28 research outputs found
Effect of pressure support ventilation and positive end expiratory pressure on the rapid shallow breathing index in intensive care unit patients
No full textObjective: We compared rapid shallow breathing index (RSBI) values under various ventilatory support settings prior to extubation. Design and setting: Prospective study in the intensive care unit at a university hospital. Patients: Thirty six patients ready for extubation. Interventions: Patients were enrolled when receiving pressure support ventilation (PSV) of 5 cmH2O, PEEP of 5 cmH2O, and FIO2 of 40percent (PS). Subsequently each patient received a trial of PSV of 0 cmH2O, PEEP of 5 cmH 2O, and FIO2 of 40percent (CPAP), a trial of PSV of 0 cmH 2O, PEEP of 5 cmH2O and FIO2 of 21percent (CPAP-R-A), and a 1-minute spontaneously breathing room air trial off the ventilator (T-piece). Trials were carried out in random order. Measurements and results: Respiratory frequency (f) and tidal volume (VT) were measured during PS, CPAP, CPAP-R-A, and T-piece in all patients. RSBI (f-VT) was determined for each patient under all experimental conditions, and the average RSBI was compared duringPS, CPAP, CPAP-R-A, and T-piece. RSBI was significantly smaller during PS (46 ± 8bpm-l), CPAP (63 ± 13bpm-l) and CPAP-R-A (67 ± 14bpm-l) vs. T-piece (100 ± 23bpm-l). There was no significant difference in RSBI between CPAP and CPAP-R-A. RSBI during CPAP and CPAP-R-A were significantly smaller than RSBI during T-piece. In all patients RSBI values were less than 105 bpm-l during PS, CPAP, and CPAP-R-A. However, during T-piece the RSBI increased to greater than 105 bpm-l in 13 of 36 patients. Conclusions: In the same patient the use of PSV and-or PEEP as low as 5 cmH2O can influence the RSBI. In contrast, changes in FIO 2 may have no effect on the RSBI. © 2007 Springer-Verlag.Acosta P, 2007, CRIT CARE CLIN, V23, P251, DOI 10.1016-j.ccc.2006.12.012; BROCHARD L, 1994, AM J RESP CRIT CARE, V150, P896; Calzia E, 2004, CRIT CARE, V8, P308, DOI 10.1186-cc2914; Chao DC, 2007, RESPIR CARE, V52, P159; Cohen JD, 2006, CRIT CARE MED, V34, P682, DOI 10.1097-01.CCM.0000201888.32663.6A; El-Khatib MF, 2002, CHEST, V121, P475, DOI 10.1378-chest.121.2.475; EPSTEIN SK, 1995, AM J RESP CRIT CARE, V152, P545; Eskandar N, 2007, CRIT CARE CLIN, V23, P263, DOI 10.1016-j.ccc.2006.12.002; HABERTHUR C, 2005, CRIT CARE, V9, P407; Hoo GWS, 2002, CHEST, V121, P1947; Johannigman JA, 1997, SURGERY, V122, P737, DOI 10.1016-S0039-6060(97)90081-7; Khamiees Mohammad, 2002, Respir Care, V47, P150; Krieger BP, 1997, CHEST, V112, P1029, DOI 10.1378-chest.112.4.1029; Kuo PH, 2006, J FORMOS MED ASSOC, V105, P390; MacIntyre NR, 2001, CHEST, V120, p375S, DOI 10.1378-chest.120.6_suppl.375S; PESENTI A, 1993, CHEST, V103, P1185, DOI 10.1378-chest.103.4.1185; Petrini Marcy F., 1998, Biomedical Instrumentation and Technology, V32, P273; Saura Pilar, 2002, Respir Care, V47, P279; SYDOW M, 1995, INTENS CARE MED, V21, P887, DOI 10.1007-BF01712329; Tehrani Fleur, 2002, J Clin Monit Comput, V17, P367, DOI 10.1023-A:1024261021473; Tobin MJ, 2006, INTENS CARE MED, V32, P2002, DOI 10.1007-s00134-006-0439-4; Toth I, 2007, CRIT CARE MED, V35, P787, DOI 10.1097-01.CCM.0000257330.54882.BE; Vitacca M, 2004, CHEST, V126, P851, DOI 10.1378-chest.126.3.851; YANG KL, 1991, NEW ENGL J MED, V324, P1445, DOI 10.1056-NEJM19910523324210121211
Extranodal marginal zone lymphoma of MALT involving the lungs, the stomach, and the colon
