American journal of respiratory and critical care medicine
-
Am. J. Respir. Crit. Care Med. · Nov 2015
Randomized Controlled Trial Multicenter StudyEarly High-volume Hemofiltration vs. Standard Care for Postcardiac Surgery Shock (The HEROICS Study).
Post-cardiac surgery shock is associated with high morbidity and mortality. By removing toxins and proinflammatory mediators and correcting metabolic acidosis, high-volume hemofiltration (HVHF) might halt the vicious circle leading to death by improving myocardial performance and reducing vasopressor dependence. ⋯ For patients with post-cardiac surgery shock requiring high-dose catecholamines, the early HVHF onset for 48 hours, followed by standard volume until resolution of shock and recovery of renal function, did not lower Day-30 mortality and did not impact other important patient-centered outcomes compared with a conservative strategy with delayed CVVHDF initiation only for patients with persistent, severe acute kidney injury. Clinical trial registered with www.clinicaltrials.gov (NCT 01077349).
-
Am. J. Respir. Crit. Care Med. · Nov 2015
Randomized Controlled Trial Multicenter StudyFLIGHT: Efficacy and Safety of QVA149 (Indacaterol/Glycopyrrolate) Versus its Monocomponents and Placebo in Patients with COPD.
Current Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy recommends the combination of two long-acting bronchodilators of different pharmacologic classes for the management of chronic obstructive pulmonary disease (COPD) if symptoms are not adequately controlled by a single bronchodilator. ⋯ Indacaterol/glycopyrrolate twice daily can be an alternative treatment option for the management of symptomatic patients with moderate-to-severe COPD. Clinical trial registered with www.clinicaltrials.gov (NCT 01727141 and NCT 0171251).
-
Am. J. Respir. Crit. Care Med. · Nov 2015
Randomized Controlled Trial Multicenter Study Comparative StudyComparison of Treatment Response in Idiopathic and Connective Tissue Disease-Associated Pulmonary Arterial Hypertension.
Studies suggest that patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) have a poorer treatment response to therapies for PAH compared with patients with idiopathic PAH (IPAH), but individual randomized controlled trials (RCTs) have been underpowered to examine differences within these subgroups. ⋯ Treatment for PAH was less effective in CTD-PAH compared with IPAH in terms of increasing 6MWD and preventing clinical worsening. The heterogeneity of treatment response supports the need for identifying therapies that are more effective for CTD-PAH.
-
Am. J. Respir. Crit. Care Med. · Nov 2015
Multicenter StudyAmbrisentan and Tadalafil Upfront Combination Therapy in Scleroderma-Associated PAH.
Scleroderma-associated pulmonary arterial hypertension (SSc-PAH) is a rare disease characterized by a very dismal response to therapy and poor survival. We assessed the effects of up-front combination PAH therapy in patients with SSc-PAH. ⋯ Up-front combination therapy with ambrisentan and tadalafil significantly improved hemodynamics, RV structure and function, and functional status in treatment-naive patients with SSc-PAH and may represent a very effective therapy for this patient population. In addition, we identified novel hemodynamic and imaging biomarkers that could have potential value in future clinical trials. Clinical trial registered with www.clinicaltrials.gov (NCT01042158).