Chest
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To determine the predictors of outcome in cardiac surgical patients with prolonged ICU stay. ⋯ Preoperative health status and early organ failure were not predictive of late hospital mortality. The pattern of late organ failure associated with hospital mortality changed with time.
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Multicenter Study Clinical Trial
Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes.
The purpose of this investigation is to determine the characteristics of the history, physical examination, chest radiograph, and ECG, and the ventilation/perfusion (V/Q) lung scan probability in patients with pulmonary embolism (PE) stratified according to their presenting syndrome. ⋯ Many of the findings in the various syndromes of PE can be understood in terms of the severity of PE as it increases from mild with the pulmonary infarction syndrome to moderate with the isolated dyspnea syndrome to severe with circulatory collapse. The prevalence of various clinical and laboratory characteristics of patients with the syndrome of pulmonary infarction, isolated dyspnea, or circulatory collapse may give clues to the diagnosis or suggest characteristics that may reduce the likelihood of inadvertently discarding the diagnosis of PE.
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Preoperative evaluation of patients being considered for pulmonary resection is a common practice for both pulmonologists and internists. Traditionally, preoperative evaluation of this population has entailed identifying patients in whom pulmonary resection carries an unacceptably high risk of morbidity and mortality. However, recent advances in surgical technique and patient management have prompted a reconsideration of traditional preoperative approaches. This article reviews procedures currently used in the preoperative evaluation of patients considered for pulmonary resection, including the patient history, physical examination, and preoperative interventions, and addresses further evaluation of the high-risk patient.
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Comparative Study
Stability of improvements in exercise performance and quality of life following bilateral lung volume reduction surgery in severe COPD.
To evaluate the long-term stability of improvements in exercise capacity and quality of life (QOL) after lung volume reduction surgery (LVRS). ⋯ We conclude that bilateral LVRS via median sternotomy in selected patients with severe, diffuse emphysema improves exercise performance and QOL at 3 months following LVRS and these improvements are maintained for at least 12 to 18 months in follow-up.
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To assess the relations among right ventricular (RV) pressures and volumes in sepsis. ⋯ During sepsis, RV EDV and ESV vary independently of changes in Pra and ejection pressure. These data can be explained by assuming that the RV is a highly compliant chamber during filling, such that changes in RV EDV do not alter RV wall stress (preload) or ejection efficiency (RVEF). Thus, changes in RV EDV should proportionally alter RV ESV. Furthermore, the slope of the ESV/EDV relation should be inversely proportional to ejection efficiency.