Annals of the American Thoracic Society
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Randomized Controlled Trial Multicenter Study
Hospital patterns of mechanical ventilation for patients with exacerbations of COPD.
Randomized trials have shown that noninvasive ventilation (NIV) can reduce the need for intubation and improve the survival of patients with severe exacerbations of chronic obstructive pulmonary disease (COPD); however, it is not known whether hospitals with greater use of NIV achieve lower rates of intubation and better patient outcomes. ⋯ Use of NIV as the initial ventilation strategy for patients with COPD varies considerably across hospitals. Institutions with greater use of NIV have lower rates of invasive mechanical ventilation and better patient outcomes.
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Randomized Controlled Trial Multicenter Study
Identification of five chronic obstructive pulmonary disease subgroups with different prognoses in the ECLIPSE cohort using cluster analysis.
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease that likely includes clinically relevant subgroups. ⋯ Cluster analysis using baseline data in ECLIPSE identified five COPD subgroups that differ in outcomes and inflammatory biomarkers and show different relationships between clinical parameters, suggesting the clusters represent clinically and biologically different subtypes of COPD.
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Multicenter Study
A genome-wide association study of chronic obstructive pulmonary disease in Hispanics.
Genome-wide association studies (GWAS) of chronic obstructive pulmonary disease (COPD) have identified disease-susceptibility loci, mostly in subjects of European descent. ⋯ We have identified two novel loci (in or near the genes KLHL7/NUPL2 and DLG2) that may play a role in COPD pathogenesis in Hispanic populations.
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Based on preclinical data, cell-based therapy with bone marrow-derived mesenchymal stem (stromal) cells (MSCs) is a potentially attractive new therapeutic option for treating patients with the acute respiratory distress syndrome. Small and large animal models of acute lung injury from endotoxin, live bacteria, and sepsis have shown that MSCs can decrease lung injury and increase survival. ⋯ Some of the beneficial effects are mediated by microvesicles. A phase 1 safety and dose-escalation trial was completed and a randomized, double-blind clinical trial is currently underway.
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Review
Confronting the frustrations of negative clinical trials in acute respiratory distress syndrome.
Despite robust successes in trials of mechanical ventilation, pharmacologic interventions in acute respiratory distress syndrome have been disappointing. Although ineffective therapy remains the compelling explanation for these negative trials, other possible explanations exist. ⋯ These options can be organized into strategies that increase sample size, increase the signal from the therapy, and reduce the noise or variation in the study. Each of the strategies to improve the likelihood of a positive clinical trial poses a potential tradeoff in generalizability, cost, sample size, signal, or noise.