Chest
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Prospective multicenter study of relapse following emergency department treatment of COPD exacerbation.
To determine the incidence and risk factors of relapse after an emergency department (ED) visit for COPD exacerbation. ⋯ Among patients discharged to home after ED treatment of a COPD exacerbation, one in five patients will experience an urgent/emergent relapse event during the next 2 weeks. Both chronic factors (ie, a history of urgent clinic or ED visits) and acute factors (ie, activity limitations and initial respiratory rate) are associated with increased risk. Further research should focus on ways to decrease the relapse rate among these high-risk patients. The clinicians may wish to consider these historical factors when making ED decisions.
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To evaluate the role of nebulized opioids in COPD. ⋯ The recently published Global Initiative for Lung Disease guidelines have specifically stated that opioids are contraindicated in COPD management due to the potential respiratory depression and worsening hypercapnia. Nebulized opioids should be discouraged, as current data do not support their use.
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Comparative Study
Treatment of complicated parapneumonic pleural effusion with intrapleural streptokinase in children.
To evaluate the role of intrapleural streptokinase in the management of complicated parapneumonic effusions in children. ⋯ Intrapleural fibrinolytic treatment with streptokinase is safe and effective, and it can obviate the need for surgery in most cases. The combination treatment should be attempted early on, when complicated parapneumonic effusion is first diagnosed.
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Comparative Study
Epidemiology of nosocomial pneumonia in infants after cardiac surgery.
The pattern of nosocomial pneumonia (NP) in infants in a pediatric surgical ICU after cardiac surgery may differ from that seen in adult ICUs. ⋯ The pattern of pathogens and their antibiotic-resistance patterns in NP in infants after cardiac surgery had not shown an increasing prevalence of Gram-positive pathogens as reported by several adult ICUs. GNB still remained the most common pathogens during the last 3 years in our hospital. There was a trend of increasing antibiotic resistance in these isolates.
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Comparative Study
Transpyloric feeding tube placement in critically ill patients using electromyogram and erythromycin infusion.
Transpyloric feeding is desirable in critically ill patients who often have gastroparesis; however, correct placement is difficult, requiring fluoroscopy, endoscopy, or time-consuming blind attempts. This study evaluated the success rate and time required to place transpyloric tubes using erythromycin infusion and GI electromyogram (EMG) signal. ⋯ Erythromycin infusion and EMG guidance can facilitate rapid transpyloric feeding tube placement in critically ill patients at the bedside.