Chest
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Prolonged mechanical ventilation (MV) is associated with high morbidity, mortality, and cost. However, few and limited data are available on the prediction of duration of MV. We conducted an observational cohort study to seek predictive criteria. ⋯ Low incidence of MV > or = 15 days was observed (13% and 20%, respectively, in observational cohort study and validation study) in unselected SICU patients. LIS > or = 1 at the time of intubation provides excellent negative predictive value (0.93 and 0.91) of duration of MV > or = 15 days. These data suggest that tracheotomy should not be considered for patients with LIS < 1.
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The purpose of this report is to review our experience with multiple primary lung cancers (MPLC) at the Walter Reed Army Medical Center, Washington, DC, and to determine the outcome of our surgical management of this complex problem. ⋯ We conclude that an aggressive surgical approach is safe and justified in most patients with MPLC, especially patients with metachronous cancers, while patients with synchronous lung cancers have poorer prognosis. The operative morbidity and mortality are acceptable and long-term survival is possible in many patients with metachronous lung cancer.
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The development of right ventricular (RV) hypertrophy in emphysema is accompanied by involvement of the left ventricle (LV) and its systolic function. Our objective was to study the relation between RV hypertrophy and LV ejection fraction in emphysema by means of MRI. ⋯ These data are in support of the hypothesis that flattening of the interventricular septum explains the relatively normal LV ejection fraction in emphysematous patients with severe RV hypertrophy.
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We did a retrospective study in 12 patients with iatrogenic tracheal or tracheobronchial ruptures treated since 1975. Ten female subjects, one male subject, and one child (age range, 8 to 72 years), all of whom had undergone intratracheal intubation, were admitted to the hospital. Four patients had been intubated with a double-lumen catheter (two Carlens type with carinal spur, two Robertshaw without spur), and seven had had "high volume-low pressure" tubes, placed under emergency conditions in three of those seven cases. ⋯ The longest interval until diagnosis was 5 days; only then did the patient show subcutaneous emphysema and have retrosternal pain. All patients had surgical repair. Nine recovered without sequelae, and three died of septic multiorgan failure.