Chest
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To define risk factors, identifiable on initial presentation, that predict subsequent physiologic derangements that are consistent with critical illness in patients presenting to hospital with GI hemorrhage (GIH). ⋯ Many patients with GIH were admitted to the ICU who never met local criteria for admission, and these patients experienced a significantly longer length of hospital stay than other, similarly ill patients. Coagulopathy, hypotension, neurologic dysfunction, and a higher (> or = 15) APACHE II score in the first 2 h of hospitalization were the best independent predictors of the subsequent development of critical illness.
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Comparative Study
Reduction in tracheal lumen due to endotracheal intubation and its calculated clinical significance.
The flow in the human trachea is turbulent. Thus, the tracheal resistance (R) and the pressure gradient (DeltaP) required to maintain a given flow across the trachea is inversely related to its radius raised to the fifth power. If the caliber reduction ratio (X) after endotracheal intubation is calculated as X = radius of the endotracheal tube (rETT)/radius of the trachea (rT), then DeltaP and/or R will be increased by (1/X)(5). ⋯ : The common value of X due to endotracheal intubation is between 0.5 and 0.6, which in and of itself results in an increase in R across the intubated trachea up to 32-fold. The calculated increase in P as a result of this is between 2 and 3 cm H(2)O for adolescents or young adults. The addition of pressure support of at least 3 cm H(2)O during spontaneous ventilation via an endotracheal tube, which is common practice in pediatric critical care, should alleviate any respiratory distress emanating from the increased R. However, a value for X < 0.5, which was found in 10% of our patients (2 of 20 patients), results in a much higher calculated increase in the pressure gradient and, therefore, a higher level of pressure support is required to overcome this increase.
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Sleepiness is a key symptom in obstructive sleep apnea syndrome (OSAS) and can be objectively assessed with a multiple sleep latency test (MSLT). We studied the terms that patients prefer to describe their symptoms-sleepiness, fatigue, tiredness, or lack of energy-and how these terms relate to objective findings. ⋯ Complaints of fatigue, tiredness, or lack of energy may be as important as that of sleepiness to OSAS patients, among whom women appear to have all such complaints more frequently than men. The diagnosis of OSAS should not be excluded based only on a person's tendency to emphasize fatigue, tiredness, or lack of energy more than sleepiness.
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Comparative Study
Psychological functioning and quality of life in lung transplant candidates and recipients.
The purpose of this study was to examine the psychological functioning and quality of life (QOL) of lung transplant candidates and recipients. ⋯ Although lung transplant recipients have better general, physical, and psychological health than their pretransplant counterparts, the present research suggests that both groups experience impairment in several areas of psychological functioning. Future research into the QOL of the lung transplant population should be aimed at recognizing, intervening, and improving patients' psychological and emotional well-being.
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Comparative Study
Outpatient pleurodesis of malignant pleural effusions using a small-bore pigtail catheter.
Patients with symptomatic malignant pleural effusion are usually treated with large-bore chest tube placement and pleurodesis requiring > or = 3 days of hospitalization. We sought to demonstrate the feasibility of ambulatory drainage and sclerosis using a small-bore pigtail catheter in patients with malignant pleural effusions. We reasoned that this approach would improve symptoms and quality of life at a reduced cost. ⋯ Ambulatory sclerosis of malignant effusion using a small-bore catheter is a feasible alternative to inpatient sclerosis with a large-bore chest tube, especially in patients with strong preferences for outpatient care.