American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Oct 2011
Randomized Controlled Trial Multicenter StudyTherapeutic decision-making for sleep apnea and hypopnea syndrome using home respiratory polygraphy: a large multicentric study.
Home respiratory polygraphy (HRP) is an alternative to polysomnography (PSG) for sleep apnea-hypopnea syndrome (SAHS) diagnosis. However, therapeutic decision-making is a different process than diagnosis. ⋯ The HRP-based therapeutic decision was adequate when AHI was high, but deficient in the large population of patients with mild to moderate AHI. Therefore, both selecting patients with a high suspicion and severity of SAHS and future prospective cost-effectiveness studies are necessary.
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Am. J. Respir. Crit. Care Med. · Oct 2011
Randomized Controlled TrialUsing laboratory models to test treatment: morphine reduces dyspnea and hypercapnic ventilatory response.
Opioids are commonly used to relieve dyspnea, but clinical data are mixed and practice varies widely. ⋯ (1) A moderate morphine dose produced substantial relief of laboratory dyspnea, with a smaller reduction of ventilation. (2) In contrast to an earlier laboratory model of breathing effort, this laboratory model of air hunger established a highly significant treatment effect consistent in magnitude with clinical studies of opioids. Laboratory studies require fewer subjects and enable physiological measurements that are difficult to make in a clinical setting. Within-subject comparison of the response to carefully controlled laboratory stimuli can be an efficient means to optimize treatments before clinical trials.
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Am. J. Respir. Crit. Care Med. · Oct 2011
Randomized Controlled Trial Multicenter StudyContinuity of care in intensive care units: a cluster-randomized trial of intensivist staffing.
Little is known about the consequences of intensivists’ work schedules, or intensivist continuity of care. ⋯ Work schedules where intensivists received weekend breaks were better for the physicians and, despite lower continuity of intensivist care, did not worsen outcomes for medical ICU patients.