American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Aug 2015
Trends in Tracheostomy for Mechanically Ventilated Patients in the United States, 1993-2012.
National trends in tracheostomy for mechanical ventilation (MV) patients are not well characterized. ⋯ Over the past two decades, tracheostomy use rose substantially in the United States until 2008, when use began to decline. The observed dramatic increase in discharge of tracheostomy patients to long-term care facilities may have significant implications for clinical care, healthcare costs, policy, and research. Future studies should include long-term facilities when analyzing outcomes of tracheostomy.
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Am. J. Respir. Crit. Care Med. · Aug 2015
Timing and Duration of Traffic-Related Air Pollution Exposure and the Risk for Childhood Wheeze and Asthma.
The timing and duration of traffic-related air pollution (TRAP) exposure may be important for childhood wheezing and asthma development. ⋯ Early-life exposure to TRAP is associated with increased risk for persistent wheezing, but only long-term exposure to high levels of TRAP throughout childhood was associated with asthma development.
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Am. J. Respir. Crit. Care Med. · Aug 2015
Institutional Tuberculosis Transmission: Controlled Trial of Upper Room Ultraviolet Air Disinfection - A Basis for New Dosing Guidelines.
Transmission is driving the global tuberculosis epidemic, especially in congregate settings. Worldwide, natural ventilation is the most common means of air disinfection, but it is inherently unreliable and of limited use in cold climates. Upper room germicidal ultraviolet (UV) air disinfection with air mixing has been shown to be highly effective, but improved evidence-based dosing guidelines are needed. ⋯ Upper room germicidal UV air disinfection with air mixing was highly effective in reducing tuberculosis transmission under hospital conditions. These data support using either a total fixture output (rather than electrical or UV lamp wattage) of 15-20 mW/m(3) total room volume, or an average whole-room UV irradiance (fluence rate) of 5-7 μW/cm(2), calculated by a lighting computer-assisted design program modified for UV use.
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Am. J. Respir. Crit. Care Med. · Aug 2015
The Host Response to the Lung Microbiome in Chronic Obstructive Pulmonary Disease.
The relatively sparse but diverse microbiome in human lungs may become less diverse in chronic obstructive pulmonary disease (COPD). This article examines the relationship of this microbiome to emphysematous tissue destruction, number of terminal bronchioles, infiltrating inflammatory cells, and host gene expression. ⋯ These results support the hypothesis that there is a host immune response to microorganisms within the lung microbiome that appears to contribute to the pathogenesis of COPD.