American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Nov 2009
Multicenter StudyEffectiveness of treatments for severe sepsis: a prospective, multicenter, observational study.
Several Surviving Sepsis Campaign Guidelines recommendations are reevaluated. ⋯ In severe sepsis, early administration of broad-spectrum antibiotics in all patients and administration of drotrecogin alfa (activated) in the most severe patients reduce mortality.
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Am. J. Respir. Crit. Care Med. · Nov 2009
Obesity and underweight are associated with an increased risk of death after lung transplantation.
Obesity is considered a relative contraindication to lung transplantation, based on studies that have not accounted for key confounders. Little is known about the risk of death for underweight candidates after transplantation. ⋯ Both obesity and underweight are independent risk factors for death after lung transplantation, contributing to up to 12% of deaths in the first year after transplantation. Primary care providers and pulmonologists should promote a healthy weight for patients with lung disease long before transplantation is considered.
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Am. J. Respir. Crit. Care Med. · Nov 2009
Antibiotic treatment of Mycobacterium abscessus lung disease: a retrospective analysis of 65 patients.
The optimal therapeutic regimen and duration of treatment for Mycobacterium abscessus lung disease is not well established. ⋯ Standardized combination antibiotic therapy was moderately effective in treating M. abscessus lung disease. However, frequent adverse reactions and the potential for long-duration hospitalization are important problems that remain to be solved.
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With the advent of new and expensive therapies for severe refractory asthma, targeting the appropriate patients is important. An important issue is identifying nonadherence with current therapies. The extent of nonadherence in a population with difficult asthma has not been previously reported. ⋯ A significant proportion of patients with difficult-to-control asthma remained nonadherent to corticosteroid therapy. Objective surrogate and direct measures of adherence should be performed as part of a difficult asthma assessment and are important before prescibing expensive novel biological therapies.
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Am. J. Respir. Crit. Care Med. · Nov 2009
The triterpenoid CDDO-imidazolide confers potent protection against hyperoxic acute lung injury in mice.
Oxygen supplementation (e.g., hyperoxia) is used to support critically ill patients with noninfectious and infectious acute lung injury (ALI); however, hyperoxia exposure can potentially further contribute to and/or perpetuate preexisting ALI. Thus, developing novel therapeutic agents to minimize the side effects of hyperoxia is essential to improve the health of patients with severe ALI and respiratory dysfunction. We have previously shown that mice with a genetic disruption of the Nrf2 transcription factor, which squelches cellular stress by up-regulating the induction of several antioxidant enzymes and proteins, have greater susceptibility to hyperoxic lung injury. Moreover, we have recently demonstrated that Nrf2-deficiency impairs the resolution of lung injury and inflammation after nonlethal hyperoxia exposure. ⋯ These results suggest that up-regulation of Nrf2 signaling by CDDO-Im or its analogs may provide a novel therapeutic strategy to minimize the adverse effects of hyperoxia.