human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Thirty-four otherwise healthy patients having to undergo elective upper abdominal surgery were r and omly assigned to two equal groups . In the treatment group , constant positive airway pressure ( CPAP ) with an expiratory pressure of 12 cm H2O was applied at one hour following extubation , and at daily intervals for the first five days following surgery for a continuous period of three hours . The control group received no CPAP treatment . All patients were given postoperative physiotherapy . In patients who received postoperative CPAP with an end-expiratory pressure of 12 cm H2O , marked normalization of pulmonary function was noted BACKGROUND Surgery has become an integral part of global health care , with an estimated 234 million operations performed yearly . Surgical complications are common and often preventable . We hypothesized that a program to implement a 19-item surgical safety checklist design ed to improve team communication and consistency of care would reduce complications and deaths associated with surgery . METHODS Between October 2007 and September 2008 , eight hospitals in eight cities ( Toronto , Canada ; New Delhi , India ; Amman , Jordan ; Auckl and , New Zeal and ; Manila , Philippines ; Ifakara , Tanzania ; London , Engl and ; and Seattle , WA ) representing a variety of economic circumstances and diverse population s of patients participated in the World Health Organization 's Safe Surgery Saves Lives program . We prospect ively collected data on clinical processes and outcomes from 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery . We subsequently collected data on 3955 consecutively enrolled patients after the introduction of the Surgical Safety Checklist . The primary end point was the rate of complications , including death , during hospitalization within the first 30 days after the operation . RESULTS The rate of death was 1.5 % before the checklist was introduced and declined to 0.8 % afterward ( P=0.003 ) . Inpatient complications occurred in 11.0 % of patients at baseline and in 7.0 % after introduction of the checklist ( P<0.001 ) . CONCLUSIONS Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals STUDY OBJECTIVES Patients who undergo surgical repair of thoracoabdominal aortic aneurysms have a high risk for the development of respiratory complications , which cause significant postoperative morbidity and prolong hospitalization , compared to patients who undergo other types of surgery . We studied whether prophylactic noninvasive application of nasal continuous positive airway pressure ( nCPAP ) administered via a facemask immediately after extubation may reduce pulmonary morbidity and shorten the length of hospitalization . DESIGN Prospect i ve r and omized clinical trial . SETTING Surgical ICU of a university hospital . PATIENTS Fifty-six patients following elective prosthetic replacement of the thoracoabdominal aorta , of whom 6 patients were excluded because they had received prolonged mechanical ventilation . INTERVENTIONS Following extubation in the ICU , nCPAP was applied for 12 to 24 h at an airway pressure of 10 cm H2O to patients in the study group ( n = 25 ) . Subjects in the control group ( n = 25 ) received st and ard treatment including intermittent nCPAP ( 10 cm H2O for 10 min ) every 4 h. MEASUREMENTS AND RESULTS In the study group , nCPAP was applied for a mean ( + /- SD ) duration of 23 + /- 3 h at an airway pressure of 10 + /- 1 cm H2O , which improved pulmonary oxygen transfer without altering hemodynamics ( ie , heart rate , mean arterial BP , and central venous pressure ) . The application of nCPAP was associated with fewer pulmonary complications ( Pa(O2)/fraction of inspired oxygen [ F(IO2 ) ] < 100 , atelectasis , pneumonia , reintubation rate ) compared to the control group ( 7 of 25 patients vs 24 of 25 subjects , respectively ; p = 0.019 ) . The mean duration of intensive care treatment tended to be shorter in the study group compared to the control group ( 8 + /- 1 vs 12 + /- 2 days , respectively ; difference not significant ) , while the mean length of hospital stay was shorter with nCPAP therapy ( 22 + /- 2 vs 34 + /- 5 days , respectively ; p = 0.048 ) . CONCLUSIONS The prophylactic application of nCPAP at airway pressures of 10 