Chest
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Randomized Controlled Trial Comparative Study Clinical Trial
Right ventricular function during weaning from respirator after coronary artery bypass grafting. Comparison of two different weaning techniques.
The purpose of this investigation was to determine right ventricular function during weaning from controlled ventilation comparing a biphasic positive airway pressure ventilatory support system (BiPAP [Respironics]) with pressure support ventilation (PSV). In 22 patients following coronary artery bypass grafting, both weaning techniques were used in randomized chronological order for 60 min each. Right ventricular end-systolic (RVESV) and end-diastolic volume (RVEDV) and ejection fraction (RVEF) were evaluated using the fast-response Swan-Ganz catheter. ⋯ No differences in left ventricular function or arterial blood gas analyses were measured during both study periods. In summary, the RV afterload was higher with the BiPAP system compared with PSV which suggested that this was due to differences in the respiratory support between both weaning modes. Because of the Frank-Starling mechanism, this higher afterload did cause a small but significant increase in RV volumes and a significant decrease in RV ejection fraction with the BiPAP system.
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Clinical Trial
Low-dose almitrine bismesylate in the treatment of hypoxemia due to chronic obstructive pulmonary disease.
Assessment of acute and chronic effects of low-dose almitrine bismesylate (AB) in stable chronic obstructive pulmonary disease (COPD). ⋯ Low-dose AB therapy, 75 mg daily, resulted in sustained elevation of arterial oxygen tension in hypoxemic patients with COPD. Although pulmonary artery pressure increased transiently after the first dose, it remained unchanged with long-term treatment despite persistent improvement of pulmonary gas exchange.(ABSTRACT TRUNCATED AT 250 WORDS)
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Measurement of pleural fluid constituents (pH, PCO2, protein, lactic dehydrogenase [LDH], glucose, red blood cells [RBC], and white blood cells [WBC]) are of value in the diagnosis of pleural effusions and in the separation of exudates from transudates. The position of the patient (sitting or lying) prior to thoracentesis may result in differences in the measurement of these constituents. ⋯ The location of basal pleural tumors and the molecular weight of certain constituents may explain this postural sedimentary effect. Repeated thoracentesis after 30 min in the sitting position may result in exudative values when borderline transudates are found in a patient previously in a supine position.
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A high proportion of patients admitted to a medical emergency department due to chest pain are directly sent home, since the initial suspicion of acute myocardial infarction (AMI) can be quickly ruled out. ⋯ Patients who came to a medical emergency department due to chest pain, and who were sent home, had a low risk of death and development of infarction during the following year. Survivors after 1 year do, however, more frequently report emotional and psychosomatic symptoms than survivors of AMI.
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Case Reports
Prolonged treatment with almitrine for refractory hypoxemia in adult respiratory distress syndrome.
A 49-year-old man presented with an atypical pneumonia entailing an adult respiratory distress syndrome (ARDS). The refractory hypoxemia caused a myocardial infarction, leading us to try pharmacologic treatments. Almitrine bismesilate (AB) infusion allowed improvement of arterial oxygenation during 115 h without adverse effect. This case is, to our knowledge, the first reported prolonged treatment using AB for hypoxemia due to ARDS.