Chest
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Bronchopleural fistula (BPF) continues to present a treatment problem in mechanically ventilated patients. We report a patient with a traumatic BPF, pneumonia, and adult respiratory distress syndrome (ARDS) who was successfully ventilated with pressure-controlled ventilation (PCV). This mode, by allowing the use of lower inspiratory airway pressures, may promote closure of the fistula.
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Asthma is a leading cause of morbidity in the United States and is a leading cause of disability in children. Prevalence has been shown to be highest in male children, blacks, and urban residents. Racial and residential differences have been attributed to economics. ⋯ Black, urban residents obtained fixed-combination drugs more frequently and steroids less frequently than other groups. Rural patients, in general, had fewer medical contacts but obtained more prescription products per provider contact, whether black or white. Possible reasons for this variation are discussed.
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To formulate recommendations for the development of early intensive care unit (ICU) discharge criteria for low-risk monitor patients. ⋯ Objective methods (such as APACHE III) should be used to identify low-risk patients at 24 h post-ICU admission. A multicenter study should be conducted to compare outcomes on patients identified as low risk who are randomly assigned to alternative hospital locations for treatment versus those assigned to continued ICU treatment until routine ICU discharge. Mortality and quality of life data should be used as outcome measures (prior to ICU admission and 6 months post-ICU discharge).
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Randomized Controlled Trial Clinical Trial
Amrinone in cardiac surgical patients with left-ventricular dysfunction. A prospective, randomized placebo-controlled trial.
To evaluate the efficacy of amrinone for facilitating weaning from cardiopulmonary bypass (CPB). ⋯ Amrinone by itself is an effective agent to facilitate weaning from CPB, and therapy with amrinone reduced the need for individualized titration of epinephrine. Amrinone is as effective as individualized titration of epinephrine (after CPB) to improve cardiac function. Patients in the group receiving amrinone had no greater need for vasoconstricting agents than did patients in the group receiving placebo; however, proactive administration of amrinone before separation from CPB appears to offer no greater benefit to high-risk patients than selective administration of drugs (epinephrine) only to those patients who demonstrate the need for drug support at the time of weaning.