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ABSTRACT: Hydrostatic pulmonary edema is a common complication of congestive heart failure, resulting in substantial morbidity and mortality. Keratinocyte growth factor (KGF) is a mitogen for type II alveolar epithelial and microvascular cells. We utilized the isolated perfused rat lung model to produce hydrostatic pulmonary edema by varying the left atrial and pulmonary capillary pressure. Pretreatment with KGF attenuated hydrostatic edema formation. This was demonstrated by lower wet-to-dry lung weight ratios, histological evidence of less alveolar edema formation, and reduced alveolar accumulation of intravascularly administered FITC-labeled large-molecular-weight dextran in rats pretreated with KGF. Thus KGF attenuates injury in this ex vivo model of hydrostatic pulmonary edema via mechanisms that prevent increases in alveolar-capillary permeability.
AJP Heart and Circulatory Physiology 04/2001; 280(3):H1311-7. · 3.71 Impact Factor
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ABSTRACT: To determine whether the bronchodilator effects of albuterol and ipratropium bromide are greater if updraft nebulization is driven by 80% helium and 20% oxygen (HELIOX) than if driven by compressed room air (AIR) during the treatment of an acute exacerbations of chronic obstructive pulmonary disease (COPD).
The emergency department of a 750-bed inner-city community hospital.
Over a 12-month period, a convenience sample of 50 normoxic patients presenting with signs and symptoms of an acute exacerbation of COPD were prospectively randomized to receive either HELIOX or AIR as the driving gas for updraft nebulization of a mixture of albuterol 2.5 mg and ipratropium bromide 0.5 mg. Additional aerosol treatments with albuterol 2.5 mg were given at 20, 40, and 120 mins after randomization using the assigned gas. Spirometry was obtained while breathing room air before the first treatment (baseline) and at 1 hr and 2 hrs after the initiation of treatment. The primary measure of efficacy was the change in percent of predicted forced expiratory volume in 1 sec (FEV1) over the treatment period. A secondary measure of efficacy was the change in percentage of predicted forced expiratory flow after 25% to 75% of vital capacity had been expelled (FEF25-75).
Twenty-five patients were randomized to each treatment group. Three patients (1 HELIOX, 2 AIR) were unable to complete the study. The baseline FEV1was 44% (95% confidence interval, 35% to 52%) of predicted in the HELIOX group and 39 (31% to 46%) of predicted in the AIR group. There were no adverse outcomes observed in either the HELIOX group or the AIR group. There were no significant differences in the change of FEV1 between the two groups by either the 1 hr or 2 hr time point (1 hr, HELIOX + 10% [7% to 13%], AIR + 9% [5% to 13%]; 2 hr HELIOX + 10% [6% to 15%], AIR + 10% [6% to 14%]). The improvement in FEF25-75 was significantly greater in the HELIOX group than in the AIR group at both the 1 hr time point (HELIOX + 14% [7% to 22%] vs. AIR + 7% [3% to 10%], p = .05) and at the 2 hr time point (HELIOX + 15% [8% to 21%] vs. AIR + 7% [4% to 11%], p = .05).
Use of HELIOX as a driving gas for the updraft nebulization of bronchodilators during the first 2 hrs of treatment of an acute COPD exacerbation failed to improve FEV1 faster than the use of AIR. The faster improvement in FEF25-75 during the first 2 hrs of treatment was small and of uncertain clinical significance.
Critical Care Medicine 10/2000; 28(9):3177-80. · 6.33 Impact Factor
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ABSTRACT: Using the arterial occlusion method, we compared five literature-based estimates of pulmonary capillary pressure (Ppc) with the corresponding double occlusion pressures (Pdo) in anesthetized dogs whose chests had been closed after sternotomy for instrumentation. Arterial occlusions were performed with a balloon-tipped pulmonary artery catheter that housed pressure transducers immediately proximal and distal to the balloon. Separation of the proximal and distal pressure waveforms during balloon inflation allowed us to precisely define the moment of occlusion. We fit a monoexponential curve to pressure data beginning 200 ms after the onset of occlusion and a biexponential curve to data beginning at the instant of occlusion, with data obtained over a range of vascular states (control, serotonin infusion, histamine infusion). In addition, we investigated the use of sampling of the raw data to estimate capillary pressure. Three of the five literature-based estimates of Ppc yielded values similar to Pdo. The optimal (least average difference from Pdo) interpolation/extrapolation time points of the curve fits varied, depending on the type of curve fitting and the state of the pulmonary vasculature. We also determined that a close approximation of Pdo may be derived from the raw data, as an alternative to exponential curve fitting.
