Heart & lung : the journal of critical care
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A healthy young woman presented with an overwhelming hyperacute herpes simplex virus-1 pneumonia that dramatically responded to intravenous acyclovir. It is postulated that the infection was a reactivation of latent virus in the vagal ganglia, in the absence of retrograde extension of herpes labialis/gingivostomatitis, or hematogenous spread from extragenital and other sources of infection. It is also postulated that the patient's amazing improvement overnight was a real-time coincidence of spontaneous recovery from the viral infection and prompt initiation of acyclovir treatment.
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Oversedation masks neurologic changes and increases mortality/morbidity, whereas undersedation risks prolonged stress mobilization and patient injury. In situations such as deep sedation/analgesia, the Bispectral Index (BIS) has potential use as an adjunct to clinical assessment of sedation to help determine depth of sedation. Determining the correlation between clinical and BIS measures of sedation will help to determine the correct role of BIS in intensive care unit (ICU) practice settings. ⋯ In situations in which the clinical assessment is equivocal, BIS monitoring may have an adjunctive role in sedation assessment. BIS values should be interpreted with caution, however, because electromyography activity and other factors seem to confound BIS scores. More research is necessary to determine the role of BIS monitoring in ICU practice.
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Randomized Controlled Trial
The effect of music intervention in stress response to cardiac surgery in a randomized clinical trial.
To evaluate the effect of bed rest with music on the first postoperative day to decrease stress for patients who have undergone heart surgery. ⋯ There is sufficient practical evidence of stress reduction to suggest that a proposed regimen of listening to music while resting in bed after open heart surgery be put into clinical use.
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Case Reports
Management of cardiac arrest caused by coronary artery spasm: epinephrine/adrenaline versus nitrates.
Cardiopulmonary resuscitation guidelines imply the use of epinephrine/adrenaline during cardiopulmonary arrest. However, in cardiac arrest situations resulting from coronary artery spasm (CAS), the use of epinephrine/adrenaline could be deleterious. ⋯ Resuscitation guidelines do not specify the use of trinitrate derivatives in cardiac arrest situations caused by CAS. The pros and cons of the use of nitrates and epinephrine/adrenaline during cardiac arrest caused by CAS are analyzed in this case report.