Annals of the American Thoracic Society
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Multicenter Study
The Effect of Intensive Care Unit Admission Patterns on Mortality-based Critical Care Performance Measures.
Current mortality-based critical care performance measurement focuses on intensive care unit (ICU) admissions as a single group, conflating low-severity and high-severity ICU patients for whom performance may differ and neglecting severely ill patients treated solely on hospital wards. ⋯ Hospitals that perform well in caring for high-severity ICU patients do not necessarily also perform well in caring for low-severity ICU patients or high-severity ward patients, indicating that risk-standardized mortality rates for ICU admissions as a whole offer only a narrow window on a hospital's overall performance for critically ill patients.
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Hepatic hydrothorax is a complication of cirrhosis in which hydrostatic imbalances result in fluid accumulation within the pleural space. Although uncommon, this may cause significant morbidity, resulting in dyspnea requiring repeated pleural drainage procedures. Liver transplantation is curative, but it is rarely immediately available to qualified patients, presenting the clinical challenge of managing recurrent pleural effusions. Indwelling tunneled pleural catheters (ITPCs) have been used successfully to palliate dyspnea associated with recurrent malignant pleural effusions. ⋯ ITPCs may be successfully and safely used to control symptoms associated with hepatic hydrothorax. The rate of spontaneous pleurodesis that occurs is similar to that observed with ITPCs placed for malignant pleural effusion, although the infection rate may be higher. Clinical trial registered with www.clinicaltrials.gov (NCT02595567).
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Comparative Study Observational Study
Characteristics and Prevalence of Asthma/Chronic Obstructive Pulmonary Disease Overlap in the United States.
The asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) occurs in patients with fixed airway obstruction that defines COPD and with symptoms more typical of asthma. ACOS prevalence and the comorbidities associated with this syndrome have been inadequately characterized. ⋯ The patients with a dual diagnosis of asthma and COPD are younger and with more disparities than those diagnosed with COPD alone. ACOS has a higher burden of self-reported comorbidity, disability, and hospitalization or ED visitation than COPD alone.
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The ICU Mobility Scale (IMS) is a measure of mobility milestones in critically ill patients. ⋯ Our findings support the validity and responsiveness of the IMS as a measure of mobility in the ICU.
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Comparative Study
Microalbuminuria in Patients with Obstructive Sleep Apnea-Chronic Obstructive Pulmonary Disease Overlap Syndrome.
Microalbuminuria is said to reflect systemic vascular damage and endothelial dysfunction and is an established indicator of cardiovascular morbidity and mortality. Patients with obstructive sleep apnea (OSA)-chronic obstructive pulmonary disease (COPD) overlap syndrome have worse survival than those with OSA or COPD alone. ⋯ OSA-COPD overlap syndrome was more prevalent than OSA alone in patients with microalbuminuria, but the difference might be mediated by conventional risk factors rather than the addition of COPD itself.