Chest
-
Multicenter Study
Blood glucose control in critically ill adults and children: a survey on stated practice.
We document clinicians' stated blood glucose control practice patterns in North American pediatric and adult ICUs. ⋯ Blood glucose control with insulin is used frequently for critically ill adults and children. A wide variation in practice exists in blood glucose targets, hyperglycemia and hypoglycemia definitions, and decision algorithms among North American adult and pediatric ICUs.
-
Multicenter Study
Impact of COPD on outcome among patients with complicated peptic ulcer.
COPD is associated with an increased risk of peptic ulcer disease, but limited data exist on whether COPD influences short-term mortality among patients with bleeding and a perforated peptic ulcer. We examined the association between COPD and 30-day mortality following bleeding and perforation of a peptic ulcer. ⋯ COPD substantially increased 30-day mortality among patients with bleeding and perforated peptic ulcers.
-
Randomized Controlled Trial Multicenter Study Comparative Study
Family member satisfaction with end-of-life decision making in the ICU.
Families of ICU patients may be at risk for increased psychological morbidity due to end-of-life decision making. The identification of chart-based quality indicators of palliative care that predict family satisfaction with decision making may help to guide interventions to improve decision making and family outcomes. ⋯ Increased family satisfaction with decision making is associated with withdrawing life support and the documentation of palliative care indicators including the following: physician recommendations to withdraw life support; expressions of patients' wishes; and discussions of families' spiritual needs. These findings provide direction for future studies to investigate approaches to improving family satisfaction in end-of-life decision making. In addition, because there were few nonwhites in this study, these results may not be generalizable to more diverse populations. Future studies should target diverse populations in order to test whether similar factors are similarly important for end-of-life decision making.
-
Randomized Controlled Trial Multicenter Study Comparative Study
Donepezil improves obstructive sleep apnea in Alzheimer disease: a double-blind, placebo-controlled study.
There is an association between Alzheimer disease and sleep-disordered breathing. Donepezil is the drug most frequently used to treat cognitive symptoms in Alzheimer disease. This study evaluates the effects of donepezil on obstructive sleep apnea in patients with Alzheimer disease. ⋯ Donepezil treatment improved AHI and oxygen saturation in patients with Alzheimer disease. Treatment also increased REM sleep duration and reduced ADAS-cog scores.
-
Multicenter Study Comparative Study
The presence of pneumococcal bacteremia does not influence clinical outcomes in patients with community-acquired pneumonia: results from the Community-Acquired Pneumonia Organization (CAPO) International Cohort study.
It remains unknown whether pneumococcal bacteremia increases the risk of poor outcomes in hospitalized patients with community-acquired pneumonia (CAP). The objective of this study was to investigate whether the presence of pneumococcal bacteremia influences the clinical outcomes of hospitalized patients with CAP. ⋯ Pneumococcal bacteremia does not increase the risk of poor outcomes in patients with CAP. Factors related to severity of disease are confounders of the association between pneumococcal bacteremia and poor outcomes. This study indicates that the presence of pneumococcal bacteremia by itself should not be a contraindication for deescalation of therapy in clinically stable hospitalized patients with CAP.