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https://www.readbyqxmd.com/read/28527880/intensive-monitoring-of-urine-output-is-associated-with-increased-detection-of-acute-kidney-injury-and-improved-outcomes
#1
Kui Jin, Raghavan Murugan, Florentina E Sileanu, Emily Foldes, Priyanka Priyanka, Gilles Clermont, John A Kellum
BACKGROUND: Urine output (UO) is a vital sign for critical ill patients but standards for monitoring and reporting vary widely between ICUs. Careful monitoring of UO could lead to earlier recognition of acute kidney injury (AKI) and better fluid management. We sought to determine if intensity of UO monitoring is associated with outcomes in patients with and without AKI. METHODS: Retrospective cohort study including 15,724 adults admitted to ICUs from 2000-2008. Intensive UO monitoring was defined as hourly recordings and no gaps >3 hours for the first 48 hours after ICU admission...
May 17, 2017: Chest
https://www.readbyqxmd.com/read/28527879/ventricular-diastolic-pressure-ratio-as-a-marker-of-treatment-response-in-pulmonary-hypertension
#2
Arun Jose, Christopher S King, Oksana A Shlobin, Joseph M Kiernan, Nicolas A Cossa, A Whitney Brown, Steven D Nathan
BACKGROUND: Pulmonary hypertension (PH) is diagnosed and classified through right heart catheterization (RHC), with a number of hemodynamic markers used to help guide treatment decisions. These markers may not reflect the complex remodeling of the right ventricle or the interplay between ventricles, and struggle to predict treatment response. This study investigates the use of a novel marker; the ratio of left to right ventricular end-diastolic pressures (LVEDP/RVEDP), in predicting treatment outcomes in a cohort of PH patients...
May 17, 2017: Chest
https://www.readbyqxmd.com/read/28527878/obstructive-sleep-apnea-and-diabetes-a-state-of-the-art-review
#3
REVIEW
Sirimon Reutrakul, Babak Mokhlesi
Obstructive sleep apnea (OSA) is a chronic treatable sleep disorder and a frequent comorbidity in patients with type 2 diabetes. Cardinal features of OSA, including intermittent hypoxemia and sleep fragmentation, have been linked to abnormal glucose metabolism in laboratory-based experiments. OSA has also been linked to the development of incident type 2 diabetes. The relationship between OSA and type 2 diabetes may be bidirectional in nature given that diabetic neuropathy can affect central control of respiration and upper airway neural reflexes promoting sleep-disordered breathing...
May 17, 2017: Chest
https://www.readbyqxmd.com/read/28526656/effects-of-pulmonary-rehabilitation-on-exacerbation-number-and-severity-in-people-with-copd-an-historical-cohort-study-using-electronic-health-records
#4
Elizabeth Moore, Roger Newson, Miland Joshi, Thomas Palmer, Kieran J Rothnie, Sally Singh, Azeem Majeed, Michael Soljak, Jennifer K Quint
BACKGROUND: In previous systematic reviews, predominantly of randomised controlled trials, pulmonary rehabilitation (PR) has been shown to reduce hospital admissions for acute exacerbations of COPD (AECOPD). However, findings have been less consistent for cohort studies. We aimed to compare rates of hospitalized and general practice (GP) treated AECOPD before and after PR. METHODS: Using anonymised data from the Clinical Practice Research Datalink and Hospital Episode Statistics, hospital admissions and GP visits for AECOPD were compared one year before and after PR in patients referred for PR...
May 16, 2017: Chest
https://www.readbyqxmd.com/read/28526655/digital-morphometrics-a-new-upper-airway-phenotyping-paradigm-in-obstructive-sleep-apnea
#5
Richard J Schwab, Sarah E Leinwand, Cary B Bearn, Greg Maislin, Ramya Bhat Rao, Adithya Nagaraja, Stephen Wang, Brendan T Keenan
BACKGROUND: Obstructive sleep apnea (OSA) is associated with changes in pharyngeal anatomy. The goal of this study was to objectively and reproducibly quantify pharyngeal anatomy using digital morphometrics based on a laser ruler, and to assess differences between apneics and controls and associations with AHI (apnea-hypopnea index). This is the first study to use digital morphometrics to quantify intraoral risk factors for OSA. METHODS: Digital photographs were obtained using an intraoral laser ruler and digital camera in 311 controls (mean AHI=4...
