Chest
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Review Meta Analysis
Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis.
This study compares, by meta-analysis, the use of anterior-posterior chest radiography (CR) with transthoracic ultrasonography for the diagnosis of pneumothorax. ⋯ The meta-analysis indicated that bedside ultrasonography performed by clinicians had higher sensitivity and similar specificity compared with CR in the diagnosis of pneumothorax, but the accuracy of ultrasonography in the diagnosis of pneumothorax depended on the skill of the operators.
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COPD is a preventable and treatable disease characterized by airflow limitation that is not fully reversible. The diagnosis of COPD is based on spirometric evidence of airways obstruction following bronchodilator administration. Although it used to be commonly believed that patients with COPD have largely irreversible airflow obstruction, evidence now suggests that a considerable proportion of patients exhibit clinically significant bronchodilator reversibility. ⋯ Although bronchodilator reversibility commonly is defined based on thresholds for improvement in FEV(1), lung volume-based measures of pulmonary function may be of particular importance in patients with severe COPD. The usefulness of acute reversibility to short-acting bronchodilators in predicting a patient's long-term response to bronchodilator maintenance therapy is also unclear, although most studies suggest that a lack of acute response to short-acting bronchodilators does not preclude a beneficial long-term response to maintenance bronchodilator treatment. This review outlines recent findings about the prevalence and usefulness of bronchodilator reversibility in patients with COPD based on the available literature and proposes areas of future research.
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Multicenter Study
Pancreatic stone protein: a marker of organ failure and outcome in ventilator-associated pneumonia.
Ventilator-associated pneumonia (VAP) is the most common hospital-acquired, life-threatening infection. Poor outcome and health-care costs of nosocomial pneumonia remain a global burden. Currently, physicians rely on their experience to discriminate patients with good and poor outcome. However, standardized prognostic measures might guide medical decisions in the future. Pancreatic stone protein (PSP)/regenerating protein (reg) is associated with inflammation, infection, and other disease-related stimuli. The prognostic value of PSP/reg among critically ill patients is unknown. The aim of this pilot study was to evaluate PSP/reg in VAP. ⋯ Serum PSP/reg is a biomarker related to organ failure and outcome in patients with VAP.
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Comparative Study
Overnight rostral fluid shift in obstructive sleep apnea: does it affect the severity of sleep-disordered breathing?
Obstructive sleep apnea (OSA) is a common disorder with multifactorial pathogenesis. It has been proposed that rostral fluid displacement contributes to the pathogenesis of OSA. We hypothesized that if fluid shift is an important factor in OSA, then it would be more severe during the second one-half of the night when there is maximally displaced fluid rostrally. ⋯ There is a significant fluid shift rostrally to the neck overnight in patients with and without OSA. However, this fluid shift is not associated with worsening of OSA, thus making it unlikely that fluid displacement is a contributing factor in the pathogenesis or severity of OSA.
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In patients with atrial fibrillation (AF), adherence to guidelines for antithrombotic treatment is poorly followed, and undertreatment (or nonadherence with guidelines) is associated with a worse prognosis. The study objective was to evaluate whether this was also the case in a large contemporary series of unselected patients with AF in real-world clinical practice. ⋯ Guideline nonadherence and undertreatment with antithrombotic agents in unselected real-world patients with AF or atrial flutter are independently associated with a high risk of stroke and mortality.