Chest
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To assess the necessity of thoracentesis in febrile medical ICU (MICU) patients, and to evaluate the efficiency and reliability of sonographic effusion patterns for diagnosing empyema. ⋯ Portable chest ultrasound examination and ultrasound-guided thoracentesis in febrile MICU patients are safe, feasible, and useful methods for diagnosing thoracic empyema. Our results suggest that only some sonographic patterns of pleural effusion (homogeneously echogenic, complex nonseptated and relatively hyperechoic, and complex septated) deserve aggressive assessment and rapid management.
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Comparative Study
Outcome in noninvasively and invasively ventilated hematologic patients with acute respiratory failure.
The survival rate of patients with a hematologic malignancy requiring mechanical ventilation (MV) in the ICU has improved over the last few decades. The objective of this study was to identify the factors affecting the in-hospital mortality of these particular patients, and to assess whether the use of noninvasive positive pressure ventilation (NPPV) was protective in our study population. ⋯ Although the in-hospital mortality rate in hematologic patients who develop ARF remains high, the reluctance to intubate and start treatment with invasive MV in this population is unjustified, especially when bacteremia has precipitated ICU admission.
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Hypothyroidism is cited as an uncommon cause of ventilator-dependent respiratory failure. The objective of this study was to determine the incidence of hypothyroidism in patients with respiratory failure, receiving prolonged mechanical ventilation (PMV) with failure to wean, referred to a regional weaning center (RWC) for weaning. ⋯ Hypothyroidism is an uncommon cause of failure to wean in patients receiving PMV (with an incidence of 3%). However, it is a potentially treatable cause and should be considered in all patients who fail to wean. Serum TSH level does not appear to affect successful weaning from PMV.