Chest
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative evaluation of three heat and moisture exchangers during short-term postoperative mechanical ventilation.
This study compared performance of three heat and moisture exchangers (HME) during short-term postoperative mechanical ventilation. Temperature and absolute humidity (AH) were measured at various points of the ventilatory circuit. There was no statistical difference between the groups, regarding ambient and body To, body weight, fraction of inspired oxygen, tidal volume, and respiratory rate. ⋯ Indirect evaluation (variations of inspiratory gases and tracheal temperatures, AH of the expired gases) confirmed the superiority of the hygroscopic HME. These data suggest that humidification of inspiratory gases with a hygroscopic HME is a defensible practice during short-term postoperative mechanical ventilation. Performance of hydrophobic HME may be weak and can expose the patient to an unacceptable risk of endotracheal tube occlusion.
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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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Clinical Trial Controlled Clinical Trial
Effects of nebulized morphine sulfate on the exercise tolerance of the ventilatory limited COPD patient.
We have shown previously that the administration of morphine (0.8 mg/kg) to patients with COPD increases the VO2max by 19.3 percent. A recent study demonstrated that the administration of low-dose nebulized morphine (approximately 2 mg) increased the endurance time of patients with severe lung disease by 1 min (35 percent) with few systemic side effects. This double-blind crossover study evaluated the effects of various doses of nebulized morphine (0, 1, 4, and 10 mg) on the exercise tolerance and the psychologic status of COPD patients. ⋯ The mean changes (+/- SD) in the exercise test results after each of the four different regimens were as follows: [table: see text] Although there tended to be larger increases in the workload, VO2max, and VEmax after the largest dose of morphine, none of the changes was statistically significant. Likewise, there were no significant differences in spirometry, resting metabolic measurements, or psychologic test scores after the four different regimens. We conclude that aerosolized morphine in the doses used in this study has no significant beneficial effect on the exercise tolerance of patients with COPD.
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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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Twelve patients with the adult respiratory distress syndrome were included in this study and evaluated by transesophageal echocardiography and Doppler, assessing right and left ventricular intracardiac blood flow alterations with progressive increase of inspiration-to-expiration (I-E) ratios. Whereas midpulmonary artery flow parameters did not show any change, early left ventricular filling demonstrated a significant increase after switching the ventilatory mode from volume to pressure-controlled ventilation with 2:1 I-E ratio (end-inspiration: 39 +/- 26 cm with positive end-expiratory pressure [PEEP]-ventilation to 68 +/- 56 cm with pressure-controlled inverse-ratio ventilation, 2:1; p < 0.01; at end-expiration, from 67 +/- 21 cm with PEEP-ventilation to 83 +/- 36 cm with pressure-controlled ventilation 1:1; p < or = 0.05), resulting probably from different ventilatory flow and pressure curves. In the meanwhile, cardiac index demonstrated a significant augmentation (from 4.73 +/- 1.71 L/min.m2 to 5.56 +/- 1.66 L/min.m2; p < 0.05). Pressure-controlled inverse ratio ventilation results in both respiratory and hemodynamic advantages as is demonstrated by this study.