O presente estudo objetivou avaliar as alterações hemodinâmicas, de oxigenação, de ventilação e metabólicas em cavalos sedados com a associação de romifidina e tartarato de butorfanol submetidos a pneumotórax unilateral de baixa pressão por 20 minutos. Foram utilizados cinco eqüinos machos, hígidos, de diferentes raças, submetidos a dois procedimentos. No primeiro procedimento (Grupo I) os animais receberam a associação de romifidina (0,06 mg/kg) e tartarato de butorfanol (0,04 mg/kg) por via intravenosa. A coleta de dados foi realizada imediatamente antes da administração dos fármacos e após 10, 30, 40 e 65 minutos. No segundo procedimento (Grupo II), os mesmos animais receberam a associação dos fármacos e foram submetidos a toracoscopia, com a criação de pneumotórax unilateral esquerdo de 20 minutos de duração. A coleta de dados foi realizada imediatamente antes e 10 minutos após sedação; 20 minutos após o início do pneumotórax; 5 e 30 minutos após o término do pneumotórax. Os valores obtidos foram confrontados estatisticamente através de provas paramétricas, com a Análise de Variância seguida do Teste de Tukey para a comparação dos diferentes momentos em cada grupo e teste t-Student entre os dois grupos, adotando-se significância estatística de 5% (p<0,05). No Grupo I observou-se redução significativa da freqüência, débito e índice cardíacos até o término das mensurações. No Grupo II houve redução semelhante, porém o débito e índice cardíacos diminuíram de forma não significativa. Os valores da pressão arterial sistólica, diastólica e média permaneceram constantes no Grupo I, e apresentaram diminuição gradativa no Grupo II, significante somente para pressão arterial sistólica aos 5 e 30 minutos após o pneumotórax, e aos 30 minutos após o pneumotórax para pressão arterial média. O valor médio da pressão de artéria pulmonar apresentou aumento após a sedação apenas no Grupo I. A pressão venosa central apresentou incremento significativo aos 10 e 40 minutos após a sedação no Grupo I, e aos 10 minutos após a sedação e 20 minutos de pneumotórax no Grupo II. O índice de resistência vascular sistêmica apresentou aumento significativo somente no Grupo I após a sedação. Não foram presenciadas alterações significativas nos valores do índice de resistência vascular pulmonar em ambos os grupos. A pressão parcial de oxigênio no sangue arterial reduziu de forma significativa no Grupo II após a sedação e aos 20 minutos de pneumotórax. Também neste grupo, os valores de conteúdo, pressão parcial e saturação de oxigênio no sangue venoso misto reduziram de forma significativa em todos os momentos após a mensuração controle. Em ambos os grupos o índice de oferta de oxigênio diminuiu após a sedação, permanecendo reduzido de forma significativa somente no Grupo I. Os valores da diferença arteriovenosa de oxigênio e da taxa de extração de oxigênio apresentaram elevação significativa após a sedação no Grupo II, que persistiu até o término das mensurações. Em ambos os grupos, as alterações na freqüência respiratória, pressão parcial de dióxido de carbono arterial e pH não foram significativas. O bicarbonato plasmático arterial apresentou aumento significativo 30 minutos após o término do pneumotórax no Grupo II. A partir dos resultados obtidos foi possível concluir que: o pneumotórax unilateral induzido com baixo fluxo e mantido a baixo nível pressórico não leva a alterações hemodinâmicas, de oxigenação, ventilação e metabólicas significativas em eqüinos hígidos. A associação de romifidina e butorfanol conferiu sedação e analgesia suficientes para a realização do procedimento. porém foi a responsável pelas alterações hemodinâmicas e de oxigenação. / The aim of this study was to evaluate changes on hemodynamic, oxygenation, ventilation and metabolic values in horses sedated with romifidine and butorphanol, submitted to a low pressure induced unilateral pneumothorax for 20 minutes. Five healthy male horses, of different breeds, were submitted to two procedures. In the first one (Group I) the horses were treated with the intravenous combination of romifidine (0,06 mg/kg) and butorphanol (0,04 mg/kg). Data were collected immediately before and 10, 30, 40 and 65 minutes after drug application. In the second procedure (Group II), the same horses were treated with the drug combination and were submitted to thoracoscopy, with a left unilateral pneumothorax of 20 minutes long. Data were collected immediately before and 10 minutes after drug application, as well 20 minutes after the beginning of the pneumothorax and 5 and 30 minutes after the end of the pneumothorax. Data were submitted to Analysis of Variance test followed by Tukey?s test to compare different moments in each group and t-Student test between groups, with 5% of significance (p<0,05). In Group I was observed a significantly reduction of the heart rate, cardiac output and cardiac index until the end of the measurements. In Group II there was similar reduction, however the decrease of the cardiac output and cardiac index was not significant. The systolic, diastolic and mean arterial pressure remained constant in Group I, and a gradual decrease was observed in Group II. In this group, a significant decrease of the systolic arterial pressure was present at 5 and 30 minutes after the end of the pneumothorax, and the mean arterial pressure only 30 minutes after the end of the pneumothorax. The mean pulmonary arterial pressure increased after sedation only in Group I. The central venous pressure increased significantly 10 and 40 minutes after sedation in Group I and at 20 minutes after the end of the pneumothorax in Group II. The systemic vascular resistance increased significantly after sedation only in Group I. The pulmonary vascular resistance values did not change significantly in both groups. The arterial partial pressure of oxygen reduced significantly after sedation and at 20 minutes after the end of the pneumothorax in Group II. In this group a significant decrease of mixed venous oxygen content, partial pressure and saturation was present in all moments in relation to baseline values. In both groups the oxygen delivery index reduced after sedation, remaining significantly reduced only in Group I. The arteriovenous oxygen difference and the oxygen extraction ratio increased significantly after sedation in Group II, and persisted until the end of the procedure. In both groups the respiratory rate, the arterial pressure of carbon dioxide and pH did not change significantly. Plasma bicarbonate increased only in Group II 30 minutes after the end of the pneumothorax. In view of the obtained results its possible to conclude that: low pressure unilateral pneumothorax induced with low flow did not induce significant changes in hemodynamic, oxygenation, ventilation and metabolic values in healthy horses. The combination of romifidine and butorphanol provided good sedation and analgesia to the surgery perform, however was the responsible for the hemodynamic and oxygenation changes that occurred.

