American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · May 1997
Does transfusion practice affect mortality in critically ill patients? Transfusion Requirements in Critical Care (TRICC) Investigators and the Canadian Critical Care Trials Group.
In 4,470 critically ill patients, we examined the impact of transfusion practice on mortality rates. As compared with survivors, patients who died in intensive care units (ICU) had lower hemoglobin values (95 +/- 26 versus 104 +/- 23 g/L, p < 0.0001) and were transfused red cells more frequently (42.6% versus 28.0%, p < 0.0001). In patients with cardiac disease, there was a trend toward an increased mortality when hemoglobin values were < 95 g/L (55% versus 42%, p = 0.09) as compared with anemic patients with other diagnoses. ⋯ In the subgroup with cardiac disease, increasing hemoglobin values in anemic patients was associated with improved survival (OR = 0.80 for each 10 g/L increase, p = 0.012). We conclude that anemia increases the risk of death in critically ill patients with cardiac disease. Blood transfusions appear to decrease this risk.
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Ultrasound has been used to evaluate diaphragm thickness in the zone of apposition of the diaphragm to the rib cage. The purpose of this study was to determine if ultrasonography could distinguish between a paralyzed and normally functioning diaphragm. We predicted that a paralyzed diaphragm would be atrophic and not shorten, therefore it would be thin and not thicken during inspiration. ⋯ In patients with unilateral paralysis, t(di) and delta t(di) for the paralyzed hemidiaphragm were significantly less than those values for the normally functioning hemidiaphragm (1.7 +/- 0.2 mm versus 2.7 +/- 0.5 mm [mean + SD] p < 0.01 for t(di), and -8.5 +/- 13% versus 65 +/- 26% [p < 0.001] for delta t(di)). The t(di) and delta t(di) for patients with bilateral diaphragm paralysis were significantly less than those values for the healthy volunteers (1.8 +/- 0.2 versus 2.8 +/- 0.4 and -1 +/- 15% versus 37 +/- 9% for t(di) and delta t(di), respectively) (p < 0.001). We conclude that ultrasound measurements of t(di) and delta t(di) can be used to determine if a diaphragm is paralyzed and confirm our predictions that a chronically paralyzed diaphragm is atrophic and does not thicken during inspiration.
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Am. J. Respir. Crit. Care Med. · May 1997
Cigarette smoke induces interleukin-8 release from human bronchial epithelial cells.
Cigarette smoking causes the development of chronic bronchitis and chronic obstructive pulmonary disease. We hypothesized that exposure to cigarette smoke might initiate release of inflammatory mediators by bronchial epithelial cells. To evaluate this, the effect of cigarette smoke extract (CSE) on IL-8 release from cultured human bronchial epithelial cells was examined. ⋯ IL-8 concentration was greater in the proximal, bronchial samples than in distal, alveolar samples, and IL-8 in BAL from smokers was higher than in BAL from nonsmokers. There was a significant correlation between IL-8 concentration and neutrophil count in bronchial samples of BAL fluid. These data support the hypothesis that exposure to cigarette smoke may induce bronchial epithelial cells to release IL-8 and that this may contribute to airway inflammation in smokers.
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Am. J. Respir. Crit. Care Med. · Apr 1997
Randomized Controlled Trial Multicenter Study Clinical TrialBovine surfactant therapy for patients with acute respiratory distress syndrome.
Lung surfactant is deficient in patients with acute respiratory distress syndrome (ARDS). We performed a randomized, prospective, controlled, open-label clinical study of administration of a bovine surfactant to patients with ARDS to obtain preliminary information about its safety and efficacy. Patients received either surfactant by endotracheal instillation in addition to standard therapy or standard therapy only. ⋯ Mortality in the same group of patients was 18.8%, as compared with 43.8% in the control group (p = 0.075). The surfactant instillation was generally well tolerated, and no safety concerns were identified. This pilot study presents preliminary evidence that surfactant might have therapeutic benefit for patients with ARDS, and provides rationale for further clinical study of this agent.
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Am. J. Respir. Crit. Care Med. · Apr 1997
Randomized Controlled Trial Multicenter Study Clinical TrialQuality of life changes in COPD patients treated with salmeterol.
Changes in health-related quality of life (HRQoL) were evaluated in patients with chronic obstructive pulmonary disease (COPD) following treatment with placebo, salmeterol 50 microg twice a day or 100 microg twice a day by metered-dose inhaler. Patients completed the disease-specific St. George's Respiratory Questionnaire (SGRQ) and the Medical Outcomes Study Short Form 36 (SF-36) at baseline and after 16 wk of treatment. ⋯ Changes in SGRQ and SF-36 scores correlated. They also showed a weak but significant relationship with FEV1. This study has shown that a modest change in lung function may be associated with clinically significant gain in health and well-being in COPD patients.