Chest
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion.
To demonstrate the efficacy, safety, and appropriate mode of instillation of talc for sclerosis in treatment of malignant pleural effusions (MPEs). ⋯ Both methods of talc delivery are similar in efficacy; TTI may be better for patients with either a lung or breast primary. The etiology and incidence of respiratory complications from talc need further exploration.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD.
Pulmonary rehabilitation (PR) improves exercise tolerance in COPD patients. Tiotropium is a once-daily, inhaled anticholinergic bronchodilator that provides sustained 24-h improvements in airflow and lung hyperinflation reduction. We hypothesized that ventilatory mechanics improvements from tiotropium would permit enhanced ability to train muscles of ambulation and therefore augment exercise tolerance benefits of PR. ⋯ Tiotropium in combination with PR improved endurance of a constant work rate treadmill task and produced clinically meaningful improvements in dyspnea and health status compared to PR alone. Improvements with tiotropium were sustained for 3 months following PR completion.
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Multicenter Study
Incidence and impact of organ dysfunctions associated with sepsis.
To study the incidence and severity of organ dysfunction associated with sepsis. ⋯ Our study identifies a subgroup of patients with an ICU stay > 24 h and SS with at least two organ dysfunctions. This group of patients requires special attention since their ICU mortality is > 40% and they occupy almost 40% of all ICU beds.
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Multicenter Study
A descriptive evaluation of transfusion practices in patients receiving mechanical ventilation.
To characterize and compare transfusion practices in a broad sample of patients receiving mechanical ventilation (MV) and not receiving MV in the ICU. ⋯ Mechanical ventilation appears to be an easily identifiable early marker for allogeneic blood exposure risk in ICU patients. While the longer ICU stays account for much of this risk, patients receiving MV also appear to undergo transfusions at higher hemoglobin thresholds than patients not receiving MV, at least early in the ICU stay. Justification of this relatively liberal transfusion practice in patients receiving MV will require further study.