Chest
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We studied eight men with chronic obstructive pulmonary disease (COPD) (age, 60.57 +/- 7.59 years; height, 162 +/- 10.43 cm; weight, 65 +/- 9.7 kg). Functional values of the sample were as follows: FEV1, 46 percent; FVC, 67 percent; PO2, 72.4 mm Hg; and pH, 7.41. We used a modification of the Nickerson and Keens method. ⋯ The MEP was not different from the basal value. We concluded that in patients with COPD, MIP decreases significantly after inspiration through umbral inspiratory weight equal to 65 percent MIP and does not return to basal value for 30 minutes. The MEP does not change with respect to basal determination.
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Randomized Controlled Trial Comparative Study Clinical Trial
Are low tidal volumes safe?
High airway pressure may be injurious to lung parenchyma, but lowering airway pressure using conventional mechanical ventilation necessitates lowering tidal volume (VT). Intubated patients in the surgical intensive care unit (SICU) were randomly assigned to group 1 (VT = 12 ml/kg, n = 56) or group 2 (VT = 6 ml/kg, n = 47). ⋯ The use of low VT was associated with a statistically significant but clinically irrelevant decrease in oxygenation. The routine use of low VT appeared to be safe in a selected population of patients in the SICU.
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Comparative Study
Clinical predictors of prolonged translaryngeal intubation in patients with the adult respiratory distress syndrome.
This study was designed to determine if clinical features apparent after seven days of mechanical ventilation predict long-term intubation beyond 14 days and subsequent need for tracheotomy in patients with ARDS. Twenty-four patients were entered into the study. Group 1 patients were successfully extubated in less than or equal to 14 days after onset of ARDS and group 2 patients remained intubated greater than 14 days. ⋯ None of group 1 and 11 group 2 patients eventually underwent tracheotomy. Clinical features apparent after seven days of mechanical ventilation in patients with ARDS suggest the likelihood of prolonged intubation beyond 14 days and eventual tracheotomy. Recognition of these features may allow more timely conversion of endotracheal intubation to tracheotomy.
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A comprehensive evaluation of 62 spirometers from 37 different sources was performed using a two-part protocol: calibrated syringe, and dynamic waveform testing. All testing was done with ambient air. Calibrated syringe testing examined the ability of the spirometers to accurately measure the output of a 3 L calibrating syringe under varying conditions. ⋯ Software errors were found in 25 percent of the computerized systems evaluated. Although using a 3 L syringe for quality control purposes is essential, simple testing of spirometers with a 3 L calibrating syringe for validation purposes was inadequate to assess spirometer performance when compared to dynamic waveform testing. Dynamic waveform testing is essential to accurately measure and validate acceptability of spirometer system performance.