Chest
-
Evidence on the effectiveness of pulmonary artery catheters (PACs) in cardiac surgery is scarce. ⋯ Perioperative use of PACs was associated with a significant reduction in the risk of postoperative 1-year all-cause mortality. This association was driven predominantly by patients who underwent off-pump coronary artery bypass grafting and those who underwent cardiac surgery in less experienced centers.
-
Critical illness can render patients at heightened risk of anonymity, loss of dignity, and dehumanization. Because dehumanization results in significant patient distress, it is imperative to find ways to humanize care in the ICU. A Get to Know Me board (GTKMB) is a personal patient profile designed to bring the patient from anonymity; however, its widespread adoption has been challenging. ⋯ The GTKMB was considered important in fostering humanized caring in the ICU by diverse members of an interprofessional ICU team, helping to facilitate communication, establish family connection, and guide care.
-
Obesity-associated asthma results in increased morbidity and mortality. We report one-year asthma outcomes with the Counterweight-Plus weight management programme (CWP) compared to usual care (UC) in a single-centre, randomised, controlled trial in patients with difficult-to-treat asthma and obesity. ⋯ Use of a dietitian-supported weight management programme results in sustained weight-loss and is a potential treatment for obesity in asthma. CWP resulted in a higher proportion achieving MCID improvement in AQLQ compared to UC. Within group differences in AQLQ and exacerbation frequency suggest potential with CWP. These encouraging signals justify a larger sample study to further assess asthma-related outcomes.
-
Research on isolating genetically different strains within the same species in patients undergoing treatment for Mycobacterium avium complex (MAC) pulmonary disease (PD) is limited. We investigated the frequency of genetically distinct strains identified within the same species among on-treatment isolates compared with pretreatment isolates throughout the course of MAC-PD treatment. ⋯ We identified a genetically distinct strain within the same species at least once in approximately 25% of patients in whom the same species was isolated after the initiation of anti-MAC-PD therapy. These findings may affect the determination of treatment outcomes and corresponding MAC-PD treatment strategies.
-
Albumin infusions may be renally protective or harmful in patients with septic shock who have kidney impairment. This can affect the need for renal replacement therapy (RRT) and in-hospital mortality. ⋯ In patients with septic shock and kidney impairment on hospital admission, early albumin use may be associated with an increased composite outcome of RRT or in-hospital mortality. This increased risk is most associated with hyperoncotic albumin rather than iso-oncotic albumin.