Thesis--Western Reserve University. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Ulm, Univ., Diss., 1999.

Thesis--Western Reserve University. / Includes bibliographical references.

Contrary to traditional teaching, patients with Primary Spontaneous Pneumothorax (PSP) do not have normal lungs. Emphysema-like change (ELC) and inflammation are common. However, the natural history of ELC and its significance in terms of future disease is not known. Current management of pneumothorax is generic and not personalised. This thesis updates the UK epidemiology of pneumothorax, describes the use of two novel methods to examine the lungs, a method of predicting early treatment failure, the association of CT findings and recurrence, and a systematic review of chemical pleurodesis to reduce recurrence. Analysis of fifty years' data on ~150,000 admissions demonstrated that the incidence of pneumothorax is increasing, and established a method to identify primary from secondary pneumothoraces and their relative risk of recurrence. Reduced ventilation of hyperpolarised Xenon on enhanced-Magnetic Resonance Imaging (MRI) was seen in those PSP patients with greater low attenuation areas on Computed Tomography (CT) and with reduced pulmonary function. A model of lung inhomogeneity found that metrics of lung ventilation distinguished pneumothorax patients from healthy volunteers and Chronic Obstructive Pulmonary Disease (COPD) patients. This may represent subtle or mild disease, not identified on standard testing, which may be exacerbated by smoking. CT scanning found that mild emphysema and cystic airspaces were common in PSP patients. Ex- or current smokers had more (and larger) cysts. Emphysema was more common in smokers and patients with a history of previous pneumothorax: who were at higher risk of recurrence. However, variation in number and size of cysts were seen in both those patients with and without recurrence. As such, no single algorithm to predict recurrence was identified. Airflow measurement early in the patient pathway has the potential to identify those likely to fail treatment, potentially allowing early triage to surgery. The addition of talc or minocycline as an adjunct to surgery provides the lowest recurrence rates, but physician-led talc poudrage may be similarly effective. Those in whom surgery is not suitable, chemical pleurodesis could be offered via chest drain. Data presented in this thesis thus provides insights into the underlying abnormalities in PSP and lays the groundwork for strategies to fundamentally alter the management paradigm.

