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1.
Suctioning through a double-lumen endotracheal tube helps to prevent alveolar collapse and to preserve ventilation 总被引:1,自引:1,他引:1
Reissmann H Böhm SH Suárez-Sipmann F Tusman G Buschmann C Maisch S Pesch T Thamm O Plümers C Schulte am Esch J Hedenstierna G 《Intensive care medicine》2005,31(3):431-440
Objective
Endotracheal suctioning can cause alveolar collapse and impede ventilation. One reason is the gas flow through a single-lumen endotracheal tube (ETT) provoking a gradient between airway opening and tracheal (Ptr) pressures. Separately extending the patient tubing limbs of a suitable ventilator into the trachea via a double-lumen ETT should maintain Ptr. Can this technique reduce the side effects?Design and setting
Bench and animal studies in a university hospital laboratory.Interventions
A lung model was ventilated via single and double-lumen ETTs. Closed-system suctioning was applied with catheters introduced into the single-lumen ETT or the expiratory lumen of the double-lumen ETT via swivel adapter. Seven anesthetized pigs (lungs lavaged) underwent three runs of ventilation and suctioning through (a, b) an 8.0-mm ID single-lumen ETT, (c) a double-lumen ETT (41Ch outer diameter, OD). In (a) the single-lumen ETT was disconnected for suctioning, in (b) and (c) ventilator mode was set to continuous positive airway pressure mode, and the ETTs remained connected.Measurements and results
Bench: Suction through single-lumen ETTs impaired ventilation and led to strongly negative Ptr (common: ?10 to ?20 mbar); the double-lumen ETT technique maintained ventilation and pressures. Animals: Lung gas content (computed tomography, n=4) and arterial oxygen partial pressure, initially 1462±65 ml/532±76 mmHg, were significantly reduced by suctioning through single-lumen ETT: to 302±79 ml/62±6 mmHg with disconnection and to 851±211 ml/158±107 mmHg with closed suction. With double-lumen ETT they remained at 1377±95 ml/521±56 mmHg.Conclusions
The double-lumen ETT technique minimizes side effects of suctioning by maintaining Ptr. 相似文献2.
Francesco Mojoli Giorgio A. Iotti Ilaria Curr�� Marco Pozzi Gabriele Via Aaron Venti Antonio Braschi 《Intensive care medicine》2013,39(1):38-44
Objective
To test the effects on mechanical performance of helmet noninvasive ventilation (NIV) of an optimized set-up concerning the ventilator settings, the ventilator circuit and the helmet itself.Subjects and methods
In a bench study, helmet NIV was applied to a physical model. Pressurization and depressurization rates and minute ventilation (MV) were measured under 24 conditions including pressure support of 10 or 20?cmH2O, positive end expiratory pressure (PEEP) of 5 or 10?cmH2O, ventilator circuit with ??high??, ??intermediate?? or ??low?? resistance, and cushion deflated or inflated. In a clinical study pressurization and depressurization rates, MV and patient?Cventilator interactions were compared in six patients with acute respiratory failure during conventional versus an ??optimized?? set-up (PEEP increased to 10?cmH2O, low resistance circuit and cushion inflated).Results
In the bench study, all adjustments simultaneously applied (increased PEEP, inflated cushion and low resistance circuit) increased pressurization rate (46.7?±?2.8 vs. 28.3?±?0.6?%, p?<?0.05), depressurization rate (82.9?±?1.9 vs. 59.8?±?1.1?%, p????0.05) and patient MV (8.5?±?3.2 vs. 7.4?±?2.8?l/min, p?<?0.05), and decreased leaks (17.4?±?6.0 vs. 33.6?±?6.0?%, p?<?0.05) compared to the basal set-up. In the clinical study, the optimized set-up increased pressurization rate (51.0?±?3.5 vs. 30.8?±?6.9?%, p?<?0.002), depressurization rate (48.2?±?3.3 vs. 34.2?±?4.6?%, p?<?0.0001) and total MV (27.7?±?7.0 vs. 24.6?±?6.9?l/min, p?<?0.02), and decreased ineffective efforts (3.5?±?5.4 vs. 20.3?±?12.4?%, p?<?0.0001) and inspiratory delay (243?±?109 vs. 461?±?181?ms, p?<?0.005).Conclusions
An optimized set-up for helmet NIV that limits device compliance and ventilator circuit resistance as much as possible is highly effective in improving pressure support delivery and patient?Cventilator interaction. 相似文献3.
