Chest
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Patients in the ICU are known to have severely disrupted sleep with disturbed circadian pattern, decreased nocturnal sleep time, abnormally increased stages 1 and 2 sleep, and reduced or absent deep sleep. Recent data reveal that a subpopulation of critically ill patients manifests unique EEG sleep patterns. ⋯ How sleep disruption contributes to outcomes in critically ill patients, such as recovery time and weaning from mechanical ventilation, is unknown. This article reviews the literature describing sleep in ICU patients, including recent investigations in patients who require mechanical ventilation, factors that affect sleep in critically ill patients, and the potential mechanisms and clinical implications of disturbed sleep in the ICU setting with directions to consider for future investigations.
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Controlled Clinical Trial
Diagnostic and prognostic values of pleural fluid procalcitonin in parapneumonic pleural effusions.
The role of procalcitonin (PCT) in parapneumonic pleural effusion (PPPE) as a diagnostic and prognostic biomarker of the outcome has not been examined before. ⋯ S-PCT has higher diagnostic accuracy than PF-PCT in differentiating PPPEs from non-PPPEs. However, both PF-PCT and S-PCT are useful in the severity assessment of patients with PPPEs. The PF-PCT/S-PCT ratio may help to predict prolonged chest tube drainage.
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Randomized Controlled Trial
Endobronchial ultrasonography-guided transbronchial needle aspiration increases the diagnostic yield of peripheral pulmonary lesions: a randomized trial.
The diagnostic yield of endobronchial ultrasonography (EBUS)-guided transbronchial needle aspiration (TBNA) for peripheral pulmonary lesions (PPLs) has not been evaluated. The diagnostic impact of TBNA when the EBUS probe is adjacent to lesions remains to be determined. ⋯ Applying TBNA to EBUS-guided CDPs further increased the diagnostic yield of PPLs without additional risk. The diagnostic advantage of TBNA became more obvious if the EBUS probe was adjacent to the lesions.
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Multicenter Study
Soluble p-selectin and the risk of primary graft dysfunction after lung transplantation.
Platelet activation with subsequent neutrophilic adherence to the vasculature initiates ischemia-reperfusion injury. We hypothesized that higher plasma P-selectin levels reflecting platelet activation would therefore be associated with primary graft dysfunction (PGD) after lung transplantation. ⋯ Higher postoperative soluble P-selectin levels were associated with an increased risk of PGD at 72 h following lung transplantation.
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Randomized Controlled Trial
Morphine with adjuvant ketamine vs higher dose of morphine alone for immediate postthoracotomy analgesia.
Thoracotomy is associated with severe pain. We hypothesized that the concomitant use of a subanesthetic dose of ketamine plus a two-third-standard morphine dose might provide more effective analgesia with fewer side effects than a standard morphine dose for early pain control. ⋯ Subanesthetic ketamine combined with a 35%-lower morphine dose provided equivalent pain control compared to the standard morphine dose alone, with fewer adverse side effects and a 45% reduction in morphine consumption.