American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Oct 2012
Multicenter StudyEarly intensive care sedation predicts long-term mortality in ventilated critically ill patients.
Choice and intensity of early (first 48 h) sedation may affect short- and long-term outcome. ⋯ Early sedation depth independently predicts delayed extubation and increased mortality, making it a potential target for interventional studies.
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Am. J. Respir. Crit. Care Med. · Oct 2012
Randomized Controlled Trial Multicenter StudyEfficacy of antibiotic therapy for acute exacerbations of mild to moderate chronic obstructive pulmonary disease.
Antimicrobial therapy remains a controversial issue in nonsevere exacerbations of chronic obstructive pulmonary disease (COPD). ⋯ Treatment of ambulatory exacerbations of mild-to-moderate COPD with amoxicillin/clavulanate is more effective and significantly prolongs the time to the next exacerbation compared with placebo.
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Am. J. Respir. Crit. Care Med. · Oct 2012
Multicenter StudyEndobronchial ultrasound skills and tasks assessment tool: assessing the validity evidence for a test of endobronchial ultrasound-guided transbronchial needle aspiration operator skill.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is becoming standard of care for the sampling of mediastinal adenopathy. The need for a safe, effective, accurate procedure makes EBUS-TBNA ideal for mastery training and testing. ⋯ The EBUS-STAT can be used to reliably and objectively score and classify EBUS-TBNA operators from novice to expert. Its use to assess and document the acquisition of knowledge and skill is a step toward the goal of mastery training in EBUS-TBNA.
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Am. J. Respir. Crit. Care Med. · Oct 2012
Changing demographics, epidemiology, and survival of incident pulmonary arterial hypertension: results from the pulmonary hypertension registry of the United Kingdom and Ireland.
Incident pulmonary arterial hypertension was underrepresented in most pulmonary hypertension registries and may have a different disease profile to prevalent disease. ⋯ This study highlights the influence of age on phenotypes of incident pulmonary arterial hypertension and has shown the changes in demographics and epidemiology over the past decade in a national setting. The results suggest that there may be two subtypes of patients: the younger subtype with more severe hemodynamic impairment but better survival, compared with the older subtype who has more comorbidities.
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Am. J. Respir. Crit. Care Med. · Oct 2012
Idiopathic pulmonary fibrosis: lung function is a clinically meaningful endpoint for phase III trials.
Idiopathic pulmonary fibrosis causes progressive morbidity and has a worldwide incidence that is increasing. There are a number of promising therapies, one of which has been approved in Europe, parts of Asia, and India, and others that are at various stages of development. ⋯ In a recent Pulmonary Perspective in this journal, the case for the use of a variety of clinical endpoints was analyzed, and the article concluded that FVC, the endpoint most commonly used recently and in ongoing studies, was not an appropriate option. In this Pulmonary Perspective we present a counterpoint in which we explore the basis on which this conclusion is drawn and present data that strongly and logically support the use of FVC as a valid and robust measure that fulfils the criteria for an ideal clinical endpoint and that is meaningful to patient and clinician alike.