Marco Matteo Ciccone Massimo Iacoviello Agata Puzzovivo Pietro Scicchitano Francesco Monitillo Francesco De Crescenzo Vito Caragnano Marco Sassara Giovanni Quistelli Pietro Guida Stefano Favale 《Clinical research in cardiology》2011,100(6):515-521
Objective
There is a close link between heart failure and endothelial dysfunction. Brachial flow-mediated dilation (FMD) is a validated non-invasive measure of endothelial function. The aim of this study was to investigate the clinical correlates of FMD in patients with chronic heart failure (CHF).Design, setting, patients
We evaluated 60 CHF outpatients (age 62?±?14?years; 49 males, NYHA class 2.2?±?0.7, left ventricular ejection fraction, LVEF, 33?±?8%) taking conventional medical therapy (ACE-inhibitors and/or ARBs 93%, beta-blockers 95%) and in stable clinical conditions.Main outcome measures
The maximum recovery value of FMD was calculated as the ratio of the change in diameter (maximum-baseline) over the baseline value.Results
As compared with patients with a higher FMD, those with FMD below the median value (4.3%) were more frequently affected by ischemic cardiopathy (50 vs. 23%; p?=?0.032) and diabetes mellitus (20 vs. 3%; p?=?0.044), had a higher NYHA class (2.5?±?0.5 vs. 1.9?±?0.7; p?<?0.001) and NT-proBNP (2,690?±?3,690 vs. 822?±?1,060; p?=?0.001), lower glomerular filtration rate estimated by Cockcroft-Gault (GFRCG: 63?±?28 vs. 78?±?25; p?=?0.001) and LVEF (29?±?8 vs. 37?±?9; p?=?0.001), as well as more frequently showing a restrictive pattern (40 vs. 7%; p?=?0.002). In a multivariate regression model (R 2?=?0.48; p?<?0.001), FMD remained associated only with the NYHA class (p?=?0.039) and diabetes mellitus (p?=?0.024).Conclusions
This study demonstrates that a better functional status and absence of diabetes mellitus are associated to higher FMD regardless of the etiology of the cardiac disease. 相似文献4.
Lindgren S Odenstedt H Olegård C Söndergaard S Lundin S Stenqvist O 《Intensive care medicine》2007,33(1):172-180
Objective
To assess lung volume and compliance changes during open- and closed-system suctioning using electric impedance tomography (EIT) during volume- or pressure-controlled ventilation.Design and setting
Experimental study in a university research laboratory.Subjects
Nine bronchoalveolar saline-lavaged pigs.Interventions
Open and closed suctioning using a 14-F catheter in volume- or pressure-controlled ventilation at tidal volume 10?ml/kg, respiratory rate 20?breaths/min, and positive end-expiratory pressure 10?cmH2O.Measurements and results
Lung volume was monitored by EIT and a modified N2 washout/-in technique. Airway pressure was measured via a pressure line in the endotracheal tube. In four ventral-to-dorsal regions of interest regional ventilation and compliance were calculated at baseline and 30?s and 1, 2, and 10?min after suctioning. Blood gases were followed. At disconnection functional residual capacity (FRC) decreased by 58?±?24% of baseline and by a further 22?±?10% during open suctioning. Arterial oxygen tension decreased to 59?±?14% of baseline value 1?min after open suctioning. Regional compliance deteriorated most in the dorsal parts of the lung. Restitution of lung volume and compliance was significantly slower during pressure-controlled than volume-controlled ventilation.Conclusions
EIT can be used to monitor rapid lung volume changes. The two dorsal regions of the lavaged lungs are most affected by disconnection and suctioning with marked decreases in compliance. Volume-controlled ventilation can be used to rapidly restitute lung aeration and oxygenation after lung collapse induced by open suctioning.5.
