American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Dec 2017
Review50 Years of Research in ARDS. Long-term Follow-up After ARDS: Insights for Managing Medical Complexity After Critical Illness.
Critical illness is not a discrete disease state or syndrome. It is the culmination of a multiplicity of heterogeneous disease states and their varied health trajectories leading to extreme illness that requires advanced life support in a distinct geographic location in the hospital. It is a marker of newly acquired or worsened medical complexity and multimorbidities. ⋯ Engagement in frank and transparent communication with our patients and their caregivers about the very real and morbid consequences of being this sick is essential. We must enforce explicit consent about the morbidity of innovative, experimental, or high-risk medical and surgical procedures and ensure that our ongoing level of treatment aligns with patients' and caregivers' goals and values. Interprofessional and multidisciplinary collaboration is crucial to modify existing complex care pathways for our patients and their families to foster optimal rehabilitation and reintegration into the workplace and community.
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Am. J. Respir. Crit. Care Med. · Dec 2017
Prenatal Nitrate Exposure and Childhood Asthma: Influence of Maternal Prenatal Stress and Fetal Sex.
Impact of ambient pollution upon children's asthma may differ by sex, and exposure dose and timing. Psychosocial stress can also modify pollutant effects. These associations have not been examined for in utero ambient nitrate exposure. ⋯ Prenatal NO3- exposure during distinct sensitive windows was associated with incident asthma in boys concurrently exposed to high prenatal stress.