American journal of respiratory and critical care medicine
-
Am. J. Respir. Crit. Care Med. · Feb 1996
The determinants of pulmonary diffusing capacity in a national sample of U.S. adults.
Racial and gender differences in single-breath pulmonary diffusing capacity for carbon monoxide (DLCO) have previously received little attention. Between 1971 and 1975, the first National Health and Nutrition Examination Survey determined DLCO for 4,439 adults ages 25 to 74 residing in the United States, including 2,345 women and 438 blacks. The large sample permitted an evaluation of interactions and nonlinear relationships with DLCO, and its association with biomarkers of inflammation. ⋯ In current smokers, cigarettes per day and pack-years were predictive of DLCO even after control for FVC and controlling for these variables fully explained the difference in DLCO between never and current smokers. Peripheral neutrophil count, a biomarker of inflammation, was associated with reduced DLCO. Thus, substantial sex and race differences exist for DLCO within the general United States population.
-
Am. J. Respir. Crit. Care Med. · Feb 1996
Comparative StudyExogenous surfactants in a piglet model of acute respiratory distress syndrome.
Evidence for surfactant dysfunction in acute respiratory distress syndrome (ARDS) suggests a role for exogenous surfactant which contains apoprotein for resistance to protein inhibition. We compared the effects of KL-4-Surfactant, an artificial preparation containing a synthetic 21 amino acid peptide with SP-B-like activity, with Exosurf, an artificial protein-free surfactant, and Survanta, a bovine protein-containing surfactant, in a saline lung lavage model of ARDS in neonatal piglets. Two sequential series of lung lavages were performed to lower PaO2 < 100 mm Hg, each followed by administration of surfactant or air and a 90-min observation period. ⋯ Only KL-4-Surfactant demonstrated greater pressure-volume characteristics and lower bronchoalveolar protein than those of Controls. We conclude that the physiologic effects of KL-4-Surfactant are more like Survanta in this model. We speculate that KL-4-Surfactant may improve pulmonary function, reduce alveolar protein leak, and thus be efficacious in the treatment of ARDS.
-
Am. J. Respir. Crit. Care Med. · Feb 1996
Bedside prediction of mortality from bacteremic sepsis. A dynamic analysis of ICU patients.
The prognosis in patients with sepsis depends on severity of acute illness, underlying chronic diseases, and complications associated with infection. Adjusting for these factors is essential for evaluation of new therapies. The purpose of the present study was to determine variables readily identifiable at the bedside that predict mortality in intensive care unit (ICU) patients with sepsis and positive blood cultures. ⋯ The best two independent prognostic factors were the APACHE II score at the onset of sepsis (OR, 1.13 per unit; CI95, 1.08 to 1.17; p = 0.0016) and the number of organ dysfunctions developing thereafter (OR, 2.39; CI95, 2.02 to 2.82; p < 0.001). In ICU patients with sepsis and positive blood cultures, outcome can be predicted by the severity of illness at onset of sepsis and the number of vital organ dysfunctions developing subsequently. These variables are easily assessed at the bedside and should be included in the evaluation of new therapeutic strategies.
-
Am. J. Respir. Crit. Care Med. · Feb 1996
Occupational disease trends in black South African gold miners. An autopsy-based study.
The change in prevalence in silicosis and pulmonary tuberculosis in black South African gold miners dying from unnatural causes from 1975 to 1991 was studied. Data were analyzed for 16,454 black gold miners. Information on age at death, duration of service, year of autopsy examination, and the prevalence of silicosis and tuberculosis was collected. ⋯ A significant trend for tuberculosis, for year of autopsy, remained after adjustment for the other variables in the model, such as age and duration of service (p = 0.0046). In view of current labor stabilization in the South African mines, one can expect further increases in the prevalence of tuberculosis and silicosis. Lowering of dust levels in the mines is urgently required to prevent the increase of disease burden.
-
Am. J. Respir. Crit. Care Med. · Feb 1996
Randomized Controlled Trial Clinical TrialEfficacy of auto-CPAP in the treatment of obstructive sleep apnea/hypopnea syndrome.
The auto-CPAP (Morphée Plus) is characterized by its ability to modify the positive-pressure level applied during the night for the presence or absence of sleep-induced respiratory disorders. The aim of the study was to compare the efficacy of this new mode of CPAP therapy with that of conventional constant-CPAP in the treatment of sleep apnea/hypopnea syndrome (SAHS). Sixteen patients with SAHS were randomly allocated to two groups that were paired for age, apnea/hypopnea index, and mean sleep latency. ⋯ During the control CPAP sleep study, the positive pressure level was significantly lower during Stage III-IV than during the other sleep stages (p = 0.004). The improvement in the MWT and the TMT observed with CPAP therapy was identical in both groups. We conclude that (1) the amount of use during CPAP treatment is higher with auto-CPAP than with constant-CPAP, and (2) Morphée+auto-CPAP is an efficient as conventional CPAP in correcting nocturnal breathing disorders, daytime sleepiness, and cognitive impairment in SAHS.