cm H2O significantly reduced pulmonary morbidity and length of hospital stay following the surgical repair of thoracoabdominal aortic aneurysms . Thus , it can be recommended as a st and ard treatment procedure for this patient group OBJECTIVES Little is known about the physiologic and clinical effects of noninvasive positive pressure ventilation ( NPPV ) in patients who have acute respiratory failure ( ARF ) after abdominal surgery . We evaluated our clinical experience with the use of NPPV in the treatment of ARF after abdominal surgery . METHODS We prospect ively evaluated NPPV use during a 2-year period in a medical-surgical ICU of a university hospital . We documented demographic and diagnostic data , gas exchange , and clinical outcomes . We compared patients who were not intubated to those who were intubated after a trial of NPPV . RESULTS Of 72 patients with ARF after abdominal surgery who were treated with NPPV , 48 patients avoided intubation ( 67 % ) . Patients in the intubated and nonintubated groups had similar demographic characteristics , and similar American Society of Anesthesiologists physical status and simplified acute physiology score II scores at admission . The intubated group had a significantly lower Pa(O2)/fraction of inspired oxygen ( Fi(O2 ) ) ratio ( 123 + /- 62 mm Hg vs 194 + /- 76 mm Hg , p < 0.01 ) and more extended bilateral alveolar infiltrates ( 67 % vs 31 % , p < 0.01 ) than the non-intubated group . Within the first NPPV observation period , the Pa(O2)/Fi(O2 ) increased ( + 36 + /- 29 % [ + /- SD ] , p = 0.04 ) and the respiratory rate decreased ( 28.2 + /- 3.4 breaths/min vs 23.1 + /- 3.8 breaths/min , p < 0.01 ) significantly only in the non-intubated group . The non-intubated group had significantly lower length of ICU stay ( 17.3 + /- 10.9 days vs 34.1 + /- 28.5 days , p < 0.01 ) and mortality rate ( 6 % vs 29 % , p < 0.01 ) . CONCLUSION NPPV may be an alternative to conventional ventilation in selected patients with ARF after abdominal surgery who require ventilatory support Background : Morbidly obese patients are at elevated risk of perioperative pulmonary complications , including airway obstruction and atelectasis . Continuous positive airway pressure may improve postoperative lung mechanics and reduce postoperative complications in patients undergoing abdominal surgery . Methods : Forty morbidly obese patients with known obstructive sleep apnea undergoing laproscopic bariatric surgery with st and ardized anesthesia care were r and omly assigned to receive continuous positive airway pressure via the Boussignac system immediately after extubation ( Boussignac group ) or supplemental oxygen ( st and ard care group ) . All subjects had continuous positive airway pressure initiated 30 min after extubation in the postanesthesia care unit via identical noninvasive ventilators . The primary outcome was the relative reduction in forced vital capacity from baseline to 24 h after extubation . Results : Forty patients were enrolled into the study , 20 into each group . There were no significant differences in baseline characteristics between the groups . The intervention predicted less reduction in all measured lung functions : forced expiratory volume in 1 s ( coefficient 0.37 , SE 0.13 , P = 0.003 , CI 0.13–0.62 ) , forced vital capacity ( coefficient 0.39 , SE 0.14 , P = 0.006 , CI 0.11–0.66 ) , and peak expiratory flow rate ( coefficient 0.82 , SE 0.31 , P = 0.008 , CI 0.21–0.1.4 ) . Conclusions : Administration of continuous positive airway pressure immediately after extubation maintains spirometric lung function at 24 h after laparoscopic bariatric surgery better than continuous positive airway pressure started in the postanesthesia care unit Gastroduodenitis should be included with duodenal ulcer and gastric ulcer in the spectrum of clinical disorders that have different pathogenetic mechanisms but a similar clinical picture . Published results of a clinical , endoscopic , radiologic , and histologic study of 100 patients presenting with gastrointestinal symptoms revealed that 61 % had classic and 39 % had atypical manifestations of peptic ulcer disease . We could not clinical ly distinguish the 24 patients with ulcer crater ( 40 % of the classic group ) from the 25 patients with acute gastroduodenitis without crater ( 41 % of the classic group ) . Preliminary data of a prospect i ve study compared the treatment responses of 19 patients with gastroduodenitis and 39 patients with peptic ulcer disease . These patients were diagnosed endoscopically and restudied after treatment with a bl and diet and antacids seven times per day for 8 weeks . The responses to therapy in gastroduodenitis and peptic ulcer were as follows : endoscopically , 63 and 80 % , respectively ; histologically , 74 and 65 % , respectively ; symptomatically , 47 and 65 % , respectively . Preliminary data on the duodenal epithelial thymidine uptake revealed an increased proliferative index in duodenitis patients but not in patients with peptic ulcer or control subjects Abstract . Background : The efficacy of nasal continuous positive airway pressure ( nCPAP ) as a prophylactic method for preventing cardiopulmonary complications after major vascular surgery has not been investigated . Patients / methods : In a prospect i ve r and omized trial , 204 patients undergoing elective midline laparotomy for vascular surgery were r and omized to receive st and ard therapy ( n=105 ) or additional prophylactic nCPAP ( n=99 ) for the first postoperative night . Postoperative oxygenation , incidence of severe cardiac , and pulmonary complications , length of intensive care surveillance and length of total postoperative hospital stay ( LOS ) were compared . Results : Prophylactic nCPAP significantly reduced the number of patients with severe oxygenation disturbances defined as paO2<70 mmHg with FiO2≥ 0.7 ( 5 versus 17 , P=.01 ) . There were no differences with respect to death , cardiac and pulmonary complications , length of intensive care surveillance or LOS . Conclusion : Prophylactic 12 h nCPAP significantly reduces the occurrence of postoperative oxygenation disturbances but has no effect on cardiac or pulmonary complications , need for intensive care , LOS or mortality after major vascular surgery Sixty-two patients undergoing elective abdominal surgery with a high operative risk and anesthesia by the ASA scale ( III/2 - 3 ) , and with a high index of cardiopulmonary risk after S. Epstein were examined . The study group comprised 31 patients who had undergone noninvasive ventilation ( NIV ) in the early postoperative period for preventive purpose s. In the control group ( n = 30 )  , moistened oxygen was insufflated after transition to spontaneous breathing . In patients with low functional reserves , the preventive use of NIV contributes to a rapider normalization of gas exchange , stabilization of hemodynamics , a reduction in the incidence of complications ( from 66.6 to 25.6 % ) and in the length of stay in an intensive care unit Twenty-four patients underwent elective cholecystectomy .  They were r and omized into two groups , one consisting of 13 patients having CPAP * by face-mask for 4 h after surgery and the other , consisting of 11 patients , serving as control . The patients were all given intravenous anesthesia and were manually ventilated during anesthesia without using PEEP . The groups were comparable as concerns sex , age , weight , smoking-habits , preoperative pulmonary status , type of surgery and anesthesia-time . The study showed that both groups had a reduction in VC and PaO2 and a high percentage of them developed chest X-ray changes . In none of the variables mentioned was there any significant difference between the groups after surgery . Hypoxemia after abdominal surgery can thus not be prevented by only using CPAP for 4 h postoperatively BACKGROUND AND PURPOSE Physiotherapists use a variety of techniques aim ed at improving lung volumes and secretion clearance in patients after surgery .  