Lung function and aerobic capacity in adult patients following modified Fontan procedure.

Objective: To examine cardiopulmonary performance in 52 adult patients with a Fontan circulation.

Design: Retrospective cohort study. Values of maximum oxygen uptake (VO(2)max), maximum heart rate (HRmax), forced vital capacity (FVC), and forced expiratory volume in one second (FEV(1)) were compared with predictive values for different age groups.

Use of a screen log to audit patient recruitment into multiple randomized trials in the intensive care unit. Canadian Critical Care Trials Group.

Objective: To develop and evaluate a screen log for monitoring enrollment in multiple randomized clinical trials conducted in a single center.

Setting: University-affiliated 20-bed tertiary care medical-surgical intensive care unit (ICU).

Patients: Consecutive ICU patients admitted between April 1995 and March 1997.

Long-term follow-up of survivors of acute lung injury: lack of effect of a ventilation strategy to prevent barotrauma.

Objectives: To determine the effect of a ventilation strategy to prevent barotrauma on long-term outcome in survivors of acute lung injury.

Design: Prospective blinded cohort analysis.

Setting: Three university-affiliated medical-surgical intensive care units.

Interobserver variability in applying a radiographic definition for ARDS.

Context: Acute lung injury (ALI) and ARDS are currently defined by the American-European Consensus Conference (AECC) definition criteria, which contain a radiographic criterion. The accuracy or reliability of this consensus radiographic definition has not been evaluated, and no radiographic definition of ALI-ARDS has been evaluated by a large international group of experts.

Objective: To study the interobserver variability in applying the AECC radiographic criterion for ALI-ARDS.

Expression of the cell adhesion molecules on leukocytes that demarginate during acute maximal exercise.

The pulmonary vascular bed is an important reservoir for the marginated pool of leukocytes that can be mobilized by exercise or catecholamines. This study was designed to determine the phenotypic characteristics of leukocytes that are mobilized into the circulation during exercise. Twenty healthy volunteers performed incremental exercise to exhaustion [maximal O2 consumption (VO2 max)] on a cycle ergometer.

Assessment of three methods to reduce the influence of mathematical coupling on oxygen consumption and delivery relationships.

Study Objectives: To determine if oxygen consumption/oxygen delivery (VO2/DO2) relationships derived using calorimetry (which are not influenced by shared measurement error) agreed with those obtained using the pulmonary artery (PA) catheter alone. To evaluate three strategies to reduce the influence of shared measurement error to determine if agreement between the two methods could be improved.

Methods: Twenty-seven patients were studied following coronary artery bypass surgery.

The acute effects of nasal positive pressure ventilation in patients with advanced cystic fibrosis.

Objective: To evaluate the acute effects of noninvasive positive pressure ventilation (NPPV) in patients with stable chronic respiratory failure secondary to cystic fibrosis.

Patients: Eight patients (29+/-5 years of age) with severe airflow limitation (mean FEV1, 24+/-3% predicted) and chronic respiratory failure (PaO2=67+/-15 mm Hg and PaCO2=50+/-4 mm Hg) were evaluated.

Methods: Tidal volume, respiratory rate, minute ventilation, oxygen saturation, and transcutaneous CO2 (TcCO2) measurements were made over a 20-min period before and after the application of NPPV (inspiratory pressure of 10 to 12 cm H2O and expiratory pressure of 4 to 6 cm H2O).

Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. Pressure- and Volume-Limited Ventilation Strategy Group.

Background: A strategy of mechanical ventilation that limits airway pressure and tidal volume while permitting hypercapnia has been recommended for patients with the acute respiratory distress syndrome. The goal is to reduce lung injury due to overdistention. However, the efficacy of this approach has not been established.

Treatment of diffuse tracheomalacia secondary to relapsing polychondritis with continuous positive airway pressure.

Relapsing polychondritis (RP) is a rare disease characterized by recurrent inflammation and destruction of the cartilaginous structures. Tracheobronchial chondritis is a dreaded complication of RP. We wish to report a case of RP of the trachea and bronchi which was treated with nasal continuous positive airway pressure.

Leukocytes and decreased left-ventricular contractility during endotoxemia in rabbits.

We hypothesized that leukocytes contribute to decreased myocardial contractility following endotoxin infusion. To test this hypothesis, we administered endotoxin (1 mg/kg intravenously) to intact, anesthetized rabbits whose arterial blood perfused two isolated hearts at a constant pressure (75 mm Hg). One heart was perfused with blood passed through a leukocyte filter, whereas the other received unfiltered blood.

Mechanisms of acute lung injury.

Acute lung injury is the end result of common pathways initiated by a variety of local or systemic insults leading to diffuse damage to the pulmonary parenchyma. Despite the accumulation of abundant information regarding the physiological and cellular basis of lung injury and increasingly sophisticated intensive care, an improvement in prognosis has lagged behind. It has become clear that there is not one mediator responsible for acute lung injury but rather a complex interplay exists between diverse proinflammatory (eg, lipopolysaccharide, complement products, cytokines, chemokines, reactive oxygen species, and eicosanoids) and anti-inflammatory (interleukin-10, interleukin-1-RA, PGI2) mediators.

CPAP improves inspiratory muscle strength in patients with heart failure and central sleep apnea.

Patients with congestive heart failure (CHF) suffer from respiratory muscle weakness which may contribute to dyspnea. Nasal continuous positive airway pressure (NCPAP) can improve left ventricular ejection fraction (LVEF) and reduce dyspnea in patients with CHF and Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) but its effects on respiratory muscle strength are not known. We therefore studied the effects of NCPAP on maximal inspiratory and expiratory pressures (MIP and MEP, respectively), LVEF, dyspnea, and fatigue in patients with chronic CHF and CSR-CSA over 3 mo.

Community-acquired pneumonia in the elderly patient. Clinical features, epidemiology, and treatment.

The relationship between age and the incidence of and mortality associated with pneumonia is complex. Age itself may not be an independent risk factor, because elderly patients also have a concomitant increase in the number of underlying risk factors for disease. The authors review the clinical features, epidemiology, and treatment of community-acquired pneumonia.

Cavitary aspergillosis as a complication of AIDS.

The authors report the radiographic findings in two patients with the human immunodeficiency virus (HIV) who presented with cavitary lung disease caused by Aspergillus. Recognition of the disease in one of the patients led to successful medical therapy. Disease due to Aspergillus must be considered in HIV-positive patients with cystic or cavitary disease appearing in chest radiographs.