Chest
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Randomized Controlled Trial Clinical Trial
Early methylprednisolone treatment for septic syndrome and the adult respiratory distress syndrome.
From November 1, 1982 through December 31, 1985, there were 19 centers and 382 patients that evaluated the effect of methylprednisolone sodium succinate (MPSS) on the septic syndrome. Seventeen of these centers enrolled 304 patients in a prospective, randomized, double-blind, placebo-controlled study to determine if early treatment with MPSS would decrease the incidence of severity of the adult respiratory distress syndrome (ARDS) in patients at risk of ARDS from sepsis. To ensure early institution of the MPSS or placebo therapy (PLA), patients with the presumptive diagnosis of sepsis were identified. ⋯ The 14-day mortality in patients with ARDS treated with MPSS was 26/50 (52 percent) compared to placebo 8/22 (22 percent) p = 0.004. We conclude that early treatment of septic syndrome with MPSS does not prevent the development of ARDS. Additionally, MPSS treatment impedes the reversal of ARDS and increases the mortality rate in patients with ARDS.
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Pericardiocentesis with catheter insertion and drainage is widely used in management of large pericardial effusions and cardiac tamponade. Two potential problems with an indwelling pericardial catheter system are catheter blockage and infection. We have utilized slow infusion of heparinized saline solution (3 ml/hr) via a continuous flush device to maintain catheter patency for up to seven days (mean 3.6) in 16 patients. ⋯ This article describes practical aspects of the technique. Most pericardial effusions can be successfully treated with pericardiocentesis and catheter drainage, provided the drainage is continued reliably and safely for several days. Surgical treatment such as subxiphoid pericardiostomy or partial pericardiectomy should be reserved for loculated effusions, clotted blood, subacute effusive-constrictive pericarditis, or significant recurrences after initial drainage.
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A 26-year-old woman with partial anomalous pulmonary venous drainage into the right atrium (Scimitar syndrome) was successfully operated upon by incorporating an intra-atrial conduit. The single right pulmonary vein present was connected to the right atrial inferior vena cava junction. ⋯ The distance between the orifice of the right pulmonary vein and the enlarged atrial septal defect was too great to use an intracardiac patch, so a 14 mm woven Dacron graft, 6 cm long, was interposed between them. The patient is doing well 21 months following the operation.
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Comparative Study
Comparison of arterial-end-tidal PCO2 difference and dead space/tidal volume ratio in respiratory failure.
End-tidal CO2 monitors are used to estimate arterial CO2 pressure (PaCO2), but appropriate use of this noninvasive method of assessing blood gases is unclear. In patients with lung disease, the end-tidal CO2 pressure (PETCO2) can differ from PaCO2 because of ventilation-perfusion (VA/Q) mismatching, and changes in PETCO2 may be seen with corresponding increase, decrease, or no change in PaCO2 depending on what happens to VA/Q mismatching. We compared the difference between PETCO2 and PaCO2 in 17 patients undergoing mechanical ventilation. ⋯ Our studies confirm that PetCO2 is a poor estimate of PaCO2 in patients with respiratory failure. However, the P(a-et)CO2 may be the most appropriate use for end-tidal PCO2 monitoring. In addition, we found that the end-tidal CO2 monitor may be easily adapted for expedient measurement of VD/VT.