The American review of respiratory disease
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Am. Rev. Respir. Dis. · May 1985
Case ReportsAcute respiratory failure caused by primary pulmonary coccidioidomycosis. Two case reports and a review of the literature.
Acute respiratory failure caused by infection with Coccidioides immitis is a rare, usually fatal, event. We report 2 patients who survived acute respiratory failure caused by primary pulmonary coccidioidomycosis. ⋯ Their treatment included antifungal therapy with amphotericin B and diuresis to decrease noncardiogenic pulmonary edema. Coccidioidomycosis causing respiratory failure may be more frequent than currently clinically appreciated and may result from primary pulmonary coccidioidomycosis, miliary pulmonary disease, or as part of the multisystem organ failure seen in fungemic patients.
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Am. Rev. Respir. Dis. · May 1985
Measurement of static compliance of the total respiratory system in patients with acute respiratory failure during mechanical ventilation. The effect of intrinsic positive end-expiratory pressure.
In mechanically ventilated patients with acute respiratory failure, the static compliance of the total respiratory system is conventionally obtained by dividing the tidal volume by the difference between the "plateau" pressure measured at the airway opening (PaO) during an occlusion at end-inspiration and positive end-expiratory pressure (PEEP) set by the ventilator. This analysis is valid only if the elastic recoil pressure of the respiratory system is zero at the end of expiration, indicating that the system has reached its elastic equilibrium point. To test if this is always the case, in 14 mechanically ventilated patients with acute respiratory failure, measurements were made of PaO and of flow and volume changes. ⋯ By contrast, in the remaining 10 subjects, expiratory flow was still present when the ventilator had already begun to increase PaO, indicating that the end-expiratory elastic recoil pressure was not zero. Indeed, in all these 10 patients, a positive delta PaO (as much as 7.5 cm H2O) had to be applied by the ventilator before the actual onset of inspiratory flow. This delta PaO represents the pressure required to counterbalance the end-expiratory elastic recoil before inspiratory flow will begin, and can be termed intrinsic PEEP.(ABSTRACT TRUNCATED AT 250 WORDS)