A03586-FM.qxd 3/15/2006 9:30 AM Page i PULMONARY/ RESPIRATORY THERAPY A03586-FM.qxd 3/15/2006 9:30 AM Page ii A03586-FM.qxd 3/15/2006 9:30 AM Page iii PULMONARY/ RESPIRATORY THERAPY Third Edition Polly E Parsons, MD John E Heffner, MD Professor, Department of Medicine University of Vermont College of Medicine Chief, Critical Care Service Fletcher Allen Health Care Burlington, Vermont Professor of Medicine Executive Medical Director Medical University of South Carolina Charleston, South Carolina A03586-FM.qxd 3/15/2006 9:30 AM Page iv 1600 John F Kennedy Boulevard Suite 1800 Philadelphia, PA 19103-2899 Pulmonary/Respiratory Therapy Secrets Third Edition ISBN-13: 978-0-323-03586-6 ISBN-10: 0-323-03586-8 Copyright © 2006 by Elsevier Inc All rights reserved No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1) 215-239-3804, fax: (+1) 215-239-3805, e-mail: healthpermissions@elsevier.com.You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting “Customer Support” and then “Obtaining Permissions.” NOTICE Knowledge and best practice in this field are constantly changing As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications It is the responsibility of the practitioner, relying on his or her own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions To the fullest extent of the law, neither the Publisher nor the Editor assumes any liability for any injury and/or damage to persons or property arising out or related to any use of the material contained in this book Library of Congress Cataloging-in-Publication Data Pulmonary/respiratory therapy secrets / [edited by] Polly E Parsons, John E Heffner.–3rd ed p.; cm – (The secrets series) Includes bibliographical references and index ISBN-13: 978-0-323-03586-6 ISBN-10: 0-323-03586-8 Lungs–Diseases–Examinations, questions, etc Respiratory therapy–Examinations, questions, etc I Parsons, Polly E., 1954– II Heffner, John E III Series [DNLM: Respiratory Tract Diseases–Examination Questions WF 18.2 P982 2006] RC756.P84 2006 616.2′0076–dc22 2005057665 Vice President, Medical Student Publishing: Linda Belfus Developmental Editor: Stan Ward Senior Project Manager: Cecelia Bayruns Marketing Manager: Kate Rubin Printed in China Last digit is the print number: A03586-FM.qxd 3/15/2006 9:30 AM Page v DEDICATION To our spouses, Jim Jacobson and Ann Heffner, for their support and understanding, and to our children, Alec and Chandler Jacobson and John and Jim Heffner, for their inspiration and patience A03586-FM.qxd 3/15/2006 9:30 AM Page vi A03586-FM.qxd 3/15/2006 9:30 AM Page vii CONTENTS Top 100 Secrets I BEDSIDE EVALUATION Taking the Pulmonary History 11 Karen A Fagan, MD Physical Examination 16 Samer Saleh, MD, and Om P Sharma, MD, FRCP Smoking Cessation 22 Steven J Kolpak, MD, and Thomas D MacKenzie, MD, MSPH Pulmonary Rehabilitation 28 Bonnie F Fahy, RN, MN Pulmonary Disability Evaluation 32 Oyebode A Taiwo, MD, MPH, Carrie A Redlich, MD, MPH, and Akshay Sood, MD, MPH Preoperative Assessment of the Pulmonary Patient 38 Katherine Habeeb, MD, FCCP Postoperative Pulmonary Care 44 Jeanine P Wiener-Kronish, MD, and John M Taylor, MD II DIAGNOSTIC IMAGING Chest Radiographs 59 David L Levin, MD, PhD, and Jeffrey S Klein, MD Computed Tomography Scans and Ultrasound 65 David A Lynch, MD 10 Pulmonary Angiography and Magnetic Resonance Imaging of the Chest 72 Jonathan Kullnat, MD, and Marc V Gosselin, MD III LABORATORY EVALUATION 11 Arterial Blood Gases 79 Dean Hess, PhD, RRT 12 Pulse Oximetry 87 Philip L Goodman, MS, RRT, and Robert F Wolken, BS, RRT 13 Pulmonary Function Testing 91 Lee K Brown, MD, and Albert Miller, MD vii A03586-FM.qxd viii 3/15/2006 9:30 AM Page viii CONTENTS 14 Clinical Exercise Testing 101 Alexander S Niven, MD, Gregory B Tardie, PhD, and Idelle M Weisman, MD IV PROCEDURES 15 Thoracentesis and Percutaneous Pleural Biopsy 111 Polly E Parsons, MD, and Yuan-Po Tu, MD 16 Bronchoscopy 117 Udaya B S Prakash, MD 17 Interventional Pulmonology 125 James L Knepler, Jr., MD, and Praveen N Mathur, MBBS 18 Chest Tubes 130 Thomas Corbridge, MD, and David Ost, MD 19 Flow-Directed Pulmonary Artery Catheters 135 John E Heffner, MD 20 Mediastinoscopy 142 Francis C Nichols, MD, and James R Jett, MD 21 Thoracoscopy 151 Robert J Karman, MD, and Praveen N Mathur, MBBS V AIRWAY DISEASE 22 Asthma 157 Anne E Dixon, MD 23 Chronic Obstructive Lung Disease 162 Victor Pinto-Plata, MD, and Bartolome R Celli, MD 24 Cystic Fibrosis 171 Lori Shah, MD, and Michael C Iannuzzi, MD VI INFECTIOUS DISEASE 25 Community-Acquired Pneumonia 177 Michael S Niederman, MD 26 Nosocomial Pneumonia 191 Richard G Wunderink, MD 27 Aspiration Syndromes 198 Rajesh Bhagat, MD, C Hewitt McCuller, Jr., MD, and G Douglas Campbell, Jr., MD 28 Fungal Pneumonia 206 Carol A Kauffman, MD, and Joseph P Lynch III, MD 29 Parasitic Infections 213 Samer Saleh, MD, and Om P Sharma, MD, FRCP 30 Viral Pneumonia 218 Carlos E Girod, MD A03586-FM.qxd 3/15/2006 9:30 AM Page ix CONTENTS 31 Pneumonia Prevention 226 Kala Davis, MD, Ann Weinacker, MD, and Steve Nelson, MD 32 Empyema and Lung Abscess 232 John E Heffner, MD 33 Tuberculosis 240 Neil W Schluger, MD 34 Atypical Mycobacteria 249 Milene T Saavedra, MD, and Michael E Hanley, MD VII PULMONARY COMPLICATIONS OF AIDS 35 Infectious Pulmonary Complications of HIV Infection 255 Mark J Rosen, MD, and Mangala Narasimhan, DO 36 Noninfectious Pulmonary Complications of HIV Infection 263 Mangala Narasimhan, DO, and Mark J Rosen, MD VIII PULMONARY VASCULAR DISEASES 37 Thromboembolic Disease 269 Harold I Palevsky, MD 38 Nonthrombotic Pulmonary Emboli 285 Michael P Gruber, MD, and Mark W Geraci, MD 39 Pulmonary Hypertension 295 Richard N Channick, MD IX INTERSTITIAL LUNG DISEASES 40 General Approaches to Interstitial Lung Disease 301 Talmadge E King, Jr., MD 41 Sarcoidosis 315 Marc A Judson, MD 42 Idiopathic Pulmonary Fibrosis 323 John E Heffner, MD 43 Collagen Vascular Disease 328 Marvin I Schwarz, MD 44 Bronchiolitis, Bronchiolitis Obliterans, and Small Airway Disease 333 Richard A Helmers, MD X VASCULITIS AND IMMUNOLOGIC DISEASES 45 Small Vessel Vasculitis: Wegener’s Granulomatosis, Microscopic Polyangiitis, and Churg–Strauss Syndrome 341 Stephen K Frankel, MD, and Kevin K Brown, MD 46 Diffuse Alveolar Hemorrhage 347 Steve Yang, MBBS, MRCP, FAMS, and Ganesh Raghu, MD, FACP, FCCP ix A03586-FM.qxd x 3/15/2006 9:30 AM Page x CONTENTS XI VENTILATORY DISORDERS 47 Sleep Apnea Syndromes 353 Lee K Brown, MD 48 Alveolar Hypoventilation 365 Robert D Ballard, MD XII OCCUPATIONAL AND ENVIRONMENTAL LUNG DISEASES 49 Silicosis, Coal Workers’ Pneumoconiosis, and Chronic Beryllium Disease 373 Lisa A Maier, MD, MSPH 50 Asbestos-Related Lung Disease 380 E Brigitte Gottschall, MD, MSPH 51 Hypersensitivity Pneumonitis and Other Disorders Caused by Organic Agents 388 Cecile Rose, MD, MPH 52 Occupational Asthma 395 Anne E Dixon, MD, and Ronald Balkissoon, MD 53 Drug-Induced Lung Disease 402 Andrew H Limper, MD, and Edward C Rosenow III, MD, MS 54 Radiation Injury to the Lung 