Chest
-
Bedside testing offers a unique opportunity for earlier and more specific diagnosis, faster and more frequent monitoring, and the opportunity to improve patient care and reduce hospital costs. However, if abused it may not improve patient care and may increase hospital costs. In the future, more clinical studies will need to be performed to determine which tests are cost-effective.
-
Comparative Study
Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure.
The survival and ICU length of stay of 40 ARDS patients admitted to the ICU were analyzed to determine if a management strategy of lowering the pulmonary capillary wedge pressure (Ppw) was associated with an increased survival or a decreased ICU length of stay. ARDS was defined as three or four quadrant alveolar filling roentgenographically, a PaO2 less than 80 mm Hg with an FIO2 greater than .5 and a Ppw less than 18 mm Hg. ⋯ This difference remained statistically significant after stratifying patients by age and the APACHE II severity of illness index. We conclude that this retrospective analysis supports the notion that treatment of low pressure pulmonary edema with reduction of Ppw is associated with an increased survival.
-
Two anatomic subsets of patients with stage IIIa non-small cell cancer of the lung are candidates for definitive surgical treatment. The first group includes patients with T1, T2, or T3 primary tumors and regional lymph node metastases confined to the ipsilateral mediastinal and subcarinal lymph nodes (N2 disease). There is controversy over the selection of this group of patients for surgery; some physicians do not believe that resection is an option if there is any evidence of mediastinal lymph node involvement. ⋯ A five-year cumulative survival rate of 28 percent was documented for 198 consecutive patients undergoing complete resection for stage IIIa non-small cell lung cancer, 21 percent for the T1-3 N2 group, and 39 percent for the T3 N0-N1 patients. Cell type was not a statistically significant variable for survival; however, a superior outcome was observed for patients with squamous cell carcinoma in every TNM category. The results support surgical treatment as a valid option for selected patients with extrapulmonary extension of the disease.