American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Dec 2012
Biliary Sarcoidosis: Early Diagnosis Minimizes the Need for Surgery.
Biliary sarcoidosis is an unusual clinical entity which mimics autoimmune biliary disease and malignant distal obstruction. Three cases were managed in this series. ⋯ The third diagnosis was made using a Whipple resection specimen. Biliary sarcoidosis is an important consideration in those with an enigmatic presentation of jaundice as they may be managed non- operatively if expeditiously diagnosed.
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Am. J. Respir. Crit. Care Med. · Dec 2012
Randomized Controlled Trial Multicenter StudyNatriuretic peptide-driven fluid management during ventilator weaning: a randomized controlled trial.
Difficult weaning from mechanical ventilation is often associated with fluid overload. B-type natriuretic peptide (BNP) has been proposed as a tool for predicting and detecting weaning failure of cardiovascular origin. ⋯ Our results suggest that a BNP-driven fluid management strategy decreases the duration of weaning without increasing adverse events, especially in patients with left ventricular systolic dysfunction. Clinical trial registered with www.clinicaltrials.gov (NCT00473148).
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Am. J. Respir. Crit. Care Med. · Dec 2012
Randomized Controlled Trial Multicenter StudyRandomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults.
Most vascular catheter-related infections (CRIs) occur extraluminally in patients in the intensive care unit (ICU). Chlorhexidine-impregnated and strongly adherent dressings may decrease catheter colonization and CRI rates. ⋯ A large randomized trial demonstrated that chlorhexidine-gel-impregnated dressings decreased the CRI rate in patients in the ICU with intravascular catheters. Highly adhesive dressings decreased dressing detachment but increased skin and catheter colonization. Clinical trial registered with www.clinicaltrials.gov (NCT 01189682).
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Am. J. Respir. Crit. Care Med. · Dec 2012
Systemic steroid exposure is associated with differential methylation in chronic obstructive pulmonary disease.
Systemic glucocorticoids are used therapeutically to treat a variety of medical conditions. Epigenetic processes such as DNA methylation may reflect exposure to glucocorticoids and may be involved in mediating the responses and side effects associated with these medications. ⋯ Our analyses suggest that systemic steroid use is associated with site-specific differential methylation throughout the genome. Differentially methylated CpG sites were found in biologically plausible and previously unsuspected pathways; these genes and pathways may be relevant in the development of novel targeted therapies.
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Am. J. Respir. Crit. Care Med. · Dec 2012
Traffic-related air pollution and lung function in children at 8 years of age: a birth cohort study.
Long-term exposure to air pollution has been related to lung function decrements in children, but the role of timing of exposure remains unknown. ⋯ Our results indicate that exposure to traffic-related air pollution during infancy affects lung function in children up to 8 years of age and particularly in those sensitized to common inhalant or food allergens.