Chest
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Although it is intuitively desirable, the measurement of arterial carbon dioxide tension (PaCO2) during diagnostic polysomnography and nocturnal trials of positive pressure therapy is invasive and potentially expensive. The accuracy of end-tidal carbon dioxide tension (PETCO2) and transcutaneous carbon dioxide (tcPCO2) monitoring in these contexts has not been systematically evaluated. This investigation was undertaken to evaluate the accuracy of PETCO2 and tcPCO2 in patients undergoing polysomnography. ⋯ Neither PETCO2, measured within a face mask, nor tcPCO2 is a consistently accurate reflection of PaCO2. This limits the utility of these variables in monitoring patients during diagnostic and therapeutic sleep studies, and in particular, during trials of nocturnal ventilatory assistance where adequate levels of support are to be established and unacceptable hyperventilation and respiratory alkalosis must be recognized.
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Case Reports
Left pleural hemorrhagic effusion. A presenting sign of thoracic aortic dissecting aneurysm.
Left hemorrhagic pleural effusion was the presenting sign of painless aortic dissecting aneurysm in two elderly hypertensive patients. Computed tomography (CT) of the chest revealed the aneurysmal dilatation of the thoracic aorta and an intimal flap connecting its descending part with the left pleural space. ⋯ The second 85-year-old patient remained in stable condition for 28 days, but finally had a second fatal episode of dissection into the left pleural space. The differential diagnosis of nontraumatic left hemorrhagic pleural effusion in an elderly hypertensive patient should include dissecting aneurysm of the descending thoracic aorta and CT of the chest should be performed as the next preferable diagnostic procedure.
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To determine the efficacy and safety of talc slurry for pleurodesis. ⋯ Talc slurry instilled through a chest tube is an effective bedside method of pleurodesis. Fever occurs frequently. Respiratory failure is a rare but potentially serious complication that deserves further investigation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of pressure and flow triggering systems during continuous positive airway pressure.
Compare the inspiratory work of breathing (WOBI) during pressure triggering (PT), and flow triggering (FT) using two microprocessor ventilators. ⋯ FT reduces the WOB compared with PT, regardless of the ventilator used. The reduction in WOB during FT is related to improved responsiveness and changes in the posttrigger phase.