Chest
-
Some patients with chronic obstructive pulmonary disease (COPD) experience transient arterial hypoxemia (TAH) during rapid eye movement (REM) sleep. To examine the effect of short- and long-term low flow oxygen on TAH associated cardiopulmonary hemodynamics, we recorded pulmonary artery pressure (Ppa) and cardiac output during nocturnal sleep in seven male subjects with COPD. In all of the subjects, parameters were measured breathing room air at baseline time and after eight or more weeks of home supplemental oxygen (15 hours per day, 3 L/min). ⋯ In four of these, total pulmonary resistance was lower and cardiac output higher after home oxygen therapy. Short-term supplemental oxygen is useful in correcting REM-associated TAH and in some hypoxemic subjects, reducing mean sleeping Ppa. Sustained reductions in pulmonary vascular resistance after long-term home oxygen therapy may be indicative of improved cardiac and pulmonary vascular status even in subjects showing minimal or no reduction in mean sleeping Ppa.
-
Between 1971 and 1980, some 1,452 patients who had injuries to their chest were hospitalized and treated in our clinic; 949 (65.4 percent) of them had blunt chest injury, and 504 (34.7 percent) had open chest injury. Conservative treatment was given in 1,327 cases. ⋯ A total of 1,272 of the patients who had conservative treatment (95.9 percent) and 118 who had surgery (94 percent) recovered. The overall mortality in patients who had conservative treatment was 4.1 percent (55 cases) and in those who had surgery was 6 percent (seven cases).
-
The cardiopulmonary effects of ventilatory support were studied in 12 patients with an acute myocardial infarction complicated by respiratory failure. At constant end-expiratory pressure, controlled mechanical ventilation, intermittent mandatory ventilation with 50 percent mechanical support, and spontaneous breathing all resulted in acceptable blood gas values. ⋯ Myocardial ischemia should be one of the major determinants of mechanical ventilation when a patient with ischemic heart disease is subjected to ventilator treatment. The total withdrawal of ventilatory support carries a risk of marked ischemia and is not recommended until the patient can be extubated.