American journal of respiratory and critical care medicine
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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).
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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).
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Am. J. Respir. Crit. Care Med. · Nov 2015
Implications of Heterogeneity of Treatment Effect for Reporting & Analysis of Randomized Trials in Critical Care.
Randomized clinical trials (RCTs) are conducted to guide clinicians' selection of therapies for individual patients. Currently, RCTs in critical care often report an overall mean effect and selected individual subgroups. Yet work in other fields suggests that such reporting practices can be improved. ⋯ We further show that these results persist even in the presence of causes of death unmodified by the treatment under study. These results have implications for reporting and analyzing RCT data, both to better understand how our therapies work and to improve the bedside applicability of RCTs. We suggest a plan for measurement in future RCTs in the critically ill.
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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.
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Am. J. Respir. Crit. Care Med. · Nov 2015
Association Between Glucose Metabolism and Sleep-Disordered Breathing during REM Sleep.
Sleep-disordered breathing (SDB) has been associated with impaired glucose metabolism. It is possible that the association between SDB and glucose metabolism is distinct for non-REM versus REM sleep because of differences in sleep-state-dependent sympathetic activation and/or degree of hypoxemia. ⋯ AHIREM is associated with insulin resistance but not with fasting glycemia or glucose intolerance.