408 Deborah Z Rubin, MD, and Marie E Wood, MD 55 Inhalational Injuries 412 David A Kaminsky, MD XIII LUNG NEOPLASMS 56 Solitary Pulmonary Nodules 419 Todd M Bull, MD, and Elizabeth L Aronsen, MD 57 Lung Cancer 424 Marc A Voelkel, MD, Teofilo L Lee-Chiong, Jr., MD, and Richard A Matthay, MD 58 Malignant Pleural Effusions 437 Steven A Sahn, MD 59 Systemic Complications of Lung Cancer 443 Peter Mazzone, MD, MPH, FRCPC, FCCP, and Alejandro Arroliga, MD, FCCP 60 Benign Neoplasms of the Lung 448 Karen Wesenberg, MD, and Melvin Morganroth, MD 61 Pulmonary Metastatic Disease 453 R Hal Hughes, MD, and Stephanie M Levine, MD XIV RESPIRATORY FAILURE 62 Acute Respiratory Failure 459 Hyun Joo Kim, MD, and David H Ingbar, MD 63 Acute Respiratory Distress Syndrome 469 Ellen L Burnham, MD, and Marc Moss, MD A03586-Index.qxd 602 14/3/06 2:13 PM Page 602 INDEX Lung transplantation (Continued) as pulmonary arterial hypertension treatment, 300 rejection in, 551–552, 554, 555–556 replantation, 551 unilateral, 549, 550 Lung tumors benign, 426, 448–452 classification of, 452 doubling time of, 430 malignant See Lung cancer Lung volume in chronic obstructive pulmonary disease, 165 static, measurement of, 98 Lung volume reduction surgery, 169 Lupus pernio, 20, 317 Lupus vulgaris, 20 Lymphadenopathy, mediastinal, in HIV–infected patients, 256 Lymphangioleiomyomatosis, 305, 565 Lymphatic system, sarcoidosis of, 316 Lymph nodes intrapulmonary, 451–452 in lung cancer staging, 143, 144–145, 146 Lymphoma in HIV-infected patients, 256, 264–265 as mediastinal mass cause, 61 metastatic, 454 Lymphoproliferative disorders, 426 M MacIntosh blades, 476, 479 Macroglossia, as obstructive sleep apnea cause, 354 Macrolide antibiotics, pneumococcal resistance to, 187 Magnetic resonance imaging (MRI), 75–77 applications of, 76–77 comparison with computed tomography, 75, 76 contraindications to, 77 disadvantages of, 76 of lung cancer, 430 of mesothelioma, 572 motion artifact reduction in, 77 of pulmonary embolism, 276 Malaria, 214, 217 Malingering, 36 Maximal expiratory pressure (PEmax), 99, 100 Maximal inspiratory pressure (PImax), 99, 100 Maximal oxygen consumption (VO2), in lung resection patients, 43 Maximal voluntary ventilation (MVV), measurement of, 91, 97–98 Mean pulmonary artery pressure, measurement of, 135 Measles, as pneumonia risk factor, 220 Mebendazole, 216, 217 Mechanically-ventilated patients bronchoscopic lung biopsy in, 123 bronchoscopy in, 122 thoracentesis in, 559 Mechanical ventilation See also Noninvasive mechanical ventilation in acute respiratory distress syndrome patients, 471–472 in acute respiratory failure patients, 465–468 advanced modes of, 465–468 ARDSnet protocol for, 55, 56 assist-control, 52, 502–503, 517 as weaning strategy, 523 in chronic obstructive pulmonary disease, 168–169 chronic/prolonged, 527–533 in chronic obstructive lung disease patients, 48 definition of, 524 at home, 531–533 commonly used modes of, 52–53 dual-mode, 53 humidification reservoir changing in, 56 indications for, 462 intermittent elective, in chronic respiratory failure, 530–531 intermittent mandatory, 52 synchronized, 502, 503 without pressure support, 523 lung-protective ventilation strategies, 511–512 in acute respiratory failure, 465–467, 468 in the operating room, 56 median duration of, 524 negative pressure, as chronic obstructive pulmonary disease treatment, 371 postoperative, 52–53 ventilator settings in, 53 pressure, 52–53 pressure-control, 462, 463, 465, 502, 505–506, 511, 512–513 pressure-regulated, 506 pressure-support, 462, 463, 502, 503–504, 517, 518 as pulmonary embolism cause, 274 in status asthmaticus patients, 161 synchronized intermittent mandatory, 502, 503 traditional invasive, 501–510 usual modes of, 502 ventilation circuit changing in, 55–56 as ventilator-associated pneumonia cause, 191, 192–193 ventilator-patient dyssynchrony in, 16 volume, 52, 53 weaning from, 522–526 definition of, 522 failure of, 523, 524, 525 gradual, 526 in long-term ventilator-dependent patients, 525–526 rationale behind, 56 reintubation rate after, 524 role of noninvasive positive pressure ventilation in, 499 A03586-Index.qxd 14/3/06 2:13 PM Page 603 INDEX Mediastinal masses, common causes of, 61 Mediastinoscopy, 141–149 extended cervical, 143, 146 for lung cancer evaluation, 431 technique of, 141, 142 Mediastinotomy, anterior (Chamberlain procedure), 141, 142, 143, 147, 431 Mediastinum compartments of, 61 endoscopic ultrasound evaluation of, 146 Medicare reimbursement, for home oxygen therapy, 544 Medicare requirements, for long-term oxygen therapy, 536, 537 Medroxyprogesterone, as chronic obstructive pulmonary disease treatment, 371 Melanoma, metastatic, 453, 454, 455, 457 Melioidosis, 214 Meningitis, sarcoidosis-related, 318 Menstruation, as pneumothorax risk factor, 566 Mesothelial cells, in pleural fluid, 564 Mesothelioma, 426, 571–576 “benign,” 572 definition of, 386 diagnosis of, 572–574 medicolegal issues in, 574 differential diagnosis of, 573 histologic subsets of, 574 management of, 386–387, 575–576 thorascopic, 154 palliative therapy for, 576 paraoccupational asbestos exposure-related, 381–382 as pleural effusion cause, 438 prognosis for, 574–575 staging in, 574 Metal fume fever, 415–416 Metallic objects, as magnetic resonance imaging contraindication, 77 Metastasectomy, pulmonary, 456–457 Metastatic disease, pulmonary, 453–457 differentiated from pulmonary emboli, 292 as solitary pulmonary nodule cause, 420 Metered-dose inhalers comparison with nebulized inhalers, 167 use in intubated and nonintubated patients, 55 Methacholine challenge test, 157, 398 Methemoglobin (metHb), 79, 82 effect on pulse oximetry readings, 88 Methicillin resistance, in Staphylococcus aureus, 191, 196 Methotrexate low-dose, pulmonary complications of, 405–406 as sarcoidosis treatment, 321 Methylprednisolone as chronic obstructive pulmonary disease treatment, 166 as fat embolism syndrome treatment, 288 Methylxanthines, as asthma treatment, 160 Metronidazole, ineffectiveness as lung abscess treatment, 239 Metyrapone, as ectopic Cushing’s syndrome treatment, 446 Microaspiration, 192, 198 Miller blades, 476, 480 Mineral dust exposure, as bronchiolitis cause, 340 Minitracheostomy, 485 Minocycline as diffuse alveolar hemorrhage cause, 349 as sarcoidosis treatment, 321 Minute ventilation (VE), 82 ventilator settings in, 506 Mithramycin, as humoral hypercalcemia of malignancy treatment, 445 Mitral regurgitation, pulmonary artery catheter placement in, 135 Mitral stenosis, 349 Mixed connective tissue disease, 328, 330, 331 Mixed venous blood oxygen (MVO2), measurement of, 139 Monoclonal antibodies, as sarcoidosis treatment, 321 Mononucleosis-like syndrome, in lung transplant recipients, 553 Montgomery T-tubes, 127 Moraxella catarrhalis infections, 178, 184 in HIV-infected patients, 257 Morbidly obese patients intubation in, 478 postoperative complications in, 57 Motivational interventions, five Rs of, 23 Motor end plate disorders, as