American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Mar 2017
Randomized Controlled TrialRandomized Trial of Liposomal Amikacin for Inhalation in Nontuberculous Mycobacterial Lung Disease.
Lengthy, multidrug, toxic, and low-efficacy regimens limit management of pulmonary nontuberculous mycobacterial disease. ⋯ Although the primary endpoint was not reached, LAI added to a multidrug regimen produced improvements in sputum conversion and 6-minute-walk distance versus placebo with limited systemic toxicity in patients with refractory MAC lung disease. Further research in this area is needed. Clinical trial registered with www.clinicaltrials.gov (NCT01315236).
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Am. J. Respir. Crit. Care Med. · Mar 2017
ReviewFifty Years of Research in ARDS. Is Acute Respiratory Distress Syndrome a Preventable Disease?
Despite significant advances in our understanding and management of patients with acute respiratory distress syndrome (ARDS), the morbidity and mortality from ARDS remains high. Given the limited number of effective treatments for established ARDS, the strategic focus of ARDS research has shifted toward identifying patients with or at high risk of ARDS early in the course of the underlying illness, when strategies to reduce the development and progression of ARDS and associated organ failures can be systematically evaluated. In this review, we summarize the rationale, current evidence, and future directions in ARDS prevention.
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Am. J. Respir. Crit. Care Med. · Mar 2017
Multicenter Study Observational StudyEpidemiology of Weaning Outcome According to a New Definition. The WIND Study.
The weaning process concerns all patients receiving mechanical ventilation. A previous classification into simple, prolonged, and difficult weaning ignored weaning failure and presupposed the use of spontaneous breathing trials. ⋯ A new classification allows us to categorize all weaning situations. Every additional day without a weaning success after the first separation attempt increases the risk of dying.
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Little is known about how acute kidney injury (AKI) resolves, and whether patterns of reversal of renal dysfunction differ among patients with respect to ultimate recovery. ⋯ We have identified five distinct recovery phenotypes on the basis of the clinical course over the first week after AKI manifestation. These phenotypes may identify patients amenable to therapeutic intervention. Long-term outcomes are associated with recovery status at hospital discharge.
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Am. J. Respir. Crit. Care Med. · Mar 2017
Endogenous Protease Inhibitor in Airway Epithelial Cells Contribute to Eosinophilic Chronic Rhinosinusitis.
Cystatin A and SPINK5 are endogenous protease inhibitors (EPIs) that may play key roles in epithelial barrier function. ⋯ Cystatin A and SPINK5 play an important role in protecting the airway epithelium from exogenous proteases. The preservation of EPIs may have a therapeutic benefit in intractable airway inflammation, such as eosinophilic CRS.