Respiratory care
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Definite diagnosis of transudative or exudative pleural fluids often presents a diagnostic dilemma. The aim of this study was to evaluate whether amino-terminal brain natriuretic peptide (NT-proBNP) levels in pleural fluid has a diagnostic value for discriminating heart-failure-related pleural effusions from non-heart-failure effusions. ⋯ Pleural fluid NT-proBNP measurement in the routine diagnostic panel may be useful in differentiation of heart-failure-related pleural effusions and exudative pleural fluids with reasonable accuracy, especially in heart-failure patients treated with diuretics.
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Comparative Study
Noninvasive CPAP with face mask: comparison among new air-entrainment masks and the Boussignac valve.
The performances of 2 noninvasive CPAP systems (high flow and low flow air-entrainment masks) were compared to the Boussignac valve in 3 different scenarios. ⋯ High-flow air-entrainment mask showed the best performance in human subjects. During high flow demand, the Boussignac valve delivered lower than expected F(IO(2)) and showed higher dynamic hyper-pressurization than the air-entrainment masks.
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We report the case of an adult patient with idiopathic pneumonia syndrome following allogeneic hematopoietic stem cell transplantation, which was successfully managed with venovenous extracorporeal membrane oxygenation (ECMO) and immunosuppressive therapy. A 30-year-old man with precursor B cell acute lymphocytic leukemia had received chemotherapy 10 years previously, with complete remission. He underwent allogeneic hematopoietic stem cell transplantation 4 months prior to enrollment, owing to leukemia relapse. ⋯ He subsequently developed acute hypercapnic and hypoxic respiratory failure that was unresponsive to conventional medical therapy. He was successfully managed with venovenous ECMO for 19 days, with complete resolution of his respiratory symptoms. Thus, judicious use of ECMO as a bridge before steroid and other conventional therapy take effect in patients with isolated respiratory failure appears justified.