Chest
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Randomized Controlled Trial Comparative Study
Acute bronchodilator responsiveness to tiotropium in postinfectious bronchiolitis obliterans in children.
Patients with postinfectious bronchiolitis obliterans (PIBO) usually have severe airflow obstruction and respond poorly to β-adrenergic drugs. However, the bronchodilator response to an anticholinergic agent such as tiotropium bromide is not known. We studied the acute bronchodilator response to tiotropium for up to 24 h in children with PIBO using spirometric and plethysmographic criteria. ⋯ Tiotropium acutely decreased airway obstruction and air trapping for up to 24 h in children with PIBO.
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Multicenter Study Comparative Study Clinical Trial
Impact of COPD on Long-term Outcome After ST-Segment Elevation Myocardial Infarction Receiving Primary Percutaneous Coronary Intervention.
There are limited data describing the long-term outcome of patients with concomitant COPD who develop ST-segment elevation myocardial infarction (STEMI). ⋯ Patients with STEMI and concomitant COPD are at greater risk for death and hospital readmissions due to cardiovascular causes (eg, recurrent MI, HF, bleedings) than patients without COPD.
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Multicenter Study Comparative Study
Organ allocation waiting time during extracorporeal bridge to lung transplant affects outcomes.
The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant (LTX) is still being debated. ⋯ The duration of the ECMO bridge is a relevant cofactor in the mortality and morbidity of critically ill patients awaiting organ allocation. The NIV strategy was associated with a less complicated clinical course after LTX.
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Comparative Study
Sleep-disordered breathing and postoperative outcomes after elective surgery: analysis of the nationwide inpatient sample.
Systematic screening and treatment of sleep-disordered breathing (SDB) or obstructive sleep apnea (OSA) in presurgical patients would impose a significant cost burden; therefore, it is important to understand whether SDB is associated with worse postoperative outcomes. We sought to determine the impact of SDB on postoperative outcomes in patients undergoing four specific categories of elective surgery (orthopedic, prostate, abdominal, and cardiovascular). The primary outcomes were in-hospital death, total charges, and length of stay (LOS). Two secondary outcomes of interest were respiratory and cardiac complications. ⋯ In this large national study, despite the increased independent association of SDB with postoperative cardiopulmonary complications, the diagnosis of SDB was not independently associated with an increased rate of in-hospital death. SDB had a mixed impact on LOS and total charges by surgical category.
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Investigations on breath analysis have provided preliminary data on its potential in the noninvasive diagnosis of lung diseases. Although the conventional comparisons of exhaled breath in study populations (ie, diseased vs healthy) may help to identify patients with various lung diseases, we believe that the analysis of exhaled breath holds promise beyond this scenario. On the basis of preliminary findings, we hypothesize that breath analysis (1) could be applied not only to identify patients with lung disease but also to better phenotype healthy subjects at risk and patients with a particular disease, which is in-line with current efforts toward individualized medicine; (2) could be useful in estimating internal body time to determine the optimal time of drug administration, thereby maximizing drug activity and reducing toxicity (chronopharmacology); and (3) could be applied to monitor drugs or drug metabolites, thus, enhancing adherence to prescribed medications and enabling studies on pharmacokinetics.