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https://www.readbyqxmd.com/read/28739448/hydrocortisone-and-ascorbic-acid-synergistically-prevent-and-repair-lps-induced-pulmonary-endothelial-barrier-dysfunction
#1
Nektarios Barabutis, Vikramjit Khangoora, Paul E Marik, John D Catravas
BACKGROUND: Sepsis refers the dysregulated host immune response elicited by microbial infections resulting in life-threatening organ dysfunction. Sepsis represents a medical challenge, since it is associated with a rate of death as high as 60%. Septic shock is strongly associated with vascular dysfunction and elevated pulmonary capillary permeability. We recently reported that the combination of hydrocortisone (HC), ascorbic acid (VitC) and thiamine dramatically improves outcomes and reduces mortality in septic patients...
July 21, 2017: Chest
https://www.readbyqxmd.com/read/28736306/cardiac-troponin-values-in-patients-with-acute-coronary-syndrome-and-sleep-apnea-a-pilot-study
#2
Alicia Sánchez-de-la-Torre, Xavier Soler, Ferran Barbé, Marina Florés, Alan Maisel, Atul Malhotra, Montserrat Rue, Sandra Bertran, Albina Aldomá, Fernando Worner, Joan Valls, Chi-Hang Lee, Cecilia Turino, Estefanía Galera, Jordi de Batlle, Manuel Sánchez-de-la-Torre
BACKGROUND: An analysis of cardiac injury markers in patients with obstructive sleep apnea (OSA) who sustain an episode of acute coronary syndrome (ACS) may contribute to a better understanding of the interactions and impact of OSA in ACS subjects. We compared peak cardiac troponin-I (cTn-I) levels in patients admitted for ACS with and without OSA. METHODS: Blood samples were collected every 6 hours from the time of admission until 2 consecutive assays showed a downward trend in the cTn-I assay...
July 20, 2017: Chest
https://www.readbyqxmd.com/read/28736305/better-with-ultrasound-pleural-procedures-in-critically-ill-patients
#3
REVIEW
Scott J Millington, Seth Koenig
Procedures designed to drain fluid or air from the pleural spaces can be technically challenging in patients who are critically ill, and are associated with significant complications. Many individual ultrasound techniques have been described, each with the goal of making pleural drainage procedures safer. This article presents a systemic approach for incorporating many of these tools into procedures such as diagnostic thoracentesis, therapeutic drainage, or pleural catheter insertion. A series of illustrative figures and narrated video presentations are included to demonstrate many of the described techniques...
July 20, 2017: Chest
https://www.readbyqxmd.com/read/28728934/beyond-body-mass-index-obesity-and-lung-disease
#4
REVIEW
Ubong Peters, Benjamin T Suratt, Jason H T Bates, Anne E Dixon
The worldwide prevalence of obesity has increased rapidly in the last three decades, and this has led to important changes in the pathogenesis and clinical presentation of many common diseases. This review article examines the relationship between obesity and lung disease, highlighting some of the major findings that have advanced our understanding of the mechanisms contributing to this relationship. Changes in pulmonary function related to fat mass are important, but obesity is much more than simply a state of mass loading, and body mass index is only a very indirect measure of metabolic health...
July 17, 2017: Chest
https://www.readbyqxmd.com/read/28728933/predictors-of-mortality-in-pulmonary-sarcoidosis
#5
Gamze Kirkil, Elyse E Lower, Robert P Baughman
OBJECTIVES: To assess the prognostic strength of factors in predicting respiratory death in a large cohort of sarcoidosis patients with at least eight years' follow-up. METHODS: We collected age, sex, self-declared race, time of death, spirometry, diffusing capacity for carbon monoxide, chest x-ray stage, extent of fibrosis on high resolution computer tomography (HRCT), and presence of pre-capillary pulmonary hypertension (PH). The gender, age, physiology (GAP) index and Walsh's criteria for high versus low risk were calculated...
