Chest
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of single 7.5-mg dose treatment vs sequential multidose 2.5-mg treatments with nebulized albuterol in the treatment of acute asthma.
s: The purpose of the current trial was to compare the relief of airway obstruction from treatment with a single dose of albuterol,7.5 mg (single-dose group), with that from three sequential doses of albuterol, 2.5 mg, spaced 20 min apart (multidose group). ⋯ A single dose of 7.5 mg nebulized albuterol and sequential doses of 2.5 mg nebulized albuterol are clinically equivalent in the treatment of patients with moderate-to-severe acute asthma and result in similar dispositions from the emergency department.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of inspiratory flow waveforms on lung mechanics, gas exchange, and respiratory metabolism in COPD patients during mechanical ventilation.
The clinical usefulness of varying inspiratory flow waveforms during mechanical ventilation has not been adequately studied. The aim of this study was to compare the effects of three different respiratory waveforms on the pulmonary mechanics, gas exchange, and respiratory metabolism of ventilated patients with COPD. ⋯ The most favorable flow pattern for ventilated patients with COPD appeared to be the decelerating waveform. There are possibilities for the improvement of ventilation in these patients by selecting an appropriate inspiratory flow.
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Pulmonary fibrosis is a component of over 200 interstitial lung diseases. Some have known etiologies, however, for many diseases, the etiology remains unknown or obscure. This brief review examines the prevalence and classification of these diseases, the approach to be taken for the investigation of a patient suspected of having pulmonary fibrosis, the indications for the performance of lung biopsy, and current thoughts concerning the pathogenesis of the idiopathic forms of fibrotic lung disease. A brief review of established and emerging therapeutic strategies is included.
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Experimental methods to quantify alveolar fluid clearance have been adapted for our studies in patients with acute lung injury (ALI) or ARDS. We recently completed a study of 79 patients with ALI/ARDS that was designed to examine alveolar fluid clearance in the setting of alveolar epithelial injury from ALI/ARDS. Pulmonary edema fluid and plasma were sampled serially in the first 4 h after endotracheal intubation and the initiation of positive-pressure ventilation. ⋯ Patients with maximal alveolar fluid clearance had a significantly lower mortality rate and a shorter duration of mechanical ventilation. Several mechanisms may account for the decrease in the rate of alveolar fluid clearance in ALI/ARDS patients, including hypoxia, reactive oxygen species, reactive nitrogen species, and the loss of an intact epithelial barrier in the distal airspaces of the lung. Despite the epithelial injury in patients with ALI/ARDS, some experimental studies have suggested that alveolar fluid clearance could be increased with therapy using cyclic adenosine monophosphate agonists or other pharmacologic agents.
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To evaluate risk factors for ventilator-associated pneumonia (VAP), as well as its influence on in-hospital mortality, resource utilization, and hospital charges. ⋯ This retrospective matched cohort study, the largest of its kind, demonstrates that VAP is a common nosocomial infection that is associated with poor clinical and economic outcomes. While strategies to prevent the occurrence of VAP may not reduce mortality, they may yield other important benefits to patients, their families, and hospital systems.