Chest
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Mediastinal hematoma resulting from blunt chest trauma can cause compression of the right ventricle and extrapericardial cardiac tamponade. The diagnosis in this instance was aided by conventional two-dimensional echocardiography in addition to hemodynamic measurements. The atypical aspects of this form of cardiac tamponade are discussed.
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Noninvasive face mask ventilation has been used successfully in patients with paralytic respiratory failure. This study evaluated whether noninvasive face mask ventilation can be used for patients with acute respiratory failure due to intrinsic lung disease. Six patients with hypercapnia and four with hypoxemic acute respiratory failure met clinical and objective criteria for mechanical ventilation, which was delivered with pressure control and pressure support via a tightly strapped, clear face mask. ⋯ The mean duration of treatment was 33 h (range, 3 to 88). The physiologic response was considered similar to that which would have been achieved with conventionally delivered ventilation. Noninvasive face mask ventilation may have a role in managing respiratory failure.
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Pneumocystis carinii pneumonia (PCP) remains the most frequent life-threatening complication of HIV infection. A retrospective study was undertaken in an attempt to establish the incidence of acute respiratory failure (ARF) in AIDS-related PCP, its mortality, and the impact of adjuvant systemic corticosteroids on its outcome. Of 127 AIDS-related PCP episodes diagnosed at St. ⋯ We conclude that ARF secondary to AIDS-related PCP merits aggressive management. In particular, younger patients presenting early after the onset of respiratory symptoms appear to have a better prognosis. The decreased mortality associated with the use of adjunctive corticosteroids supports the need for prospective controlled evaluation of this therapeutic modality.
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Multiple benefits of oxygen therapy for hypoxemic patients with chronic lung disease are well established. Steady flow oxygen therapy is inefficient, wasteful and has a high cost. The Oxymizer pendant improves efficiency of oxygen delivery compared with SF. ⋯ We measured SaO2 while breathing oxygen via SF and the AP with nasal-only breathing and PLB. Results indicate that the AP maintains an increase in SaO2 over SF during nasal-only breathing and a further increase during PLB. We conclude that AP acts as an oxygen conserver during PLB; PLB with the AP achieves greater savings than with nasal-only breathing.
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Comparative Study
Homogeneity of bronchopulmonary distribution of 99mTc aerosol in normal subjects and in cystic fibrosis patients.
We characterized the bronchopulmonary distribution of a 0.9 percent saline aerosol (1.12 microM) labelled with 99mTc sulfur colloid in nine normal subjects and five patients with CF. Homogeneity of distribution was quantified using indices derived from computerized analysis of Anger camera pulmonary images including skew (a measure of distribution asymmetry) and kurtosis (a measure of distribution range). Aerosol clearance in 97 minutes (a measure of large, central airway deposition) was also assessed. ⋯ Reproducibility of skew and kurtosis were not studied in the normal subjects. Clearance was not significantly different in the two groups. We conclude that the bronchopulmonary distribution of this radioaerosol is nonuniform in patients with CF, compared to normal subjects, and clearance may be impaired in patients with CF who are severely ill.