Respiratory care
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Previous reports have demonstrated that prior cardiac surgery is independently associated with in-hospital mortality after infant tracheostomy. We aimed to determine whether these infants would continue to be at increased risk for death following hospital discharge. ⋯ Prior cardiac surgery is independently associated with decreased survival within 1 y following tracheostomy. Clinicians and families of infants with prior cardiac surgery in whom tracheostomy after cardiac surgery is deemed necessary should consider this risk when planning long-term care.
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Case Reports
Ventilation-Induced Massive Lethal Air Embolism and Subcutaneous Emphysema in a Patient With a Lung Cavern.
The simultaneous occurrence of subcutaneous emphysema and intravascular air due to an air embolism is a rare condition. Here, we report a patient with COPD who developed a severe episode of hemoptysis due to rupture of a previously undiagnosed lung cavern. ⋯ The dramatic amount of intravenous air and subsequent conduction along the venous system to the right heart and pulmonary trunk caused major hemodynamic compromise and ultimately death. The degree of subcutaneous emphysema, especially the massive venous air embolism, was unprecedented.
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Dieulafoy disease of the bronchus is a rare condition. A 28-y-old male patient with recurrent exacerbations of hemoptysis (producing up to 300 mL) over the previous 4 y was admitted to our hospital following an acute episode. A 3-mm sessile lesion covered with somewhat ulcerated smooth mucosa was detected at the distal end of the left main bronchus, at the entrance to the upper lobe bronchus. ⋯ In the very few reported cases of Dieulafoy disease, surgical resection and selective embolization were the treatments used. Endobronchial treatment has not been described before as a therapeutic approach. We emphasize that argon plasma coagulation can be a treatment option in such cases.
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Comparative Study
Physicochemical Aspects and Efficiency of Albuterol Nebulization: Comparison of Three Aerosol Types in an In Vitro Pediatric Model.
Advances in nebulizer design have produced both ultrasonic nebulizers and devices based on a vibrating mesh (vibrating mesh nebulizers), which are expected to enhance the efficiency of aerosol drug therapy. The aim of this study was to compare 4 different nebulizers, of 3 different types, in an in vitro model using albuterol delivery and physical characteristics as benchmarks. ⋯ The in vitro model was effective for comparing nebulizer types, demonstrating important differences between nebulizer types. The new devices, both the ultrasonic nebulizers and vibrating mesh nebulizers, delivered more aerosolized drug than traditional jet nebulizers.
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Observational Study
Description and Microbiology of Endotracheal Tube Biofilm in Mechanically Ventilated Patients.
A biofilm is found on the inner side of endotracheal tubes (ETT) in mechanically ventilated patients, but its features and role in pneumonia remain unclear. ⋯ ETT biofilm is always present in intubated patients whatever the duration of intubation and appears quickly after intubation. Even after soft rinse, a small but measurable part of biofilm remains always present, and seems strongly adherent to the ETT lumen. It contains potentially pathogenic bacteria for the lung.