American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Aug 1995
Case ReportsSystemic gas embolism complicating pulmonary contusion. Diagnosis and management using transesophageal echocardiography.
Systemic air embolism has been frequently reported after penetrating thoracic trauma. In blunt thoracic trauma, systemic air embolism has been rarely diagnosed, and then only after an invasive procedure such as thoracotomy. Transesophageal echocardiography has been recently introduced for the early assessment of trauma patients and is considered a sensitive noninvasive procedure to diagnose air embolism. ⋯ Transesophageal echocardiography was performed for evaluation of hemodynamic instability, and it showed air bubbles in the left atrium and left ventricle during the insufflation phase, which disappeared during apnea. A decrease in airway pressure (release of PEEP, low tidal volume, high frequency jet ventilation) significantly reduced the systemic air embolism. We concluded that systemic air embolism can occur after blunt thoracic trauma, and transesophageal echocardiography enables a rapid and accurate diagnosis that may be useful for therapeutic management.
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Am. J. Respir. Crit. Care Med. · Aug 1995
Racial differences in the association between maternal smoking during pregnancy and lung function in children.
We recently reported that suburban white schoolchildren whose mothers smoked during pregnancy have significantly reduced lung function. Because inner-city and minority children may be at greater risk for respiratory morbidity, we evaluated the relationship between maternal smoking during pregnancy and lung function in 493 white and 383 black schoolchildren 9 to 11 yr of age in three areas of Philadelphia. The child's passive smoking history was determined from reports by the mother. ⋯ After adjusting for height, weight, age, sex, area of city, race, socioeconomic status, and current exposure to environmental tobacco smoke at home, maternal smoking during pregnancy was associated with significant deficits in FEF25-75 (-8.1%) and FEV1/FVC (-2.0%). The observed deficits were larger for black children than for white children, and they were larger for boys than for girls. These results provide additional evidence of an association between maternal smoking during pregnancy and reduced pulmonary function in children, and they suggest that the association may be modified by race and/or sex.
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Am. J. Respir. Crit. Care Med. · Aug 1995
Etiology of extubation failure and the predictive value of the rapid shallow breathing index.
Failure of weaning from mechanical ventilation is thought to result from an imbalance between respiratory muscle capacity and respiratory demand. The ratio of respiratory rate to tidal volume (f/VT, rapid shallow breathing index) during spontaneous unsupported respiration increases when this imbalance exists, and may predict the success or failure of weaning from mechanical ventilation. Using f/VT, Yang and Tobin demonstrated a positive predictive value (PPV) of 0.78 (f/VT < or = 105 and weaning success) (1). ⋯ This study confirms the high PPV for an f/VT < 100. The FPR of approximately 0.20 is best explained by extubation failure caused by processes for which f/VT is physiologically or temporally unlikely to predict success or failure. The negative predictive value (f/VT > or = 100 but extubation success) for f/VT may be lower than previously reported.
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Am. J. Respir. Crit. Care Med. · Aug 1995
Multicenter Study Comparative StudyPulmonary function tests in HIV-infected patients without AIDS. Pulmonary Complications of HIV Infection Study Group.
To determine the prevalence, incidence, and types of lung diseases that occur in association with HIV infection, 1,353 subjects, including HIV-seropositive homosexual men, injection drug users, female sexual partners of HIV-positive men, and HIV-seronegative control subjects from the first two transmission categories were evaluated prospectively in a multicenter study. Patients with AIDS at the time of initial evaluation were excluded. One thousand two-hundred ninety-four subjects who had no AIDS-defining diagnosis within 3 mo of enrollment had measurements of FVC, FEV1 and DLCO at the time of enrollment. ⋯ Part of the reduction in DLCO in drug users was attributable to factors other than HIV infection, especially cigarette smoking and race. Using predicted values that take cigarette smoking into account, the prevalence of abnormality in DLCO was higher among injection drug users (33.3%) than among homosexual men (11.2%) and female sexual partners (12.7%). These results show that advanced HIV infection, characterized by CD4 count < 200/mm3 or HIV-associated symptoms, and factors unrelated to HIV infection, including race, cigarette smoking, and injection drug use, are all associated with reductions in DLCO measurements.
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Am. J. Respir. Crit. Care Med. · Aug 1995
Effects of an antibody to interleukin-5 in a monkey model of asthma.
To investigate the role of interleukin-5 (IL-5) on airway hyperreactivity and pulmonary inflammation in nonhuman primate airways, the effect of a neutralizing monoclonal antibody to murine IL-5 (TRFK-5) was investigated in a cynomolgus monkey model of allergic asthma. Anesthetized Ascaris-sensitive monkeys underwent bronchoalveolar lavage (BAL) to assess the granulocyte content of this fluid before and 24 h after aerosolized Ascaris suum extract inhalation. Airway reactivity was assessed by the concentration of inhaled histamine required to produce a 40% reduction in dynamic lung compliance (Cdyn40). ⋯ In contrast, only small nonsignificant changes in airway reactivity and granulocyte influx into the BAL occurred after aerosolized saline as a sham challenge. When the monkeys were treated 1 h before Ascaris challenge with the TRFK-5 antibody (0.3 mg/kg, intravenously), there was no increase in airway reactivity after Ascaris challenge (Cdyn40 = 0.032 +/- 0.016% before Ascaris; Cdyn40 = 0.217 +/- 0.196% after Ascaris) and there were only small increases in the number of eosinophils and neutrophils in the BAL after Ascaris challenge. The inhibition of this pulmonary eosinophilia and bronchial hyperresponsiveness by TRFK-5 was seen for up to 3 mo after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)