Chest
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To study sequences of colonization of different species of microorganisms and to determine the importance of gastric colonization for the development of nosocomial pneumonia. ⋯ Based on studying sequences of colonization in ICU patients, we concluded that the stomach is unlikely to be an important source of pathogens leading to nosocomial pneumonia as diagnosed by BAL/PSB. Furthermore, the initial site and route of colonization might not be the same for all microorganisms.
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To evaluate the ability of preoperative variables to identify patients at increased risk for complications after lung resection and the usefulness of predicted postoperative FEV1 as a marker of risk for adverse outcomes. ⋯ A low predicted postoperative FEV1 appears to be the best indicator of patients at high risk for complications, and it was the only significant correlate of complications when the effect of other potential risk factors was controlled for in a multivariate analysis. Pulmonary resection should not be denied on the basis of traditionally cited preoperative pulmonary variables, and a prediction of postoperative pulmonary function by a technique of simple calculation may be useful to identify patients at increased risk for medical complications.
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Case Reports
Prolonged use of an endotracheal tube changer in a pediatric patient with a potentially compromised airway.
A 14-year-old obese male patient presented following a motor vehicle accident with multiple injuries and respiratory failure requiring endotracheal intubation and mechanical ventilation. Because of potential problems with a difficult airway, an endotracheal tube changer was used at the time of extubation and left in place for a prolonged period of time. Leaving the tube changer in place maintained access to the airway. Additionally, the manipulation of the tube changer was used to stimulate the cough reflex.
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To describe the importance of measuring work of breathing (WOB) in patients with high airway resistance (Raw) during continuous positive airway pressure (CPAP) support. ⋯ Patients with high Raw may suffer excessive WOB even during CPAP with advanced demand-flow system type ventilators. It is vital to monitor WOB continuously using an adequate pulmonary function monitor such as that used in this study.
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A 63-year-old patient with chronic lymphocytic leukemia presented with severe hypoxemia. However, the patient's hemoglobin saturation, measured by an ear oximeter, was normal. ⋯ The PaO2 in the plasma was much higher than in whole blood and corresponded with the hemoglobin saturation measured by the ear oximeter. These findings suggest that very high leukocyte counts may interfere with the measurement of oxygen tension and that plasma may be used for blood gas analysis in this situation.