July 17, 2017: Chest
https://www.readbyqxmd.com/read/28728932/the-complex-restrictive-pulmonary-function-pattern-clinical-and-radiological-analysis-of-a-common-but-previously-undescribed-restrictive-pattern
#6
Ryan D Clay, Vivek N Iyer, Dereddi Raja Reddy, Brittany Siontis, Paul D Scanlon
BACKGROUND: Most patients with restriction have a PFT pattern in which TLC, FVC and FEV1 are reduced to a similar degree. We call this pattern 'simple' restriction (SR). In contrast, we commonly observe a pattern in which FVC percent predicted (pp) is disproportionately reduced relative to TLCpp. We term this pattern 'complex restriction' (CR) and attempted to characterize its clinical, radiologic and physiologic features. METHODS: We reviewed PFTs of patients tested between November 2009 and June 2013 who had restriction (TLC<LLN)...
July 17, 2017: Chest
https://www.readbyqxmd.com/read/28720336/baseline-symptom-score-impact-on-benefits-of-glycopyrrolate-formoterol-mdi-in-copd
#7
Fernando J Martinez, Leonardo M Fabbri, Gary T Ferguson, Chad Orevillo, Patrick Darken, Ubaldo J Martin, Colin Reisner
BACKGROUND: Chronic obstructive pulmonary disease (COPD) clinical severity is presently categorized by symptom burden and exacerbation risk. Previous 24-week Phase III trials (NCT01854645 and NCT01854658) that demonstrated better improvement of lung function with GFF MDI, a metered dose inhaler fixed-dose combination of glycopyrrolate/formoterol fumarate 18/9.6 μg, over individual monocomponent MDIs included a cross-section of patients with moderate-to-very severe airflow limitation and a broad range of COPD symptoms...
July 15, 2017: Chest
https://www.readbyqxmd.com/read/28716646/pulmonary-infarction-in-the-beginning
#8
Peter B Terry, Philip Clay Buescher
BACKGROUND: Massive pulmonary emboli can cause abrupt onset of symptoms simultaneous with large pulmonary artery occlusions. In contrast the temporal relationship between pulmonary vascular occlusion by smaller emboli and the development of pulmonary infarction symptoms is unknown. We describe the time interval between embolization and the onset of clinical symptoms and signs compatible with pulmonary infarction. METHODS: We examined the records of fifty six patients with Hereditary Hemorrhagic Telangiectasia (HHT) undergoing therapeutic balloon embolization of pulmonary arteriovenous malformations (PAVM's) in a single center after noting that some developed symptoms and signs compatible with pulmonary infarction...
July 14, 2017: Chest
https://www.readbyqxmd.com/read/28716645/update-in-management-of-severe-hypoxemic-respiratory-failure
#9
REVIEW
Dharani Kumari Narendra, Dean R Hess, Curtis N Sessler, Habtamu M Belete, Kalpalatha K Guntupalli, Felix Khusid, Charles Mark Carpati, Mark Elton Astiz, Suhail Raoof
Mortality related to severe-moderate and severe ARDS remains high. We searched the literature to update this topic. We defined severe hypoxemic respiratory failure as PaO2/FIO2 < 150 mm Hg (i.e., severe-moderate and severe ARDS). For these patients, we support setting the ventilator to a tidal volume of 4-8 mL/kg predicted body weight (PBW) with plateau pressure ≤30 cm H2O, and initial PEEP of 10 - 12 cm H2O. To promote alveolar recruitment, we propose increasing PEEP in increments of 2 - 3 cm, provided plateau pressure remains ≤30 cm H2O and driving pressure does not increase...
July 14, 2017: Chest
https://www.readbyqxmd.com/read/28716644/muc5ac-and-a-glycosylated-variant-of-muc5b-alter-mucin-composition-in-children-with-acute-asthma
#10
Kathryn G Welsh, Karine Rousseau, Gemma Fisher, Luke R Bonser, Peter Bradding, Chris E Brightling, David J Thornton, Erol A Gaillard
BACKGROUND: Diffuse airway mucus obstruction is an important feature of severe and fatal asthma. MUC5AC and MUC5B are the principal gel-forming mucins found in airway mucus. The mucin composition of airway mucus likely affects its functional properties. METHODS: We quantified the principal airway mucins MUC5AC and MUC5B in the sputum of age-matched children with acute and stable asthma and healthy controls using Western blotting. RESULTS: Sputum samples from 38 children (13 acute asthma, 15 stable asthma, 10 controls) were obtained...
