Chest
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An attempt to access the central venous circulation in a patient with a persistent left pleural effusion resulted in positioning the catheter within the pleural space. Chest roentgenograms with injection of contrast material revealed catheter location. Compliance with standard preventive practices may not assure correct placement of a central venous catheter via the internal jugular route in a patient with a hemothorax or effusion of unknown composition.
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The effect of transtracheal oxygen administration by means of a 9-French (2.7 mm) percutaneous catheter was assessed in five patients with severe obstructive sleep apnea. We hypothesized that the delivery of oxygen below the site of airway obstruction should reduce the arterial oxygen desaturation during apneas and hypopneas, thereby increasing respiratory stability. Standard sleep and respiratory measurements were recorded in these subjects with all-night polysomnography on nonconsecutive nights during four experimental conditions: room air (BL), nasal continuous positive airway pressure (CPAP), nasal O2 (NC O2), and transtracheal O2 (TT O2). ⋯ We believe that TT O2 is superior to NC O2 for some patients with obstructive sleep apnea because continuous oxygen flow below the site of airway obstruction more reliably prevents alveolar hypoxia and respiration is stabilized. Infusion of air or oxygen through the tracheal catheter flow may also increase mean airway pressure and reduce obstructive apnea similar to nasal CPAP. We conclude that TT O2 may be an effective alternative mode of therapy for some patients with severe sleep apnea/hypopnea when nasal CPAP is not tolerated or when combined oxygen and nasal CPAP are required.
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We compared bronchopulmonary distribution homogeneity of a radioaerosol before and after hospitalization in 20 patients with cystic fibrosis (CF) with pulmonary exacerbations in order to assess lung improvement. Deposition homogeneity was quantified in terms of skew (an index of distribution symmetry), derived from frequency distribution histograms generated from gamma camera images of the lungs following radioaerosol inhalation. Lower skew values indicate enhanced distribution homogeneity. ⋯ The reduction in RLS was significant in patients with Shwachman-Kulczycki (SK) clinical scores less than 50 (1.27 +/- 0.53 to 0.90 +/- 0.42), but not in patients with scores greater than 50 (0.81 +/- 0.38 to 0.80 +/- 0.52). These results indicate that treatment affected the right lung more than the left lung, particularly in patients with SK scores less than 50, and suggests that radioaerosol lung imaging may be valuable in identifying sites of impairment to be targeted during treatment. Statistically, skew was less sensitive an indicator of acute change than several other clinical indices that improved following hospital treatment.
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This study was undertaken to determine whether an infusion of local anesthetic (LA) delivered through an extrapleural tunnel could provide satisfactory control of pain in the postthoracotomy period. Twelve patients undergoing thoracotomy were studied. A T-shaped tunnel was created by elevating the parietal pleura at the posteromedial end of the thoracotomy wound. ⋯ Pain was well controlled in eight patients and satisfactory in four patients. The latter required one dose of opiate analgesia each in the 48-h postoperative period. We conclude that an infusion of bupivacaine into the extrapleural space is an effective means of control of pain after thoracotomy.
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To assess the responsiveness of mixed venous oximetry under conditions of supply-independent and supply-dependent oxygen consumption, we subjected ten pigs to graded isovolemic hemodilution while measuring cardiopulmonary variables, including oxygen consumption (VO2), oxygen delivery (DO2), and mixed venous oxyhemoglobin saturation (SvO2). Supply-dependent VO2 was reached at an average hemoglobin concentration of 3.9 +/- 0.7 g.dl-1, an SvO2 of 38.2 +/- 8.1 percent, and an oxygen extraction ratio of 0.55 +/- 0.10. ⋯ However, the rate of decline in SvO2 in the supply-dependent range was significantly slower than the rate calculated assuming unchanged VO2 (-32.6 +/- 16.3 percent; p less than 0.01). The results indicate that appearance of supply-dependence of VO2 does not render mixed venous oximetry unresponsive to further deterioration of oxygen supply during isovolemic hemodilution.