93 [+ or -] 0.97 mmol * [L.sup.-1], without END 2.81 [+ or -] 1.15 mmol * [L.sup.-1]; and in-season: with END 3.93 [+ or -] 0.50 mmol * [L.sup.-1], without END 3.49 [+ or -] 0.387 mmol * [L.sup.-1]). We conclude that (a) the END did not improve the Lactate threshold in either sedentary or trained college-age women, and (b) the END did not result in lower blood lactate levels during moderate to high-intensity exercise in the three groups examined in this study. KEY WORDS lactate threshold, anaerobic threshold, rowing performance

ABSTRACT: This paper first describes a creep damage mechanics model that shows a marked performance for both steady-state creep and tertiary creep, as evidenced by comparisons with creep test results [...]

Byline: NicolA2 Patroniti (1), Giuseppe Foti (1), Annamaria Manfio (1), Anna Coppo (1), Giacomo Bellani (1), Antonio Pesenti (1) Keywords: Continuous positive airway pressure; Head helmet; Face mask; Hypoxemic respiratory failure; Healthy volunteers Abstract: Objective To assess selected physiological effects of non-invasive continuous positive airway pressure delivered by head helmet (CPAP.sub.H), a special interface device designed to completely contain the head of the patient, compared to face mask (CPAP.sub.M). Design Randomized physiological study. Setting University research laboratory. Patients Eight healthy volunteers. Intervention Continuous positive airway pressure delivered by face mask and CPA[P.sub.H ]in random order. Three gas flow rates (20-30-40 l/min and 30-45-60 l/min, respectively, for CPAP.sub.M and CPAP.sub.H) and four CPAP levels (0-5-10-15 cm[H.sub.2]O) were employed in a randomized sequence. Measurements and results In each patient we monitored airway pressure, esophageal pressure, expiratory flow, and inspiratory and expiratory CO.sub.2 concentration. End-expiratory lung volume changes from CPAP 0 were measured by inductance plethysmography. The application of increased levels of CPAP resulted in a significant increase in end-expiratory lung volume, similar for CPAP.sub.H and CPAP.sub.M. Inspiratory changes of airway pressure were comparable for the two CPAP modes. Inspiratory CO.sub.2 concentration was higher during CPAP.sub.H (significantly decreased at increased gas flow rates), compared to CPAP.sub.M. Conclusions Continuous positive airway pressure delivered by head helmet is as effective as CPAP.sub.M in increasing end-expiratory lung volume and in compensating for airway pressure changes without the need of a reservoir bag. Higher gas flow rates are necessary to maintain a relatively low inspiratory CO.sub.2 concentration. Author Affiliation: (1) Department of Anesthesia and Intensive Care, Ospedale San Gerardo Nuovo dei Tintori, University of Milano-Bicocca, Via Donizetti 106, 20052, Monza (Milano), Italy Article History: Received Date: 17/09/2002 Accepted Date: 30/06/2003 Online Date: 28/08/2003

Byline: Davide Chiumello (1), Paolo Pelosi (2), Eleonora Carlesso (1), Paolo Severgnini (2), Michele Aspesi (2), Chiara Gamberoni (2), Massimo Antonelli (3), Giorgio Conti (3), Maurizio Chiaranda (2), Luciano Gattinoni (1) Keywords: Interfaces; Facial mask; Helmet; Comfort of breathing; Work of breathing; Noninvasive ventilation Abstract: Objective This bench and human study compared large and small helmets with face mask (FM) for delivery of noninvasive positive pressure ventilation. Design A lung simulator was employed, and the human study involved six healthy subjects. We evaluated a continuous high-flow (CPAP.sub.HF), low flow (CPAP.sub.LF), ventilator (CPAP.sub.VENT) CPAP, and pressure support ventilation (PSV 10 and 20 cm[H.sub.2]O). In the human study we used CPAP.sub.HF, CPAP.sub.VENT, and PSV 5 cm[H.sub.2]O. PEEP was 5 cm[H.sub.2]O. Measurements In the bench study during CPAP we measured the negative airway pressure time product (area.sub.CPAP), i.e., the area of airway pressure (Paw) under PEEP and during PSV the pressure airway time product (area.sub.PSV), i.e., the area of Paw from onset to end of inspiratory flow. In the human study we measured the breathing pattern and work of breathing (WOB). Results In the bench study during CPAP.sub.LF the helmets had a lower area.sub.CPAP than the FM, while during CPAP.sub.HF the three interfaces had similar area.sub.CPAP. Using CPAP.sub.VENT and PSV the FM reduced area.sub.CPAP and increased area.sub.PSV compared to helmets. At 20 cm[H.sub.2]O of PSV using helmets area.sub.PSV was similar to that obtained at 10 cm[H.sub.2]O of PSV using the FM. In human study using CPAP.sub.HF and CPAP.sub.VENT the tree interfaces had similar effects on breathing pattern and WOB, while using PSV the FM reduced WOB more than helmets. Conclusions During CPAP.sub.LF helmets were more efficient than FM, while during CPAP.sub.HF the three interfaces were comparable. Using CPAP.sub.VENT and PSV, FM was more efficient than helmets Author Affiliation: (1) Istituto di Anestesia e Rianimazione, Ospedale Maggiore Policlinico-IRCCS, Universita' degli Studi di Milano, via Francesco Sforza 35, 20122, Milan, Italy (2) Dipartimento di Scienze Cliniche e Biologiche, Universita' degli Studi dell'Insubria, Varese, Italy (3) Istituto di Anestesiologia e Rianimazione, Policlinico A. Gemelli, Universita Cattolica del Sacro Cuore, Rome, Italy Article History: Received Date: 03/12/2002 Accepted Date: 28/04/2003 Online Date: 12/06/2003

