Respiratory care
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We report a case of broncholithiasis secondary to pulmonary actinomycosis. Broncholithiasis has occasionally been reported in association with actinomycosis, but it is unclear if actinomycosis leads to lymph node calcification with subsequent erosion into the airway, producing a broncholith, or if an existing generic broncholith is secondarily colonized with Actinomyces. ⋯ The nodules included sulfur granules containing Gram-positive branching filamentous organisms consistent with Actinomyces. The finding of Actinomyces throughout the broncholith is strong evidence that the etiology of the broncholithiasis was a primary pulmonary Actinomyces infection.
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We evaluated the diagnostic performance and safety of combined blind nasotracheal suctioning and non-bronchoscopic mini-bronchoalveolar lavage (mini-BAL) to obtain respiratory secretion specimens from spontaneously breathing, non-intubated patients with infectious pneumonia in intensive care. ⋯ Blind nasotracheal suctioning confirmed via colorimetric capnography allows microbiological diagnosis, and can be enhanced by non-bronchoscopic mini-BAL. Colorimetric capnography helps confirm bronchial tube position. Non-bronchoscopic mini-BAL is a novel and feasible way to collect bronchial secretions without fibroscopy. (ClinicalTrials.gov NCT00763620.).
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The diagnosis of tuberculous pleural effusion (TBPE) has some limitations. We studied the efficacy of interleukin-27 (IL-27) in the diagnosis of TBPE. ⋯ IL-27 is less efficient than ADA and ADA-2 in the diagnosis of TBPE. However, ADA·IL-27 and ADA-2·IL-27 improve the diagnostic sensitivity of ADA and ADA-2, and thus could be useful in situations of high clinical suspicion and low ADA level. A value above the cutoff point of the latter is practically diagnostic of TBPE.
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The pediatric literature addressing extubation readiness parameters and strategies to wean from mechanical ventilation is limited. ⋯ Most pediatric critical care physicians reported assessing extubation readiness by checking air leak and suctioning need, and less often consider or perform sedation score or the rapid shallow breathing index.
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Observational Study
Family reliance on physicians' decisions in life-sustaining treatments in acute-on-chronic respiratory diseases in a respiratory intensive care unit: A single center study.
In ICUs, many patients are unable to participate in decision-making regarding life-sustaining treatments. This study evaluated the opinions of family members about family and physician participation in life-sustaining treatment decisions and examined factors that influence those decisions. ⋯ A majority of the families relied on physicians to help in the decision-making process about life-sustaining treatments in patients with acute-on-chronic respiratory diseases. From the family's point of view, the principle of autonomy can be exercised by delegating the decision-making process to the physician. To assume a uniform ethical conduct is to antagonize the definition of ethics.