Chest
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To evaluate the relationships between directly measured work of breathing (WOB) and variables of the breathing pattern commonly used at the bedside to infer WOB for intubated, spontaneously breathing patients treated with pressure support ventilation (PSV). ⋯ Our data reveal that WOB should be measured directly because variables of the breathing pattern commonly used at the bedside appear to be inaccurate and misleading inferences of the WOB. The clinical implication of these findings involves the traditional and empirical practice of titrating PSV based on the breathing pattern. We do not imply that the patient's breathing pattern should be ignored, nor undermine its importance, for it provides useful diagnostic information. It appears, however, that relying primarily on the breathing pattern alone does not provide enough information to accurately assess the respiratory muscle workload. Using the breathing pattern as the primary guideline for selecting a level of PSV may result in inappropriate respiratory muscle workloads. A more comprehensive strategy is to employ WOB measurements and the breathing pattern in a complementary manner when titrating PSV in critically ill patients.
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To assess the range of plasma C-reactive protein (CRP) in patients presenting with community-acquired pneumonia and to compare the serial changes of this acute-phase protein with clinical outcome. ⋯ CRP is a sensitive marker of pneumonia. A persistently high or rising CRP level suggests antibiotic treatment failure or the development of an infective complication. These results suggest that CRP, rather than TNF-alpha or IL-6, may have a role as a clinical marker in pneumonia.
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To estimate the cost-effectiveness of CT for detecting brain lesions in patients with lung cancer without clinical evidence of metastases. ⋯ Although a threshold cost-effectiveness has not been defined for identifying "cost-effective" diagnostic procedures, the marginal C/QALY of the CT-first strategy is substantially higher than many accepted medical interventions. At current costs, the routine use of brain CT is not warranted in patients with lung cancer who have normal findings on a standardized clinical evaluation for metastases.
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To describe and evaluate an ultrasound pattern useful in the diagnosis of pneumothorax. ⋯ Ultrasound was a sensitive test for detection of pneumothorax, although false-positive cases were noted. The principal value of this test was that it could immediately exclude anterior pneumothorax.