Resp Care
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Elevated dead space fraction (the ratio of dead space to tidal volume [V(D)/V(T)]) is a feature of ARDS. PEEP can partially reverse atelectasis, prevent alveoli recollapse, and improve lung compliance and gas exchange in patients with ARDS. However, whether V(D)/V(T) variables have a close relationship with PEEP and collapse alveolar recruitment remains under recognized. Meanwhile, few clinicians titrate PEEP in consideration of changes in V(D)/V(T). Therefore, we performed the study to evaluate V(D)/V(T), arterial oxygenation, and compliance changes during PEEP titration following lung recruitment in ARDS patients. ⋯ A significant change of V(D)/V(T), compliance and arterial oxygenation could be induced by PEEP titration in subjects with ARDS. Optimal PEEP in these subjects was 12 cm H₂O, because at this pressure level the highest compliance in conjunction with the lowest V(D)/V(T) indicated a maximum amount of effectively expanded alveoli. Monitoring of V(D)/V(T) was useful for detecting lung collapse and for establishing open-lung PEEP after a recruitment maneuver.
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A patient presented with shortness of breath and pleuritic pain shortly after bilateral knee synovial injections with sodium hyaluronate (HA). He was discharged after a brief hospitalization without a diagnosis when no Doppler or radiologic evidence of deep vein thrombosis or pulmonary emboli was found. Radiologic studies found patchy ground glass opacities that were predominantly peripheral in disposition, with prominent septal lines in the lungs; a subsequent pulmonary function test showed a reduced diffusing capacity of the lung for carbon monoxide (D(LCO)). These results prompted a lung biopsy that revealed multiple emboli composed of HA and fibrin in medium size pulmonary arteries, enlarged lymphatic vessels, and a bone marrow embolus. This is the first report of HA emboli following therapeutic HA injections and demonstrates that pulmonary function tests can be used to infer the reduction in pulmonary vascular area consequent to pulmonary emboli, and so can contribute to the detection of pulmonary emboli in unusual presentations.
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Many survivors of the tsunami that occurred following the Great East Japan Earthquake on March 11, 2011, contracted a systemic disorder called "tsunami lung," a series of severe systemic infections following aspiration pneumonia caused by near drowning in the tsunami. Generally, the cause of aspiration pneumonia is polymicrobial, including fungi and aerobic and anaerobic bacteria, but Aspergillus infection is rarely reported. Here we report a case of tsunami lung complicated by disseminated aspergillosis, as diagnosed during autopsy.
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Clinical features of pandemic H1N1 have been derived from lab-confirmed, hospitalized, or critically ill subjects. This report describes the clinical features of H1N1 and their prevalence from non-confirmed subjects according to seroprevalence status in México. The objective was to determine the prevalence of these clinical features from non-confirmed cases of pandemic H1N1 and to compare them according to seroprevalence status in northern Monterrey, México, during 2009, and to identify the predictive signs and symptoms; there have been no prior serologic studies in México. ⋯ One third of the seropositive subjects were asymptomatic, and few had an influenza-like illness. No difference was found in the symptom profiles of the seropositive and seronegative groups. No single symptom predicted seropositiveness. Large scale population studies are needed, especially in México, to characterize clinical syndromes.
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Spirometry before and after bronchodilator is performed to assess air flow-limitation reversibility. In patients with normal baseline spirometry the frequency of a positive bronchodilator response, as defined by American Thoracic Society/European Respiratory Society criteria, has not been described. ⋯ In our study population the frequency of a positive bronchodilator response in patients with normal baseline spirometry is 3.1%. None of the patients with a pre-bronchodilator FEV(1) > 100% of predicted and only 1.9% of patients with an FEV(1) between 90% and 100% of predicted responded. Bronchodilator testing can be omitted in patients with normal spirometry and an FEV(1) above 90% of predicted, as they have a low probability of a positive response.