Chest
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To evaluate the prognosis of HIV-infected patients admitted to ICUs and to identify factors predictive of short- and long-term survival. ⋯ The short-term (in-ICU and in-hospital) outcome of HIV-infected patients was mainly related to the severity of the acute illness (SAPS I, cause of admission, need for and duration of mechanical ventilation), and to the preadmission health status, based on functional status and weight loss. Some of these parameters, in particular the SAPS I and preadmission health status, also influenced the long-term outcome. Whereas HIV-related variables had little impact on the in-ICU outcome, they were closely related with the in-hospital outcome and even more strikingly with the long-term outcome. Thus, the life expectancy of HIV-infected patients, which depends primarily on the natural history of the HIV infection, is the most powerful determinant of the long-term prognosis. Our results confirm that ICU support for HIV-infected patients should not be considered futile.
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Comparative Study
Evaluation of respiratory inductive plethysmography in controlled ventilation: measurement of tidal volume and PEEP-induced changes of end-expiratory lung volume.
To determine the accuracy of respiratory inductive plethysmography (RIP) with a respiratory monitor (Respitrace Plus; NIMS Inc., Miami) operating in the DC-mode for the measurement of tidal volumes (VT) and positive end-expiratory pressure (PEEP)-induced changes of end-expiratory lung volume (deltaEELV) in patients with normal pulmonary function, acute lung injury (ALI), and COPD during volume-controlled ventilation. ⋯ In a mixed group of patients undergoing controlled ventilation, RIP using the Respitrace Plus monitor was not consistently precise enough for quantitative evaluation of VT and EELV when compared to our reference methods. This was most evident in patients with COPD. For long-term volume measurements, a better control of the baseline drift of RIP should be achieved.
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Comparative Study
Extending ventilator circuit change interval beyond 2 days reduces the likelihood of ventilator-associated pneumonia.
To determine the risk of acquiring ventilator-associated pneumonia (VAP) and the impact on costs when extending ventilator circuit change intervals beyond 2 days to 7 and 30 days. ⋯ Circuit change intervals of 7 and 30 days have lower risks for VAP than the 2-day intervals, yielding substantial reductions in morbidity as well labor and supply costs.
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Williams-Campbell syndrome is a rare disorder characterized by a deficiency of cartilage in subsegmental bronchi leading to distal airway collapse and bronchiectasis. We report the first case of lung transplantation in a patient with end-stage lung disease secondary to Williams-Campbell syndrome. Although the patient did not have proximal airway collapse prior to transplantation, his posttransplant course was complicated by the development of bronchomalacia of the right and left mainstem bronchi. ⋯ A hypothesis may be made that a combination of proximal cartilage deficiency and posttransplant airway ischemia led to the development of bronchomalacia after lung transplantation. Thus, in contrast to previous reports, the cartilage deficiency in Williams-Campbell syndrome can involve both proximal and distal airways. Consequently, bilateral sequential lung transplantation may not be an effective therapeutic option in patients with this syndrome.