Abstract
Objective: To develop recommendations for positioning the second-generation pacing esophageal stethoscope for transesophageal atrial pacing in patients positioned prone (P), right lateral decubitus (RLD), and left lateral decubitus (LLD). Design: Prospective; patients assigned consecutively. Setting: Tertiary and university hospitals. Participants: Thirty (10 in each position group) adult patients undergoing surgery. Interventions: The optimal depths of insertions (DOI) where pacing current threshold was minimal (THmin) were determined first when supine, then after positioning. Measurements and Main Results: Transesophageal atrial pacing was successful in all patients supine and after positioning. The optimal DOI varied from 2 cm less deep to 4 cm deeper in positioned patients compared with supine patients. Patients positioned P required equal or up to 8 mA greater current outputs to achieve transesophageal atrial pacing; LLD and RLD patients may require up to 8 mA greater or lesser current compared with supine patients. Conclusion: Transesophageal atrial pacing can be used safely and effectively in patients positioned P, RLD, and LLD. Recommendations are presented for positioning the pacing esophageal stethoscope. Emphasis is given to using the lowest DOIs and smallest currents to reduce the chance of transesophageal ventricular pacing. Copyright © 2001 by W.B. Saunders Company
Highlights
The aim of this study was to quantify the volume of pleural effusions (PEs) in the critically ill using ultrasound
During months three and four, the cost per patient (n=26) for sedatives was $669±1.362 - an 18% reduction in cost versus months one and two (P>0.05)
Significant reductions occurred in lorazepam (18%), midazolam (18%) and propofol (47%) usage (P
Summary
The aim of this study was to quantify the volume of pleural effusions (PEs) in the critically ill using ultrasound. In patients with acute lung injury (ALI), the prone position is a well-established method to improve gas exchange by reopening atelectasis and secret drainage This approach might lead, to increased intra-abdominal pressure and thereby impaired gastric mucosal perfusion. These findings are important in septic patients In this present study, the association of the platelet function with the systemic inflammation and the development in different parts of the septic process in patients of an internal intensive care unit were investigated. Hypercoagulability and endothelial cell activation and/or injury are mutually related and often found in acutely ill septic patients, and recently they have been reported to be related to multiple organ dysfunction syndromes (MODS).It is not clear, which parameters indicating coagulopathy are most closely related to MODS.
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