Chest
-
No score is available to assess severity and stratify mortality risk in ventilator-associated pneumonia (VAP). Our objective was to develop a severity assessment tool for VAP patients. ⋯ VAP PIRO score is a simple, practical clinical tool for predicting ICU mortality and health-care resources use that is likely to assist clinicians in determining VAP severity.
-
Editorial Comment
Childhood obstructive sleep apnea syndrome: unanswered questions.
-
The mainstay of current drug therapy is long-acting bronchodilators; several longer acting inhaled beta(2)-agonists and muscarinic antagonists (and combinations) are now in development. No treatments have so far been shown to reduce the progression or suppress the inflammation of COPD. With better understanding of the inflammatory and destructive processes in the pathophysiology of COPD, several new targets have been identified. ⋯ Broad-spectrum antiinflammatory drugs, including inhibitors of the enzymes phosphodiesterase 4, p38 mitogen-activated protein kinase, nuclear factor-kappaB, and phosphoinositide-3-kinase-gamma, may be more effective, but the side effects will be a major limitation so that inhaled delivery may be necessary. Perhaps the most promising approach is the reversal of corticosteroid resistance through increasing histone deacetylase-2 activity. This might be achieved by theophylline-like drugs, more effective antioxidants, and nonantibiotic macrolide agents.