Open lung biopsy in patients with diffuse pulmonary infiltrates and acute respiratory failure.

Patients with diffuse pulmonary infiltrates and acute respiratory failure (ARF) potentially can benefit from diagnostic information provided by open lung biopsy (OLB). To better quantify possible benefits and risks, we reviewed an 11-yr experience with 80 such patients. Although OLB did provide a specific etiologic diagnosis in 53 patients (66%) and did influence therapy in 56 patients (70%), only 24 patients (30%) survived to hospital discharge, and 9 patients (11%) survived for 1 yr or more.

Intrathoracic lymphangioma.

Of 14 cases of intrathoracic lymphangioma, 4 occurred in the anterior, 5 in the superior, and 4 in the posterior mediastinum. One lesion was diffuse and associated with disappearing bone disease (Gorham's disease). The anterior mediastinal lymphangiomas occurred in adults and seemed to arise from the mediastinum.

Clinical outcome of respiratory failure in patients requiring prolonged (greater than 24 hours) mechanical ventilation.

Patients requiring prolonged (greater than 24 hours) mechanical ventilation have various conditions that result in respiratory failure. All patients requiring prolonged mechanical ventilation were subdivided into the following six groups: uncomplicated acute lung injury; respiratory failure complicated by multisystem failure; previous lung disease; trauma; other medical causes; and routine postoperative ventilation. During a one-year period, 327 patients required prolonged mechanical ventilation; acute lung injury and chronic obstructive pulmonary disease were the predominant conditions.

Usual interstitial pneumonitis is a T-cell alveolitis.

Usual interstitial pneumonitis (UIP) is an idiopathic inflammatory disorder that produces scarring of the lung parenchyma. We studied open-lung biopsies of 13 patients with UIP using immunohistological staining and monoclonal antibodies. T lymphocytes (Leu 4+) accounted for 59% of cells in the alveolar septal infiltrates in UIP and OKT8+ cells accounted for the majority of T lymphocytes in most cases.

Intrathoracic manifestations in mixed connective tissue disease.

A high frequency of occurrence of pleuropulmonary manifestations in mixed connective tissue disease (MCTD) has been reported in the literature. A retrospective analysis of 81 adult patients with the diagnosis of MCTD who were examined at our medical center from 1973 through 1977 revealed that pleuropulmonary involvement occurred in 20 (25%). Thirteen patients (16%) had dyspnea, six (7%) had chest pain, and four (5%) had cough.

Postoperative respiratory care after transsternal thymectomy in myasthenia gravis. A 3-year experience in 53 patients.

During a three-year period, 53 patients with myasthenia gravis underwent transsternal thymectomy by a partial sternum-splitting technique at our institution. This procedure was carried out (1) because an x-ray film or a computed tomography scan had suggested the presence of a thymoma or (2) to manage symptoms of myasthenia gravis. In 41 patients the endotracheal tube was removed in the post-anesthesia recovery room.

Plasmapheresis in the treatment of ventilator-dependent myasthenia gravis patients. Report of four cases.

During a 42-month period, we used plasmapheresis to treat four cases of myasthenia gravis with refractory respiratory failure. All four patients were ventilator dependent for prolonged periods and were not responding to management with cholinesterase inhibitors and corticosteroids. All four patients rapidly responded to the plasmapheresis; respiratory muscle strength returned sufficiently to allow discontinuation of assisted mechanical ventilation and removal of the artificial airway.

Continuous monitoring of mixed venous oxygen saturation.

Continuous monitoring of arterial oxygen tension is not sufficiently accurate for practical use in adults. Because of the shape of the hemoglobin dissociation curve, fluctuations at higher levels of oxygen tension are not reflected by corresponding changes in saturation; consequently, measurement of saturation at these levels also lacks sensitivity in detecting physiologic instability. However, at the lower levels of oxygen present in venous blood, a linear relationship exists between saturation and tension.

