Chest
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A recently developed endotracheal tube with a movable bronchial blocker (Univent tube) was used for single lung ventilation. A total of 50 intubations were undertaken for a wide variety of thoracic procedures. Each case was analyzed with respect to ease or difficulty of intubation, tube dislodgment, efficacy of lung collapse, and adequacy of single lung ventilation. Successful, safe selective intubation was accomplished in all cases.
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Percutaneous thin needle biopsy, a widely used method for diagnosis of lung conditions, is generally safe and effective. A near-fatal air embolism is reported that occurred during percutaneous thin needle aspiration biopsy of the lung. Successful treatment was accomplished by hyperbaric oxygen therapy. Physicians should be aware of this possible complication and identify the location of the nearest chamber for possible transfer.
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The present study was undertaken to evaluate the effectiveness of acute ventilation by rocking bed (RB) and by negative-pressure ventilator (NPV) on arterial oxygenation and carbon dioxide tension in seven patients in whom respiratory failure (PaCO2 [+/- SD], 64 +/- 4 mm Hg; PaO2, 54 +/- 10 mm Hg) was consequent on nonobstructive ventilatory impairment. The increase in SaO2 (percent above baseline, 5 percent RB and 6 percent NPV) was similar for both methods, but a greater fall in PCO2 (percentage change in PCO2, 3 percent RB; 15 percent NPV; p less than 0.05) was observed during NPV. ⋯ These preliminary results suggest that effective mechanical ventilatory support could be achieved with either RB or NPV. However, their long-term effects as compared with those of positive-pressure ventilation remain to be explored.
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Continuous monitoring of mixed venous oxygen saturation (SvO2) and arterial oxygen saturation (SaO2) was used to guide cardiovascular and pulmonary physiologic manipulations in three patients. An index, termed the "shunt index" (SI), of venoarterial admixture (Qva/Qt) was calculated at the bedside. SI correlated significantly in each patient with Qva/Qt (p less than .01). In one of the patients, continuous end-tidal CO2(ETCO2) was also monitored, allowing rapid titrations of ventilator settings and cardiovascular support free from the need to sample arterial and mixed venous blood to assess the effect of each intervention.