Chest
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Review Meta Analysis
Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults: A Systemic Review and Meta-analysis.
Endotracheal intubation (EI) in ICU patients is associated with an increased risk of life-threatening adverse events due to unstable conditions, rapid deterioration, limited preparation time, and variability in the expertise of operators. The goal of this study was to compare the effect of video laryngoscopy (VL) and direct laryngoscopy (DL) in ICU patients requiring EI. ⋯ The VL technique did not increase the first-attempt success rate during EI in ICU patients compared with DL. These findings do not support routine use of VL in ICU patients.
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There is increasing appreciation that mitochondria serve cellular functions beyond oxygen sensing and energy production. Accordingly, it has become important to explore noncanonical roles of mitochondria in normal and pathophysiological processes that influence airway structure and function in the context of diseases such as asthma and COPD. Mitochondria can sense upstream processes such as inflammation, infection, tobacco smoke, and environmental insults important in these diseases and in turn can respond to such stimuli through altered mitochondrial protein expression, structure, and resultant dysfunction. ⋯ Thus, understanding how mitochondrial structure and function play central roles in airway disease may be critical for the development of novel therapeutic avenues targeting dysfunctional mitochondria. In this case, it is likely that mitochondria of airway epithelium, smooth muscle, and fibroblasts play differential roles, consistent with their contributions to disease biology, underlining the challenge of targeting a ubiquitous cellular element of existential importance. This translational review summarizes the current state of understanding of mitochondrial processes that play a role in airway disease pathophysiology and identifying areas of unmet research need and opportunities for novel therapeutic strategies.
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Randomized Controlled Trial Comparative Study
Rapid vs Maintenance Vitamin D Supplementation in Deficient Asthmatic Children to Prevent Exacerbations.
Whether vitamin D reduces clinically important exacerbations of childhood asthma remains uncertain. We compared rapid to maintenance vitamin D repletion analyzed by baseline vitamin D level. ⋯ Rapid compared to maintenance vitamin D supplementation for children with the lowest levels resulted in short- but not long-term reduction in asthma exacerbations.
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There is no published systematic review on the etiologies of chronic cough or the relationship between OSA and chronic cough in children aged ≤ 14 years. We thus undertook a systematic review based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format. The KQs follow: Among children with chronic (> 4 weeks) cough (KQ 1) are the common etiologies different from those in adults? (KQ 2) Are the common etiologies age or setting dependent, or both? (KQ 3) Is OSA a cause of chronic cough in children? ⋯ There is moderate-quality evidence that common etiologies of chronic cough in children are different from those in adults and are dependent on age and setting. As there are few data relating OSA and chronic cough in children, the panel suggested that these children should be managed in accordance with pediatric sleep guidelines.
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Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by abnormal behaviors emerging during REM sleep that may cause injury or sleep disruption. The diagnosis requires polysomnography (PSG) demonstrating a loss of normal skeletal muscle atonia during REM sleep. RBD results from dysfunction of the brain stem circuits responsible for maintaining normal REM sleep atonia and suppressing behaviors during REM sleep. ⋯ RBD has been linked with narcolepsy and has been associated with a variety of other disorders. The management of RBD focuses on preventive/safety measures, counseling, monitoring for the development of a neurodegenerative disorder, and pharmacotherapy, which is typically effective but not well understood. The purpose of this article is to review and update our current understanding of the clinical features, epidemiology, demographics, pathophysiology, evaluation, diagnosis, differential diagnosis, causes, associations, and the clinical management of RBD.