Dong Hoon Lee Ji Young Kim Mi Kyung Lee Choae Lee Ji-Hee Min Duck Hyoun Jeong Ji-Won Lee Sang Hui Chu Jeffrey A. Meyerhardt Jennifer Ligibel Lee W. Jones Nam Kyu Kim Justin Y. Jeon 《Supportive care in cancer》2013,21(9):2537-2545
Purpose
The purposes of this study are to examine (1) the feasibility and efficacy of two different home-based exercise protocols on the level of physical activity (PA), and (2) the effect of increased PA via home-based exercise program on biomarkers of colorectal cancer.Methods
Seventeen patients (age 55.18 ± 13.3 years) with stage II–III colorectal cancer completed the 12-week home-based exercise program. Subjects were randomized into either casually intervened home-based exercise group (CIHE) or intensely intervened home-based exercise group (IIHE). The primary outcome was the level of PA. Furthermore, insulin, homeostasis model assessment of insulin resistance, insulin-like growth factor axis, and adipocytokines were measured.Results
Both CIHE and IIHE program significantly increased the level of PA at 12 weeks compared to its level at baseline (CIHE, 10.00?±?8.49 vs. 46.07?±?45.59; IIHE, 12.08?±?11.04 vs. 35.42?±?27.42 MET hours per week). Since there was no difference in PA change between groups (p?=?0.511), the data was combined in analyzing the effects of increased PA on biomarkers. Increase in PA significantly reduced insulin (6.66?±?4.58 vs. 4.86?±?3.48 μU/ml, p?=?0.006), HOMA-IR (1.66?±?1.23 vs. 1.25?±?1.04, p?=?0.017), and tumor necrosis alpha-α (TNF-α 4.85?±?7.88 vs. 2.95?±?5.38 pg/ml, p?=?0.004), and significantly increased IGF-1 (135.39?±?60.15 vs. 159.53 ng/ml, p?=?0.007), IGF binding protein (IGFBP)-3 (2.67?±?1.48 vs. 3.48?±?1.00 ng/ml, p?=?0.013), and adiponectin (6.73?±?3.07 vs. 7.54?±?3.96 μg/ml, p?=?0.015).Conclusion
CIHE program was as effective as IIHE program in increasing the level of PA, and the increase in PA resulted in significant change in HOMA-IR, IGF-1 axis, TNF-α, and adiponectin levels in stage II–III colorectal cancer survivors. 相似文献6.
Jae Youn Chung Dong Hoon Lee Ji-Hye Park Mi Kyung Lee Dong-Woo Kang Jihee Min Dong-Il Kim Duck Hyoun Jeong Nam Kyu Kim Jeffrey A. Meyerhardt Lee W. Jones Justin Y. Jeon 《Supportive care in cancer》2013,21(6):1605-1612
Purpose
The purpose of the present study was to explore the participation in physical activity (PA) by colorectal cancer survivors across cancer trajectories and based on selected demographic and medical variables.Methods
A total of 431 participants were surveyed individually at the Shinchon Severance Hospital, Seoul, Korea, to determine their PA levels before diagnosis, during treatment and after completion of cancer treatment.Results
Percentage of survivors meeting American College of Sports Medicine guideline significantly reduced from 27 % before diagnosis to 10 % during treatment due to reduced strenuous intensity PA (28.8?±?106.2 vs 11.8?±?95.9 min, p?=?0.042), while total PA and mild intensity PA did not change. Total (187.2?±?257.7 vs. 282.6?±?282.0 min, p?<?0.001) and mild (99.1?±?191.5 vs. 175.1?±?231.2 min, p?<?0.001) intensity PA significantly increased after the completion of treatments compared with their PA level before diagnosis. Further analyses showed that age (more vs. equal or less than 60 years) and chemotherapy (chemotherapy vs. no chemotherapy) significantly influenced the level of physical activity (p?=?0.004). Survivors who were older or received chemotherapy increased their total PA and mild intensity PA after the completion of treatment more than those who did not receive chemotherapy.Conclusions
The level and the pattern of physical activity by colorectal cancer survivors differed across cancer trajectories, which were significantly influenced by age and adjuvant chemotherapy. 相似文献7.
Ricci Z Garisto C Favia I Vitale V Di Chiara L Cogo PE 《Intensive care medicine》2012,38(7):1198-1204
Purpose
To evaluate the safety and efficacy of levosimendan in neonates with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods
Neonates undergoing risk-adjusted classification for congenital heart surgery (RACHS) 3 and 4 procedures were randomized to receive either a 72?h continuous infusion of 0.1?μg/kg/min levosimendan or standard post-CPB inotrope infusion.Results
Sixty-three patients (32 cases and 31 controls) were recruited. There were no differences between groups regarding demographic and baseline clinical data. No side effects were observed. There were no significant differences in mortality (1 vs. 3 patients, p?=?0.35), length of mechanical ventilation (5.9?±?5 vs. 6.9?±?8?days, p?=?0.54), and pediatric cardiac intensive care unit (PCICU) stay (11?±?8 vs. 14?±?14?days, p?=?0.26). Low cardiac output syndrome occurred in 37?% of levosimendan patients and in 61?% of controls (p?=?0.059, OR 0.38, 95?% CI 0.14–1.0). Postoperative heart rate, with a significant difference at 6 (p?=?0.008), 12 (p?=?0.037), and 24?h (p?=?0.046), and lactate levels, with a significant difference at PCICU admission (p?=?0.015) and after 6?h (p?=?0.048), were lower in the levosimendan group. Inotropic score was significantly lower in the levosimendan group at PCICU admission, after 6?h and after 12?h, (p?0.0001). According to multivariate analysis, a lower lactate level 6?h after PCICU admission was independently associated with levosimendan administration after correction for CPB time and the need for deep hypothermic circulatory arrest.Conclusions
Levosimendan infused in neonates undergoing cardiac surgery was well tolerated with a potential benefit of levosimendan on postoperative hemodynamic and metabolic parameters of RACHS 3–4 neonates. 相似文献8.
