American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Apr 2017
SIgA Deficiency in Individual Small Airways is Associated with Persistent Inflammation and Remodeling.
Maintenance of a surface immune barrier is important for homeostasis in organs with mucosal surfaces that interface with the external environment; however, the role of the mucosal immune system in chronic lung diseases is incompletely understood. ⋯ Our findings support the concept that localized, acquired SIgA deficiency in individual small airways of patients with COPD allows colonizing bacteria to cross the epithelial barrier and drive persistent inflammation and airway wall remodeling, even after smoking cessation.
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Am. J. Respir. Crit. Care Med. · Apr 2017
Randomized Controlled Trial Multicenter StudyRandomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions-The ASAP Trial.
Patients with malignant pleural effusions have significant dyspnea and shortened life expectancy. Indwelling pleural catheters allow patients to drain pleural fluid at home and can lead to autopleurodesis. The optimal drainage frequency to achieve autopleurodesis and freedom from catheter has not been determined. ⋯ Among patients with malignant pleural effusion, daily drainage of pleural fluid via an indwelling pleural catheter led to a higher rate of autopleurodesis and faster time to liberty from catheter. Clinical trial registered with www.clinicaltrials.gov (NCT 00978939).
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Am. J. Respir. Crit. Care Med. · Apr 2017
Randomized Controlled Trial Multicenter StudyFluctuation Analysis of Peak Expiratory Flow and its Association with Treatment Failure in Asthma.
Temporal fluctuations have been demonstrated in lung function and asthma control, but the effect of controller therapy on these fluctuations is unknown. ⋯ We conclude that increased temporal self-similarity (α) of more variable lung function (CVpef) is associated with treatment failure, but the pattern of change in self-similarity leading up to treatment failure is variable across individuals.
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Am. J. Respir. Crit. Care Med. · Apr 2017
Partial Neuromuscular Blockade During Partial Ventilatory Support in Sedated Patients with High Tidal Volumes.
Controlled mechanical ventilation is used to deliver lung-protective ventilation in patients with acute respiratory distress syndrome. Despite recognized benefits, such as preserved diaphragm activity, partial support ventilation modes may be incompatible with lung-protective ventilation due to high Vt and high transpulmonary pressure. As an alternative to high-dose sedatives and controlled mechanical ventilation, pharmacologically induced neuromechanical uncoupling of the diaphragm should facilitate lung-protective ventilation under partial support modes. ⋯ Partial neuromuscular blockade facilitates lung-protective ventilation during partial ventilatory support, while maintaining diaphragm activity, in sedated patients with lung injury.