American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Nov 1995
Relationship between procedures and health insurance for critically ill patients with Pneumocystis carinii pneumonia.
The objective of the present study was to assess the association between type of health insurance coverage and use of diagnostic tests and therapies among patients with AIDS-related Pneumocystis carinii pneumonia (PCP). Fifty-six private, public, and community hospitals in Chicago, Los Angeles, and Miami were selected for the study, and the charts of 890 patients with empirically treated or cytologically confirmed PCP, hospitalized during 1987 to 1990 were retrospectively reviewed. Patients were classified by insurance status: self-pay (n = 56), Medicaid (n = 254), or private insurance, including health maintenance organizations and Medicare (n = 580). ⋯ Medicaid patients were approximately three-fourths more likely than privately insured patients (relative odds = 1.73; 95% CI = 1.01, 2.96; p = 0.04) to die in-hospital, after adjusting for patient, severity of illness, and hospital characteristics. However, with further adjustment for confirmation of PCP, Medicaid patients no longer had a significantly higher likelihood of dying in-hospital. We conclude that Medicaid patients are less likely to receive diagnostic bronchoscopy than privately insured or self-insured patients, more likely to be empirically treated for PCP, and more likely to die in-hospital.(ABSTRACT TRUNCATED AT 250 WORDS)
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Am. J. Respir. Crit. Care Med. · Nov 1995
Comparative StudyProspective validation of an acute respiratory distress syndrome predictive score.
We derived an Acute Respiratory Distress Syndrome Score (ARDS Score) from previously described training set data. To validate its diagnostic accuracy for identifying a complicated course (early death or prolonged intubation) in acute lung injury, 50 patients were prospectively scored using an ARDS Score decision threshold of > or = 2.5 to discriminate between an uncomplicated (successful extubation after < or = 14 d) and complicated course. Predictor factors incorporated in the ARDS Score were collected on Day 4 and Day 7 of ARDS and included PaO2/PAO2 ratio, required positive end-expiratory pressure (PEEP), and chest radiograph progression. ⋯ The LIS components of static respiratory system compliance (Crs) and chest radiograph description did not differ between patient groups. The interobserver concordance of the dynamic chest radiograph interpretation included in the ARDS Score was significant (p < 0.05). We conclude that the previously derived ARDS Score has valid diagnostic accuracy for identifying patients with ARDS who will follow a complicated course.
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Am. J. Respir. Crit. Care Med. · Nov 1995
Comparative StudyHypocapnia-induced ventilation/perfusion mismatch: a direct CO2 or pH-mediated effect?
The purpose of this study was to determine whether the increased ventilation/perfusion (VA/Q) mismatch caused by hypocapnic hyperventilation in dogs (J. Appl. Physiol. 1993; 74:1306-1314) is a direct CO2 or a pH-mediated effect. ⋯ PaO2 was reduced and VA/Q heterogeneity was increased in all conditions defined by a high pH, independent of the PCO2 (respiratory alkalosis and metabolic alkalosis). In contrast, PaO2 and VA/Q heterogeneity was unchanged in conditions defined by either a normal or low pH (normalized acid-base status, mixed respiratory alkalosis and metabolic acidosis, and metabolic acidosis). Therefore, we conclude that hypocapnia-induced VA/Q mismatch in hyperventilated dogs is pH-mediated and is not a function of PCO2 per se.
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Am. J. Respir. Crit. Care Med. · Nov 1995
Comparative StudyPharmacologic characterization of endothelin receptor responses in the isolated perfused rat lung.
Endothelin receptor subtypes were characterized in isolated perfused rat lungs using the peptide ETA-receptor antagonists BQ 610 and BQ 123, the nonpeptide mixed ETA-/ETB-receptor antagonist bosentan, and the ETB-receptor agonist IRL 1620. Intra-arterial injection of 1 nmol IRL 1620 caused an enhanced reduction in pulmonary conductance compared with 1 nmol endothelin (ET-1) or 0.33 nmol IRL 1620. Pretreatment of lungs with BQ 610, BQ 123, or bosentan aggravated the bronchoconstriction induced by 1 nmol ET-1 so that it was comparable to that induced by 1 nmol IRL 1620. ⋯ ET-1, but not IRL 1620, provoked the release of thromboxane B2. The main effect of ETA-receptor stimulation is vasoconstriction, whereas ETB-receptor stimulation causes bronchoconstriction. Both actions, however, are attenuated by the other receptor, i.e., the ETA-induced vasoconstriction is attenuated by ETB-receptor-induced release of vasodilators such as prostacyclin, whereas the ETB-receptor-induced bronchoconstriction is attenuated by an unknown ETA-receptor-dependent bronchodilatory mechanism.