Chest
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Case Reports
A new device that allows synchronous intermittent inspiratory chest tube occlusion with any mechanical ventilator.
Controlling a massively leaking bronchopleural fistula (BPF) can prove difficult. In combination with acute respiratory failure (ARF), BPF results in a mortality of 81 percent. ⋯ The effectiveness of the device and associated technique in controlling BPF leaks is clearly demonstrated and may have played a role in the eventual recovery of a patient with BPF. Further study of the technique is warranted.
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Bronchoalveolar lavage (BAL) was performed in 51 adult immunocompromised patients (30 acquired immunodeficiency syndrome [AIDS] and 21 non-AIDS) as part of an extensive diagnostic evaluation for diffuse pulmonary infiltrates. Because multiple episodes occurred in several patients, a total of 60 BALs were performed. A diagnosis of fungal pneumonia was eventually made in 12 patients (24 percent). ⋯ In addition, BALs detected six episodes of bacterial pneumonia and three of five cases of radiation pneumonitis. Overall, the diagnostic sensitivity of BAL was 52 of 60 or 87 percent. While examination of induced sputum for the presence of Pneumocystis may eliminate the need for bronchoscopy in some AIDS patients, BAL remains an excellent diagnostic procedure in the immunocompromised patient without AIDS.
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Comparative Study
Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure.
The survival and ICU length of stay of 40 ARDS patients admitted to the ICU were analyzed to determine if a management strategy of lowering the pulmonary capillary wedge pressure (Ppw) was associated with an increased survival or a decreased ICU length of stay. ARDS was defined as three or four quadrant alveolar filling roentgenographically, a PaO2 less than 80 mm Hg with an FIO2 greater than .5 and a Ppw less than 18 mm Hg. ⋯ This difference remained statistically significant after stratifying patients by age and the APACHE II severity of illness index. We conclude that this retrospective analysis supports the notion that treatment of low pressure pulmonary edema with reduction of Ppw is associated with an increased survival.