Chest
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Little information exists regarding the proportion of patients treated with mechanical ventilation in intensive care units (ICUs), their underlying disease states, the modes of ventilation used, duration of ventilator support, methods and time required for weaning, and mortality in these patients. We carried out a cross-sectional multicenter study in 47 medical-surgical ICUs in Spain to investigate these issues in 290 patients who required mechanical ventilation for at least 24 hs. Relative frequency of different modes was as follows: assist-control ventilation (AC), 55%; synchronized intermittent mandatory ventilation (SIMV), 26%; pressure support ventilation (PSV), 8%; SIMV plus PSV, 8%; pressure-controlled ventilation (PCV), 1%; and continuous positive airway pressure (CPAP), 2%. ⋯ Overall mortality rate was 34%, and it was higher in patients who were ventilated for 1 to 10 days than in those ventilated for a longer time. Despite the availability of several new modes of ventilator support, older modes such as AC and SIMV were more commonly used. Weaning constitutes a large portion of total ventilator time, and thus, measures that expedite the weaning process should markedly decrease the duration of mechanical ventilation.
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To assess the hemodynamic effects of manual lung hyperinflation in mechanically ventilated patients and to measure the different inspiratory pressures and tidal volumes generated by different operators. ⋯ Lung hyperinflation is frequently not achieved by the manual technique. Significant changes in cardiac output can occur and appear to be related to the tidal volume rather than pressure generated.
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Comparative Study
Comparison of the derived vectorcardiogram in apparently healthy whites and Chinese.
A total of 2,058 vectorcardiograms derived from the conventional 12-lead electrocardiogram (1,555 whites [884 men and 671 women], aged between 16 and 64 years, and 503 Chinese [248 men and 255 women], aged between 18 and 81 years) were analyzed. The results were assessed to demonstrate the importance of the impact of racial variation on vectorcardiographic appearances. ⋯ Therefore, this indicates that it is necessary to take racial variation into consideration for interpretation of the derived vectorcardiogram. In conclusion, it has been shown in the present study that derived vectorcardiogram diagnostic criteria should not only be age and sex dependent but also race dependent.
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The ipsilateral recurrence rate after the first spontaneous pneumothorax treated with tube thoracostomy is reported to be between 23 percent and 52 percent. The incidence of recurrence after the first recurrence is substantially higher. Chemical pleurodesis has been attempted to decrease the recurrence rate. ⋯ The remaining 94.4 percent did not have recurrence of pneumothorax within an observation period of 38.5 +/- 28.1 months. The follow-up was more than 2 years for 66.7 percent with no recurrence and was more than 5 years for 33.3 percent. We conclude from these observations that the insufflation of 2 g of talc into the pleural space is a safe effective treatment for control of recurrent spontaneous pneumothorax.