Chest
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Case Reports
Diagnosis of unilateral mainstem bronchial obstruction following single-lung transplantation with routine spirometry.
Single-lung transplantation has become a treatment option for many patients with advanced pulmonary disease. Recent advances in surgical technique and refined immunosuppressive regimens have led to improvement in long-term outcomes, but postoperative complications, including airway disorders, remain problematic. ⋯ Surveillance spirometry performed 6 weeks after transplantation demonstrated a new initial plateau in the maximal expiratory flow-volume curve suggestive of a variable intrathoracic airway obstruction. This unique aberration in the flow-volume curve sheds new insight into the physiologic abnormalities of spirometry in patients receiving lung transplants.
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Pulmonary pneumatoceles are uncommon but generally benign, thin-walled parenchymal air collections arising in association with acute pneumonia. Rarely, they may attain such size as to severely affect respiration. We describe the percutaneous placement of multiple drains in a patient with pneumonia due to atypical measles and large pneumatoceles. Decompression via tubes resulted in improved ventilation and acceleration of recovery.
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As a result of many interacting variables, including crowded shelters and limited access to health care, homeless persons are at high risk for tuberculosis. Using traditional approaches, control of tuberculosis in this population has been difficult. Decision analysis was used to investigate the cost-effectiveness of BCG (bacillus Calmette-Guérin) vaccination in persons attending homeless shelters. ⋯ Using conservative assumptions, a vaccine that was at least 40 percent effective would result in a net cost savings. If the efficacy of the vaccine were 50 percent, $4,000 would be saved, 12 life-years gained, and 23 cases of active tuberculosis prevented for every 1,000 persons vaccinated. Further study of the BCG vaccine in homeless persons and other populations at risk is warranted.
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Randomized Controlled Trial Clinical Trial
A computer-controlled ventilator weaning system. A clinical trial.
The purpose of this study was to determine if a computer-directed weaning system could wean patients with complex medical problems from mechanical ventilation and appropriately respond to signs of respiratory failure more effectively than traditional physician-directed weaning methods. In a prospective, randomized, controlled study, we tested the system in 15 patients who had required prolonged mechanical ventilation and met predetermined weaning tests. Patients were randomly assigned to one of two groups: (1) automatic, computer-directed weaning or (2) physician-controlled weaning. ⋯ The number of arterial blood gas samples drawn during the study was 1.4 +/- 0.7 for the computer group, 7.2 +/- 4.3 for the control group. The number of minutes per hour outside acceptable limits of RR > 30, RR < 8, or TV < 5 ml/kg was 3.2 +/- 2.8 min for the computer group and 6.6 +/- 4.1 min for the control group. The study suggests that use of the computer-directed weaning system results in fewer arterial blood gas samples, shorter weaning times, and less time spent outside acceptable RR and TV parameters.