A prospective study of the pulmonary complications occurring in 22 consecutive patients admitted to hospital within 24 hours after acute traumatic quadriplegia was compared with the findings of a retrospective survey of 22 comparable patients. Patients in the prospective group received therapy designed to prevent or reverse secretion retention. All patients in this group survived. In the retrospective group there were nine deaths; pulmonary complications and the need for tracheal intubation and mechanical ventilation were three times more frequent. Serial pulmonary function testing in the prospective group demonstrated a greater compromise of expiration than inspiration and progressive improvement in diaphragm function with time. It is concluded that vigorous pulmonary therapy in the prospective group was associated with increased survival, a decreased incidence of pulmonary complications, and a decreased need for ventilatory support.

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We examined prospectively for one year the hearts from 141 consecutive autopsy cases in which a central catheter was present at the time of death. Three deaths were attributable to catheter use, two to perforation. Furthermore, mural thrombi were present in 33 (33%) of 99 patients with pulmonary arterial catheters and in 12 (29%) of 42 patients with central venous catheters. The incidence of pulmonary emboli or bacteremia was no greater in patients with thrombi than in those without. The use of central catheters may thus be complicated by perforation or the development of mural thrombi. Although the thrombi may embolize or may become infected, the incidence and clinical significance appear to be low. The incidence of catheter-related deaths in our autopsy population does not necessarily reflect the incidence in a population of living patients.

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A prospective study of 390 indwelling central venous catheters placed via the subclavian route defined bacteremia and tracheostomy as the only significant variables associated with the colonization of the catheters by pathogenic microorganisms. Catheter related sepsis was likely in only 3 of 33 episodes of proven bacteremia. Detailed statistical analyses of other potential contaminating factors revealed no significance. Specific concern must be assigned to placement of central venous catheters by the subclavian approach, when a tracheostomy is already present,