Chest
-
To examine the effects of diaphragmatic plication on respiratory mechanics during spontaneous breathing, we grouped 28 dogs into left phrenicotomy and plication (group L, n = 11), bilateral phrenicotomy and plication (group B, n = 9), and sham operations (group C, n = 8). In groups L and B, phrenicotomy caused significant (p < 0.05) decreases in tidal volume (VT), transdiaphragmatic pressure (delta Pdi), the ratio of gastric to esophageal pressure (delta Pga/delta Pes) and dynamic lung compliance (Cdyn), and significant (p < 0.05) increases in esophageal pressure (delta Pes), and the work of breathing (WOB) per liter of ventilation. ⋯ In eight left-phrenicotomized open-chest dogs, transdiaphragmatic pressure (Pdi) and fractional shortening (FS) of right hemidiaphragm by right phrenic nerve stimulation increased significantly (p < 0.05) after plication, compared with the phrenicotomy condition, suggesting more effective kinetics of the right hemidiaphragm after plication of the left hemidiaphragm. Our results showed that diaphragmatic plication for unilateral paralysis is more effective than for bilateral paralysis, indicating that an improvement in kinetics of the intact hemidiaphragm plays an important role in functional recovery.
-
The validity of peak inspiratory mouth pressure (P. PI-max) as a measure of inspiratory muscle strength was investigated by comparing it with sniff Pes in patients with COPD with respect to (1) learning effect, (2) reproducibility, and (3) measures of agreement. To assess the discriminating capacity of P. ⋯ PImax was significantly (p < 0.001) lower in both male (8.2 kPa) and female (6.2 kPa) patients with COPD compared with healthy men (11.0 kPa) and healthy women (8.8 kPa). We conclude that P. PImax is a valid and noninvasive assessment of inspiratory muscle strength.
-
Diaphragmatic flutter is a rarely reported disorder in which the diaphragm involuntarily contracts at a rapid rate. We report a unique case in which diaphragmatic flutter was associated with inspiratory stridor and was severely disabling. A new approach to the treatment of this condition, phrenic nerve crush, provided an optimal outcome, with resolution of symptoms and the return of normal diaphragmatic function. Pathophysiology and treatment of this condition are discussed.
-
Comparative Study
Multiplane transesophageal echocardiographic doppler imaging accurately determines cardiac output measurements in critically ill patients.
To compare cardiac output and stroke volume measured by multiplane transesophageal Doppler echocardiography with that measured by the thermodilution technique. ⋯ Multiplane transesophageal echocardiography enhances the ability to estimate accurately cardiac output and stroke volume by providing new access to left ventricular outflow tract in critically ill patients.
-
To evaluate the frequency with which advance directives (ADs) are available at the time of admission and their impact on subsequent care in a medical intensive care unit (MICU) setting before and 9 months after the implementation of the Patient Self-Determination Act (PSDA). ⋯ Advanced directives were infrequently available and had little impact on the pattern of care.