American Journal of Respiratory and Critical Care Medicine 08/1999; 160(1):162-8. · 11.08 Impact Factor
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ABSTRACT: Despite a significant reduction in cigarette consumption, chronic obstructive pulmonary disease continues to be an important cause of mortality in the United States. COPD is characterized by progressive airflow obstruction which is punctuated by acute exacerbations. Nicotine substitution and use of bupropion have been shown to double long-term smoking cessation success. The combination of albuterol and ipratropium bromide produces a synergistic beneficial effect on pulmonary function and symptoms. Long-acting inhaled beta 2-agonists improve symptoms better than as needed albuterol. Oral corticosteroids appear to be helpful during acute exacerbations; however, the chronic use of steroids benefits only a minority of patients. Broad- spectrum antibiotics are indicated during acute exacerbations if there is increased sputum volume and purulence. System-oriented administration of pneumococcal and influenza vaccinations is more successful than provider or client-oriented approaches.
The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society 01/1999; 150(12):596-600.
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ABSTRACT: Asthma is a common disease that affects persons of all ages. It is responsible for more than 5,000 deaths annually in the United States and countless days absent from school and work. For these reasons, the National Institutes of Health established the National Asthma Education Program whose expert panels have published two reports: Guidelines for the Diagnosis and Management of Asthma in 1991 and a revised report in 1997. A summary of the Expert Panel Report 2 published in 1997 is presented with emphasis on the outpatient diagnosis, prevention, and treatment of asthma. Education of the clinician and the patient is essential for effective management of asthma, and effective communication between clinician and patient is essential for implementing asthma education. The goal of this summary is to communicate and disperse the asthma education provided by the Guidelines for the Diagnosis and Management of Asthma: Expert Panel Report 2 in hopes of improving asthma care and decreasing morbidity and mortality-attributed asthma.
The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society 01/1999; 150(12):611-7.
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ABSTRACT: The aim of this study was to assess the respective role of a small elevation in pulmonary capillary pressure, airway pressure, or both on alveolar capillary barrier permeability in an isolated perfused rat lung model.
Four groups were studied with low or high airway pressure (LA: 10 mL/kg (tidal volume); HA: 20 mL/kg), low or high pulmonary artery pressure (LP: 9 mm Hg; HP: 12 mm Hg): LALP, HALP, LAHP, and HAHP. The lungs were ventilated and perfused ex vivo for 30 minutes. Quantification of fluorescein isothiocyanate-labeled (FITC) dextran in bronchoalveolar lavage (BAL) fluid and radiolabeled tracers assessed alveolar capillary barrier permeability.
BALF FITC-dextran was similar in the three groups with either one or two low-pressure parameters (LALP, LAHP, HALP), but high amounts were found in the HAHP group (375.2 x 10(-6) mg/mL v, respectively, 21.4, 26.2, and 30 x 10(-6) mg/mL, P = .0001). These results were consistent with the albumin space and extravascular lung water: higher values only in the HAHP group statistically different from the other groups (P < .002). Interalveolar pore examined with scanning electron microscopy showed an increase in diameters between LALP and HAHP (P < .0001).
We can conclude that elevation of either the pulmonary artery pressure from 8 to 11 mm Hg or the alveolar pressure from 10 to 15 mm Hg alone does not change the permeability of the alveolar capillary membrane; however, there is an additive effect of these pressures.
Journal of Critical Care 07/1998; 13(2):58-66. · 2.13 Impact Factor
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ABSTRACT: Reactive airways dysfunction syndrome (RADS) is characterized by persistent bronchial hyperreactivity and asthmatic symptoms in a previously healthy individual after a single intense exposure to an irritant fume, vapor, or gas. On October 23, 1995, a cloud of dinitrogen tetroxide (N2O4) escaped from a railroad tanker car in Bogalusa, Louisiana, exposing an estimated 4,000 citizens to the gas.
A sample of 234 patients with respiratory complaints after the spill received a complete history and physical examination, a symptom questionnaire, and pulmonary function tests. Patients whose previously undocumented asthma-like symptoms persisted for 3 months after exposure to N2O4 had methacholine challenge testing.
Of the 234 patients evaluated, six met the criteria for a diagnosis of RADS. The distance of these six patients from the source of the leak, their durations of exposure, and initial symptoms were not different from those of the sample patients who did not have RADS.
After evaluation of 234 symptomatic patients who were exposed to N2O4, we diagnosed six cases of RADS. There were no demographic characteristics or initial symptoms that identified patients who were at risk of having this syndrome. We believe we are the first to report cases of RADS due to N2O4 exposure.
