Chest
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Measurement of pleural fluid constituents (pH, PCO2, protein, lactic dehydrogenase [LDH], glucose, red blood cells [RBC], and white blood cells [WBC]) are of value in the diagnosis of pleural effusions and in the separation of exudates from transudates. The position of the patient (sitting or lying) prior to thoracentesis may result in differences in the measurement of these constituents. ⋯ The location of basal pleural tumors and the molecular weight of certain constituents may explain this postural sedimentary effect. Repeated thoracentesis after 30 min in the sitting position may result in exudative values when borderline transudates are found in a patient previously in a supine position.
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Case Reports
Prolonged treatment with almitrine for refractory hypoxemia in adult respiratory distress syndrome.
A 49-year-old man presented with an atypical pneumonia entailing an adult respiratory distress syndrome (ARDS). The refractory hypoxemia caused a myocardial infarction, leading us to try pharmacologic treatments. Almitrine bismesilate (AB) infusion allowed improvement of arterial oxygenation during 115 h without adverse effect. This case is, to our knowledge, the first reported prolonged treatment using AB for hypoxemia due to ARDS.
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To examine the incidence, clinical impact, and predictors of reintubation following unplanned extubation (UE) in ICU patients. ⋯ Unplanned extubation can result in serious complications; however, about half the patients who have UE can be safely observed without immediate reintubation. Selected clinical factors, which are readily available from standard ICU records for the 24-h period prior to UE, may be useful to predict the likelihood of reintubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Regional mucus transport following unproductive cough and forced expiration technique in patients with airways obstruction.
It has previously been shown that unproductive coughing in both healthy subjects and patients with airways obstruction is not effective in clearing lung secretions. This study investigates the regional mucus transport in a group of subjects with airways obstruction who failed to expectorate following instructed cough and forced expiration technique. Fourteen patients (mean +/- SEM age: 68 +/- 2 years) with airways obstruction (mean +/- SEM percent predicted. ⋯ There were no differences in regional radioaerosol clearance between cough and forced expiration. However, both cough and forced expiration resulted in significant clearance compared with control for all regions with the exception of the forced expiration in the outer region. To our knowledge, this study is the first to demonstrate that unproductive cough and forced expiration result in movement of secretions proximally from all regions of the lung in patients with airways obstruction.