Chest
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Randomized Controlled Trial Comparative Study Clinical Trial
Preventive antibiotic usage in traumatic thoracic injuries requiring closed tube thoracostomy.
To evaluate the safety and effectiveness of antibiotics in reducing the infectious complications following closed tube thoracostomy for isolated chest trauma. ⋯ This study showed that patients receiving antibiotics had a significantly reduced rate of infection than did patients administered placebo. No significant adverse events were seen in either group.
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Comparative Study
Routine chest radiographs following repositioning of endotracheal tubes are necessary to assess correct position in pediatric patients.
Attempts to correctly reposition endotracheal tubes (ETTs) are not always successful in pediatric patients, even when chest radiographs (CXRs) are measured to determine the distance that the ETT deviates from the correct position. We determined the frequency of continued ETT malposition after repositioning in a pediatric intensive care unit (PICU). Forty children with malpositioned ETTs were identified during a 4-month period. ⋯ Despite repositioning based on measurements taken from a CXR, a large percentage of pediatric patients had continued ETT malposition. However, after radiographic documentation of correct position, we demonstrated that significant movement was uncommon. Routine confirmation of ETT position by CXRs should be considered after repositioning ETTs in pediatric patients.
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The present study was designed to evaluate if continuous positive airway pressure (CPAP) augments the effect of nitric oxide (NO) inhalation on matching between ventilation and perfusion (VA/Q) during acute lung injury. ⋯ Although pulmonary vascular resistance can be lowered with NO inhalation alone, recruitment of gas exchange units with CPAP is necessary to produce a beneficial effect of NO inhalation on VA/Q matching and oxygenation. When recruitment of gas exchange units with CPAP brings gaseous NO in contact with enough pulmonary blood vessels, NO-induced vasodilation will augment VA/Q matching by a steal mechanism.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of bronchodilators on lung mechanics in the acute respiratory distress syndrome (ARDS).
The acute respiratory distress syndrome (ARDS) is a disorder of diffuse lung injury secondary to a wide variety of clinical insults (eg, sepsis) and is manifested by impaired oxygenation, pulmonary edema, and decreased static and dynamic compliance. More recently, airflow resistance has been shown to be increased in humans with ARDS. We designed a prospective, randomized, placebo-controlled, crossover trial to determine the presence and reversibility of increased airflow resistance in ARDS. ⋯ Metaproterenol tended to increase PaO2/PAO2, but had no effect on pulmonary shunt or dead space ventilation. We conclude that the increase in airflow resistance of ARDS is substantially reversed by aerosolized metaproterenol without affecting dead space. These data suggest that abnormalities of RL are at lest partially due to bronchospasm.
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Review Case Reports
Aortobronchial fistula 13 years following repair of aortic transection.
We describe a 56-year-old man with the new onset of hemoptysis, increasing in frequency and magnitude, initially diagnosed and treated as pulmonary embolism. Bronchoscopy, computed tomography, and thoracic aortography were performed twice before the diagnosis was made. Thirteen years previously, the patient underwent thoracic aortic interposition graft placement for aortic laceration as a result of a motor vehicle accident. ⋯ The patient underwent successful resection of the graft and placement of a new dacron interposition graft. All cultures, including blood, sputum, and operative specimen cultures, were negative. The patient is alive and well 1 year following surgery.