Chest
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Randomized Controlled Trial Comparative Study
Anticholinergic premedication for flexible bronchoscopy: a randomized, double-blind, placebo-controlled study of atropine and glycopyrrolate.
Anticholinergic premedication is commonly used during flexible bronchoscopy, although the benefits are unproven and potential risks exist. ⋯ Anticholinergic premedication may reduce airway secretions during flexible bronchoscopy but is not associated with any significant reduction in cough, patient discomfort, oxygen desaturation, or procedure time and is associated with greater hemodynamic fluctuations. Routine anticholinergic premedication may be unnecessary or even harmful during flexible bronchoscopy.
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Comparative Study
Effect of age on relationship between exhaled nitric oxide and airway hyperresponsiveness in asthmatic children.
Numerous studies have examined the relationship between the fractional concentration of exhaled nitric oxide (Feno) and airway hyperresponsiveness (AHR). Our objective was to determine the effects of age on the relationship between Feno and AHR in asthmatic children. ⋯ In children with asthma, AHR is associated with airway inflammation. AHR in children with asthma may consist of variable components mainly reflecting airway inflammation. In contrast, in adolescents with asthma, AHR is associated with airway structural changes and weakly with airway inflammation. AHR in adolescents with asthma may consist of chronic components mainly reflecting airway remodeling.
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Multicenter Study Comparative Study
Treatment of persistent pulmonary air leaks using endobronchial valves.
Prolonged pulmonary air leaks are a significant source of frustration for patients and physicians. When conventional therapy fails, an alternative to prolonged chest tube drainage or surgery is needed. Bronchoscopic blockage of a bronchus can be performed with the hope of accelerating closure of the air leak by reducing the flow of air through the leak. To our knowledge, this article presents the largest series of patients with prolonged air leaks treated with an endobronchial valve. ⋯ Use of endobronchial valves is an effective, nonsurgical, minimally invasive intervention for patients with prolonged pulmonary air leaks.
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The study documented the emergence of new forms of resistant bacilli (totally drug-resistant [TDR] or super extensively drug-resistant [XDR] tuberculosis [TB] strains) among patients with multidrug-resistant TB (MDR-TB). ⋯ The isolation of TDR strains from MDR-TB patients from different regional countries is alarming and underlines the possible dissemination of such strains in Asian countries. Now the next question is how one should control and treat such cases.
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Comparative Study
Terminal withdrawal of mechanical ventilation at a long-term acute care hospital: comparison with a medical ICU.
Failure to wean from prolonged mechanical ventilation (MV) is common in long-term acute care hospitals (LTACHs), but the process of terminal withdrawal of MV in LTACHs is not well described. We compared terminal withdrawal of MV at an LTACH with that in a medical ICU (MICU). ⋯ Terminal withdrawal of MV in the LTACH differs from that in the MICU with regard to decision making, benzodiazepine use, and cause of death.