Chest
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Safe and timely liberation from venovenous extracorporeal membrane oxygenation (ECMO) would be expected to reduce the duration of ECMO, the risk of complications, and costs. However, how to liberate patients from venovenous ECMO effectively remains understudied. ⋯ Practices on liberation from venovenous ECMO are heterogeneous and are influenced strongly by clinician preference. Additional research on liberation thresholds is needed to define optimal liberation strategies and to close existing knowledge gaps in essential topics on liberation from venovenous ECMO.
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Airway closure is an underestimated phenomenon reported in hypoxemic respiratory failure under mechanical ventilation, during cardiac arrest, and in patients who are obese. Because airway and alveolar pressure are not communicating, it leads to an overestimation of driving pressure and an underestimation of respiratory system compliance. Airway closure also favors denitrogenation atelectasis. ⋯ We describe three cases of airway closure in patients with hydrostatic pulmonary edema caused by cardiogenic shock, highlighting its resolution in a limited period of time (24 h) as pulmonary edema resolved. The waveforms show a biphasic reopening that we refer to as the "uncorking effect". The detection of airway closure may require setting positive end-expiratory pressure at or above the airway opening pressure to avoid the overestimation of driving pressure.
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A 19-year-old woman with no medical history who did not use tobacco presented to the hospital with post-COVID-19 cough for 2 months and new onset of shortness of breath and blood-tinged sputum. She was initially treated empirically for community-acquired pneumonia because her chest radiograph showed a right upper lobe infiltrate. Further CT scan imaging revealed a right hilar lymph node conglomerate and extensive lymphadenopathy. ⋯ She was treated for pain, and she left for insurance reasons. Two months later, the patient presented with progressive shortness of breath and hemoptysis and a 23-kg weight loss over the past 4 months. Because of the patient's increasing medical needs, she was transferred to our institution, where she was admitted to the medical ICU.
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A 38-year-old man presented to the ED complaining of persistent fever, dry cough, shortness of breath, and diarrhea for 7 days. He reported a history of OSA with inconsistent CPAP use, tobacco use of less than one pack per day, and daily e-cigarette use or "vaping." He denied any contact with ill people or recent travels and was up to date on recommended COVID-19 vaccinations. Prior to his presentation, he had been seen at an urgent care facility twice in the last week, where he was given IV fluids and prescribed steroids without improvement.