American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Aug 2018
Initial Inflammatory Profile in Community-acquired Pneumonia Depends on Time since Onset of Symptoms.
Assessment of the inflammatory response can help the decision-making process when diagnosing community-acquired pneumonia (CAP), but there is a lack of information about the influence of time since onset of symptoms. ⋯ Time since symptom onset modifies the systemic inflammatory profile at CAP diagnosis. This information has relevant clinical implications for management, and it should be taken into account in the design of future clinical trials.
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Am. J. Respir. Crit. Care Med. · Aug 2018
Clinical Management of Multidrug-Resistant Tuberculosis in 16 European Countries.
Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower. ⋯ Conventional standard MDR-TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR-TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.
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Am. J. Respir. Crit. Care Med. · Aug 2018
Observational StudyEarly Immune Function and Duration of Organ Dysfunction in Critically III Children with Sepsis.
Late immune suppression is associated with nosocomial infection and mortality in adults and children with sepsis. Relationships between early immune suppression and outcomes in children with sepsis remain unclear. ⋯ Critically ill children with severe sepsis or septic shock demonstrate early innate and adaptive immune suppression. Early innate and adaptive immune suppression are associated with longer durations of organ dysfunction and may be useful markers to help guide future investigations of immunomodulatory therapies in children with sepsis.
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Am. J. Respir. Crit. Care Med. · Aug 2018
Excess Mucin Impairs Subglottic Epithelial Host Defense in Mechanically Ventilated Patients.
Aspiration of infective subglottic secretions causes ventilator-associated pneumonia (VAP) in mechanically ventilated patients. Mechanisms underlying subglottic colonization in critical illness have not been defined, limiting strategies for targeted prevention of VAP. ⋯ Mechanical ventilation in the ICU is characterized by substantial mucin secretion and neutrophilic inflammation. Mucin impairs neutrophil function and promotes bacterial growth. Mucolytic agents reverse mucin-mediated neutrophil dysfunction. Enhanced mucus disruption and removal has potential to augment preventive benefits of subglottic drainage.