Byline: Guilherme Schettino (1), Mauro Tucci (1), Rogerio Sousa (1), Carmen Barbas (1), Marcelo Amato (1), Carlos Carvalho (1) Keywords: Noninvasive positive pressure ventilation Facial mask Mask mechanics Air leak Abstract: Objective: To study the mask mechanics and air leak dynamics during noninvasive pressure support ventilation. Setting: Laboratory of a university hospital. Design: A facial mask was connected to a mannequin head that was part of a mechanical respiratory system model. The mask fit pressure (P.sub.mask-fit) measured inside the mask's pneumatic cushion was adjusted to 25 cm[H.sub.2]O using elastic straps. Pressure support (PS) was set to ensure a maximal tidal volume distal to the mask (VT.sub.distal) but avoiding failure to cycle to exhalation. Measurements: Airway pressure (P.sub.aw), P.sub.mask-fit, mask occlusion pressure (P.sub.mask-occl=P.sub.mask-fit--P.sub.aw), VT proximal (VT.sub.prox), distal to the mask (VT.sub.distal), air leak volume (Leak=VT.sub.prox--VT.sub.distal), and inspiratory air leak flow rate (difference between inspiratory flow proximal and distal to the mask) were recorded. Results: PS 15 cm[H.sub.2]O was the highest level that could be used without failure to cycle to exhalation (VT.sub.distal of 585+-4 ml, leak of 32+-1 ml or 5.2+-0.2% of VT.sub.prox, and a minimum P.sub.mask-occl of 1.7+-0.1 cm[H.sub.2]O). During PS 16 cm[H.sub.2]O the P.sub.mask-occl dropped to 1.1+-0.1 cm[H.sub.2]O, and at this point all flow delivered by the ventilator leaked around the mask, preventing the inspiratory flow delivered by the ventilator from reaching the expiratory trigger threshold. Conclusion: P.sub.mask-fit and P.sub.mask-occl can be easily measured in pneumatic cushioned masks and the data obtained may be useful to guide mask fit and inspiratory pressure set during noninvasive positive pressure ventilation. Author Affiliation: (1) Experimental Laboratory of Mechanical Ventilation, Respiratory ICU, Pulmonary Division, Hospital das Clinicas and Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil (2) Rua Maria Figueiredo 396 Apt. 141, Sao Paulo, SP, CEP 04002-002, Brazil Article History: Received Date: 11/06/2001 Accepted Date: 26/09/2001 Article note: Final revision received: 15 September 2001 Electronic Publication

Byline: Dwivedi. Deepak, Jinjil. Kavitha, Sheshadri. Kiran, Bhatnagar. Vidhu Sir, Incident reporting is a key factor in maintaining patient safety in the perioperative scenario. We report an incident of near [...]

Byline: Raj. Singh, Michell. Gulabani, Mohandeep. Kaur, Rajesh. Sood Background and Aims: Swapping of the endotracheal tube with laryngeal mask airway (LMA) before emergence from anaesthesia is one of the [...]

Results of a study to evaluate whether exposure of extremely preterm infants to oxygen saturation was effective in reducing the incidence of retinopathy, and if so, then what was the appropriate range have revealed that a lower target range of 85-89% oxygenation did not significantly reduce the outcome of severe retinopathy as compared to a higher range; however, did result in an increase in mortality and a substantial decrease in retinopathy among survivors. Long-term follow up is vital to determine whether either intervention was associated with neurodevelopmental problems.

Many patients admitted to emergency departments (EDs) require therapy delivered by cannula. Mid-Western Regional Hospital, Tipperary, used to run a system in which many patients had to endure two invasive [...]

Supplemental oxygen is one of the life-sustaining therapies and the decision of withholding or withdrawing of life-sustaining interventions is a difficult task for clinicians. Informed patients with decision-making capacity have well-established rights to forgo any and all forms of life-sustaining therapy but correct assessment of the medical situation of the patient needs to be done so that no misunderstanding appears later.

Byline: Mohd Saif. Ghaus Sir, An 80-year-old male, in-patient, known case of hypertension, insulin dependent diabetes mellitus, hemiplegia, chronic renal failure and bed ridden for 5 years, admitted with the [...]

Byline: Valter. Perilli, Paola. Aceto, Teresa. Sacco, Nunzia. Martella, Maria. Cazzato, Liliana. Sollazzi Background: The use of suction catheter (SC) has been shown to improve success rate during ProSeal laryngeal [...]

Byline: J. Fraser (1), C. Hill (1), D. McDonald (1), C. Jones (2), A. Petros (1) Keywords: Key words Layngeal mask airway; Laryngotracheo-oesophageal cleft; Inter-hospital transfers Abstract: Type 3 laryngotracheo-oesophageal clefts are rare congenital anomalies with a high mortality. In the past, transport of such infants to tertiary centres for surgical correction has proved extremely difficult, with the child's ventilatory status often deteriorating to such an extent that ultimate surgical intervention has not proved possible. We describe two cases of successful inter-hospital transfer of infants with type 3 laryngotracheo-oesophageal clefts using the laryngeal mask airway. Author Affiliation: (1) Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children, NHS Trust, Great Ormond Street, London WC1N 3JH, UK Tel.: + 44 (1 71) 8 13 82 13 Fax: + 44 (1 71) 8 13 82 06, GB (2) Department of Anaesthesia, Royal Liverpool Childrens Hospital, Alderhey, Liverpool, UK, GB Article note: Received: 18 December 1998 Accepted: 19 April 1999