Chest
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Acute pulmonary embolism (PE) is a common disease encountered by pulmonologists, cardiologists, and critical care physicians throughout the world. For patients with high-risk acute PE (defined by systemic hypotension) and intermediate high-risk acute PE (defined by the absence of systemic hypotension, but the presence of numerous other concerning clinical and imaging features), intensive care often is necessary. Initial management strategies should focus on optimization of right ventricle (RV) function while decisions about advanced interventions are being considered. ⋯ Norepinephrine is a reasonable first choice for hemodynamic support with vasopressin as an adjunct. IV loop diuretics may be useful if evidence of RV dysfunction or volume overload is present. Fluids should be given only if concern exists for hypovolemia and absence of RV dilatation. Supplemental oxygen administration should be considered even without hypoxemia. Positive pressure ventilation should be avoided if possible. Venoarterial extracorporeal membrane oxygenation cannulation should be implemented early if ongoing deterioration occurs despite these interventions.
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Review
Recommendations for Clinicians to Combat Environmental Disparities in Pediatric Asthma: A Review.
Asthma is a common and complex lung disease in children, with disproportionally higher prevalence and related adverse outcomes among children in racial and ethnic minority groups and of lower socioeconomic position. Environmental factors, including unhealthy housing and school-based exposures, can contribute to increased asthma morbidity and widening disparities. This underscores a significant environmental justice issue and suggests the need for clinical interventions to reduce sources of environmental exposures and ultimately diminish the observed disparities in childhood asthma. ⋯ Racial, ethnic, and socioeconomic disparities exist in asthma morbidity in children, and such disparities are driven in part by environmental factors at the housing and school level. Clinicians can make evidence-based recommendations to drive effective exposure reduction strategies to mitigate asthma morbidity and reduce observed disparities.
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Multicenter Study
"Occupational exposure to charcoal smoke and dust, a major risk factor for COPD: a multiregional cross-sectional study in the Democratic Republic of Congo".
Occupational exposure to charcoal smoke and dust is a threat to workers' respiratory systems. ⋯ In rural areas of DRC, producing or selling charcoal is associated with a higher risk of COPD.
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Randomized Controlled Trial
Dexmedetomidine for Reducing Mortality in Patients with Septic Shock: A Randomized Controlled Trial (DecatSepsis).
Sepsis, especially septic shock, and its complications have been linked to the hyperadrenergic stress response. ⋯ gov.