American journal of respiratory and critical care medicine
-
Am. J. Respir. Crit. Care Med. · Nov 2015
Implications of Heterogeneity of Treatment Effect for Reporting & Analysis of Randomized Trials in Critical Care.
Randomized clinical trials (RCTs) are conducted to guide clinicians' selection of therapies for individual patients. Currently, RCTs in critical care often report an overall mean effect and selected individual subgroups. Yet work in other fields suggests that such reporting practices can be improved. ⋯ We further show that these results persist even in the presence of causes of death unmodified by the treatment under study. These results have implications for reporting and analyzing RCT data, both to better understand how our therapies work and to improve the bedside applicability of RCTs. We suggest a plan for measurement in future RCTs in the critically ill.
-
Am. J. Respir. Crit. Care Med. · Nov 2015
Randomized Controlled Trial Multicenter Study Comparative StudyComparison of Treatment Response in Idiopathic and Connective Tissue Disease-Associated Pulmonary Arterial Hypertension.
Studies suggest that patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) have a poorer treatment response to therapies for PAH compared with patients with idiopathic PAH (IPAH), but individual randomized controlled trials (RCTs) have been underpowered to examine differences within these subgroups. ⋯ Treatment for PAH was less effective in CTD-PAH compared with IPAH in terms of increasing 6MWD and preventing clinical worsening. The heterogeneity of treatment response supports the need for identifying therapies that are more effective for CTD-PAH.
-
Am. J. Respir. Crit. Care Med. · Nov 2015
Multicenter StudyAmbrisentan and Tadalafil Upfront Combination Therapy in Scleroderma-Associated PAH.
Scleroderma-associated pulmonary arterial hypertension (SSc-PAH) is a rare disease characterized by a very dismal response to therapy and poor survival. We assessed the effects of up-front combination PAH therapy in patients with SSc-PAH. ⋯ Up-front combination therapy with ambrisentan and tadalafil significantly improved hemodynamics, RV structure and function, and functional status in treatment-naive patients with SSc-PAH and may represent a very effective therapy for this patient population. In addition, we identified novel hemodynamic and imaging biomarkers that could have potential value in future clinical trials. Clinical trial registered with www.clinicaltrials.gov (NCT01042158).
-
Am. J. Respir. Crit. Care Med. · Nov 2015
Association Between Glucose Metabolism and Sleep-Disordered Breathing during REM Sleep.
Sleep-disordered breathing (SDB) has been associated with impaired glucose metabolism. It is possible that the association between SDB and glucose metabolism is distinct for non-REM versus REM sleep because of differences in sleep-state-dependent sympathetic activation and/or degree of hypoxemia. ⋯ AHIREM is associated with insulin resistance but not with fasting glycemia or glucose intolerance.
-
Am. J. Respir. Crit. Care Med. · Nov 2015
Airflow Limitation and Histology-shift in the National Lung Screening Trial: the NLST-ACRIN Cohort Substudy (N=18, 714).
Annual computed tomography (CT) is now widely recommended for lung cancer screening in the United States, although concerns remain regarding the potential harms, including those from overdiagnosis. ⋯ In the CT arm of the NLST-ACRIN (American College of Radiology Imaging Network) cohort, COPD status was associated with a doubling of lung cancer incidence, no apparent overdiagnosis, and a more favorable stage shift.