Resp Care
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Comparative Study
Quantitative analysis of acid-base disorders in patients with chronic respiratory failure in stable or unstable respiratory condition.
The Stewart approach theorizes that plasma pH depends on P(aCO₂), the strong ion difference, and the plasma total concentration of non-volatile weak acids (A(tot)). The conventional approach measures standardized base excess, bicarbonate (HCO₃⁻), and the anion gap. ⋯ In patients with chronic respiratory failure the acid-base pattern is complex, metabolic alkalosis is present in some patients with elevated HCO₃⁻, and metabolic acidosis is present in some with non-elevated HCO₃⁻. The diagnostic performance of the Stewart approach was better than that of the conventional approach, even when corrected anion gap was taken into account.
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In obesity-hypoventilation-syndrome patients mechanically ventilated for hypercapnic respiratory failure we investigated the relationship between CO₂ response, body mass index, and plasma bicarbonate concentration, and the effect of acetazolamide on bicarbonate concentration and CO₂ response. ⋯ Patients with obesity-hypoventilation syndrome and higher bicarbonate concentrations had a more blunted CO₂ response. Body mass index was not related to CO₂ response. Acetazolamide decreased bicarbonate concentration and increased CO₂ response.
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Intercostal artery laceration is an unusual complication following thoracentesis, and has been reported only in elderly patients. We report a case of a 78-year-old man who developed a massive hemothorax following thoracentesis. Post-thoracentesis radiograph revealed a substantial increase in pleural fluid, and emergency chest tube insertion identified the hemothorax. He underwent right thoracotomy for repair of the intercostal artery laceration.