Chest
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Randomized Controlled Trial Multicenter Study
Risk indexes for exacerbations and hospitalizations due to COPD.
The ability to predict exacerbations in patients with COPD might permit more rational use of preventive interventions. Our objective was to develop risk indexes for exacerbations and hospitalizations due to exacerbations that might be applied to the individual patient. ⋯ Spirometry along with a few questions directed to the patient are strongly predictive of exacerbations and related hospitalizations over the ensuing 6 months.
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The selection of lobectomy or wedge resection in the treatment of patients with stage I primary lung cancer remains controversial. Clinical judgment based on comorbidities remains the main decision factor. We investigated the impact of procedure on long-term survival in a multicenter retrospective analysis. ⋯ Although the overall difference in survival time between patients undergoing lobectomy and those undergoing wedge resection was not significant, patients with tumors < 3 cm in size had improved survival times after undergoing lobectomy. Thus, tumor size appears to be an important factor to be considered in preoperative planning. Randomized trials are necessary to confirm the superiority of lobectomy over wedge resection for stage IA lung cancers.
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Multicenter Study
Post-ICU mechanical ventilation at 23 long-term care hospitals: a multicenter outcomes study.
This multicenter study was undertaken to characterize the population of ventilator-dependent patients admitted to long-term care hospitals (LTCHs) with weaning programs, and to report treatments, complications, weaning outcome, discharge disposition, and survival in these patients. ⋯ Patients admitted to LTCHs for weaning attempts were elderly, with acute-on-chronic diseases, and continued to require considerable medical interventions and treatments. The frequency and type of complications were not surprising following prolonged and aggressive ICU interventions. In the continuum of critical care medicine, more than half of ventilator-dependent survivors of catastrophic illness transferred from the ICU were successfully weaned from prolonged mechanical ventilation in the setting of an LTCH.
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Multicenter Study
Lung function and ischemic stroke incidence: the Atherosclerosis Risk in Communities study.
Few studies have examined the relation between lung function and ischemic stroke incidence; none have studied African Americans. ⋯ Among white subjects, participants with impaired lung function have a modestly higher risk of ischemic stroke even if they have never smoked nor had respiratory symptoms.
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Multicenter Study Comparative Study
A statistical rationale for the use of forced expired volume in 6 s.
The purpose of the study was to determine the best surrogate for FVC when performing spirometry to detect obstruction or restriction. Volume-time curves from 3,539 participants in the Family Heart Study with acceptable quality test sessions were analyzed. An index of the variability of each timed volume (FEVx) from 1 to 12 s was determined for each subject. ⋯ Sensitivity was 76% before the 50-mL error analysis and 95% after. Specificity was 98% before the 50-mL error analysis and 99.5% after. We conclude that use of FEV(6) to replace the FVC for spirometry testing will result in improved reproducibility, with no significant loss of sensitivity or specificity, after allowing a 50-mL measurement error, for detecting obstruction or restriction.