Chest
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A 48-year-old male patient had arrest due to rupture of a dissecting aneurysm of the thoracic aorta into the pericardial cavity with tamponade; he received treatment in a general hospital lacking the facilities to practice heart surgery. The patient was treated by means of intermittent pericardial drainage while being transferred to another hospital at 100-km distance for surgical treatment.
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A simple multiple system organ failure (MSOF) score may predict mortality of patients who have sepsis syndrome. Using an MSOF scoring system, we prospectively determined the presence or absence of respiratory, cardiovascular, renal, hepatic, gastrointestinal, hematologic, and neurologic organ failure on day 1 of sepsis syndrome in 154 consecutive patients who had sepsis syndrome in the ICU of a tertiary care, teaching hospital. We used 30-day hospital mortality as the primary outcome variable. ⋯ Using logistic regression, the adjusted odds ratios (OR) for covariates most predictive of mortality were hematologic (OR = 6.2), neurologic (OR = 4.4), hepatic (OR = 3.4), cardiovascular (OR = 2.6), and age (1.05 per year). The logistic model using the seven organ system failures and age as covariates accurately predicted outcome 75 percent of the time with a sensitivity of 51 percent and specificity of 87 percent. In conclusion, a simple scoring system tabulating the number of organ system failures present on day 1 of sepsis syndrome predicts the mortality of patients who have sepsis syndrome with reasonable accuracy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Protective effect of inhaled piretanide on the bronchial obstructive response to ultrasonically nebulized H2O. A dose-response study.
Inhaled furosemide prevents the obstructive response to several bronchoconstrictor stimuli in asthma. To verify whether this protective effect is also shared by other loop diuretics, we investigated the effect of inhaled piretanide on the bronchial obstructive response to ultrasonically nebulized distilled water (UNW) in ten patients with moderate, stable asthma. ⋯ Piretanide caused a significant, dose-dependent increase in UNW PD20 with respect to placebo, corresponding to 0.6 +/- 0.2 doubling doses (mean +/- SE) after 12 mg, 1.3 +/- 0.2 after 24 mg, and 2.0 +/- 0.2 after 48 mg, and had a remarkable diuretic effect; 40 mg of furosemide increased UNW PD20 by 2.3 +/- 0.3 doubling doses (p < 0.01), but showed only a modest diuretic activity. These data indicate that inhaled piretanide is as effective as furosemide in preventing UNW-induced asthma, and this effect is unrelated to their diuretic potency.
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Cardiac tamponade, a potentially lethal complication following cardiac surgery, may present either early or late postoperatively and may be difficult to diagnose due to atypical clinical, hemodynamic, or echocardiographic findings. To determine the frequency and clinical features of postoperative cardiac tamponade, we performed a review of 510 consecutive patients who underwent cardiac surgery. The incidence of postoperative cardiac tamponade was 2.0 percent (10/510 patients) and occurred following valvular, bypass, and aortic surgery. ⋯ Eight of ten patients survived; all of these patients underwent surgical removal of fluid and/or hematoma in the operating room. We conclude that postoperative tamponade after cardiac surgery may have varied clinical and hemodynamic presentations, often due to selective chamber compression by loculated fluid or clot. Due to its frequently atypical features and presentation that may simulate other disorders, the diagnosis of tamponade should be considered whenever hemodynamic deterioration or signs of low output failure occur in the postcardiotomy patient.
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To determine the value of tonometrically measured gastric intramucosal pH (pHi) and accepted indices of systemic oxygenation in predicting multiorgan dysfunction syndrome (MODS) and death in critically ill patients with sepsis. ⋯ In patients with sepsis, indices of tissue oxygenation are better predictors of outcome than the hemodynamic and oxygen-derived variables obtained by invasive hemodynamic monitoring. These indices should be used to direct therapy.