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Background: Chronic Obstructive Pulmonary Disease (COPD), a common disease worldwide, refers to two frequently coexisting lung diseases, chronic bronchitis and emphysema. Physiologically, COPD represents a disruption in ventilation and in the exchange of gases in the lungs. A sharp worsening obstructive pulmonary disease with respiratory acidosis leads to repeated hospitalizations and high mortality rates., Objective: This study examined patients with COPD during hospitalization. Parameters included: the number of patients admitted for a defined period of time, the time of ventilation, the average length of hospitalization, the treatment modality, the mortality rate and the percentage of returning patients., Methods: We chose 260 admissions with worsening chronic obstructive pulmonary disease during a six month period in internal medicine departments and the intensive care unit. We selected patients who met the criteria and collected demographic data, complete blood tests including blood gases and checking the ventilator during hospitalization. We checked the relationship between the indices for hospitalization, and the mechanical ventilation., Results: A total of 255 admissions were enrolled in the study; 13 patients were excluded. Data was collected from 242 hospitalizations; 242 admissions included 71 patients hospitalized more than once. Patients' age ranged from 34 to 97 years with a median age of 66.6 years. During hospitalization, 194 patients (80%) were admitted to the internal medicine departments and 48 patients (19.8%) needed mechanical ventilation in intensive care. Most patients (60.7%) were hospitalized for 2 to 4 days, but 50% of the group of patients were hospitalized for almost one week., Conclusion: Although the results were almost identical to those found in the literature we found other factors related to the aggravation of the disease e.g. smoking, ischemic heart disease and malignancy, which are more common in this group of diseases.

Fat embolism syndrome is a clinical entity characterized by varying degrees of cerebral dysfunction, pulmonary changes and petechial rash that usually develop within 24-48 hours in a small percentage of victims after trauma and Long bone fractures. Deterioration can occur within a few hours Leading to unconsciousness or acute respiratory insufficiency, similar to adult respiratory distress syndrome (ARDS). The pathophysiology is still not clearly understood and there are two theories--the mechanical and biochemical cascade of events. It seems that the most significant diagnostic sign is hypoxemia with relatively normaL values of PaCO2 leading to development of radiographic "snow-like appearance" of the Lungs, resulting from the typical interstitial lung edema. Treatment consists of early fracture fixation, volume replacement, respiratory support and analgesia carefully managed since some of the patients may develop acute respiratory distress. The role of steroids and other drugs is still under debate. The vast majority of patients may heal without any complications, while 5%-10% of the patients may develop some neurological complications manifesting as behavior disturbances. The aim of this review is to update the clinical and pathophysiological aspects of fat embolism syndrome and to describe the various aspects of prevention and treatment.

Background: Chronic Obstructive Pulmonary Disease (COPD), a common disease worldwide, refers to two frequently coexisting lung diseases, chronic bronchitis and emphysema. Physiologically, COPD represents a disruption in ventilation and in the exchange of gases in the lungs. Laboratory tests indicate elevated CO2 level, gradual reduction of the levels of oxygen and pH in arterial blood and elevated PeCO2. It does not include other obstructive diseases such as asthma., Objective: Patients with COPD represent a large portion of those artificially ventilated in an ICU. In an attempt to determine the length of ventilation and stay in ICU, we compared the length of ventilation, weaning, reintubation and discharge during a period of ten months., Methods: This study included 73 patients on mechanical ventilation (MV) due to severe exacerbation of COPD that were not suitable for non-invasive ventilation. Each patient's arterial blood gases (ABG) were measured upon admission and PeCO2 was tested using a Datex S/5 instrument., Results: All patients included in the study needed MV; 67 patients were ventilated from 5 to 161 hours (average 40 + 47), 6 patients need more than one week. Three of these patients died due to severe ventilated associated pneumonia. No correlation was found between pH, Pco2 and length of artificial respiration; these findings do not contribute to evaluation of the patient's condition nor do they enable us to predict the length of treatment necessary., Conclusion: Most of the patients (92%) ventilated for acute respiratory failure due to chronic obstructive pulmonary disease (COPD) needed MV for only between 40-47 hours.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a common disease that tends to occur worldwide. Physiologically, COPD represents a disruption in ventilation and in the exchange of gases in the lungs. Laboratory tests indicate elevated CO2 level, gradual reduction of the levels of oxygen and pH in arterial blood, and a consequent rise in the Dead Space Fraction (DSF) of the lungs., Objective: Patients with COPD represent a large portion of those artificially ventilated in the Intensive Care Unit (ICU). In an attempt to develop a prognostic tool for the length of treatment, we compared the proportion of DSF to the length of artificial respiration., Methods: This study included 49 patients receiving ventilation due to exacerbation of COPD. Each patient's arterial blood gases (ABG) were measured upon admission. PECO2 was tested using a Datex S/5 instrument. Subsequently, DSF was calculated using the Bohr equation. Statistical data was analyzed using the SPSS-11 program., Results: Patients included in the study were respirated from 5 to 161 hours (average 40 +/- 47). In addition to ABG measurements, PECO2 levels were measured and DSF calculated for each patient. DSF values varied from 0.22 to 0.74 (average 0.119 +/- 0.489). No correlation was found between DSF and length of artificial respiration. These findings do not contribute to the evaluation of the patient's condition nor do they enable us to predict the length of treatment necessary., Conclusion: Evaluation of Dead Space Fraction does not provide a factor in estimating the length of treatment for patients with acute respiratory failure due to Chronic Obstructive Pulmonary Disease (COPD).

This is an unusual case, of an adult man who was hospitalized with a severe asthmatic attack and severe hypercapnia, refractory to intensive medical treatment, which responded to pressure mechanical ventilation. We advise to consider this mode of treatment in similar cases.

Introduction: Community-acquired pneumonia, that requires hospitalization, is a severe illness with high mortality rates, especially in cases of delay of appropriate treatment. At times, the correct diagnosis of the disease is difficult due to equivocal clinical picture or chest film, accompanying diseases that could mask or simulate the pneumonia., The Aims of Our Study Were: 1. follow-up levels of fibrinogen throughout hospitalization in the group of patients admitted to the hospital due to pneumonia and pulmonary edema of non-infectious origin; 2. an estimation opportunity using them as possible new markers for diagnosis of pneumonia and for following response to treatment., Methods: Three groups of patients were studied: a group of 15 patients admitted due to pneumonia, a group of 15 patients admitted due to pulmonary edema, and a control group 15 healthy subjects. The blood samples for white blood cells count, erythrocyte sedimentation rates, levels of fibrinogen, C-reactive protein, albumin, were taken for each patient on admission, 48 and 72 hours following admission and on discharge day. The received dates were compared using Student t-test., Results: The levels of fibrinogen were higher on admission, in the patients with pneumonia, maximally after 48 and 72 hours (P<0.001) in comparison to the control group. In pulmonary edema the fibrinogen levels were also high but less than those with pneumonia (P=0.0044), with gradual declining throughout hospitalization period (P> 0.027 for both groups in discharge day). The comparison of fibrinogen levels between groups of patients with pneumonia and pulmonary edema reveal statistically significant results at time of admission, after 48 and 72 hours but not on discharge day., Conclusion: Fibrinogens can be used as reliable markers for primary diagnosing of pneumonia or differential diagnosis from pulmonary edema, on admission and until 72 hours but not for patient follow-up throughout hospitalization period. Additional studies are needed for discovering other new markers for patient follow-up throughout hospitalization period.