Articles: mechanical-ventilation.
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Successful extubation is difficult to predict. Ultrasound measurement of the diaphragm thickening fraction (DTF) might help predict weaning failure after cardiothoracic surgery. ⋯ U1111-1180-1999.
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Perioperative hypersensitivity reactions may be difficult to diagnose during general anesthesia. Postinduction hypotension is the most common sign but is not specific. It was recently suggested that low end-tidal carbon dioxide (ETco2) might be a marker of anaphylaxis (Ring and Messmer grades III to IV immediate hypersensitivity reactions) in hypotensive patients under mechanical ventilation. To test this hypothesis, the authors compared ETco2 in patients with a diagnosis of anaphylaxis and in patients with severe hypotension from any other cause after the induction of anesthesia. ⋯ In case of severe hypotension after anesthesia induction, a low ETco2 contributes to the diagnosis of anaphylaxis, in addition to the classical signs of perioperative immediate hypersensitivity.
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Background and Objectives: The routine daily chest X-ray (CXR) strategy is no longer recommended in intensive care unit (ICU) patients. However, it is difficult for intensivists to collectively accept the on-demand CXR strategy because of the ambiguous clinical criteria for conducting CXRs. This study evaluated the predictive value of the change in PaO2/FiO2 (PF ratio) for abnormal CXR findings in ICU patients after mechanical ventilation (MV). ⋯ Of the 558 CXRs (normal = 418, abnormal = 140) and PF ratios, the daily change in PF ratio had a significant predictive accuracy for abnormal CXR findings (AUROC = 0.741, p < 0.01). Conclusions: The change in PF ratio (the Youden index point: ≤-23) had a sensitivity of 65.7%, and a specificity of 79.9%. Based on these results, the daily change in the PF ratio could be utilized as a predictive indicator of abnormal CXRs in ICU patients after MV treatment.