Chest
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Randomized Controlled Trial Comparative Study Clinical Trial
Hemodynamic, cardiac, and electrolyte effects of low-dose aerosolized terbutaline sulfate in asthmatic patients.
Aerosolized beta2-agonists have been associated with increased morbidity in asthmatics. These drugs cause transient increases in heart rate and decreases in serum potassium levels after these drugs are first utilized. This study is designed to elucidate whether beta-adrenergic tolerance to the hemodynamic, cardiac, and electrolyte effects of inhaled terbutaline occurs during 14 days of maintenance therapy. ⋯ Cardiovascular beta2-receptors in patients with stable asthma do not develop tolerance to the effects of low-dose aerosolized terbutaline after 14 days of maintenance therapy. In contrast, the homeostatic mechanisms regulating serum potassium develop tolerance to low-dose terbutaline maintenance therapy. Lack of cardiovascular tolerance to maintenance doses of aerosolized beta2-agonists may be important in increased morbidity if excessive amounts of these drugs are administered during asthma exacerbations.
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Comparative Study
The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation.
To determine whether the use of continuous i.v. sedation is associated with prolongation of the duration of mechanical ventilation. ⋯ We conclude from these preliminary observational data that the use of continuous i.v. sedation may be associated with the prolongation of mechanical ventilation. This study suggests that strategies targeted at reducing the use of continuous i.v. sedation could shorten the duration of mechanical ventilation for some patients. Prospective randomized clinical trials, using well-designed sedation guidelines and protocols, are required to determine whether patient-specific outcomes (eg, duration of mechanical ventilation, patient comfort) can be improved compared with conventional sedation practices.
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Comparative Study
Identification of smokers susceptible to development of chronic airflow limitation: a 13-year follow-up.
Cigarette smoking is the cardinal cause of COPD, but only a relatively small percentage of smokers have development of clinically overt disease. ⋯ Middle-aged smokers are at no evident risk of functional deterioration if their FEV1/VC ratio is normal. This is so even if results of small airways tests are abnormal. A decreased FEV1/VC ratio has no serious implications in itself. Only an associated high N2 slope adds the necessary information to predict a low FEV1. Present data suggest that a subgroup of smokers in their 50s, characterized by a low FEV1/VC ratio and a high N2 slope, are probably the susceptible smokers at high risk for development of COPD.
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Comparative Study
Pulmonary Wegener's granulomatosis: correlation between high-resolution CT findings and clinical scoring of disease activity.
To evaluate the usefulness of high-resolution CT (HRCT) for monitoring pulmonary disease activity in Wegener's granulomatosis (WG). ⋯ HRCT may be a useful adjunct to clinical scoring of pulmonary disease activity in patients with WG and suspected lung involvement.
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Comparative Study
Utility of transbronchial biopsy in patients with acute respiratory failure: a postmortem study.
To determine the diagnostic yield of histologic specimens obtained by postmortem transbronchial biopsy (TBB) in patients with acute respiratory failure requiring mechanical ventilation. ⋯ These findings suggest poor overall agreement between standard postmortem histologic examination and TBB specimens. Although not performed in a clinical setting, this postmortem investigation suggests that TBB may be of limited value in mechanically ventilated patients with acute respiratory failure because of its low sensitivity.