CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Résumé de cet Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Chomel, A.
Right arrow Articles by Freysz, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chomel, A.
Right arrow Articles by Freysz, M.
Canadian Journal of Anesthesia 48:1040-1044 (2001)
© Canadian Anesthesiologists' Society, 2001
Neuroanesthesia and Intensive Care

L'insufflation trachéale de gaz permet d'éviter l'hypercapnie chez le traumatisé crânien grave avec syndrome de détresse respiratoire aiguë

[Tracheal gas insufflation avoids hypercapnia in patients with severe head trauma and acute lung injury]

A. Chomel, MD, J.C. Combes, MD, J.M. Yeguiayan, MD and M. Freysz, MD PhD

Du département d'anesthésie réanimation, Hôpital Général, C.H.U., Dijon, France.

Adresser la correspondance à: Dr Anne Chomel, Département d'Anesthésie Réanimation, Hôpital Général, 3 rue du Faubourg Raines, B.P. 1519, 21033 Dijon Cedex, France. Téléphone: 03.80.29.37.55; Télécopieur: 03.80.29.38.29; Courriel: jean-christophe.combes{at}chu-dijon.fr

Purpose:The purpose of the ventilatory management of acute respiratory distress syndrome (ARDS) is to avoid any barotrauma to the lungs by decreasing the tidal volume at the expense of permissive hypercapnia. This hypercapnia is extremely dangerous for severe head trauma patients because it increases intracranial pressure. The solution could be the use of tracheal gas which insufflation (TGI) allows the reduction of arterial carbon dioxide tension (PaCO2) while controlling airway pressures.

Clinical features: We report the cases of two patients with ARDS and severe head trauma. The decrease of tidal volume ( by 60 and 25% respectively) in association with tracheal gas insufflation allowed to reduce plateau airway pressure (<35 cm d'H2O) and PaCO2 (in the first case by 23% and in the second case, by 11% for the second hour then by 24%), while intracranial pressure remained constant or was lowered (in the second case by 39% for the second hour). TGI consisted in insufflating fresh gas via a small catheter placed in the trachea (02 at 6 L•min–1 in the first patient and 4 L•min–1 in the second case).

Conclusion:TGI appears to be an important component of ventilatory management when ARDS is associated with severe head trauma.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2001 by the Canadian Anesthesiologists' Society.