American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Sep 2011
ReviewUse of central venous oxygen saturation to guide therapy.
The use of pulmonary artery catheters has diminished, so that other technologies are emerging. Central venous oxygen saturation measurement (ScvO₂) as a surrogate for mixed venous oxygen saturation measurement (SvO₂) is simple and clinically accessible. To maximize the clinical utility of ScvO₂ (or SvO₂) measurement, it is useful to review what the measurement means in a physiologic context,how the measurement is made, important limitations, and how this measurement may be helpful in common clinical scenarios. ⋯ Furthermore,when tissue oxygenation is a clinical concern, SvO₂ is less prone to error compared with cardiac output, where small measurement errors may lead to larger errors in interpreting adequacy of oxygen delivery. ScvO₂ should be measured from the tip of a central venous catheter placed close to, or within, the right atrium to reduce measurement error. Correct clinical interpretation of SvO₂, or its properly measured ScvO₂ surrogate, can be used to (1) estimate cardiac output using the Fick equation, (2) better understand whether a patient's oxygen delivery is adequate to meet their oxygen demands, (3) help guide clinical practice, particularly when resuscitating patients using validated early goal directed therapy treatment protocols, (4) understand and treat arterial hypoxemia, and (5) rapidly estimate shunt fraction (venous admixture).
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Am. J. Respir. Crit. Care Med. · Sep 2011
ReviewCurrent controversies and future perspectives in chronic obstructive pulmonary disease.
Over the past decade there has been much research and interest in COPD. As a result, the understanding and management of the disease has improved significantly. Yet, there are many uncertainties and controversies that require further work. This review discusses these controversies and anticipates some of the changes that may occur in the near future in the field of COPD.
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Am. J. Respir. Crit. Care Med. · Sep 2011
Comparative StudyCase-control study of lung function in World Trade Center Health Registry area residents and workers.
Residents and area workers who inhaled dust and fumes from the World Trade Center disaster reported lower respiratory symptoms in two World Trade Center Health Registry surveys (2003-2004 and 2006-2007), but lung function data were lacking. ⋯ This study links persistent respiratory symptoms and oscillometric abnormalities in World Trade Center-exposed residents and area workers. Elevated R₅ and R₅₋₂₀ in cases despite normal spirometry suggested distal airway dysfunction as a mechanism for symptoms.
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Am. J. Respir. Crit. Care Med. · Sep 2011
Comparative StudyPriorities for screening and treatment of latent tuberculosis infection in the United States.
To improve the effectiveness of tuberculosis (TB) control programs in the United States by identifying cost-effective priorities for screening for latent tuberculosis infection (LTBI). ⋯ LTBI screening guidelines could make progress toward TB elimination by prioritizing screening for close contacts, those infected with HIV, and the foreign-born regardless of time living in the United States. For these groups, IGRA screening was more cost-effective than TST screening.
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Am. J. Respir. Crit. Care Med. · Sep 2011
Comparative StudyUnderstanding socioeconomic and racial differences in adult lung function.
The contribution of socioeconomic factors to racial differences in the distribution of lung function is not well understood. ⋯ High school completion is associated with racially patterned improvements in the FEV₁ of adults in the general population. The application of routine exclusion criteria leads to underestimates of the role of high school completion on FEV₁.