Chest
-
Review Case Reports
Nephrobronchial fistula and lung abscess resulting from nephrolithiasis and pyelonephritis.
There are multiple etiologies reported as causes of lung abscess; however, this differential rarely includes intra-abdominal abnormalities other than extension of a hepatic process. We describe a patient who was found to have a lung abscess and empyema resulting from the development of a nephrobronchial fistula secondary to nephrolithiasis and pyelonephritis. The patient had no urinary symptoms or known abdominopelvic infection and the etiology of lung abscess was only incidentally discovered after chest CT revealed extension of pleural fluid below the diaphragm.
-
To determine (1) the spectrum and frequency of causes of chronic cough with a history of excessive sputum production (CCS) and (2) the response of these causes to specific therapy. ⋯ (1) The anatomic diagnostic protocol for cough is also valid for CCS; (2) the major causes of chronic excessive sputum production and chronic cough are so similar that CCS should be considered a form of chronic cough; (3) the evaluation of CCS is more complicated and takes longer than the evaluation of chronic cough; (4) the major strength of the laboratory diagnostic protocol is that it reliably rules out conditions; (5) the outcome of specific therapy is almost always successful; and (6) the term "bronchorrhea" can be misleading if it is applied to excessive sputum production before a specific diagnosis of its source is made since the most common cause of excessive sputum that is expectorated (PNDS) is a disorder of the upper respiratory tract. Therefore, nonspecific therapies theoretically aimed at reducing mucus production in the lower respiratory tract are not likely to be helpful.
-
Comparative Study
The effects of applied vs auto-PEEP on local lung unit pressure and volume in a four-unit lung model.
The application of positive end-expiratory pressure (PEEP) and maintenance of increased mean airway pressure (MAP) has been associated with improved oxygenation in adult respiratory distress syndrome. Recently, attention has been directed toward elevating MAP by establishing auto-PEEP when ventilating with an inverse inspiratory to expiratory ratio in opposition to applied PEEP. We theorized that FRC distribution and local lung unit end-expiratory pressure (EEP) would be different when equal levels of PEEP were established by applying PEEP or by producing auto-PEEP. ⋯ Comparing equal levels of the auto-PEEP with applied PEEP, a greater maldistribution of local lung unit EEP and EELV was established with the auto-PEEP. During auto-PEEP, the greatest EEP and EELV occurred in the slow lung unit, and the lowest EEP and EELV developed in the fast lung unit.
-
Comparative Study
Cardiopulmonary effects of positive pressure ventilation during acute lung injury.
To assess the gas exchange and hemodynamic effects of pressure-limited ventilation (PLV) strategies in acute lung injury (ALI). We hypothesized that in ALI, the reduction of plateau airway pressure (Paw) would be associated with less alveolar overdistention and thus have better hemodynamic and gas exchange characteristics than larger tidal volume (Vr) ventilation. ⋯ Changes in lung volume determine Ppc and Ppl. PLV strategies do not alter hemodynamics but result in less of an increase in VD/VT than would be predicted from the obligatory decrease in VT.