Bo He Hong Jiang Zhibing Lu Meichun Zhang Xiaorong Hu Bo Yang He Huang Gang Wu Jun Wan Huafen Liu Xiaohong Wang Congxin Huang 《Clinical research in cardiology》2011,100(1):37-43
Background
The feasibility and safety of the transradial approach for catheter ablation of idiopathic left ventricular tachycardia (ILVT) have not been evaluated. The aim of this study was to investigate the feasibility and safety of transradial approach for catheter ablation in ILVT patients.Methods
Thirty consecutive ILVT patients with negative Allen??s test undergoing catheter ablation via transradial approach were enrolled to compare the safety and efficacy with 30 other ILVT patients who previously underwent catheter ablation via transfemoral approach.Results
Ablation was successfully performed in all patients. In the transradial group, the total procedural and the fluoroscopy time (42.8?±?6.9?min and 9.7?±?1.9?min, respectively) were significantly shorter when compared with transfemoral group (52.8?±?8.4?min and 11.5?±?2.1?min, respectively) (both P?<?0.05). The two groups were similar in the number of current applications (4.1?±?0.8 vs. 4.4?±?1.1, P?>?0.05), the power energy (47.3?±?7.3 vs. 49.7?±?6.9?W, P?>?0.05), and the total duration of current application (110.3?±?15.6 vs. 112.3?±?16.5?s, P?>?0.05), respectively. The duration of hospitalization in transradial group was shorter than that in transfemoral group (4.1?±?0.9 vs. 5.8?±?1.1?days, P?<?0.05). During follow-up, there was no recurrence of tachycardia in all patients. One patient in transfemoral group developed access site complications while none occurred in the transradial group.Conclusions
The transradial approach is feasible and safe for catheter ablation of ILVT. 相似文献9.
Sasaki O Nishioka T Inoue Y Isshiki A Akima T Toyama K Koike A Ando T Yuhara M Sato S Kamiyama T Kirimura M Ito H Maruyama Y Yoshimoto N 《Clinical research in cardiology》2012,101(7):545-551
Background
How coronary distensibility contributes to stable or unstable clinical manifestations remains obscure. We postulated that the heterogeneous plaque distensibility is associated with unstable clinical presentations in patients with acute coronary syndrome (ACS).Methods and results
Seventeen and 19 ACS-related and -unrelated lesions, respectively, were visualized using intravascular ultrasound imaging with simultaneous intracoronary pressure recording. Systolic and diastolic lumen cross-sectional areas were measured at the lesion site and at five evenly spaced sites between the proximal and distal reference sites. The coronary distensibility index and stiffness index β were calculated for each site and averaged for each coronary segment. Maximal distensibility index, standard deviation and the difference between maximal and minimal distensibility indices within each segment were significantly higher in the ACS-related than -unrelated plaques (5.6?±?2.3 vs. 3.7?±?1.8, p?0.001, 2.1?±?0.9 vs. 1.1?±?0.6, p?0.001 and 5.3?±?2.3 vs. 2.8?±?1.5, p?0.001, respectively). Moreover, the difference in the distensibility index between the lesion site of ACS-related plaques and the immediate proximal site was significantly larger (2.88?±?2.35 vs. 1.17?±?1.44, p?=?0.022) than that in ACS-unrelated plaques.Conclusions
Coronary artery distensibility is longitudinally more heterogeneous in ACS-related than-unrelated plaques, especially between the lesion and the immediate proximal site. 相似文献10.
