Heart & lung : the journal of critical care
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Our purpose in this study was to investigate the factors coincident with the occurrence of dyspnea in ventilator-assisted patients. Five alert and oriented patients with pulmonary disease that was restrictive, obstructive, or both, who were receiving mechanical ventilation, participated in this descriptive study. ⋯ A moderate correlation (r = 0.51, p less than 0.001) was found between the number of events and activities occurring in the intensive care unit environment and the occurrence and severity of dyspnea. The visual analogue scale and modified Borg scale measures of dyspnea were highly correlated (r = 0.92, p less than 0.001) and may be useful tools for assessing dyspnea in patients undergoing mechanical ventilation.
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With positive end-expiratory pressure (PEEP)-induced reduction in cardiac output, measurement of ventricular filling pressure assists in proper therapeutic decision-making. Because PEEP may increase pleural and juxtacardiac pressure, central venous pressure (CVP) and left atrial pressure (LAP) measurements during PEEP may not simply reflect ventricular filling, but rather reflect the sum of intracardiac and extracardiac forces. Monitoring devices placed within the central circulation use saline solution-filled lumens and transducer systems for pressure monitoring. ⋯ In the present study, esophageal pressure (Pes) was measured with a saline solution-filled balloon-equipped nasogastric tube to estimate the extracardiac influence of PEEP on CVP and LAP. Pes, CVP, LAP, and cardiac index (CI) were measured in 17 patients subjected to 0, 5, 10, 15, 20 cm H2O PEEP. Comparing 0 with 20 cm H2O PEEP, CVP (7 +/- 1.0 mm Hg to 13.4 +/- 1.3 mm Hg), LAP (6.3 +/- 1.1 mm Hg to 11.7 +/- 1.4 mm Hg), and Pes (6.1 +/- 1.4 mm Hg to 12.1 +/- 1.5 mm Hg) all increased significantly as CI fell (2.72 +/- 0.14 L/min/m2 to 2.20 +/- 0.15 L/min/m2).(ABSTRACT TRUNCATED AT 250 WORDS)
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Closed system suctioning (CSS) is a method of removing secretions from the tracheobronchial tree of patients with mechanical ventilation without disconnecting the mechanical ventilator. The putative benefits of CSS include the maintenance of positive pressure ventilation, oxygen supply, and positive end-expiratory pressure (PEEP). However, some evidence indicates that negative airway pressure may develop during CSS if inappropriate ventilator settings are selected. ⋯ During each suctioning trial, the peak positive and negative airway pressures were recorded. The negative airway pressure was above -10 cm H2O in most situations. In the control mode at all flow rates with or without PEEP, the Bennett MA1 and the Bourns-Bear 1 and 2 produced sustained peak negative airway pressure of less than -50 cm H2O.(ABSTRACT TRUNCATED AT 250 WORDS)
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Review Case Reports
Iliac vein to pulmonary artery missile embolus: case report and review of the literature.
Intravascular foreign body emboli, although first reported in 1834, are rare sequelae of penetrating injuries. We report a case of missile embolus to the pulmonary artery after penetrating injury to the left iliac vein and artery. A review of the literature and discussion of appropriate management are presented.
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Pain is a multidimensional, complex experience. Critically ill patients are particularly vulnerable to pain. Patients in a critical care environment often have difficulty communicating their pain, and their pain may be aggravated by fear and anxiety. ⋯ Finally, methods of pain measurement and treatment are outlined, and their appropriateness to critical care is evaluated. Although knowledge about pain mechanisms, measurement, and therapies has expanded, many issues remain unexplained. This article poses questions regarding pain in critically ill patients and presents specific areas for future nursing research.