May 16, 2017: Chest
https://www.readbyqxmd.com/read/28526654/clinical-and-angiographic-characteristics-of-35-patients-with-cryptogenic-hemoptysis
#6
Takahiro Ando, Masahiro Kawashima, Kimihiko Masuda, Keita Takeda, Kenichi Okuda, Junko Suzuki, Nobuharu Ohshima, Hirotoshi Matsui, Atsuhisa Tamura, Hideaki Nagai, Shinobu Akagawa, Ken Ohta
BACKGROUND: Hemoptysis can cause a life threatening condition and often need to be treated urgently. Nearly 20% of hemoptysis cases were diagnosed as cryptogenic after clinical investigation. The purpose of this study was to clarify clinical and angiographic characteristics of cryptogenic hemoptysis. METHODS: We retrospectively reviewed medical records of 35 patients admitted to our hospital with cryptogenic hemoptysis from October 2010 to September 2014. RESULTS: In the 35 cases, bronchial artery embolization was successfully performed in 33 patients (94...
May 16, 2017: Chest
https://www.readbyqxmd.com/read/28522112/diffuse-parenchymal-lung-disease-on-chest-radiographs-and-ct
#7
Theodore J Dubinsky, Hardik Shah, Rachelle Sonneborn, Daniel S Hippe
BACKGROUND: We prospectively identified B-lines in patients undergoing ultrasound examinations following liver transplants who also had a chest x-ray (CXR) and/or chest CT scan on the same day to determine if an association between the presence of B-lines s from the thorax on ultrasound images correlates with the presence of pulmonary abnormalities on chest radiographs. MATERIALS AND METHODS: Following IRB approval, patients undergoing routine postoperative liver transplant ultrasound examinations and a CXR and/or CT scan on the same day between 1/1/2015 through 7/1/2016 were prospectively identified...
May 15, 2017: Chest
https://www.readbyqxmd.com/read/28511929/clinical-characteristics-of-pertussis-associated-cough-in-adults-and-children-a-diagnostic-systematic-review-and-meta-analysis
#8
Abigail Moore, Helen F Ashdown, Bethany Shinkins, Nia W Roberts, Cameron C Grant, Daniel S Lasserson, Anthony Harnden
BACKGROUND: Pertussis (whooping cough) is a highly infective cause of cough that causes significant morbidity and mortality. Existing case definitions include paroxysmal cough, whooping and post-tussive vomiting but diagnosis can be difficult. We determined the diagnostic accuracy of clinical characteristics of pertussis-associated cough. METHODS: We systematically searched CINAHL, Embase, Medline and SCI-EXPANDED/CPCI-S up to June 2016. Eligible studies compared clinical characteristics in those positive and negative for Bordetella pertussis infection, confirmed by laboratory investigations...
May 13, 2017: Chest
https://www.readbyqxmd.com/read/28506612/identification-of-pulmonary-hypertension-caused-by-left-heart-disease-world-health-organization-group-2-based-on-cardiac-chamber-volumes-derived-from-chest-ct
#9
Galit Aviram, Zach Rozenbaum, Tomer Ziv-Baran, Shlomo Berliner, Yan Topilsky, Dominik Fleischmann, Yon K Sung, Roham T Zamanian, Haiwei Henry Guo
BACKGROUND: Evaluations of patients with pulmonary hypertension (PH) commonly include chest computed tomography (CT). We hypothesized that cardiac chamber volumes calculated from the same CT scans can yield additional information to distinguish left heart disease-related PH (WHO Group 2) from other PH subtypes. METHODS: Patients with right heart catheterization (RHC)-confirmed PH and contrast-enhanced chest CT studies were enrolled in this retrospective multicenter study...
May 12, 2017: Chest
https://www.readbyqxmd.com/read/28506611/clinical-and-genetic-associations-of-objectively-identified-interstitial-changes-in-smokers
#10
Samuel Y Ash, Rola Harmouche, Rachel K Putman, James C Ross, Alejandro A Diaz, Gary M Hunninghake, Jorge Onieva Onieva, Fernando J Martinez, Augustine M Choi, David A Lynch, Hiroto Hatabu, Ivan O Rosas, Raul San Jose Estepar, George R Washko
BACKGROUND: Smoking related lung injury may manifest on computed tomography (CT) as both emphysema and interstitial changes. We have developed an automated method to quantify interstitial changes and hypothesized that this measurement would be associated with lung function, quality of life, mortality, and a MUC5B polymorphism. METHODS: Using CT scans from the COPDGene study, lung parenchyma was objectively labeled as a tissue subtype and the percentage of the lung occupied by interstitial subtypes was calculated...
