Chest
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Our aim was to document the following in patients with septic shock and disseminated intravascular coagulation (DIC): (1) the influence of DIC in the mortality rate and the occurrence of organ failure; (2) the comparative prognostic value of initial antithrombin III (ATIII), protein C (PC), and protein S (PS) levels; and (3) the compared pattern of sequential ATIII, PC, and PS levels according to clinical outcome. ⋯ DIC is a strong predictor of death and multiple organ failure in patients with septic shock. Sequential ATIII, PC, and PS measurements were consistent with prolonged consumption or inhibition that might account for a sustained procoagulant state and inhibition of fibrinolysis. The initial ATIII level was the best laboratory predictor of death in these patients.
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We have developed a computerized protocol that provides a systematic approach for management of pressure control-inverse ratio ventilation (PCIRV). The protocols were used for 1,466 h in ten around-the-clock PCIRV evaluations on seven patients with severe adult respiratory distress syndrome (ARDS). Patient therapy was controlled by protocol 95 percent of the time (1,396 of 1,466 h) and 90 percent of the protocol instructions (1,937 of 2,158) were followed by the clinical staff. ⋯ Right atrial and pulmonary artery pressures were higher and cardiac output lower in PCIRV but blood pressure was unchanged. The success of this protocol has demonstrated the feasibility of using PEEPi as a primary control variable for oxygenation. This computerized PCIRV protocol should make the future use of PCIRV less mystifying, simpler, and more systematic.
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Comparative Study
An international comparison of asthma morbidity and mortality in US soldiers. 1984 to 1988.
Asthma-related morbidity, as measured by hospital discharges, and mortality are compared for US soldiers assigned to central Europe and to the continental United States. The populations, as well as the level and type of medical care available, are quite similar in both locations and permit a purer contrast of the effect of geography than is possible by comparing indigenous populations across national boundaries. The results reveal higher discharge rates and mortality in Europe than in the United States; a peak discharge rate in the third calendar quarter in Europe but less clearly in the United States; similar mortality in black and white subjects, in contrast to US civilian data; and declining discharge rates over time among soldiers less than 24 yr old.