Chest
-
Comparative Study
Agreement between noninvasive oximetric values for oxygen saturation.
We made an assessment of five pulse oximeters in regard to their ability to replace the HP ear oximeter as a noninvasive measurement of SaO2. Trials were performed during isocapnic progressive hypoxia (SaO2 range, 99 to 70 percent) in 22 white and six black subjects. Comparisons between values of SaO2 by oximetry were analyzed by comparing the difference of values by the two methods against their mean. ⋯ The distribution of differences between pulse oximeters and the HP were larger below 80 percent than above 85 percent. We conclude that pulse oximeters give higher values than the HP, a tendency which is more pronounced in black than in white subjects. While the limits of agreement are better at saturations above 85 percent, the 95 percent confidence limits of agreement between pulse oximeters and the HP are rather large (+/- 10 percent) and unacceptable for assuming that pulse oximeters will provide the same values as found in clinical studies using the HP.
-
One hundred seven acutely ill ventilated patients were prospectively studied to ascertain the severity and frequency of alterations in gas exchange and hemodynamic parameters during brief bronchoscopy. Sedation was performed using midazolam (0.1 mg/kg IV) without topical anesthesia. An average decline in PaO2 of 26 percent was observed at the end of the procedure, compared to the baseline value, and this was associated with a mild increase in PaCO2 in spite of the use of a special adapter. ⋯ Fourteen patients developed hypoxemia of less than 60 mm Hg on FIO2 adjusted to 0.8. Of the ten risk factors univariately associated with hypoxemia, only the presence of ARDS (p less than 0.001) and "fighting" the ventilator during the procedure (p less than 0.05) remained significant after stepwise logistic regression. Attempts to prevent hypoxemia in critically ill patients should focus on inducing complete sedation, with careful attention to hemodynamic status, or providing maximal levels of oxygen to the ventilator (or both).
-
We present a patient who had chronic, bilateral pleural effusions without evidence of parenchymal, retrocardiac or mediastinal masses. A CAT scan of the abdomen and chest revealed the extension of a large abdominal pseudocyst through the diaphragm into the posterior mediastinum. The pseudocyst resolved with conservative management.
-
The validity and utility of physical examination maneuvers were determined in diagnosing congestive heart failure (CHF) in patients with acute dyspnea. Fifty one patients presented to the emergency room with the chief complaint of shortness of breath. ⋯ The hepatojugular reflux and Valsalva maneuvers were valid in the diagnosis of congestive heart failure in acutely dyspneic patients. Although these maneuvers rarely added to the routine assessment of patients in this study, they may provide a useful, noninvasive adjunct to clinical diagnosis in problematic cases.
-
The objective of this study was to determine the prevalence of tuberculous infection and the incidence of active tuberculosis in homeless men attending a shelter-based clinic and to examine risk factors for acquisition of infection and development of active disease. The design was a prospective cross-sectional survey. Men were evaluated by standardized interviews using a questionnaire. ⋯ Increasing age, length of stay in the shelter system, black race, and intravenous drug use were found to be independently associated with tuberculous infection. Age, length of stay in the shelter system, and intravenous drug use were independently associated with active tuberculosis. We achieved a compliance rate of 36 percent completing treatment and 13 percent receiving treatment at the conclusion of the study.