Chest
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
An early test of survival in patients with the adult respiratory distress syndrome. The PaO2/FIo2 ratio and its differential response to conventional therapy. Prostaglandin E1 Study Group.
Patients with established adult respiratory distress syndrome (ARDS) have a mortality rate that exceeds 50 percent. We analyzed the magnitude of hypoxemia as manifest by the PaO2/FIO2 ratio and its early response to conventional therapy including positive end-expiratory pressure (PEEP) in the placebo group of a large multicenter study. The PaO2/FIO2 ratio was not different at the time of diagnosis of ARDS in those patients who lived compared to those who subsequently died. ⋯ The nonsurvivors did not improve over a seven-day course. The difference in the PaO2/FIO2 ratio was significant throughout the seven-day observation period. We conclude that the early response to conventional therapy picks a patient population with a good prognosis and can be used as a test of likely survival from ARDS.
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Comparative Study
Energy expenditure associated with CPAP and T-piece spontaneous ventilatory trials. Changes following prolonged mechanical ventilation.
The use of portable metabolic carts to assess energy expenditure (EE) by measuring oxygen consumption (VO2) and carbon dioxide production (VCO2) has recently been applied to patients undergoing weaning from mechanical ventilation. The VO2 and EE can be used to estimate changes in the work of breathing (WOB) associated with different weaning strategies. The purpose of this study was to use VO2 and EE to assess changes in the WOB when assisted mechanical ventilation (AMV) was replaced with two spontaneous ventilatory trial (SVT) techniques: continuous positive airway pressure (CPAP) and T-piece. ⋯ Respiration rate (f) increased and tidal volume (VT) decreased during both SVTs compared to AMV although no significant change in minute ventilation was seen. The WOB, as judged from changes in VO2, was only 5 percent higher during T-piece compared to CPAP; however, patients tolerated an average of only 141 +/- 45 min on T-piece vs 165 +/- 29 minutes on CPAP. We conclude that during the initial weaning stages in patients who have received prolonged mechanical ventilatory support, the WOB associated with SVTs is increased compared to AMV but that the WOB associated with T-piece is not significantly greater than that for CPAP.
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Pneumocystis carinii pneumonia (PCP) causing acute respiratory failure (ARF) in patients with acquired immunodeficiency syndrome (AIDS) has been reported in several studies to have a mortality of 84 to 100 percent. A recent report found a 42 percent survival rate. ⋯ The mean duration of survival after discharge from the hospital was 7.9 +/- 1.8 months, which is an improvement over previous reports. These data suggest that we should reevaluate the reported recommendations that patients with AIDS, PCP and ARF should not receive intensive care or mechanical ventilation.
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In this study, 82 patients who experienced translaryngeal intubation (TLI) for more than four days were prospectively evaluated for laryngeal complications. At the time of extubation or tracheostomy, direct laryngoscopy was performed in these patients and laryngeal damage evaluated. ⋯ Laryngoscopy was repeated at two-week intervals in 54 patients and laryngeal damage was resolved within four weeks in 63 percent. These 54 patients were evaluated for adverse clinical effects arising from TLI-induced laryngeal pathology and no relationship was found between laryngeal pathology seen at initial laryngoscopy and the development of adverse effects.