Southern Medical Journal 05/1998; 91(4):338-41. · 0.83 Impact Factor
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ABSTRACT: Both inhaled and oral corticosteroids have proven benefit in the management of asthma, but their efficacy in nonasthmatic, smoking-related chronic obstructive pulmonary disease (COPD) remains controversial. Recent data suggest that responsiveness to beta 2-agonists predicts oral and inhaled steroid responsiveness in most patients with COPD, however, a poor bronchodilator response does not preclude a good response to steroids. COPD patients with histologic, cytologic, or biochemical indices of inflammation characteristic of asthma, such as sputum eosinophilia, are more likely to be steroid responsive than are COPD patients without these characteristics. Contrary to previous experience, steroid responsiveness does not appear to be an all-or-nothing phenomenon; rather there appears to be a continuous spectrum of steroid responses from none to marked. The effects of long-term inhaled steroid use on the natural progression of chronic airflow obstruction are currently under investigation.
Current opinion in pulmonary medicine 04/1998; 4(2):61-5. · 3.08 Impact Factor
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Critical Care Medicine 03/1998; 26(3):429-30. · 6.33 Impact Factor
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ABSTRACT: Patients with risk factors for VTE and developing signs or symptoms remotely consistent with DVT or PE should undergo formal testing. Ultrasound and IPG have good sensitivity and specificity in symptomatic DVT. V/Q lung scans should be obtained in all patients with suspected PE or proven DVT. A prior clinical assessment of probability, based on risk factors, history, physical examination, chest film, and arterial blood gas analysis, can aid in the interpretation of V/Q scans. Normal scans exclude PE. High-probability scans confirm PE if the clinical probability is at least intermediate. Nondiagnostic scans are common, but diagnosis in such cases can be aided by noninvasive leg studies. Heparin therapy should be started when there is suspicion of VTE. To avoid recurrence, a therapeutic aPTT of 1.5 to 2.5 times the control rate should be achieved as soon as possible after the diagnosis of VTE is confirmed. Thrombolytics are reserved for hemodynamically compromised patients. Warfarin should be administered to achieve an INR of 2.0 to 3.0 and should be continued for at least 3 months in patients with low risk of recurrence and probably for at least 6 months in all other patients.
Postgraduate Medicine 11/1997; 102(4):179-81, 185-7, 191-4. · 1.78 Impact Factor
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ABSTRACT: The objectives of the present study were to: (1) evaluate the safety of Filgrastim therapy in non-neutropenic patients with severe community-acquired pneumonia; (2) determine the absolute neutrophil count (ANC) response to various dosages of Filgrastim in non-neutropenic patients with active infection; and (3) describe the impact of therapy with Filgrastim in combination with antibiotics on selected pneumonia-related clinical parameters. The study design was an open-label, dose-ranging, clinical trial, set in the General Clinical Research Unit of a large, public community hospital. The study population consisted of 30 patients who had presented to the Emergency Department with severe, community-acquired pneumonia. One of five dosages (75, 150, 300, 450 or 600 micrograms day-1) of Filgrastim (r-metHuG-CSF) was given subcutaneously daily for 10 days, until discharge or until the absolute neutrophil count > 75 x 10(9) l(-1), whichever was earlier. Vital signs, pulse oximetry, arterial blood gases, daily complete blood counts with differential, serum chemistries, coagulation profiles, electrocardiograms, chest radiographs, plasma G-CSF concentrations and duration of hospitalization were measured. There was no evidence of Filgrastim-related lung injury or evidence of extra-pulmonary toxicity. There was no apparent dose-response effect of Filgrastim on pneumonia-related clinical variables. Dosages of Filgrastim between 150 and 600 micrograms day-1 had similar effects on increasing the ANC. Filgrastim appeared to be safe in non-neutropenic patients with severe, community-acquired pneumonia when given in dosages of 75-600 micrograms day-1 in combination with appropriate antibiotic therapy. Further study is needed to determine the effect of Filgrastim on morbidity, mortality and duration of symptoms in this patient population.
Respiratory Medicine 08/1997; 91(7):387-94. · 2.47 Impact Factor
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ABSTRACT: Continuous-infusion prostacyclin improves symptom scores and decreases mortality in patients with primary pulmonary hypertension, but use of prostacyclin in patients with pulmonary veno-occlusive disease may precipitate pulmonary edema. A patient with pulmonary veno-occlusive disease received a graduated intravenous infusion of prostacyclin and pulmonary capillary pressures were calculated during prostacyclin dose ranging. Calculated capillary pressure increased with low-dose prostacyclin (< or = 6 ng/kg/min) but decreased with higher doses. These data suggest that the post-capillary pulmonary venules in our patient had reversible vasomotor tone, but required a higher dose of prostacyclin to vasodilate than did the precapillary arterioles.