Clinical implications of variation in total venoarterial shunt fraction calculated by different methods during severe acute respiratory failure.

Ventilation-perfusion imbalance is the major physiologic disturbance that produces hypoxemia in acute respiratory failure, and total venoarterial shunt fraction is frequently used as a measure of its severity. Ninety-one total venoarterial shunt fractions were calculated from 29 patients with severe acute respiratory failure. Four different methods were used for each estimation, only two of which considered the influence of cardiac output and tissue oxygen uptake.

Mechanical ventilation for respiratory failure in myasthenia gravis. Two-year experience with 22 patients.

We evaluated a 2-year experience involving 22 patients who required prolonged mechanical ventilation for respiratory failure associated with myasthenia gravis. The most frequent cause of respiratory failure was operation, and the most common type of procedure was thymectomy. Next in frequency as exacerbating factors were myasthenic crisis and cholinergic crisis.

Avoidance of aggravated hypoxemia during measurement of mean pulmonary artery wedge pressure in ARDS.

A marked drop occurs in mixed venous oxygen saturation during temporary interruption of mechanical ventilation. To avoid this potentially dangerous problem and eliminate possible errors induced by associated hemodynamic changes, a simple electronic circuit was constructed for measurement of mean pulmonary artery wedge pressure without separation of the patient from the ventilator. Its 12-second time constant was sufficient to cover two to four respiratory cycles.

Respiratory failure in Guillain-Barré syndrome: a 6-year experience.

Seventy-nine patients with acute Guillain-Barré syndrome were seen during a 6-year period. Twenty-one were admitted to a respiratory intensive care unit, where they remained for 58 +/- 26 days (range 14 to 105 days). Thirteen patients required nasotracheal intubation followed by tracheostomy and mechanical ventilation.

The adult respiratory distress syndrome.

Acute lung injury from a variety of causes may result in capillary leakage and the nonhydrostatic edema of the adult respiratory distress syndrome. The mechanism of development of this syndrome is not yet fully understood. There is increasing hypoxemia from disturbance of normal ventilation-perfusion relationships in the lung and progressive loss of compliance.

Accumulation of radionuclide-labeled platelets and fibrinogen in paraquat-damaged rat lungs.

After intraperitoneal injection of paraquat, rats showed evidence of neurologic and respiratory damage and had a mortality rate of 41% in 3 days. The lungs quadrupled in weight between the third and the fifth day. Pulmonary edema and extravascular fibrin and platelets were identified by light and transmission electron microscopy.

Preoperative pulmonary preparation of patients with chronic obstructive pulmonary disease: a prospective study.

A group of 157 patients with chronic obstructive pulmonary disease who were treated before surgery using a standardized pulmonary preparation underwent physiologic assessment both before and after the prophylactic program. The postoperative course of each patient also was evaluated to assess the incidence of respiratory morbidity and mortality. Although many physiologic values were statistically improved after the pulmonary preparation, most of the changes are of doubtful functional significance.

Experimental squamous cell lung tumors in Sprague-Dawley and murine pneumonitis-free rats.

Squamous cell bronchogenic carcinoma was produced in 34% of a group of specific pathogen-free rats in a mean time of 139 days by the use of point-source irradiation. In a group of Sprague-Dawley rats, identical tumors developed in 54% of animals after an average exposure time of 147 days. This study was undertaken to clarify whether the bronchogenic squamous cell carcinomas produced by this method are due to the effects of the point source of irradiation alone or to the additive effects of irradiation and chronic murine pneumonitis.

Aggressive therapy in acute respiratory failure from leukemic pulmonary infiltrates.

Three young adults with respiratory failure as a first or early manifestation of acute leukemia were hospitalized. Aggressive support with mechanical ventilation, high fractions of inspired oxygen, and positive end-expiratory pressure provided time for appropriate chemotherapy to be used. One patient was alive, with the disease controlled, 18 months after these events.