Annals of the American Thoracic Society
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Rationale: Many studies of critical illness outcomes have been restricted to short-term outcomes, selected diagnoses, and patients in one or a few Intensive Care Units (ICUs). Objective: Evaluate a range of relevant outcomes in a population-based cohort of patients admitted to ICUs. Methods: Among all adult residents of the Canadian province of Manitoba admitted to ICUs over a nine year period we assessed ICU, hospital, 30 day and 180 day mortality rates; ICU and hospital lengths-of-stay; post-hospital utilization of hospital care, ICU care, outpatient physician care, medications, and home care; and post-hospital residence location. ⋯ Conclusions: Post-hospital medical resource use among ICU survivors is substantial, though similar to that after non-ICU hospitalization. While the fraction of survivors unable to live independently was small, a larger fraction required home care services. Identifying post-hospital supports needed by ICU survivors can be useful for policy-makers and others responsible for healthcare planning.
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Multicenter Study
Factors associated with swallowing assessment after oral endotracheal intubation and mechanical ventilation for acute lung injury.
Endotracheal intubation is associated with postextubation swallowing dysfunction, but no guidelines exist for postextubation swallowing assessments. ⋯ In this multisite prospective study, female sex, intubation duration, and hospital site were associated with postextubation swallowing assessment. These results demonstrate variability in practice patterns between institutions and highlight the need to determine the appropriate timing and indications for swallowing assessment and to more fully understand swallowing dysfunction after intubation.
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The airway epithelium is the primary site of the earliest pathologic changes induced by smoking, contributing to the development of chronic obstructive pulmonary disease (COPD). The normal human airway epithelium is composed of several major cell types, including differentiated ciliated and secretory cells, intermediate undifferentiated cells, and basal cells (BC). BC contain the stem/progenitor cell population responsible for maintenance of the normally differentiated airway epithelium. ⋯ Significant progress has been recently made in understanding the biology of human airway BC, including gene expression features, stem/progenitor, and other functions, including interaction with other airway cell types. Accumulating evidence suggests that human airway BC function as both sensors and cellular sources of various cytokines and growth factors relevant to smoking-associated airway injury, as well as the origin of various molecular and histological phenotypes relevant to the pathogenesis of COPD. In the context of these considerations, we suggest that early BC-specific smoking-induced molecular changes are critical to the pathogenesis of COPD, and these represent a candidate target for novel therapeutic approaches to prevent COPD progression in susceptible individuals.
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Randomized Controlled Trial
Optimum insufflation capacity and peak cough flow in neuromuscular disorders.
For patients with neuromuscular disorders, lung insufflation with positive pressure is an accepted technique to increase inspiratory volume over VC to improve peak cough flow (PCF). ⋯ A submaximal insufflation is ideal for generating the best individual PCF even in patients with severely reduced compliance of the respiratory system. Optimum insufflation capacity can be achieved using IPPB or LIAM with moderate pressures. Both techniques are equally effective and considered safe.