Chest
-
Comparative Study
Quantitative CT predicts the severity of physiologic dysfunction in patients with lymphangioleiomyomatosis.
To assess quantitative high-resolution CT (quantitative CT) as a diagnostic and prognostic tool in pulmonary lymphangioleiomyomatosis. ⋯ Quantitative CT techniques can distinguish subjects with LAM from normal controls. Further, the quantitative CT index correlates well with physiologic measurements of airflow, lung volumes, diffusing capacity, and exercise performance and, thus, may provide a useful measure of disease severity.
-
Comparative Study
The usefulness of transesophageal echocardiography in diagnosing cardiac contusions.
To assess the usefulness of transesophageal echocardiography in diagnosing cardiac contusions in patients with blunt trauma. ⋯ Transesophageal echocardiographically diagnosed cardiac contusion in trauma patients carries a high mortality rate. Transesophageal examinations are safe and provide excellent quality images where transthoracic examinations were inadequate. Right ventricular contusions are approximately twice as common as left ventricular contusions.
-
The purpose of this study was to examine and compare the systemic and pulmonary hemodynamic effects of a central venous infusion of adenosine in cardiac surgical patients. ⋯ Adenosine may be used clinically as a selective pulmonary vasodilator to optimize pulmonary hemodynamics without adverse systemic hemodynamic effects in cardiac surgical patients. It may be particularly valuable in patients with right heart dysfunction by selectively lowering right ventricular afterload.
-
We have previously reported our experience with noninvasive positive pressure ventilation (NPPV) via face mask in a small group of selected patients with acute respiratory failure (ARF). NPPV was frequently effective (70% success rate) in correcting gas exchange abnormalities and in avoiding endotracheal intubation (ETI); NPPV also had a low rate of complications. We have evaluated the clinical application of NPPV as first-line intervention in patients with hypercapnic and short-term hypoxemic ARF. A dedicated respiratory therapist conducted an educational program with physicians-in-training rotating through the medical ICUs of a university medical center and supervised implementation of a simplified management protocol. Over 24 months, 164 patients with heterogeneous forms of ARF received NPPV. We report on the effectiveness of NPPV in correcting gas exchange abnormalities, in avoiding ETI, and associated complications, in different conditions precipitating ARF. ⋯ We conclude that application of NPPV in clinical practice is an effective and safe alternative to ETI in many hemodynamically stable patients with hypercapnic ARF and in those with hypoxemic ARF in whom the clinical condition can be readily reversed in 48 to 72 h. An educational and supervision program is essential to successfully implement this form of therapy.
-
Randomized Controlled Trial Comparative Study Clinical Trial
The accuracy of a handheld portable spirometer.
Objective measurement of lung function is considered essential in the management of patients with asthma and COPD. Many primary care practitioners lack the means necessary to obtain these measurements conveniently. To meet this need, electronic spirometers, offering portability, ease of operation, and timesaving readout options have been introduced. We compared the accuracy of a typical pneumotachograph-based device with a conventional volume displacement spirometer. ⋯ Our data suggest that measurements obtained using the pneumotachograph device are closely related to those obtained by volume displacement spirometry and that the handheld device may be useful in clinical practice. However, because the limits of agreement are wide and the difference between the two instrument measurements are significant for FEV1, FEF25-75%, and PEFR, the bias between them is not consistent nor is it insignificant. Therefore, the measurements made with the two types of machine cannot be used interchangeably.