Chest
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Case Reports
Bilateral pneumothorax after percutaneous transthoracic needle biopsy. Evidence for incomplete pleural fusion.
Although the pleural cavities are anatomically separate in humans, we describe bilateral pneumothoraces that occurred after percutaneous needle biopsy of the lung. In some individuals, there may be communication between the pleural spaces; it is important for those performing interventional procedures to be aware of this uncommon anatomic variant.
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Case Reports
Endotracheal tube and tracheobronchial obstruction as causes of hypoventilation with high inspiratory pressures.
Two cases of difficult ventilation are presented, the first caused by endotracheal tube obstruction with nasal turbinate, and the second caused by tracheobronchial obstruction with blood clots. The clinical presentation in each case was characterized by extreme difficulty in ventilating and severe hypercapnia despite vigorous ventilatory efforts with either a mechanical ventilator or resuscitator bag. A simple manipulation of the endotracheal tube cuff helped to differentiate between increased impedance caused by endotracheal tube obstruction as opposed to increased respiratory system impedance beyond the tip of tube. In the second patient, in whom even a short interruption of ventilation was poorly tolerated, simultaneous rigid bronchoscopy (for removal of intratracheal masses) and ventilation via endotracheal tube were successfully performed.
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To evaluate an equation that estimates resting energy expenditure from two easily obtained measurements--expired carbon dioxide and minute ventilation, and compare the results of this equation with standard methods of estimating and measuring caloric expenditure in mechanically ventilated patients. ⋯ Minute ventilation and expired carbon dioxide measurements are easily and inexpensively obtainable. Energy expenditures calculated from these measurements (CEE) compare favorably with values obtained from a metabolic cart and are significantly more accurate than HBc.