Chest 12/1995; 108(6):1754-6. · 5.25 Impact Factor
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ABSTRACT: Endoscopic guidance during percutaneous dilational tracheostomy reduces the risk of paratracheal insertion of the tracheostomy tube but may impair ventilation and does not eliminate the possibility of premature endotracheal extubation. Use of a small-caliber, hollow endotracheal tube exchanger during stomal dilation in lieu of a fiberoptic bronchoscope allows for better ventilation and more secure airway control.
Chest 09/1995; 108(2):572-4. · 5.25 Impact Factor
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ABSTRACT: The pathophysiologic disturbance observed in volume-resuscitated patients with septic shock is primarily that of hyperdynamic circulation with a markedly reduced systemic vascular resistance. We hypothesized that external, mechanically applied, phasic lower body positive pressure could increase systemic vascular resistance and, thus, blood pressure in patients with refractory septic shock. A total of nine studies were performed on seven patients with septic shock refractory to volume resuscitation and vasopressors. All pre-existing therapies were continued unaltered during the study period. Phasic lower body positive pressure was produced by rapid synchronized inflation of pneumatic fabric cuffs fitted around each lower extremity. The cuffs were inflated for 200 ms to a pressure of 150 mm Hg, and the timing of inflation was adjusted to coincide with the peak systolic arterial pressure. Hemodynamic measurements were obtained at baseline and after 15 min of phasic lower body positive pressure. This off-on cycle was repeated twice for each study. Phasic lower body positive pressure increased mean arterial pressure by 12% and cardiac index by 14% (p = 0.01) over baseline (p < or = 0.001). Heart rate, central venous pressure, pulmonary capillary wedge pressure, arterial pH, arterial pO2, and mixed venous pO2 were unchanged. Synchronized external systolic compression of the lower extremities increased mean arterial pressure and cardiac output in seven patients with refractory septic shock. This hemodynamic improvement was independent of changes in calculated systemic vascular resistance.
American Journal of Respiratory and Critical Care Medicine 03/1995; 151(3 Pt 1):719-23. · 11.08 Impact Factor
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ABSTRACT: The effect of G-CSF pretreatment on experimental acute lung injury was studied in Sprague-Dawley rats receiving one of the following treatments: (1) G-CSF 50 micrograms/kg subcutaneously twice daily beginning 2 d prior to being killed; (2) ANTU 50 mg/kg intraperitoneally; (3) ANTU+G-CSF 50, 25, or 12.5 micrograms/kg; (4) HCl 0.6 ml of a 0.1 N solution intratracheally; (5) HCl+G-CSF 50 or 25 micrograms/kg; (6) control solutions. Lung injury was quantified by measurement of lung wet/dry weights, by histopathologic scoring, and by measurement of fluid flux during ex vivo perfusion. G-CSF pretreatment elevated the baseline blood neutrophil counts as much as 6-fold compared with Control, and it increased the numbers of lung neutrophils and caused a mild histologic lung injury, but it did not significantly alter wet/dry weight ratios or fluid flux. ANTU alone and HCl alone caused a moderate histologic lung injury, increased wet/dry weight ratio, and resulted in a small increase in flux. The combination injuries, ANTU+G-CSF and HCl+G-CSF, caused a more severe lung injury manifested by increased wet/dry weight ratios and increase in flux when compared with ANTU alone and HCl alone, respectively. We conclude that pretreatment with G-CSF potentiates ANTU- and HCl-induced lung injury in non-neutropenic rats. The potential for G-CSF to aggravate acute lung injury in patients remains speculative.
American Journal of Respiratory and Critical Care Medicine 03/1995; 151(2 Pt 1):302-9. · 11.08 Impact Factor
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ABSTRACT: A morbidly obese patient was emergently nasotracheally intubated using a fiberoptic bronchoscope. Simultaneous application of 20 cm H2O nasal continuous positive airway pressure (CPAP) to the contralateral naris using a nasal pillow helped maintain ventilation of the patient during intubation and greatly facilitated visualization of anatomic landmarks and translaryngeal passage of the bronchoscope. Fiberoptic video images of this patient's hypopharynx demonstrate the pharyngeal splinting action of nasal CPAP thus applied. This is a novel approach to difficult intubation of the obese patient.
