Respiration; international review of thoracic diseases
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Varying degrees of impairment in pulmonary function in survivors of adult respiratory distress syndrome (ARDS) have been reported. Physiologic indices of the severity of disease have been associated with impaired pulmonary function after ARDS, including duration of exposure to FIO2 > 0.6, AaDO2, maximal mean pulmonary artery pressure, lowest total static thoracic compliance, and peak airway pressure. Prediction of impairment following ARDS is difficult because clinical observations may reflect reversible lung injury (e.g. lung edema) and clinical features of ARDS do not predict subsequent function reliably. ⋯ Significant correlations (p < 0.001) were found between linear regressions of percent predicted FEV1, FVC, TLC and DLCO against ARDSscore. ARDSscore > +20 predicted an 82% probability of impaired FEV1, FVC or TLC and a 100% probability of an impaired DLCO. We conclude that a score based upon duration of positive pressure ventilation and lowest static thoracic compliance predicts impaired pulmonary function more than 1 year after ARDS.
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Clinical appearance, radiologic findings, lung function and results of corticosteroid therapy were analyzed in 42 adult cases of biopsy-proven pulmonary histiocytosis X. Symptoms were present in only 64%. Using the ILO classification 1980, the evaluation of chest radiographs revealed all categories of profusion, size and shape of nodules. ⋯ Bronchial reactivity to carbachol was significantly higher than in controls (n = 12). Lung perfusion scintigram showed an abnormal, but uncharacteristic pattern in 81% (n = 26). During corticosteroid therapy, no progression was observed (n = 36). 85% of patients with radiographic evidence of progressive disease improved after administration of corticosteroids (n = 14).