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Impact on clinical decision making of quality control standards applied to sputum analysis in COPD☆

Sputum analysis is important in COPD exacerbation management. We determined whether application of stringent quality control criteria for sputum samples had an impact on culture results.

Methods: We analyzed sputum samples of 108 patients during stable COPD and during exacerbations. To all samples quality control standards and culture interpretation rules according to the American Society of Microbiologists (ASM) were applied.

Results: In sputum exacerbation samples considered appropriate according to ASM quality standards, criteria for infection (40%) were met more often compared to inappropriate samples (13%) (p<0.001). The same pattern was observed when applying these rules to sputum samples obtained during stable disease, (50% vs....

 

Optimizing the utility of high-resolution computed tomography in diagnosing cryptogenic organizing pneumonia

Publication year: 2010
Source: Respiratory Medicine, In Press, Corrected Proof, Available online 18 November 2010
Edson, Marchiori , Gustavo, de Souza Porta Meirelles , Gláucia, Zanetti , Bruno, Hochhegger

The lung permeability index: A feasible measurement of pulmonary capillary permeability

We performed this study to determine the pulmonary capillary permeability (PCP) measuring radiolabeled human serum albumin leakage into the lung. The objective was to use PCP to differentiate between cardiogenic and non-cardiogenic pulmonary edema etiologies.

Methods: We conducted this study in 10 patients admitted to the intensive care unit who had recently developed bilateral pulmonary infiltrates and required hemodynamic monitoring. In these patients we determined the association among the lung permeability index, cardiac output, pulmonary capillary wedge pressure, myocardial performance index, and the protein content of the bronchoalveolar lavage as expressed by bronchoalveolar lavage (BAL) total protein and BAL-to-serum protein ratio. Twenty...

Long-term non-invasive ventilation in COPD after acute-on-chronic respiratory failure☆

COPD patients who remain hypercapnic after acute respiratory failure requiring mechanical ventilation have a poor prognosis. Long-term nocturnal non-invasive ventilation (NIV) may be beneficial for these patients. We hypothesized that stable patients on long-term NIV would experience clinical worsening after withdrawal of NIV.

Methods: We included 26 consecutive COPD patients (63 ± 6 years, 58% male, FEV1 31 ± 14% predicted) who remained hypercapnic after acute respiratory failure requiring mechanical ventilation. After a six month run-in period, during which all patients received NIV, they were randomised to either continue (ventilation group, n = 13) or to stop NIV (withdrawal group, n = 13). The primary endpoint was time to clinical...

Cutaneous Ear Lobe PCO2 at 37{degrees}C To Evaluate Microperfusion in Patients With Septic Shock

Background:

Tissue hypercarbia is related to hypoperfusion and microcirculatory disturbances in patients with septic shock. Transcutaneous Pco2 devices using a heated sensor to arterialize the tissue have been used as an alternative method for estimation of Paco2. This study investigates whether a cutaneous sensor attached to an ear lobe and regulated to 37°C could be used to measure cutaneous Pco2 (Pcco2) and evaluate microperfusion in patients with septic shock.

 Methods:

Fifteen stable patients in an ICU were studied as a control group. Forty-six patients with septic shock who were ventilated were enrolled as the study group. The difference of the gradients between Pcco2 and Paco2 (Pc-aco2) and between Pcco2 and end-tidal Pco2(Pc-etco2) were evaluated for 36 h. Variations of the Pc-aco2 and Pc-etco2 during fluid challenge were compared with microcirculatory skin blood flow (mBFskin) assessed by laser Doppler flowmetry.

 Results:

The baseline levels for Pc-aco2 and Pc-etco2 were significantly higher in the patients with septic shock than in the control group (14.8 [12.6] vs 6 [2.7] mm Hg and 25 [16.3] vs 9 [3.8] mm Hg, P < .0001, respectively). During the following 36 h, the Pc-aco2 and Pc-etco2 for the surviving patients with septic shock decreased significantly compared with the nonsurvivors (P < .01). The evolution of macrohemodynamic parameters showed no differences between survivors and nonsurvivors. At hour 24, a Pc-aco2 > 16 mm Hg and a Pc-etco2 > 26 mm Hg were related to poor outcome. Pc-aco2 and Pc-etco2 variations during fluid challenge were inversely correlated with changes in mBFskin (r2 = 0.7).

 Conclusions:

Ear lobe cutaneous Pco2 at 37°C represents a noninvasive technique to assess tissue Pco2 measurement. Pc-aco2 and Pc-etco2 were related to outcome and provide continuous information on microperfusion in patients with septic shock.

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