No full textExtranodal marginal zone lymphoma of MALT, previously known as MALT lymphoma, is a low grade B-cell Non-Hodgkin's lymphoma (NHL). Its most frequent locations are the gastrointestinal tract and the lungs while that of the colon is rare. Involvement of multiple mucosal sites is not a frequent finding but it does occur. We describe a case of a 70-year-old man who presented with extranodal marginal zone lymphoma of MALT involving three different sites: the lungs, the stomach, and the colon. © 2006 Elsevier Ireland Ltd. All rights reserved.Cadranel J, 2002, EUR RESPIR J, V20, P750, DOI 10.1183-09031936.02.00404102; Cavalli F, 2001, Hematology Am Soc Hematol Educ Program, P241; Graziadei G, 1998, ANN HEMATOL, V76, P81, DOI 10.1007-s002770050367; HARRIS N, 1994, BLOOD, V84, P161; ISAACSON P, 1983, CANCER, V52, P1410, DOI 10.1002-1097-0142(19831015)52:81410::AID-CNCR28205208133.0.CO;2-3; Jaffe ES, 1999, AM J CLIN PATHOL S1, V111, P8; ROBBINS SL, 2005, PATHOLOGIC BASIS D E, V7; Thieblemont C, 2000, BLOOD, V95, P802; Zinzani PL, 2003, LEUKEMIA LYMPHOMA, V44, P821, DOI 10.1080-1042819031000067972; Zucca E, 2003, BLOOD, V101, P2489, DOI 10.1182-blood-2002-04-12791
A New Oxygenation Index for Reflecting Intrapulmonary Shunting in Patients Undergoing Open-Heart Surgery
No full textStudy objectives: To assess the reliability of new and traditional oxygenation measurements in reflecting intrapulmonary shunt. Design: Prospective study. Setting: Cardiac surgery unit at a university hospital. Patients: Fifty-five patients undergoing coronary artery bypass grafting. Measurements and results: Simultaneous blood samples were collected from an indwelling arterial line and a catheter for determination of blood gases. Standard accepted formulas were utilized to measure a new oxygenation index: PaO2-fraction of inspired oxygen (FIO2) x mean airway pressure (Paw). The standard formulas used were the oxygenation ratio (PaO 2-FIO2), PaO2-alveolar partial oxygen pressure (PAO2), alveolar-arterial oxygen tension gradient (P[A-a]O 2), and intrapulmonary shunt (venous admixture [Qsp-Qt]). There were significant negative (p andlt; 0.05) correlations between the PaO 2-(FIO2 X Paw) and Qsp-Qt (r = - 0.85), between the PaO2-FIO2 and Qsp-Qt (r = - 0.74), and between the PaO2-PAO2 and Qsp-Qt (r = - 0.71). There was a significant positive (p andlt; 0.05) correlation between the P(A-a)O2 gradient and Qsp-Qt (r = 0.66). However, the correlation was strongest between the PaO2-(FIO2 x Paw) and Qsp-Qt. Conclusion: In this group of patients, PaO2-(FIO2 x Paw) might be more reliable than other oxygenation measurements in reflecting intrapulmonary shunt.Brower RG, 2000, NEW ENGL J MED, V342, P1301; BAIGELMAN W, 1984, CRIT CARE MED, V12, P486, DOI 10.1097-00003246-198406000-00003; BERNARD GR, 1994, AM J RESP CRIT CARE, V149, P818; BERTHELSEN P, 1986, ACTA ANAESTH SCAND, V30, P243; BONE RC, 1989, CHEST, V96, P849, DOI 10.1378-chest.96.4.849; CANE RD, 1988, CRIT CARE MED, V16, P1243, DOI 10.1097-00003246-198812000-00014; CHATBURN R, 1990, HDB RESP CARE; COVELLI HD, 1983, CRIT CARE MED, V11, P646, DOI 10.1097-00003246-198308000-00012; DOWNS JB, 1976, CRIT CARE MED, V4, P295, DOI 10.1097-00003246-197611000-00002; Dyhr T, 2002, ACTA ANAESTH SCAND, V46, P717, DOI 10.1034-j.1399-6576.2002.460615.x; Gould MK, 1997, CRIT CARE MED, V25, P6, DOI 10.1097-00003246-199701000-00005; Gowda MS, 1997, CRIT CARE MED, V25, P41, DOI 10.1097-00003246-199701000-00010; Hess D., 1985, RESP CARE, V30, P961; HOFFSTEIN V, 1984, J LAB CLIN MED, V104, P685; HOROVITZ JH, 1974, ARCH SURG-CHICAGO, V108, P349; MARVEL SL, 1986, CHEST, V90, P537, DOI 10.1378-chest.90.4.537; MURRAY JF, 1988, AM REV RESPIR DIS, V138, P720; Nirmalan M, 2001, BRIT J ANAESTH, V86, P477, DOI 10.1093-bja-86.4.477; NUNN JF, 1993, APPL RESP PHYSL; RASANEN J, 1987, CRIT CARE MED, V15, P1058; ROBINSON N B, 1981, American Review of Respiratory Disease, V123, P92; SIGGAARDANDERSEN O, 1995, ACTA ANAESTH SCAND, V39, P41; SUTER PM, 1978, HERZ, V3, P198; SYDOW M, 1994, AM J RESP CRIT CARE, V149, P1550; VALTA P, 1992, CHEST, V141, P281; VIALE JP, 1986, CRIT CARE MED, V14, P153, DOI 10.1097-00003246-198602000-00018; ZETTERSTROM H, 1988, ACTA ANAESTH SCAND, V32, P57920151
