The American review of respiratory disease
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Am. Rev. Respir. Dis. · Dec 1993
Randomized Controlled Trial Comparative Study Clinical TrialEarly bactericidal and sterilizing activities of ciprofloxacin in pulmonary tuberculosis.
The early bactericidal and sterilizing activities of ciprofloxacin were evaluated in the treatment of adult patients with smear positive pulmonary tuberculosis. Two randomized prospective studies were performed in Northern Tanzania. In study 1, ten patients received either 750 mg ciprofloxacin or 300 ng isoniazid daily for 7 days. ⋯ When HRZE and HRC regimens were compared, the HRC regimen appeared to be inferior in its sterilizing ability, with a culture conversion rate of 67% at 2 months compared with 100% for HRZE. The difference in outcome was most marked in HIV-1 positive patients. The role of ciprofloxacin in combination regimens may be as a bactericidal rather than a sterilizing agent.
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Am. Rev. Respir. Dis. · May 1993
Randomized Controlled Trial Clinical TrialPEEP does not improve pulmonary mechanics in infants with bronchiolitis.
Positive end-expiratory pressure (PEEP) may improve pulmonary mechanics, work of breathing, and gas exchange in some patients with respiratory failure. These beneficial effects do not occur consistently, however, and side effects, such as gas trapping due to expiratory flow limitation, may be exacerbated. We determined the effects of PEEP (0, 3, 6, and 9 cm H2O applied in random order) on the expiratory airway resistance and static compliance of nine infants mechanically ventilated for acute bronchiolitis. ⋯ Increases in end-expiratory lung volumes ranged from 18 to 40% of the tidal volume at maximal PEEP. Although all infants had PEEPi (5 +/- 2 cm H2O), PEEPi had no influence on the response of mechanics to applied PEEP other than that peak inspiratory pressures increased when PEEP > PEEPi. We conclude that the routine use of PEEP in infants with bronchiolitis does not consistently improve passive expiratory pulmonary mechanics and may increase the risk of barotrauma from gas trapping.
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Am. Rev. Respir. Dis. · Oct 1992
Randomized Controlled Trial Comparative Study Clinical TrialOxygen may improve dyspnea and endurance in patients with chronic obstructive pulmonary disease and only mild hypoxemia.
Oxygen (O2) has been reported to improve exercise tolerance in some patients with chronic obstructive pulmonary disease (COPD) despite only mild resting hypoxemia (PaO2 greater than 60 mm Hg). To confirm these prior studies and evaluate potential mechanisms of benefit, we measured dyspnea scores by numeric rating scale during cycle ergometry endurance testing and correlated the severity of dyspnea with right ventricular systolic pressure (RVSP) measured by Doppler echocardiography during a separate supine incremental exercise test. Both sets of exercise were performed according to a randomized double-blind crossover protocol in which patients breathed compressed air or 40% O2. ⋯ Duration of exercise increased on 40% O2 from 10.3 +/- 1.6 to 14.2 +/- 1.5 min (p = 0.005), and the rise in dyspnea scores was delayed. Oxygen delayed the rise in RVSP with incremental exercise in all patients and lowered the mean RVSP at maximum exercise from 71 +/- 8 to 64 +/- 7 mm Hg (p less than 0.03). Improvement in duration of exercise correlated with decrease in dyspnea (r2 = 0.66, p = 0.001) but not with decreases in heart rate, minute ventilation, or RVSP.(ABSTRACT TRUNCATED AT 250 WORDS)
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Am. Rev. Respir. Dis. · Aug 1992
Randomized Controlled Trial Comparative Study Clinical TrialEffect of inhaled furosemide and torasemide on bronchial response to ultrasonically nebulized distilled water in asthmatic subjects.
Inhaled furosemide has been shown to reduce the bronchoconstriction induced by several indirect stimuli, including ultrasonically nebulized distilled water (UNDW). Because the protective effect could be due to the inhibition of the Na(+)-2Cl(-)-K+ cotransport system of bronchial epithelium, we have compared the protective effect of inhaled furosemide with that of inhaled torasemide, a new and more potent loop diuretic, on UNDW-induced bronchoconstriction in a group of 12 asthmatic subjects. UNDW challenge was performed by constructing a stimulus-response curve with five increasing volume outputs of distilled water (from 0.5 to 5.2 ml/min) and the bronchial response expressed as the provocative output causing a 20% fall in FEV1 (PO20UNDW). ⋯ A remarkable increase in diuresis was noted only after torasemide in most subjects. We conclude that inhaled furosemide has a better protective effect than does inhaled torasemide against UNDW-induced bronchoconstriction. However, the protective effect of furosemide is variable, with some asthmatic patients showing no change in bronchial response to UNDW.(ABSTRACT TRUNCATED AT 250 WORDS)
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Am. Rev. Respir. Dis. · May 1992
Randomized Controlled Trial Clinical TrialImproved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization.
We performed a randomized, prospective trial to evaluate whether fluid management that emphasized diuresis and fluid restriction in patients with pulmonary edema could affect the development or resolution of extravascular lung water (EVLW), as well as time on mechanical ventilation and time in the intensive care unit (ICU), in critically ill patients requiring pulmonary artery catheterization (PAC). PAC was performed on 101 patients. A total of 52 patients were randomized to an EVLW management group using a protocol based on bedside indicator-dilution measurements of EVLW. ⋯ EVLW decreased significantly, and ventilator-days and ICU days were significantly shorter only in patients from the EVLW group. No clinically significant adverse effect occurred as a result of following the EVLW group algorithm. Thus, a lower positive fluid balance, especially in patients with pulmonary edema regardless of cause, is associated with reduced EVLW, ventilator-days, and ICU days.