“Objectives The aim of
this study was to determine the relative contribution of the muscle and ventilatory pumps to stroke volume in patients without a subpulmonic ventricle.\n\nBackground In patients with Fontan circulation, it is unclear how venous return is augmented to increase stroke volume and cardiac output during exercise.\n\nMethods Cardiac output (acetylene rebreathing), heart rate (electrocardiography), oxygen uptake (Douglas bag technique), and ventilation were measured in 9 patients age 15.8 +/- 6 years at 6.1 +/- 1.8 years after Fontan operation and 8 matched controls. Data were obtained at rest, after 3 min of steady-state exercise (Ex) on a cycle ergometer at 50% of individual working capacity, during unloaded selleck screening library cycling at 0 W (muscle pump alone), during unloaded cycling with isocapnic hyperpnea (muscle and ventilatory pump), during Ex plus an inspiratory load of 12.8 +/- 1.5 cm water, and during Ex plus an expiratory load of 12.8 +/- 1.6 cm water.\n\nResults In Fontan patients, the largest increases in stroke volume and stroke volume index were during zero-resistance cycling. An additional increase with submaximal exercise occurred in controls only. During Ex plus expiratory load, stroke volume indexes were reduced to baseline, non-exercise Cl-amidine price levels in Fontan patients, without significant changes in controls.\n\nConclusions
With Fontan circulation increases in cardiac output and stroke volume during Ex were due to the muscle pump, with
a small additional contribution by the ventilatory pump. An increase in intrathoracic pressure played a deleterious role in Fontan circulation YM155 by decreasing systemic venous return and stroke volume. (J Am Coll Cardiol 2012;60:2115-21) (C) 2012 by the American College of Cardiology Foundation”
“Accidental extubation of an intubated patient is a serious consideration in the surgical patient. Adequate fixation in the intubated patient is essential to prevent potentially life-threatening complications. Several methods of endotracheal tube fixation have been described in the literature. In this study, we examine 3 common methods of fixation: adhesive tape alone, suture, and tape-suture. Testing occurred in a laboratory setting with 2 fresh cadavers. Endotracheal tubes were inserted, using the methods of fixation in question. We subjected each fixation technique to progressively increasing weight to determine which technique is most resistant to accidental removal. We found that fixation of the tube by combining tape around the tube with a suture through the tape is the best noninvasive technique of the 3 methods evaluated in cases where movement of the head is anticipated.”
“The bone infections are the most divesting complications confronted by the physicians and patients. The antibiotic loaded bone cements, such as synthetic ceramics and natural ceramics were accepted for bone infections.