Cleveland Clinic journal of medicine
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Randomized Controlled Trial Multicenter Study Clinical Trial
A perspective on the fluids and catheters treatment trial (FACTT). Fluid restriction is superior in acute lung injury and ARDS.
Restricting fluid intake and promoting fluid excretion (a "dry" or conservative strategy) is more effective than a "we or liberal strategy in patients with acute lung injury and acute respiratory distress syndrome. In a multicenter, randomized, prospective clinical comparison of the two strategies in 1000 patients, those in the conservative-strategy group experienced faster improvement in lung function and spent significantly fewer days on ventilation and in the intensive care unit (N Engl J Med 2006; 354:2564-2574). No significant differences were observed in the incidence of death by 60 days or of nonpulmonary organ failure at 28 days except for days of central nervous system failure, which were fewer in the conservative-strategy group.
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Obstructive sleep apnea is common, underdiagnosed, undertreated, and highly associated with cardiovascular risk. It is characterized by daytime sleepiness and disrupted sleep and is confirmed by overnight sleep studies (polysomnography). Treatment with continuous positive airway pressure (CPAP) improves sleep and daytime sleepiness, but its effects on cardiovascular risk while promising, are still unclear.
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Advances have brought cautious hope for patients with this progressive and deadly disease. Intravenous prostanoids are still the most effective long-term medications, but oral options are available for select patients who are closely monitored. General internists and specialists in pulmonary, cardiac, and rheumatic diseases each have their role in managing these patients.