Heart & lung : the journal of critical care
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This study investigated the relationship of incidence, degree, and duration of PCD to age of the patient, time on cardiopulmonary bypass, mean arterial pressure on bypass, ICU time, and body temperature postoperatively. The study sample consisted of 50 open-heart surgery patients. The delirium assessment was made each evening for 7 days after operation. ⋯ Duration of delirium was related to age, ICU time, and temperature on the third postoperative day. Thus, the findings supported the multiple factor theory for etiology of PCD. Certain factors interacted to produce PCD, while different factors interacted to prolong and intensify the delirium produced.
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A three-part study identified factors essential to accurate determination of pressure exerted against the lateral wall of the trachea by three types of endotracheal tube cuffs. Part I compared 31 mercury sphygmomanometer measurements of tracheal cuff pressures to those of pressure-sensitive aneroid Portex manometer during simulated intubation and found 99.28% of mercury manometer readings accurate to within 2 mm Hg of Portex readings. ⋯ Part III compared two methods of obtaining tracheal cuff pressure readings with the mercury sphygmomanometer during simulated intubation. Accurate measurement was made only with a stopcock system that simultaneously opened to the cuff, the manometer, and the inflator syringe and when a separate cuff distensibility factor was used in the computation.
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Complete left bundle branch block often masks old as well as acute myocardial infarctions. However, a diagnosis of acute myocardial infarction in the presence of complete left bundle branch block can be made when the acute injury current is large enough to modify the secondary repolarization abnormalities of left bundle branch block. Under these circumstances the classical ST-T changes of an acute infarction may evolve in serial electrocardiograms.
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Pulmonary complications are the leading cause of morbidity and death during the postoperative period in patients who have undergone upper abdominal surgery. Significant pulmonary mechanical alterations, such as reductions in VC, TV, and FRC and an increase in CV, are noted postoperatively in this patient population. Preexisting patient conditions, postoperative treatments, and certain respiratory maneuvers may increase the patient's risk in the development of postoperative pulmonary complications. ⋯ Commonly utilized maneuvers, such as blowing into a rubber glove or bag, blow bottles, and the like, should be avoided in all situations. A guide for preoperative and postoperative pulmonary assessment and care based on current research is included. After consideration of the data in addition to personal clinical experience, I conclude that to prevent pulmonary complications in patients after upper abdominal surgery, as well as in all hospitalized patients, sustained maximal inspiration, preferably with an incentive spirometer, and conscientious nurse supervision and coaching is the method of choice.