Chest
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Pulmonary hypertension (PH) due to chronic lung disease is associated with a poor prognosis, regardless of the underlying respiratory condition. Updated PH guidelines recommend optimal treatment of the underlying lung disease, including long-term oxygen therapy, in patients with chronic hypoxemia despite the lack of randomized controlled clinical trials supporting this statement. So far, randomized controlled trials of drugs approved for pulmonary arterial hypertension have yielded discouraging results in both interstitial lung diseases and COPD with PH. ⋯ In cases of PH due to idiopathic pulmonary fibrosis, new therapies under investigation use a combination of novel antifibrotic treatments and other treatments approved for pulmonary arterial hypertension. The choice of robust end points as well as a target group of patients with specific hemodynamic criteria may help in the selection of innovative therapeutic strategies. The aim of this review is to discuss recent studies and clinical trials for the treatment of PH due to the main chronic respiratory diseases and to discuss possible future scenarios for the evaluation of new therapeutic strategies.
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Although noninvasive ventilation (NIV) has been used since the 1950s in the polio epidemic, the development of modern bilevel positive airway pressure (BPAP) devices did not become a reality until the 1990s. Over the past 25 years, BPAP technology options have increased exponentially. ⋯ However, a knowledge gap exists in the way the settings on these devices are adjusted to achieve synchrony and match the patient's unique physiology of respiratory failure. This issue is further complicated by differences in pressure and flow dynamic settings among different types of NIV devices available for inpatient and home care.
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Comparative Study Observational Study
Comparing Pulmonary Nodule Location During Electromagnetic Bronchoscopy with Predicted Location Based on Two Virtual Airway Maps at Different Phases of Respiration.
Electromagnetic navigational bronchoscopy (ENB) is guided bronchoscopy to pulmonary nodules (PN) that relies on a preprocedural chest CT to create a three-dimensional (3D) virtual airway map. The CT is traditionally done at a full inspiratory breath hold (INSP), but the procedure is performed while the patient tidal breaths, when lung volumes are closer to functional residual capacity. Movement of a PN from INSP to expiration (EXP) has been shown to average 17.6 mm. Therefore, the hypothesis of this study is that preprocedural virtual maps built off a CT closer to physiological lung volumes during bronchoscopy may better represent the actual 3D location of a PN. ⋯ Predicted 3D nodule location using an EXP scan for ENB is significantly closer to actual nodule location when compared with an INSP scan, but whether this leads to increased yields needs to be determined.
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Comparative Study
Comparative Effectiveness of Enoxaparin versus Dalteparin for Thromboprophylaxis after Traumatic Injury.
Enoxaparin 30 mg twice daily and dalteparin 5,000 units once daily are two common low-molecular-weight heparin (LMWH) thromboprophylaxis regimens used in the trauma population. Pharmacodynamic studies suggest that enoxaparin provides more potent anticoagulation than does dalteparin. ⋯ Our results suggest that dalteparin has an effectiveness similar to that of enoxaparin in real-world trauma patients. Future research should investigate how the timing and consistency of prophylaxis affects LMWH effectiveness.
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Observational Study
Driving Pressure and Hospital Mortality in Patients Without ARDS: A Cohort Study.
Driving pressure (ΔP) is associated with mortality in patients with ARDS and with pulmonary complications in patients undergoing general anesthesia. Whether ΔP is associated with outcomes of patients without ARDS who undergo ventilation in the ICU is unknown. Our objective was to determine the independent association between ΔP and outcomes in mechanically ventilated patients without ARDS on day 1 of mechanical ventilation. ⋯ In this cohort of patients without ARDS on day 1 of mechanical ventilation and within the limits of ventilatory settings normally used by clinicians, ΔP was not associated with hospital mortality. This study also confirms the association between ΔP and mortality in patients with ARDS not enrolled in a trial and in hypoxemic patients without ARDS.