Chest
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Heterotopic ossification (HO), deposition of para-articular ectopic bone, is associated with musculoskeletal trauma and certain congenital and metabolic disorders. Additionally, HO may follow paralysis from diverse traumatic and nontraumatic neurologic insults. We describe three cases of HO associated with catastrophic nontraumatic respiratory illness requiring prolonged chemical paralysis and cardiorespiratory support.
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Do-not-resuscitate (DNR) orders have been espoused for the enhancement of patient autonomy, avoidance of futile medical intervention, and cost containment. Outcomes of cardiopulmonary resuscitation (CPR) in the intensive care setting have been dismal, with few patients surviving to discharge. This study compares patients who died in medical and surgical ICUs in a DNR status with those who died after attempted CPR. ⋯ Among patients dying in the medical and surgical ICUs in the authors' institution, only age and level of consciousness discriminated patients who died in a DNR status from those who died after attempted CPR.
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Comparative Study
Measurement of respiratory acoustical signals. Comparison of sensors.
We assessed the performance of three air-coupled and four contact sensors under standardized conditions of lung sound recording. Recordings were obtained from three of the investigators at the best site on the posterior lower chest as determined by auscultation. Lung sounds were band-pass filtered between 100 and 2,000 Hz and sampled simultaneously with calibrated airflow at a rate of 10 kHz. ⋯ Unexpectedly, less sensitivity (lower signal-to-noise ratio) at high frequencies was observed in the air-coupled devices. Sensor performance needs to be characterized in studies of lung sounds. We suggest that lung sound spectra should be averaged at known airflows over several breaths and that all measurements should be reported relative to sounds recorded at zero flow.
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A prospective study was done to compare four different methods of securing oral endotracheal tubes: adhesive tape (A), Twill tape (T), Twill tape with FlexBlue bite block (TFXB), and Velcro tie with FlexBlue (VFXB), used on sequential days. Thirty-six patients were enrolled for 136 patient-days and 18 had complete 4-day cycles. The methods were evaluated twice daily by nurses, respiratory therapist, and patient, on a five-point Likert scale with regard to oral hygiene, patient comfort, nurse satisfaction, and ease of use. ⋯ Adhesive tape and T required an oral airway on only 14 days compared with 69 days of FlexBlue use. Extubation on 2 and near extubation occurred on 18 occasions with FlexBlue use and only once with T and accounted for most decisions to change securing method. We cannot recommend the use of the FlexBlue system for securing oral endotracheal tubes.
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Comparative Study
Estimation of ventilatory reserve by stair climbing. A study in patients with chronic airflow obstruction.
Clinicians and surgeons have used the subjective response to the climb of "one or two flights of stairs" to assess the "reserve" of patients with chronic airflow obstruction (CAO). Very little objective data exist regarding the metabolic and ventilatory cost for any level of stair climbing in these patients. Therefore, this study was designed to evaluate the use of symptom-limited stair climbing as a simple method to estimate the peak oxygen uptake (VO2) and minute ventilation (VE) in patients with CAO. ⋯ We conclude that a symptom-limited maximal stair climb helps estimate peak VO2 and VE in patients with CAO. The frequently advocated test to climb one to two flights to evaluate cardiopulmonary reserve is not adequate for most patients with CAO. Symptom-limited maximal stair climbing is a simple, inexpensive and readily available test that may be used to evaluate the cardiopulmonary reserve of stable patients with CAO.