Chest
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Cardiovascular Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: We present a case of progressive hypoxemia with platypnea-orthodeoxia developing after lung resection surgery for lung cancer. ⋯ Symptoms of hypoxemia with platypnea-orthodeoxia are concerning for shunt physiology. The differential diagnosis includes sources of intracardiac (ASD, PFO) and intrapulmonary shunting. He had a prior intracardiac shunt on an earlier echo but not on the post-operative study. He had no evidence of other cardiac causes such as pericardial effusion, constrictive pericarditis or aortic aneurysm. He had an interstitial lung disease by CT scan but this was unchanged radiographically. There was no evidence of other pulmonary causes such as COPD, thromboembolic disease or an intrapulmonary shunt (arteriovenous malformation). He had no history of liver disease with shunt from cirrhosis or history of kyphoscoliosis. Platypnea-orthodeoxia was first described in 1949 and major causes are intracardiac shunts and intrapulmonary shunts. The intracardiac shunts are right-to-left and most often include atrial septal defect, patent foramen ovale or fenestrated atrial aneurysm. Other causes include pericardial effusion, lobectomy, pneumonectomy or upper abdominal surgery. This occurs from preferential blood flow towards the atrial septum that is accentuated by altered intracardiac anatomy, compliances of the right and left heart, pulmonary vascular resistance and transient right to left pressure gradients associated with respiratory and positional changes. This is generally not associated with pulmonary hypertension and atrial right-to-left shunting has been reported despite normal right-sided pressures. A right-to-left shunt is more likely to appear after a right-sided lung resection with most patients having symptoms develop a month to several months afterwards. Noncardiac causes can include intrapulmonary shunting, such as thromboembolic disease and AVMs, or cirrhosis and kyphoscolisoss. The key to diagnosis is clinical suspicion of symptoms of dyspnea and hypoxemia, induced or worsened by an upright posture. In conclusion, interatrial shunting through a PFO or ASD is a rare but clinically significant condition after thoracic surgery. There are several underlying etiologies and can occur in the immediate postoperative period or can be more delayed.Reference #1: Interatrial Shunting After Major Thoracic Surgery: A Rare but Clinically Significant Event. Ann Thorac Surg 2012;93:1647-51Reference #2: Dyspnoea and hypoxaemia after lung surgery: the role of interatrial right-to-left shunt. Eur Respir J 2006; 28: 174-181Reference #3: Platypnoea-orthodeoxia syndrome. Heart 2000;83:221-223DISCLOSURE: The following authors have nothing to disclose: Nitin Bhatt, Ulysses MagalangNo Product/Research Disclosure Information.
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Slide PresentationsPRESENTED ON: Saturday, March 22, 2014 at 12:15 PM - 01:15 PMPURPOSE: The relationship between maximal cardiopulmonary exercise testing (CPX) and submaximal exercise in patients with idiopathic pulmonary fibrosis (IPF) is poorly understood. CPX and the 6-minute walk test (6MWT) were compared with a focus on exercise tolerance (ET) and systemic oxidant stress (OS) in patients with IPF. ⋯ The following authors have nothing to disclose: Lawrence Cahalin, Carol Ramos, Ignacio Gaunaurd, Nicole Eustis, Constanza Sol, Meryl Cohen, Orlando Gomez-Marin, Diana Cardenas, Robert JacksonNo Product/Research Disclosure Information.
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Respiratory Support PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Non invasive ventilation (NIV) in COPD patients with acute respiratory failure (ARF) is a clearly effective treatment. The long-term prognosis of COPD patients who required NIV during the hospital admission is not known exactly. ⋯ The following authors have nothing to disclose: Andrés Vega Arias, Jesús Sánchez, Virginia Almadana, Maria Pavon, Patricia Guerrero, Natalia Fouz, Ana Gómez-Bastero, Juan Polo, Teodoro MontemayorNo Product/Research Disclosure Information.
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Respiratory Support PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Pulse oximetry is nowadays a disseminated technology available almost over the corner. "Pocket" pulse oximeters are now widely available and knowing its precision and accuracy is of great importance in clinical practice. ⋯ The following authors have nothing to disclose: João Cordeiro da Costa, Ana Roque, Paula Faustino, Ricardo Lima, Filipa Viveiros, Miguel GuimarãesNo Product/Research Disclosure Information.
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Critical CareSESSION TYPE: Slide PresentationPRESENTED ON: Saturday, March 22, 2014 at 04:15 PM - 05:15 PMPURPOSE: Non invasive ventilation (NIV) is a standardized treatment that has proven beneficial effects in different respiratory and cardiologic diseases. The increasing development of NIV has enabled chest physicians to assist more complex patients and stimulate the setting-up of specials units (Respiratory High-Dependency Care Units [RHDCU]). These units are specialized in severe respiratory patients who need NIV and monitoring. The aim of this study was to evaluate the impact of a RHDCU in non-invasive ventilated patients. ⋯ The following authors have nothing to disclose: Alejandro Peralta, Lucia Gimeno, Cristina Oliver, Alicia Binimelis, Belen Nuñez, Miguel Carrera, Monica de la Peña, Ernest SalaNo Product/Research Disclosure Information.