Chest 08/1994; 106(1):287-8. · 5.25 Impact Factor
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ABSTRACT: Previous computed tomography reports of pulmonary actinomycosis most commonly describe single, unilateral parenchymal or pleural masses with or without cavitation. The authors describe a thoracic computed tomograph of histologically proven actinomycosis that revealed multiple, bilateral, small pulmonary parenchymal nodules with an associated liver mass, suggesting hematogenous dissemination to the lungs from the liver via the hepatic veins.
The American Journal of the Medical Sciences 07/1994; 307(6):418-9. · 1.39 Impact Factor
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ABSTRACT: In the present investigation we researched the effects of low calorie diet without protein restriction on the renal function and glomerular injury of uninephrectomized spontaneously hypertensive rats. We compared the findings with those that occurred in two different groups of uninephrectomized spontaneously hypertensive rats: one treated with oral hydralazine (10 mg/kg per day) and a second fed regular food. The low calorie diet and hydralazine treatment significantly reduced intra-arterial blood pressure in each group (p < 0.05 and p < 0.001, respectively). The control group showed at the end of the experiment a slight but not significantly different increase in the intra-arterial blood pressure. Low calorie diet was more effective in protecting the kidney function. Creatinine clearance after treatment was significantly higher in uninephrectomized spontaneously hypertensive rats on a low calorie diet than in either the hydralazine-treated or control groups (p < 0.01). The 24-hour urinary protein excretion in the low calorie diet group was significantly lower than in the control group (p < 0.05) and lower but not statistically different from the hydralazine-treated group. The mean glomerular injury index of the remaining kidney in the low calorie diet group was lower than in either the hydralazine-treated or control groups (p < 0.05), and the mean mesangial expansion index in the low calorie diet group was significantly lower than in the control group (p < 0.05). The favorable effect of low calorie diet on renal function was independent of protein restriction or sodium and potassium content.(ABSTRACT TRUNCATED AT 250 WORDS)
Hypertension 06/1993; 21(6 Pt 2):971-4. · 6.21 Impact Factor
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ABSTRACT: We hypothesized that continuous, automatic turning utilizing a patient-friendly, low air loss surface would reduce the incidence of early ICU pneumonia in selected groups of critically ill medical patients.
Prospective, randomized, controlled clinical trial.
Medical ICU of a large community teaching hospital.
One hundred twenty-four critically ill new admissions to the medical ICU at Charity Hospital in New Orleans.
Patients were prospectively randomized within one of five diagnosis-related groups (DRG)--sepsis (SEPSIS), obstructive airways disease (OAD), metabolic coma, drug overdose, and stroke--to either routine turning on a standard ICU bed or to continuous turning on an oscillating air-flotation bed for a total of five days.
Patients were monitored daily during the treatment period for the development of pneumonia. The incidence of pneumonia during the first five ICU days was 22 percent in patients randomized to the standard ICU bed vs 9 percent for the oscillating bed (p = 0.05). This treatment effect was greatest in the SEPSIS DRG (23 percent vs 3 percent, p = 0.04). Continuous automatic oscillation did not significantly change the number of days of required mechanical ventilation, ICU stay, hospital stay, or hospital mortality overall or within any of the DRGs.
We conclude that air-supported automated turning during the first five ICU days reduces the incidence of early ICU pneumonia in selected DRGs; however, this form of automated turning does not reduce other measured clinical outcome parameters.
Chest 06/1993; 103(5):1543-7. · 5.25 Impact Factor
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ABSTRACT: We investigated the effect of dichloroacetate (DCA) on tension generation and carbohydrate metabolism of the rat diaphragm in vitro. Isolated diaphragms were placed in individual organ chambers and were hooked to force-displacement transducers. Net lactate production and glucose and lactate oxidation were measured in vitro. Diaphragmatic fatigue was precipitated by in vivo endotoxemic shock, by in vitro hypoxia, or by in vitro repetitive tetanic stimulation. In diaphragms isolated from endotoxemic rats, DCA increased tension generation by 30 and 20% at stimulation frequencies of 20 and 100 Hz, respectively. Associated with changes in mechanical performance, DCA reduced net lactate production by 53% after 60 min of incubation and increased glucose oxidation 54% but had no effect on lactate oxidation. During in vitro hypoxia, DCA reduced net diaphragmatic lactate production by 30% and increased glucose oxidation by 45% but did not attenuate hypoxic fatigue. DCA had no effect on tension generation during repetitive tetanic stimulation. We conclude that DCA improves in vitro diaphragmatic fatigue due to endotoxicosis but not due to hypoxia or repetitive stimulation.
Journal of Applied Physiology 04/1992; 72(3):1149-55. · 3.75 Impact Factor
