Annals of the American Thoracic Society
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Observational Study
Association between Chronic Rhinosinusitis and Health-Related Quality of Life in Adults with Cystic Fibrosis.
Over the past four decades, the median age of survival has nearly doubled for individuals living with cystic fibrosis (CF). Chronic diseases such as chronic rhinosinusitis increase in prevalence with age. In the non-CF population, chronic rhinosinusitis is associated with reduced health-related quality of life. ⋯ The majority of adults with CF have evidence of concomitant chronic rhinosinusitis. Chronic rhinosinusitis is independently associated with worse respiratory symptom on the CFQ-R 14+. Chronic rhinosinusitis should be diagnosed and managed to optimize the health-related quality of life of adults with CF. Clinical trial registered with clinicaltrials.gov (NCT02003079).
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Open lung biopsy may be performed to guide therapy in mechanically ventilated patients with diagnostic uncertainty regarding etiology of pulmonary infiltrates. Current evidence for open lung biopsy in mechanically ventilated patients comes from single-center case series. ⋯ Among mechanically ventilated patients with respiratory failure of unclear etiology, lung biopsy yielded a wide range of diagnoses and was associated with a change in therapy in most patients.
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Review Meta Analysis
Effects of opioids on breathlessness and exercise capacity in chronic obstructive pulmonary disease. A systematic review.
Patients with chronic obstructive pulmonary disease (COPD) commonly suffer from breathlessness, deconditioning, and reduced health-related quality of life (HRQL) despite best medical management. Opioids may relieve breathlessness at rest and on exertion in COPD. ⋯ Opioids improved breathlessness but not exercise capacity in severe COPD.
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A bundled approach to intensive care unit (ICU) care known as "Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility" (ABCDE) has been proposed, with evidence supporting individual interventions as well as the bundle as a whole. Few data exist on the bundle's implementation and efficacy in community practice. ⋯ There is incomplete penetrance of aspects of ABCDE across ICUs in this highly motivated statewide quality improvement collaborative. Yet, implementation of exercise in the context of both sedation interruption and delirium screening was associated with improved self-reported mobility outcomes. Effective knowledge translation and implementation strategies may offer substantial benefits to ICU patients.
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In acute ascent to altitude, untreated obstructive sleep apnea (OSA) is often replaced with central sleep apnea (CSA). In patients with obstructive sleep apnea who travel to altitude, it is unknown whether their home positive airway pressure (PAP) settings are sufficient to treat their obstructive sleep apnea, or altitude-associated central sleep apnea. ⋯ Acute altitude exposure in patients with obstructive sleep apnea treated with positive airway pressure is associated with hypoxemia, decreased sleep time, and increased frequency of hypopneas compared with baseline altitude. Application of positive airway pressure at altitude is associated with decreased central sleep apnea and increased sleep efficiency.