Annals of the American Thoracic Society
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Multicenter Study Clinical Trial
Lower leptin/adiponectin ratio and risk of rapid lung function decline in chronic obstructive pulmonary disease.
The rate of annual change in FEV1 is highly variable among patients with chronic obstructive pulmonary disease (COPD). Reliable blood biomarkers are needed to predict prognosis. ⋯ A lower leptin/adiponectin ratio was associated with lung function decline in patients with COPD in two independent Japanese and Western cohort studies of populations of different ethnicity. Measure of systemic adipokines may provide utility in predicting patients with COPD at higher risk of lung function decline.
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Neurocognitive impairments are associated with reduced quality of life and may adversely affect medical compliance, but their prevalence after lung transplantation has not been extensively studied. ⋯ Neurocognitive impairments are prevalent among lung transplant candidates and appear to worsen in some patients after transplant. Delirium during hospitalization is associated with worse neurocognitive function after transplant among patients without cystic fibrosis.
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Comparative Study
An empiric antibiotic protocol using risk stratification improves antibiotic selection and timing in critically ill children.
Timely and appropriate empiric antibiotics can improve outcomes in critically ill patients with infection. Evidence and guidelines to guide empiric antibiotic decisions are lacking for critically ill children. ⋯ An empiric antibiotic protocol in the pediatric intensive care unit incorporating risk stratification for healthcare-associated infections resulted in increased appropriateness of empiric antibiotics and in decreased time to appropriate antibiotics in critically ill children with infection.
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Randomized Controlled Trial
Optimum insufflation capacity and peak cough flow in neuromuscular disorders.
For patients with neuromuscular disorders, lung insufflation with positive pressure is an accepted technique to increase inspiratory volume over VC to improve peak cough flow (PCF). ⋯ A submaximal insufflation is ideal for generating the best individual PCF even in patients with severely reduced compliance of the respiratory system. Optimum insufflation capacity can be achieved using IPPB or LIAM with moderate pressures. Both techniques are equally effective and considered safe.