Obstructive sleep apnea: an unrecognized but prevalent condition.

Obstructive sleep apnea remains an unrecognized and under appreciated disease. The reported prevalence ranges from 2% to 10%. Risk factors include obesity, increased neck circumference, and certain ethnic groups. An apnea index > 20 is associated with higher mortality rate.

Unilateral absence of right-lung perfusion with normal ventilation on radionuclide lung scan as a sign of aortic dissection.

A case of aortic dissection with unilateral absence of right-lung perfusion and normal ventilation on radionuclide ventilation/perfusion (V/Q) lung scan is presented with a review of the literature. Anticoagulation or thrombolytic therapy for presumed pulmonary embolism may be catastrophic if the clinical syndrome and V/Q scan appearance are instead due to aortic dissection. With this V/Q scan appearance, these therapies should not be instituted unless pulmonary embolism is diagnosed by pulmonary arteriography.

Aspiration pneumonia. A threat when deglutition is compromised.

Aspiration results from abnormal structure or from dysfunction during the oral, pharyngeal, or esophageal stage of deglutition. Chemically induced inflammation of the lungs and obstruction of the airways may ensue. Feeding and swallowing problems may occur at any age, but they are particularly prevalent in the elderly, and the morbidity and mortality that result from impaired oral intake are now recognized as a major geriatric problem. Aspiration pneumonitis and/or pneumonia has a high morbidity and mortality rate. Medical management is mainly aimed at supportive care with the hope of resolution over time. Complications demand aggressive measures. Prevention of aspiration is apt to be more rewarding than treatment of consequences. All predisposing factors should be carefully assessed by the physician and modified whenever possible.

Bronchoscopy in critically ill patients. When is it appropriate?

Fiberoptic bronchoscopy is a valuable diagnostic and therapeutic tool for use in carefully selected patients with serious pulmonary disease. The authors review the benefits and risks of fiberoptic bronchoscopy and discuss the essentials of nursing care before, during, and after the procedure.