Chest
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Comparative Study
Do-not-resuscitate decisions in the medical ICU: comparing physician and nurse opinions.
To determine how soon after admission to a medical ICU physicians and nurses decide that attempts at resuscitation are inappropriate and how frequently physicians and nurses disagree about do-not-resuscitate (DNR) decisions. ⋯ At our institution, recognition of DNR appropriateness by nurses and physicians occurs over a similar time frame. However, physicians are more likely to recommend DNR in cases of disagreement between nurses and physicians.
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To identify and discriminate between patient and institutional determinants of investigation costs in the ICU. ⋯ ICU investigation costs vary significantly between institutions and are not always linked to patient-dependent factors. Acquisition of nosocomial and iatrogenic events during ICU admission increases costs dramatically. Costs are not necessarily greater in teaching hospitals.
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Bilevel pressure ventilators are being used increasingly to provide noninvasive ventilatory support in the management of obstructive sleep apnea, chronic ventilatory failure, and acute respiratory failure. However, the ability of these ventilators to respond to inspiratory demand without imposing expiratory loads has not been evaluated extensively. We evaluated the performance of nine bilevel pressure ventilators in a lung model, as compared with the Nellcor Puritan-Bennett 7200ae adult critical care ventilator. ⋯ As ventilatory demand increased, D-E and Area E significantly (p<0.05) changed. With some units, D-E and Area E increased, while with others they decreased. Most bilevel pressure ventilators evaluated were able to respond to high ventilatory demands and outperformed the Nellcor Puritan-Bennett 7200ae ventilator.
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This study reports histopathologic findings in a group of emphysema patients who underwent thoracoscopic lung volume reduction surgery (75) or sternotomy (five) with the purpose to induce functional improvement and relief of dyspnea. Immediate outcome and complications were correlated to histologic patterns. ⋯ A significant portion of patients diagnosed as having severe emphysema will have other unsuspected histologic findings. When subjected to lung volume reduction surgery, this subgroup will have more serious complications and longer periods of air leaks, requiring longer hospitalization time. Retrospective review of imaging studies and preoperative pulmonary function tests used to select patients for lung volume reduction failed to identify this subgroup.
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Randomized Controlled Trial Clinical Trial
Oxygen uptake kinetics and cardiopulmonary performance in lone atrial fibrillation and the effects of sotalol.
Atrial fibrillation (AF) is associated with impaired exercise capacity. Oxygen uptake (VO2) kinetics determines cardiopulmonary performance during submaximal exercise, which may be impaired in patients with AF. ⋯ In addition to maximal exercise capacity and cardiopulmonary performance, patients with chronic AF without significant structural heart disease had impaired submaximal exercise performance as assessed by VO2 kinetics. These parameters were not significantly affected by sotalol used for rate control.