July 14, 2017: Chest
https://www.readbyqxmd.com/read/28716643/reduced-risk-of-acute-exacerbation-of-chronic-obstructive-pulmonary-disease-after-bariatric-surgery-a-self-controlled-case-series-study
#11
Tadahiro Goto, Yusuke Tsugawa, Mohammad Kamal Faridi, Carlos A Camargo, Kohei Hasegawa
BACKGROUND: Obesity is common among individuals with chronic obstructive pulmonary disease (COPD) and associated with increased COPD morbidities. However, little is known about the impact of weight reduction on COPD-related outcomes in obese patients. METHODS: Using the population-based emergency department (ED) and inpatient sample in three U.S. states (California, Florida, and Nebraska), we performed a self-controlled case series study of 481 obese adults (aged 40-65 years) with COPD who underwent bariatric surgery...
July 14, 2017: Chest
https://www.readbyqxmd.com/read/28716642/long-term-use-of-inhaled-corticosteroids-in-copd-and-the-risk-of-fracture
#12
Anne V Gonzalez, Janie Coulombe, Pierre Ernst, Samy Suissa
INTRODUCTION: It is uncertain whether long-term use of inhaled corticosteroids (ICS), widely used to treat COPD, increases the risk of fracture, particularly in women, in view of the post-menopausal risks. We assessed whether long-term ICS use in patients with COPD increases the risk of hip or upper extremity fractures, and examined sex-related differences. METHODS: The Quebec healthcare databases were used to form a cohort of patients with COPD over 1990-2005, followed until 2007 for the first hip or upper extremity fracture...
July 14, 2017: Chest
https://www.readbyqxmd.com/read/28711593/clinical-evaluation-of-sepsis-1-and-sepsis-3-in-the-intensive-care-unit
#13
Xueling Fang, Zhenzhen Wang, Jun Yang, Hongliu Cai, Zhengjie Yao, Kun Li, Qiang Fang
BACKGROUND: There has been considerable controversy between sepsis-1 and sepsis-3 criteria. METHODS: Patients with infection meeting SIRS ≥ 2 criteria (sepsis-1) or a SOFA score ≥ 2 (sepsis-3) on the first day after ICU admission were selected from the MIMIC-III database, and their outcomes were compared using all-cause death as the endpoint. Subgroup analysis was also performed based on prior chronic organ dysfunction. RESULTS: 21,491 infected patients were included...
July 12, 2017: Chest
https://www.readbyqxmd.com/read/28694200/the-prevention-and-treatment-of-smoking-and-tobacco-use-during-pregnancy-in-selected-indigenous-communities-in-high-income-countries-of-usa-canada-australia-and-new-zealand-an-evidence-based-review
#14
REVIEW
Gillian S Gould, Ling Li Lim, Joerg Mattes
IMPORTANCE: Tobacco smoking during pregnancy is the most important modifiable risk factor for adverse pregnancy outcomes and long-term health complications for mother and bab(ies). Tobacco use during pregnancy has reduced in high-income countries; but not for Indigenous women in Australia, New Zealand, the United States, and Canada. APPROACH/AIM: This evidence-based review focusses on tobacco use among Indigenous pregnant women in high-income countries, who share a history of European colonisation...
July 7, 2017: Chest
https://www.readbyqxmd.com/read/28694198/survival-with-smog-and-smoke-precision-intervention
#15
Hua Linda Cai, Chen Wang
Despite continuous efforts of regional government agencies, air pollution remains a major threat to public health worldwide. In the January of 2017, a severe episode of smog similar to the London Fog in 1952, appeared in London. A longest episode of Chinese Haze also developed in Beijing, during which the PM2.5 (particular matter sized less than 2.5 micrometers) levels rose up to 500 μg/m(3). The European smog and the Chinese Haze are associated with large numbers of premature deaths each year, at 400,000 and 1...
