Immediate post-operative effects of tracheotomy on respiratory function during mechanical ventilation

INTRODUCTION: Tracheotomy is widely performed in the intensive care unit after long-term oral intubation. The present study investigates the immediate influence of tracheotomy on respiratory mechanics and blood gases during mechanical ventilation. METHODS: Tracheotomy was performed in 32 orally intubated patients for 10.5 ± 4.66 days (all results are means ± standard deviations). Airway pressure, flow and arterial blood gases were recorded immediately before tracheotomy and half an hour afterwards. Respiratory system elastance (E(rs)), resistance (R(rs)) and end-expiratory pressure (EEP) were evaluated by multiple linear regression. Respiratory system reactance (X(rs)), impedance (Z(rs)) and phase angle (φ(rs)) were calculated from E(rs )and R(rs). Comparisons of the mechanical parameters, blood gases and pH were performed with the aid of the Wilcoxon signed-rank test (P = 0.05). RESULTS: E(rs )increased (7 ± 11.3%, P = 0.001), whereas R(rs )(-16 ± 18.4%, P = 0.0003), X(rs )(-6 ± 11.6%, P = 0.006) and φ (rs )(-14.3 ± 16.8%, P = <0.001) decreased immediately after tracheotomy. EEP, Z(rs), blood gases and pH did not change significantly. CONCLUSION: Lower R(rs )but also higher E(rs )were noted immediately after tracheotomy. The net effect is a non-significant change in the overall R(rs )(impedance) and the effectiveness of respiratory function. The extra dose of anaesthetics (beyond that used for sedation at the beginning of the procedure) or a higher FiO(2 )(fraction of inspired oxygen) during tracheotomy or aspiration could be related to the immediate elastance increase

Increasing Skin Pigmentation Following Severe Head Trauma: All That Glitters Is Not Gold!

We report the case of a 67-year-old man who was admitted to our Intensive Care Unit because of traumatic brain injury. During his prolonged hospitalization, gradual darkening of the skin all over his body was observed. An excess corticotropin (ACTH) production syndrome was considered. The patient’s hormone study showed high levels of ACTH (978 pg/ml) with normal cortisol levels. Extensive clinical and laboratory investigations revealed adenocarcinoma of the colon, which was likely the site of the ectopic ACTH production. This is a very rare manifestation of paraneoplastic syndrome during the course of colon adenocarcinoma. The most important feature of this case report is that this rare syndrome was accidentally discovered, in a patient hospitalized for unrelated reasons, by simple clinical investigation