Chest
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Transfusion practice has been under great scrutiny over the last 2 decades. The examination of transfusion risks and benefits have been particularly important in the critically ill patient population. This review will examine some of the important controversies still surrounding the use of RBC transfusion in the critically ill patient.
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Observational studies of patients receiving prolonged mechanical ventilation and other forms of critical care support have determined acquired neuromuscular disorders to be extremely common. Early studies used electrophysiologic investigations to diagnose critical illness polyneuropathy (CIP) and muscle biopsy to confirm critical illness myopathy (CIM). More recent approaches seek to obviate these invasive techniques and build on a standardized bedside neuromuscular examination to identify patients with acquired weakness syndromes. ⋯ In addition, a strong association appears to exist between acquired weakness and protracted ventilator dependence, an important determinant of ICU length of stay. Multivariate analysis has identified several risk factors associated with increased incidence for ICU-acquired weakness, including severe systemic inflammation, medications (specifically, corticosteroids and neuromuscular blocking agents), glycemic control, and immobility. We advocate an approach to this common syndrome that identifies risk factors early in the hope of minimizing their impact.
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Comparative Study
Area of residence, birthplace, and asthma in Puerto Rican children.
Puerto Ricans have the highest prevalence of asthma among all ethnic groups in the United States. There have been no studies that directly compare the burden of asthma between Puerto Ricans living in Puerto Rico and those living in the mainland United States. ⋯ Puerto Rican children in Puerto Rico had a higher risk of asthma than Puerto Rican children in the South Bronx, highlighting the need for further examination of the roles of migration, acculturation, and environmental and psychosocial factors on the development of asthma in this high-risk population.
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Comparative Study Clinical Trial
Differential flow analysis of exhaled nitric oxide in patients with asthma of differing severity.
The majority of asthmatic patients achieve control of their illness; others do not. It is therefore crucial to validate/develop strategies that help the clinician monitor the disease, improving the response to treatment. ⋯ Differential flow analysis of exhaled NO provides additional information about the site of inflammation in asthma and may be useful in assessing the response of peripheral inflammation to therapy.
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Multicenter Study
Statins reduce the risk of lung cancer in humans: a large case-control study of US veterans.
Statins are commonly used cholesterol-lowering agents that are noted to suppress tumor cell growth in several in vitro and animal models. ⋯ Statins appear to be protective against the development of lung cancer, and further studies need to be done to define the clinical utility of statins as chemo protective agents.