Chest
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Case Reports
Pneumomediastinum and bilateral pneumothoraces in a patient with hyperemesis gravidarum.
Hyperemesis gravidarum (HG) is a severe form of the more common nausea of early pregnancy. We report an unusual case of pneumomediastinum and bilatetral pneumothoraces presenting in the tenth week of pregnancy complicating HG.
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To evaluate the clinical feasibility of using real-time measurements of work of breathing obtained at the bedside with a portable, commercially available respiratory monitor as an objective and quantifiable guideline for appropriately setting pressure support ventilation (PSV) to partially and totally unload the respiratory muscles in patients with respiratory failure. ⋯ We propose an objective and goal-oriented clinical approach for using PSV by directly measuring the work of breathing performed by the patient with an easy to operate, bedside respiratory monitor and then applying pressure support ventilation to decrease the work to appropriate levels. Partially or totally shifting the workload from the respiratory muscles to the ventilator is appropriate under specific clinical conditions.
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To assess the respective diagnostic accuracy of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) and their therapeutic implications in mechanically ventilated patients, in the intensive care unit (ICU). ⋯ TEE is a valuable well-tolerated imaging technique in mechanically ventilated patients. For the assessment of left ventricular systolic function and pericardial effusion; however, TTE continues to be an excellent diagnostic tool, even when positive end-expiratory pressure is present. Both TTE and TEE have a therapeutic impact in approximately 25 percent of cases.
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Despite improved technology, central venous catheters are associated with many complications that occur usually within 48 h of placement. We report a 42-year-old man with a rare erosion of a venous catheter (Silastic) into a bronchus 2 years after its insertion.