Periodic continuous positive airway pressure ( PCPAP ) is used to treat patients following elective upper abdominal surgery . However , the optimal method of application has not been identified , more specifically , the dosage of application of PCPAP . The present r and omized controlled trial compared the effects of two dosages of PCPAP application and ' traditional ' physiotherapy upon functional residual capacity ( FRC ) , vital capacity ( VC ) , oxyhaemoglobin saturation ( SpO2 ) , incidence of post-operative pulmonary complications and length of stay with a control group receiving ' traditional ' physi 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Thirty-four otherwise healthy patients having to undergo elective upper abdominal surgery were r and omly assigned to two equal groups . In the treatment group , constant positive airway pressure ( CPAP ) with an expiratory pressure of 12 cm H2O was applied at one hour following extubation , and at daily intervals for the first five days following surgery for a continuous period of three hours . The control group received no CPAP treatment . All patients were given postoperative physiotherapy . In patients who received postoperative CPAP with an end-expiratory pressure of 12 cm H2O , marked normalization of pulmonary function was noted BACKGROUND Surgery has become an integral part of global health care , with an estimated 234 million operations performed yearly . Surgical complications are common and often preventable . We hypothesized that a program to implement a 19-item surgical safety checklist design ed to improve team communication and consistency of care would reduce complications and deaths associated with surgery . METHODS Between October 2007 and September 2008 , eight hospitals in eight cities ( Toronto , Canada ; New Delhi , India ; Amman , Jordan ; Auckl and , New Zeal and ; Manila , Philippines ; Ifakara , Tanzania ; London , Engl and ; and Seattle , WA ) representing a variety of economic circumstances and diverse population s of patients participated in the World Health Organization 's Safe Surgery Saves Lives program . We prospect ively collected data on clinical processes and outcomes from 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery . We subsequently collected data on 3955 consecutively enrolled patients after the introduction of the Surgical Safety Checklist . The primary end point was the rate of complications , including death , during hospitalization within the first 30 days after the operation . RESULTS The rate of death was 1.5 % before the checklist was introduced and declined to 0.8 % afterward ( P=0.003 ) . Inpatient complications occurred in 11.0 % of patients at baseline and in 7.0 % after introduction of the checklist ( P<0.001 ) . CONCLUSIONS Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals STUDY OBJECTIVES Patients who undergo surgical repair of thoracoabdominal aortic aneurysms have a high risk for the development of respiratory complications , which cause significant postoperative morbidity and prolong hospitalization , compared to patients who undergo other types of surgery . We studied whether prophylactic noninvasive application of nasal continuous positive airway pressure ( nCPAP ) administered via a facemask immediately after extubation may reduce pulmonary morbidity and shorten the length of hospitalization . DESIGN Prospect i ve r and omized clinical trial . SETTING Surgical ICU of a university hospital . PATIENTS Fifty-six patients following elective prosthetic replacement of the thoracoabdominal aorta , of whom 6 patients were excluded because they had received prolonged mechanical ventilation . INTERVENTIONS Following extubation in the ICU , nCPAP was applied for 12 to 24 h at an airway pressure of 10 cm H2O to patients in the study group ( n = 25 ) . Subjects in the control group ( n = 25 ) received st and ard treatment including intermittent nCPAP ( 10 cm H2O for 10 min ) every 4 h. MEASUREMENTS AND RESULTS In the study group , nCPAP was applied for a mean ( + /- SD ) duration of 23 + /- 3 h at an airway pressure of 10 + /- 1 cm H2O , which improved pulmonary oxygen transfer without altering hemodynamics ( ie , heart rate , mean arterial BP , and central venous pressure ) . The application of nCPAP was associated with fewer pulmonary complications ( Pa(O2)/fraction of inspired oxygen [ F(IO2 ) ] < 100 , atelectasis , pneumonia , reintubation rate ) compared to the control group ( 7 of 25 patients vs 24 of 25 subjects , respectively ; p = 0.019 ) . The mean duration of intensive care treatment tended to be shorter in the study group compared to the control group ( 8 + /- 1 vs 12 + /- 2 days , respectively ; difference not significant ) , while the mean length of hospital stay was shorter with nCPAP therapy ( 22 + /- 2 vs 34 + /- 5 days , respectively ; p = 0.048 ) . CONCLUSIONS The prophylactic application of nCPAP at airway pressures of 10 cm H2O