Heart & lung : the journal of critical care
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Randomized Controlled Trial Comparative Study
Comparison of effects of manual versus ventilator hyperinflation on respiratory compliance and arterial blood gases in patients undergoing mitral valve replacement.
To compare the effects of manual hyperinflation (MHI) and ventilator hyperinflation (VHI) delivered to completely sedated and paralyzed patients undergoing mitral valve replacement (MVR) while maintaining minute ventilation. ⋯ In the immediate postoperative phase of MVR, both techniques produced similar effects on respiratory compliance and oxygenation. MHI produced longer lasting improvements in oxygenation than VHI, whereas VHI produced better improvements in dynamic compliance. Paco(2) and pH were maintained by both.
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Despite the benefits of prompt treatment of myocardial infarction, gender disparities exist in emergency department (ED) nurses' cardiac triage decisions. ⋯ The evaluation supports the feasibility and utility of the ACT intervention.
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We investigated whether mortality in intensive care unit (ICU) patients without cerebral damage is associated with fever manifestation and characteristics. ⋯ These findings imply that, although fever is not generally associated with mortality in patients without cerebral damage, it can be harmful and should be suppressed when it becomes very high. Rigorous clinical trials are needed to help establish antipyretic therapy guidelines.
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Nearly 75% of critically ill patients develop anemia in the intensive care unit (ICU). Anemia can be treated with red blood cell (RBC) transfusions, although evidence suggests that lower hemoglobin levels are tolerated in the critically ill. Despite such recommendations, variation exists in clinical practice. ⋯ Anemia was common in this critically ill cohort, with hemoglobin levels continuing to drop with ICU stay. Pretransfusion hemoglobin levels were lower than reported by others, yet the RBC transfusion rate was comparable. There was no association between anemia and phlebotomy practices in our ICU.
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Case Reports
Clinical presentation and treatment of atrial fibrillation in Wolff-Parkinson-White syndrome.
A case of Wolff-Parkinson-White syndrome with atrial fibrillation (AF) is reported in a patient who presented with syncope, tachycardia, and hypotension. The electrocardiogram (ECG) showed a fast irregular rhythm with wide polymorphic QRS tachycardia without the QRS twisting around the isoelectric baseline, diagnostic of AF and Wolff-Parkinson-White syndrome. The patient did not respond to intravenous amiodarone. ⋯ AF was easily induced during the electrophysiologic study, requiring electrical cardioversion for severe hypotension. Successful radiofrequency ablation of the accessory pathway completely prevented further inducible AF. The patient no longer had any evidence of pre-excitation on ECG and remained symptom-free with no medications for 11 months.