Chest
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Comparative Study
Clinical features and outcomes in combined pulmonary fibrosis and emphysema in idiopathic pulmonary fibrosis.
Combined pulmonary fibrosis and emphysema (CPFE) is increasingly recognized, but its prevalence and prognosis remain unclear. We sought to determine the prevalence, clinical features, and prognosis of CPFE in idiopathic pulmonary fibrosis (IPF), using a standardized and reproducible definition. ⋯ CPFE was identified in 8% of patients with IPF and is a distinct, clinical phenotype with potential therapies that remain underutilized. Patients with CPFE and IPF and those with non-CPFE IPF have similar mortality.
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Comparative Study
Is a strategy based on routine endotracheal cultures the best way to prescribe antibiotics in ventilator-associated pneumonia?
The objectives of this study were to evaluate if a strategy based on routine endotracheal aspirate (ETA) cultures is better than using the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines to prescribe antimicrobials in ventilator-associated pneumonia (VAP). ⋯ The ATS/IDSA guidelines-based approach was more accurate than the ETA-based strategy for prescribing appropriate, initial, empirical antibiotics in VAP, unless a sample was available≤2 days of the onset of VAP. The ETA-based strategy led to fewer days on prescribed antimicrobials.
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Multicenter Study
Reference values for cardiorespiratory response and fitness on the treadmill in a 20- to 85-year-old population.
Existing reference values for clinical exercise testing have been derived from small nonrandom samples, lacking women and older individuals and some with poor or no maximal end criteria. The objective was to study the cardiorespiratory response during maximal exercise in a representative predominantly Caucasian sample of men and women. ⋯ This study establishes reference values for V.O2max (absolute, relative to body weight and fat-free weight), maximal HR, oxygen pulse, BP, ventilation, breathing reserve, respiratory exchange ratio, and blood lactate concentration during maximal exercise on treadmill in a large population.
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Adult studies have demonstrated that ventilator-associated tracheobronchitis (VAT) may be a precursor to ventilator-associated pneumonia (VAP). No published data on VAT in pediatric ICUs (PICUs) were found. The purposes of this retrospective, descriptive study are to describe the incidence, characteristics, and outcomes of patients at risk for VAT and formalize a process of VAT surveillance in the PICU population. ⋯ VAT occurred less frequently in our PICU than reported in adult studies, and no cases of VAT progressed to VAP in our population. Our results suggest that VAT is a clinically significant health-care-associated infection in the PICU population.
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Cognitive impairment is one of the least well-studied COPD comorbidities. It is known to occur in hypoxemic patients, but its presence during acute exacerbation is not established. ⋯ In patients hospitalized with an acute COPD exacerbation, impaired cognitive function is associated with worse health status and longer hospital length of stay. A significant proportion of patients are discharged home with unrecognized mild to severe cognitive impairment, which may not improve with recovery.