Chest
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Multicenter Study Comparative Study
Portopulmonary hypertension: a report from the US-based REVEAL Registry.
We evaluated survival and hospitalization rates in patients with group 1 portopulmonary hypertension (PoPH) in the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL Registry). ⋯ Patients with PoPH had significantly poorer survival and all-cause hospitalization rates compared with patients with IPAH/FPAH, despite having better hemodynamics at diagnosis. Further studies should investigate such outcomes and differences in treatment patterns.
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It is estimated that 350,000 people suffer a cardiac arrest each year in the United States, with one-half occurring out-of-hospital and the other half in-hospital. Overall survival is < 10% and has not changed significantly for decades. CPR is the umbrella term for attempts to restore organized cardiac contractility and functional blood flow. ⋯ In addition, a greater emphasis has been placed on quality of CPR, with the need to minimize interruptions, the reordering of CPR priorities to place chest compressions before ventilations, and the need for comprehensive postarrest care that includes both targeted temperature and hemodynamic management. Whether a cardiac arrest occurs out-of-hospital or in-hospital, the basic approach to CPR and postarrest care is identical. Documentation should be performed in a standardized fashion, using a consensus set of data elements known as the Utstein format, and can contribute to quality improvement, research, and billing efforts.
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Multiple medical disorders can lead to the development of pleural effusions. Most effusions are given a single diagnosis in clinical practice. ⋯ Five causes for the pleural effusion were diagnosed, namely malignant pleural effusion, empyema, chylothorax, transudative pleural effusion secondary to hypoalbuminemia, and esophagopleural fistula. This case serves as a reminder to clinicians that recurrent pleural effusion, even within the same pleural space, can arise from different causes and, whenever clinically appropriate, reinvestigation of the pleural effusion may be needed.
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Pneumothorax in critically ill patients remains a common problem in the ICU, occurring in 4% to 15% of patients. Pneumothorax should be considered a medical emergency and requires a high index of suspicion, prompt recognition, and intervention. The diagnosis of pneumothorax in the critically ill patient can be made by physical examination findings or radiographic studies including chest radiographs, ultrasonography, or CT scanning. ⋯ If there is suspicion for tension pneumothorax, immediate decompression and drainage should be performed. With widespread use of CT scanning, there have been more occult pneumothoraces diagnosed, and the most recent literature suggests that drainage is preferred. In patients with a persistent air leak or failure of the lung to expand, current guidelines suggest that an early thoracic surgical consultation be requested within 3 to 5 days.