-
Critical Care (London, England) Jul 2017The adverse effects of mechanical ventilation in acute respiratory distress syndrome (ARDS) arise from two main causes: unphysiological increases of transpulmonary... (Review)
Review
The adverse effects of mechanical ventilation in acute respiratory distress syndrome (ARDS) arise from two main causes: unphysiological increases of transpulmonary pressure and unphysiological increases/decreases of pleural pressure during positive or negative pressure ventilation. The transpulmonary pressure-related side effects primarily account for ventilator-induced lung injury (VILI) while the pleural pressure-related side effects primarily account for hemodynamic alterations. The changes of transpulmonary pressure and pleural pressure resulting from a given applied driving pressure depend on the relative elastances of the lung and chest wall. The term 'volutrauma' should refer to excessive strain, while 'barotrauma' should refer to excessive stress. Strains exceeding 1.5, corresponding to a stress above ~20 cmHO in humans, are severely damaging in experimental animals. Apart from high tidal volumes and high transpulmonary pressures, the respiratory rate and inspiratory flow may also play roles in the genesis of VILI. We do not know which fraction of mortality is attributable to VILI with ventilation comparable to that reported in recent clinical practice surveys (tidal volume ~7.5 ml/kg, positive end-expiratory pressure (PEEP) ~8 cmHO, rate ~20 bpm, associated mortality ~35%). Therefore, a more complete and individually personalized understanding of ARDS lung mechanics and its interaction with the ventilator is needed to improve future care. Knowledge of functional lung size would allow the quantitative estimation of strain. The determination of lung inhomogeneity/stress raisers would help assess local stresses; the measurement of lung recruitability would guide PEEP selection to optimize lung size and homogeneity. Finding a safety threshold for mechanical power, normalized to functional lung volume and tissue heterogeneity, may help precisely define the safety limits of ventilating the individual in question. When a mechanical ventilation set cannot be found to avoid an excessive risk of VILI, alternative methods (such as the artificial lung) should be considered.
Topics: Barotrauma; Extracorporeal Membrane Oxygenation; Forecasting; Humans; Respiration, Artificial; Respiratory Distress Syndrome; Respiratory Mechanics; Tidal Volume; Ventilator-Induced Lung Injury
PubMed: 28701178
DOI: 10.1186/s13054-017-1750-x -
Annals of Internal Medicine Jan 2018International travel can result in new illness or exacerbate existing conditions, and primary care clinicians have the opportunity to provide both pre- and posttravel... (Review)
Review
International travel can result in new illness or exacerbate existing conditions, and primary care clinicians have the opportunity to provide both pre- and posttravel health care. Providers should be familiar with destination-specific disease risks, be knowledgeable about travel and routine vaccines, be prepared to prescribe chemoprophylaxis and self-treatment regimens, and be aware of travel medicine resources.
Topics: Accidents, Traffic; Aircraft; Altitude Sickness; Animals; Barotrauma; Food Safety; Humans; Insect Bites and Stings; Primary Health Care; Sexually Transmitted Diseases; Ships; Travel Medicine; United States; Wounds and Injuries; Zoonoses
PubMed: 29297035
DOI: 10.7326/AITC201801020 -
Jornal Brasileiro de Pneumologia :... Jul 2019
Topics: Adult; Barotrauma; Cocaine-Related Disorders; Humans; Male; Mediastinal Emphysema; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 31365685
DOI: 10.1590/1806-3713/e20190169 -
Current Pain and Headache Reports May 2019This review will focus on the most recent information regarding the ICHD-3 definition of diving headache as well as other important causes of diving headache that are... (Review)
Review
This review will focus on the most recent information regarding the ICHD-3 definition of diving headache as well as other important causes of diving headache that are not listed in the ICHD-3 classification system. The paper will discuss etiology, diagnosis, and management of these disorders, focusing, when possible, on the newest research available. ICHD-3 diving headache is due to hypercapnia and is treated accordingly with oxygen. Other causes of diving headache range from decompression sickness to external compression headache to primary headache disorders, such as migraine. Correctly determining the underlying cause of the diving headache is critical to management and relies on history taking and physical exam. The pathophysiology of newly described types of diving headache, such as diving ascent headache, remains under investigation but may be related to other homeostatic headache causes, such as airplane headache. Further investigation may yield more information regarding management as well as possible insight into other headache disorders.
Topics: Barotrauma; Decompression Sickness; Disease Management; Diving; Headache; Humans; Migraine Disorders
PubMed: 31147799
DOI: 10.1007/s11916-019-0787-8 -
The Journal of Emergency Medicine Oct 2015Blast injuries in the United States and worldwide are not uncommon. Partially due to the increasing frequency of both domestic and international terrorist bombing... (Review)
Review
BACKGROUND
Blast injuries in the United States and worldwide are not uncommon. Partially due to the increasing frequency of both domestic and international terrorist bombing attacks, it is prudent for all emergency physicians to be knowledgeable about blasts and the spectrum of associated injuries.
OBJECTIVE
Our aim was to describe blast physiology, types of blast injuries associated with each body system, and manifestations and management of each injury.
DISCUSSION
Blast injuries are generally categorized as primary to quaternary injuries. Primary injuries result from the effect of transmitted blast waves on gas-containing structures, secondary injuries result from the impact of airborne debris, tertiary injury results from transposition of the entire body due to blast wind or structural collapse, and quaternary injuries include almost everything else. Different body systems are affected and managed differently. Despite previous dogma, multiple studies now show that tympanic membrane perforation is a poor predictor of other blast injury.
