Chest
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective randomized comparison of train-of-four monitoring and clinical assessment during continuous ICU cisatracurium paralysis.
Train-of-four (TOF) monitoring is often recommended during the continuous use of neuromuscular blockade (NMB) [paralysis] in the ICU. Prior study results are conflicting regarding the benefits of TOF monitoring. ⋯ TOF monitoring does not lead to improved recovery time or lower cisatracurium dosing compared with monitoring by clinical assessment. We conclude that TOF monitoring is unnecessary, and careful titration of the neuromuscular blocking agent by clinical assessment alone is sufficient in patients undergoing continuous cisatracurium NMB.
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Randomized Controlled Trial Clinical Trial
Impact of evacuated collection tube fill volume and mixing on routine coagulation testing using 2.5-ml (pediatric) tubes.
Anecdotal observations by pharmacists monitoring anticoagulated patients indicate that blood samples collected in 2.7-mL (pediatric) evacuated tubes frequently produced falsely elevated international normalized ratio (INR) results. ⋯ Pediatric blood collection tubes should be filled at least 90% full to ensure accurate INR test results. Anticoagulation therapy providers should routinely inquire about the type of collection tube used (adult vs pediatric) and the adequacy of sample collection volume before deriving therapeutic plans in asymptomatic excessively anticoagulated patients.
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Mean pulmonary artery pressure (MPAP) and systolic pulmonary artery pressure (SPAP) are used interchangeably to define pulmonary hypertension (PH). We tested the hypothesis that the measurement of MPAP and SPAP is redundant in resting humans over a wide pressure range. ⋯ In resting humans, MPAP can be accurately predicted from SPAP over a wide pressure range. The new formula may help to refine the threshold pressure values used in the diagnosis of PH. Further studies are needed to test the hypothesis that our formula may allow the noninvasive prediction of MPAP from Doppler-derived SPAP values.
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The aim of this study was to investigate the prognostic value of plasma d-dimer levels in patients with community-acquired pneumonia (CAP). ⋯ d-Dimer plasma levels could be useful for predicting clinical outcome in patients with CAP.
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Comparative Study Clinical Trial
The effects of high-flow vs low-flow oxygen on exercise in advanced obstructive airways disease.
Current options to enhance exercise performance in patients with COPD are limited. This study compared the effects of high flows of humidified oxygen to conventional low-flow oxygen (LFO) delivery at rest and during exercise in patients with COPD. ⋯ High flows of humidified oxygen improved exercise performance in patients with COPD and severe oxygen dependency, in part by enhancing oxygenation.