Clinics in chest medicine
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Definitions have been considered important in all fields of medicine, both at a patient level to facilitate accurate diagnosis and treatment, and at a research level to clarify patient inclusion criteria and interpretation of study results. Although there is agreement that sepsis refers to the host response to infection, the complexity of this response and of the patient groups affected, however, has meant that establishing accepted definitions of sepsis has been difficult. Recent consensus has provided global definitions of sepsis and infection, but further work is necessary to provide a means of more completely characterizing the sepsis response in individual patients, such that new interventions can be targeted better as physicians strive to decrease the still high mortality rates associated with this condition.
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Sarcoidosis continues to be a disease of research interest because of its complicated immune mechanisms and elusive etiology. So far, it has been established that granulomatous inflammation in sarcoidosis is predominantly a T-helper 1 immune response mediated by a complex network of lymphocytes, macrophages, and cytokines. The cause of progression to a chronic and potentially fibrotic form is unclear but may involve loss of apoptotic mechanisms, loss of regulatory response, or a persistent antigen that cannot be cleared. Recent genomic and proteomic technology has emphasized the importance of host susceptibility and gene-environment interaction in the expression of the disease.
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Sarcoidosis is a multigenic and multifactorial disease. Predisposing genes have been identified and fast progress in molecular technologies including systematic genome-wide association studies and large-scale resequencing will aid the discovery of further risk loci and variants. ⋯ To this end, different granulomatous disorders of known and unknown etiology should be investigated jointly by genetic, immunobiological, and proteomic approaches. The definition of individual genetic risk profiles in sarcoidosis and other chronic inflammatory disorders seems achievable and a useful route for clinical translation.
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Clinics in chest medicine · Jun 2008
ReviewDoes closed loop control of assist control ventilation reduce ventilator-induced lung injury?
The standard of care for mechanical ventilation of the patient who has acute lung injury remains volume control ventilation at 6 mL/kg. Despite this fact, clinicians often employ pressure control ventilation and adaptive pressure control ventilation in an attempt to improve synchrony and limit the possibility for overdistension. ⋯ Neither of these techniques has been compared with volume control in a randomized setting. Understanding operation of these techniques is essential for determining any impact on outcome or ventilator induced lung injury.
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Clinics in chest medicine · Jun 2008
Review Comparative StudyProtocol-driven ventilator weaning: reviewing the evidence.
Though seminal clinical trials have identified efficacious methods of liberating patients from mechanical ventilation (ie, weaning), this knowledge is not applied often by physicians in routine practice. Weaning protocols are a strategies by which research results can be translated effectively and efficiently into clinical practice, but results of clinical trials evaluating weaning protocols have not been uniform, and controversy continues to surround this important area in critical care medicine. This article reviews the rationale for and against the routine use of weaning protocols and highlights informative details of many clinical trials that have evaluated such protocols.