Organic dust toxic syndrome: a follow-up study.
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Adult↗
Biomedical subjects
D P Coppolo
Publications and source records attributed to D P Coppolo.
Self-extubations. A 12-month experience.
Unplanned removal of an endotracheal airway tube by a patient (SXT) represents a potentially life-threatening incident. Prospective monitoring of all intubated adult ICU patients for one year revealed that 12 of 112 extubated themselves (overall incidence, 11 percent). Comparison of SXT patients with the NXT group disclosed no risk factors for this occurrence. The proportion of patient-hours was similar when both groups were examined for tube size, tube site, ventilation mode and ventilator type. The mean hours of intubation was lower in the SXT group. Sixty-nine percent of unplanned extubations were deliberate; the majority of these occurred despite use of sedation and restraints. No death resulted from these events. The complication (and reintubation) rate in the SXT group was 31 percent. The reintubation rate in deliberate extubations was 11 percent. Self-extubation is a common occurrence which, despite obvious hazards, often is tolerated well by adults.
Adult↗
An improved method of cell recovery following bronchial brushing.
Cytologic examination of bronchial brush specimens is effective in diagnosing bronchogenic carcinoma. A major problem is loss of cells and cellular detail associated with the direct smear technique (DST). A more recent method, the Saccomanno brush wash (SBW), uses a narrow-mouthed vial to scrape cells off the brush directly into fixative. We sampled 12 directly visualized airway tumors using standard brush technique. The same brush was then agitated in a SBW vial, which was centrifuged, the cell pellet being smeared over a predetermined area of a slide. Designated areas of each slide were counted and total malignant cells per slide extrapolated. DST slides had significantly fewer cells than SBW slides, and cellular detail was better with SBW in seven cases, DST in one case, and equal in four cases. SBW appears preferable for handling of bronchial brush specimens.
Biopsy↗
A role for the respiratory therapist in flexible fiberoptic bronchoscopy.
UNLABELLED: All bronchoscopies in our institution are performed by physician-respiratory therapist teams. The therapist instructs the patient, anesthetizes him, does the biopsies, and prepares specimens for laboratory testing. METHODS: We undertook a retrospective study of our performance to evaluate the safety, yield, and cost of this system. RESULTS: Of 216 procedures evaluated, therapist-performed biopsies provided a specific diagnosis in 55%. When a tumor-like mass was seen directly, biopsies were positive 95.7% of the time. No procedure was associated with death. Complications included fever in about 9%, hoarseness in 2%, hemoptysis in 1%, and pneumothorax in one procedure (0.5%). Our institutional costs for flexible fiberoptic bronchoscopy by a physician-respiratory therapist team were only 34% of what they would have been if the same procedures had been performed in the operating room. RESULTS performed were comparable to all others reported in the literature. CONCLUSION: This study clearly demonstrates that respiratory therapists can provide high quality, low cost, safe bronchoscopic assistance to pulmonary internists.
Bronchoscopy↗