Chest
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Review Case Reports
Greenfield inferior vena cava filter dislodged during central venous catheter placement.
Two cases of a Greenfield inferior vena cava (IVC) filter being dislodged during central venous catheter placement are described. This event appears to be related to J-tip guidewire use during venous catheterization. ⋯ One of the two filters was dislodged from the IVC to a new position in the right atrium. Dislodging of the filter in these two particular cases did not give rise to clinical signs or symptoms.
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To determine the effectiveness of oronasal masks for positive pressure therapy in alleviating obstructive sleep apnea (OSA). ⋯ Oronasal masks are a viable alternative interface for alleviating OSA with positive pressure therapy in those patients who are unwilling or unable to tolerate conventional nasal interfaces. Although there were no adverse consequences associated with the use of oronasal masks in our patients, appropriate safety precautions should be taken to minimize the possibility of aspiration of gastric contents and avoid untoward sequelae due to positive pressure device failure.
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Comparative Study
Oxygen therapy using pulse and continuous flow with a transtracheal catheter and a nasal cannula.
Pulse delivery (PD) of oxygen was compared with continuous flow (CF) utilizing transtracheal oxygen catheter (TTO) and nasal cannula (NC) in 20 stable patients with chronic hypoxemia. Oxygen saturation, respiratory rate, and accuracy of pulsed oxygen delivery were measured during sleep studies and these parameters, as well as arterial blood gases, were evaluated during rest and exercise. Additionally, bulk liquid oxygen use was measured under each condition, for a period of 1 month. ⋯ The PD settings in the remaining subjects were equivalent to continuous flow settings for TTO and NC as assessed by PaO2 for rest and SaO2 for exercise and sleep. Compared with standard CF NC, the daily bulk oxygen use was decreased by 29.4 percent with CF TTO, by 48.2 percent with PD NC, and by 49.9 percent with PD TTO. We conclude that, compared with CF NC, PD of oxygen via TTO or NC by this method appears to be a safe, reliable, effective, and cost-effective method of oxygen delivery in the majority of subjects when used with proper screening.
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Comparative Study
A functional and morphologic analysis of pressure-controlled inverse ratio ventilation in oleic acid-induced lung injury.
To compare volume-controlled ventilation (VCV PEEP) with pressure-controlled inverse ratio ventilation (PCIRV) at equal levels of end-expiratory pressure. ⋯ PCIRV was no better than VCV with similar PEEP levels in alveolar recruitment and aeration of the lung tissues or in oxygenating the blood. Cardiac output was lower with PCIRV than with VCV, causing lower oxygen delivery to peripheral tissues. PCIRV does allow for a reduction in minute ventilation and for lowering peak airway pressure.
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The rising healthcare costs and the ethical and economic implications of cardiopulmonary resuscitation (CPR) have generated interest in defining criteria to predict the appropriateness of CPR in specific patients. Age has been proposed as one such a criterion. ⋯ Age alone is not a valid criterion to decide whether a patient is a suitable candidate for CPR, and the principal diagnosis and main comorbidity at the time of admission do not appear to predict long-term survival either. Whether in-hospital CPR in noncritical care areas is cost-effective is an issue that society at large must eventually decide.