[AnaConDa as last resort treatment. Case report of a chronic obstructive pulmonary disease].
Treatment of patients suffering from decompensated chronic pulmonary disease (COPD) not responding to pharmacological therapy is still a major challenge in intensive care medicine. Administration of volatile anaesthetics may be a therapy of last resort in these cases. We report on a 65-year-old woman suffering from exacerbated COPD, who could not be sufficiently ventilated despite comprehensive pharmacological therapy. In order to administer a volatile anaesthetic in the ICU, we employed the "Anaesthetic Conserving Device" (AnaConDa) consisting of a vaporizer chamber embedded in a charcoal filter system. With this device, every standard intensive care ventilator can be used to deliver volatile anaesthetics in a safe and economic manner. The AnaConDa converts the open breathing system of the intensive care ventilator into a de facto half-closed system. The very low pulmonary compliance of the patient increased dramatically after administration of 0.75 vol% halothane for 48 h (27 vs. 150 ml/mbar). Elimination of CO(2) was improved and weaning from controlled ventilation was achieved. After surgical removal of a pulmonary abscess and a total of 78 days of intensive care therapy, the patient was discharged in good health.
Nickel
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EA
Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität Göttingen, 37099 Göttingen. enickel@zari.de
Benken
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I
Bartels
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U
Voelckel
W G
WG
Quintel
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M
D000368:Aged; D000764:Anesthesia, Closed-Circuit / Q000295:instrumentation*; D000769:Anesthesia, Inhalation / Q000295:instrumentation*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D002245:Carbon Dioxide / Q000097:blood; D003422:Critical Care; D005260:Female; D006221:Halothane / Q000008:administration & dosage; D006801:Humans; D008170:Lung Compliance / Q000502:physiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D015656:Respiratory Mechanics; D012122:Ventilators, Mechanical
D018685:Anesthetics, Inhalation; D002245:Carbon Dioxide; D006221:Halothane