significantly reduced pulmonary morbidity and length of hospital stay following the surgical repair of thoracoabdominal aortic aneurysms . Thus , it can be recommended as a st and ard treatment procedure for this patient group OBJECTIVES Little is known about the physiologic and clinical effects of noninvasive positive pressure ventilation ( NPPV ) in patients who have acute respiratory failure ( ARF ) after abdominal surgery . We evaluated our clinical experience with the use of NPPV in the treatment of ARF after abdominal surgery . METHODS We prospect ively evaluated NPPV use during a 2-year period in a medical-surgical ICU of a university hospital . We documented demographic and diagnostic data , gas exchange , and clinical outcomes . We compared patients who were not intubated to those who were intubated after a trial of NPPV . RESULTS Of 72 patients with ARF after abdominal surgery who were treated with NPPV , 48 patients avoided intubation ( 67 % ) . Patients in the intubated and nonintubated groups had similar demographic characteristics , and similar American Society of Anesthesiologists physical status and simplified acute physiology score II scores at admission . The intubated group had a significantly lower Pa(O2)/fraction of inspired oxygen ( Fi(O2 ) ) ratio ( 123 + /- 62 mm Hg vs 194 + /- 76 mm Hg , p < 0.01 ) and more extended bilateral alveolar infiltrates ( 67 % vs 31 % , p < 0.01 ) than the non-intubated group . Within the first NPPV observation period , the Pa(O2)/Fi(O2 ) increased ( + 36 + /- 29 % [ + /- SD ] , p = 0.04 ) and the respiratory rate decreased ( 28.2 + /- 3.4 breaths/min vs 23.1 + /- 3.8 breaths/min , p < 0.01 ) significantly only in the non-intubated group . The non-intubated group had significantly lower length of ICU stay ( 17.3 + /- 10.9 days vs 34.1 + /- 28.5 days , p < 0.01 ) and mortality rate ( 6 % vs 29 % , p < 0.01 ) . CONCLUSION NPPV may be an alternative to conventional ventilation in selected patients with ARF after abdominal surgery who require ventilatory support Background : Morbidly obese patients are at elevated risk of perioperative pulmonary complications , including airway obstruction and atelectasis . Continuous positive airway pressure may improve postoperative lung mechanics and reduce postoperative complications in patients undergoing abdominal surgery . Methods : Forty morbidly obese patients with known obstructive sleep apnea undergoing laproscopic bariatric surgery with st and ardized anesthesia care were r and omly assigned to receive continuous positive airway pressure via the Boussignac system immediately after extubation ( Boussignac group ) or supplemental oxygen ( st and ard care group ) . All subjects had continuous positive airway pressure initiated 30 min after extubation in the postanesthesia care unit via identical noninvasive ventilators . The primary outcome was the relative reduction in forced vital capacity from baseline to 24 h after extubation . Results : Forty patients were enrolled into the study , 20 into each group . There were no significant differences in baseline characteristics between the groups . The intervention predicted less reduction in all measured lung functions : forced expiratory volume in 1 s ( coefficient 0.37 , SE 0.13 , P = 0.003 , CI 0.13–0.62 ) , forced vital capacity ( coefficient 0.39 , SE 0.14 , P = 0.006 , CI 0.11–0.66 ) , and peak expiratory flow rate ( coefficient 0.82 , SE 0.31 , P = 0.008 , CI 0.21–0.1.4 ) . Conclusions : Administration of continuous positive airway pressure immediately after extubation maintains spirometric lung function at 24 h after laparoscopic bariatric surgery better than continuous positive airway pressure started in the postanesthesia care unit Gastroduodenitis should be included with duodenal ulcer and gastric ulcer in the spectrum of clinical disorders that have different pathogenetic mechanisms but a similar clinical picture . Published results of a clinical , endoscopic , radiologic , and histologic study of 100 patients presenting with gastrointestinal symptoms revealed that 61 % had classic and 39 % had atypical manifestations of peptic ulcer disease . We could not clinical ly distinguish the 24 patients with ulcer crater ( 40 % of the classic group ) from the 25 patients with acute gastroduodenitis without crater ( 41 % of the