alveolar hypotension cause, 365 Mucoepidermoid tumors, 426 Mucoid impaction syndromes, 118, 119, 174 Mucolytic therapy in cystic fibrosis patients, 174, 175 in postoperative patients, 51 Mucormycosis (zygomycosis), 210, 238 Mucosa-associated lymphoid tissue (MALT), 335 Müller’s maneuver, 357, 358 Multiple-organ dysfunction syndrome (MODS), 473 Muscular dystrophy, 365, 366, 370–371 Musculoskeletal disorders lung cancer-related, 425 sarcoidosis-related, 319 Mustard gas, 417 Myasthenia gravis, 48, 365 Mycetomas, pulmonary, 206–207 Mycobacterial infections, 173 atypical, 249–254 classification of, 249 clinically significant, 249–250 lung infiltrates in, 189 Mycobacterium abscessus infections, 249, 250, 251, 252, 254 603 A03586-Index.qxd 604 14/3/06 2:13 PM Page 604 INDEX Mycobacterium avium complex (MAC) infections, 249, 250, 251, 252–254 in HIV-infected patients, 253–254, 267 Mycobacterium avium-intracellulare infections, in HIV- infected patients, 256 Mycobacterium bovis infections, 249 Mycobacterium kansasii infections, 249, 250, 251 differentiated from Mycobacterium tuberculosis, 252 Mycobacterium leprae infections, 249 Mycobacterium tuberculosis infections, 240, 243, 249, 315 See also Tuberculosis in HIV-infected patients, 256, 267 treatment of, 183, 184 Mycophenolate, use in lung transplant recipients, 554 Mycoplasma infections, as sarcoidosis cause, 315 Mycoplasma pneumoniae infections, 178, 336 in HIV-infected patients, 257 treatment of, 183 Myoblastomas, granular cell, 452 Myocardial infarction, 56, 357 Myositis, interstitial lung disease-related, 306 N Nail polish, effect on pulse oximetry readings, 87 Nasal airways, 478 Nasal cannula, for oxygen delivery, 541, 543 complications of, 544, 546 Nasal obstruction, treatment of, 361 Nasogastric tubes, proper radiographic position of, 64 Nasotracheal intubation, as nosocomial pneumonia risk factor, 229 Nebulization continuous, 55 jet, 55 Nebulizers, differentiated from humidifiers, 53 Necrobiotic nodules, 330 Nematodes, 215 Nephrotic syndrome, 425, 561 Nerve agents, as chemical weapons, 416–417 Neurofibromas, 452 Neurofibromatosis, 578 Neurologic disorders fat embolism syndrome-related, 285, 286 lung cancer-related, 425, 426 Neuromuscular diseases as alveolar hypotension cause, 365, 370 as aspiration cause, 199 Neuropathy, sarcoidosis-related, 318 Neurosarcoidosis, 318 Nicotine dependence See also Smoking assessment of, 22 Nicotine replacement therapy (NRT), 25–26, 27 contraindications to, 26 Nicotine withdrawal, 23 Niemann-Pick disease, 305 Nitrofurantoin, 404 Nitrogen dioxide, as bronchiolitis cause, 335 Nitrogen washout technique, 98 Nocardia infections, 189, 238, 257, 336 Nocturia, obstructive sleep apnea-related, 355 Nodules, pulmonary metastatic, 453 necrobiotic, 330 pneumoconiotic, 330 silicotic, 373 solitary, 419–423, 455 benign, 419, 448 calcification of, 430 definition of, 448 doubling of volume of, 423 imaging of, 448–449 malignant, 419, 420, 421–422, 429–430 Mycobacterium avium complex-related, 254 radiographic evaluation of, 63 subcentimeter, 451 Noninvasive mechanical ventilation, 490–500 alternative strategies for, 511–521 adaptive support, 517–518 airway pressure release, 511, 514–515 assist-control, 52, 502–503, 517, 523 automatic tube compensation, 518–519 closed-loop, 511, 515–516 dual-control breath-to-breath pressure, 519 high-frequency, 511, 519–520 liquid, 521 neurally adjusted ventilatory assist, 517 partial liquid, 511, 521 permissive hypercapnia, 511, 513–514 pressure-controlled inverted ratio, 511, 512–513 pressure-support, 462, 463, 502, 503–504, 517, 518 proportional-assist, 465–466, 467, 516–517 in chronic obstructive pulmonary disease, 168 continuous positive airway pressure (CPAP), 462, 490 in cardiogenic pulmonary edema treatment, 498, 499 in congestive heart failure treatment, 56 definition of, 508 in intubated patients, 53 in myocardial infarction treatment, 56 nasal, as obesity hypoventilation syndrome treatment, 369 in nonintubated patients, 53 obstacles to compliance with, 360 as obstructive sleep apnea treatment, 358–360 as postoperative airway obstruction treatment, 50 contraindications to, 463 definition of, 462, 490 indications for, 462–463 noninvasive positive pressure ventilation (NPPV), 490, 491–499 in acute cardiogenic pulmonary edema, 498 A03586-Index.qxd 14/3/06 2:13 PM Page 605 INDEX Noninvasive mechanical ventilation (Continued) in acute respiratory failure, 490–491, 493–496, 499 air leakage during, 498 in asthmatic patients, 161 complications of, 497 as contraindication to lung transplantation, 550 gastric tube use with, 495 humidification use with, 495, 497–498 indications for, 492, 493 masks (interfaces) for delivery of, 491 in postextubation respiratory failure, 524 predictors of failure of, 493, 494 ventilators for, 491–492 positive end-expiratory pressure (PEEP), 490, 507–508 in acute respiratory distress syndrome patients, 470, 472 auto-positive end-expiratory pressure (auto-PEEP), 491, 508–509, 524 definition of, 507 effect on pulmonary artery catheter pressure measurements, 139 face or nasal masks for, 463 as gastric aspiration treatment, 202 intrinsic See Auto-positive end-expiratory pressure (auto-PEEP) Nursing home residents, influenza vaccination in, 221 O Obesity See also Morbidly obese patients expiratory reserve volume in, 93 as obstructive sleep apnea cause, 354, 355 Obesity hypoventilation (Pickwickian) syndrome, 357, 358, 366, 368–369 Obliterative arteritis, schistosomiasis-related, 216–217 Obliterative bronchiolitis See Bronchiolitis obliterans Obstructive lung disease collagen vascular diseases-related, 332 differentiated from restrictive lung disease, 94–95 as solitary pulmonary nodule cause, 420 Obstructive sleep apnea, 47, 354–364 evaluation of, 15 hypothyroidism-related, 367–368 hypoventilation-related, 368 as postoperative pulmonary complications risk factor, 41 preoperative management of, 40 Occupational exposure history, 14, 34 in interstitial lung disease patients, 304 Octreotide, as ectopic Cushing’s syndrome treatment, 446 Oleoresin Capsicum, 417 Omalizumab (anti-immunoglobulin E), 160 Oral airways, 478 Oral cavity cancer, smoking-related, 25 Oral contraceptives, pulmonary hypertensionaggravating effect of, 300 Organic agents definition of, 388 as lung disorder cause, 388–394 Organic dust toxic syndrome (ODTS), 388, 415–416 Organ transplantation as bronchiolar disorders cause, 334 as cytomegalovirus infection cause, 222–223 as sarcoidosis treatment, 322 Oropharynx, microbial colonization of, 192 Orthopnea, 11 Oseltamivir, 220, 221, 225 Osteoarthropathy, hypertrophic pulmonary, 19, 425, 447 Osteopenia, cystic fibrosis-related, 173 Osteoporosis, 173, 554, 557 Ovarian cancer, as pleural effusion cause, 437, 439, 440, 455 Oxygen-conserving devices, 543–544, 545 Oxygen delivery devices, 540, 541–542 Oxygen delivery (DO2), measurement of, 139 Oxygen saturation of arterial blood, 79 measurement of, 82 Oxygen therapy, 535–546 for acute chest syndrome-related