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Biomedical subjects

M H Kollef

Publications and source records attributed to M H Kollef.

At least 127 records · Page 7Linked to original sources
PubMed1991

Pulmonary embolism associated with the act of defecation.

Pulmonary embolism associated with the act of defecation has not been well described in the medical literature. We report our experience with deep vein thrombosis in patients who had a pulmonary embolism triggered by the act of defecation. In these individuals the embolization of peripheral thrombus appeared to have resulted from the performance of the Valsalva maneuver and its effects on peripheral blood flow and intrathoracic pressures. In addition, the important role of nursing personnel in recognizing and diagnosing this disorder as well as in initiating prophylactic measures directed against the development of thromboembolic disease is discussed.

Defecation↗
PubMed1990

Loculated hemopneumothorax of a major fissure in patients with COPD and associated pleural disease.

Two patients with underlying COPD and bullous changes of the lungs were found to have a loculated hemopneumothorax within a major fissure by computed tomography. Both patients had associated pleural disease. In one of the patients, the hemopneumothorax was believed to be potentially compromising pulmonary function. Percutaneous needle drainage of the loculated hemopneumothoraces resulted in large symptomatic pneumothoraces requiring urgent insertion of closed thoracostomy tubes. Loculated hemopneumothorax is an unusual finding within a major fissure mimicking pulmonary abscess, infected bullae, pulmonary cyst, or a cavitary carcinoma of the lung. Physicians treating patients with COPD and associated pleural disease should be aware of this rare condition, since percutaneous needle drainage may be associated with serious life-threatening complications.

Hemopneumothorax↗
PubMed1990

Trapped-lung syndrome after cardiac surgery: a potentially preventable complication of pleural injury.

A case of trapped-lung syndrome after coronary artery bypass grafting (CABG) is presented. A significant pleural injury occurred during the bypass operation resulting in intrapleural hemorrhage, pleural fibrosis, and trapped-lung syndrome. The physicians caring for the patient when she was first seen with the trapped-lung syndrome were unaware of the potential relationship between the two prior bypass surgeries to this pulmonary complication. Recognition of the potential for pleural injury to occur after cardiac operations is important and may allow for earlier diagnosis and institution of appropriate therapeutic interventions. Early recognition and treatment with pleural fluid drainage and reexpansion of the collapsed lung may help prevent this potentially serious pleuropulmonary complication from occurring. In addition, the presentation of this pleuropulmonary complication may be delayed after the cardiac surgery, making early diagnosis more problematic.

Aged↗
PubMed1990

Occult coiled drinking straw aspiration.

A 23-year-old man had a 7-month history of recurrent right lower lobe pneumonia. Flexible fiber-optic bronchoscopy revealed an occluded bronchus intermedius. Rigid bronchoscopy demonstrated a coiled drinking straw in the bronchial lumen, which was removed by forceps. This article represents the first reported case of an aspirated coiled drinking straw obstructing an airway.

Adult↗
PubMed1989

Pulmonary embolism masquerading as pulmonary arteriovenous malformation on computerized tomography.

A 57-year-old man with massive hemoptysis was thought to have a pulmonary arteriovenous malformation (PAVM) on the basis of computerized tomography of the chest. Angiography, however, revealed a pulmonary artery embolus as the case of the hemoptysis; the tomographic appearance of PAVM had been mimicked by the delay of contrast material within the involved pulmonary artery proximal to the occluding embolus. This finding suggests caution in the use of CT to diagnose PAVM, especially in clinical situations compatible with other diagnoses, and confirms the importance of pulmonary angiography in the definitive evaluation of suspected PAVM.

Arteriovenous Malformations↗
PubMed1988

Delayed pleuropulmonary complications following coronary artery revascularization with the internal mammary artery.

We have seen four cases of delayed postoperative pleuro-pulmonary complications associated with use of the internal mammary artery (IMA) conduit. In each case the left IMA was used as a bypass conduit to the left anterior descending (LAD) coronary artery. In two of the instances the complications were life-threatening to the patients. Each patient was left with symptomatic residual roentgenographic changes. The IMA is becoming the graft of choice for coronary artery revascularization. The potential for delayed pleuropulmonary complications associated with use of this graft is not well recognized.

