Prediction of right ventricular dysfunction from radiographic estimates of right descending pulmonary artery in hemodynamically stable pulmonary embolism patients

Background: The evaluation of right ventricular (RV) dysfunction by echocardiography isone of the most important established determinants of the prognosis of acute pulmonary embolism.The aim of the study was to investigate possible association between diameter of rightdescending pulmonary artery on chest X-rays and RV dysfunction by echocardiography inhemodynamically stable pulmonary embolism patients.Methods: Eighty-nine patients with the diagnosis of hemodynamically stable pulmonaryembolism were included.Results: The frequency of RV dysfunction was signifi cantly higher in patients with anenlarged right descending pulmonary artery on chest X-rays (p = 0.001). There wasa signifi cant positive correlation between the diameter of the right descending pulmonary arteryon postero-anterior chest X-rays and the diameter of the RV (r = 0.469; p = 0.002). Diameterof right descending pulmonary artery on chest X-rays was also found as a signifi cant predictorof RV dysfunction besides the troponin-T levels and systolic pulmonary arterial pressure (p < 0.05).Conclusions: Diameter of right descending pulmonary artery on chest X-rays may provideinformation about the risk for pulmonary embolism patients and may be used as a prognosticradiological parameter for the appropriate management of acute pulmonary embolism

Noninvasive positive pressure ventilation in unplanned extubation

<b>Background:</b>Unplanned extubation is quite common in intensive care unit (ICU) patients receiving mechanical ventilatory support. The present study aimed to investigate the effectiveness of noninvasive positive pressure ventilation (NPPV) in patients with unplanned extubation. <b> Materials and Methods:</b> A total of 15 patients (12 male, age: 57 &#x00B1; 24 years, APACHE II score: 19 &#x00B1; 7) monitored at the medical ICU during the year 2004 who developed unplanned extubation were included in the study. NPPV was tried in all of them following unplanned extubation. Indications for admission to the ICU were as follows: nine patients with pneumonia, three with status epilepticus, one with gastrointestinal bleeding, one with cardiogenic pulmonary edema and one with diffuse alveolar bleeding. <b> Results:</b>Eleven of the patients (74&#x0025;) were at the weaning period at the time of unplanned extubation. Among these 11 patients, NPPV was successful in 10 (91&#x0025;) and only one (9&#x0025;) was reintubated due to the failure of NPPV. The remaining four patients (26&#x0025;) had pneumonia and none of them were at the weaning period at the time of extubation, but their requirement for mechanical ventilation was gradually decreasing. Unfortunately, an NPPV attempt for 6-8 h failed and these patients were reintubated. <b>Conclusions:</b>Patients with unplanned extubation before the weaning criteria are met should be intubated immediately. On the other hand, when extubation develops during the weaning period, NPPV may be an alternative. The present study was conducted with a small number of patients, and larger studies on the effectiveness of NPPV in unplanned extubation are warranted for firm conclusions

Spontaneous pneumothorax and ozone levels: is there a relation?

Abstract Study objectives Although links between meteorological conditions and spontaneous pneumothorax (SP) have been proposed, the reports are controversial. In this study ozone levels, which are known to have some adverse effects on lung tissues, were investigated as a potential triggering factor of SP. At present there is not sufficient information about the effects of ozone on SP. Methods Of a total 79 pneumothorax patients recruited for the study, 21 secondary pneumothorax cases were excluded. In the remaining 58 SP patients, meteorological data at the time of SP occurrence were recorded. Results The number of SP patients was higher in spring than in the other seasons (p Conclusions The number of SP patients increases in spring when ozone levels are highest. Ozone is known to affect alveolar cells and cause interstitial edema. Ozone causes damage to the lung interstitium by way of oxidative stress. Rupture of unrecognized underlying blebs/bullae has been proposed as a cause of SP. Increased levels of ozone may be a triggering factor for these ruptures.</p

Current Statement of Intensive Care Units in Turkey: Data obtained from 67 Centers

OBJECTIVES: We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study