American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Nov 2009
Comparative StudyTension-time index as a predictor of extubation outcome in ventilated children.
Indices that assess the load on the respiratory muscles, such as the tension-time index (TTI), may predict extubation outcome. ⋯ Invasive and noninvasive measurements of TTI may provide accurate prediction of extubation outcome in mechanically ventilated children.
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Am. J. Respir. Crit. Care Med. · Nov 2009
Combined effects of obesity and chronic obstructive pulmonary disease on dyspnea and exercise tolerance.
Severity of lung hyperinflation is known to influence the extent of dyspnea and exercise intolerance among patients with chronic obstructive pulmonary disease (COPD) with similar degrees of airway obstruction. Lung volume components are consistently affected by body mass index (BMI) in health and in disease. ⋯ The combined mechanical effects of obesity and COPD reduced operating lung volumes at rest and throughout exercise with favorable influences on dyspnea perception and peak oxygen uptake during cycle ergometry.
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Am. J. Respir. Crit. Care Med. · Nov 2009
Identification of PCDH1 as a novel susceptibility gene for bronchial hyperresponsiveness.
Asthma is a chronic inflammatory airway disease that affects more than 300 million individuals worldwide. Asthma is caused by interaction of genetic and environmental factors. Bronchial hyperresponsiveness (BHR) is a hallmark of asthma and results from increased sensitivity of the airways to physical or chemical stimulants. BHR and asthma are linked to chromosome 5q31-q33. ⋯ PCDH1 is a novel gene for BHR in adults and children. The identification of PCDH1 as a BHR susceptibility gene may suggest that a structural defect in the integrity of the airway epithelium, the first line of defense against inhaled substances, contributes to the development of BHR.
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Am. J. Respir. Crit. Care Med. · Nov 2009
Multicenter StudyPrevalence and factors of intensive care unit conflicts: the conflicus study.
Many sources of conflict exist in intensive care units (ICUs). Few studies recorded the prevalence, characteristics, and risk factors for conflicts in ICUs. ⋯ Over 70% of ICU workers reported perceived conflicts, which were often considered severe and were significantly associated with job strain. Workload, inadequate communication, and end-of-life care emerged as important potential targets for improvement.
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Am. J. Respir. Crit. Care Med. · Nov 2009
Review Practice GuidelineCystic fibrosis pulmonary guidelines: treatment of pulmonary exacerbations.
The natural history of cystic fibrosis lung disease is one of chronic progression with intermittent episodes of acute worsening of symptoms frequently called acute pulmonary exacerbations These exacerbations typically warrant medical intervention. It is important that appropriate therapies are recommended on the basis of available evidence of efficacy and safety. The Cystic Fibrosis Foundation therefore established a committee to define the key questions related to pulmonary exacerbations, review the clinical evidence using an evidence-based methodology, and provide recommendations to clinicians. It is hoped that these guidelines will be helpful to clinicians in the treatment of individuals with cystic fibrosis.