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Symptom relief after large-volume thoracentesis in the absence of lung perfusion.
Klecka ME, Maldonado F
(2014) Chest 145: 1141-1143
MeSH Terms: Dyspnea, Humans, Male, Middle Aged, Pleural Effusion, Pulmonary Circulation, Recovery of Function, Recurrence, Respiratory Function Tests, Thoracostomy, Ventilation-Perfusion Ratio
Show Abstract · Added July 28, 2015
The physiologic basis for relief from dyspnea after therapeutic thoracentesis remains poorly understood. Here, we describe the case of a 46-year-old man with large recurrent pleural effusion with absent perfusion to the affected lung who experienced dramatic dyspnea relief after large-volume thoracentesis. This patient's improvement in breathlessness cannot be attributed to improved gas exchange and suggests the primary physiologic basis for the relief in dyspnea is a change in respiratory system mechanics or work of breathing.
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11 MeSH Terms
Inhaled nitric oxide reduces lung fluid filtration after endotoxin in awake sheep.
Bjertnaes LJ, Koizumi T, Newman JH
(1998) Am J Respir Crit Care Med 158: 1416-23
MeSH Terms: Animals, Blood Pressure, Blood Proteins, Capillary Permeability, Endotoxemia, Endotoxins, Escherichia coli, Lung, Lymph, Microcirculation, Nitric Oxide, Oxygen, Proteins, Pulmonary Artery, Pulmonary Wedge Pressure, Respiratory Insufficiency, Sheep, Vascular Resistance, Vasodilator Agents, Ventilation-Perfusion Ratio
Show Abstract · Added March 5, 2014
We studied the effect on lung fluid filtration of 37.6 ppm inhaled nitric oxide (NO) imposed for 1 h 2.5 h after endotoxin in seven awake sheep, with seven control subjects. The effects of NO on the longitudinal distribution of pulmonary vascular resistance (PVR) before and after endotoxin were specifically addressed in six sheep. Following endotoxin, sheep developed respiratory distress; PaO2, the alveolar-arterial oxygen tension difference (AaPO2) and venous admixture (Q S/Q T) changed significantly, as did the pulmonary artery pressure (Ppa), PVR, and lung lymph flow (Q L). Inhaled NO reduced Ppa and PVR by 50%; Q L decreased from 7.8 +/- 0.34 ml/15 min to 4.7 +/- 0.80 ml/15 min (mean +/- SEM), and lymph protein clearance from 4.9 +/- 0.18 ml/15 min to 3.6 +/- 0.75 ml/15 min. Lymph/plasma protein concentration ratio (L/P) increased from 0.63 +/- 0.016 to 0.72 +/- 0.006, concomitant with the decrease in Q L. The L/P - Q L relationships shifted from left, at baseline, to the right during endotoxemia, as did the permeability surface product (PS) isolines. The rightward shift was significantly less in the NO group. Inhaled NO significantly improved PaO2, AaPO2, and Q S/Q T, reduced the increase in pulmonary microwedge pressure back to baseline and decreased upstream and downstream PVR at 3.0 through 4. 0 h. We conclude that, in sheep, inhaled NO reduces lung fluid filtration by decreasing microvascular pressure and apparently also by declining the enhanced microvascular permeability during the late phase of endotoxemia.
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20 MeSH Terms
Adult respiratory distress syndrome. Strategies to provide support and enhance oxygen delivery.
Morris P, Bernard GR
(1991) Postgrad Med 90: 163-6, 169-70, 172
MeSH Terms: Humans, Positive-Pressure Respiration, Pulmonary Gas Exchange, Respiration, Artificial, Respiratory Distress Syndrome, Adult, Ventilation-Perfusion Ratio
Show Abstract · Added March 5, 2014
Respiratory failure itself is rarely the cause of death in patients with adult respiratory distress syndrome (ARDS). The multiple-organ failure that often accompanies the syndrome or the underlying disease or trauma that leads to ARDS is more frequently the cause. Thus, care of these patients consists of providing life-sustaining support until they respond to therapy. The authors explain what happens in respiratory failure and how gas exchange can be enhanced in these critically ill patients.
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6 MeSH Terms
Exercise testing in the evaluation of patients at high risk for complications from lung resection.
Morice RC, Peters EJ, Ryan MB, Putnam JB, Ali MK, Roth JA
(1992) Chest 101: 356-61
MeSH Terms: Aged, Exercise Test, Female, Forced Expiratory Volume, Humans, Lung, Lung Neoplasms, Male, Middle Aged, Pneumonectomy, Radionuclide Imaging, Respiratory Function Tests, Risk Factors, Total Lung Capacity, Ventilation-Perfusion Ratio, Vital Capacity
Show Abstract · Added March 27, 2014
Exercise testing was performed on 37 patients with resectable lung lesions who were deemed inoperable because of any of the following risk factors: (1) FEV1 less than or equal to 40 percent of predicted; (2) radionuclide calculated postlobectomy FEV1 less than or equal to 33 percent of predicted; or (3) arterial PCO2 greater than or equal to 45 mm Hg. The patients who reached a peak level of oxygen consumption during exercise (VO2Peak) of greater than or equal to 15 ml/kg/min were offered surgical treatment. Patients with a VO2Peak of less than 15 ml/kg/min were referred for nonsurgical management and excluded from the study. Eight patients underwent lung resection. Their pulmonary function revealed a severe obstructive lung defect with a group mean predicted FEV1 of 40 +/- 6 percent, an FEV1/FVC ratio of 47 +/- 10, a radionuclide calculated postlobectomy FEV1 of 31 +/- 4 percent, and a mean arterial PCO2 of 44 +/- 6 mm Hg. No relationship was found between each patient's exercise performance and spirometric function. Six of the patients had an uncomplicated postoperative course. Two patients had complications but no patient died as a result of surgery or postoperative complications. All patients were discharged from the hospital within 22 days (mean = 9.8 days). We conclude that exercise testing is a useful complement to conventional cardiopulmonary evaluation used in selecting patients for lung resection.
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16 MeSH Terms