Articles: chronic.
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Am. J. Respir. Crit. Care Med. · May 2014
Randomized Controlled TrialReduction of Bacterial Resistance with Inhaled Antibiotics in the ICU.
Multidrug-resistant organisms (MDRO) are the dominant airway pathogens in the intensive care unit (ICU) and present a major treatment challenge to intensivists. Aerosolized antibiotics (AA) result in airway concentrations of drug 100-fold greater than the minimal inhibitory concentration of most bacteria including MDRO. These levels, without systemic toxicity, may eradicate MDRO and reduce the pressure for selection of new resistant organisms. ⋯ In chronically intubated critically ill patients, AA successfully eradicated existing MDRO organisms and reduced the pressure from systemic agents for new respiratory resistance. Clinical trial registered with www.clinicaltrials.gov (NCT 01878643).
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Spinal cord stimulation is a treatment modality used to treat various chronic pain conditions, including complex regional pain syndrome (CRPS). We present a case in which spinal cord stimulation was used for the treatment of lower extremity CRPS in a patient with ankylosing spondylitis. ⋯ The sacral hiatus remained open and was used to access the epidural space, facilitating the placement of 2 thoracic epidural electrodes. The resulting stimulation controlled not only the patient's lower extremity CRPS pain but also alleviated his chronic axial pain secondary to ankylosing spondylitis.
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Am. J. Respir. Crit. Care Med. · May 2014
Multicenter Study Observational StudyAssociation between source of infection and hospital mortality in patients who have septic shock.
Mortality caused by septic shock may be determined by a systemic inflammatory response, independent of the inciting infection, but it may also be influenced by the anatomic source of infection. ⋯ Anatomic source of infection should be considered in future trial designs and analyses, and in development of prognostic scoring systems.
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Am. J. Respir. Crit. Care Med. · May 2014
Revealing the pathogenic and aging-related mechanisms of the enigmatic idiopathic pulmonary fibrosis: An integral model.
A growing body of evidence indicates that aberrant activation of alveolar epithelial cells and fibroblasts in an aging lung plays a critical role in the pathogenesis of idiopathic pulmonary fibrosis (IPF). However, the biopathological processes linking aging with IPF and the mechanisms responsible for the abnormal activation of epithelial cells and fibroblasts have not been elucidated. ⋯ Therefore, an unanswered question is why a current/former smoker of about 60 years of age with shorter telomeres, alveolar epithelial senescence, excessive oxidative stress, and mitochondrial dysfunction develops IPF and not COPD; in other words, what makes old lungs specifically susceptible to develop IPF? In this Perspective, we propose an integral model in which the combination of some gene variants and/or gene expression in the aging lung results in the loss of epithelial integrity and consequently in the failure of the alveoli to correctly respond to injury and to face the stress associated with mechanical stretch. Afterward, a distinctive epigenetic "reprogramming" that affects both epithelial cells and fibroblasts provokes, among others, the recapitulation of developmental pathways and the aberrant activation and miscommunication between both cell types, resulting in the exaggerated production and accumulation of extracellular matrix and the subsequent destruction of the lung architecture.
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Randomized Controlled Trial
Pulmonary Function after Emergence on 100% Oxygen in Patients with Chronic Obstructive Pulmonary Disease: A Randomized, Controlled Trial.
During emergence from anesthesia, breathing 100% oxygen is frequently used to provide a safety margin toward hypoxemia in case an airway problem occurs. Oxygen breathing has been shown to cause pulmonary gas exchange disorders in healthy individuals. This study investigates how oxygen breathing during emergence affects lung function specifically whether oxygen breathing causes added hypoxemia in patients with chronic obstructive pulmonary disease. ⋯ In this experiment, the authors examined oxygen breathing during emergence-a widely practiced maneuver known to generate pulmonary blood flow heterogeneity. In the observed cohort of patients already presenting with pulmonary blood flow disturbances, emergence on oxygen resulted in deterioration of oxygen-related blood gas parameters. In the perioperative care of patients with chronic obstructive pulmonary disease, oxygen breathing during emergence from anesthesia may need reconsideration.