American journal of respiratory and critical care medicine
-
Am. J. Respir. Crit. Care Med. · Feb 2017
Multicenter Study Observational StudyAnti-N-methyl-D-aspartate Receptor Encephalitis in Adult Patients Requiring Intensive Care.
Encephalitis caused by anti-N-methyl-d-aspartate receptor (NMDAR) antibodies is the leading cause of immune-mediated encephalitis. There are limited data on intensive care unit (ICU) management of these patients. ⋯ The prognosis of adult patients with anti-NMDAR encephalitis requiring intensive care is good, especially when immunotherapy is initiated early, advocating for prompt diagnosis and early aggressive treatment.
-
Am. J. Respir. Crit. Care Med. · Feb 2017
SH2 Domain-containing Phosphatase-SHP-2 is a Novel Anti-fibrotic Regulator in Pulmonary Fibrosis.
Idiopathic pulmonary fibrosis (IPF) is a chronic fatal lung disease with dismal prognosis and no cure. The potential role of the ubiquitously expressed SH2 domain-containing tyrosine phosphatase-2 (SHP2) as a therapeutic target has not been studied in IPF. ⋯ Our data suggest that SHP2 is an important regulator of fibroblast differentiation, and its loss as observed in IPF facilitates profibrotic phenotypic changes. Augmentation of SHP2 activity or expression should be investigated as a novel therapeutic strategy for IPF.
-
Am. J. Respir. Crit. Care Med. · Feb 2017
Multicenter Study Clinical TrialBiomarkers Predictive of Exacerbations in the SPIROMICS and COPDGene Cohorts.
Chronic obstructive pulmonary disease exacerbations are associated with disease progression, higher healthcare cost, and increased mortality. Published predictors of future exacerbations include previous exacerbation, airflow obstruction, poor overall health, home oxygen use, and gastroesophageal reflux. ⋯ Blood biomarkers were significantly associated with the occurrence of exacerbations but were not robust between cohorts and added little to the predictive value of clinical covariates for exacerbations.
-
Am. J. Respir. Crit. Care Med. · Feb 2017
Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure.
Mechanical ventilation is used to sustain life in patients with acute respiratory failure. A major concern in mechanically ventilated patients is the risk of ventilator-induced lung injury, which is partially prevented by lung-protective ventilation. Spontaneously breathing, nonintubated patients with acute respiratory failure may have a high respiratory drive and breathe with large tidal volumes and potentially injurious transpulmonary pressure swings. ⋯ Recent data suggest that these patients may develop lung injury that is similar to the ventilator-induced lung injury observed in mechanically ventilated patients. As such, we argue that application of a lung-protective ventilation, today best applied with sedation and endotracheal intubation, might be considered a prophylactic therapy, rather than just a supportive therapy, to minimize the progression of lung injury from a form of patient self-inflicted lung injury. This has important implications for the management of these patients.