RESUMO
UNLABELLED: The cost-effectiveness of pulmonary artery catheterization (PAC) has been questioned in many clinical situations. We sought to assess the cost-effectiveness of PAC in patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. METHODS: We constructed a decision analysis model and calculated the incremental cost/quality-adjusted life-year (QALY) saved for hypothetical patients, comparing a PAC strategy to one of no PAC. Sensitivity analyses were performed to test the stability of conclusions over wide ranges of values. RESULTS: The incremental cost/QALY saved in the cost-effectiveness analysis using baseline data is $77,407 when catheterization-driven therapeutic changes result in a 5% improvement in survival. Cost-effectiveness is sensitive to variations in post-hospital life expectancy, quality of life, and the probability of favorable therapeutic changes resulting from the use of catheterization data. CONCLUSIONS: Pulmonary artery catheterization in COPD exacerbation requiring mechanical ventilation is expensive compared to accepted medical interventions for other conditions, unless changes in therapy prompted by catheterization increase hospital survival to a level 8.7% above baseline. Randomized, controlled trials are needed to investigate the economic impact of PAC and its effect on morbidity and mortality of critically ill patients.
Assuntos
Cateterismo de Swan-Ganz/economia , Pneumopatias Obstrutivas/terapia , Artéria Pulmonar/cirurgia , Avaliação da Tecnologia Biomédica , Cateterismo de Swan-Ganz/efeitos adversos , Análise Custo-Benefício , Árvores de Decisões , Custos Hospitalares , Humanos , Expectativa de Vida , Pneumopatias Obstrutivas/economia , Pennsylvania , Qualidade de Vida , Respiração Artificial , Avaliação da Tecnologia Biomédica/economia , Valor da VidaRESUMO
Adult respiratory distress syndrome (ARDS) was described in 1971 by Petty and Ashbaugh. Since that time it has been reported in association with many disease entities. We report a case in which a patient with postanginal sepsis, also known as Lemierre's syndrome, had development of ARDS.
Assuntos
Infecções por Fusobacterium/complicações , Fusobacterium necrophorum , Faringite/complicações , Síndrome do Desconforto Respiratório/etiologia , Sepse/complicações , Adulto , Humanos , MasculinoRESUMO
A case of Mycobacterium fortuitum presenting as an asymptomatic enlarging pulmonary nodule is described. This case is unusual because the patient was female, did not have underlying pulmonary disease, was not immunocompromised, had no evidence of dissemination, and had no history of aspiration or diabetes mellitus. The patient underwent thoractomy for resection of the pulmonary nodule, which led to the diagnosis. She recovered fully and is doing well without chemotherapy.
Assuntos
Infecções por Mycobacterium não Tuberculosas/diagnóstico , Nódulo Pulmonar Solitário/microbiologia , Tuberculose Pulmonar/microbiologia , Idoso , Feminino , Humanos , Radiografia , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico por imagemRESUMO
Two cases of recent-onset dyspnea and wheezing initially treated with bronchodilator therapy for presumed reactive airway disease are presented. Plain-film chest radiographs subsequently demonstrated mediastinal masses causing extrinsic tracheal compression. The first patient had inoperable poorly differentiated squamous cell carcinoma resistant to radiotherapy. The second patient underwent resection of a substernal multinodular goiter with complete resolution of symptoms. The physician should always entertain the diagnosis of upper airway obstruction in all adult patients with new-onset wheezing. New-onset adult wheezing of uncertain etiology should prompt the physician to refer the patient for pulmonary function testing with flow-volume loops.