The clinical respiratory journal
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Review Meta Analysis Comparative Study
Early vs late tracheostomy in critically ill patients: a systematic review and meta-analysis.
This study aims to compare the outcomes of early tracheostomy (ET) (≤10 days after translaryngeal intubation) with late tracheostomy (LT) (>10 days after translaryngeal intubation) in critically ill patients with prolonged mechanical ventilation (MV). ⋯ Our meta-analysis suggested that ET might be able to reduce the duration of sedation but did not significantly alter the mortality, incidence of VAP, duration of MV and length of ICU stay.
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Lung cancer is the most common cause of malignant pleural effusions (MPEs). For patients with lung cancer and MPE, median survival is only 3-4 months. The aim of this study was to evaluate lung cancer patients with MPE by clinical and laboratory findings on admission, and determine 2-year survival rate and prognostic factors. ⋯ High level of serum CRP, lower serum albumin and lower pleural protein, MPE with distant metastasis were most important prognostic factors for non-small cell lung carcinoma in patients with MPEs.
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Excessive daytime sleepiness (EDS), which is commonly considered a cardinal sign of obstructive sleep apnea (OSA), may lead to an increased rate of metabolic syndrome (MetS), and be an independent risk factor for cardiovascular morbidity and mortality. The aim of this cross-sectional study was to examine the role of EDS in MetS and its components by researching severe OSA patients. ⋯ EDS was independently correlated with the sum of metabolic components in severe OSA patients. Our study suggested that EDS might be a potentially useful clinical marker to identify patients with severe OSA at risk of MetS.
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Review Case Reports
Successful embolization in childhood hemoptysis due to abnormal systemic arterial bleeding of the lung and review of the literature.
Hemoptysis in children is a rare but potentially life-threatening symptom of an underlying respiratory tract abnormality. Hemoptysis, when massive and untreated, has a mortality rate of more than 50%. With interventional radiological procedures and surgery, this rate has dropped to 7%-18%. The experience with bronchial arterial embolization in childhood is very limited; only a few case reports with short-term follow-up have been reported. ⋯ Massive hemoptysis due to abnormal systemic bleeding of the lung in the absence of parenchymal disease is an uncommon and severe symptom in childhood. Embolization can be a treatment option in children with abnormal vasculature bleeding and can be repeated safely when needed.
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Pulmonary embolism (PE) is a potentially life-threatening cardiovascular emergency with a high mortality rate. Rapid diagnosis and treatment are important in optimising clinical outcomes in patients with PE, and anticoagulants are the mainstay of treatment. Traditionally, anticoagulant therapy involves parenteral anticoagulants, overlapping with and followed by oral vitamin K antagonists. Direct oral anticoagulants (DOACs), including the factor Xa inhibitors rivaroxaban, apixaban and edoxaban, and the direct thrombin inhibitor dabigatran etexilate, have been developed to address limitations associated with traditional anticoagulant therapy. Apixaban, dabigatran and rivaroxaban have recently been approved for the treatment of acute deep vein thrombosis (DVT) and PE and prevention of recurrent DVT or PE. Edoxaban is approved in the United States but not currently in the European Union for the treatment of DVT and PE; approval of edoxaban in Europe is anticipated in the near future. ⋯ DOACs offer an alternative and potentially simplified option for anticoagulation therapy in patients with PE compared with traditional anticoagulants and are likely to assist physicians in optimising management of patients with PE and improve clinical outcomes.