The American review of respiratory disease
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Am. Rev. Respir. Dis. · Sep 1989
Case ReportsUnilateral lung transplantation in end-stage pulmonary emphysema.
Patients with end-stage pulmonary emphysema are usually proposed for either heart-lung or double-lung transplantation. The single-lung transplantation is reversed for patients with pulmonary fibrosis. Patients with emphysema are thought to be unsuitable for single-lung transplantation because of the ventilation-perfusion imbalance that is supposed to occur, the ventilation being preferentially distributed to the native lung when the perfusion is distributed to the transplanted lung. ⋯ Despite the persistence after transplantation of an obstructive syndrome, the clinical status was good, the blood gases were markedly improved, and ventilation-perfusion imbalance did not occur on lung scans. After discharge from the hospital, the patients could return to an almost normal life. Thus, our data support the feasibility of single-lung transplantation in patients with end-stage pulmonary emphysema, and we consider that single-lung transplantation could be the optimal form of lung transplantation in these patients.
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Am. Rev. Respir. Dis. · Sep 1989
Expiratory glottic widening in asthmatic subjects during exercise-induced bronchoconstriction.
Glottic caliber is modulated in a way that optimizes the airway resistance and the work of breathing. The midexpiratory glottic narrowing that normally occurs during tidal breathing is enhanced during histamine- or methacholine-induced airway narrowing. Exercise is associated with increased ventilatory demand and midexpiratory glottic widening in healthy subjects. ⋯ This midexpiratory glottic widening was also associated with increased tidal flow rates. We conclude that in marked contrast to airway obstruction induced by histamine or methacholine, exercise-induced asthma is associated with midexpiratory glottic widening, which occurs concomitantly with a decrease in lower airway caliber. We suggest that modulation of glottic aperture during acute asthma is heterogeneous and depends partly on the initiating stimulus.
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Am. Rev. Respir. Dis. · Aug 1989
Multicenter Study Clinical TrialPrognosis with mechanical ventilation: the influence of disease, severity of disease, age, and chronic health status on survival from an acute illness.
This report presents a model for relating readily available clinical and physiologic measurements to prognosis from mechanical ventilation. Using data from 571 acutely ill, ventilated patients admitted to the intensive care units of 12 hospitals, it illustrates the relationship between the disease, the initiating respiratory failure, the acute severity of the disease, and the patient's age and chronic health status and the patient's probability of survival. ⋯ After 3 days of ICU treatment, estimates for hospital mortality increased to 97% (39 patients). We believe that such estimates, when available from a larger number of patients and combined with additional information on the patient's desires, expectations, preillness quality of life, and prognosis for long-term survival, can be helpful in decisions to withhold and withdraw mechanical ventilation.
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Am. Rev. Respir. Dis. · Aug 1989
ReviewIntensive care unit survival of patients with systemic illness.
Many patients with systemic illness are admitted to intensive care units (ICUs) and placed on life support. This occurs in patient populations even when the projected mortality rate might be as high as 80 to 90%. Patients with systemic illness often are life-support-dependent in ICUs as chronically critically ill patients for many weeks. ⋯ Numerous studies have identified that chronologic age is associated with increased mortality rates. However, a better assessment would be biologic age, which would take into account both chronologic age and health status. ICU survival of patients with cancer, hematologic neoplasms, renal failure, liver failure, AIDS, and burns is reviewed.(ABSTRACT TRUNCATED AT 250 WORDS)