Chest
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The management of nosocomial pneumonia represents a major challenge in the ICU. European guidelines from 2017 proposed an algorithm for the prescription of empirical antimicrobial treatment based on medical history, local ecology, and severity (ie, presence or absence of septic shock). We assessed this algorithm's usefulness by comparing outcomes with and without guideline adherence in a population at high risk of multiresistance and mortality. ⋯ The European guideline treatment algorithm has proven to be effective in reducing mortality in patients without septic shock but not in those with septic shock at the time of diagnosis. Future studies should clarify whether adjustments need to be made to improve outcomes in patients with septic shock.
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Oronasal masks are used widely for treating OSA with CPAP. However, oronasal CPAP is associated with lower effectiveness and lower adherence than nasal CPAP. ⋯ gov.
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Aspergillus species cause diverse clinical manifestations in bronchiectasis including allergic bronchopulmonary aspergillosis (ABPA), Aspergillus sensitization (AS), and raised IgG indicating exposure to or infection with Aspergillus. ⋯ Aspergillus lung disease is common in bronchiectasis. Raised IgG levels to Aspergillus are associated with significantly worse outcomes, whereas ABPA and AS are associated with severe disease and exacerbations with a risk that is attenuated by ICS use.
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The clinical and prognostic characteristics of mild-to-moderate COPD with and without emphysema remain inadequately investigated. ⋯ gov.
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Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). Although most have normalization of pulmonary artery (PA) pressures, development of residual pulmonary hypertension (RPH) is challenging to predict. ⋯ Patients with mixed thrombi were less likely to have RPH, suggesting there may be an optimum time to perform PEA after the clot has mostly organized, but prior to development of irreversible small vessel disease.