American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Jan 1995
Comparative Studyvon Willebrand factor antigen levels are not predictive for the adult respiratory distress syndrome.
In patients with nonpulmonary sepsis, von Willebrand factor antigen (vWF:Ag or Factor VIIR:Ag) levels have been reported to be predictive for the development of the adult respiratory distress syndrome (ARDS). We addressed the ability to generalize these results by measuring serial Factor vWF:Ag levels in 96 patients at risk for the development of ARDS. Patients with sepsis, pancreatitis, hypertransfusion, witnessed aspiration of gastric contents, abdominal trauma, chest trauma, and multiple fractures were studied. ⋯ In the sepsis group, the best value for vWF:Ag above which patients would actually develop ARDS was 399%, resulting in a 70% sensitivity and a 47% specificity. For the non-sepsis patients, the optimal value was 273%, yielding a sensitivity of 64% and a specificity of 52%. We conclude that measuring vWF:Ag levels are not helpful in predicting the progression to ARDS in multiple at-risk patients.
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Am. J. Respir. Crit. Care Med. · Jan 1995
Randomized Controlled Trial Comparative Study Clinical TrialMandibular advancement splint: an appliance to treat snoring and obstructive sleep apnea.
Snoring and obstructive sleep apnea (OSA) are related to narrowing of the upper airway. A mandibular advancement splint (MAS) could improve both conditions by increasing oropharyngeal and hypopharyngeal dimensions. The effects of a MAS on snoring and OSA was evaluated 3.5 +/- 2.1 (mean +/- SD) mo after issue in 57 subjects with habitual loud snoring, 39 of whom had an apnea-hypopnea index (AHI) > or = 10. ⋯ Using the MAS significantly improved OSA: AHI decreased from 32.2 +/- 28.5 to 17.5 +/- 22.7 (p < 0.01) and arousal index decreased from 31.4 +/- 20.6 to 19.0 +/- 14.6 (p < 0.01). AHI decreased to < 20 with the MAS in 12 of 17 subjects where untreated AHI was between 20 and 60, and in 2 of 9 subjects where untreated AHI was > 60. Forty-five patients continued to use the MAS regularly.(ABSTRACT TRUNCATED AT 250 WORDS)
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Am. J. Respir. Crit. Care Med. · Jan 1995
NHLBI Task Force summary. Task Force on Research in Cardiopulmonary Dysfunction in Critical Care Medicine.
Research accomplishments during the past decade have led to a much greater understanding of molecular, cellular, and pathophysiological derangements occurring in the lung and other organ systems during critical illness. Despite this progress, care of critically ill patients with cardiopulmonary dysfunction remains a major health challenge. ⋯ Key observations gained through clinical and epidemiological studies must be tested in the basic science laboratory. Increased and coordinated efforts in epidemiology, clinical, and basic research are essential for future progress.
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Am. J. Respir. Crit. Care Med. · Jan 1995
Comparative StudyDecreased tobacco-glycoprotein-induced lymphocyte proliferation in vitro in pulmonary eosinophilic granuloma.
Pulmonary eosinophilic granuloma is a disorder caused by localized collections of proliferating histiocytes in the lung. Little is known about its etiology except that the majority (58 to 97%) of patients are current or ex-smokers, making the potential etiologic role of tobacco products an important area for research. Tobacco glycoprotein (TGP) is a potent immunostimulator that has been isolated from cigarette smoke. ⋯ The mean responses of the patients with pulmonary eosinophilic granuloma to TGP was significantly lower than the mean of nondiseased smokers or of normal nonsmokers. Twenty-four-hour culture supernatants were collected and assayed for cytokine levels (IL-1, IL-2, and IL-6). TGP-stimulated IL-2 production was significantly lower in the patients with pulmonary eosinophilic granuloma than in the normal subjects, confirming the reduced T-cell proliferative response.(ABSTRACT TRUNCATED AT 250 WORDS)
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Am. J. Respir. Crit. Care Med. · Dec 1994
Comparative StudyVentilator-associated pneumonia by Staphylococcus aureus. Comparison of methicillin-resistant and methicillin-sensitive episodes.
All episodes of ventilator-associated pneumonia (VAP) caused by Staphylococcus aureus were prospectively analyzed for a 30-mo period. Methicillin-sensitive S. aureus (MSSA) was isolated in 38 episodes and methicillin-resistant S. aureus (MRSA) in 11 others. The two groups were similar regarding sex, severity of underlying diseases, prior surgery, and presence of renal failure, diabetes, cardiopathy, and coma. ⋯ Finally, mortality directly related to pneumonia was significantly higher among patients with MRSA episodes (RR = 20.72, 95% CI = 2.78-154.35). This analysis was repeated for monomicrobial episodes, and the difference remained statistically significant. We conclude that MRSA and MSSA strains infect patients with different demographic profiles; previous antibiotic therapy is the most important risk factor for developing MRSA infection.(ABSTRACT TRUNCATED AT 250 WORDS)