Chest
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Reduced dose bolus alteplase vs conventional alteplase infusion for pulmonary embolism thrombolysis. An international multicenter randomized trial. The Bolus Alteplase Pulmonary Embolism Group.
To test the hypothesis that a reduced dose of bolus recombinant human tissue-type plasminogen activator (rt-PA) (0.6 mg/kg/15 min, maximum of 50 mg) would result in fewer bleeding complications than standard 100 mg of rt-PA administered as a continuous infusion over 2 h among hemodynamically stable patients with pulmonary embolism (PE). Subsidiary objectives were to compare the two rt-PA regimens with respect to the following: (1) the rate of other adverse clinical events; (2) the magnitude of change from baseline on perfusion lung scans, pulmonary angiograms, or echocardiograms; and (3) the differences in coagulation parameters over time. ⋯ No significant differences were detected between the bolus rt-PA and 2-h rt-PA with respect to bleeding complications, adverse clinical events, or imaging studies. There was less fibrinogenolysis with the bolus dosing regimen.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Effect of injectate temperature and thermistor position on reproducibility of thermodilution cardiac output determinations.
The purpose of this study was to evaluate the effect of thermistor position with varying injectate temperatures on the reproducibility of thermodilution cardiac output determination. The key hypothesis to be tested was that the positioning of the proximal thermistor at the right atrial port would improve the reproducibility of thermodilution cardiac output determination, independent of injectate temperature. ⋯ Reproducibility of thermodilution cardiac output determinations is improved when injectate temperature is measured internally, at the RA, as opposed to externally in the reservoir. This has clinical implications for determining significant changes in serial cardiac output determinations.
-
Review Case Reports
Greenfield inferior vena cava filter dislodged during central venous catheter placement.
Two cases of a Greenfield inferior vena cava (IVC) filter being dislodged during central venous catheter placement are described. This event appears to be related to J-tip guidewire use during venous catheterization. ⋯ One of the two filters was dislodged from the IVC to a new position in the right atrium. Dislodging of the filter in these two particular cases did not give rise to clinical signs or symptoms.
-
To determine the effectiveness of oronasal masks for positive pressure therapy in alleviating obstructive sleep apnea (OSA). ⋯ Oronasal masks are a viable alternative interface for alleviating OSA with positive pressure therapy in those patients who are unwilling or unable to tolerate conventional nasal interfaces. Although there were no adverse consequences associated with the use of oronasal masks in our patients, appropriate safety precautions should be taken to minimize the possibility of aspiration of gastric contents and avoid untoward sequelae due to positive pressure device failure.
-
Comparative Study
Oxygen therapy using pulse and continuous flow with a transtracheal catheter and a nasal cannula.
Pulse delivery (PD) of oxygen was compared with continuous flow (CF) utilizing transtracheal oxygen catheter (TTO) and nasal cannula (NC) in 20 stable patients with chronic hypoxemia. Oxygen saturation, respiratory rate, and accuracy of pulsed oxygen delivery were measured during sleep studies and these parameters, as well as arterial blood gases, were evaluated during rest and exercise. Additionally, bulk liquid oxygen use was measured under each condition, for a period of 1 month. ⋯ The PD settings in the remaining subjects were equivalent to continuous flow settings for TTO and NC as assessed by PaO2 for rest and SaO2 for exercise and sleep. Compared with standard CF NC, the daily bulk oxygen use was decreased by 29.4 percent with CF TTO, by 48.2 percent with PD NC, and by 49.9 percent with PD TTO. We conclude that, compared with CF NC, PD of oxygen via TTO or NC by this method appears to be a safe, reliable, effective, and cost-effective method of oxygen delivery in the majority of subjects when used with proper screening.