J Formos Med Assoc
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Hemodynamic and respiratory parameters were continuously monitored in 45 septic shock patients, 15 of whom developed adult respiratory distress syndrome (ARDS). Low oxygenation index (OI = PaO2/FIO2), pulmonary artery hypertension (high mean pulmonary artery pressure, MPAP) and elevated pulmonary vascular resistance (PVR) were observed in all ARDS, as well as in non-ARDS septic patients, as a baseline. These same pulmonary factors were compared between those who survived and those who died during the first few days (early fatalities) in both the ARDS group (5 patients) and the non-ARDS group (8 patients). ⋯ In the non-ARDS group, the MPAP of the early fatalities was significantly lower (p less than 0.01) than that of survivors, but their OI was not significantly lower. PVR, when compared between groups (ARDS versus non-ARDS) or between subgroups within each group, was elevated concurrently with the elevation of MPAP. It is concluded that patients with septic shock and ARDS who show a severely depressed OI and a modestly elevated MPAP and PVR during the first few days can be predicted to have a poor outcome.
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Instances of left atrial (LA) thrombus and spontaneous echo contrast were evaluated by both transthoracic echocardiography (TTE) and subsequent transesophageal echocardiography (TEE) in 50 patients with rheumatic mitral stenosis (Group I) and 52 patients with non-rheumatic atrial fibrillation (Group II). Among these 102 patients, TEE detected LA thrombi in 16 patients (15.7%) and spontaneous echo contrast in 35 (34.3%). In contrast, TTE revealed LA thrombi in only 8 patients (7.8%) and spontaneous echo contrast in only 2 patients (2.0%). ⋯ In Group II, 7 patients (13.5%) were also found to have spontaneous echo contrast, which could only be detected by TEE. Of these 7 patients, LA thrombus was noted in 4 by TEE, but only in 1 by TTE. Thus, it can be concluded that: (1) TEE is superior to TTE for detecting LA thrombus and spontaneous echo contrast; (2) spontaneous echo contrast in LA is not only frequently encountered in mitral stenosis without significant mitral regurgitation, but is also found in some patients with non-rheumatic atrial fibrillation; and (3) the presence of spontaneous echo contrast is associated with a higher incidence of LA thrombus and may be considered as a warning sign for further formation of LA thrombus.