Chest
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Comparative Study
Complications of bronchoscopy: comparison of rigid bronchoscopy under general anesthesia and flexible fiberoptic bronchoscopy under topical anesthesia.
A prospective study of 4,595 bronchoscopic procedures performed over four years (1975 to 1978) on 2,143 patients with various bronchopulmonary diseases is described. Of the 4,595 procedures, 1,146 were performed with a flexible fiberoptic bronchoscope (Olympus BF-5B2 or BF-B2) under topical anesthesia with tetracaine and procaine, and 3,449 procedures were performed with a rigid bronchoscope under general intravenous anesthesia with hexobarbital (Evipan) using a modified Sanders' technique to ventilate the patients. ⋯ A comparison of the complications of rigid bronchoscopy and flexible fiberoptic bronchoscopy revealed significantly higher rates of complications of fiberoptic bronchoscopy attributable to toxic effects of tetracaine and of complications of rigid bronchoscopy associated with insufficient general anesthesia. With rigid bronchoscopy, the number of major complications induced by diagnostic manipulations through the bronchoscope and the total number of major complications were significantly higher than with flexible fiberoptic bronchoscopy.
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Clinical Trial
A graphic approach for prediction of arterial oxygen tension at different concentrations of inspired oxygen.
A rapid, simple method for predicting the arterial oxygen tension (PaO2) at any fractional concentration of inspired oxygen (FIO2) is presented. The method is based on a nomogram interrelating PaO2, arterial carbon dioxide tension (PaCO2) and FIO2, allowing rapid determination of the arterial to alveolar oxygen tension ratio a/A PO2. The applicability of the nomogram and its reliability for predicting the PaO2 at any FIO2 were studied prospectively in nine consecutive patients requiring mechanical ventilation (16 trials). ⋯ Retrospectively, we analyzed the nomogram's ability to predict the PaO2 +/- 9.6 mm Hg (2 SD) at varying FIO2. The overall sensitivity of this method was 85 percent (126 predictions out of 149 trials). We conclude that appropriate levels of supplemental oxygen can be rapidly and reliably chosen using the nomogram in selected patients.
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Edema fluid and a coagulation profile were obtained in 45 patients (17 to 87 years) during fulminant pulmonary edema. Left ventricular failure and/or volume overload accounted for edema in 18 patients. In another 27 patients, edema developed in association with other features that typify the adult respiratory distress syndrome (ARDS). ⋯ ARDS is characterized by permeability pulmonary edema that usually stems from a combination of multisystemic disorders. Permeability pulmonary edema and coagulation changes appear to be interrelated. However, it is not clear the extent to which the coagulation disturbances are a cause or a result of the alterations in the alveolar-capillary membrane.
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Comparative Study
Sensitivity and specificity of early diagnostic tests of lung function in smokers.
What are the relative sensitivities and specificities of the "early" tests of lung dysfunction? We describe the findings from a study of virtually the entire population of a rural pollution-free community. Using abnormal spirometry as a marker of obstructive disease, we evaluated the two tests obtained from the single-breath nitrogen curve, closing volume (CV/VC) and the slope of the alveolar plateau (delta N2/L), as well as combinations of the two tests. ⋯ The group of smokers with abnormal delta N2/L did include fair numbers with abnormal spirometry (20.7 percent in male and 16.1 percent in female subjects). A combination of the two tests (abnormal in either delta N2/L and/or CV/VC) has good sensitivity (68.4 and 80.0 percent for male and female subjects, respectively) and specificity (74.3 and 69.0 percent for male and female subjects, respectively).
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Case Reports
Pulmonary embolism in the patient with chronic obstructive pulmonary disease. A diagnostic dilemma.
It is often difficult to distinguish pulmonary embolism from worsening underlying disease in the setting of severe chronic obstructive lung disease. We describe three patients with severe COPD and angiographically documented pulmonary embolus to stress that standard clinical and radioisotopic studies were of little value in establishing a diagnosis. All patients had acute increases in alveolar ventilation immediately following the embolus with a reduction in previously elevated levels of PaCO2, as well as hypoxemia. Such changes in arterial blood gases in the patient with severe COPD should suggest pulmonary embolus rather than increased obstruction.