Tüberküloz ve toraks
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Tüberküloz ve toraks · Jan 2010
[The influence of community-acquired pneumonia to the clinical course in COPD cases admitted to intensive care unit with acute respiratory failure].
In this study the influence of community-acquired pneumonia to the clinical course in 173 COPD patients admitted to ICU with acute respiratory failure (ARF) was evaluated. In prospective descriptive study, patients with pneumonia at admission to ICU were grouped as Group 1, others Group 2. The demographics, "Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II" scores, body mass index (BMI), comorbidities, steroid use, admission arterial blood gases (ABG), leucocyte and CRP, utilization and duration of non-invasive and invasive mechanical ventilation (NIMV and IMV), development of ventilator associated pneumonia (VAP) and septic shock, length of stay (LOS) in ICU and mortality of groups were recorded and compared. ⋯ Mortality risk factors are higher CRP levels (p< 0.016, OR: 1.01 CI 95%: 1.00-1.02), NIMV application determined to reduce the mortality. In conclusions, the presence of pneumonia, on admission to ICU in COPD patients with ARF, didn't influence IMV duration, LOS and mortality in ICU. Although mortality can be higher in COPD patients with high CRP levels, but NIMV is thought to be a mortality reducing treatment approach.
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Central venous ports are used in long term therapies of cancer patients. The insertion technique and maintenance of central venous ports is very important to avoid catheter associated complications. ⋯ The most frequent complications of central venous ports are catheter obstruction, infection, venous thrombosis and extravasation. In this paper, a rare intrapulmonary catheter dislocation is presented.
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The excess production or depleted absorbtion of pleural fluid is the major mechanism of pleural effusion formation. Primary lung pathologies or pathologies that originated from the other organs can be cause of pleural effusion. The search for suitable, practical and ideal treatment is continued at the present day. ⋯ The simple and small-diameter catheters are administrated easily with minimal morbidity and no mortality. It's not only used in malign effusion but also used in benign effusion. Finally, simple catheter can be first treatment choice in short-term therapy and alternative choice in long-term therapy because of it's administrating facility, effectiveness in pleurodesis and cost-effectiveness.
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Mechanically ventilated patients interact with ventilator functions at different levels such as triggering of the ventilator, pressurization and cycling from inspiration to expiration. Patient ventilator asynchrony in any one of these phase results in fighting with ventilator, increase in work of breathing and respiratory muscle fatigue. Patient ventilator dyssynchrony occurs when gas delivery from the ventilator does not match with the neural output of the respiratory center. ⋯ Patient-ventilator interaction during noninvasive mechanical ventilation may be affected by the type of masks used, ventilator types, ventilation modes and parameters, humidification and sedation. Among the different patient groups it is important to know causes and solutions of patient-ventilator asynchrony problems. By this way patient will adapt ventilator and then dyspnea, ineffective respiratory effort and work of breathing may decrease subsequently.
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In Turkey, there is inadequate data about the direct or indirect cost of community acquired pneumonia (CAP). This study aims to identify the clinical, laboratory, and radiological properties, direct hospital costs of CAP, and the factors that affect these costs. Grouping of the subjects and cost analysis were evaluated in accordance with Pneumonia Severity Index (PSI) and 'Turkish Thoracic Society (TTS) CAP Guideline'. 114 cases with an average age of 70.9 were analyzed retrospectively. ⋯ Existence of a comorbid disease was detected to have increased the total cost (p= 0.003). Total costs according to PSI scoring were 1274.60 Euro in low-risk group, and 1929.49 Euro in high-risk group (p= 0.04). Hospital mortality due to CAP was 2.6%.