Administration of aerosol pentamidine: a program design.

Aerosol pentamidine (AP) is an FDA-approved prophylaxis against pneumocystis carinii pneumonia (PCP) in HIV-infected individuals who have a CD4+ lymphocyte count less than 200/mm3, constitutional symptoms, or a previous history of the pneumonia. The University of Washington Medical Center, a 450-bed tertiary care center, established a successful aerosol pentamidine treatment program, providing treatment in its special procedure nit. The authors present an overview of AP and discuss the role of interdisciplinary teamwork, staff training, patient teaching, and the provision of safety measures for patients and healthcare providers.

Growth potential of the transplanted lung in the infant primate.

Success in neonatal lung transplantation depends on the growth of the transplanted lung. To study the effects of transplantation and denervation on primate lung growth without rejection or immunosuppression, an autotransplant model was chosen. Eight-week-old baboons underwent left lung autotransplantation (n = 5) or sham operation (n = 1). At age 13 weeks and 9 months, single lung volumes were calculated by nitrogen washout and computed tomography. Results were compared with those of 4 unoperated weight-matched controls (2 per age group). Over the growth period, mean total lung capacity in operated baboons increased 82% (137 to 249 mL) by nitrogen washout and 70% (182 to 309 mL) by computed tomography compared with 85% (128 to 237 mL) and 74% (141 to 245 mL) for the sham-operated baboon, respectively. Transplanted left lung volume increased 91% (53 to 101 mL) by nitrogen washout and 75% (68 to 119 mL) by computed tomography compared with 85% (54 to 100 mL) and 80% (56 to 101 mL) for the sham-operated baboon, respectively. In the absence of rejection and immunosuppression, normal volume growth occurs in the transplanted infant primate lung.

A disposable end-tidal CO2 detector to verify endotracheal intubation.

STUDY OBJECTIVE: We compared the performance of the Fenem FEF end-tidal CO2 detector with the TRIMED capnometer to verify endotracheal intubation. DESIGN: The FEF indicates the presence of CO2 by the color change of a chemically treated indicator; the TRIMED uses infrared technology. Both devices were used during 60 intubations. SETTING: Intubations during in-hospital emergency situations outside of the operating room were studied. TYPE OF PARTICIPANTS: Adult patients undergoing intubation for respiratory failure, CPR, and other airway protection situations were enrolled in the study. INTERVENTIONS: The TRIMED monitor and FEF detector were placed in series between the manual resuscitator and the patient's endotracheal tube adapter after endotracheal tube placement. MEASUREMENTS AND MAIN RESULTS: We defined the acceptable criterion for detection of CO2 as production of a positive signal within six manual resuscitator bag breaths. The TRIMED met this criterion in 58 of 60 patients (sensitivity, 0.97) and the FEF met this criterion in 59 of 60 patients (sensitivity, 0.98). A paired t test showed no statistically significant difference in performance between the two devices. In five of nine cases of intubation during CPR, the color change of the FEF was described as "subtle." In one CPR case, a positive signal was not obtained by either device. CONCLUSION: We conclude that the performance of the FEF CO2 detector is equal to that of the TRIMED monitor for verification of endotracheal intubation in nonCPR situations. Interpretation of FEF color changes during CPR should be approached with caution until further studies using the FEF during CPR are completed.