Chest
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A 27-year-old, 37-weeks' primigravida survived an acute myocardial infarction. Coronary angiography 25 days after infarction demonstrated multiple dissections in the left coronary artery. She had no vascular risk factors or connective tissue disease. This is a rare case of spontaneous, multiple coronary artery dissections that were diagnosed by coronary angiography.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative evaluation of three heat and moisture exchangers during short-term postoperative mechanical ventilation.
This study compared performance of three heat and moisture exchangers (HME) during short-term postoperative mechanical ventilation. Temperature and absolute humidity (AH) were measured at various points of the ventilatory circuit. There was no statistical difference between the groups, regarding ambient and body To, body weight, fraction of inspired oxygen, tidal volume, and respiratory rate. ⋯ Indirect evaluation (variations of inspiratory gases and tracheal temperatures, AH of the expired gases) confirmed the superiority of the hygroscopic HME. These data suggest that humidification of inspiratory gases with a hygroscopic HME is a defensible practice during short-term postoperative mechanical ventilation. Performance of hydrophobic HME may be weak and can expose the patient to an unacceptable risk of endotracheal tube occlusion.
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Randomized Controlled Trial Comparative Study Clinical Trial
Protective effect of inhaled piretanide on the bronchial obstructive response to ultrasonically nebulized H2O. A dose-response study.
Inhaled furosemide prevents the obstructive response to several bronchoconstrictor stimuli in asthma. To verify whether this protective effect is also shared by other loop diuretics, we investigated the effect of inhaled piretanide on the bronchial obstructive response to ultrasonically nebulized distilled water (UNW) in ten patients with moderate, stable asthma. ⋯ Piretanide caused a significant, dose-dependent increase in UNW PD20 with respect to placebo, corresponding to 0.6 +/- 0.2 doubling doses (mean +/- SE) after 12 mg, 1.3 +/- 0.2 after 24 mg, and 2.0 +/- 0.2 after 48 mg, and had a remarkable diuretic effect; 40 mg of furosemide increased UNW PD20 by 2.3 +/- 0.3 doubling doses (p < 0.01), but showed only a modest diuretic activity. These data indicate that inhaled piretanide is as effective as furosemide in preventing UNW-induced asthma, and this effect is unrelated to their diuretic potency.
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Twelve patients with the adult respiratory distress syndrome were included in this study and evaluated by transesophageal echocardiography and Doppler, assessing right and left ventricular intracardiac blood flow alterations with progressive increase of inspiration-to-expiration (I-E) ratios. Whereas midpulmonary artery flow parameters did not show any change, early left ventricular filling demonstrated a significant increase after switching the ventilatory mode from volume to pressure-controlled ventilation with 2:1 I-E ratio (end-inspiration: 39 +/- 26 cm with positive end-expiratory pressure [PEEP]-ventilation to 68 +/- 56 cm with pressure-controlled inverse-ratio ventilation, 2:1; p < 0.01; at end-expiration, from 67 +/- 21 cm with PEEP-ventilation to 83 +/- 36 cm with pressure-controlled ventilation 1:1; p < or = 0.05), resulting probably from different ventilatory flow and pressure curves. In the meanwhile, cardiac index demonstrated a significant augmentation (from 4.73 +/- 1.71 L/min.m2 to 5.56 +/- 1.66 L/min.m2; p < 0.05). Pressure-controlled inverse ratio ventilation results in both respiratory and hemodynamic advantages as is demonstrated by this study.
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To determine the value of tonometrically measured gastric intramucosal pH (pHi) and accepted indices of systemic oxygenation in predicting multiorgan dysfunction syndrome (MODS) and death in critically ill patients with sepsis. ⋯ In patients with sepsis, indices of tissue oxygenation are better predictors of outcome than the hemodynamic and oxygen-derived variables obtained by invasive hemodynamic monitoring. These indices should be used to direct therapy.