Respiratory care
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Obstructive fibrinous tracheal pseudomembrane (OFTP) is an uncommon complication that results after tracheal intubation. Herein, we perform a systematic review of the PubMed and EmBase databases for all the cases describing OFTP. The systematic search yielded 28 citations describing 53 subjects with OFTP. ⋯ OFTP is a complication of tracheal intubation and presents with respiratory failure. The diagnosis can be confirmed by flexible bronchoscopy. Treatment involves removal of the obstructing membrane with either flexible or rigid bronchoscopy.
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Review
Brain Tissue Oxygen Monitoring and the Intersection of Brain and Lung: A Comprehensive Review.
Traumatic brain injury is a problem that affects millions of Americans yearly and for which there is no definitive treatment that improves outcome. Continuous brain tissue oxygen (PbtO2 ) monitoring is a complement to traditional brain monitoring techniques, such as intracranial pressure and cerebral perfusion pressure. PbtO2 monitoring has not yet become a clinical standard of care, due to several unresolved questions. ⋯ Thus, continuous monitoring of PbtO2 yields important information about both the brain and the lung. The preclinical and clinical studies demonstrating these findings are discussed. In this review, we demonstrate that patient management in a PbtO2 -directed fashion is not the sole answer to the problem of treating traumatic brain injury but is an important adjunct to the armamentarium of multimodal neuromonitoring.
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Persistent Empiric COPD Diagnosis and Treatment After Pulmonary Function Test Showed No Obstruction.
Health-care providers often diagnose and empirically treat COPD without a confirmative pulmonary function test (PFT) or even despite a PFT that is not diagnostic of obstructive lung disease. We hypothesized that a portion of patients continue to carry a persistent empiric COPD diagnosis and receive treatment with bronchodilators and inhaled steroids after a PFT shows no obstruction. ⋯ Persistent empiric COPD diagnosis was 7%, but persistent empiric treatment was common.
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The lung diffusion capacity (DLCO) determined by the single-breath technique greatly helps in the differential diagnosis and classification of severity of common lung diseases. However, widespread use of single-breath DLCO tests in Latin America has been limited, in part, by the lack of appropriate reference values. Our objective was to derive robust reference equations for single-breath DLCO from healthy Hispanic adults, using the most recent guidelines and taking into account altitude above sea level and hemoglobin. ⋯ We recommend these new single-breath DLCO reference equations to predict single-breath DLCO in Latin America performed with current instruments and procedures and including as a predictor altitude above sea level.
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Obstructive sleep apnea is a clinical disorder characterized by loud snoring, apneic episodes, and chronic sleep disruption. Collegiate football players exhibit several risk factors for OSA, including large neck circumference and high body mass index, although the prevalence of OSA in this cohort is unknown. ⋯ Based on our sample, we estimate the prevalence of SDB among collegiate football players to be 8%, regardless of risk stratification. Given the strong link between SDB and cardiovascular disease, these data underscore the importance of screening and subsequent treatment of SDB in this highly conditioned yet potentially vulnerable group of athletes.