Thromboembolism and toxic shock syndrome: A case presentation and literature update
No full textA case of progressive shock and multisystem organ failure is reported for an 18 year old Lebanese woman, clinically diagnosed as toxic shock syndrome (TSS). The patient developed cough and dyspnea during hospitalization; chest CT angiography revealed thromboembolism of the pulmonary artery. CBC analysis showed leukocytosis with a white cell count (WCC) with a marked increase in PT and PTT coupled with reduced protein S, antithrombin III, and protein C levels. The patient improved gradually and was discharged from the hospital 7 days later on oral anticoagulation, and was followed up for six months with no disease recurence or complications. To our knowledge, this is the first reported case in the literature of toxic shock syndrome associated with pulmonary thromboembolism. © 2004 Kluwer Academic Publishers.Aihara M, 1997, INTERNAL MED, V36, P97, DOI 10.2169-internalmedicine.36.97; AMBROSE RE, 1992, CLIN RADIOL, V45, P355, DOI 10.1016-S0009-9260(05)80096-0; CRAMER SF, 1995, HUM PATHOL, V26, P1157, DOI 10.1016-0046-8177(95)90281-3; DAIL DH, 1988, PULMONARY PATHOLOGY, P677; Eriksson BKG, 1998, CLIN INFECT DIS, V27, P1428, DOI 10.1086-515012; GRONIOWSKI J, 1963, ARCH PATHOL, V101, P230; HERZER CM, 2001, AM BOARD FAM PRACT, V14, P131; HESSELVIK JF, 1991, THROMB HAEMOSTASIS, V65, P126; Horlander KR, 2003, ARCH INTERN MED, V163, P1711, DOI 10.1001-archinte.163.14.1711; JOSELSON R, 1983, HUM PATHOL, V14, P88, DOI 10.1016-S0046-8177(83)80052-5; LARKIN SM, 1982, ANN INTERN MED, V96, P858; Levi M, 1999, NEW ENGL J MED, V341, P586, DOI 10.1056-NEJM199908193410807; MARRARO G, 1991, CANCER, V67, P696, DOI 10.1002-1097-0142(19910201)67:3696::AID-CNCR28206703283.0.CO;2-V; Mesters RM, 1996, BLOOD, V88, P881; Raumanns J, 1995, ANAESTHESIST, V44, P869, DOI 10.1007-s001010050224; REINGOLD AL, 1982, ANN INTERN MED, V96, P871; REINGOLD AL, 1982, ANN INTERN MED, V96, P875; ROBBOY SJ, 1972, HUM PATHOL, V3, P327, DOI 10.1016-S0046-8177(72)80034-0; Sharma S, 2003, CURR OPIN PULM MED, V9, P199, DOI 10.1097-00063198-200305000-00008; Slotman GJ, 2000, SHOCK, V14, P101, DOI 10.1097-00024382-200014020-00004; TODD JK, 1987, LANCET, V2, P1116; TODD JK, 1982, ANN INTERN MED, V96, P83911
Use of heparinized versus non-heparinized syringes for measurements of the pleural fluid pH
No full textBackground: Pleural fluid (PF) pH measurement is important for establishing a diagnosis and for guiding clinical management. The current standard practice is to collect PF samples for pH measurement in heparinized syringes at room temperature and to instantaneously process these samples. Objective: The purpose of this study is to investigate the effect of collecting PF in heparinized versus non-heparinized syringes at room temperature on PF pH measurements when processed at various time intervals. Methods: From 50 consecutive thoracenteses, 1 ml of PF was collected anaerobically in each of six 3-ml syringes. Only three syringes were coated with heparin. The samples were processed for PF pH measurements at time 0 (T0) and 1 h (T1) and 2 h (T 2) after collection. All specimens were preserved at room temperature, until the measurements were carried out in duplicates by a calibrated blood gas analyzer. Results: PF pH values were significantly lower with heparinized versus non-heparinized syringes at all time intervals (T 0: pH heparinized = 7.378 ± 0.107 vs. pH