Resp Care
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A patient presented with shortness of breath and pleuritic pain shortly after bilateral knee synovial injections with sodium hyaluronate (HA). He was discharged after a brief hospitalization without a diagnosis when no Doppler or radiologic evidence of deep vein thrombosis or pulmonary emboli was found. Radiologic studies found patchy ground glass opacities that were predominantly peripheral in disposition, with prominent septal lines in the lungs; a subsequent pulmonary function test showed a reduced diffusing capacity of the lung for carbon monoxide (D(LCO)). These results prompted a lung biopsy that revealed multiple emboli composed of HA and fibrin in medium size pulmonary arteries, enlarged lymphatic vessels, and a bone marrow embolus. This is the first report of HA emboli following therapeutic HA injections and demonstrates that pulmonary function tests can be used to infer the reduction in pulmonary vascular area consequent to pulmonary emboli, and so can contribute to the detection of pulmonary emboli in unusual presentations.
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Muscle oxygenation correlates with systemic oxygen uptake (V(O₂)) in normal subjects; however, whether this relationship exists in COPD patients remains unclear. The purpose of this study was to investigate the influence of skeletal muscle oxygenation on V(O₂) during exercise in patients with COPD. ⋯ V(O₂) is highly influenced by oxygen utilization in exercising muscles, as well as by blood oxygenation levels and cardiac function. However, the impact of skeletal muscle utilization during exercise on peak V(O₂) varied greatly among the subjects.
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Timing and preparation for tracheal extubation are as critical as the initial intubation. There are limited data on specific strategies for a planned extubation. The extent to which the difficult airway at reintubation contributes to patient morbidity is unknown. The aim of the present study was to describe the occurrence and complications of failed extubation and associated risk factors, and to estimate the mortality and morbidity associated with reintubation attempts. ⋯ Nearly 20% of critically ill patients required out of operating room reintubation. Reintubation was associated with higher mortality, stay, and cost. Moreover, a difficult airway at reintubation was associated with higher mortality.
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Many survivors of the tsunami that occurred following the Great East Japan Earthquake on March 11, 2011, contracted a systemic disorder called "tsunami lung," a series of severe systemic infections following aspiration pneumonia caused by near drowning in the tsunami. Generally, the cause of aspiration pneumonia is polymicrobial, including fungi and aerobic and anaerobic bacteria, but Aspergillus infection is rarely reported. Here we report a case of tsunami lung complicated by disseminated aspergillosis, as diagnosed during autopsy.
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Critical illness myopathy and/or neuropathy (CRIMYNE) is a common alteration seen in the ICU. The currently available bedside methods of measuring respiratory and peripheral muscle function in critically ill patients are somewhat inadequate. The objective of this study was to evaluate the presence of diaphragmatic and peripheral CRIMYNE in septic patients with prolonged weaning from mechanical ventilation (MV). ⋯ Our pilot findings suggested that CRIMYNE is common in septic patients with prolonged weaning from MV (MV ≥ 14 d). The inability to move limbs against gravity is frequently associated with peripheral and diaphragmatic CRIMYNE, and the findings of CRIMYNE in peripheral electrophysiological tests are associated with diaphragmatic involvement.