Chest
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
The effect of adding ipratropium bromide to salbutamol in the treatment of acute asthma: a pooled analysis of three trials.
To assess the effect on FEV1 and clinical outcomes of adding ipratropium bromide to salbutamol in the treatment of acute asthma. ⋯ Adding ipratropium bromide to salbutamol in the treatment of acute asthma produces a small improvement in lung function, and reduces the risk of the need for additional treatment, subsequent asthma exacerbations, and hospitalizations. These apparent benefits of adding ipratropium bromide were independent of the amount of beta-agonist that had been used earlier in the attack, and possibly related to a recent upper respiratory tract infection. Confirmatory studies are needed, especially for clinical outcomes.
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To examine the impact of the timing of tracheotomy on the duration of mechanical ventilation, the secondary changes to the trachea, and the clinical course of critically ill patients in the ICU. ⋯ There is insufficient evidence to support that the timing of tracheotomy alters the duration of mechanical ventilation or extent of airway injury in critically ill patients.
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Comparative Study
The effects of preoperative therapy with angiotensin-converting enzyme inhibitors on clinical outcome after cardiovascular surgery.
To determine the effect of preoperative therapy with angiotensin-converting enzyme (ACE) inhibitors on clinical outcome after cardiovascular surgery. ⋯ Preoperative therapy with ACE inhibitors did not influence the clinical outcome after cardiac surgery. It is unlikely that therapy with ACE inhibitors can alter the clinical sequelae of cardiopulmonary bypass and cardiac surgical procedures performed in high-risk patients because of underlying severe left ventricular dysfunction.
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Comparative Study
The new onset of atrial arrhythmias following major noncardiothoracic surgery is associated with increased mortality.
To examine the incidence and consequences of atrial arrhythmias in surgical ICU patients following major noncardiac, nonthoracic surgery. ⋯ Patients admitted to a surgical ICU after noncardiothoracic surgery with a history of or who developed new atrial arrhythmias had greater mortality and longer ICU stays than patients without arrhythmias. The incidence of new-onset arrhythmias was lower than reported after cardiac and thoracic surgery, but higher than in the general population. Atrial arrhythmias were not the cause of death and appear to be markers of increased mortality and morbidity.
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Randomized Controlled Trial Comparative Study Clinical Trial
Hemodynamic, cardiac, and electrolyte effects of low-dose aerosolized terbutaline sulfate in asthmatic patients.
Aerosolized beta2-agonists have been associated with increased morbidity in asthmatics. These drugs cause transient increases in heart rate and decreases in serum potassium levels after these drugs are first utilized. This study is designed to elucidate whether beta-adrenergic tolerance to the hemodynamic, cardiac, and electrolyte effects of inhaled terbutaline occurs during 14 days of maintenance therapy. ⋯ Cardiovascular beta2-receptors in patients with stable asthma do not develop tolerance to the effects of low-dose aerosolized terbutaline after 14 days of maintenance therapy. In contrast, the homeostatic mechanisms regulating serum potassium develop tolerance to low-dose terbutaline maintenance therapy. Lack of cardiovascular tolerance to maintenance doses of aerosolized beta2-agonists may be important in increased morbidity if excessive amounts of these drugs are administered during asthma exacerbations.