Piccin VS Calciolari C Yoshizaki K Gomes S Albertini-Yagi C Dolhnikoff M Macchione M Caldini EG Saldiva PH Negri EM 《Intensive care medicine》2011,37(1):132-140
Objective
To evaluate the effects of different mechanical ventilation (MV) strategies on the mucociliary system.Design and setting
Experimental study.Subjects
Twenty-seven male New Zealand rabbits.Interventions
After anesthesia, animals were tracheotomized and ventilated with standard ventilation [tidal volume (Vt) 8?ml/kg, positive end expiratory pressure (PEEP) 5?cmH2O, flow 3?L/min, FiO2 0.4] for 30?min. Next, animals were randomized into three groups and ventilated for 3?h with low volume (LV): Vt 8?ml/kg, PEEP 5?cmH2O, flow 3?L/min (n?=?6); high volume (HV): Vt 16?ml/kg, PEEP 5?cmH2O, flow 5?L/min (n?=?7); or high pressure (HP): Ppeak 30?cmH2O, PEEP 12?cmH2O (n?=?8). Six animals (controls) were ventilated for 10?min with standard ventilation. Vital signals, blood lactate, and respiratory system mechanics were verified. Tracheal tissue was collected before and after MV.Measurements
Lung and tracheal tissue sections were stained to analyze inflammation and mucosubstances by the point-counting method. Electron microscopy verified tracheal cell ultrastructure. In situ tracheal ciliary beating frequency (CBF), determined using a videoscopic technique, and tracheal mucociliary transport (TMCT), assessed by stereoscopic microscope, were evaluated before and after MV.Results
Respiratory compliance decreased in the HP group. The HV and HP groups showed higher lactate levels after MV. Macroscopy showed areas of atelectasis and congestion on HV and HP lungs. Lung inflammatory infiltrate increased in all ventilated groups. Compared to the control, ventilated animals also showed a reduction of total and acid mucus on tracheal epithelium. Under electron microscopy, injury was observed in the ciliated cells of the HP group. CBF decreased significantly after MV only in the HP group. TMCT did not change significantly in the ventilated groups.Conclusions
Different MV strategies induce not only distal lung alterations but also morphological and physiological tracheal alterations leading to mucociliary system dysfunction. 相似文献11.
Refaat E. Gabr AbdEl-Monem M. El-Sharkawy Michael Schär Gurusher S. Panjrath Gary Gerstenblith Robert G. Weiss Paul A. Bottomley 《Journal of cardiovascular magnetic resonance》2018,20(1):81
Background
It has been hypothesized that the supply of chemical energy may be insufficient to fuel normal mechanical pump function in heart failure (HF). The creatine kinase (CK) reaction serves as the heart’s primary energy reserve, and the supply of adenosine triphosphate (ATP flux) it provides is reduced in human HF. However, the relationship between the CK energy supply and the mechanical energy expended has never been quantified in the human heart. This study tests whether reduced CK energy supply is associated with reduced mechanical work in HF patients.Methods
Cardiac mechanical work and CK flux in W/kg, and mechanical efficiency were measured noninvasively at rest using cardiac pressure-volume loops, magnetic resonance imaging and phosphorus spectroscopy in 14 healthy subjects and 27 patients with mild-to-moderate HF.Results
In HF, the resting CK flux (126?±?46 vs. 179?±?50 W/kg, p?< 0.002), the average (6.8?±?3.1 vs. 10.1?±?1.5 W/kg, p ?<0.001) and the peak (32?±?14 vs. 48?±?8 W/kg, p <?0.001) cardiac mechanical work-rates, as well as the cardiac mechanical efficiency (53%?±?16 vs. 79%?±?3, p <?0.001), were all reduced by a third compared to healthy subjects. In addition, cardiac CK flux correlated with the resting peak and average mechanical power (p <?0.01), and with mechanical efficiency (p?= 0.002).Conclusion
These first noninvasive findings showing that cardiac mechanical work and efficiency in mild-to-moderate human HF decrease proportionately with CK ATP energy supply, are consistent with the energy deprivation hypothesis of HF. CK energy supply exceeds mechanical work at rest but lies within a range that may be limiting with moderate activity, and thus presents a promising target for HF treatment.Trial registration
ClinicalTrials.gov Identifier: NCT00181259.12.