non-heparinized = 7.390 ± 0.108; T1: pH heparinized = 7.378 ± 0.115 vs. pH non-heparinized = 7.389 ± 0.111; T2: pH heparinized = 7.367 ± 0.105 vs. pH non-heparinized = 7.389 ± 0.121). In the heparinized syringes, there was a significant decrease in PF pH values at T 2 versus T0 and T1. There were no significant changes in PF pH values over time in the non-heparinized syringes. Conclusions: For serial PF pH measurements, the same type of syringes (either heparinized or non-heparinized) should be consistently used. With heparinized syringes, processing of PF pH measurements should be performed within 1 h after collection. Copyright © 2007 S. Karger AG.Aelony Y, 2006, RESPIRATION, V73, P334, DOI 10.1159-000092085; Chandler TH, 1999, SOUTHERN MED J, V92, P214, DOI 10.1097-00007611-199902000-00010; Cheng DS, 1998, CHEST, V114, P1368, DOI 10.1378-chest.114.5.1368; Goldstein LS, 1997, CHEST, V112, P707, DOI 10.1378-chest.112.3.707; GOOD JT, 1980, CHEST, V78, P55, DOI 10.1378-chest.78.1.55; Heffner JE, 2005, RESPIRATION, V72, P351, DOI 10.1159-000086247; Pieters T, 1998, CHEST, V114, P656, DOI 10.1378-chest.114.2.656; Sarodia BD, 2000, CHEST, V117, P1043, DOI 10.1378-chest.117.4.104343
Thiazolidinediones associated with recurrent pleural effusions post coronary artery bypass surgery
No full textWe report the case of a patient in which thiazolidinediones (TZDs) were associated with recurrent pleural effusions post coronary artery bypass surgery, in spite of a normal left ventricular function. The potential mechanisms are discussed, particularly in relation to the vascular leak syndrome. This finding has important implications for the management of diabetic patients who are referred for coronary artery bypass surgery and who are on TZDs for glycemic control. © 2005 Elsevier Ireland Ltd. All rights reserved.Emoto M, 2001, DIABETES, V50, P1166, DOI 10.2337-diabetes.50.5.1166; GARG A, 2003, MAYO CLIN P, V78, P1088; Kennedy FP, 2003, MAYO CLIN PROC, V78, P1076; Nesto RW, 2003, CIRCULATION, V108, P2941, DOI 10.1161-01.CIR.0000103683.99399.7E; Tang WHW, 2003, J AM COLL CARDIOL, V41, P1394, DOI 10.1016-S0735-1097(03)00159-121
Metastases in malignant pleural mesothelioma: A new radiological appearance
No full textThis report describes a patient with malignant pleural mesothelioma who presented with a right-sided pleural effusion and contralateral parenchymal metastases manifesting as alveolar opacities with air bronchograms. This radiological pattern of metastases has never been described before. The patient died from respiratory failure related to extensive parenchymal metastases, an outcome seldom reported with malignant pleural mesothelioma. © 2008 The Authors.Heki U, 1999, Respirology, V4, P279; Livasy Chad A, 2003, Ann Diagn Pathol, V7, P249, DOI 10.1016-S1092-9134(03)00071-6; MUSK AW, 1991, AUST NZ J MED, V21, P460, DOI 10.1111-j.1445-5994.1991.tb01355.x; Ohishi N, 1996, CHEST, V110, P296, DOI 10.1378-chest.110.1.296; Parker C, 2003, THORAX, V58, P809, DOI 10.1136-thorax.58.9.809; Pistolesi M, 2004, CHEST, V126, P1318, DOI 10.1378-chest.126.4.1318; ROBERTS GH, 1976, BRIT J DIS CHEST, V70, P246; Robinson BWS, 2005, NEW ENGL J MED, V353, P1591, DOI 10.1056-NEJMra050152; SCULLY RE, 1987, NEW ENGL J MED, V316, P1462; URI AJ, 1988, CHEST, V93, P433, DOI 10.1378-chest.93.2.4331
Benign Macrocystic Serous Cystadenoma of the Tail of the Pancreas: A Case Report
