Chest
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Randomized Controlled Trial Comparative Study Clinical Trial
Continuous positive airway pressure effect on functional residual capacity, vital capacity and its subdivisions.
Thirty-four otherwise healthy patients having to undergo elective upper abdominal surgery were randomly assigned to two equal groups. In the treatment group, constant positive airway pressure (CPAP) with an expiratory pressure of 12 cm H2O was applied at one hour following extubation, and at daily intervals for the first five days following surgery for a continuous period of three hours. ⋯ All patients were given postoperative physiotherapy. In patients who received postoperative CPAP with an end-expiratory pressure of 12 cm H2O, marked normalization of pulmonary function was noted.
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Although pulmonary disability is usually minimal following total sternectomy, the potential for remote complications exists. We present a case of severe respiratory failure resulting from simple rib fractures occurring two years after sternectomy for sternal osteomyelitis. Respiratory failure resulted from flail chest due to the combination of acute rib fracture and the lack of anterior fixation of the thoracic cage.
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Surgical repair of complex thoracic aneurysms requiring aortic valve replacement and coronary revascularization is occasionally complicated by significant bleeding despite the experience of the surgeon. While bleeding from the mediastinal tissues and the anterior suture line is usually easily controlled, posterior bleeding may require dismantling the repair and a second bypass run. The synergism of a second bypass run and continued bleeding may result in increased mortality and/or morbidity. ⋯ The shunt in the first patient has remained open without cardiac decompensation. The last patient developed heart failure and required elective repair of a leak at the descending end of an arch replacement. Our experience suggests that these shunts can be effective, particularly if posterior suture line bleeding is encountered.
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Comparative Study Clinical Trial Controlled Clinical Trial
Ventricular assist by cardiac cycle-specific increases in intrathoracic pressure.
Changes in intrathoracic pressure can influence cardiac performance by altering ventricular loading conditions. Since ventricular loading, both from systemic venous return (preload) and from left ventricular wall stress (afterload), varies during the cardiac cycle, we reasoned that appropriately placed, phasic, cardiac cycle-specific (synchronous) increases in intrathoracic pressure might augment ventricular ejection in acute ventricular failure. Recent studies in animals suggest that synchronous increases in intrathoracic pressure during systole increase ejection. ⋯ Cardiac output was greater with synchronous HFJV than with either IPPB or asynchronous HFJV (4.5 +/- 0.7 L/min compared with 3.5 +/- 0.7 and 3.4 +/- 0.6 L/min [mean +/- SE], respectively; p less than 0.05). Mixed venous oxygen saturation covaried with cardiac output (p less than 0.05), such that calculated oxygen consumption remained constant for all conditions. We conclude that synchronous HFJV augments cardiac output more efficiently than do similar increases in intrathoracic pressure delivered randomly in the cardiac cycle.