Chest
-
Atelectasis occurred in 17 of 20 patients treated with assisted ventilation for respiratory failure due to neuromuscular disease. A retrospective review of chest roentgenograms and medical records indicated that atelectasis occurs early in the course of respiratory failure and has a predilection for the lower lobes. ⋯ This study demonstrates that atelectasis in this condition still occurs frequently despite modern practices of mechanical ventilatory assistance. Infection, occurring soon after intubation, is identified as the principal cofactor.
-
Comparative Study
The measurement of dyspnea. Contents, interobserver agreement, and physiologic correlates of two new clinical indexes.
To improve the clinical measurement of dyspnea, we developed a baseline dyspnea index that rated the severity of dyspnea at a single state and a transition dyspnea index that denoted changes from that baseline. The scores in both indexes depend on ratings for three different categories: functional impairment; magnitude of task, and magnitude of effort. At the baseline state, dyspnea was rated in five grades from 0 (severe) to 4 (unimpaired) for each category. ⋯ The baseline focal score had the highest correlation (r = 0.60; P less than 0.001) with the 12-minute walking distance (12 MW), while significant, but lower, correlations existed for lung function. For the transition focal score, there was a significant correlation only with the 12 MW (r = 0.33; p = 0.04). These results indicate that dyspnea can receive a direct clinical rating that provides important information not disclosed by customary physiologic tests.
-
Case Reports
Plasmapheresis in the treatment of ventilator-dependent myasthenia gravis patients. Report of four cases.
During a 42-month period, we used plasmapheresis to treat four cases of myasthenia gravis with refractory respiratory failure. All four patients were ventilator dependent for prolonged periods and were not responding to management with cholinesterase inhibitors and corticosteroids. All four patients rapidly responded to the plasmapheresis; respiratory muscle strength returned sufficiently to allow discontinuation of assisted mechanical ventilation and removal of the artificial airway. In our experience, plasmapheresis is indicated in the treatment of the myasthenia gravis patient with respiratory failure which is refractory to conventional drug therapy.