Annals of the American Thoracic Society
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Review Meta Analysis
Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease.
There is a need to identify clinically meaningful predictors of mortality following hospitalized COPD exacerbation. ⋯ Different factors correlate with mortality from COPD exacerbation in the short term, long term, and after ICU admission. These parameters may be useful to develop tools for prediction of outcome in clinical practice.
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The proliferation of endobronchial ultrasound as the standard of care in lymph node sampling has significantly impacted the way fellows are trained in transbronchial needle aspiration (TBNA). To assess the impact of starting an endobronchial ultrasound (EBUS) program on fellows training of conventional TBNA (cTBNA), we reviewed all TBNAs performed at the Johns Hopkins Hospital from September 2006 until December of 2009. ⋯ There was an associated significant decline in the number of cTBNA procedures performed by the pulmonary fellows, as well as the diagnostic yield and accuracy, when compared with EBUS. As interventional pulmonology fellowships and the overall use of EBUS become more prevalent, institutions will need to consider how to train their fellows in lymph node sampling.
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Review Meta Analysis
Meta-analysis: continuous positive airway pressure improves insulin resistance in patients with sleep apnea without diabetes.
Obstructive sleep apnea (OSA) is an independent risk factor for the development of insulin resistance (IR). Treatment with continuous positive airway pressure (CPAP) for OSA has shown conflicting results on IR. ⋯ The pooled estimate of RCTs shows a favorable effect of CPAP on insulin resistance as measured by HOMA-IR in patients with OSA without diabetes. The effect size on HOMA-IR is modest, but not insignificant, when compared with the effects of thiazolidinedione in nondiabetic patients with metabolic syndrome. Further research and RCTs are warranted involving a larger number of patients and longer treatment periods to determine the beneficial effects of CPAP on IR.
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Multicenter Study Comparative Study
Comparison of moderate versus deep sedation for endobronchial ultrasound transbronchial needle aspiration.
Most bronchoscopic procedures are performed using moderate sedation achieved by combining a short-acting benzodiazepine with an opioid agent. Propofol (2.6-diisopropylphenol), a short-acting hypnotic agent, has been increasingly used to provide deep sedation in the endoscopy community with an acceptable safety profile. ⋯ Diagnostic yield and number of lymph nodes sampled using deep sedation is superior to moderate sedation in patients undergoing EBUS-TBNA. Prospective studies accounting for other factors including patient selection and cost are needed.
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Although pulmonary function testing plays a key role in the diagnosis and management of chronic pulmonary conditions in children under 6 years of age, objective physiologic assessment is limited in the clinical care of infants and children less than 6 years old, due to the challenges of measuring lung function in this age range. Ongoing research in lung function testing in infants, toddlers, and preschoolers has resulted in techniques that show promise as safe, feasible, and potentially clinically useful tests. ⋯ In these proceedings, the current state of the art for each of these tests is reviewed as it applies to the clinical management of infants and children under 6 years of age with cystic fibrosis, bronchopulmonary dysplasia, and recurrent wheeze, using a standardized format that allows easy comparison between the measures. Although insufficient evidence exists to recommend incorporation of these tests into the routine diagnostic evaluation and clinical monitoring of infants and young children with cystic fibrosis, bronchopulmonary dysplasia, or recurrent wheeze, they may be valuable tools with which to address specific concerns, such as ongoing symptoms or monitoring response to treatment, and as outcome measures in clinical research studies.