Chest
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Randomized Controlled Trial Clinical Trial
Inhaled furosemide prevents ultrasonically nebulized water bronchoconstriction in children with both atopic and nonatopic asthma.
To determine whether inhaled furosemide can modify the bronchoconstriction induced by ultrasonically nebulized distilled water (UNDW) in children with both atopic and nonatopic asthma, a single-blind, randomized, placebo-controlled study was undertaken. The UNDW inhalation challenge was performed in 21 asthmatic children (atopic, 14; nonatopic, 7; mean +/- SEM age, 11.5 +/- 0.5 years), who had a fall in FEV1 of at least 20 percent after distilled water inhalation. ⋯ Inhaled furosemide exerted a protective effect against bronchoconstriction induced by UNDW in children with both atopic and nonatopic asthma (p < 0.01, p < 0.05, respectively). These results indicate that the protective action of furosemide against UNDW-induced bronchoconstriction may be independent of its direct inhibitory effect on airway mast cell activation.
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To formulate recommendations for the development of intensive care unit (ICU) admission policies. ⋯ The use of decision-making models for ICU and CCU admissions must be tested in prospective, randomized clinical trials. Critical care units and ICUs should be studied separately. Existing studies of early discharge from CCUs need to be summarized and evaluated. The triaging of ICU patients to alternative hospital locations needs to be evaluated, as do existing predictive models for early triage decision-making.
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The relative importance of neurologic dysfunction in critically ill mechanically ventilated patients has not been well studied. This study investigates the prevalence of neurologic dysfunction in critically ill mechanically ventilated patients and its influence on preventing the discontinuation of mechanical ventilation and patient outcome. ⋯ There is a high prevalence of neurologic dysfunction in critically ill patients and this problem plays a significant role in preventing the discontinuation of mechanical ventilation. Altered mental status is a major factor necessitating continued mechanical ventilation in combined medical-surgical intensive care units.
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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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The aim of this study was to assess the effect of nasal continuous positive airway pressure (CPAP) breathing on patients with COPD when they are in respiratory failure during acute episodes of the disease. We studied 15 male patients with COPD who were in acute, unstable condition, without mechanical ventilatory support, before and during 4 h of nasal CPAP. ⋯ Nasal CPAP was generally well tolerated. According to these results, nasal CPAP should be considered as a possibility for treatment in patients with COPD who are in acute respiratory failure, in order to avoid mechanical ventilation.