Annals of the American Thoracic Society
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Factors associated with long-term brain dysfunction (LTBD) in survivors of chronic critical illness (CCI) have not been explored but may be important for clinical practice and planning by patients, families, and providers. ⋯ LTBD after treatment for CCI is associated with brain dysfunction during such treatment as well as with older age and higher severity of illness of the patients.
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Respiratory diseases are a major cause of morbidity and mortality worldwide. The greatest impact of many of these diseases is felt in low- and middle-income countries, but their control and management is hampered by lack of accurate estimates of their prevalence, risk factors, and distribution, and knowledge of the social and cultural setting in which they occur. Providing enough information for cost-effective response to respiratory diseases requires research by trained investigators and public health personnel. ⋯ Post-MECOR, 64% of participants have published a medical paper, 79% have presented at a scientific or academic meeting, 51% have submitted a research protocol for funding, and 42% have had one funded. One-quarter have been awarded an academic or clinical fellowship, and 78% reported that MECOR had made a significant or extremely important contribution to their professional life and accomplishments. Future challenges include funding, recruitment of local faculty, helping to build the research infrastructure in MECOR countries, and providing ongoing mentoring for research.
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Observational Study
Pilot study of extracorporeal carbon dioxide removal to facilitate extubation and ambulation in exacerbations of chronic obstructive pulmonary disease.
Acute exacerbations of chronic obstructive pulmonary disease (COPD) requiring invasive mechanical ventilation (IMV) are associated with significant morbidity and mortality. Extracorporeal carbon dioxide removal (ECCO₂R) may facilitate extubation and ambulation in these patients and potentially improve outcomes. ⋯ ECCO₂R facilitates early extubation and ambulation in exacerbations of COPD requiring IMV and has the potential to serve as a new paradigm for the management of a select group of patients. Rigorous clinical trials are needed to corroborate these results and to investigate the effect on long-term outcomes and cost effectiveness over conventional management.