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Abstract

significantly altered by right lung hyperinflation and resultant compression atelectasis and impaired diaphragm excursion. He was unable to trigger the ventilator resulting in dysynchrony, air hunger, worsened hyperinflation and atelectasis and carbon dioxide retention. In order to achieve synchrony, he was transitioned to NAVA ventilation. Once on NAVA, the patient was able to maintain minute ventilation, was weaned from sedation and had improvement in overdistension, atelectasis and gas exchange. While there is limited data describing its use in older infants, in the setting of prolonged ventilation, and/or inability to flow trigger the ventilator, the use of NAVA should be considered early to improve patient ventilator synchrony and minimize ventilator associated lung injury.Case Report: Serratia marcescens, a gram-negative bacilli, is responsible for approximately 2% of nosocomial lower respiratory tract and urinary tract infections. The risk of developing Serratia infections are increased in patients who are admitted to ICUs, immunocompromised, treated with long-term broadspectrum antibiotics, and have had instrumentation, such as indwelling catheters and tracheostomy tubes. The most striking feature of this member of the Enterobacteriaceae family, is its ability to produce prodigiosin, a red pigment that is responsible for the documented manifestation of pseudohemoptysis in patients who have Serratia pneumonia. We report a case of an 88-year-old man with chronic tracheostomy secondary to a history of intracranial hemorrhage, admitted to our institution for hemoptysis of one day's duration without signs of systemic infection. Upon admission, blood was noted in both the oropharynx and tracheostomy tube. Vitals signs were normal without signs of SIRS or infection and laboratory data showed mild leukocytosis and borderline urinalysis for which he was started on antibiotics. Lung examination and chest radiograph were unrevealing for pneumonia. On day 2, a bronchoscopy was performed that did not reveal a source of bleeding. On day 3, direct laryngoscopy performed by ENT also did not reveal a bleeding source in upper respiratory tract. Bronchoalveolar lavage washings which had been sent for culture ultimately grew Serratia marcescens and Providencia. While there have been published cases of pseudohemoptysis associated with Serratia pneumonia, there has been no report, to our knowledge, of Serratia colonization causing pseudohemoptysis. Clinical awareness of this finding may help deter unnecessary antibiotics and procedures in these patients and reduce length of hospitalization.Case Report: Kaposi's sarcoma is a low-grade mesenchymal tumor involving blood and lymphatic vessels. It is the most common tumor among patients with HIV infection, occurring predominantly in homosexual or bisexual men. A 55-year-old male with no known medical history, presented with weakness and malaise, worsening over the course of 6 mo. He had no toxic habits, and he was a homosexual. He was tachycardic (155 bpm), tachypneic (25 bpm) and ...