Mayo Clinic proceedings
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Mayo Clinic proceedings · Mar 1992
ReviewClinical utility of bronchoalveolar lavage in immunocompromised hosts.
Bronchoalveolar lavage (BAL) has been used extensively for assessment of immunocompromised hosts with pulmonary infiltrates. Reported estimates of the diagnostic utility of BAL have varied because of differences in patient populations, diagnostic criteria, and study methods. Herein we report on the use of BAL to determine at least one of the final diagnoses in 150 immunocompromised patients. ⋯ Organisms such as cytomegalovirus, Aspergillus, and Candida were frequently identified in BAL specimens but were eventually proved to be pathogens in only 24%, 25%, and 0% of cases, respectively. BAL detected pulmonary malignant lesions on the basis of positive cytologic results in four of six patients eventually found to have primary or metastatic lung cancer. Our results should enhance the understanding of the strengths and weaknesses of BAL and assist in the interpretation of associated microbiologic findings.
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Mayo Clinic proceedings · Feb 1992
Outcomes of patients admitted to a chronic ventilator-dependent unit in an acute-care hospital.
The outcomes in 61 patients admitted to a chronic ventilator-dependent unit (CVDU) at Saint Marys Hospital in Rochester, Minnesota, during an 18-month period are summarized. This unit was designed for patients who could not be weaned from mechanical ventilators after repeated attempts. Most patients had been ventilator dependent for more than 21 days, but some patients were admitted to the CVDU after briefer periods if special circumstances suggested that weaning from mechanical ventilation would be difficult. ⋯ One patient remains in the CVDU. Thus, the CVDU has successfully liberated patients from ventilator dependence. In addition, because of a decreased need for nursing care, the unit has been cost-effective.
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Mayo Clinic proceedings · Feb 1992
Outcome of recipients of bone marrow transplants who require intensive-care unit support.
To determine the outcome and prognostic factors associated with bone marrow transplantation (BMT), we reviewed the clinical course of 35 adult recipients of such a transplant who were admitted to our intensive-care unit (ICU). This constituted 24% of patients who underwent BMT for treatment of hematologic disorders during the study period. The reasons for admission to the ICU were postsurgical care in 5, respiratory failure in 25, shock in 4, and renal failure in 1. ⋯ The APACHE II (acute physiology and chronic health evaluation) prognostic scoring system underestimated mortality and had no correlation with the duration of stay in the ICU or the hospital. Vasopressors, total parenteral nutrition, and transfusion of blood components in the ICU had no influence on the outcome. Open-lung biopsy was helpful in making specific diagnoses, and pulmonary artery catheters were used in most patients to guide therapy but did not improve survival.(ABSTRACT TRUNCATED AT 250 WORDS)
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Antituberculous agents have radically improved the prognosis of patients with active tuberculosis. Generally, 6-month and 9-month antituberculous regimens have been successful, and surgical therapy is rarely needed. Extrapulmonary tuberculosis should be managed with the same drug regimens as pulmonary tuberculosis. ⋯ When failure of treatment is apparent, careful reassessment by physicians experienced in the treatment of tuberculosis is indicated. A single drug should never be added to a failing regimen. Isoniazid administered prophylactically for 6 to 12 months is effective in most cases.