hypoxemia, 582–593 for acute respiratory failure, 463 during air travel, 537–538 for chronic obstructive pulmonary disease, 371 cost of, 540 hazards to, 53 at home, 539–540 Medicare reimbursement for, 544 implication for within-hospital patient transport, 546 indications for, 535–536 long-term in chronic obstructive pulmonary disease, 167, 169 indications for, 535–536 Medicare requirements for, 536 monitoring and adjustment of, 544 in nonintubated patients, 51–52 for pneumothorax, 568 postoperative, 44–45 prescription for, 537 risks associated with, 544, 546 Oxyhemoglobin dissociation curve, 82 Ozone, pulmonary toxicity of, 413 P Pacemakers, as magnetic resonance imaging contraindication, 77 Pain, thoracentesis-related, 112 Palliative therapy for lung cancer, 432 for mesothelioma, 576 Panbronchiolitis, diffuse, 334, 339–340 Pancoast’s tumor, 426, 432 605 A03586-Index.qxd 606 14/3/06 2:13 PM Page 606 INDEX Pancreatic cancer, 25, 454, 455 Pancreatitis, 577, 580–581 Panniculitis, pulmonary, 578, 579 Papillary muscles, pulmonary artery catheter-related injury to, 140 Papilledema, 20 Papillomatosis, 452 Paragonimiasis, 213–214, 215, 217, 238 Parainfluenza, as pneumonia risk factor, 218 Paralytic agents, 482 Paraneoplastic syndromes, 443–447 carcinoid syndrome-related, 450 definition of, 443 endocrine, 443–447 lung cancer-related, 425–426, 443–447 neurologic, 447 Parapneumonic effusions, 115 antibiotic therapy for, 235, 562 chest tube placement for, 129 clinical signs of, 232–233 complicated, 562, 563 definition of, 232 diagnosis of, 233 drainage of, 132–133, 233–236 as rounded atelectasis cause, 385 Paraproteinemias, 578 Parasitic infections, 213–217 as solitary pulmonary nodules cause, 419 Parathyroid hormone-related protein, 444 Parenchymal bands, asbestosis-related thickening of, 382 Parotid gland, in sarcoidosis, 319 Partial pressure of carbon dioxide in alveolar gas (PaCO2), body temperature-adjusted, 86 Partial pressure of oxygen in arterial blood (PaO2), 79 in acute respiratory failure, 459, 463–464 calculation of, 80–81 determinants of, 82, 83 levels of, 80–81 in lung impairment evaluation, 34–35 relationship to oxygen saturation, 82 Passive smoking, as asthma risk factor, 157 Peak expiratory flow, 97 Peak inspiratory pressure, 510 Pelvis, fractures of, 285 D-Penicillamine, as diffuse alveolar hemorrhage cause, 349 Penicillin resistance, in Streptococcus pneumoniae, 186–187 Pentastomiasis, 217 Pentoxifylline, as sarcoidosis treatment, 321 Penumbra effect, 89 Peptic ulcer disease, in lung transplant recipients, 554, 557 Peptostreptococcus infections, 204, 238 Percodan, 403 Perfusion scans, 43 Pericarditis Dressler’s syndrome-related, 584 interstitial lung disease-related, 306 tuberculous, 247 Petechiae, fat embolism syndrome-related, 285, 287 pH of arterial blood, 79 body temperature-adjusted, 86 of pleural fluid, 234–235 Phenytoin, as diffuse alveolar hemorrhage cause, 349 Phosgene, pulmonary toxicity of, 335, 412, 413 Photodynamic therapy (PDT), 127 PHOX2 B gene mutations, 367 Phthisis, 376 Physical examination, 16–21 Pickwickian syndrome (obesity-hypoventilation), 357, 358, 366, 368–369 Pigeon breeder’s disease, 304 Pillar procedure, 362 Plasma cell granuloma, 452 Plasmodium spp., as malaria cause, 214, 217 Plateau pressure, 507 Platypnea, 11 Plethysmography body, 98 impedance, for pulmonary embolism diagnosis, 277 Pleura, inflammation of, as chest pain cause, 14 Pleural effusions, 565 benign asbestos-related, 381, 385–386 as chest pain cause, 14 chest tube placement in, 129, 130 chest x-ray findings in, 111 chyliform, 115 cirrhosis-related, 20 collagen vascular diseases-related, 328–329 congestive heart failure-related, 114 cryptogenic organizing pneumonia-related, 337 cytology of, 439, 440 differentiated from consolidation, 17 extrathoracic cancer-related, 455 hemorrhagic, 113, 561 in HIV-infected patients, 256 in liver transplant recipients, 583 malignant, 437–441, 563 chest tube placement in, 129, 132 pleurodesis of, 129, 132 thorascopic pleurodesis of, 152–153 treatment of, 440–441 mesothelioma-related, 386, 572, 573 as nosocomial pneumonia mimic, 193 pancreatitis-related, 580 paramalignant, 437 parapneumonic See Parapneumonic effusion size determination of, 62, 63 unilateral hemorrhagic exudative, 561 yellow nail syndrome-related, 578–579 A03586-Index.qxd 14/3/06 2:13 PM Page 607 INDEX Pleural fluid in diagnostic thoracentesis, 114 drainage of, 233–236 eosinophilia of, 564 glucose content of, 564 gross characteristics of, 114–115 malignant, pH of, 439 mesothelial cells in, 564 pH of, 234–235, 439 protein content of, 561 routine tests on, 114 undrained, 235 Pleural fluid cytology, 440 Pleural plaques asbestosis-related, 381, 382, 384, 385 non-asbestosis-related, 384 Pleural thickening, diffuse, asbestos exposurerelated, 381, 385 Pleurisy rheumatoid, 563 tuberculous, 563 Pleuritis, collagen vascular diseases-related, 329 Pleurodesis chemical, 441 indications for, 569 of malignant pleural effusions, 129, 132 for palliation of mesothelioma, 576 sclerosing agents for, 132, 150, 152, 154, 384, 441–442 thorascopy use in, 150 Pneumococci, antibiotic resistance in, 187, 257 Pneumococcal vaccination, 226, 227–228 contraindications to, 228 in immunocompromised patients, 230 side effects of, 228 Pneumoconiosis chest x-ray classification in, 383 coal workers’, 32, 376 as impairment and disability cause, 36 rheumatoid (Caplan’s disease), 377 Pneumoconiotic nodules, 330 Pneumocystis carinii infections in bone marrow transplant recipients, 583 in HIV-infected patients, 255, 256, 258–260 low-dose methotrexate-related, 405 as pneumothorax risk factor, 566 prevention of, in lung transplant recipients, 552 treatment of, 259–260 Pneumocystis jiroveci infections, 230–231 in HIV-infected patients, 256, 258 Pneumonectomy extrapleural, of mesothelioma, 576 pulmonary function testing prior to, 48 Pneumonia as acute lung injury cause, 46 as acute respiratory distress syndrome cause, 46 as acute respiratory failure cause, 459, 460 aspiration, 177, 198, 202 Pneumonia (Continued) causes of, 204, 216 clinical manifestations of, 203–204 prevention of, 191–192, 231 bacterial differentiated from viral pneumonia, 218 in HIV-infected patients, 255, 256, 257–258 in lung transplant recipients, 552 in bone marrow transplant recipients, 583 bronchiolitis obliterans-organizing (BOOP), 331, 334, 337, 402–403 in bone marrow transplant recipients, 583 connective tissue disease-related, 339 idiopathic, 334 lung infiltrates in, 189 as solitary pulmonary nodules cause, 419 as chest pain cause, 14 community-acquired, 177–190 collagen vascular diseases-related, 329 prevention of, 226–229 treatment of, 182–189 cryptogenic-organizing (COP), 334, 335, 336, 337 diagnosis and treatment of, 338 differentiated from cryptogenic bronchiolitis, 338–339 radiographic features of, 337–338 cytomegalovirus, 218, 219, 220, 222–223 in lung transplant recipients, 553 desquamative interstitial, 313 fungal, 206–212 in HIV-infected