RESUMEN
OBJECTIVE: We compared rapid shallow breathing index (RSBI) values under various ventilatory support settings prior to extubation. DESIGN AND SETTING: Prospective study in the intensive care unit at a university hospital. PATIENTS: Thirty six patients ready for extubation. INTERVENTIONS: Patients were enrolled when receiving pressure support ventilation (PSV) of 5 cmH2O, PEEP of 5 cmH2O, and FIO2 of 40% (PS). Subsequently each patient received a trial of PSV of 0 cmH2O, PEEP of 5 cmH2O, and FIO2 of 40% (CPAP), a trial of PSV of 0 cmH2O, PEEP of 5 cmH2O and FIO2 of 21% (CPAP-R/A), and a 1-minute spontaneously breathing room air trial off the ventilator (T-piece). Trials were carried out in random order. MEASUREMENTS AND RESULTS: Respiratory frequency (f) and tidal volume (VT) were measured during PS, CPAP, CPAP-R/A, and T-piece in all patients. RSBI (f/VT) was determined for each patient under all experimental conditions, and the average RSBI was compared during PS, CPAP, CPAP-R/A, and T-piece. RSBI was significantly smaller during PS (46+/-8 bpm/l), CPAP (63+/-13 bpm/l) and CPAP-R/A (67+/-14 bpm/l) vs. T-piece (100+/-23 bpm/l). There was no significant difference in RSBI between CPAP and CPAP-R/A. RSBI during CPAP and CPAP-R/A were significantly smaller than RSBI during T-piece. In all patients RSBI values were less than 105 bpm/l during PS, CPAP, and CPAP-R/A. However, during T-piece the RSBI increased to greater than 105bpm/l in 13 of 36 patients. CONCLUSIONS: In the same patient the use of PSV and/or PEEP as low as 5 cmH2O can influence the RSBI. In contrast, changes in FIO2 may have no effect on the RSBI.
Asunto(s)
Respiración con Presión Positiva/métodos , Insuficiencia Respiratoria/terapia , Anciano , Femenino , Humanos , Unidades de Cuidados Intensivos , Intubación Intratraqueal , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Regresión , Mecánica Respiratoria/fisiología , Desconexión del Ventilador/métodos , Ventiladores MecánicosRESUMEN
BACKGROUND: Pleural fluid (PF) pH measurement is important for establishing a diagnosis and for guiding clinical management. The current standard practice is to collect PF samples for pH measurement in heparinized syringes at room temperature and to instantaneously process these samples. OBJECTIVE: The purpose of this study is to investigate the effect of collecting PF in heparinized versus non-heparinized syringes at room temperature on PF pH measurements when processed at various time intervals. METHODS: From 50 consecutive thoracenteses, 1 ml of PF was collected anaerobically in each of six 3-ml syringes. Only three syringes were coated with heparin. The samples were processed for PF pH measurements at time 0 (T(0)) and 1 h (T(1)) and 2 h (T(2)) after collection. All specimens were preserved at room temperature, until the measurements were carried out in duplicates by a calibrated blood gas analyzer. RESULTS: PF pH values were significantly lower with heparinized versus non-heparinized syringes at all time intervals (T(0): pH heparinized = 7.378 +/- 0.107 vs. pH non-heparinized = 7.390 +/- 0.108; T(1): pH heparinized = 7.378 +/- 0.115 vs. pH non-heparinized = 7.389 +/- 0.111; T(2): pH heparinized = 7.367 +/- 0.105 vs. pH non-heparinized = 7.389 +/- 0.121). In the heparinized syringes, there was a significant decrease in PF pH values at T(2) versus T(0) and T(1). There were no significant changes in PF pH values over time in the non-heparinized syringes. CONCLUSIONS: For serial PF pH measurements, the same type of syringes (either heparinized or non-heparinized) should be consistently used. With heparinized syringes, processing of PF pH measurements should be performed within 1 h after collection.
Asunto(s)
Anticoagulantes/administración & dosificación , Heparina/administración & dosificación , Paracentesis/instrumentación , Derrame Pleural/química , Jeringas , Exudados y Transudados/química , Femenino , Humanos , Concentración de Iones de Hidrógeno , Masculino , Persona de Mediana Edad , TemperaturaRESUMEN
Extranodal marginal zone lymphoma of MALT, previously known as MALT lymphoma, is a low grade B-cell Non-Hodgkin's lymphoma (NHL). Its most frequent locations are the gastrointestinal tract and the lungs while that of the colon is rare. Involvement of multiple mucosal sites is not a frequent finding but it does occur. We describe a case of a 70-year-old man who presented with extranodal marginal zone lymphoma of MALT involving three different sites: the lungs, the stomach, and the colon.
