Chest
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Comparative Study
Acute lung injury complicating imported Plasmodium falciparum malaria.
To characterize adult patients with acute lung injury complicating severe imported Plasmodium falciparum malaria. ⋯ Acute lung injury is more likely to occur in patients with extremely severe, multisystemic P falciparum malaria. In patients with acute lung injury and septic shock, bacterial coinfection should be suspected and treated empirically since it contributes substantially to early mortality.
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Comparative Study
Emphysema in silica- and asbestos-exposed workers seeking compensation. A CT scan study.
It has been established that coal pneumoconiosis and confluent silicosis are associated with emphysematous changes in the lungs. In the present study, we addressed the concept of emphysema in simple silicosis and asbestosis and in workers exposed to these minerals without the pneumoconiosis. The study was done on 207 consecutive workers evaluated for possible pneumoconiosis at Québec Workman Compensation Board, who had a radiographic reading of pneumoconiosis in the category 0 or 1 of the ILO scale, and in 5 control subjects. ⋯ We conclude that, in our population, there was a significant excess of CT scan emphysema, associated with lung dysfunction, in those with pneumoconioses and in smokers with silica exposure. In the absence of smoking, it took a patient with pneumoconiosis to have emphysema. These changes contributed to the lung function impairment of these subjects with ILO category 0 or 1 pneumoconioses.
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In a rodent model of cardiac arrest and resuscitation in which the inspired gas mixture was enriched with oxygen, resuscitability and survival were unaffected by positive pressure ventilation. In the present study, in a larger animal model, tidal volumes generated during precordial compression and with spontaneous gasping were quantitated. ⋯ Positive pressure mechanical ventilation did not improve resuscitability or postresuscitation outcome in this porcine model of cardiac arrest.
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To obtain spirometry and maximal respiratory pressure (MRP) reference values for elderly persons. ⋯ Spirometry and MRP reference values used for elderly patients should come from population studies using similar techniques and with large numbers of subjects over age 65 years.
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Randomized Controlled Trial Comparative Study Clinical Trial
Evaluation of carbon dioxide rebreathing during pressure support ventilation with airway management system (BiPAP) devices.
The purpose of this study was to evaluate whether carbon dioxide (CO2) rebreathing occurs in acute respiratory failure patients ventilated using the standard airway management system (BiPAP pressure support ventilator; Respironics; Murrysville, Pa) with positive inspiratory airway pressure and a minimal level of positive end-expiratory pressure (PEEP) and whether any CO2 rebreathing may be efficiently prevented by the addition of a nonrebreathing valve to the BiPAP system circuit. In the first part of the study, the standard device was tested on a lung model with a nonrebreathing valve (BiPAP-NRV) and with the usual Whisper Swivel connector (BiPAP-uc). With the BiPAP-uc device, the resident volume of expired air in the inspiratory circuit at the end of expiration (RVEA) was 55% of the tidal volume (VT) when the inspiratory pressure was 10 cm H2O and the frequency was at 15 cycles per minute. ⋯ When we compared the BiPAP system use with the other two systems, we observed no significant effect on blood gases but found significant increases in VT, minute ventilation, and work of breathing. These findings are experimental and are clinical evidence that significant CO2 rebreathing occurs with the standard BiPAP system. This drawback can be overcome by using a non-rebreathing valve, but only at the expense of greater expiratory resistance.