Chest
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Comparative Study
Comparison of three methods of respiratory care following upper abdominal surgery.
Incentive spirometry, as a method for preventing postoperative atelectasis, was compared with intermittent positive-pressure breathing (IPPB) and resistance breathing in 126 patients undergoing upper-abdominal surgery, most of whom had cholecystectomy. There was no statistically significant difference in the incidence of atelectasis among the three groups, who were matched for age, sex, smoking history, previous respiratory disease, and duration of surgery. There was a significantly higher incidence of atelectasis in patients over the age of 50 years (P = 0.004) than in younger subjects, where the incidence was not different among the three groups. Incentive spirometric therapy, as used in this study, offered no advantage over the other methods of treatment.
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The relationship between changes in cardiac output and intrapulmonary shunt associated with mechanical ventilation was evaluated in 20 patients with the adult respiratory distress syndrome (ARDS). The distribution of ventilation-perfusion (VA/Q) ratios and the level of intrapulmonary shunt was determined by the multiple inert gas technique. Pulmonary blood flow was distributed predominantly to either effective gas-exchanging units or shunt units. ⋯ Changes in shunt and cardiac output were quantitatively and qualitatively silimar and a strong correlation was found between changes in shunt and cardiac output with both PEEP and high tidal volumes (r = 0.76). Cardiac output depression associated with tese modes of ventilation appears to be a mechanism of shunt reduction in ARDS. Interpretation of improvements in gas exchange in ARDS must take into account concomitant hemodynamic changes.
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The patient had classic ECG changes of hypothermia (sinus bradycardia, prolonged PR interval, prolonged QT interval, and Osborn waves). These changes occurred in hypothermia resulting from sepsis, without exposure being a factor. Documentation of Osborn waves in this clinical setting supports the theory that they result as a direct consequence of myocardial cooling.