classic group ) . Preliminary data of a prospect i ve study compared the treatment responses of 19 patients with gastroduodenitis and 39 patients with peptic ulcer disease . These patients were diagnosed endoscopically and restudied after treatment with a bl and diet and antacids seven times per day for 8 weeks . The responses to therapy in gastroduodenitis and peptic ulcer were as follows : endoscopically , 63 and 80 % , respectively ; histologically , 74 and 65 % , respectively ; symptomatically , 47 and 65 % , respectively . Preliminary data on the duodenal epithelial thymidine uptake revealed an increased proliferative index in duodenitis patients but not in patients with peptic ulcer or control subjects Abstract . Background : The efficacy of nasal continuous positive airway pressure ( nCPAP ) as a prophylactic method for preventing cardiopulmonary complications after major vascular surgery has not been investigated . Patients / methods : In a prospect i ve r and omized trial , 204 patients undergoing elective midline laparotomy for vascular surgery were r and omized to receive st and ard therapy ( n=105 ) or additional prophylactic nCPAP ( n=99 ) for the first postoperative night . Postoperative oxygenation , incidence of severe cardiac , and pulmonary complications , length of intensive care surveillance and length of total postoperative hospital stay ( LOS ) were compared . Results : Prophylactic nCPAP significantly reduced the number of patients with severe oxygenation disturbances defined as paO2<70 mmHg with FiO2≥ 0.7 ( 5 versus 17 , P=.01 ) . There were no differences with respect to death , cardiac and pulmonary complications , length of intensive care surveillance or LOS . Conclusion : Prophylactic 12 h nCPAP significantly reduces the occurrence of postoperative oxygenation disturbances but has no effect on cardiac or pulmonary complications , need for intensive care , LOS or mortality after major vascular surgery Sixty-two patients undergoing elective abdominal surgery with a high operative risk and anesthesia by the ASA scale ( III/2 - 3 ) , and with a high index of cardiopulmonary risk after S. Epstein were examined . The study group comprised 31 patients who had undergone noninvasive ventilation ( NIV ) in the early postoperative period for preventive purpose s. In the control group ( n = 30 )  , moistened oxygen was insufflated after transition to spontaneous breathing . In patients with low functional reserves , the preventive use of NIV contributes to a rapider normalization of gas exchange , stabilization of hemodynamics , a reduction in the incidence of complications ( from 66.6 to 25.6 % ) and in the length of stay in an intensive care unit Twenty-four patients underwent elective cholecystectomy .  They were r and omized into two groups , one consisting of 13 patients having CPAP * by face-mask for 4 h after surgery and the other , consisting of 11 patients , serving as control . The patients were all given intravenous anesthesia and were manually ventilated during anesthesia without using PEEP . The groups were comparable as concerns sex , age , weight , smoking-habits , preoperative pulmonary status , type of surgery and anesthesia-time . The study showed that both groups had a reduction in VC and PaO2 and a high percentage of them developed chest X-ray changes . In none of the variables mentioned was there any significant difference between the groups after surgery . Hypoxemia after abdominal surgery can thus not be prevented by only using CPAP for 4 h postoperatively BACKGROUND AND PURPOSE Physiotherapists use a variety of techniques aim ed at improving lung volumes and secretion clearance in patients after surgery .  Periodic continuous positive airway pressure ( PCPAP ) is used to treat patients following elective upper abdominal surgery . However , the optimal method of application has not been identified , more specifically , the dosage of application of PCPAP . The present r and omized controlled trial compared the effects of two dosages of PCPAP application and ' traditional ' physiotherapy upon functional residual capacity ( FRC ) , vital capacity ( VC ) , oxyhaemoglobin saturation ( SpO2 ) , incidence of post-operative pulmonary complications and length of stay with a control group receiving ' traditional ' physi 
    Output:
    