Chest
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Multicenter Study Clinical Trial Controlled Clinical Trial
Clarithromycin in the treatment of Mycobacterium avium lung infections in patients without AIDS. Clarithromycin Study Group of France.
Mycobacterium avium complex infections, common in patients with AIDS as either pulmonary or disseminated disease, are infrequent in patients without AIDS. Participants were 45 HIV-negative patients with lung disease and positive sputum cultures for M avium; 10 had documented immunocompromise, and 24 had preexisting lung disease. Clarithromycin dosage was 500 to 2,000 mg daily (mean +/- SD = 1,633 +/- 432 mg). ⋯ During the follow-up, one patient suffered a relapse with peripheral lymph nodes. A daily dose of 30 mg/kg of clarithromycin in the treatment of M avium infections appears to be effective and safe. Concomitant drug therapy should be assessed for its ability to prevent relapse.
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Randomized Controlled Trial Clinical Trial
The effect of short-term instillation of a mucolytic agent (mesna) on airway resistance in mechanically ventilated patients.
To determine whether bolus instillation of a mucolytic agent (mesna) could diminish airway resistance, endotracheal tube resistance, or both in patients mechanically ventilated for acute respiratory failure. ⋯ In our patients, bolus tracheal instillation of mesna does not improve airway resistance; in fact, mesna instillation induces episodes of bronchospasm that disappear 2 h later.
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Multicenter Study
Hospital survival rates of patients with acute respiratory failure in modern respiratory intensive care units. An international, multicenter, prospective survey.
An international, multicenter, prospective survey has been conducted to determine the hospital survival rates of patients with potentially reversible acute respiratory failure (ARF) who are managed in sophisticated intensive care units by leading critical care specialists, using current (1991 to 1992) support and treatment techniques and protocols. Twenty-five clinical centers participated in the survey, 11 in the United States and 14 in Europe. A total of 1,426 patients with ARF were studied, all of whom had been receiving closed system positive pressure mechanical ventilation at an FIo2 of at least 0.50 for at least 24 h at the time of entry into the survey. ⋯ Peak inspiratory pressure (PIP) > 50 cm H2O at entry into the survey was associated with survival rate of less than 20%, while PIP < 30 cm H2O was associated with survival rate of 60%. Shorter periods of mechanical ventilation (< 48 h) of group A patients before entering the survey were associated with higher survival rates (38%) than patients requiring mechanical ventilation for more than 2 weeks (30%). Patients with ARF with multiorgan failure had lower survival rates (10%) than those with pulmonary dysfunction alone (45%).(ABSTRACT TRUNCATED AT 400 WORDS)
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To investigate the initial and long-term effect of nitric oxide (NO) inhalation in patients with severe acute respiratory distress syndrome (ARDS). ⋯ Beneficial effects of NO inhalation can be observed in most patients with severe ARDS; in some cases, however, it may fail to improve pulmonary gas exchange or to reduce pulmonary hypertension without obvious explanation. To demonstrate a possible increase in survival associated with NO inhalation, large randomized prospective trials are required.
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A 53-year-old woman had a serious air embolism from the central venous catheter tract after lung transplantation. Lung transplant patients appear to be at increased risk for this complication, and four other known cases are reported.