Asunto(s)
Neoplasias del Colon/diagnóstico , Neoplasias Pulmonares/diagnóstico , Linfoma de Células B de la Zona Marginal/diagnóstico , Neoplasias Gástricas/diagnóstico , Anciano , Neoplasias del Colon/diagnóstico por imagen , Neoplasias del Colon/patología , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Linfoma de Células B de la Zona Marginal/diagnóstico por imagen , Linfoma de Células B de la Zona Marginal/patología , Masculino , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/patología , Tomografía Computarizada por Rayos XRESUMEN
STUDY OBJECTIVES: To assess the reliability of new and traditional oxygenation measurements in reflecting intrapulmonary shunt. DESIGN: Prospective study. SETTING: Cardiac surgery unit at a university hospital. PATIENTS: Fifty-five patients undergoing coronary artery bypass grafting. MEASUREMENTS AND RESULTS: Simultaneous blood samples were collected from an indwelling arterial line and a catheter for determination of blood gases. Standard accepted formulas were utilized to measure a new oxygenation index: PaO(2)/fraction of inspired oxygen (FIO(2)) x mean airway pressure (Paw). The standard formulas used were the oxygenation ratio (PaO(2)/FIO(2)), PaO(2)/alveolar partial oxygen pressure (PAO(2)), alveolar-arterial oxygen tension gradient (P[A-a]O(2)), and intrapulmonary shunt (venous admixture [Qsp/Qt]). There were significant negative (p < 0.05) correlations between the PaO(2)/(FIO(2) x Paw) and Qsp/Qt (r = - 0.85), between the PaO(2)/FIO(2) and Qsp/Qt (r = - 0.74), and between the PaO(2)/PAO(2) and Qsp/Qt (r = - 0.71). There was a significant positive (p < 0.05) correlation between the P(A-a)O(2) gradient and Qsp/Qt (r = 0.66). However, the correlation was strongest between the PaO(2)/(FIO(2) x Paw) and Qsp/Qt. CONCLUSION: In this group of patients, PaO(2)/(FIO(2) x Paw) might be more reliable than other oxygenation measurements in reflecting intrapulmonary shunt.
Asunto(s)
Dióxido de Carbono/sangre , Puente de Arteria Coronaria/métodos , Enfermedad Coronaria/cirugía , Respiración con Presión Positiva , Circulación Pulmonar/fisiología , Intercambio Gaseoso Pulmonar/fisiología , Adaptación Fisiológica , Anciano , Análisis de los Gases de la Sangre , Enfermedad Coronaria/diagnóstico , Femenino , Estudios de Seguimiento , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio , Oximetría , Cuidados Posoperatorios/métodos , Probabilidad , Estudios Prospectivos , Pruebas de Función Respiratoria , Medición de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
We report a case of brainstem infarction resulting in apneustic breathing, which was alleviated with buspirone. We discuss apneusis, review the literature, and speculate about the benefit of serotonin 1A receptor agonists in the treatment of apneusis and other respiratory disorders.
Asunto(s)
Apnea/tratamiento farmacológico , Apnea/etiología , Infartos del Tronco Encefálico/complicaciones , Buspirona/uso terapéutico , Agonistas de Receptores de Serotonina/uso terapéutico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: To compare the rapid shallow breathing index (RSBI) under different ventilatory support settings prior to extubation trials. DESIGN: Prospective study. SETTING: Cardiac surgery unit at a university hospital. PATIENTS: A total of 33 coronary artery bypass grafting patients ready for extubation. INTERVENTIONS: Enrolled patients received a continuous positive airway pressure (CPAP) trial of 5 cm H(2)O and fraction of inspired oxygen (FIO(2)) of 40% (condition 1), a CPAP trial of 5 cmH(2)O and FIO(2) of 21% (condition 2), and a 1-min spontaneously breathing room air trial without ventilatory support (condition 3). These trials were applied in random order. MEASUREMENTS AND MAIN RESULTS: Average values of respiratory frequency and tidal volume were measured under the three experimental conditions in all patients immediately prior to extubation. The RSBIs were determined for each patient under each condition; the average RSBIs under conditions 1, 2, and 3 were compared for significance. The average RSBIs (+/- SD) were significantly smaller under condition 1 (34 +/- 13) and condition 2 (36 +/- 14) compared to condition 3 (71 +/- 24). There was no significant difference in RSBI between conditions 1 and 2. CONCLUSIONS: The administration of 5 cm H(2)O of CPAP can influence the determination of the RSBI. In contrast, changes in FIO(2) have no effect on RSBI determination. We speculate that using the RSBI during CPAP may mislead the clinician into premature discontinuation of mechanical ventilation. Consequently, different threshold values for the RSBI should be derived for different ventilatory support levels.