patients, 256–257 idiopathic interstitial, 302 in immunocompromised patients, prevention of, 230–231 influenza-related, 219, 220–222 inhalational agents-related, 412 interstitial, 331 Legionella, 388 nosocomial, 191–197 conditions which mimic, 193 definition of, 191 diagnosis of, 193–195 mechanical ventilation-related, 55 prevention of, 191–193, 229–230 quantitative cultures in, 193–195 treatment failure in, 196–197 treatment of, 195–196 ventilator-associated, 191, 192–193, 194, 195, 196 pleural effusions associated with, 115 pneumococcal, 179 Pneumocystis in HIV-infected patients, 255, 256, 258–260, 261 as pneumothorax risk factor, 566 prevention of, 230–231 prevention of, in lung transplant recipients, 552 treatment of, 259–260 prevention of, 226–231 Rhodococcus equi-related, 419 607 A03586-Index.qxd 608 14/3/06 2:13 PM Page 608 INDEX Pneumonia (Continued) “round,” 419 tracheostomy-related, 486 usual interstitial, 313, 323 diagnosis of, 325 histopathologic features of, 323 imaging of, 68, 69, 71 varicella, 224 acyclovir prophylaxis in, 224 ventilator-associated, 191, 192–193, 194, 195, 196 prevention of, 229 viral, 218–225 differentiated from bacterial pneumonia, 218 prevention of, 220–222 Pneumonitis aspiration, 198 cytomegalovirus infection-related, 222–224 in organ transplant patients, 223–224 hypersensitivity, 304, 388–394 diagnosis of, 390–392 treatment of, 392–393 lupus, 189, 328 lymphocytic interstitial, 331 in bone marrow transplant recipients, 583 radiation-related, 406, 408–409, 410, 411 as nosocomial pneumonia mimic, 193 toxoplasmosis-related, 216 usual interstitial, 392 Pneumothorax, 566–570 bronchoscopic lung biopsy-related, 120, 122 catamenial, 566 as chest pain cause, 14 chest tube placement in, 129, 131 classification of, 566 in cystic fibrosis patients, 172 iatrogenic, 567, 568 neonatal, 566 percutaneous pleural biopsy-related, 115 pulmonary artery catheterization-related, 141 radiographic appearance of, 59, 567–568 as rounded atelectasis cause, 385 secondary, 568 size determination of, 62 spontaneous, 566 primary, 566, 568, 569 recurrence rate for, 569 secondary, 566, 567, 569 thorascopic diagnosis and treatment of, 155 as subcutaneous emphysema cause, 16 tension, 569 thoracentesis-related, 559 thoracentesis-related, 112, 113, 560 tracheostomy-related, 486 transthoracic needle biopsy-related, 67 treatment of, 568–569 tuberculosis-related, 384 Polio vaccination, as mesothelioma risk factor, 572 Polyangiitis, microscopic, 342–343, 347, 348, 349 Polyarteritis nodosa, 343 microscopic, 343 Polymerase chain reaction (PCR), for viral pneumonia diagnosis, 219 Polymer fever, 415–416 Polymyositis-dermatomyositis, 302–303, 328, 331, 332 Polyneuropathy, critical illness, 525 Polypharmacy, 402 Polyps, nasal, cystic fibrosis-related, 172 Polysomnography for obstructive sleep apnea diagnosis, 356, 357, 358–359 for pulmonary hypertension evaluation, 296 Posaconazole, 210 Positive end-expiratory pressure (PEEP), 490, 507–508 as acute respiratory distress syndrome treatment, 470, 472 auto-positive end-expiratory pressure (auto-PEEP), 491, 508–509 with hyperinflation, 524 definition of, 507 effect on pulmonary artery catheter pressure measurements, 139 face or nasal masks for, 463 in gastric aspiration treatment, 202 intrinsic See Auto-positive end-expiratory pressure (auto-PEEP) Positron emission tomography (PET) in combination with computed tomography, 66 definition of, 148 of lung cancer, 142, 148, 149, 429, 430, 431 of mesothelioma, 572 of solitary pulmonary nodules, 421, 449 Postanesthesia care unit (PACU), 44 Postcardiac injury (Dressler’s syndrome), 385, 584 Postoperative lung function, 43 Postoperative pulmonary care, 44–57 general principles of, 44–45 Postoperative pulmonary complications (PPCs), 38–39 Posttransplantation lymphoproliferative disorder (PTLD), 553, 554, 557 Praziquantel, 214, 217 Prednisolone, use in cystic fibrosis patients, 175 Prednisone, as radiation pneumonitis treatment, 409 Pregnancy amniotic fluid embolism syndrome (AFES) during, 291–292 in cystic fibrosis patients, 176 expiratory reserve volume during, 93 influenza vaccination during, 221 malaria during, 217 nicotine replacement therapy during, 26–27 pulmonary embolism during, 283–284 anticoagulation therapy for, 284 fetal radiation exposure and, 283 pulmonary hypertension during, 300 tuberculosis during, 246 A03586-Index.qxd 14/3/06 2:13 PM Page 609 INDEX Preoperative assessment, of pulmonary patients, 38–43 Pressure-control ventilation, 462, 463, 465, 467 Pressure control-ventilation, 462, 463, 465, 467, 502, 505–506, 511, 512–513 Pressure-support ventilation, 462, 463, 502, 503–504, 517, 518 Pressure-volume curve, 309 Prevotella infections, 238 Prone position, 66, 475 Proopiomelanocortin, 445 Propionibacter acnes infections, 315 Proportional-assist ventilation, 465–466, 467, 516–517 Propylthiouracil, as diffuse alveolar hemorrhage cause, 349 Prostacyclin, as acute respiratory failure treatment, 464 Prostate cancer, metastatic, 454 Prostheses, cardiac valve, as magnetic resonance imaging contraindication, 77 Proton pump inhibitors, as nosocomial pneumonia risk factor, 229–230 Pseudallescheria boydii (Scedosporium apiospermum), 211 Pseudoaneurysms, pulmonary artery catheter-related perforation of, 140 Pseudomonal infections, in lung transplant recipients, 557 Pseudomonas aeruginosa infections, 173, 174, 178, 183, 191 antibiotic-resistant, 196 as aspiration pneumonia cause, 204 in cystic fibrosis patients, 173, 174, 175 in HIV-infected patients, 256 treatment of, 183, 184 Pulmonary artery, pulmonary artery catheterizationrelated rupture of, 140 Pulmonary artery diastolic pressure, measurement of, 137 Pulmonary artery occlusion pressure (PPAO) clinical significance of, 134, 137–138 effect of airway and alveolar pressures on, 139 measurement of, 134, 137–138 relationship to left ventricular end-diastolic pressure, 137–138 pulmonary capillary pressure, 138 Pulmonary artery systolic pressure, measurement of, 137 Pulmonary artery wedge pressure (PAWP) in acute respiratory distress syndrome, 469 measurement of, 134, 135 Pulmonary-cutaneous syndromes, 578–579 Pulmonary disability evaluation, 32–37 Pulmonary function organic agents-related impairment of, 388 postoperative, 43 Pulmonary function testing, 34, 35–36, 91–100 in acute respiratory distress syndrome, 473 in acute respiratory failure, 464 in asthma, 159, 398 in chronic obstructive pulmonary disease, 163–164 in cystic fibrosis, 173 effect of smoking cessation on, 22, 23–24 effect of smoking on, 23, 24 in hypersensitivity pneumonitis, 390 in hypoventilation, 366 in idiopathic pulmonary fibrosis, 325 in interstitial lung disease, 304, 308–309, 310 in lung transplantation candidates, 550–551 postoperative changes in, 39 preoperative, 40, 42 in chronic obstructive pulmonary disease patients, 169–170 in lung resection patients, 42–43 in preoperative risk assessment, 48–49 Pulmonary history, 11–15 Pulmonary reimplantation response, 551 Pulmonary-renal