Chest
-
Randomized Controlled Trial Comparative Study
Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy.
Therapy with antibiotics influences recovery only in selected cases of COPD exacerbations. We evaluated the efficacy and safety of procalcitonin guidance compared to standard therapy with antibiotic prescriptions in patients experiencing exacerbations of COPD. ⋯ Procalcitonin guidance for exacerbations of COPD offers a sustained advantage over standard therapy in reducing antibiotic use for up to 6 months with a number-needed-to-treat of 3.
-
COPD is projected to be the third leading cause of death worldwide by 2020. The Burden of Obstructive Lung Disease initiative was started to measure the prevalence of COPD in a standardized way and to provide estimates of the social and economic burden of disease. ⋯ One quarter of residents of Salzburg County (Austria) who were >or= 40 years of age had at least mild irreversible airflow obstruction. The high prevalence of COPD highlights the impending health-care crisis that will affect many countries as a result of this greatly underappreciated condition.
-
Interventional pulmonology (IP) provides comprehensive care to patients with structural airway disorders and pleural diseases. A growing armamentarium of diagnostic and therapeutic tools has expanded the interventional pulmonologist's ability to care for pulmonary patients with complex abnormalities, often in concert and close collaboration with physicians in other specialties, such as thoracic surgery. Innovative technologies promise to have an impact on diseases and clinical entities not traditionally treated by invasive pulmonary interventions, such as asthma, COPD, and the solitary pulmonary nodule. Training, credentialing, reimbursement, and scientific validation remain key necessities for the continued growth of IP, and require a concerted effort by chest physicians and their professional organizations.
-
The selection of lobectomy or wedge resection in the treatment of patients with stage I primary lung cancer remains controversial. Clinical judgment based on comorbidities remains the main decision factor. We investigated the impact of procedure on long-term survival in a multicenter retrospective analysis. ⋯ Although the overall difference in survival time between patients undergoing lobectomy and those undergoing wedge resection was not significant, patients with tumors < 3 cm in size had improved survival times after undergoing lobectomy. Thus, tumor size appears to be an important factor to be considered in preoperative planning. Randomized trials are necessary to confirm the superiority of lobectomy over wedge resection for stage IA lung cancers.
-
Multicenter Study
Post-ICU mechanical ventilation at 23 long-term care hospitals: a multicenter outcomes study.
This multicenter study was undertaken to characterize the population of ventilator-dependent patients admitted to long-term care hospitals (LTCHs) with weaning programs, and to report treatments, complications, weaning outcome, discharge disposition, and survival in these patients. ⋯ Patients admitted to LTCHs for weaning attempts were elderly, with acute-on-chronic diseases, and continued to require considerable medical interventions and treatments. The frequency and type of complications were not surprising following prolonged and aggressive ICU interventions. In the continuum of critical care medicine, more than half of ventilator-dependent survivors of catastrophic illness transferred from the ICU were successfully weaned from prolonged mechanical ventilation in the setting of an LTCH.