Chest
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Shortness of breath after pneumonectomy is a common finding that has multiple causes. We report the cases of two patients with shortness of breath on assuming an upright posture (platypnea) that followed pneumonectomy; these individuals developed right-to-left shunt across a patent foramen ovale (PFO) with normal right-sided intracardiac pressures. Both contrast echocardiography and magnetic resonance imaging (MRI), including a recently introduced dynamic ultrafast imaging technique, proved helpful in diagnosing this condition noninvasively.
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Randomized Controlled Trial Comparative Study Clinical Trial
Should all patients undergoing cardiac catheterization or percutaneous transluminal coronary angioplasty receive oxygen?
Supplemental oxygen is routinely administered to patients with acute coronary syndromes. The risk of significant morbidity during cardiac catheterization or coronary angioplasty has been well described; however, to our knowledge, the need for routine oxygen supplementation in these patients has not been investigated. ⋯ Significant hypoxemia is a common finding among patients undergoing cardiac catheterization or angioplasty despite the absence of predictive risk factors. Severe and prolonged hypoxemic episodes occurred in 10 percent (14/142, phase 1) of patients breathing room air. Patients undergoing diagnostic catheterization with history of chronic lung disease or a baseline SpO2 < 95 percent are at high risk to develop moderate-severe hypoxemia. Oxygen therapy significantly reduced the incidence and severity of procedure-induced hypoxemia in both groups. Our data support the use of both pulse oximetry and oxygen supplementation in patients undergoing cardiac catheterization and PTCA.
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Comparative Study
Assessment of interrater and intrarater reliability in the evaluation of metered dose inhaler technique.
To determine if a training session using videotaped metered dose inhaler (MDI) performances can result in high interrater and intrarater reliability of five evaluators assessing MDI technique. ⋯ High interrater and intrarater reliability in MDI evaluation is difficult to obtain. Clinicians and researchers involved in MDI evaluation and education should be trained to achieve consistency. A single training session using videotaped MDI demonstrations was not adequate in achieving consistency among evaluators. To improve accuracy of research results, researchers should include at least two evaluators to assess MDI technique or take other measures to show and report reliability.
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Case Reports
Prolonged use of an endotracheal tube changer in a pediatric patient with a potentially compromised airway.
A 14-year-old obese male patient presented following a motor vehicle accident with multiple injuries and respiratory failure requiring endotracheal intubation and mechanical ventilation. Because of potential problems with a difficult airway, an endotracheal tube changer was used at the time of extubation and left in place for a prolonged period of time. Leaving the tube changer in place maintained access to the airway. Additionally, the manipulation of the tube changer was used to stimulate the cough reflex.
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A 63-year-old patient with chronic lymphocytic leukemia presented with severe hypoxemia. However, the patient's hemoglobin saturation, measured by an ear oximeter, was normal. ⋯ The PaO2 in the plasma was much higher than in whole blood and corresponded with the hemoglobin saturation measured by the ear oximeter. These findings suggest that very high leukocyte counts may interfere with the measurement of oxygen tension and that plasma may be used for blood gas analysis in this situation.