syndrome, 343, 349 Pulmonary tumor embolism, 292–294 Pulmonary vascular resistance index (PVRI), measurement of, 139 Pulmonary vascular resistance (PVR), measurement of, 139 Pulse, paradoxical, 524 Pulse oximetry, 87–90 in carbon monoxide poisoning, 414 in community-acquired pneumonia, 182 inaccurate readings in, 46–47 nocturnal, in chronic obstructive pulmonary disease, 371 in obstructive sleep apnea, 356 postoperative, 44–45 “Pump failure,” 459 Purified protein derivative (PPD) testing, in tuberculous pleurisy, 562 Pyrazinamide, as tuberculosis treatment, 244 R Radial artery, arterial puncture-related injury to, 79 Radiation exposure computed tomography-related, 65 as lung cancer cause, 424 as lung injury cause, 408–411 Radiation therapy in combination with chemotherapy, 410 endobronchial See Brachytherapy for lung cancer, 410, 432 for mesothelioma, 575 as pneumonitis cause, 406 prophylactic, in mesothelioma, 574 Radioallergosorbent test (RAST), in asthma, 395, 398, 399 Radon exposure, as lung cancer cause, 424–425 609 A03586-Index.qxd 610 14/3/06 2:13 PM Page 610 INDEX Rales definition of, 17 “Velcro,” 305 Raynaud’s phenomenon, 306 Reactive airways dysfunction syndrome (RADS), 395, 398 Recurrent laryngeal nerve, tracheostomy-related injury to, 486 Rehabilitation, pulmonary, 28–31 in chronic obstructive pulmonary disease, 170 comprehensive, 29 definition of, 28 goals of, 28 self-management education component of, 29–30 Renal cell carcinoma metastatic, 454, 455, 457 as pleural effusion cause, 455 Renal disease end-stage, 578 lung cancer-related, 425 in lung transplant recipients, 557 Wegener’s granulomatosis-related, 342 Renal failure, contrast media-related, 74 Renal insufficiency, as pulmonary angiography contraindication, 72 Residual volume (RV), definition of, 91 Respiration, types of, 16 Respiratory disorders apportionment in, 37 preexisting, 34 Respiratory distress syndrome See also Acute respiratory distress syndrome (ARDS) clinical signs of, 16 gastric content aspiration-related, 201 Respiratory failure acute, 459–468 complications of, 465, 466 continuous positive airway pressure ventilation in, 491 definition of, 459 hypercapnic, 459, 460 noninvasive positive pressure ventilation in, 490–491, 493–495, 499 oxygenation, 459 in perioperative patients, 464–465 prognosis for, 459–460 reversible causes of, 460 treatment of, 462–464 chronic, noninvasive positive pressure ventilation in, 495–497 drug-related, 407 hypercapnic, 20, 501 hypercarbic, 332 hypoxemic, 498 positive end-expiratory pressure ventilation in, 507–508 hypoxic, 501 as indication for bronchoscopy, 119 postextubation, 524 talc-related, 154 Respiratory insufficiency drug-related, 403–404 fat embolism syndrome-related, 285, 286, 287 Respiratory muscle strength, assessment of, 99, 100 Respiratory rate in fat embolism syndrome, 287 normal, 16 in respiratory distress, 16 Respiratory syncytial virus infections, 218, 220, 222 Respiratory tract infections as chronic obstructive pulmonary disease cause, 162 in cystic fibrosis patients, 173 as indication for bronchoscopy, 118, 119 as postoperative pulmonary complications risk factor, 38 upper, in children, 222 viral, relationship to asthma, 157, 159 Restrictive lung disease, 309 differentiated from obstructive lung disease, 94–95 postoperative complications of, 49 Retinoic acid, 349, 445 Rheumatoid arthritis coal miners’ pneumoconiosis-related, 377 as eye disorders cause, 19 interstitial lung disease-related, 302–303 low-dose methotrexate treatment of, 405 obstructive bronchiolitis associated with, 339 pulmonary manifestations of, 328, 329, 330, 331 Rheumatoid factor, 330 Rheumatologic disorders, lung cancer-related, 425 Rhinitis allergic, symptoms of, 390 in cat-sensitive individuals, 388 hydrogen sulfide poisoning-related, 415 Rhinoconjunctivitis, 388, 393 Rhodococcus equi infections, 238, 257, 419 Rhonchi airway obstruction-related, 17 differentiated from wheezes, 17, 18 inspiratory, interstitial lung disease-related, 303 Rib, fractures of, 14, 64 Ribavirin, 220, 222 Rifabutin, side effects of, 253 Rifampin side effects of, 253 as tuberculosis treatment, 244, 247 Rifapentine, as tuberculosis treatment, 244 Right atrial pressure, measurement of, 137 Right ventricular pressure, measurement of, 137 Right ventricular stroke work index (RVSWI), measurement of, 139 Rimantadine, 220, 221, 227 Riot-control agents, 417 Rituximab, 349 Rotten-egg odor, of hydrogen sulfide, 415 A03586-Index.qxd 14/3/06 2:13 PM Page 611 INDEX S Salivary glands, in sarcoidosis, 319 Sarcoidosis, 315–322 antigen exposure-related, 315–316 definition of, 315 extrapulmonary, 19, 20, 316, 317–319, 322 as eye disorders cause, 19, 20 as interstitial lung disease cause, 301, 306, 307, 312 pulmonary, 316–317, 319, 320 relationship to Crohn’s disease, 581 severity staging of, 317 treatment of, 320–322 Sarcoma Kaposi, 255, 256 metastatic, 453, 454, 455 SARS (severe acute respiratory syndrome), 229 Saturation, functional and fractional, 88 Scalene muscles, 16 Scedosporium, 210, 211 Schistosomiasis, 213, 215, 216–217 Scleritis, interstitial lung disease-related, 306 Scleroderma, pulmonary manifestations of, 328, 331 Secretion removal, in postoperative patients, 51 Secrets, Top 100, 1–9 Seldinger technique, 485 Selective decontamination of the digestive tract (SDD), 230 Self-management education, 29–30 Sellick maneuver (“cricoid pressure”), 480 Sensitizers, in asthma, 395, 396–397 Sepsis, 46, 469, 470–471 pulmonary embolism-related, 294 Serratia infections, 336 Severe acute respiratory syndrome (SARS), 225, 229 Severe acute respiratory syndrome (SARS)associated coronavirus, 220, 225 Shock anaphylactoid, 74 gastric content aspiration-related, 200–201 Shunts cystic fibrosis-related, 173 as hypoxemia cause, 81, 461 intrapulmonary, 200–201 left-to-right, detection of, 137 measurement of, 139 transjugular intrahepatic portosystemic, 561 Shuttle walk test, 101–102 Sickle cell anemia, 577, 581–583 Sildenafil, as pulmonary hypertension treatment, 298–299, 300 Silica carcinogenicity of, 375 exposure to, 330, 373–374 as pleural plaques cause, 384 Silicoproteinosis, 374, 376 Silicosis, 373–376, 374–375, 376 Silicotuberculosis, 375 Silo filler’s disease, 413 Simian virus 40, as mesothelioma risk factor, 572 Sinus disease, cystic fibrosis-related, 172 Sinusitis, 12, 229 Sirolimus, use in lung transplant recipients, 554, 555, 557 6-minute walk test (6MWT), 101 Sjögren’s syndrome, 331, 339 Skin cancer, in lung transplant recipients, 554, 557 Skin disorders, pulmonary disease-related, 19, 20, 306, 316, 317, 342, 425 Skin testing, in occupational asthma, 399 Sleep hypoventilation during, 367 oxygen therapy during, 167, 536 Sleep apnea syndromes, 353–364 See also Obstructive sleep apnea central, 362, 363 eucapnic, 363, 364 hypercapnic, 363–364 hypocapnic, 363, 364 definition of, 353 Sleepiness, excessive, obstructive sleep apnearelated, 355 Slow vital capacity, comparison with forced vital capacity, 98 Small airways disease, 336 