May 12, 2017: Chest
https://www.readbyqxmd.com/read/28506610/decreased-serum-sirtuin-1-in-chronic-obstructive-pulmonary-disease
#11
Satoru Yanagisawa, Andriana I Papaioannou, Anastasia Papaporfyriou, Jonathan Baker, Chaitanya Vuppusetty, Stelios Loukides, Peter J Barnes, Kazuhiro Ito
BACKGROUND: The protein deacetylase sirtuin-1 (SIRT1) is an anti-aging molecule that is decreased in the lung from patients with chronic obstructive pulmonary disease (COPD). Recently, SIRT1 was reported to be detectable in serum, but serum SIRT1 levels have not yet been reported in patients with COPD. METHODS: Serum SIRT1 was measured by Western blotting, and relative ratio of band density in samples against that of a positive control were calculated. RESULTS: Several molecular sizes of SIRT1, including 120kDa (actual size) and fragments (102, 75kDa) were quantified by Western blotting...
May 12, 2017: Chest
https://www.readbyqxmd.com/read/28499516/improving-cpr-performance
#12
REVIEW
Boulos S Nassar, Richard Kerber
Cardiac arrest continues to represent a public health burden with most patients having dismal outcomes. Cardiopulmonary resuscitation (CPR) is a complex set of interventions requiring leadership, coordination, and best practices. Despite the widespread adoption of new evidence in various guidelines, the provision of CPR remains variable with poor adherence to published recommendations. Key steps health care systems can take to enhance the quality of CPR and, potentially, to improve outcomes, include optimizing chest compressions; avoiding hyperventilation; encouraging intraosseus access, and monitoring capnography...
May 9, 2017: Chest
https://www.readbyqxmd.com/read/28499515/incidence-of-pneumonitis-with-use-of-pd-1-and-pd-l1-inhibitors-in-non-small-cell-lung-cancer-a-systematic-review-and-meta-analysis-of-trials
#13
Monica Khunger, Sagar Rakshit, Vinay Pasupuleti, Adrian V Hernandez, Peter Mazzone, James Stevenson, Nathan A Pennell, Vamsidhar Velcheti
BACKGROUND: PD-1/PD-L1 inhibitors show significant clinical activity in non-small cell lung carcinoma (NSCLC). However, they are often associated with potentially fatal immune mediated pneumonitis. Preliminary reports of trials suggest a difference in the rate of pneumonitis with PD-1 and PD-L1 inhibitors. We sought to determine the overall incidence of pneumonitis, and differences according to type of inhibitors and prior chemotherapy use. METHODS: Medline, Embase and Scopus databases were searched up to November 2016...
May 9, 2017: Chest
https://www.readbyqxmd.com/read/28499514/tension-pneumothorax-decompression-with-needle-thoracostomy-colorimetric-capnography
#14
Nimesh D Naik, Matthew C Hernandez, Jeff R Anderson, Erika K Ross, Martin D Zielinski, Johnathon M Aho
BACKGROUND: The success of needle decompression for tension pneumothorax is variable, and there are no objective measures assessing effective decompression. Colorimetric capnography, which detects carbon dioxide present within the pleural space, may serve as a simple test to assess effective needle decompression. METHODS: Three swine underwent traumatically induced tension pneumothorax, (n=15 standard of care, n=15 with needle capnography). Standard of care needle thoracostomy (n=15) using an 8 cm angiocatheter was performed...
May 9, 2017: Chest
https://www.readbyqxmd.com/read/28487139/a-multicenter-randomized-trial-of-ramped-position-versus-sniffing-position-during-endotracheal-intubation-of-critically-ill-adults
#15
Matthew W Semler, David R Janz, Derek W Russell, Jonathan D Casey, Robert J Lentz, Aline N Zouk, Bennett P deBoisblanc, Jairo I Santanilla, Yasin A Khan, Aaron M Joffe, William S Stigler, Todd W Rice
BACKGROUND: Hypoxemia is the most common complication during endotracheal intubation of critically ill adults. Intubation in the ramped position has been hypothesized to prevent hypoxemia by increasing functional residual capacity and decreasing the duration of intubation, but has never been studied outside of the operating room. METHODS: Multicenter, randomized trial comparing ramped position (head of the bed elevated to 25 degrees) to sniffing position (torso supine, neck flexed, head extended) among 260 adults undergoing endotracheal intubation by Pulmonary and Critical Care Medicine fellows in four intensive care units between July 22, 2015 and July 19, 2016...
