Treatment of respiratory failure using minitracheotomy and intratracheal oxygenation in selected patients with chronic lung disease.

OBJECTIVE: To evaluate the efficacy of minitracheotomy (MT) insertion for intratracheal oxygen insufflation (ITO2) on arterial blood gases and survival in patients with respiratory failure from chronic lung disease. DESIGN: Open, prospective clinical study. SETTING: A 12-bed medical intensive care unit in a non-university hospital. PATIENTS: 20 patients (14 males and 6 females, mean age 74.8 +/- 2.6 years), admitted for respiratory failure and denied mechanical ventilation. INTERVENTION: Percutaneous insertion of an MT for ITO2. Arterial blood gases were drawn just prior to, then 3, 24, 48 h and 1 week after MT insertion. Data are evaluated with a two-way analysis of variance for distribution-free data (Friedman's rank sums test). MEASUREMENTS AND RESULTS: Three hours after starting ITO2, the partial pressure of oxygen in arterial blood (PaO2) and the arterial oxygen saturation (SaO2) both increased from 51.7 +/- 2.8 to 85.4 +/- 5.6 mmHg and from 79.7 +/- 3.1 to 93.7 +/- 0.9%, respectively (p < 0.001 for both), along with a slight worsening in the partial pressure of carbon dioxide in arterial blood (PaCO2), from 59.6 +/- 2.5 to 63.5 +/- 3.0 mmHg (p < 0.05). At 1 week, improvements in PaO2 and SaO2 were maintained in all patients, while PaCO2 decreased in 14 patients (mean decrease 8.3 mmHg) and increased in the remaining patients (mean 12.5 mmHg), when compared to pre-ITO2 values. Seven patients died during follow-up, leading to a success rate of 65%. Eight and 4 patients were discharged home and to a nursing home, respectively, 9 still receiving ITO2 via MT as chronic oxygen therapy. CONCLUSION: Our results suggest that MT insertion for ITO2 may be a therapeutic option in selected patients with respiratory failure from CLD.

[Plasma cell granuloma in the lung and mediastino-pulmonary sarcoid lesions (author's transl)]. / Granulome plasmocytaire du poumon et lésions sarcoïdiennes médiastino-pulmonaires.

The authors report a case of inflammatory plasma cell pseudo-tumor in the lung associated with mediastino-pulmonary sarcoid histological lesions. Diffusion of the latter to pulmonary parenchyma, the intensity of the follicular reaction in mediastinal lymph nodes together with a positive Kveim test suggest the fortuitous association of a mediastinal-pulmonary sarcoidosis with a plasma cell granuloma.

Lack of clinical benefit from subcutaneous tunnel insertion of central venous catheters in immunocompromised patients.

To assess the efficacy of subcutaneous tunneling, we randomly designated 212 central venous catheters for tunneling (107 catheters) or for standard insertion (105 catheters) in 169 immunocompromised patients. The patients who received tunneled catheters (TCs) and the patients who received nontunneled catheters (NTCs) were similar with respect to age, gender, underlying disease, incidence of leukopenic episodes, receipt of blood product transfusions or parenteral nutrition, and medical care and attendants. The life span of catheters was 112.5 +/- 9.5 days in the TC group and 119 +/- 9 days in the NTC group (P = .5). Clinically relevant bacteremia occurred in 26 cases in the TC group (0.22 episode per 100 catheter-days), a rate not significantly different from that in the NTC group (25 episodes; 0.20 episode per 100 catheter-days). Catheter-related bacteremia was documented in seven cases and non-catheter-related bacteremia in five cases. In most instances, the precise origin of the septic episode could not be determined. Cutaneous infection and bacteremia were associated with the same microorganism in two cases in each group. Since the present study failed to demonstrate any clinical benefit of subcutaneous tunneling, such a procedure is no longer performed in our hospital.

[Diffuse interstitial pneumopathy associated with limited Sjögren's syndrome (author's transl)]. / Pneumopathies interstitielles diffuses au cours du syndrome de Sjögren limité (sans connectivite associée).

Diffuse interstitial pneumopathy was found to be associated with limited Sjögren's syndrome (i.e. without connective tissue involvement) in 5 women aged from 48 to 83 years. The respiratory symptoms (dyspnoea, unproductive cough and crepitations) appeared before the dry-eye-and-mouth syndrome was diagnosed in two patients and several years afterwards in three. Respiratory function studies showed a mixed restrictive and obstructive syndrome, perturbed Co transfer and increased total expiratory airways resistance. These changes reflected the underlying pathology, as revealed by bronchial and lung biopsies, which consisted of lymphocyte and plasmocyte infiltration and fibrosis of the interalveolar septa, peribronchial spaces and bronchial glands. Abnormal respiratory function tests in 5 other patients without any respiratory symptom suggest that subclinical and subradiological lesions of the lungs and bronchi are not uncommon in Sjögren's syndrome.