Chest
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To identify the spectrum of respiratory disturbances during sleep in patients with obesity hypoventilation syndrome (OHS) and to examine the response of hypercapnia to treatment of the specific ventilatory sleep disturbances. ⋯ This study demonstrates that OHS encompasses a variety of distinct pathophysiologic disturbances that cannot be distinguished clinically at presentation. Sustained obstructive hypoventilation due to partial upper airway obstruction was demonstrated as an additional mechanism for OHS that is not easily classified as SHVS or OSAHS.
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To determine the incidence of systemic inflammatory response syndrome (SIRS) and organ failure and to describe the outcomes in critically ill obstetric patients who have been treated in medical ICUs. ⋯ The most common reason for admission to the ICU of critically ill obstetric patients was respiratory failure. Despite the severity of illness and the development of SIRS and organ failure in most patients, the mortality rate was low.
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To identify the impact of upright and supine spirometry (USS) on the choice of anesthesia and outcomes in patients undergoing surgery for anterior mediastinal masses (AMMs). ⋯ The recommendation to perform USS prior to surgery on AMMs is based on anecdotal data. Our study found that the incidence of perioperative complications in surgery for AMMs is low. We also found that USS is not ordered in all patients preoperatively and that the results do not always alter the anesthetic technique when abnormal. One patient who experienced a perioperative complication had normal USS values. Larger studies are necessary to further evaluate the utility of USS in surgery for AMMs.
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In the airline industry, training is costly and operator error must be avoided. Therefore, virtual reality (VR) is routinely used to learn manual and technical skills through simulation before pilots assume flight responsibilities. In the field of medicine, manual and technical skills must also be acquired to competently perform invasive procedures such as flexible fiberoptic bronchoscopy (FFB). Until recently, training in FFB and other endoscopic procedures has occurred on the job in real patients. We hypothesized that novice trainees using a VR skill center could rapidly acquire basic skills, and that results would compare favorably with those of senior trainees trained in the conventional manner. ⋯ A short, focused course of instruction and unsupervised practice using a virtual bronchoscopy simulator enabled novice trainees to attain a level of manual and technical skill at performing diagnostic bronchoscopic inspection similar to those of colleagues with several years of experience. These skills were readily reproducible in a conventional inanimate airway-training model, suggesting they would also be translatable to direct patient care.
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Improved understanding of the pathogenesis of acute lung injury (ALI)/ARDS has led to important advances in the treatment of ALI/ARDS, particularly in the area of ventilator-associated lung injury. Standard supportive care for ALI/ARDS should now include a protective ventilatory strategy with low tidal volume ventilation by the protocol developed by the National Institutes of Health ARDS Network. ⋯ In addition, novel modes of mechanical ventilation are being studied and may augment standard therapy in the future. Although results of anti-inflammatory strategies have been disappointing in clinical trials, further trials are underway to test the efficacy of late corticosteroids and other approaches to modulation of inflammation in ALI/ARDS.