Chest
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Comparative Study
Predicting death after CPR. Experience at a nonteaching community hospital with a full-time critical care staff.
To identify a series of variables which predict death after in-hospital cardiopulmonary resuscitation (CPR). ⋯ The CPR outcome can be predicted early during hospital course, which may assist physicians to formulate a do-not-resuscitate order. Patients surviving a CPR should be considered candidates for another resuscitation if clinically warranted. Low-risk patients can safely be admitted to telemetry units instead of to more costly ICUs.
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The dissemination of tracheal tube biofilm into the mechanically ventilated lung has been proposed as a contributory factor in the pathogenesis of ventilator-associated pneumonia. In the present study, conventional light microscopy, confocal laser scanning microscopy, and scanning electron microscopy were used to examine luminal tracheal tube biofilm in tubes from ten consecutive medical intensive care patients. Biofilms also were cultured. ⋯ Microorganisms were either dispersed throughout the biofilm or restricted to the most superficial layer. Neutrophil polymorphonuclear cells were present in all biofilms in a pattern suggesting that a layering or stratification had taken place. The distribution of neutrophils and microorganisms was consistent with a progressive accretion of respiratory secretions, rather than formation of a predominantly microbial biofilm.
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Predicting patient responses to changes in ventilatory support or weaning is primarily based on bedside measure of respiratory mechanics and clinical judgement. Work of breathing (WOB) has been considered to be the best predictive factor in weaning. This study evaluated patient WOB as a predictive measure of weaning and extubation. ⋯ In this group of mechanically ventilated patients, measurement of patient WOB was less accurate than conventional weaning parameters and clinical judgement for predicting successful extubation. This clinical evaluation study suggests that WOB alone is inadequate as a weaning parameter.