American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Feb 2013
Integrating mortality and morbidity outcomes: using quality-adjusted life years in critical care trials.
Outcome measures that integrate mortality and morbidity, like quality-adjusted life years (QALYs), have been proposed for critical care clinical trials. ⋯ QALYs may be a feasible outcome in critical care trials yielding a patient-centered result and major gains in statistical power under certain conditions, but this approach is susceptible to several threats, including loss to follow-up.
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Am. J. Respir. Crit. Care Med. · Feb 2013
Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis.
Many patients with severe acute respiratory distress syndrome (ARDS) caused by influenza A(H1N1) infection receive extracorporeal membrane oxygenation (ECMO) as a rescue therapy. ⋯ Under ECMO, an ultraprotective ventilation strategy minimizing plateau pressure may be required to improve outcome. When patients with severe influenza A(H1N1)-related ARDS treated with ECMO were compared with conventionally treated patients, no difference in mortality rates existed. The unmatched, severely hypoxemic, and younger ECMO-treated patients had, however, a lower mortality.
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Am. J. Respir. Crit. Care Med. · Feb 2013
Elevated fibrinogen levels are associated with risk of pulmonary embolism, but not with deep venous thrombosis.
It is unclear whether elevated plasma fibrinogen is associated with both deep venous thrombosis (DVT) and its complication, pulmonary embolism (PE), and whether elevated fibrinogen is a direct cause of these disorders. ⋯ Elevated plasma fibrinogen levels are associated with increased risk of PE in combination with DVT but not with DVT alone. Elevated fibrinogen levels per se may not be causally associated with PE or DVT. Limitations include imprecise definitions of PE and DVT.
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Am. J. Respir. Crit. Care Med. · Feb 2013
Reduced microRNA-150 is associated with poor survival in pulmonary arterial hypertension.
MicroRNAs (miRNAs or miRs) are implicated in the pathogenesis of various cardiovascular diseases, including pulmonary arterial hypertension (PAH). ⋯ Reduced circulating miR-150 levels are associated with poor survival in PAH.
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Am. J. Respir. Crit. Care Med. · Feb 2013
Identification of the mechanism mediating genioglossus muscle suppression in REM sleep.
Inhibition of pharyngeal motoneurons accompanies REM sleep and is a cause of hypoventilation and obstructive sleep apnea in humans. One explanation posits that the neurotransmitters glycine and γ-aminobutyric acid are responsible for REM sleep motor inhibition. However, blockade of that mechanism at cranial motor nuclei increases motor activity in all sleep-wake states, and least of all in REM sleep, arguing against it as a major mechanism of REM sleep pharyngeal motor inhibition. ⋯ We identify a powerful cholinergic-GIRK channel mechanism operating at the hypoglossal motor pool that has its largest inhibitory influence in REM sleep and minimal or no effects in other sleep-wake states. This mechanism is the major cause of REM sleep inhibition at a pharyngeal motor pool critical for effective breathing.