Chest
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Randomized Controlled Trial Multicenter Study
The efficacy and safety of combination salmeterol (50 microg)/fluticasone propionate (500 microg) inhalation twice daily via accuhaler in Chinese patients with COPD.
Few studies of the efficacy and safety of therapy with combinations of salmeterol/fluticasone propionate (SFCs) have been conducted in Chinese patients with COPD, and the benefits of combination therapy in nonsmoking patients with COPD are, to our knowledge, not known. ⋯ SFC therapy achieved sustained improvement in lung function, quality of life, and control of symptoms, and was well tolerated in Chinese patients. Greater improvements in lung function were found only for COPD patients with a history of smoking.
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Randomized Controlled Trial Multicenter Study
Goal-directed intraoperative therapy reduces morbidity and length of hospital stay in high-risk surgical patients.
Postoperative organ failures commonly occur after major abdominal surgery, increasing the utilization of resources and costs of care. Tissue hypoxia is a key trigger of organ dysfunction. A therapeutic strategy designed to detect and reverse tissue hypoxia, as diagnosed by an increase of oxygen extraction (O2ER) over a predefined threshold, could decrease the incidence of organ failures. The primary aim of this study was to compare the number of patients with postoperative organ failure and length of hospital stay between those randomized to conventional vs a protocolized strategy designed to maintain O2ER < 27%. ⋯ Early treatment directed to maintain O2ER at < 27% reduces organ failures and hospital stay of high-risk surgical patients. Clinical trials.gov reference No. NCT00254150.
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Randomized Controlled Trial
Oral or IV prednisolone in the treatment of COPD exacerbations: a randomized, controlled, double-blind study.
Treatment with systemic corticosteroids for exacerbations of COPD results in improvement in clinical outcomes. On hospitalization, corticosteroids are generally administered IV. It has not been established whether oral administration is equally effective. We conducted a study to demonstrate that therapy with oral prednisolone was not inferior to therapy with IV prednisolone using a double-blind, double-dummy design. ⋯ Therapy with oral prednisolone is not inferior to IV treatment in the first 90 days after starting therapy. We suggest that the oral route is preferable in the treatment of COPD exacerbations.
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Randomized Controlled Trial
Hemodynamic parameters are prognostically important in cardiogenic shock but similar following early revascularization or initial medical stabilization: a report from the SHOCK Trial.
In cardiogenic shock (CS), conclusive data on serial hemodynamic measurements for treatment guidance and prognosis are lacking. ⋯ SVI and SWI are the most powerful hemodynamic predictors of 30-day mortality in CS patients. Hemodynamic parameters are similar for surviving patients following ERV and IMS. Thus, early hemodynamic stability after IMS should not delay revascularization since long-term outcomes are superior with ERV.
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Randomized Controlled Trial
Noninvasive positive airway pressure and risk of myocardial infarction in acute cardiogenic pulmonary edema: continuous positive airway pressure vs noninvasive positive pressure ventilation.
The addition of both noninvasive continuous positive airway pressure (n-CPAP) or noninvasive intermittent positive pressure ventilation (n-IPPV) to medical treatment has been shown to improve the outcome of patients with acute cardiogenic pulmonary edema (ACPE). Previous studies indicated a potential risk of new-onset acute myocardial infarction (AMI) associated with the use of n-IPPV. Although further studies did not confirm this observation, a few recent metaanalyses could not eliminate all the doubts at this regards because of the paucity of data available and the presence of confounding factors. This study aims to assess whether the application of n-IPPV, as opposed to n-CPAP, increases the rate of AMI in ACPE patients. ⋯ The AMI rate was not different with n-CPAP and n-IPPV, which resulted to be equally effective in the treatment of ACPE.