Chest
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Comparative Study
Esophageal pressure measurements in cardiopulmonary exercise testing.
We sought to determine the adaptability and effectiveness of a new esophageal balloon technique to measure changes in esophageal pressure (Pes) as a reflection of pleural pressure with progressive incremental exercise testing in normal subjects. ⋯ The small esophageal balloon was well tolerated by all subjects. Plots of deltaPes vs PTP, VE, and VO2 demonstrated a linear correlation. This apparatus could be added to the standard CPX to assess the contribution of the diaphragm and respiratory muscles in patients with dyspnea.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of noninvasive positive pressure ventilation on gas exchange and sleep in COPD patients.
The role of nocturnal noninvasive positive pressure ventilation (NPPV) in the treatment of patients with hypercapnic COPD remains controversial. Beneficial effects reported after prolonged use have included an improvement in gas exchange. The purpose of this study was to examine the short-term effects of NPPV on gas exchange and sleep characteristics in patients with hypercapnic COPD and to determine if similar acute changes in gas exchange are associated with improved sleep quality. ⋯ NPPV acutely improved sleep efficiency and TST in patients with hypercapnic COPD without significantly improving gas exchange. Other sleep parameters, including sleep architecture and the number of arousals during the night, remained unchanged during NPPV. These data suggest that the beneficial effects of NPPV in patients with hypercapnic respiratory failure are not solely due to an improvement in gas exchange but may be more complex with other factors potentially having contributing roles.
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Comparative Study
Extracorporeal membrane oxygenation for adult respiratory failure.
To review the first 50 patients to receive extracorporeal membrane oxygenation (ECMO) for respiratory failure at Glenfield Hospital, and to compare them with published series of patients receiving positive pressure ventilation. ⋯ Survival with ECMO is 66% for adults with severe respiratory failure. ECMO should be considered in patients who remain hypoxic despite maximal positive pressure ventilation.
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Comparative Study
The impact of nosocomial infections on patient outcomes following cardiac surgery.
To evaluate the relationship between nosocomial infections and clinical outcomes following cardiac surgery, and to identify risk factors for the development of nosocomial infections in this patient population. ⋯ Nosocomial infections, which are common following cardiac surgery, are associated with prolonged lengths of hospitalization, the development of multiorgan dysfunction, and increased hospital mortality. These data suggest potential interventions for the prevention of nosocomial infections following cardiac surgery that could substantially improve patient outcomes and decrease medical care costs.
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Comparative Study
Is direct collection of pleural fluid into a heparinized syringe important for determination of pleural pH? A brief report.
It has long been believed that pleural fluid must be directly aspirated into a heparinized syringe to obtain an accurate value. Many operators aspirate 30 to 60 mL of pleural fluid into a syringe without heparin, and then place 1 mL into a heparinized syringe from which the pH is determined. We postulated that this technique does not cause a clinically significant difference in pleural pH values. ⋯ Pleural fluid can be collected in a large syringe and then placed into a heparinized syringe to assess pH. This is useful information because the use of just one syringe saves time and reduces the risk of iatrogenic complications.