Sittig, Steve E

Congenital cystic adenomatoid malformation (CCAM) is a congenital malformation of the lung that can present on imaging studies as abnormal air, air/fluid-filled cysts, or fluid-filled/solid-appearing cysts. The use of ultrasound in prenatal management has increased the number of cases diagnosed in utero. Early diagnosis is vital in the medical management of CCAM. Outcome varies from hydrops and fetal demise to complete resolution before birth. Many CCAMs diagnosed in utero may decrease in size even if substantial mediastinal shift and lung compression are noted at the time of diagnosis. Once the disorder has been diagnosed, use of serial ultrasound is helpful in providing medical management of the fetus. Two cases of CCAM in the newborn are presented that reflect characteristic clinical features but with distinctly different outcomes, one patient successfully re-sponding to resection and ventilatory support, the other succumbing in the first day of life. The embryology, histology, prenatal and postnatal clinical presentation, and treatment of this malfor-mation are discussed on the basis of a review of the literature. Recent developments in fetal diagnosis and treatment, including fetal surgery, are also presented. We conclude that CCAM should be considered in the differential diagnosis in the presence of respiratory distress and me-diastinal shift. It is especially important for respiratory therapists, nurses, and other members of neonatal transport teams to consider CCAM in the differential diagnosis for any patient who presents with respiratory distress and a chest radiograph showing mediastinal shift. The treatment of choice for this lesion is surgical resection by either segmentectomy or lobectomy. Even in cases of relatively asymptomatic patients with CCAM, surgical resection should be considered because of the reported association of carcinoma and unresected CCAM.

We searched MEDLINE, CINAHL, and Cochrane Library database for articles published between January 1990 and December 2012. The update of this clinical practice guideline is based on 237 clinical trials, 54 reviews, and 23 meta-analyses on blood gas analysis (BGA) and hemoximetry. The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation scoring system. BGA and hemoximetry are recommended for evaluating a patient's ventilatory, acid-base, and/or oxygenation status. BGA and hemoximetry are suggested for evaluating a patient's response to therapeutic interventions. BGA and hemoximetry are recommended for monitoring severity and progression of documented cardiopulmonary disease processes. Hemoximetry is recommended to determine the impact of dyshemoglobins on oxygenation. Capillary BGA is not recommended to determine oxygenation status. Central venous BGA and hemoximetry are suggested to determine oxygen consumption in the setting of early goal-directed therapies. For the assessment of oxygenation, a peripheral venous P O 2 is not recommended as a substitute for an arterial blood measurement (P aO 2 ). It is not recommended to use venous P CO 2 and pH as a substitute for arterial blood measurement of P aCO 2 and pH. It is suggested that hemoximetry is used in the detection and evaluation of shunts during diagnostic cardiac catheterization.