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        Non-invasive positive pressure ventilation with average volume assured pressure support may benefit patients with acute hypercapnic respiratory failure

        Alexander Bracey,Scott D Weingart 대한응급의학회 2020 Clinical and Experimental Emergency Medicine Vol.7 No.4

        Acute respiratory failure is a commonly encountered entity in the emergency department and intensive care unit. Non-invasive positive pressure ventilation (NIPPV) has dramatically changed the management of acute respiratory failure, particularly when chronic obstructive pulmonary disease (COPD) or congestive heart failure is the underlying etiology.1,2 In the case of hypercapnic respiratory failure due to COPD, the NIPPV augments the ability of the patient to ventilate by assisting with the work of breathing and therefore increasing tidal volume and ensuring a minimum respiratory rate. Traditional settings for a bilevel positive airway pressure ventilator (BPAP) include an inspiratory positive airway pressure (IPAP) and an expiratory positive airway pressure. Adjustments in the IPAP change the tidal volume delivered for a given breath. The difference between IPAP and expiratory positive airway pressure is the driving pressure, which, in combination with respiratory rate, determines a patient’s ventilation. The limitations of this device are that it requires frequent attention from the physician or respiratory therapist in order to assure that a patient has an adequate tidal volume. Factors that may influence adequate tidal volumes are dynamic and include level of consciousness, position, and lung compliance. If any of these factors change during a patient’s hospital course, it may reduce the tidal volume and thus ventilation, which can be deleterious to the patient if unrecognized or underrecognized.

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        Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study

        Aykan Ahmet Çağrı,Gökdeniz Tayyar,Gül İlker,Kalaycıoğlu Ezgi,Karabay Can Yücel,Boyacı Faruk,Hatem Engin,Weingart Scott D.,Dursun İhsan 대한응급의학회 2023 Clinical and Experimental Emergency Medicine Vol.10 No.3

        Objective: Severe pulmonary embolism (PE) has a high mortality rate, which can be lowered by thrombolytic therapy (TT). However, full-dose TT is associated with major complications, including life-threatening bleeding. The aim of this study was to explore the efficacy and safety of extended, low-dose administration of tissue plasminogen activator (tPA) on in-hospital mortality and outcomes in massive PE. Methods: This was a single-center, prospective cohort trial at a tertiary university hospital. A total of 37 consecutive patients with massive PE were included. A peripheral intravenous infusion was used to administer 25 mg of tPA over 6 hours. The primary endpoints were in-hospital mortality, major complications, pulmonary hypertension, and right ventricular dysfunction. The secondary endpoints were 6-month mortality and pulmonary hypertension and right ventricular dysfunction 6 months after the PE. Results: The mean age of the patients was 68.76±14.54 years. The mean pulmonary artery systolic pressure (PASP; 56.51±7.34 mmHg vs. 34.16±2.81 mmHg, P<0.001) and right/left ventricle

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