Chest
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Sleep deprivation and fragmentation occurring in the hospital setting may have a negative impact on the respiratory system by decreasing respiratory muscle function and ventilatory response to CO2. Sleep deprivation in a patient with respiratory failure may, therefore, impair recovery and weaning from mechanical ventilation. We postulate that light, sound, and interruption levels in a weaning unit are major factors resulting in sleep disorders and possibly circadian rhythm disruption. ⋯ The number of sound peaks greater than 80 decibels, which may result in sleep arousals, was especially high in the intensive and respiratory care areas, but did show a day-night rhythm in all settings. Patient interruptions tended to be erratic, leaving little time for condensed sleep. We conclude that the potential for environmentally induced sleep disruption is high in all areas, but especially high in the intensive and respiratory care areas where the negative consequences may be the most severe.
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Unilateral pulmonary edema (UPE) is an unusual clinical condition occurring in left heart failure (LHF). Normally, cardiogenic UPE is more pronounced on the right side when no right pulmonary artery obstructive lesion exists. ⋯ Although the precise mechanism of unilateral presentation is not clear, such a left-sided unilateral manifestation is extremely rare in LHF. This is believed to be the first reported case of left-sided UPE with postinfarction VSR.
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Mortality is high in unrecognized pulmonary embolism (PE), but the diagnosis is difficult to establish, especially in patients with coexisting cardiopulmonary disorders. We describe a group of 14 patients with pulmonary thromboemboli in whom transesophageal echocardiography (TEE) performed for coexisting cardiopulmonary conditions established the clinical diagnosis of PE not suspected prior to TEE. The patients had initial clinical diagnoses of heart failure (eight patients), cardiogenic shock (two patients), atrial septal defect (two patients), aortic dissection (one patient), and pneumonia (one patient). ⋯ Ten of the 14 patients were successfully discharged from the hospital. We conclude that occult central pulmonary artery thromboemboli are not uncommon in patients presenting with acute cardiopulmonary disorders and the presence of risk factors for PE and right heart strain on TTE should alert the physician to suspect PE. If and when TEE is performed in patients with acute cardiopulmonary disorders with risk factors for PE and right heart strain, the physician should evaluate the main pulmonary artery and its branches for central pulmonary artery thromboemboli.
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To assess the effect of hypermetabolism, dead-space ventilation, and parenteral nutrition on the minute ventilation requirement in mechanically ventilated patients. ⋯ Increased VCO2 is the main cause of increased VE demand in the majority of mechanically ventilated ICU patients. Parenteral nutrition at energy intakes close to actual REE does not increase the ventilatory demand.