Heart & lung : the journal of critical care
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There are many noninfectious disorders in the critical care unit (CCU) that mimic sepsis. Pseudosepsis is the term applied to noninfectious disorders that mimic sepsis. Fever/leukocytosis is not diagnostic of infection but frequently accompanies a wide variety of noninfectious disorders. ⋯ Evacuation of the rectus sheath hematoma rapidly reverses the patient's hypotension and is curative. We describe a case of pseudosepsis caused by rectus sheath hematoma in an elderly man with hypotension unresponsive to fluids/pressors and mimicking septic shock. Clinicians should be aware that rectus sheath hematoma is a rare but important cause of pseudosepsis in patients in the CCU.
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Backrest elevation, defined as the angle of the backrest height above the horizontal position, is a common nursing intervention that is often used by subjective visual estimation in critically ill patients. ⋯ The results indicate that the subjective assessment of backrest angle may result in errors that may potentially compromise the patient's condition and supports the need for a more objective method for determining backrest angle.
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The study objective was to validate among patients with chronic obstructive pulmonary disease (COPD) clinical predictors of emergency department (ED) disposition (admission vs discharge) found in a previous study. We hypothesized that the initial heart rate (HR) at presentation and the number of nebulizer treatments would predict visit disposition adequately and that existing triage criteria would not. ⋯ The initial HR on arrival predicted disposition of ED visits for patients with COPD with operating characteristics that were superior to the existing triage criteria. Triage of patients with COPD could be improved simply, and at no additional expense, by recognizing that almost any degree of tachycardia in a patient with COPD substantially increases the likelihood of admission.
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Randomized Controlled Trial Comparative Study
Comparison of the effectiveness of manual and ventilator hyperinflation at different levels of positive end-expiratory pressure in artificially ventilated and intubated intensive care patients.
Manual hyperinflation (MHI) and ventilator hyperinflation (VHI) are two methods of recruitment maneuvers used in ventilated patients to improve lung compliance and secretion mobilization. The use of VHI may minimize the adverse effects of disconnection from the ventilator, but it is uncertain whether high levels of positive end-expiratory pressure (PEEP) would decrease the peak expiratory flow rate (PEFR) and consequently affect secretion clearance. ⋯ The VHI technique seems to promote greater improvements in respiratory mechanics with less metabolic disturbance compared with MHI. Other variables such as sputum production, hemodynamics, and oxygenation were affected similarly by both techniques.
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Few studies have examined functional limitations in Chinese elders with chronic obstructive pulmonary disease (COPD). ⋯ The results of this study demonstrate that depressive symptoms to some extent predict functional limitations in Chinese elders with COPD. Investigation of the effect of appropriate screening and interventions for depressive symptoms on preventing, delaying, or reducing functional limitations in this patient group is suggested.