ABSTRACT
Inhalation therapy with the use of helium-oxygen has been advocated in the treatment of upper airway obstruction due to various causes. The therapeutic effect is secondary to a decrease in turbulent flow and airway resistance in areas of obstruction. We present a patient with acute respiratory failure secondary to upper airway obstruction caused by a tumor involving the distal trachea and proximal left mainstem bronchus. Despite assistance with a mechanical ventilator, the patient remained tachypneic and hypercarbic. Following institution of helium therapy, the patient became less short of breath and her carbon dioxide returned to a normal level. She was later weaned from mechanical ventilation and discharged from the hospital.
Subject(s)
Airway Obstruction/drug therapy , Helium/therapeutic use , Administration, Inhalation , Airway Obstruction/etiology , Bronchial Neoplasms/complications , Carcinoma, Small Cell/complications , Female , Humans , Middle Aged , Oxygen/therapeutic useSubject(s)
Acquired Immunodeficiency Syndrome/complications , Pneumonia, Pneumocystis/etiology , Adult , Humans , Louisiana , MaleABSTRACT
Two patients with severe pulmonary blastomycosis were treated with ketoconazole. One patient developed disseminated disease while receiving this drug. After responding to incomplete treatment with amphotericin B, this patient relapsed while continuing ketoconazole therapy. The second patient failed to respond to ketoconazole and died shortly after treatment with amphotericin B was instituted. We conclude that it is dangerous to use ketoconazole as initial treatment in patients with severe forms of blastomycosis. Death, relapse, and prolonged morbidity may be the result. In such cases, amphotericin B is still the drug of first choice despite its toxicity, inconvenience, and expense of administration.
