Chest
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Although the indications for extracorporeal membrane oxygenation (ECMO) have been extended, ECMO has yet to be used as a respiratory support system during thoracic surgery. The purpose of this experimental study was to investigate whether veno-right ventricular (veno-RV) ECMO can be used for thoracic surgery without mechanical ventilation. ⋯ Video-assisted tracheal surgery can be performed without conventional respiratory support. Veno-RV ECMO as total lung support may become an alternative respiratory management device for thoracic surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Sputum rheology changes in cystic fibrosis lung disease following two different types of physiotherapy: flutter vs autogenic drainage.
The aim of the present study was to investigate the efficacy of two frequently used physiotherapies (PTs) for the removal of bronchial secretions in cystic fibrosis (CF) lung disease: autogenic drainage (AD) and the Flutter (Desitin in Germany). AD is believed to improve mucus clearance from peripheral to central airways due to airway caliber changes in combination with a special breathing technique. The Flutter is an easy-to-use physiotherapy device based on oscillations of a steel ball during expiration through a pipe-type device. ⋯ No significant changes were noted for FVC, FEV1, or sputum volume throughout the study. Sputum viscoelasticity (rigidity index), however, was significantly lower (p<0.01) after therapy with the Flutter in comparison with AD, predicting improvements in mucociliary and cough clearability of the secretions. In a companion in vitro experiment, oscillations generated by passing humidified air over CF sputum lining an acrylic tube connected to a Flutter de-ice were found to decrease sputum elasticity, as measured by a filancemeter. These findings suggest that applied oscillations are capable of decreasing mucus viscoelasticity within the airways at frequencies and amplitudes achievable with the Flutter device, and provide direct evidence that PT can reduce the viscoelasticity of sputum.
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Multicenter Study
Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis.
To evaluate the incidence and risk factors for catheter-related central vein thrombosis in ICU patients. ⋯ Catheter-related central vein thrombosis is a frequent complication of central venous catheterization in ICU patients and is closely associated with catheter-related sepsis.
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Comparative Study
Quantification of aortic stenosis in mechanically ventilated patients using multiplane transesophageal Doppler echocardiography.
To evaluate the feasibility and accuracy of multiplane transesophageal Doppler echocardiographic assessment of the severity of aortic stenosis in mechanically ventilated patients using modified transgastral views of the left ventricular outflow tract and the aortic valve. ⋯ Multiplane transesophageal Doppler echocardiography offers an alternative approach for assessing the severity of aortic stenosis in mechanically ventilated patients in whom conventional TTE is not feasible.
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Comparative Study
Is it 'worthwhile' to continue treating patients with a prolonged stay (>14 days) in the ICU? An economic evaluation.
To compare the cost and consequences of a policy of continuing to care for patients with a prolonged stay in the ICU with a proposed policy of withdrawing support. ⋯ A considerable proportion of patients with a prolonged length of stay in the ICU survive their critical illness. Furthermore, their long-term quality of life seems reasonable. Our data suggest that continuing treatment for patients with a prolonged ICU stay may represent an efficient use of hospital resources and should be considered in the context of local budgets.