Aged↗
PubMedDate not supplied

The identification of ICU-specific outcome predictors: a comparison of medical, surgical, and cardiothoracic ICUs from a single institution.

OBJECTIVES: To identify ICU-specific predictors of mortality. DESIGN: An inception cohort study. SETTING: Barnes Hospital, an academic tertiary care center. PATIENTS: Consecutive patients, requiring mechanical ventilation, admitted to the medical intensive care unit (ICU) (75 patients), surgical ICU (100 patients), and cardiothoracic ICU (102 patients). INTERVENTIONS: Prospective data collection and outcomes evaluation. MEASUREMENTS AND MAIN RESULTS: Stepwise logistic regression analysis identified the following variables to be independent predictors of mortality for the individual ICUs: medical ICU, an Organ System Failure Index (OSFi) greater than or equal to 3; surgical ICU, OSFI greater than or equal to 3; cardiothoracic ICU, OSFI greater than or equal to 3, requiring acute dialysis, and the occurrence of an iatrogenic event. The same analysis was repeated after removing the OSFI as a potential confounding variable. Independent predictors of mortality identified in this subsequent analysis were as follows: medical ICU, occurrence of renal failure; surgical ICU, supine head positioning, acute physiology score greater than or equal to 10, preadmission lifestyle score greater than or equal to 2; cardiothoracic ICU, requiring acute dialysis, occurrence of ventilator-associated pneumonia, and the occurrence of an iatrogenic event. CONCLUSIONS: We identified the presence of ICU-specific predictors of mortality amongst the three ICUs examined. These data suggest that ICU-specific interventions could be developed to improve the quality of patient care and potentially to reduce patient mortality.

APACHE↗
PubMedDate not supplied

Inhaled nitric oxide for severe acute respiratory distress syndrome: a blessing or a curse?

The effects of inhaled nitric oxide (NO) in two young adults who developed severe acute respiratory distress syndrome are presented. Modest improvements in gas exchange and reductions in pulmonary artery pressures occurred after the initiation of treatment with inhaled NO. However, both patients became "dependent" on the inhaled NO for stabilization of their cardiopulmonary function. Repeated attempts to discontinue the inhaled NO resulted in life-threatening deterioration in gas exchange and hemodynamic instability. Prolonged family discussions were held regarding the withdrawal of inhaled NO and other life-sustaining therapies, when the irreversible nature of the patients' lung disease became apparent. However, both families were strong in their desire to continue all therapies--due in large part to the single organ nature of the disease process. Both patients died while receiving inhaled NO and escalating doses of sedative and analgesics. Based on this experience, it is recommended that clearly defined goals or endpoints for the discontinuation of inhaled NO should be established before its initial administration. If these goals are not achieved, then the therapy should be considered a failure and withdrawn. A similar strategy should be applied to all life-sustaining therapies in the intensive care unit setting (e.g., mechanical ventilation, vasopressors, dialysis). This requires that critical care clinicians effectively communicate the difference between aggressive supportive care and definitive treatment of the underlying disease process to patients or their families, or both. Furthermore, until the results of ongoing clinical trials of inhaled NO become available, it is recommended that its administration be restricted to medical centers examining its use in clinical trials.

Acute Disease↗
PubMedDate not supplied

Antibiotic use and antibiotic resistance in the intensive care unit: are we curing or creating disease?

Antibiotics represent one of the most commonly prescribed medical therapies for hospitalized patients. The practice of "spiralling empiricism" has increasingly led to the unnecessary administration of antibiotics, resulting in the emergence of infections with antibiotic-resistant bacteria that are associated with increased rates of patient mortality. Ventilator-associated pneumonia due to antibiotic-resistant bacteria has become recognized as an important problem resulting from prior antibiotic exposure. Health professionals must be aware of this problem and avoid the unnecessary administration of these drugs. Future research efforts should be aimed at improving our ability to diagnose and exclude infections and to develop better strategies for antibiotic administration in the intensive care unit setting.

Anti-Bacterial Agents↗