The American journal of the medical sciences
-
Randomized Controlled Trial Comparative Study
Comparison of pressure support ventilation and T-piece in determining rapid shallow breathing index in spontaneous breathing trials.
The threshold values of rapid shallow breathing index (RSBI) were compared in pressure support ventilation (PSV) and T-piece assessments for spontaneous breathing trials (SBT). The ability of ΔRSBI to also predict successful weaning was evaluated. ⋯ The threshold values of RSBI, thus 75 breaths per min/L (PSV) and 100 breaths per min/L (T-piece), for predicting successful weaning were more accurate than other values. Similarly, the change in the RSBI could also predict such successes.
-
: Mitral regurgitation and other conditions marked by a pure isolated volume overload (VO) of the heart result in a progressive form of eccentric left ventricular remodeling and dysfunction. As opposed to the more extensively studied pressure overload, there are no approved medical therapies because an understanding of the underlying pathological mechanisms at work in VO is lacking. ⋯ Specifically, we have noted perturbed matrix homeostasis, detrimental adrenergic signaling, increased intracellular reactive oxygen species and an intense inflammatory response that implicates mast cells and their product chymase, which seems to cause extensive remodeling both inside and outside the cardiomyocyte. How these multiple pathways intersect over the course of VO and their response to various single and combined interventions are now the subject of intense investigation.
-
Using the common sense model of illness adjustment, this study aimed to explore the impact of chronic kidney disease (CKD) on individual illness perceptions, coping styles and psychological well-being. ⋯ The results provide evidence that it is the perception of an illness rather than the actual symptoms themselves that best account for adaption to CKD. These findings suggest that intervention strategies aimed at increasing psychological well-being need to focus on changing illness perceptions rather than improving symptoms of CKD or coping mechanisms.
-
Although individuals with kidney disease, including those dependent on dialysis, often present clinically with signs and symptoms consistent with frailty, there is limited information about sociodemographic and clinical risk factors that may be associated. ⋯ In multivariable analyses, the risk for frailty in patients undergoing hemodialysis, as assessed by the presence of 3 or more criteria that comprise the Fried frailty index, was increased in association with peripheral vascular disease and cardiac conditions, such as dysrhythmia and atrial fibrillation, and was decreased for those with higher serum albumin concentration and for blacks compared with whites. Among patients who met the Fried definition of frailty, 78% scored as frail on walk speed and 56% scored as frail on grip strength, the 2 physical performance measures.