mineral dust-related, 340 Smoke inhalation, 335, 416 Smoking as asthma cause, 157 as atherosclerosis cause, 42 as bronchiolitis cause, 334, 336 carcinogenicity of, 25 as chronic obstructive pulmonary disease cause, 162, 163 as diffusing capacity of the lung (DLCOSB) decrease cause, 100 as interstitial lung disease cause, 304 as lung cancer cause, 16, 25, 37, 424, 425, 430 in asbestos-exposed individuals, 386 in silica-exposed individuals, 375 in women, 425, 430 as pneumonia risk factor, 177, 179 as pneumothorax risk factor, 566 as postoperative pulmonary complications risk factor, 38, 40 prevalence of, 22 as solitary pulmonary nodule cause, 420 Smoking cessation, 22–27 in asbestos-exposed workers, 386 in bronchiolitis-associated lung disease patients, 337 in chronic obstructive pulmonary disease patients, 165 health benefits of long-term, 25 short-term, 24–25 pharmacologic therapies for, 26–27 preoperative, 38, 48 in silica-exposed workers, 375 societal interventions for, 27 611 A03586-Index.qxd 612 14/3/06 2:13 PM Page 612 INDEX Smoking cessation counseling, 22, 23 Smoking history, 11–12, 22 Sniffing position, 478, 479 Snoring, 15, 354, 357 SOAR mnemonic, for postanesthesia extubation, 45–46 Sodium nitrate as cyanide poisoning antidote, 415 as hydrogen sulfide poisoning antidote, 415 Sodium thiosulfate, as cyanide poisoning antidote, 415 Somnoplasty, 362 Spinal cord lesions, sarcoidosis-related, 318 Spirometry, 34, 91–97 in chronic obstructive pulmonary disease patients, 165 definition of, 91 forced expiratory, 92–95 flow-volume loops in, 95–97 in lung cancer patients, 430 in lung resection patients, 42–43 Spleen, thoracentesis-related injury to, 113 Split-lung ventilation, 465–466, 468 Spontaneous breathing tests (SBTs), 523 failure of, 523, 524 reintubation rate following, 524 Sputum Aspergillus isolation in, 207 black-pigmented, 376, 406 Candida isolation in, 208 cytomegalovirus isolation in, 223 Sputum analysis in community-acquired pneumonia, 182, 190 for lung cancer diagnosis, 429 for tuberculosis diagnosis, 261–262 Sputum production cough-related, 12 cystic fibrosis-related, 172 purulent, hemoptysis-related, 13 Squamous cell carcinoma, pulmonary, 426, 427 Staphylococcus aureus infections, 173, 184, 204, 232, 238 in HIV-infected patients, 257 methicillin-resistant, 191, 196 Static compliance, 507 Static deflation volume, in idiopathic pulmonary fibrosis, 309, 410 Status asthmaticus, mechanical ventilation in, 161 Stent, Charles S., 127 Stents, 127–128 Stevens-Johnson syndrome, 20 Stomach carcinoma, as pleural effusion cause, 437, 439–440, 455 Strength training, in pulmonary rehabilitation, 30 Streptococcus infections, 238 Streptococcus pneumoniae infections, 178, 181, 191 aspiration pneumonia, 204 drug-resistant, 228 empyema, 232 in HIV-infected patients, 257 Streptococcus pneumoniae infections (Continued) parapneumonic effusions, 232 penicillin-resistant, 186–187 pneumonia, 232 prevention of, 226, 228 treatment of, 183 Streptococcus pyogenes infections, 238 Streptokinase, 236, 279, 280 Streptomycin, as tuberculosis treatment, 244 Stress testing, cardiac, 101, 102 Strictures, tracheobronchial, 119 Stridor, treatment of, 52 Strokes, paradoxical embolism-related, 284 Stroke volume index (SVI), measurement of, 139 Stroke volume (SV), measurement of, 134, 139 Strong ion difference, 85 Strongyloidiasis, 213, 217 in immunocompromised patients, 216 Subpleural lines, curvilinear, asbestosis-related, 382 Succinylcholine, 482 Suicide attempts, drug-related, 403–404 Sulfur dioxide, pulmonary toxicity of, 335, 413 Superior vena cava syndrome, 16, 425 Supine position effect on functional residual capacity, 44 as nosocomial pneumonia risk factor, 229 during thoracic computed tomography scans, 66 Supplemental oxygen See Oxygen therapy Surgery, pulmonary function effects of, 44 Surgical sites, as postoperative pulmonary complications risk factor, 39, 40 Swallowing See also Dysphagia effect of tracheostomy on, 488–489 Syncope, pulmonary embolism-related, 269, 270 Syndrome of critical illness polyneuropathy, 525 Syndrome of inappropriate secretion of antidiuretic hormone (SIADH), lung cancer-related, 425, 429, 443–444 Systemic disorders lung cancer-related, 425 pulmonary manifestations of, 577–584 Systemic lupus erythematosus, 343 as diffuse alveolar hemorrhage cause, 347, 349 as eye disorders cause, 19 interstitial lung disease-related, 302–303 pulmonary manifestations of, 328, 329, 330, 331–332 Systemic sclerosis, pulmonary manifestations of, 331 Systemic vascular resistance (SVR), measurement of, 134, 139 T Tacrolimus, use in lung transplant recipients, 554 Talc, as pleurodesis agent, 132, 152, 440–441 side effects of, 132, 154, 384 Tamponade, 524 pulmonary artery catheterization in, 137 A03586-Index.qxd 14/3/06 2:13 PM Page 613 INDEX Telangiectasia hereditary hemorrhagic, 578 interstitial lung disease-related, 306 Teratomas, 451, 452 Terbutaline, as pulmonary edema cause, 406–407 Testicular cancer, metastatic, 454 Thalidomide, as sarcoidosis treatment, 321 Theophylline as central hypoventilation treatment, 368 as chronic obstructive pulmonary disease treatment, 166, 371 Thiabendazole, 217 Thoracentesis, 112–115 in combination with ultrasound, 68 complications of, 112–113 contraindications to, 112, 559 diagnostic in community-acquired pneumonia, 182 in mesothelioma, 573 in pleural effusion, 559 indications for, 112 as pneumothorax cause, 559, 567 technique of, 233 therapeutic complications of, 560–561 for malignant pleural effusions, 440 ultrasound-guided, 112 Thoracic outlet syndrome, neurogenic, 426 Thoracostomy as bronchopleural fistula cause, 569–570 chest tubes for complications of, 569 removal of, 570 size of, 568 lung nonexpansion in, 569 in pneumothorax patients, 568–569 Thoracotomy complications of, 49, 50 of empyemas, 235–236 of interstitial lung disease, 312 of mesothelioma, 573 preoperative patient evaluation for, 49 of solitary pulmonary nodules, 423 Thorascopy, 150–155 complications of, 153 contraindications to, 151 diagnostic, indications for, 150 equipment for, 151 medical, 150 of mesothelioma, 154 of spontaneous pneumothorax, 155 surgical, 150 technique of, 151–152 therapeutic of chylothorax, 154 indications for, 150–151 video-assisted, of solitary pulmonary nodules, 423 Thorotrast, as mesothelioma cause, 571 Three-dimensional (3-D) treatment planning, 410–411 Thromboembolic disease, pulmonary, 269–284 angiographic findings in, 73 collagen vascular diseases-related, 330 Thromboendarterectomy, pulmonary, 298 Thrombolytic therapy for pulmonary embolism, 279–282 complications of, 280–281 local versus systemic, 281–282 during pregnancy, 284 for upper-extremity deep venous thrombosis, 282 Thrombosis, deep venous aggressive therapeutic intervention for, 282 D-dimer assay in, 271–273 factor V Leiden mutation-related, 282–283 pulmonary artery catheterization-related, 140 treatment of, 282 ultrasound-based diagnosis of, 69–70 upper-extremity, as pulmonary embolism cause, 277 