O presente estudo objetivou avaliar as alterações hemodinâmicas, de oxigenação, de ventilação e metabólicas em cavalos sedados com a associação de romifidina e tartarato de butorfanol submetidos a pneumotórax unilateral de baixa pressão por 20 minutos. Foram utilizados cinco eqüinos machos, hígidos, de diferentes raças, submetidos a dois procedimentos. No primeiro procedimento (Grupo I) os animais receberam a associação de romifidina (0,06 mg/kg) e tartarato de butorfanol (0,04 mg/kg) por via intravenosa. A coleta de dados foi realizada imediatamente antes da administração dos fármacos e após 10, 30, 40 e 65 minutos. No segundo procedimento (Grupo II), os mesmos animais receberam a associação dos fármacos e foram submetidos a toracoscopia, com a criação de pneumotórax unilateral esquerdo de 20 minutos de duração. A coleta de dados foi realizada imediatamente antes e 10 minutos após sedação; 20 minutos após o início do pneumotórax; 5 e 30 minutos após o término do pneumotórax. Os valores obtidos foram confrontados estatisticamente através de provas paramétricas, com a Análise de Variância seguida do Teste de Tukey para a comparação dos diferentes momentos em cada grupo e teste t-Student entre os dois grupos, adotando-se significância estatística de 5% (p<0,05). No Grupo I observou-se redução significativa da freqüência, débito e índice cardíacos até o término das mensurações. No Grupo II houve redução semelhante, porém o débito e índice cardíacos diminuíram de forma não significativa. Os valores da pressão arterial sistólica, diastólica e média permaneceram constantes no Grupo I, e apresentaram diminuição gradativa no Grupo II, significante somente para pressão arterial sistólica aos 5 e 30 minutos após o pneumotórax, e aos 30 minutos após o pneumotórax para pressão arterial média. O valor médio da pressão de artéria pulmonar apresentou aumento após a sedação apenas no Grupo I. A pressão venosa central apresentou incremento significativo aos 10 e 40 minutos após a sedação no Grupo I, e aos 10 minutos após a sedação e 20 minutos de pneumotórax no Grupo II. O índice de resistência vascular sistêmica apresentou aumento significativo somente no Grupo I após a sedação. Não foram presenciadas alterações significativas nos valores do índice de resistência vascular pulmonar em ambos os grupos. A pressão parcial de oxigênio no sangue arterial reduziu de forma significativa no Grupo II após a sedação e aos 20 minutos de pneumotórax. Também neste grupo, os valores de conteúdo, pressão parcial e saturação de oxigênio no sangue venoso misto reduziram de forma significativa em todos os momentos após a mensuração controle. Em ambos os grupos o índice de oferta de oxigênio diminuiu após a sedação, permanecendo reduzido de forma significativa somente no Grupo I. Os valores da diferença arteriovenosa de oxigênio e da taxa de extração de oxigênio apresentaram elevação significativa após a sedação no Grupo II, que persistiu até o término das mensurações. Em ambos os grupos, as alterações na freqüência respiratória, pressão parcial de dióxido de carbono arterial e pH não foram significativas. O bicarbonato plasmático arterial apresentou aumento significativo 30 minutos após o término do pneumotórax no Grupo II. A partir dos resultados obtidos foi possível concluir que: o pneumotórax unilateral induzido com baixo fluxo e mantido a baixo nível pressórico não leva a alterações hemodinâmicas, de oxigenação, ventilação e metabólicas significativas em eqüinos hígidos. A associação de romifidina e butorfanol conferiu sedação e analgesia suficientes para a realização do procedimento. porém foi a responsável pelas alterações hemodinâmicas e de oxigenação. / The aim of this study was to evaluate changes on hemodynamic, oxygenation, ventilation and metabolic values in horses sedated with romifidine and butorphanol, submitted to a low pressure induced unilateral pneumothorax for 20 minutes. Five healthy male horses, of different breeds, were submitted to two procedures. In the first one (Group I) the horses were treated with the intravenous combination of romifidine (0,06 mg/kg) and butorphanol (0,04 mg/kg). Data were collected immediately before and 10, 30, 40 and 65 minutes after drug application. In the second procedure (Group II), the same horses were treated with the drug combination and were submitted to thoracoscopy, with a left unilateral pneumothorax of 20 minutes long. Data were collected immediately before and 10 minutes after drug application, as well 20 minutes after the beginning of the pneumothorax and 5 and 30 minutes after the end of the pneumothorax. Data were submitted to Analysis of Variance test followed by Tukey?s test to compare different moments in each group and t-Student test between groups, with 5% of significance (p<0,05). In Group I was observed a significantly reduction of the heart rate, cardiac output and cardiac index until the end of the measurements. In Group II there was similar reduction, however the decrease of the cardiac output and cardiac index was not significant. The systolic, diastolic and mean arterial pressure remained constant in Group I, and a gradual decrease was observed in Group II. In this group, a significant decrease of the systolic arterial pressure was present at 5 and 30 minutes after the end of the pneumothorax, and the mean arterial pressure only 30 minutes after the end of the pneumothorax. The mean pulmonary arterial pressure increased after sedation only in Group I. The central venous pressure increased significantly 10 and 40 minutes after sedation in Group I and at 20 minutes after the end of the pneumothorax in Group II. The systemic vascular resistance increased significantly after sedation only in Group I. The pulmonary vascular resistance values did not change significantly in both groups. The arterial partial pressure of oxygen reduced significantly after sedation and at 20 minutes after the end of the pneumothorax in Group II. In this group a significant decrease of mixed venous oxygen content, partial pressure and saturation was present in all moments in relation to baseline values. In both groups the oxygen delivery index reduced after sedation, remaining significantly reduced only in Group I. The arteriovenous oxygen difference and the oxygen extraction ratio increased significantly after sedation in Group II, and persisted until the end of the procedure. In both groups the respiratory rate, the arterial pressure of carbon dioxide and pH did not change significantly. Plasma bicarbonate increased only in Group II 30 minutes after the end of the pneumothorax. In view of the obtained results its possible to conclude that: low pressure unilateral pneumothorax induced with low flow did not induce significant changes in hemodynamic, oxygenation, ventilation and metabolic values in healthy horses. The combination of romifidine and butorphanol provided good sedation and analgesia to the surgery perform, however was the responsible for the hemodynamic and oxygenation changes that occurred.

