Chest
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Meta Analysis
Intrapleural fibrinolytic agents for empyema and complicated parapneumonic effusions: a meta-analysis.
Randomized controlled trials have shown conflicting findings about the role of intrapleural fibrinolytic therapy for the treatment of empyema and complicated parapneumonic effusions in adult patients. ⋯ Our meta-analysis does not support the routine use of fibrinolytic therapy for all patients who require chest tube drainage for empyema or complicated parapneumonic effusions. However, there was significant heterogeneity of the treatment effects among the trials. Selected patients might benefit from the treatment.
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Randomized Controlled Trial Comparative Study
Equivalence of autoadjusted and constant continuous positive airway pressure in home treatment of sleep apnea.
Whether computerized autoadjusted continuous positive airway pressure (aCPAP) is effective or even superior to constant continuous positive airway pressure (cCPAP) in the treatment of obstructive sleep apnea syndrome (OSAS) is still controversial. We performed a randomized, double-blind, controlled, cross-over trial comparing efficacy of sleep apnea home therapy by a novel aCPAP machine (REMStarAuto; Respironics; Murrysville, PA) operated in autoadjusted or constant mode. Thirty sleep apnea patients were recruited consecutively. ⋯ We conclude that patients with OSAS preferred aCPAP over cCPAP in the initial phase of therapy. The effectiveness aCPAP in improving major outcomes was equivalent to cCPAP. Since aCPAP does not require initial titration, it is a simple and promising modality for sleep apnea home therapy.
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Randomized Controlled Trial
Effect of high-frequency chest wall oscillation on the central and peripheral distribution of aerosolized diethylene triamine penta-acetic acid as compared to standard chest physiotherapy in cystic fibrosis.
High-frequency chest wall oscillation (HFCWO) has been shown to be as effective as standard chest physiotherapy (SCPT) for removal of pulmonary secretions as well as increasing FEV(1) in cystic fibrosis (CF) patients. Patients using HFCWO often administer aerosolized medications simultaneously, reducing time required for daily care. While peripheral pulmonary distribution of tracer in normal subjects has been shown to be unaffected by HFCWO, this has not been studied in CF patients. We evaluated distribution of aerosolized (99m)Tc diethylene triamine penta-acetic acid (DTPA) administered simultaneously with HFCWO and compared this with DTPA aerosolized after SCPT. ⋯ Use of HFCWO in combination with aerosolized DTPA did not result in increased central deposition as compared with aerosolized DTPA administered after SCPT. Further study is required to determine if combining HFCWO with aerosolized medications can be modified to improve peripheral deposition.
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Randomized Controlled Trial
Clinical effects of heliox administration for acute bronchiolitis in young infants.
To assess the effect of heliox, a helium-oxygen mixture, on respiratory distress symptoms in young infants. ⋯ In young infants, even those born prematurely, heliox breathing induced a rapid reduction in accessory muscles use and expiratory wheezing. Further studies are needed to confirm the decreased respiratory muscle work of breathing during heliox inhalation in this population.
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Most surveys of pediatric outpatient asthma management obtain information from parents and caregivers. Studies based on surveys of primary health-care providers are sparse. Suboptimal outpatient management may play a role in the high hospitalization rates among inner-city asthmatic children. Asthma management practices were compared between hospital-based and community-based primary care providers (PCPs). Adherence to National Heart, Lung, and Blood Institute (NHLBI) guidelines was evaluated, along with practices not clearly defined in the guidelines such as use of oral cough medicines and albuterol suspension. ⋯ Greater emphasis is needed to increase the awareness among PCPs of the NHLBI guideline recommendations, as suboptimal outpatient asthma management may contribute to the disproportionately higher hospitalization rates among inner-city asthmatic children. Clarification on the use of potentially harmful medications and those of doubtful value need to be incorporated in the guidelines. The extent to which these negative practices contribute to the elevated pediatric hospitalization rates warrants further investigation.