This V/Q mismatching is the main reason for gas exchange disturbances in patients with NIC. Additional factors that may cause bilateral changes on chest x-ray film and V/Q studies on admission in patients with multiple injuries are occult fat embolism and structural lung disease. Fat embolism is common with simple extremity fractures and initially results in small multiple perfusion defects that clear slowly over days to weeks. None of our patients had any clinical indications of fat embolism. Read the rest of this entry »
The principal findings of our study are that V/Q studies are useful parameters to define the extent as well as changes in regional lung function in patients with unilateral NIC. Within 24 h of chest injury, V/Q abnormalities are significantly more extensive than suggested by chest x-ray film abnormalities. These chest x-ray film changes as well as changes 24 h later tend to lag behind changes in V/Q studies. Our data further suggest that the extent of ventilation, perfusion, and chest x-ray film abnormalities on admission are predictors of increased morbidity. Read the rest of this entry »
There was a tendency for chest x-ray changes to worsen on the second day, while the reverse was true for ventilation and perfusion studies (Fig 1). In six patients, the direction of change of x-ray film and V/ Q abnormalities were the same, with the magnitude of V/Q changes more pronounced than the chest x-ray film changes.
Of the three parameters investigated, ventilation was the best to evaluate the extent as well as change in regional lung function, and it correlated best with clinical improvement or deterioration in the patients. This is well illustrated by a patient who had sustained four left lateral rib fractures, an associated pneumothorax, and radiologic signs of lung contusion (Fig 3). Read the rest of this entry »
Differences between values and groups were assessed using Students t test or the Mann-Whitney U test as appropriate. All values are expressed as the mean ± SEM, and significance was attributed to values with an associated p<0.05.
The median age of the 28 patients was 39 years (range, 19 to 59); 15 were men and 13 women. Twenty-one patients were smokers (15 cigarettes/day for longer than ten years). Lung infection (a pulmonary infiltrate with at least two of the following: purulent sputum, raised temperature, raised WBC count, positive sputum Gram stain and/or culture) developed in five patients during their stay in hospital. Read the rest of this entry »
A normovolemic state was established and all blood or air drained from pleural cavities before V/Q studies. The impairment of ventilation was estimated by the percentage decrease of activity during the wash-in phase or delayed clearance of activity during the washout phase. Impairment of perfusion was reported in a similar manner. An AP chest roentgenogram was taken with patients supine within 6 h of V/Q studies. Chest x-ray film abnormality was assessed by two independent radiologists without prior knowledge of V/Q abnormalities on the basis of the estimated percentage of parenchymal opacification or volume loss of the total radiologic lung volume. itat on
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We addressed the question of whether ventilation-perfusion radionuclide studies performed early (within 24 h of admission) and repeated 24 h later in patients with moderate to severe NIC are more sensitive than conventional parameters to determine the extent of pathophysiologic abnormalities caused by chest wall and lung injury. We also assessed the value of such studies in predicting complications or outcome following NIC. Read the rest of this entry »
Anatomic evaluation of the thoracic cage and its contents after nonpenetrating injury of the chest (NIC) is done clinically and radiographically, while alterations in ventilation and perfusion have been studied by spirometry and blood gas analysis. However, it has been difficult to correlate the pathophysiologic changes found with the anatomic lesions present, especially in the early period following NIC. The sensitivity of these parameters (clinical, radiographic, spirometric, and blood gas analysis) within the first 24 h following NIC to evaluate the extent of pulmonary damage and to predict eventual outcome is questionable. Pulmonary contusion, for example, has been described to be more common and extensive than suggested by radiographic findings and arterial Po2 abnormalities. More info
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