Resp Care
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To validate the hypothesis that fat tissue accumulation adjacent to the upper airway contributes to a predisposition to obstructive sleep apnea (OSA), irrespective of body mass index (BMI), as well as investigate the effect of the volume of fat tissue on pharyngeal mechanical loads. ⋯ Patients with OSA have more fat tissue adjacent to the pharyngeal cavity than BMI-matched controls. Fats deposited around the upper airway may contribute to the collapsibility of retropalatal and retroglossal airway in both patients and controls.
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P(aCO(2)) as measured during exercise in patients with COPD is poorly predicted (predicted P(aCO(2))) from lung function testing and some noninvasive measurements, such as end-tidal P(CO(2)) (P(ETCO(2))). ⋯ A validated mixed-model regression derived equation yields a predicted P(aCO(2)) trend during exercise that can be helpful when interpreting exercise testing to determine P(aCO(2)) - P(ETCO(2)) and exercise-induced hypercapnia.
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Case Reports
Pulmonary zygomycosis in a non-neutropenic patient with myelodysplastic syndrome on lenalidomide.
Pulmonary zygomycosis is an uncommon infection that occurs mostly in immunocompromised patients. We report the case of a 75-year-old man with myelodysplastic syndrome, treated with lenalidomide for 3 months, who developed respiratory failure and a rapidly progressive left upper lobe consolidation. ⋯ This unique case illustrates the potential risks of lenalidomide therapy in patients with myelodysplastic syndrome and the difficulties in diagnosing pulmonary zygomycosis. To our knowledge this is the first report of a diagnostic in situ post-mortem transbronchial lung biopsy.
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There is paucity of data from India on the use of noninvasive ventilation (NIV) in acute respiratory failure (ARF). In this observational study, we report the indications and outcomes of patients requiring NIV in the respiratory ICU of a tertiary care hospital. ⋯ NIV was found to be a useful modality in management of patients with hypercapnic versus hypoxemic respiratory failure. The severity of illness at admission, new-onset organ dysfunction, hypoxemic ARF, and delay in improvement in P(aO(2))/F(IO(2)) at 1 hour from baseline are independent predictors of NIV failure.
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A 20-year-old man was admitted in the neurology ICU after the drainage of a large frontal hematoma related to the spontaneous bleeding of a recently diagnosed cavernoma. On admission the Glasgow coma score was 4/15, with evidence of sub-falcorial herniation and elevated intracranial pressure. On the 4th postoperative day the patient developed acute lung injury, with an apparently normal bedside chest x-ray examination. ⋯ The correction of hypoxemia can usually be achieved by increasing PEEP or by alveolar recruitment maneuvers. Ventilation in the prone position can also be helpful in improving oxygenation, but is not always possible. The potential benefit of inhaled nitric oxide in similar cases has been described, but has still to be further explored.