Lovat R Watremez C Van Dyck M Van Caenegem O Verschuren F Hantson P Jacquet LM 《Intensive care medicine》2008,34(2):355-360
Objective
To compare in intubated patients manually ventilated in order to mirror the ventilator, the respiratory and hemodynamic effects induced by a bag device equipped with an inspiratory gas flow-limiting valve (Smart Bag, 0-Two Medical Technologies Inc., Mississauga, ON, Canada) and a Standard bag.Design
Non-randomized crossover study comparing 13?respiratory and eight hemodynamically paired parameters. Eight intubated patients were manually ventilated, each by three different intensive care workers yielding 24 sets of data for comparison. Data were collected during two sessions of manual ventilation, first with the Standard bag and then with the Smart Bag. Between each session, the patient was reconnected to the ventilator until return to the baseline. Patients, included after coronary surgery, were sedated and paralyzed.Setting
Intensive Care Unit, university hospital.Results
Compared with Standard bag, the Smart Bag® provided a decrease of inspiratory flow (23?±?4.7 vs. 47.3?±?16.5?l/min) with a decrease of peak pressure (13.3?±?2.9 vs. 21.9?±?7.3?cmH2O) and tidal volume (9.4?±?2.8 vs. 12.4?±?2.7?ml/kg). While the expiratory time was similar, the inspiratory time increased (1.83?±?0.58 vs. 1.28?±?0.46?s) with the Smart Bag, limiting the respiratory rate (14?±?5 vs. 17?±?6?cycles/min) and the minute volume (8.8?±?2.9 vs. 14.4?±?4.9?l/min). Finally, it limited the fall of the ETCO2 (27.9?±?5.1 vs. 24.3?±?5.7?mmHg) and probably the risks of severe respiratory alkalosis. The bags similarly affected hemodynamic states.Conclusion
In intubated patients manually ventilated, the Smart Bag limits the risks of excessive airway pressure and the fall of the ETCO2, with hemodynamic effects similar to those of the Standard bag. 相似文献13.
Michelle Nadler Shabbir Alibhai Pamela Catton Charles Catton Jennifer Jones 《Supportive care in cancer》2014,22(9):2409-2415
Purpose
Men receiving androgen deprivation therapy for prostate cancer have low knowledge of osteoporosis (OP) and engage in few healthy bone behaviors (HBBs). A multicomponent intervention was piloted in this population. Changes in OP knowledge, self-efficacy, health beliefs, and engagement in HBBs were evaluated.Methods
A pre-post pilot study was performed in a convenience sample of men recruited from the Princess Margaret Cancer Centre. Men were sent personalized letters explaining their dual x-ray absorptiometry (DXA) results and fracture risk assessment with an OP-related education booklet. Participants completed questionnaires assessing OP knowledge, self-efficacy, health beliefs, and current engagement in HBBs at baseline (T1) and 3 months post-intervention (T2). Paired t tests and McNemar’s test were used to assess changes in outcomes.Results
A total of 148 men completed the study. There was an increase in OP knowledge (9.7?±?4.3 to 11.4?±?3.3, p?<?0.0001) and feelings of susceptibility (16.5?±?4.3 to 17.4?±?4.7, p?=?0.015), but a decrease in total self-efficacy (86.3?±?22.9 to 81.0?±?27.6, p?=?0.007) from baseline to post-intervention. Men made appropriate changes in their overall daily calcium intake (p?≤?0.001), and there was uptake of vitamin D supplementation from 44 % (n?=?65) to 68 % (n?=?99) (p?<?0.0001). Men with bone loss (osteopenia or OP) had a greater change in susceptibility (1.9?±?4.3 vs. ?0.22?±?4.2, p?=?0.005) compared to men with normal bone density.Conclusions
Our results provide preliminary evidence that a multicomponent intervention such as the one described can lead to increased knowledge and feelings of susceptibility regarding OP and can enhance uptake of some HBBs. 相似文献14.
