American journal of respiratory and critical care medicine
-
Am. J. Respir. Crit. Care Med. · Aug 2000
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialComparable efficacy of administration with face mask or mouthpiece of nebulized budesonide inhalation suspension for infants and young children with persistent asthma.
A randomized, double-blind, placebo-controlled, parallel-group study including 481 children at 37 centers in the United States demonstrated the efficacy and safety of budesonide inhalation suspension in doses of 0.25 mg once daily, 0.25 mg twice daily, 0.5 mg twice daily, and 1.0 mg daily in infants and young children with persistent asthma. The retrospective analysis presented here compares the efficacy of treatment with the suspension administered through a face mask or mouthpiece. All patients receiving budesonide inhalation suspension via face mask or mouthpiece showed clinical improvements in nighttime and daytime asthma symptoms as compared with administration of a placebo. ⋯ Patients receiving budesonide at 0.5 mg twice daily via a face mask improved significantly in daytime asthma symptoms (p = 0.009). The use of breakthrough medication was reduced in patients receiving budesonide via face masks or mouthpieces relative to placebo, and treatment was well tolerated in all study groups. This retrospective analysis suggests that nebulized budesonide inhalation suspension can be administered effectively by either face mask or mouthpiece to young children with persistent asthma.
-
Am. J. Respir. Crit. Care Med. · Aug 2000
Lung function reference values in Chinese children and adolescents in Hong Kong. II. Prediction equations for plethysmographic lung volumes.
As part of a comprehensive evaluation of lung function in Hong Kong Chinese children and adolescents, over a thousand healthy subjects aged 7-19 yr from seven schools were recruited for lung function testing that included spirometry and, in many cases, lung subdivision measurements. Lung function tests were performed using SensorMedics Automated Body Plethysmograph according to published standards. ⋯ After allowing for standing height or sitting height in the regression models for lung volumes, age at examination was the second best parameter, although its inclusion into the equations contributed to less than 1% of explained variance for boys and 3% for girls. These are the first reported data in international literature on reference values for lung subdivisions in Chinese children and adolescents.
-
Am. J. Respir. Crit. Care Med. · Aug 2000
Randomized Controlled Trial Clinical TrialShort-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription.
Inappropriate antibiotic use for pulmonary infiltrates is common in the intensive care unit (ICU). We sought to devise an approach that would minimize unnecessary antibiotic use, recognizing that a gold standard for the diagnosis of nosocomial pneumonia does not exist. In a randomized trial, clinical pulmonary infection score (CPIS) (Pugin, J., R. ⋯ Thus, overtreatment with antibiotics is widely prevalent, but unnecessary in most patients with pulmonary infiltrates in the ICU. The operational criteria used, regardless of the precise definition of pneumonia, accurately identified patients with pulmonary infiltrates for whom monotherapy with a short course of antibiotics was appropriate. Such an approach led to significantly lower antimicrobial therapy costs, antimicrobial resistance, and superinfections without adversely affecting the length of stay or mortality.
-
Am. J. Respir. Crit. Care Med. · Aug 2000
Tracheal gas insufflation. Limits of efficacy in adults with acute respiratory distress syndrome.
In mechanically ventilated adults with acute respiratory distress syndrome (ARDS), peak airway pressures (Paw(peak)) above 35 cm H(2)O may increase the risk of barotrauma or volutrauma. Tracheal gas insufflation (TGI), an adjunctive ventilatory technique, may facilitate a reduction in set inspiratory pressure in these patients, and thereby in the tidal volume (VT) and Paw(peak) used in their ventilation, without a consequent increase in arterial carbon dioxide tension (PaCO(2)). The purpose of this study was to: (1) assess the limits of efficacy of continuous TGI at two levels of decreased mechanical ventilatory support; and (2) determine an appropriate time interval after initiation of TGI at which to evaluate response. ⋯ TGI can be used to rapidly facilitate a 5 cm H(2)O reduction in set inspiratory pressure without an increase in Pa(CO(2)). The ability to achieve a 5 cm H(2)O reduction in set inspiratory pressure without adverse physiologic effects was evident within 30 min. Attempts to further reduce set inspiratory pressure were not successful.
-
Am. J. Respir. Crit. Care Med. · Aug 2000
Lung and chest wall mechanics in anesthetized children. Influence of body position.
The mechanical behavior of the lung and chest wall has not been determined in preschool children. We therefore obtained static expiratory pressure-volume (P-V) curves of the respiratory system, partitioned into lung and chest wall components using esophageal (Pes) and airway pressure (Paw) registration in 17 anesthetized children (0.2 to 15.5 yr) in the supine and lateral position. From the P-V curves the inspiratory capacity (IC), the chest wall elastance (Ecw), and the maximal compliance of the respiratory system (Crs) and lungs (C(lung)) were calculated and related to growth. ⋯ Crs and IC were approximately 20% greater (p /= 0.93) with power functions of length in both positions. Ecw expressed as a fraction of total respiratory system elastance (Ecw/Ers) was 33 +/- 12% in the lateral position and 12 +/- 16% supine (p < 0.001). We conclude that the respiratory mechanics in children correlated closely with body size and showed important differences between the supine and lateral positions.