No description available.

Traumatic injury is a major burden in global healthcare systems, ranking among the leading causes of morbidity and mortality worldwide.1 Patients are first encountered at the pre-hospital scene by providers of varying levels of expertise, such as emergency medical technicians (EMTs) and paramedics, who provide temporizing measures while patients are transported to receiving hospitals to receive definitive care.2 Ultrasound is an ever-improving medical imaging modality which is increasingly portable, low cost, and provides diagnostic imaging rapidly without the harmful effects of radiation. The objective of this study is to determine whether introduction of prehospital ultrasound (PHUS) for use on ground ambulances by prehospital providers in order to improve choice of destination hospital and aid in needle thoracostomy for tension pneumothorax will have a positive impact on mortality rate of trauma patients in an urban EMS environment. In the proposed study, trauma patients in the city of Boston, Massachusetts receiving care from Boston Emergency Medical Services (EMS) prehospital providers will be recruited over a 12-month period with a minimum goal of 2,500 patients in total. Emergency responses coded as trauma by EMS dispatch will be randomized at a 1:1 ratio to either utilize PHUS or to refrain from utilizing PHUS. A z-test will be used to analyze primary outcome of 30-day mortality rate in patients who receive PHUS care as needed compared with patients who do not receive PHUS care. Study data will be collected directly from Boston EMS Electronic Medical Record (EMR). This study will be the first of its kind to randomize at the patient level, and the first to investigate a major clinical outcome of ultrasound in prehospital medical care: 30-day mortality. Point-of-care Ultrasound is an intriguing diagnostic modality that is becoming increasingly feasible in the prehospital environment, and may improve outcomes in trauma patients. Current studies provide convincing evidence for the diagnostic accuracy of these devices, especially in evaluating hemoperitoneum and pneumothorax. If an improvement in mortality rate of patients treated with prehospital ultrasound (PHUS) is demonstrated, this will be convincing evidence for the implementation of PHUS in ground ambulances and air medical services across the United States and worldwide.

Diss. (sammanfattning) Uppsala : Univ., 2001. / Härtill 5 uppsatser.

Thesis--Helsinki. / At head of title: University of Helsinki Central Hospital, Surgical Clinic II. Bibliography: p. [128]-134.