C Michael Dunham Charlene Rabel Barbara M Hileman Jason Schiraldi Elisha A Chance Mark T Shima Alddo A Molinar David A Hoffman 《Thrombosis journal》2014,12(1):1-5
Background
Thromboelastography® (TEG) utilizes kaolin, an intrinsic pathway activator, to assess clotting function. Recent published studies suggest that TEG results are commonly normal in patients receiving warfarin, despite an increased International Normalized Ratio (INR). Because RapidTEG? includes tissue factor, an extrinsic pathway activator, as well as kaolin, we hypothesized that RapidTEG would be more sensitive in detecting a warfarin-effect.Methods
Included in this prospective study were 22 consecutive patients undergoing elective cardioversion and receiving warfarin. Prior to cardioversion, blood was collected to assess INR, Prothrombin Time, TEG, and RapidTEG.Results
INR Results: 2.8?±?0.5 (1.6 to 4.2). Prothrombin Time Results: 19.1?±?2.2 (13.9. to 24.3). TEG Results (Reference Range): R-Time: 8.3?±?2.7 (2–8); K-Time: 2.1?±?1.4 (1–3); Angle: 62.5?±?10.3 (55–78); MA: 63.2?±?10.3 (51–69); G: 9.4?±?3.5 (4.6-10.9); R-Time within normal range: 10 (45.5%) with INR 2.9?±?0.3; Correlation coefficients for INR and each of the 5 TEG variables were insignificant (P?>?0.05). RapidTEG Results (Reference Range): ACT: 132?±?58 (86–118); K-Time: 1.2?±?0.5 (1–2); Angle: 75.4?±?5.2 (64–80); MA: 63.4?±?5.1 (52–71); G: 8.9?±?2.0 (5.0-11.6); ACT within normal range: 9 (40.9%) with INR 2.7?±?0.5; Correlation coefficients for INR and each of the 5 RapidTEG variables were insignificant (P?>?0.05).Conclusions
TEG, using kaolin activation, and RapidTEG, with kaolin and tissue factor activation, were normal in a substantial percent of warfarin patients, despite an increased INR. The false-negative rate for detecting warfarin coagulopathy with either test is unacceptable. The lack of correlation between INR and all TEG and RapidTEG components further indicates that these methodologies are insensitive to warfarin effects. Findings suggest that intrinsic pathway activation may mitigate detection of an extrinsic pathway coagulopathy. 相似文献15.
Su-Peng Yeh Woei-Chung Lo Ching-Yun Hsieh Li-Yuan Bai Ching-Chan Lin Po-Han Lin Chen-Yuan Lin Yu-Min Liao Chang-Fang Chiu 《Supportive care in cancer》2014,22(5):1199-1206
Purpose
The primary aim of this study was to evaluate the efficacy of palonosetron combined with dexamethasone in the prevention of vomiting, and especially nausea, in patients receiving allogeneic stem cell transplantation.Methods
Palonosetron 0.25 mg was given to 27 patients receiving allogeneic transplantation on the first day of conditioning, and then every other day during the entire conditioning period. Dexamethasone was given daily also during conditioning. Vomiting and nausea were recorded daily according to CTCAE version 4.0 from the start of conditioning to Day 7 after transplantation. In addition, MASCC antiemetic tool (MAT) was also used in parallel to evaluate the intensity of nausea.Results
The treatment was well tolerated; 25.9 and 40.7 % of the patients had grade 2/3 vomiting and nausea respectively during conditioning. The incidences of grade 2/3 vomiting and nausea were even higher in the first week after transplantation (40.7 and 51.8 %, respectively). The score of MAT correlated well with the grade of CTCAE. However, the difference in the mean intensity of nausea between period of conditioning and the first week after HSCT was significant only by using MAT (0.96?±?1.829 vs. 3.81?±?3.386, p?=?0.001) but not CTCAE (1.26?±?0.903 vs. 1.63?±?0.967, p?=?0.152).Conclusion
Palonosetron combined with dexamethasone is effective in preventing vomiting during conditioning. However, more effort should be made to alleviate nausea during conditioning and both nausea and vomiting in the first week after transplantation. Furthermore, MAT has a higher discriminant power than CTCAE in assessing the intensity of nausea in patients receiving allogeneic transplantation. 相似文献16.
Lampe B Hammerstingl C Schwab JO Mellert F Stoffel-Wagner B Grigull A Fimmers R Maisch B Nickenig G Lewalter T Yang A 《Clinical research in cardiology》2012,101(10):829-836
Background
The impact of atrial fibrillation (AF) on heart failure (HF) was evaluated in patients with preserved left ventricular (LV) function and long-term right ventricular (RV) pacing for complete heart block.Methods
Clinical, echocardiographic, and laboratory parameters of HF were assessed in 35 patients with established AF who had undergone ablation of the atrioventricular node and pacemaker implantation (Group A) and 31 patients who received dual-chamber pacing for spontaneous complete heart block (Group B).Results
During a follow-up period of 12.7?±?7.5?years, New York Heart Association (NYHA) functional class increased from 1.3?±?0.5 to 2.1?±?0.6 (p?0.0001) in Group A, and from 1.3?±?0.4 to 1.6?±?0.7 (p?0.01) in Group B. Left ventricular ejection fraction (LVEF) decreased from 59.7?±?5.1 to 53.0?±?8.2?(p?0.0001) in Group A, but remained stable (58.6?±?4.2 vs. 56.9?±?7.0?%, p?=?0,21) in Group B. At the end of follow-up, markers of LV function were moderately depressed in Group A compared with those in Group B: NYHA class 2.1?±?0.6 versus 1.6?±?0.7, p?=?0.001; LVEF 53.0?±?8.2 versus 56.9?±?7.0?%, p?0.05; LV diastolic diameter 53.6?±?5.8?mm versus 50.7?±?4.9?mm, p?0.05; N-terminal pro-brain natriuretic peptide (NT-proBNP) 1116.8?±?883.9 versus 622.9?±?1059.4?pg/ml, p?0.05. Progression of paroxysmal AF to permanent AF during follow-up was common, while new onset of AF was rare. Permanent AF was an independent predictor of declining LVEF >10?%, increasing NYHA class ≥1, and NT-proBNP levels >1,000?pg/ml.Conclusions
Permanent AF was associated with adverse effects on LV function and symptoms of HF in patients with long-term RV pacing for complete heart block, and appears to play an important role in the development of HF in this specific patient cohort. 相似文献17.
