American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Nov 2011
Randomized Controlled Trial Comparative StudyAttenuation of obstructive sleep apnea by compression stockings in subjects with venous insufficiency.
Fluid accumulation in the legs and its overnight redistribution into the neck appears to play a causative role in obstructive sleep apnea (OSA) in sedentary men. Chronic venous insufficiency (CVI) promotes fluid accumulation in the legs that can be counteracted by compression stockings. ⋯ Redistribution of fluid from the legs into the neck at night contributes to the pathogenesis of OSA in subjects with CVI. Prevention of fluid accumulation in the legs during the day, and its nocturnal displacement into the neck, attenuates OSA in such subjects.
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Intracranial hemorrhage is a life-threatening condition, the outcome of which can be improved by intensive care. Intracranial hemorrhage may be spontaneous, precipitated by an underlying vascular malformation, induced by trauma, or related to therapeutic anticoagulation. The goals of critical care are to assess the proximate cause, minimize the risks of hemorrhage expansion through blood pressure control and correction of coagulopathy, and obliterate vascular lesions with a high risk of acute rebleeding. ⋯ Most functional and cognitive recovery takes place weeks to months after discharge; expected levels of functional independence (no disability, disability but independence with a device, dependence) may guide conversations with patient representatives. Goals of care impact mortality, with do-not-resuscitate status increasing the predicted mortality for any level of severity of intraparenchymal hemorrhage. Future directions include refining the use of bedside neuro-monitoring (electroencephalogram, invasive monitors), novel approaches to reduce intracranial hemorrhage expansion, minimizing vasospasm, and refining the assessment of quality of life to guide rehabilitation and therapy.
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Am. J. Respir. Crit. Care Med. · Nov 2011
Multicenter StudyObesity and primary graft dysfunction after lung transplantation: the Lung Transplant Outcomes Group Obesity Study.
Obesity has been linked to acute lung injury and is a risk factor for early mortality after lung transplantation. ⋯ Obesity is an independent risk factor for primary graft dysfunction after lung transplantation.