Clinics in chest medicine
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Clinics in chest medicine · Sep 1993
ReviewOutcome assessment in elderly patients with critical illness and respiratory failure.
Although elderly patients tend to have diminished physiologic reserve, the independent impact of age on outcome from critical illness is controversial. Physiologic status is perhaps a more important measure of a patient's underlying health and anticipated response to critical illness. Age, therefore, should not be used as a sole determinant for intensive care department admission.
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Cardiopulmonary resuscitation has become an increasingly common event in the terminal illness of hospitalized seriously ill elderly patients. Elderly patients, however, tend to respond poorly to the resuscitation procedure. The authors analyze the ethical and legal considerations in offering or withholding cardiopulmonary resuscitation. The central position of the physician in decision-making is emphasized.
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The symptom of dyspnea in the elderly person should not be considered part of the "normal aging process." Instead, the history, examination, and testing should focus on cardiac disease, respiratory disease, and deconditioning as the most likely causes. Because respiratory sensation is diminished with aging, breathlessness may not develop until a more advanced stage of disease or dysfunction. ⋯ Specific treatment should be directed toward the pathophysiology of the underlying disease. General strategies for relieving dyspnea include breathing techniques, exercise training and reconditioning, oxygen therapy, improved nutrition, and, in selective cases, psychotropic medication.
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The basic objectives of any anesthetic are to provide the patient with safe analgesia and amnesia and to provide the surgeon with adequate conditions to perform the surgical procedure. This article discusses the different routes through which these objectives may be met.
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This article describes the pathophysiology of the respiratory system after upper abdominal surgery, emphasizing the role of respiratory muscle dysfunction. The history of current techniques to measure respiratory muscle function are reviewed. The authors describe the postoperative pattern of breathing, speculate on the physiologic mechanisms responsible and discuss the data supporting the role of reflexes arising from the abdomen and the shift of neural output to different respiratory muscles. Finally, the authors review the impact of "closed" surgical interventions such as laparoscopic cholecystectomy.