American journal of respiratory and critical care medicine
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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.
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Am. J. Respir. Crit. Care Med. · Feb 2017
Age and Small Airway Imaging Abnormalities in Subjects With and Without Airflow Obstruction in SPIROMICS.
Aging is associated with reduced FEV1 to FVC ratio (FEV1/FVC), hyperinflation, and alveolar enlargement, but little is known about how age affects small airways. ⋯ In never- and ever-smokers without airflow obstruction, aging is associated with increased FVC and CT-defined functional small airway abnormality regardless of respiratory symptoms.
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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.