Thymomas, as mediastinal mass cause, 61 Thyrotoxicosis, 577, 580 Tibia, fractures of, 285 Tidal volume (TV), 91 during exercise, 108, 109 Tietze’s syndrome (costochondritis), 17 Timoptic ophthalmic solution, 403 Tissue plasminogen activator, 236 recombinant, 279, 280 Tobramycin, aerosolized, 174 Tocolytic agents, as pulmonary edema cause, 406–407 Top 100 Secrets, 1–9 Total lung capacity (TLC), 91 in chest wall disease, 99 in interstitial lung disease, 99, 309 in neuromuscular disease, 99 Toxocariasis (visceral larva migrans), 213, 215–216 Toxoplasmosis in immunocompromised patients, 216 neonatal, 213 Tracheobronchial lesions, clinical findings in, 124 Tracheobronchial papillary tumors, 450–451 Tracheostomy, 484–489 benefits of, 487–488 as central hypoventilation treatment, 368 complications of, 486 long-term, 488 in critically ill patients, 484–485 effect on ability to eat or talk, 488–489 in intubated, ventilator-dependent patients, 486–487 for long-term ventilatory support, 531 open surgical, 484, 486 percutaneous dilatational, 124, 484–486 complications of, 485, 486 contraindications to, 485–486 as pneumothorax cause, 567 as postoperative airway obstruction treatment, 50 613 A03586-Index.qxd 614 14/3/06 2:13 PM Page 614 INDEX Tracheostomy tubes, removal of, 489 Transfer factor (TL), 99 Transitional cell carcinoma, spontaneous regression of, 457 Transudates, classification of, 560 Trapped lung, 562 Trauma as acute respiratory distress syndrome cause, 469, 470–471, 474 thoracic, as rounded atelectasis cause, 385 Travelers, influenza vaccination in, 221 Treadmill exercise test, 101 with cardiopulmonary exercise testing, 104 Trendelenburg’s position, in air embolism patients, 290, 291 Treprostinil, as pulmonary hypertension treatment, 298–299, 300 Trichinella spp., 215 Trichinosis, 214, 215, 217 Tricuspid insufficiency, 136 Trimellitic anhydride, as diffuse alveolar hemorrhage cause, 350 Trimethoprim-sulfamethoxazole, 231, 552 Tripod sign, 16 Trophoblastic carcinoma, spontaneous regression of, 457 Trypanosoma cruzi, 216 Trypanosomiasis, American (Chagas’ disease), 216 Tuberculin testing, 240–241 in HIV-infected patients, 248, 261 during pregnancy, 240, 246 second-strength, 240 for tuberculous pleurisy diagnosis, 563 Tuberculosis, 240–248 choroid tubercles associated with, 19, 20 contact investigations of, 243–244 drug-resistant, preventive therapy for, 247–248 in HIV-infected patients, 255, 260–262 immune reconstitution inflammatory syndrome (IRIS)- related, 267 latent, 241 multidrug-resistant, 262 preventive therapy for, 241 in silica-exposed workers, 375 treatment of, 241, 244–247 directly observed, 244, 245 Tuberous sclerosis, pulmonary manifestations of, 578, 579 Tumor embolism, 292–294 Tumor growth doubling time, 430 Tumorlets, pulmonary, 451, 452 Tumor necrosis factor, as sarcoidosis treatment, 321 Tumor seeding, thoracentesis-related, 113 U Ulcers, cutaneous, 20 Ultrasound, 68–70 compression, of deep venous thrombosis, 278 Ultrasound (Continued) duplex, of pulmonary embolism, 277 endobronchial, 124, 126 endoscopic esophageal, of lung cancer, 142 for mediastinum evaluation, 146 Ultrasound-guided thoracentesis, 112 Upper airway, inhalation-related injury to, 416 Upper airway resistance syndrome, 353 Upper respiratory tract, sarcoidosis of, 319 Upper respiratory tract infections, in children, 222 Urinothorax, 560, 561 Urokinase, 236, 279, 280 Urticaria, 74, 425 Uveitis, 19, 306, 317 Uvulopalatopharyngoplasty, 361 V Valacyclovir, 552 Valves, cardiac, pulmonary artery catheter-related injury to, 140 Varicella, as pneumonia cause, 224 acyclovir prophylaxis in, 224 Varicella vaccine, 220 Varicella zoster immunoglobulin (VZIG), 224 Varicella-zoster virus, as pneumonia cause, 218, 220 Vascular endothelial growth factor (VEGF), 438 Vascular injuries, radiation-related, 410 Vasculitis computed tomographic findings in, 68 definition of, 341 interstitial lung disease-related, 306 retinal, 19, 20 small vessel, 341–345 disease which mimic, 341–342 idiopathic, 341 prognosis for, 345 Venography, computed tomographic, 70 Veno-occlusive disease, 296, 583 Ventilation See also Mechanical ventilation apnea or hypopnea-related decrease or absence of, 353 bag mask, 477 Ventilation-perfusion lung scans, 43 of lung cancer, 430 prior to pneumonectomy, 48 of pulmonary embolism, 274–276 for pulmonary hypertension evaluation, 296, 297 Ventilation-perfusion mismatch, 200–201 cystic fibrosis-related, 173 as hypoxemia cause, 81, 461 as oxygenation failure cause, 459 postoperative, 39 Ventilator alarms, 509–510 Ventilator breath, 511–512 Ventilator circuitry, spontaneous breathing tests through, 524 A03586-Index.qxd 14/3/06 2:13 PM Page 615 INDEX Ventilators for noninvasive positive pressure ventilation (NVVP), 491–493 rebreathing in, 492 settings for, 506–507 Ventilatory muscle fatigue, during chronic ventilatory support, 530 Vesicles, 20 Video-assisted thoracic surgery (VATS), 141–142, 143, 147, 150 lymph node access in, 143 Viral infections See also specific viruses as community-acquired pneumonia cause, 178 Visceral larva migrans (toxocariasis), 213, 215–216 Vital capacity (VC), 91 preoperative assessment of, 48 slow (SVC), 91, 92 surgery-related decrease in, 44 Vocal cords dysfunction of, 158 visualization of, 479–480 Volume of oxygen maximal utilization (VO2max), as exercise capacity index, 105 Volume recruitment therapy, postoperative, 53–54 Voriconazole, 206, 207, 208, 209, 553–554 side effects of, 212 W Warfarin, as pulmonary hypertension treatment, 297 Weapons of mass destruction, 416–417 Weber-Christian disease, 578, 579 Wegener’s granulomatosis, 19, 341, 342, 343, 344 as diffuse alveolar hemorrhage cause, 347, 348, 349, 350 lung infiltrates in, 189 Weight gain, smoking cessation-related, 25 Weight loss, mesothelioma-related, 572 Wheezing airway obstruction-related, 17 asthma-related, 158, 389 benign lung tumors-related, 448 chronic obstructive pulmonary disease-related, 163 differentiated from rhonchi, 17, 18 gastric aspiration-related, 200–201 interstitial lung disease-related, 303 postoperative, 47 Whipple’s disease, 578, 579 Workers’ compensation, 37 definition of, 33–34 guidelines for determination of, 32 Wuchereria bancrofti, 215 Y Yellow nail syndrome, 578–579 Z Zanamivir, 220, 221 Zygomycetes, 210 Zygomycosis (mucormycosis), 210, 238 615 A03586-Index.qxd 14/3/06 2:13 PM Page 616 ... the first two editions of Pulmonary/ Respiratory Therapy Secrets In this third edition, we have again been fortunate to have many leaders in pulmonary medicine and respiratory therapy contribute... Charleston, South Carolina A03586-FM.qxd 3/15 /2006 9:30 AM Page iv 1600 John F Kennedy Boulevard Suite 1800 Philadelphia, PA 19103-2899 Pulmonary/ Respiratory Therapy Secrets Third Edition ISBN-13: 978-0-323-03586-6... of Congress Cataloging-in-Publication Data Pulmonary/ respiratory therapy secrets / [edited by] Polly E Parsons, John E Heffner.–3rd ed p.; cm – (The secrets series) Includes bibliographical references