Respirology : official journal of the Asian Pacific Society of Respirology
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Meta Analysis Comparative Study
Comparison of tiotropium plus formoterol to tiotropium alone in stable chronic obstructive pulmonary disease: a meta-analysis.
It is not clear whether combination therapy with tiotropium plus formoterol has greater efficacy, without increasing the burden of adverse events, compared with tiotropium alone. This meta-analysis was performed to evaluate the differences in efficacy and adverse events associated with combination therapy compared with tiotropium alone, in patients with stable COPD. ⋯ Tiotropium plus formoterol significantly improved lung function and symptom scores compared with tiotropium alone. There was a trend towards a reduction in adverse events, although the difference was not statistically significant. Long-term trials are necessary to evaluate the effects of tiotropium plus formoterol and to clarify the role of combination therapy, compared with tiotropium alone.
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Review
Basic principles and current applications of lung ultrasonography in the intensive care unit.
Until recently, the sonographic visualization of pulmonary and pleural diseases was considered a poorly accessible method, due to the inability of sound to penetrate air-filled lung. Despite its limitations, lung ultrasonography is becoming an important diagnostic tool in a growing number of pathological situations such as pneumonia, atelectasis, interstitial-alveolar syndrome, pulmonary embolism, pneumothorax and pleural effusion. The low sensitivity of CXR and the difficulties of performing CT make this technique invaluable for bedside use in the intensive care unit. Lung ultrasonography is an easily repeatable and radiation-free technique, and therefore, an attractive imaging tool for use on a daily basis, especially in the management of critically ill patients.
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In recent years, a higher and higher percentage of patients with pleural effusions or pneumothorax are being treated with small-bore (10-14 F) chest tubes rather than large-bore (>20 F). However, there are very few randomized controlled studies comparing the efficacy and complication rates with the small- and large-bore catheters. Moreover, the randomized trials that are available have flaws in their design. ⋯ Most patients with pneumothorax can be managed with aspiration or small-bore chest tubes. If these fail, a large-bore chest tube may be necessary. Patients on mechanical ventilation with barotrauma induced pneumothoraces are best managed with large-bore chest tubes.