Document Detail


Management of severe respiratory insufficiency due to Pneumocystis carinii pneumonitis in immunosuppressed hosts: the role of continuous negative-pressure ventilation.
MedLine Citation:
PMID:  302099     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Continuous negative-pressure therapy was used to assist ventilation in 19 spontaneously breathing patients, 6 months to 17 years of age, who developed progressive respiratory insufficiency (arterial PO2 less than 70 mm Hg despite a fraction of inspired O2 larger than or equal to 50 per cent) due to Pneumocystis carinii pneumonitis. Within 1 hour of therapy, arterial PO2 increased from a mean +/- SE of 61.9 +/- 3.7 to 75.4 +/- 7.0 mm Hg (P less than 0.05) and, by 6 hours, to 79.9 +/- 4.7 mm Hg (P less than 0.005). In the 14 survivors, these improvements were sustained and, within 24 hours, permitted a decrease in inspired O2 concentration from a mean +/- SE of 50.4 +/- 1.2 per cent to 40.1 +/- 1.6 per cent (P less than 0.005). By contrast, in nonsurvivors, O2 requirements could not be decreased significantly despite increases in negative pressure. Improvements in arterial oxygenation were associated with decreases in alveolar-arterial PO2 differences in all patients; however, significant decreases occurred only with pressures of -8 to -12 cm H2O. Higher negative pressures were ineffective and usually produced pulmonary air leak. Since the introduction of continuous negative-pressure therapy as a means of assisting ventilation in management of progressive respiratory insufficiency, the over-all survival rate among patients with Pneumocystis carinii pneumonitis at this institution has increased from 69 to 89 per cent.
Authors:
S K Sanyal; T L Avery; W T Hughes; M A Kumar; K S Harris
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The American review of respiratory disease     Volume:  116     ISSN:  0003-0805     ISO Abbreviation:  Am. Rev. Respir. Dis.     Publication Date:  1977 Aug 
Date Detail:
Created Date:  1977-09-29     Completed Date:  1977-09-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370523     Medline TA:  Am Rev Respir Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  223-31     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Child
Child, Preschool
Humans
Immunosuppression*
Infant
Oxygen / blood
Oxygen Inhalation Therapy
Pneumonia, Pneumocystis / blood,  mortality,  therapy*
Pneumothorax / etiology
Pulmonary Diffusing Capacity
Respiration, Artificial / methods*
Respiratory Insufficiency / blood,  mortality,  therapy*
Chemical
Reg. No./Substance:
7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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