Heart & lung : the journal of critical care
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Clinical Trial Controlled Clinical Trial
Patient-controlled analgesia versus intermittent analgesia dosing.
Actively involving the patient in his or her own pain management by using patient-controlled analgesia (PCA) during the postoperative period is a concept recently introduced. This method allows self-administration of small, frequent doses of an analgesic agent to maintain a state of constant pain control. We studied the relative efficacy of PCA compared with intermittent analgesic dosing in 16 male patients requiring posterolateral thoracotomy. ⋯ In the patients using PCA, a significant reduction in the postoperative pulmonary complication rate, as evidenced by radiographic findings, was noted. In addition, significantly less medication was used and postoperative fever was substantially reduced in the PCA group. We believe PCA to be a safe, effective, and beneficial pain management modality that deserves attention in the postoperative period.
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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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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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In a prospective study, the intensity of extrapyramidal symptoms (EPS) was rated in two groups of delirious, medically ill patients. Fourteen patients received intravenous (IV) haloperidol and benzodiazepines for control of severe agitation and four received IV haloperidol alone. Patients were rated daily by a standardized scale for EPS by raters blind to the dose of haloperidol and benzodiazepines. ⋯ In the haloperidol and benzodiazepine group there were only one case of very mild parkinsonian-like EPS and no cases of akathisia or dystonia. No adverse respiratory or cardiac reactions were seen in any patients. The literature on the use of IV haloperidol alone and in combination with benzodiazepines is briefly reviewed and possible explanations of the lower intensity of EPS with IV haloperidol in combination with benzodiazepines are discussed.