July 7, 2017: Chest
https://www.readbyqxmd.com/read/28694197/feasibility-safety-and-utility-of-advanced-critical-care-transesophageal-echocardiography-performed-by-pulmonary-critical-care-fellows-in-a-medical-icu
#16
Yunuen Aguilera Garcia, Luis Quintero, Karan Singh, Viera Lakticova, AnnaMaria Iakovou, Seth Koenig, Mangala Narasimhan, Paul H Mayo
BACKGROUND: Competence in advanced critical care transesophageal echocardiography allows the intensivist to diagnose and manage cardiopulmonary failure when transthoracic echocardiography is not sufficient to answer the clinical question. This report describes the feasibility, safety, and utility of transesophageal echocardiography performed by pulmonary and critical care fellows in a medical ICU in critically ill patients who were mechanically ventilated. METHODS: This longitudinal descriptive study of advanced transesophageal echocardiography was performed in patients who were mechanically ventilated...
July 8, 2017: Chest
https://www.readbyqxmd.com/read/28694199/initiation-of-non-invasive-ventilation-for-sleep-related-hypoventilation-disorders-advanced-modes-and-devices
#17
REVIEW
Bernardo J Selim, Lisa Wolfe, John M Coleman, Naresh Dewan
Although non-invasive ventilation (NIV) has been used since the 1960's in the polio epidemic, the development of modern bilevel PAP devices did not become a reality until the 1990's. Over the last 25 years bilevel PAP technology options have exponentially increased. The number of patients receiving this treatment both in the acute setting as well as at home is steadily growing. However, a knowledge gap exists in the way these device settings are adjusted to achieve synchrony and match patient's unique respiratory failure physiology...
July 7, 2017: Chest
https://www.readbyqxmd.com/read/28687380/patient-and-family-engagement-in-designing-and-implementing-a-weaning-trial-a-novel-research-paradigm-in-critical-care
#18
Karen E A Burns, John W Devlin, Nicholas S Hill
The call for meaningful patient and family engagement in research has recently gained considerable momentum. This article defines patient and family engagement broadly and specifically in clinical research. Using a multicenter, North American weaning trial as an exemplar, we describe our early experiences as clinical researchers with patient and family engagement. The role of our Patient and Family Advisory Committee in trial design and implementation is illustrated. Through our experiences, we share our insights regarding the perceived opportunities and also highlight some challenges associated with engaging patients and family engagement in critical care research...
July 4, 2017: Chest
https://www.readbyqxmd.com/read/28687379/moderate-sedation-changes-for-bronchoscopy-in-2017
#19
REVIEW
Michael E Nelson
The reimbursement for procedures using moderate (conscious) sedation has changed significantly as of January 1, 2017. Due to the increasing use of anesthesia services to provide moderate sedation during endoscopy, the Centers for Medicare & Medicaid Services made the decision to remove work relative value units from many of the services requiring moderate sedation, including the bronchoscopy codes. If a bronchoscopist provides moderate sedation to a patient without using anesthesia services or another qualified provider, that work (and revenue) can be reclaimed by using the relevant codes...
July 4, 2017: Chest
https://www.readbyqxmd.com/read/28684289/change-in-psychological-physiological-and%C3%A2-situational-factors-in-adults-after%C3%A2-treatment-of-chronic-cough
#20
Cynthia L French, Sybil L Crawford, Carol Bova, Richard S Irwin
BACKGROUND: We hypothesized that addressing anxiety and depressive mood disorders will improve chronic cough severity and cough quality of life (CQOL). METHODS: Major tenets of the theory of unpleasant symptoms were examined in a longitudinal observational study of consecutive adults with cough of > 8 weeks' duration treated in our cough clinic. At baseline and 3 and 6 months, subjects completed 3 Punum Ladders rating cough severity, the CQOL Questionnaire, the Depression, Anxiety, and Stress Scales-21, and the Duke Functional Social Support Questionnaire...
July 3, 2017: Chest
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