No full textSerous cystadenoma is a rare benign cystic lesion of the pancreas, predominantly affecting women with a mean age of onset around 62 years. While often asymptomatic, it can manifest with nonspecific symptoms such as abdominal pain and nausea. We present the case of a 68-year-old woman with abdominal pain and nausea, diagnosed with a serous cystadenoma in the tail of the pancreas through imaging modalities. Radiological examinations revealed a septated, multilayered cystic lesion with lobulated contour and calcifications. Surgical resection was performed, and pathological examination confirmed a serous cystadenoma. Differential diagnosis from pseudocysts and malignant serous cystadenocarcinomas is crucial. Treatment options include pancreatic resection, with close monitoring recommended for asymptomatic patients or those at high surgical risk. Despite their benign nature, accurate diagnosis and management of serous cystadenomas are essential
Metabolic and respiratory variables during pressure support versus synchronized intermittent mandatory ventilation
No full textBackground: Mechanically ventilated patients interact and respond differently to different modes of ventilatory support. Objectives: To assess changes in metabolic and respiratory variables during equivalent changes with either pressure support ventilation (PSV) or volume-cycled synchronized intermittent mandatory ventilation (SIMV) in non-tracheostomized patients without known obstructive pulmonary disease receiving short-term mechanical ventilation in the intensive care unit. Methods: Fourteen patients receiving volume-cycled SIMV at 12 breaths-min (SIMV100percent) were included in the study. The PSV level (PSV100percent) resulting in a minute volume and respiratory rate equivalent to that during SIMV100percent was determined for each patient. Then each patient underwent trials at 66percent and 33percent of initial ventilator support with volume-cycled SIMV (SIMV66percent and SIMV 33percent) and PSV (PSV66percent and PSV33percent) in random order. At the end of each trial, oxygen consumption (V̇O2), carbon dioxide production (V̇CO2), measured energy expenditures (MEE), peak inspiratory flow, total respiratory frequency, tidal volume, minute ventilation, occlusion pressure (P0.1) and inspiratory duty cycle (Ti-Ttot) were measured. Results: There were smaller changes in V̇O2, V̇CO2 and MEE when equivalent changes were applied with PSV (15.7 ± 4.4; 12.5 ± 2.2 and 15 ± 3.5percent) compared with volume-cycled SIMV (32.7 ± 7.7; 23 ± 5.2 and 30.7 ± 6.8percent; p andlt; 0.05). P0.1 and T i-Ttot were significantly smaller during PSV (2.64 ± 0.28 and 0.38 ± 0.03 cm H2O) than volume-cycled SIMV (4.01 ± 0.21 and 0.43 ± 0.02 cm H2O; p andlt; 0.05). Conclusions: Changes in the level of PSV resulted in smaller changes in metabolic and respiratory variables compared with equivalent changes in the level of volume-cycled SIMV support. PSV may be more suitable for progressive respiratory muscle reloading. Copyright © 2008 S. Karger AG.BROCHARD L, 1994, AM J RESP CRIT CARE, V150, P896; BROCHARD L, 1989, AM REV RESPIR DIS, V139, P513; Corne S, 1997, AM J RESP CRIT CARE, V156, P304; ESTEBAN A, 1995, NEW ENGL J MED, V332, P345, DOI 10.1056-NEJM199502093320601; Esteban A, 2002, JAMA-J AM MED ASSOC, V287, P345, DOI 10.1001-jama.287.3.345; GIULIANI R, 1995, AM J RESP CRIT CARE, V151, P1; IMSAND C, 1994, ANESTHESIOLOGY, V80, P13, DOI 10.1097-00000542-199401000-00006; Leung P, 1997, AM J RESP CRIT CARE, V155, P1940; MACINTYRE NR, 1991, CHEST, V99, P134, DOI 10.1378-chest.99.1.134; PUDDY A, 1992, AM REV RESPIR DIS, V146, P787; Putensen Christian, 2002, Curr Opin Crit Care, V8, P51, DOI 10.1097-00075198-200202000-00009; Tejeda M, 1997, CHEST, V111, P1322, DOI 10.1378-chest.111.5.1322; TISSOT S, 1995, INTENS CARE MED, V21, P149, DOI 10.1007-BF01726538; Tobin MJ, 2001, AM J RESP CRIT CARE, V163, P1059; VANDEGRAAFF WB, 1991, CHEST, V100, P1082, DOI 10.1378-chest.100.4.1082; WARD ME, 1988, ANESTHESIOLOGY, V69, P29, DOI 10.1097-00000542-198807000-0000554
