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instability or need for continuous moderate sedation or neuromuscular blockade. Data from the control period (Pre) including demographics, severity of illness, ventilator days, and LOS data was compared to Post intervention (Post) data (also 6 months). Complications were also compared. Results: A total of 69 Pre patients (age 54.8 ± 10.9 yrs) were compared to 52 Post patients (age 55.6 ± 12.2 yrs). Mean ventilator days were similar (Pre 6.3 ± 9.0 vs Post 6.0 ± 8.2 days, p=0.708); however, the median duration favored Post intervention (4.0 versus 2.0 days). Mean ICU LOS decreased by an average of 1.7 days from 12.8 ± 11.5 to 11.1 ± 9.7 and total hospital LOS decreased slightly from 20.2 ± 15.6 to 19.5 ± 12.2 although not statistically different. There was no difference in complications between Pre and Post intervention groups related to PUM. Conclusions: Our study demonstrated a trend towards decreased ventilator days as well as both ICU and hospital length of stays in cancer patients requiring mechanical ventilation through the use of an early Progressive Upright Mobility Program. Moreover, our study demonstrated this technique can be used safely in patients with advanced malignancy, a previously unstudied group.Learning Objectives: Acute pulmonary embolism (PE) is a diagnostic challenge as symptoms vary widely and are often nonspecific. Definitive diagnosis requires costly testing that involves exposure to radiation and intravenous contrast. PE increases alveolar dead space (AVDS). Exhaled carbon dioxide, capnography, may assist with the diagnosis of PE by providing estimates of AVDS. Methods: Research utilizing capnography for PE diagnosis was systematically reviewed using electronic data bases, ancestry searches and personal communication. Included studies contained capnography data and PE diagnosis confirmed by conventional radiologic methods. Data from 21 studies (n = 3417 subjects) published between 1950 and 2012 were synthesized. Three separate meta-analyses were conducted using random-effects models. Standardized mean differences (d) were calculated to compare the capnography values of end-tidal carbon dioxide (EtCO2) (k=13), AVDS fraction (AVDSf ) (k=10) and EtCO2 gradient (PaCO2 -EtCO2) (k=6) in patients with and without PE. Heterogeneity statistics were calculated using Q and I 2 . Results: Overall prevalence of PE was 22%. Mean EtCO2 was lower for patients with PE (28.4mmHg) versus without (36.0mmHg) (d = -1.229 p <.001; 95% confidence interval (CI) -1.521 to -.936). Mean AVDSf was higher for patients with PE (.276 L) versus without (.117 L) (d = 2.250 p < .001; 95% CI 1.030 to 3.469). Mean End-tidal CO2 gradient was higher in patients with PE (7.0mmHg) versus without (3.6mmHg) (d = 3.004 p = 0.010; 95% CI 0.717 to 5.290). The true variation among effects was substantial across studies (Q = 49.06, I 2 =75.54; Q =366.95, I 2 = 97.55; Q = 224.48, I 2 = 97.77 respectively). Conclusions: These meta-analyses suggest capnography assessment can detect differences between patients with and without PE by ident...

western reserve health education, youngstown, OH Learning Objectives: Introduction Fibrosing mediastinitis (FM) is a rare entity, predominant in women, in their third or fourth decades. The two most important forms of FM are histoplasmosis related and idiopathic. In US, more than 90% of cases are histoplasmosis related seen predominantly in Histoplasma endemic regions. However, only about a dozen cases of idiopathic fibrosing mediastinitis have been described worldwide. To our best knowledge, we describe the first reported case of idiopathic fibrosing mediastinitis in pregnancy, presenting with insidious onset of near complete obstruction of right pulmonary artery. Case report A 20-year-old, 19 weeks pregnant, Caucasian female, presented with cold-like symptoms, low-grade fever and cough for one day. Physical exam was unremarkable except for tachycardia. Chest X-ray showed right basilar atelectasis and infiltrates. A spiral CAT scan of the chest, showed a 5 cm mediastinal mass obstructing the right pulmonary artery and encasing the right main bronchus along with mediastinal adenopathy.Histoplasmal serology was negative. Bronchoscopy did not reveal any endobronchial lesion suggestive of tumor. Bronchial mucosa and lymph node biopsies revealed paucicellular aspirate with a few benign/reactive bronchial epithelial, alveolar and mixed inflammatory cells without any malignant cells or granulomatous inflammation. Mediastinoscopy revealed a dense, thick and fibrous mass surrounding the right main pulmonary artery and main stem bronchus. Histologically, there was acellular sclerotic fibrous tissue along with increased reticular fibrosis. There was no vasculitis, significant fibroblastic proliferation, inflammation or granulomatous reaction. PAS and acid fast stains were negative for fungal and acid fast organisms. Immunohistochemical stains for CD20 and CD3 showed a reactive mixed population of T-cells and B-cells. Additional stains for CD138 and IgG4 showed only a few scattered plasma cells. Pankeratin and calretinin stains showed no evidence of an infiltrative neoplasm. A diagnosis of idiopathic FM was made.Learning Objectives: Biotin (vitamin B7) is a water-soluble vitamin found in all organisms that functions as a cofactor for enzymes known as biotin-dependent carboxylases. Deficiency of the biotin dependent carboxylases, also known as multiple carboxylase deficiency (MCD), is a rare inherited metabolic disease secondary to deficiency of holocarboxylase synthetase (HCS) or biotinidase. Case description: A four-year old Hispanic female presented with rash, vomiting and lethargy. Past medical history was significant for a similar rash that intermittently occurred in conjunction with prior illnesses. Vitals were notable for a heart rate of 140 beats per minute and a respiratory rate of 35 breaths per minute. Physical exam revealed diffuse skin mottling and clearly demarcated, erythematous, and scaling rash located around body orifices and intertriginous locations. Pertinent workup showed a serum pH of 6.76, base deficit...

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