Nouira S Boukef R Bouida W Kerkeni W Beltaief K Boubaker H Boudhib L Grissa MH Trimech MN Boussarsar H Methamem M Marghli S Ltaief M 《Intensive care medicine》2011,37(2):249-256
Introduction
Noninvasive pressure support ventilation (NIPSV) and continuous positive airway pressure (CPAP) are both advocated in the treatment of cardiogenic pulmonary edema (CPE); however, the superiority of one technique over the other has not been clearly demonstrated. With regard to its physiological effects, we hypothesized that NIPSV would be better than CPAP in terms of clinical benefit.Methods
In a prospective, randomized, controlled study performed in four emergency departments, 200 patients were assigned to CPAP (n?=?101) or NIPSV (n?=?99). Primary outcome was combined events of hospital death and tracheal intubation. Secondary outcomes included resolution time, myocardial infarction rate, and length of hospital stay. Separate analysis was performed in patients with hypercapnia and those with high B-type natriuretic peptide (>500?pg/ml).Results
Hospital death occurred in 5 (5.0%) patients receiving NIPSV and 3 (2.9%) patients receiving CPAP (p?=?0.56). The need for intubation was observed in 6 (6%) patients in the NIPSV group and 4 (3.9%) patients in the CPAP group (p?=?0.46). Combined events were similar in both groups. NIPSV was associated to a shorter resolution time compared to CPAP (159?±?54 vs. 210?±?73?min; p?0.01), whereas the incidence of new myocardial infarction was not different between both groups. Similar results were found in hypercapnic patients and those with high B-type natriuretic peptide.Conclusions
During CPE, NIPSV accelerates the improvement of respiratory failure compared to CPAP but does not affect primary clinical outcome either in overall population or in subgroups of patients with hypercapnia or those with high B-type natriuretic peptide. 相似文献18.
Eberhardt F Hanke T Fitschen J Heringlake M Bode F Schunkert H Wiegand UK 《Clinical research in cardiology》2012,101(8):647-653
Background
Atrioventricular (AV) interval optimization is often deemed too time-consuming in dual-chamber pacemaker patients with maintained LV function. Thus the majority of patients are left at their default AV interval.Objective
To quantify the magnitude of hemodynamic improvement following AV interval optimization in chronically paced dual chamber pacemaker patients.Patients and methods
A pressure volume catheter was placed in the left ventricle of 19 patients with chronic dual chamber pacing and an ejection fraction >45?% undergoing elective coronary angiography. AV interval was varied in 10?ms steps from 80 to 300?ms, and pressure volume loops were recorded during breath hold.Results
The average optimal AV interval was 152?±?39?ms compared to 155?±?8?ms for the average default AV interval (range 100–240?ms). The average improvement in stroke work following AV interval optimization was 935?±?760?mmHg/ml (range 0–2,908; p?0.001), which translates into an average improvement of 14?±?9?% (range 0–28). A 10?ms variation of the AV interval changes the average stroke work by 207?±?162?mmHg/ml. AV interval optimization also leads to improved systolic dyssynchrony indices (17.7?±?7.0 vs. 19.4?±?7.1?%; p?=?0.01).Conclusion
The overall hemodynamic effect of AV interval optimization in patients with maintained LV function is in the same range as for patients undergoing cardiac resynchronization therapy for several parameters. The positive effect of AV interval optimization also applies to patients who have been chronically paced for years. 相似文献19.
Manolis Vavuranakis Dimitrios A. Vrachatis Harisios Boudoulas Theodore G. Papaioannou Carmen Moldovan Maria G. Kariori Konstantinos I. Kalogeras Panagiota G. Pietri Constantinos Tentolouris Christodoulos Stefanadis 《Clinical research in cardiology》2012,101(11):895-899