CONCLUSIONS
Blast events can produce a myriad of injuries affecting any and every body system. All emergency physicians should be familiar with the presentation and management of these injuries. This knowledge may also be incorporated into triage and discharge protocols guiding management of mass casualty events.
Topics: Blast Injuries; Emergency Medical Services; Explosions; Explosive Agents; Humans; Mass Casualty Incidents; Terrorism; Triage
PubMed: 26072319
DOI: 10.1016/j.jemermed.2015.03.013 -
Medicina (Kaunas, Lithuania) Jan 2022Dysbarism is a general term which includes the signs and symptoms that can manifest when the body is subject to an increase or a decrease in the atmospheric pressure... (Review)
Review
Dysbarism is a general term which includes the signs and symptoms that can manifest when the body is subject to an increase or a decrease in the atmospheric pressure which occurs either at a rate or duration exceeding the capacity of the body to adapt safely. In the following review, we take dysbarisms into account for our analysis. Starting from the underlying physical laws, we will deal with the pathologies that can develop in the most frequently affected areas of the body, as the atmospheric pressure varies when acclimatization fails. Manifestations of dysbarism range from itching and minor pain to neurological symptoms, cardiac collapse, and death. Overall, four clinical pictures can occur: decompression illness, barotrauma, inert gas narcosis, and oxygen toxicity. We will then review the clinical manifestations and illustrate some hints of therapy. We will first introduce the two forms of decompression sickness. In the next part, we will review the barotrauma, compression, and decompression. The last three parts will be dedicated to gas embolism, inert gas narcosis, and oxygen toxicity. Such an approach is critical for the effective treatment of patients in a hostile environment, or treatment in the emergency room after exposure to extreme physical or environmental factors.
Topics: Barotrauma; Decompression Sickness; Embolism, Air; Humans; Hyperbaric Oxygenation
PubMed: 35056412
DOI: 10.3390/medicina58010104 -
Internal and Emergency Medicine Oct 2021
Topics: Barotrauma; Diving; Humans; Male; Middle Aged; Treatment Outcome
PubMed: 33765301
DOI: 10.1007/s11739-021-02709-9 -
The Journal of Head Trauma... 2014Up to 53% of individuals suffering from traumatic brain injuries develop tinnitus. (Review)
Review
BACKGROUND
Up to 53% of individuals suffering from traumatic brain injuries develop tinnitus.
OBJECTIVE
To review the current literature on trauma-associated tinnitus in order to provide orientation for the clinical management of patients with trauma-associated tinnitus.
MATERIALS
A systematic literature search has been conducted in PubMed database applying the search terms posttraumatic tinnitus and trauma-associated tinnitus. Results have been complemented by related studies, book chapters, and the authors' clinical experience.
RESULTS
Not only mechanical, pressure-related, or noise-related head traumata but also neck injuries and emotional trauma can cause tinnitus. Exact diagnosis is essential. Disorders such as ossicular chain disruption, traumatic eardrum perforation, or perilymphatic fistula can be surgically treated. It should also be considered that pulsatile tinnitus can be a sign of life-threatening disorders such as carotid cavernous fistulas, arteriovenous malformations, and carotid dissections. Also, posttraumatic stress disorder should be taken into consideration as a potential contributing factor.
CONCLUSIONS
There is an evident mismatch between the high incidence of trauma-associated tinnitus and scarce literature on the topic. A consistent and-at best-standardized assessment of tinnitus- and hearing-related sequelae of trauma is recommended both for the improvement of clinical care and for a deeper understanding of the various pathophysiological mechanisms of trauma-associated tinnitus.
Topics: Barotrauma; Blast Injuries; Brain Injuries; Carotid Artery Injuries; Carotid-Cavernous Sinus Fistula; Ear Ossicles; Ear, Inner; Fistula; Humans; Labyrinth Diseases; Neck Injuries; Noise; Skull Fractures; Stress Disorders, Post-Traumatic; Temporal Bone; Tinnitus
PubMed: 23982788
DOI: 10.1097/HTR.0b013e31829d3129 -
Undersea & Hyperbaric Medicine :... 2022Divers are regularly exposed to a unique and changing environment that dentists must consider when treating such patients. This review focuses around two case studies... (Review)
Review
Divers are regularly exposed to a unique and changing environment that dentists must consider when treating such patients. This review focuses around two case studies encountered in naval dentistry: (i) diving barotrauma (pressure-induced injury related to an air space); and (ii) scuba diving mouthpiece-related oral conditions. Each condition is described by its effect on the oral cavity and in particular the teeth. Then we generally review the latest literature on the different effects of scuba diving on the diver's head, face and oral regions and emphasize methods of dental disease prevention, diagnostic tools and treatment guidelines.
Topics: Barotrauma; Diving; Humans; Military Dentistry
PubMed: 36001570
DOI: 10.22462/05.06.2022.11 -
Pulmonology 2020
Topics: Barotrauma; Cannula; Diving; Humans; Incidence; Male; Mediastinal Emphysema; Mediastinum; Oxygen Inhalation Therapy; Pressure; Radiography, Thoracic; Subcutaneous Emphysema; Treatment Outcome; Young Adult
PubMed: 31735688
DOI: 10.1016/j.pulmoe.2019.09.010