American journal of respiratory and critical care medicine
-
Am. J. Respir. Crit. Care Med. · Dec 2017
Review50 Years of Research in ARDS. Long-term Follow-up After ARDS: Insights for Managing Medical Complexity After Critical Illness.
Critical illness is not a discrete disease state or syndrome. It is the culmination of a multiplicity of heterogeneous disease states and their varied health trajectories leading to extreme illness that requires advanced life support in a distinct geographic location in the hospital. It is a marker of newly acquired or worsened medical complexity and multimorbidities. ⋯ Engagement in frank and transparent communication with our patients and their caregivers about the very real and morbid consequences of being this sick is essential. We must enforce explicit consent about the morbidity of innovative, experimental, or high-risk medical and surgical procedures and ensure that our ongoing level of treatment aligns with patients' and caregivers' goals and values. Interprofessional and multidisciplinary collaboration is crucial to modify existing complex care pathways for our patients and their families to foster optimal rehabilitation and reintegration into the workplace and community.
-
Am. J. Respir. Crit. Care Med. · Dec 2017
Multicenter StudyEffect of Obstructive Sleep Apnea Treatment on Renal Function in Patients with Cardiovascular Disease.
Obstructive sleep apnea (OSA) is associated with impaired renal function, but uncertainty exists over whether OSA treatment can influence renal outcomes. ⋯ CPAP treatment of OSA in patients with cardiovascular disease does not alter renal function or the occurrence of renal adverse events. Clinical trial registered with www.clinicaltrials.gov (NCT00738179).
-
Am. J. Respir. Crit. Care Med. · Dec 2017
Prenatal Nitrate Exposure and Childhood Asthma: Influence of Maternal Prenatal Stress and Fetal Sex.
Impact of ambient pollution upon children's asthma may differ by sex, and exposure dose and timing. Psychosocial stress can also modify pollutant effects. These associations have not been examined for in utero ambient nitrate exposure. ⋯ Prenatal NO3- exposure during distinct sensitive windows was associated with incident asthma in boys concurrently exposed to high prenatal stress.
-
Am. J. Respir. Crit. Care Med. · Dec 2017
High Attenuation Areas on Chest CT and Clinical Respiratory Outcomes in Community-dwelling Adults.
Areas of increased lung attenuation visualized by computed tomography are associated with all-cause mortality in the general population. It is uncertain whether this association is attributable to interstitial lung disease (ILD). ⋯ Areas of increased lung attenuation are a novel risk factor for ILD hospitalization and mortality. Measurement of high-attenuation areas by screening and diagnostic computed tomography may be warranted in at-risk adults.