Chest
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Multicenter Study
Radiologic progression of pulmonary infiltrates predicts a worse prognosis in severe community-acquired pneumonia than bacteremia.
It remains unknown whether bacteremia and rapid radiologic progression of pulmonary infiltrates increase the risk of shock and mortality in ICU patients with community-acquired pneumonia (CAP). The objective of this study was to investigate the relative importance of these two factors in the outcome of patients with severe CAP (sCAP). ⋯ In this cohort of patients with severe CAP, radiologic progression of pulmonary infiltrates in the first 48 h is a significant adverse prognostic feature. In contrast, bacteremia does not affect outcomes.
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The combination antiretroviral therapy (ART) era (1996 to the present) has been associated with improved survival among HIV-infected outpatients, but ICU data from 2000 to the present are limited. ⋯ In this sixth in a series of consecutive studies started in 1981, we found that the epidemiology of ICU admission diagnoses continues to change. Our study also found that survival for critically ill HIV-infected patients continues to improve in the current era of ART. Although ART use was not associated with survival, it was associated with predictors that were associated with survival in a multivariate analysis.
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The Burden of Obstructive Lung Disease (BOLD) initiative provides a standardized way of measuring the prevalence of COPD. ⋯ In this population, respiratory impairment is highly prevalent and associated with comorbid disease and physical, but not mental, dysfunction.
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Randomized Controlled Trial Multicenter Study
A phase 3, randomized, double-blind study to assess the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy.
Fospropofol disodium is a water-soluble prodrug of propofol with unique pharmacokinetic/pharmacodynamic properties. This randomized, double-blind, multicenter study evaluated the use of fospropofol in patients undergoing flexible bronchoscopy. ⋯ Fospropofol provided safe and effective sedation for patients undergoing flexible bronchoscopy.
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Randomized Controlled Trial
Estimating a minimally important difference in pulmonary arterial hypertension following treatment with sildenafil.
No guidelines exist to help physicians determine whether functional and health-related quality of life (HRQoL) changes observed following treatment of patients with pulmonary arterial hypertension (PAH) represent important benefits. These analyses were undertaken to help define a minimally important difference (MID) in exercise capacity, measured by the 6-min walk distance (6MWD), and HRQoL, measured by the Short Form-36 (SF-36) questionnaire in patients with PAH. ⋯ This is the first clinical investigation to estimate MIDs for key SF-36 domains and 6MWD in patients with PAH and provides a much needed metric for interpreting the level of change in patients with PAH against which other treatments and trials can be measured.