Chest
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Randomized Controlled Trial
The effects of helium-hyperoxia on 6-min walking distance in COPD: a randomized, controlled trial.
We hypothesized that breathing helium-hyperoxia (HeO2) would significantly improve 6-min walking test (6MWT) distance in COPD subjects. ⋯ The use of HeO2 increased 6MWT distance in COPD subjects more than either mask O2 or nasal O2 compared to RA. The increased walking distance was not associated with increased shortness of breath or leg fatigue. The results suggest that clinical benefit would be obtained by administering HeO2 during exercise, which may have significant clinical implications for the management of COPD patients.
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Multicenter Study
Platelet count decline: an early prognostic marker in critically ill patients with prolonged ICU stays.
Thrombocytopenia is common in ICU patients. The objective of this study was to evaluate possible links between declining platelet counts early in the ICU stay and survival. ⋯ In patients who spend > 5 days in the ICU and have normal platelet counts at ICU admission, a decline in platelet counts provides prognostic information. This parameter deserves to be included in new scoring systems.
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Hypertension affects > 65 million people in the United States and is one of the leading causes of death. One to two percent of patients with hypertension have acute elevations of BP that require urgent medical treatment. ⋯ Severe hypertension without acute end-organ damage is referred to as a hypertensive urgency and is usually treated with oral antihypertensive agents. This article reviews definitions, current concepts, common misconceptions, and pitfalls in the diagnosis and management of patients with acutely elevated BP as well as special clinical situations in which BP must be controlled.
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Electromagnetic navigation bronchoscopy (ENB) with biopsy under fluoroscopic guidance has enhanced the yield of flexible bronchoscopy in the diagnosis of peripheral lung lesions. However, the accuracy of ENB navigation suggests that the addition of fluoroscopy is redundant. ⋯ ENB can be used as a stand-alone bronchoscopic technique without compromising diagnostic yield or increasing the risk of pneumothorax. This may result in sizable timesaving and avoids radiation exposure.
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The latest edition of The International Classification of Sleep Disorders: Diagnostic and Coding Manual subsumes a broad range of disorders under the heading "Sleep Related Hypoventilation/Hypoxemic Syndromes." Some are quite common, such as COPD with worsening gas exchange during sleep; while some are exceedingly rare, such as congenital central hypoventilation syndrome. All share the attribute of abnormal gas exchange that worsens, or may only be present, during sleep. ⋯ These changes are largely inconsequential in the normal individual but interact with respiratory, neurologic, or neuromuscular disease to manifest as the sleep-related hypoventilation/hypoxemic syndromes. In addition to optimal treatment of the underlying disorder (when known and when possible), treatment usually involves nocturnal ventilatory support that is now most commonly provided by noninvasive positive pressure ventilation.