Chest
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Lactic acidosis previously has been reported during treatment of asthma with beta-2 agonists. However, this metabolic disturbance never had any clinical consequence. We report a case of a patient with asthma in whom beta-2 agonist administration increased dyspnea by metabolic acidosis due to a sharp increase in lactate levels (hyperlactatemia) and led to inappropriate intensification of bronchodilator therapy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pressure vs flow triggering during pressure support ventilation.
Adult mechanical ventilators have traditionally been pressure- or time-triggered. More recently, flow triggering has become available and some adult ventilators allow the choice between pressure or flow triggering. Prior studies have supported the superiority of flow triggering during continuous positive airway pressure, but few have compared pressure and flow triggering during pressure support ventilation (PSV). The purpose of this study was to compare pressure and flow triggering during PSV in adult mechanically ventilated patients. ⋯ For this group of patients, flow triggering was not superior to pressure triggering at -0.5 cm H2O during PSV.
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Multicenter Study Comparative Study
Assessment of the prognosis of coronary patients: performance and customization of generic severity indexes.
To assess the prognostic performance of general severity systems (APACHE II [acute physiology and chronic health evaluation], simplified acute physiology score [SAPS II], and mortality probability models [MPM II]) in coronary patients and to derive new customized indexes for coronary patients using a reduced number of variables. ⋯ Prognostic indexes developed for multidisciplinary patients show good performance when applied to patients with acute myocardial infarction, but customization can reduce the number of variables necessary to compute them without a loss of, and a possible improvement in, prognostic accuracy.
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Comparative Study
Post-ICU mechanical ventilation: treatment of 1,123 patients at a regional weaning center.
To update our database, reporting changes in the results of weaning attempts and profile of patients transferred to us after prolonged mechanical ventilation (PMV) in the ICU. ⋯ Patients are being transferred from the ICU to our RWC for attempted weaning sooner in their course of PMV. Although more severely ill on arrival than in past years, mortality is unchanged, more than half of the patients continue to be successfully weaned, and survival after RWC discharge is improved.