Articles: function.
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Critical Care Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: First described in 1950, cerebral salt wasting syndrome (CSW) is defined by development of extracellular volume depletion due to renal sodium transport abnormality in patients with intracranial disease and normal adrenal and thyroid function [1]. The entity has been controversial and its existence debatable. ⋯ This case illustrates the need for CSW recognition as a separate entity from SIADH. Failure to make this distinction in a patient with hyponatremia who has cranial conditions could lead to unbefitting and dangerous therapy with water restriction resulting in fatal outcomes.Reference #1: Peters JP, et al. A salt-wasting syndrome associated with cerebral disease. Trans Assc Am Phys. 1950, 63:57-64Reference #2: Schwartz WB, et al. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 1957 Oct 23(4):529-42DISCLOSURE: The following authors have nothing to disclose: Anita Rajagopal, John LuciaNo Product/Research Disclosure Information.
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Miscellaneous Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: ICU readmissions after lung transplantation (LTx) have increased over the years, as a consequence of expanded criteria for LTx-list inclusion, with higher severity scores of patients in the list, together with the use of marginal grafts. ⋯ The following authors have nothing to disclose: Mauricio Acuña, Jordi Riera, Jordi Rello, Antonio RomanNo Product/Research Disclosure Information.
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Critical CareSESSION TYPE: Slide PresentationPRESENTED ON: Saturday, March 22, 2014 at 04:15 PM - 05:15 PMPURPOSE: This QI intervention is aimed at reducing delirium,increasing implementation of goal directed sedation and improving patient's functional status by early physical therapy (PT) in CCU. Based on current data, this can effectively decrease delirium and neuromuscular deconditioning in intensive care patients. Our goals are to: 1) Increase delirium recognition by consistent implementation of Confusion Assessment Measurement (CAM-ICU), 2) reduce deep sedation by goal directed sedation protocols, 3)improve patients' functional mobility by increasing the number and earlier timing of PT treatments. ⋯ The following authors have nothing to disclose: Jasleen Pannu, Sarah Lee, Dereddi Raja Reddy, Pramod Guru, Mazen Al-Qadi, Bernardo SelimNo Product/Research Disclosure Information.
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Pleural CasesSESSION TYPE: Case ReportsPRESENTED ON: Sunday, March 23, 2014 at 09:00 AM - 10:00 AMINTRODUCTION: Patients with large pleural effusions often experience dramatic relief from dyspnea after thoracentesis. While this is well-recognized, the physiological basis for such relief remains poorly understood. One commonly held belief is that thoracentesis allows for lung reexpansion, ventilation of previously atelectatic lung, and improved ventilation-perfusion matching, subsequently leading to dyspnea relief. This contrasts with the concept of "length-tension inappropriateness," which posits chest wall mechanics best explain dyspnea relief. ⋯ Our case established that dyspnea relief after thoracentesis likely results from changes in chest wall mechanics and/or work of breathing. This observation has direct clinical implications and could inform therapeutic decisions.Reference #1: Brown NE et al. Changes in pulmonary mechanics and gas exchange following thoracentesis. Chest. 1978; 74: 540-42Reference #2: Estenne M et al. Mechanism of relief of dyspnea after thoracentesis in patients with large pleural effusions. Am J Med. 1983; 74(5):813-9Reference #3: Wang LM et al. Improved lung function after thoracentesis in patients with paradoxical movement of a hemidiaphragm secondary to a large pleural effusion. Respirology. 2007; 12(5):719-23DISCLOSURE: The following authors have nothing to disclose: Mary Klecka, Fabien MaldonadoNo Product/Research Disclosure Information.
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Cardiovascular Case Report Posters IISESSION TYPE: Case Report PosterPRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PMINTRODUCTION: We present a case of progressive hypoxemia with platypnea-orthodeoxia developing after lung resection surgery for lung cancer. ⋯ Symptoms of hypoxemia with platypnea-orthodeoxia are concerning for shunt physiology. The differential diagnosis includes sources of intracardiac (ASD, PFO) and intrapulmonary shunting. He had a prior intracardiac shunt on an earlier echo but not on the post-operative study. He had no evidence of other cardiac causes such as pericardial effusion, constrictive pericarditis or aortic aneurysm. He had an interstitial lung disease by CT scan but this was unchanged radiographically. There was no evidence of other pulmonary causes such as COPD, thromboembolic disease or an intrapulmonary shunt (arteriovenous malformation). He had no history of liver disease with shunt from cirrhosis or history of kyphoscoliosis. Platypnea-orthodeoxia was first described in 1949 and major causes are intracardiac shunts and intrapulmonary shunts. The intracardiac shunts are right-to-left and most often include atrial septal defect, patent foramen ovale or fenestrated atrial aneurysm. Other causes include pericardial effusion, lobectomy, pneumonectomy or upper abdominal surgery. This occurs from preferential blood flow towards the atrial septum that is accentuated by altered intracardiac anatomy, compliances of the right and left heart, pulmonary vascular resistance and transient right to left pressure gradients associated with respiratory and positional changes. This is generally not associated with pulmonary hypertension and atrial right-to-left shunting has been reported despite normal right-sided pressures. A right-to-left shunt is more likely to appear after a right-sided lung resection with most patients having symptoms develop a month to several months afterwards. Noncardiac causes can include intrapulmonary shunting, such as thromboembolic disease and AVMs, or cirrhosis and kyphoscolisoss. The key to diagnosis is clinical suspicion of symptoms of dyspnea and hypoxemia, induced or worsened by an upright posture. In conclusion, interatrial shunting through a PFO or ASD is a rare but clinically significant condition after thoracic surgery. There are several underlying etiologies and can occur in the immediate postoperative period or can be more delayed.Reference #1: Interatrial Shunting After Major Thoracic Surgery: A Rare but Clinically Significant Event. Ann Thorac Surg 2012;93:1647-51Reference #2: Dyspnoea and hypoxaemia after lung surgery: the role of interatrial right-to-left shunt. Eur Respir J 2006; 28: 174-181Reference #3: Platypnoea-orthodeoxia syndrome. Heart 2000;83:221-223DISCLOSURE: The following authors have nothing to disclose: Nitin Bhatt, Ulysses MagalangNo Product/Research Disclosure Information.