Chest
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Comparative Study
Multiplane transesophageal echocardiographic doppler imaging accurately determines cardiac output measurements in critically ill patients.
To compare cardiac output and stroke volume measured by multiplane transesophageal Doppler echocardiography with that measured by the thermodilution technique. ⋯ Multiplane transesophageal echocardiography enhances the ability to estimate accurately cardiac output and stroke volume by providing new access to left ventricular outflow tract in critically ill patients.
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To evaluate the frequency with which advance directives (ADs) are available at the time of admission and their impact on subsequent care in a medical intensive care unit (MICU) setting before and 9 months after the implementation of the Patient Self-Determination Act (PSDA). ⋯ Advanced directives were infrequently available and had little impact on the pattern of care.
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The validity of peak inspiratory mouth pressure (P. PI-max) as a measure of inspiratory muscle strength was investigated by comparing it with sniff Pes in patients with COPD with respect to (1) learning effect, (2) reproducibility, and (3) measures of agreement. To assess the discriminating capacity of P. ⋯ PImax was significantly (p < 0.001) lower in both male (8.2 kPa) and female (6.2 kPa) patients with COPD compared with healthy men (11.0 kPa) and healthy women (8.8 kPa). We conclude that P. PImax is a valid and noninvasive assessment of inspiratory muscle strength.
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A high incidence of embolic phenomena is associated with atrial fibrillation (AF) and the left atrial appendage (LAA) is frequently the source of the emboli. Thrombus formation may be due to stasis within the fibrillating and inadequately emptying LAA. Because LAA emptying in AF may be the result of mechanical compression by the adjacent left ventricle, it is possible that left ventricular diastolic filling duration will importantly influence passive emptying of the LAA. We hypothesized that the magnitude of emptying of the LAA in AF is related to the duration of left ventricular diastolic filling which is determined by the ventricular response rate in AF. ⋯ These results indicate that the magnitude of LAA emptying in AF is strongly and inversely influenced by ventricular rate. Direct current cardioversion to sinus rhythm is associated with an increase in the magnitude of LAA emptying that is not influenced by heart rate. The magnitude of LAA emptying may be an important factor in the formation of thromboemboli in AF. The extent to which controlling the VRR in chronic AF will prevent stasis and LAA thrombus formation remains to be determined.
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Diaphragmatic flutter is a rarely reported disorder in which the diaphragm involuntarily contracts at a rapid rate. We report a unique case in which diaphragmatic flutter was associated with inspiratory stridor and was severely disabling. A new approach to the treatment of this condition, phrenic nerve crush, provided an optimal outcome, with resolution of symptoms and the return of normal diaphragmatic function. Pathophysiology and treatment of this condition are discussed.