May 6, 2017: Chest
https://www.readbyqxmd.com/read/28483610/decision-making-on-withholding-or-withdrawing-life-support-in-the-icu-a-worldwide-perspective
#16
Suzana M Lobo, Flávio Henrique Barros de Simoni, Stephan M Jakob, Angel Estella, Sonali Vadi, Andreas Bluethgen, Ignacio Martin-Loeches, Yasser Sakr, Jean-Louis Vincent
BACKGROUND: Many critically ill patients who die will do so after a decision has been made to withhold/withdraw life-sustaining therapy. Our objective was to document the characteristics of intensive care unit (ICU) patients with a decision to withhold/withdraw life-sustaining treatment, including the types of supportive treatments used, patterns of organ dysfunction, and international differences, including gross national income (GNI). METHODS: In this observational cohort study conducted in 730 ICUs in 84 countries, all adult patients admitted between May 8 and May 18, 2012, except admissions for routine postoperative surveillance, were included...
May 5, 2017: Chest
https://www.readbyqxmd.com/read/28483609/reduced-copd-exacerbation-risk-correlates-with-improved-fev1-a-meta-regression-analysis
#17
Alexander D Zider, Xiaoyan Wang, Russell G Buhr, Worawan Sirichana, Igor Z Barjaktarevic, Christopher B Cooper
BACKGROUND: The mechanism by which various classes of medication reduce COPD exacerbation risk remains unknown. We hypothesized a correlation between reduced exacerbation risk and improvement in airway patency as measured by the forced expiratory volume in 1 second (FEV1). METHODS: By systematic review, we identified COPD trials that reported therapeutic changes in pre-dose FEV1 (dFEV1) and occurrence of moderate to severe exacerbations. Using meta-regression analysis, we generated a model with dFEV1 as moderator variable, and absolute difference in exacerbation rate (RD), ratio of exacerbation rates (RR), or hazard ratio (HR) as dependent variables...
May 5, 2017: Chest
https://www.readbyqxmd.com/read/28483608/safety-and-effectiveness-of-clofazimine-for-primary-and-refractory-nontuberculous-mycobacterial-infection
#18
Stacey L Martiniano, Brandie D Wagner, Adrah Levin, Jerry A Nick, Scott D Sagel, Charles L Daley
BACKGROUND: Clofazimine is an antimicrobial agent that has activity in vitro against mycobacteria. Increasingly, it has been used for the treatment of nontuberculous mycobacteria (NTM), despite limited data supporting use in this setting. The objective of this study was to evaluate safety, tolerability, and clinical outcomes associated with clofazimine in patients with NTM infection. METHODS: Observational-cohort study of clofazimine used for pediatric and adult cystic fibrosis (CF) and non-CF patients with pulmonary and extrapulmonary NTM infection as part of a multidrug regimen from 2006-2014...
May 5, 2017: Chest
https://www.readbyqxmd.com/read/28479115/statin-use-is-associated-with-a-lower-risk-of-tuberculosis
#19
Vincent Yi-Fong Su, Wei-Juin Su, Yung-Feng Yen, Sheng-Wei Pan, Pei-Hung Chuang, Jia-Yih Feng, Kun-Ta Chou, Kuang-Yao Yang, Yu-Chin Lee, Tzeng-Ji Chen
BACKGROUND: Statins are widely used to lower cholesterol levels and cardiovascular risk. Further, studies have shown that statins may decrease the risks of infectious diseases and infection-related mortality. However, the association between statin use and active tuberculosis (TB) disease remains unclear. METHODS: Using the Taiwan National Health Insurance Research Database, we conducted a nationwide population-based study. Patients taking statins during 2000-2013, without antecedent TB disease, were included...
May 4, 2017: Chest
https://www.readbyqxmd.com/read/28479114/bronchopulmonary-dysplasia-where-have-all-the-stem-cells-gone-origin-and-potential-function-of-resident-lung-stem-cells
#20
Marius Alexander Möbius, Bernard Thébaud
Celebrating its 50(th) anniversary in 2017, bronchopulmonary dysplasia (BPD) - the chronic lung disease of prematurity that follows ventilator and O2 therapy for acute respiratory failure - remains the most frequent complication of extreme prematurity. Survival of premature infants born at increasingly earlier stages of gestation has made the prevention of lung injury increasingly challenging. BPD is postulated to be a misdirection of many functions in the developing lung including growth factor signalling and matrix as well as cellular composition, resulting in impaired alveolar and lung vascular growth...
May 4, 2017: Chest
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