Chest
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Multicenter Study
Nonspecific interstitial pneumonia associated with polymyositis and dermatomyositis: serial high-resolution CT findings and functional correlation.
We described the features seen on serial high-resolution CT scans of nonspecific interstitial pneumonia (NSIP) that was associated with polymyositis (PM) and dermatomyositis (DM), and we correlated the changes in the CT scan findings with those of pulmonary function test results. ⋯ With treatment, serial CT scans of PM/DM patients with NSIP showed significant improvement in the abnormal opacities, and radiographic progression of lung fibrosis was limited. The CT scan features and clinical course of NSIP in PM/DM patients were relatively uniform, and this constitutes a subset of NSIP.
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Multicenter Study Comparative Study
Variability in antibiotic prescribing patterns and outcomes in patients with clinically suspected ventilator-associated pneumonia.
To describe the variation in clinical practice strategies for the treatment of suspected ventilator-associated pneumonia (VAP) in a population of critically ill patients, and to determine whether initial empiric treatment with certain antibiotics, monotherapy vs combination antibiotic therapy, or appropriate vs inappropriate antibiotic therapy is associated with survival, length of hospital stay, or days free of antibiotics. ⋯ Patients with clinically suspected VAP who receive initial empiric therapy with antipseudomonal penicillins plus beta-lactamase inhibitors, and possibly aminoglycosides, have lower in-hospital mortality rates when compared with those who are not treated with these antibiotics. These agents should be considered for the initial empiric therapy of VAP.
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Multicenter Study Clinical Trial
Ultrasound-guided transbronchial needle aspiration: an experience in 242 patients.
Conventional transbronchial needle aspiration (TBNA) is a valuable procedure but remains underutilized. Recently, imaging guidance such as CT fluoroscopy has created considerable interest. As CT fluoroscopy is cumbersome and exposes patients and staff to radiation, we have examined the feasibility of endobronchial ultrasound (EBUS) in providing imaging support for TBNA. ⋯ EBUS is simply performed and if used for TBNA guidance affords an excellent yield independent of lymph node location. Randomized trials comparing standard TBNA and imaging-guided TBNA by CT fluoroscopy and EBUS are indicated.
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Multicenter Study
Changing patterns in long-term noninvasive ventilation: a 7-year prospective study in the Geneva Lake area.
To describe a 7-year follow-up (1992 to 2000) of patients who were treated by home nasal positive-pressure ventilation (NPPV) for chronic hypercapnic respiratory failure. ⋯ Major changes in patient selection for NPPV occurred during the study period with a marked increase in COPD and OHS. The shift toward less expensive pressure-cycled ventilators and the decrease in hospitalizations after initiating NPPV have had positive impacts on the cost-effectiveness of NPPV in patients with chronic respiratory failure.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Mask proportional assist vs pressure support ventilation in patients in clinically stable condition with chronic ventilatory failure.
To compare the short-term physiologic effects of mask pressure support ventilation (PSV) and proportional assist ventilation (PAV) in patients in clinically stable condition with chronic ventilatory failure (CVF). ⋯ In resting, awake patients in clinically stable condition with CVF caused by either COPD or RCWD, noninvasive application of PAV, set at the patient's comfort, was not superior to PSV either in increasing VT and E or in unloading the inspiratory muscles. We failed to find any difference in patient/ventilator interaction between ventilatory modes.