Medical science monitor : international medical journal of experimental and clinical research
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The aim of this study was to investigate weather beta blockers are associated with an increased mortality in sepsis. ⋯ We did not show a significant association between beta blockers and increased mortality in patients with sepsis. Sicker patients had an increase risk of death, and possibility that beta blocker use may have contributed to this risk cannot be completely ruled out. Our study was limited by a small sample size and retrospective design. Further investigations of potential benefits and side effect of beta blockers in patients with sepsis are warranted.
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The aim of manual hyperinflation (MH) is to mobilize airway secretions and prevent sputum plugging in intubated and mechanically ventilated patients. With MH, the nurse applies a larger than normal breath with a slow inspiratory flow and, after an inspiratory pause, a high expiratory flow is created by completely releasing the resuscitation bag. ⋯ Performance of MH by certified ICU nurses is far from appropriate. These results emphasize the necessity for clearer guidelines with explicit directions for this frequently applied procedure, if it is decided to practice it in the daily care of intubated and mechanically ventilated patients.
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Although low-tidal ventilation may reduce mortality in acute respiratory distress syndrome (ARDS), it can also result in severe respiratory acidosis and lung derecruitment. This study tested the hypothesis that combining "open-lung" ventilation and arteriovenous extracorporeal lung assist (av-ECLA) allows for maximal tidal volume (VT) reduction without the development of decompensated respiratory acidosis and impairment of oxygenation. ⋯ Due to sufficient CO2 elimination during av-ECLA, the VTs could be reduced to 0-2 ml/kg without the risk of decompensated respiratory acidosis. It was also shown that the "open-lung" strategy chosen was associated with sustained improvements in oxygenation, even though VTs were minimized.
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Assuming that HFOV (high frequency oscillatory ventilation) with hypercapnia could be more protective than normocapnia, in a rat model of lung injury, we evaluated the effect of hypercapnic acidosis during HFOV. ⋯ Although edema formation was less pronounced in the hypercapnia group, we found no increased numbers of inflammatory cytokines or general histological evidence to suggest that permissive hypercapnia during HFOV was protective.
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Case Reports
Early prediction of ventricular recovery in Takotsubo syndrome using stress and contrast echocardiography.
Takotsubo syndrome is a primary, stress-provoked acquired cardiomyopathy mimicking acute myocardial infarction. Because of the less severe prognosis of takotsubo patients, a reliable method of predicting complete functional recovery has great practical value. ⋯ Microcirculation assessment using myocardial contrast echocardiography as well as early contractile reserve in a low-dose dobutamine echocardiographic test might be useful in the prediction of functional recovery in suspected takotsubo syndrome.