American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Jun 2015
Controlled Clinical TrialUnderstanding the Anatomic Basis for Obstructive Sleep Apnea Syndrome in Adolescents.
Structural risk factors for obstructive sleep apnea syndrome (OSAS) in adolescents have not been well characterized. Because many adolescents with OSAS are obese, we hypothesized that the anatomic OSAS risk factors would be more similar to those in adults than those in children. ⋯ Increased size of the pharyngeal lymphoid tissue, rather than enlargement of the upper airway soft tissue structures, is the primary anatomic risk factor for OSAS in obese adolescents. These results are important for clinical decision making and suggest that adenotonsillectomy should be considered as the initial treatment for OSAS in obese adolescents, a group that has poor continuous positive airway pressure adherence and difficulty in achieving weight loss.
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Am. J. Respir. Crit. Care Med. · Jun 2015
Comparative StudyComparison of Clinical Features, Virulence, and Relapse among Mycobacterium avium Complex Species.
Traditionally, Mycobacterium avium complex (MAC) has been composed of M. avium and M. intracellulare; however, advances in genetic sequencing have allowed discovery of several novel species. With these discoveries, investigation of differences in risk factors, virulence, and clinical outcomes have emerged. ⋯ Our findings suggest that specific MAC species have varying degrees of virulence and classifying MAC isolates into distinct species aids in identifying which patients are at higher risk of clinical relapse/reinfection.
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Am. J. Respir. Crit. Care Med. · Jun 2015
Practice GuidelineAn Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units.
There is controversy about how to manage requests by patients or surrogates for treatments that clinicians believe should not be administered. ⋯ The multisociety statement on responding to requests for potentially inappropriate treatments in intensive care units provides guidance for clinicians to prevent and manage disputes in patients with advanced critical illness.
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Am. J. Respir. Crit. Care Med. · Jun 2015
Clinical TrialEffect of Ultrafiltration on Sleep Apnea and Sleep Structure in Patients with End Stage Renal Disease.
In end-stage renal disease (ESRD), a condition characterized by fluid overload, both obstructive and central sleep apnea (OSA and CSA) are common. This observation suggests that fluid overload is involved in the pathogenesis of OSA and CSA in this condition. ⋯ These findings indicate that fluid overload contributes to the pathogenesis of OSA and CSA in ESRD, and that fluid removal by UF attenuates sleep apnea without altering uremic status.
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Am. J. Respir. Crit. Care Med. · Jun 2015
Observational StudyThe Effect of Macrolide-Resistance on the Presentation and Outcome of Patients Hospitalized for Streptococcus pneumoniae Pneumonia.
There are conflicting reports describing the effect of macrolide resistance on the presentation and outcomes of patients with Streptococcus pneumoniae pneumonia. ⋯ We found no evidence suggesting that patients hospitalized for macrolide-resistant S. pneumoniae pneumonia were more severely ill on presentation or had worse clinical outcomes if they were treated with guideline-compliant versus noncompliant regimens.