Chest
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We report an uncommon and potentially dangerous complication of continuous positive airway pressure (CPAP) applied during spontaneous respiration. A patient with multiple fractures and recurrernt atelectasis developed pneumocephalus on the seventh day of respiratory therapy with CPAP via a face mask. A fracture of the base of the skull, not recognized despite neurologic and radiologic evaluation at admission, was at the origin of this complication.
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In a study of 12 critically ill patients, values for mixed venous oxygen saturation (SVO2) were measured from samples of pulmonary arterial blood drawn at five rates of withdrawal (1, 3, 10, 20, and 30 ml/min). Samples were drawn from properly placed pulmonary arterial catheters with the balloon deflated. ⋯ Evaluations by paired t-test comparing all rates of withdrawal with the slowest rate (1 ml/min) showed no significant differences. The rate of withdrawal of the sample is not associated with significant errors in SVO2 when samples are drawn from a properly positioned pulmonary arterial catheter.
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One hundred eighty-three patients had simultaneous blood and pleural fluid pH determinations. Thirty-six effusions were transudates, and 147 were exudates. ⋯ The results of pleural fluid pH determination are immediately available, narrow the differential diagnosis of the exudate, and may expedite patient management. The pH of pleural fluid should be measured whenever a diagnostic thoracocentesis is performed.
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Comparative Study
Comparison of three methods of respiratory care following upper abdominal surgery.
Incentive spirometry, as a method for preventing postoperative atelectasis, was compared with intermittent positive-pressure breathing (IPPB) and resistance breathing in 126 patients undergoing upper-abdominal surgery, most of whom had cholecystectomy. There was no statistically significant difference in the incidence of atelectasis among the three groups, who were matched for age, sex, smoking history, previous respiratory disease, and duration of surgery. There was a significantly higher incidence of atelectasis in patients over the age of 50 years (P = 0.004) than in younger subjects, where the incidence was not different among the three groups. Incentive spirometric therapy, as used in this study, offered no advantage over the other methods of treatment.