Chest
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Bedside percutaneous dilational tracheostomy was performed by critical care attending physicians or supervised pulmonary and critical care fellows on 100 patients in the ICU at Cook County Hospital, Chicago, over a 3-year period. A needle is inserted in the first or second tracheal interspace followed by a guidewire. The tract is enlarged with a series of dilators to allow placement of a standard tracheostomy tube. ⋯ Comparison of percutaneous dilational tracheostomy with two other techniques of percutaneous tracheostomy reveals a similar success rate with a lower incidence of serious complications. Bedside percutaneous dilational tracheostomy can be performed in the ICU by trained physicians with a low complication rate. We believe it to be the procedure of choice for many critically ill patients who require tracheostomies.
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To determine whether continuous Fick cardiac output measurement is applicable to exercise testing, cardiac output data obtained by the continuous Fick method (Qcf) during exercise were compared with data obtained by the thermodilution method (Qth). Seventeen patients with old myocardial infarction underwent a 1-min or 3-min incremental exercise test (protocols 1 and 2, respectively). During exercise, the oxygen consumption (VO2), arterial oxygen saturation (SaO2), and mixed venous oxygen saturation (SvO2) were monitored continuously. ⋯ In exercise protocol 2, SvO2 almost reached a steady-state by the end of each stage. The correlation between Qcf and Qth was good in protocol 1 (r = 0.86), except in phases 2 and 4, and was also good in protocol 2 (r = 0.80). We conclude that the continuous Fick method may be applicable for determining the cardiac output during exercise provided that the variation in SvO2 is slight.
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A patient with obesity resulting from sleep-related eating disorder demonstrated signs and symptoms of obstructive sleep apnea (OSA). Incarceration restricted access to food during the night, leading to weight loss and clinical improvement. Release from prison allowed recurrence of unrestricted sleep-eating, recurrent obesity, and documented OSA. Successful treatment of sleep-related eating disorder can result in improvement in coexisting OSA.
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To examine the impact of pulse oximetry on the use of arterial blood gas and other laboratory determinations and to examine predictors of the use of arterial blood gas measurements. ⋯ The implementation of pulse oximetry in this manner gives an idea how effective the technology will be in reducing the use of arterial blood gas determinations without guidelines for the use of pulse oximetry. As only a marginal decrease was observed in the total population of medical and surgical patients, and only on the night shift, formal and standardized guidelines for the most efficient use of pulse oximetry should be considered. If these were considered, pulse oximetry may indeed make a significant contribution to improving the efficiency of care services.