Chest
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The aim of this study was to describe the facility, patient population, outcome of treatment, and survival of patients transferred to a regional weaning center (RWC) after prolonged mechanical ventilation in the ICU setting. ⋯ Selected patients who become ventilator dependent for prolonged periods in the ICU may be transferred to an RWC with the expectation of successful weaning in a majority of cases.
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To evaluate the incidence and cause of parenteral nutrition-induced lipogenesis. ⋯ Net fat synthesis was found in a surprisingly large number of critically ill patients receiving central venous nutrition. Many of these patients received carbohydrate calories in excess of their measured energy expenditure, even though it appeared that they needed this level of caloric intake by clinical assessment. The high carbohydrate total parenteral nutrition (TPN) solutions with lipids provided only for prevention of essential fatty acid depletion resulted in an unacceptably high incidence of fat synthesis. The results suggest that caloric intake may be optimized in critically ill patients using indirect calorimetry. When calorimetry is not available, a total caloric intake of up to 140 percent of the BEE with glucose infusion rates not exceeding 4 mg/kg-min and fats providing 40 to 60 percent of calories will meet the energy requirements of most critically ill patients without forcing the RQ > 1.
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Case Reports
Bilateral pneumothorax after percutaneous transthoracic needle biopsy. Evidence for incomplete pleural fusion.
Although the pleural cavities are anatomically separate in humans, we describe bilateral pneumothoraces that occurred after percutaneous needle biopsy of the lung. In some individuals, there may be communication between the pleural spaces; it is important for those performing interventional procedures to be aware of this uncommon anatomic variant.