Chest
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Comparative Study
Can portable chest x-ray examination accurately diagnose lung consolidation after major abdominal surgery? A comparison with computed tomography scan.
To prospectively quantify the degree of accuracy of portable chest x-ray film examination in the detection of postoperative lung consolidations. ⋯ In postoperative conditions, x-ray film examination is a method which presents good specificity but poor sensitivity in the diagnosis of lung consolidations.
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To assess the effects of long-term nasal continuous positive airway pressure (CPAP) in occlusive sleep apnea syndrome (OSA), 17 patients with severe symptomatic OSA had repeated spirometry, arterial blood gases, and nocturnal polysomnograms off nasal CPAP after 3 to 46 months of treatment with nasal CPAP. Without loss of weight or change in respiratory mechanics, the ventilatory disturbance index fell from a mean of 87 events per hour to 57 events per hour (p < 0.0001), correlating with an improvement in mean nocturnal desaturation with sleep-disordered breathing events (r = 0.54, p = 0.03). ⋯ The improvement in PaO2 correlated significantly with the number of months of CPAP therapy, suggesting a continuing effect over time (r = 0.58, p = 0.015). These results indicate that there is a reversible element of the severity of OSA and suggest a result of nasal CPAP therapy may be to reverse the adverse and time-dependent effects of hypoxemia and sleep fragmentation on ventilatory control in severe OSA.
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Open-chest direct cardiac compression represents a more potent but highly invasive option for cardiac resuscitation when conventional techniques of closed-chest cardiac resuscitation fail after prolonged cardiac arrest. We postulated that venoarterial extracorporeal circulation might be a more effective intervention with less trauma. In the setting of human cardiac resuscitation, however, controlled studies would be limited by strategic constraints. ⋯ Extracorporeal circulation, in conjunction with transthoracic DC countershock and epinephrine, successfully reestablished spontaneous circulation in each of eight animals after 15 min of untreated ventricular fibrillation. This contrasted with the outcome after open-chest cardiac compression, in which spontaneous circulation was reestablished in only four of eight animals (p = .038). We conclude that extracorporeal circulation is a more effective alternative to direct cardiac compression for cardiac resuscitation after protracted cardiac arrest.
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Although weaning parameters can accurately predict weaning outcome, variability of the measurements of these parameters has not been closely examined. In the current study, we examined the reproducibility of these parameters using a standardized technique. Before the weaning trial, maximal inspiratory pressure (PImax), minute ventilation (VE), respiratory frequency (f), tidal volume (VT), rapid shallow breathing index (f/VT), and vital capacity (VC) were obtained on three trials over a period of 15 min. ⋯ The VC was the only parameter that showed statistical differences among three trials (p < 0.05). For the group, respiratory frequency had the lowest coefficient of variation (COV = SD/mean x 100 percent) at 6.7 percent while the VC had the highest COV at 19.6 percent. We concluded that most weaning parameters of breathing pattern can be measured reliably with bedside instruments using a standard technique.