Chest
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Randomized Controlled Trial
Average volume-assured pressure support in obesity hypoventilation: A randomized crossover trial.
Average volume-assured pressure support (AVAPS) has been introduced as a new additional mode for a bilevel pressure ventilation (BPV) device (BiPAP; Respironics; Murrysville, PA), but studies on the physiologic and clinical effects have not yet been performed. There is a particular need to better define the most efficient ventilatory treatment modality for patients with obesity hypoventilation syndrome (OHS). ⋯ BPV-S/T substantially improved oxygenation, sleep quality, and HRQL in patients with OHS. AVAPS provided additional benefits on ventilation quality, thus resulting in a more efficient decrease of PtcCO2. However, this did not provide further clinical benefits regarding sleep quality and HRQL.
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Until relatively recently, critical care practitioners have focused on the survival of their patients and not on long-term outcomes. The incidence of chronic neurocognitive dysfunction has been underestimated and underreported, and only recently has it been studied in critically ill patients. However, neurocognitive outcomes have been the subject of extensive investigation in other medical populations for many years. ⋯ Current research indicates that neurocognitive sequelae following critical illness are common, may be permanent, and are associated with impairments in daily function, decreased quality of life, and an inability to return to work. Research needs to be done to better understand the prevalence, nature, risk factors, and nuances of the neurocognitive impairments observed in ICU survivors.
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Comparative Study Clinical Trial
Comparison of endobronchial ultrasound, positron emission tomography, and CT for lymph node staging of lung cancer.
To perform a prospective comparison of direct real-time endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA), positron emission tomography (PET), and thoracic CT for detection of mediastinal and hilar lymph node metastasis in patients with lung cancer considered for surgical resection. ⋯ Compared to CT and PET, EBUS-TBNA has a high sensitivity as well as specificity for mediastinal and hilar lymph node staging in patients with lung cancer. EBUS-TBNA should be considered for evaluation of the mediastinum early in the staging process of lung cancer.
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Comparative Study
Long-term prognosis for patients with COPD treated in the prehospital setting: Is it influenced by hospital admission?
Our aim was to assess long-term prognosis for patients with an exacerbation of COPD who were treated by the anesthesiologists of the Mobile Emergency Care Unit (MECU) of Copenhagen. We specifically sought to examine whether mortality was different among patients released before hospital admission and those admitted to the hospital. ⋯ Mortality was high among COPD patients. Less than one fifth of patients treated at home and released are admitted to hospital secondarily. Mortality was significantly higher among admitted patients. A set of criteria selecting the patient prone to secondary admission is desirable.
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To determine the incidence and trends of pneumococcal community-acquired pneumonia (CAP) resistant to antibiotics, to describe clinical and microbiological features of pneumococcal CAP, and to ascertain prognostic risk factors in a third-level hospital. ⋯ We found a decrease in drug resistance compared with a previous report and a relatively high incidence of serotype 1 pneumococcal CAP. We also observed a high prevalence of HIV-1 infection among individuals with pneumococcal pneumonia. We confirm the lack of association of drug resistance with mortality and length of hospitalization. Mortality was associated with female gender, pleural effusion, and previous oral corticoid treatment. These results should be better ascertained in further studies.