Lung
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Review Case Reports
Postextubation obstructive pseudomembranes: a case series and review of a rare complication after endotracheal intubation.
Endotracheal intubation obviously may be life-saving, but it may also lead to complications, including those related to damage of the airways. Superficial damage of the trachea at the site of the endotracheal cuff may trigger the formation of an obstructive fibrinous tracheal pseudomembrane (OFTP). Shortly after extubation, this clot, consisting of fibrin, leucocytes, and necrotic epithelium, can cause stridor due to adherence to the tracheal wall and obstruction of the airway. ⋯ This report describes a series of five adult cases and reviews all 19 other previously described cases. A careful analysis of all reported cases, however, did not highlight a simple predisposing factor or illness. It is important to consider OFTP in the differential diagnosis of stridor and respiratory insufficiency in the postextubation period.
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This study sought to determine whether reduced pulmonary function in obstructive airway disease (OAD) is an independent risk factor for obstructive sleep apnea (OSA). This was a prospective observational study conducted at an outpatient pulmonary clinic. Adults with a known diagnosis of COPD/asthma were enrolled as OAD group. ⋯ There was no correlation between FEV(1) % predicted and total apnea-hypopnea index (AHI), oxygen desaturation index, % time spent below oxygen saturation 90%, and mean oxygen saturation on multiple regression analysis. OSA appears to be common in patients with COPD or asthma in an urban outpatient pulmonary clinic. However, the high prevalence of OSA in OAD patients appears to be due to obesity, and reduced pulmonary function is not an independent risk factor for OSA.
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The objective of this prospective cohort study was to see the effect of the implementation of a Sepsis Intervention Program on the standard processes of patient care using a collaborative approach between the Emergency Department (ED) and Medical Intensive Care Unit (MICU). This was performed in a large urban tertiary-care hospital, with no previous experience utilizing a specific intervention program as routine care for septic shock and which has services and resources commonly available in most hospitals. The study included 106 patients who presented to the ED with severe sepsis or septic shock. ⋯ There was no improvement in secondary outcomes, including total length of hospital stay, MICU days, and mortality. Implementation of a sepsis intervention program as a standard of care in a typical hospital protocol leads to improvements in processes of care. However, despite a collaborative approach, the sepsis intervention program was underutilized with only 48% of the patients completing the sepsis intervention protocol.