Chest
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of bronchodilator therapy delivered by nebulization and metered-dose inhaler in mechanically ventilated patients.
The optimal method of delivering bronchodilators in mechanically ventilated patients is unclear. The purpose of this study was to compare the pulmonary bioavailability of albuterol delivered by the nebulizer, the metered-dose inhaler (MDI) and spacer, and the right-angle MDI adaptor in ventilated patients using urinary analysis of drug levels. ⋯ The three delivery systems varied markedly in their efficiency of drug delivery to the lung. As previous studies have confirmed, this study has demonstrated that using an MDI and spacer is an efficient method for delivering inhaled bronchodilators to the lung. The pulmonary bioavailability was poor with the right-angle MDI port. This port should not be used to deliver bronchodilators in mechanically ventilated patients.
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Case Reports
Purulent pericarditis with tamponade in a postpartum patient due to group F streptococcus.
Bacterial pericarditis with cardiac tamponade is a life-threatening disorder that has been associated with a variety of organisms. There is usually an associated underlying condition or a seeding of the pericardium from an infection elsewhere. We report the development of cardiac tamponade and a subsequent pericardial constriction due to group F streptococcus purulent pericarditis. We believe this to be the first report of a postpartum patient with purulent pericarditis.
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We report a novel intraoperative use of epicardial echocardiography in detecting and guiding the removal of pulmonary arterial thromboemboli. We describe a patient with a right atrial thrombus that could not be visualized with intraoperative transesophageal echocardiography. Because we suspected acute pulmonary embolization, epicardial echocardiography was used to visualize the right and left pulmonary arteries. Pulmonary thromboemboli were identified, and pulmonary thromboembolectomy was successfully performed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Salmeterol vs theophylline: sleep and efficacy outcomes in patients with nocturnal asthma.
To compare the efficacy, safety, and effects on sleep quality of salmeterol and extended-release theophylline in patients with nocturnal asthma. ⋯ Salmeterol (but not theophylline) was associated with sustained improvements in morning PEF, protection from nighttime lung function deterioration, reductions in albuterol use, and improvements in patient perceptions of sleep. No differences were seen in polysomnographic measures of sleep quality.