Chest
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The use of single-dose etomidate to facilitate intubation in critically ill patients has recently been debated given its suppression of steroidogenesis with possible resultant adverse outcomes. Our objective was to assess the effects of single-dose etomidate used during rapid-sequence intubation (RSI) on various measures of outcome, such as mortality, vasopressor use, corticosteroid use, ICU length of stay (ICU-LOS), and number of ventilator days. ⋯ Single-dose etomidate used during RSI in critically ill patients with severe sepsis and septic shock was not associated with increased mortality, vasopressor use, ICU-LOS, or number of ventilator days. Patients intubated with etomidate had an increased incidence of subsequent corticosteroid use, with no difference in outcomes.
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Identification of people with Parkinson disease (PD) who are at risk for aspiration is important, especially because of the high prevalence of aspiration pneumonia. ⋯ The data from this pilot study suggest that in patients with PD, objective airflow measures from voluntary cough production may identify at-risk penetrator/aspirators. To our knowledge, this is the first study to evaluate the discriminative ability of voluntary cough airflow characteristics to model airway compromise in people with PD.
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Comparative Study
The value of adding a verbal report to written handoffs on early readmission following prolonged respiratory failure.
Patients who survive the acute phase of respiratory failure often are transferred to units with specialized expertise. These patients have a high risk of being readmitted to the acute care hospital. We conducted this study to determine whether supplementing a written report with a verbal telephone report reduces readmission rates within the first 72 h after discharge and decreases hospital costs. ⋯ The OR for readmission if the handoff included a verbal report was 0.42 (95% CI, 0.17-1.04). The total hospital cost was significantly lower in the group where verbal report was used ($111,723 vs $148,574; P = .002). Supplementing a written report with a verbal telephone report was associated with a significant reduction in cost and an average savings of ∼ $184,000 for every 100 patients discharged, representing added value in delivered care.
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Electromagnetic navigation bronchoscopy (ENB) has been developed as a novel ancillary tool for the bronchoscopic diagnosis of pulmonary nodules. Despite successful navigation in 90% of patients, ENB diagnostic yield does not generally exceed 70%. We sought to determine whether the presence of a bronchus sign on CT imaging conditions diagnostic yield of ENB and might account for the discrepancy between successful navigation and diagnostic yield. ⋯ ENB diagnostic yield is highly dependent on the presence of a bronchus sign on CT imaging.
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Pneumonia is an infection of the lung and a common presentation problem in EDs. The objective of this study was to describe the epidemiology of pneumonia presentations to EDs in the province of Alberta, Canada. ⋯ Pneumonia is a common presenting problem in Alberta EDs, and further study is required to understand the factors associated with the variation in presentations. Findings include a decrease in presentations after the first fiscal year, disparities based on age, sex, and socioeconomic/cultural status, and a low rate of early follow-up.