Annals of the American Thoracic Society
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Recent studies on video laryngoscopy have demonstrated improvements in both safety and success of endotracheal intubation in the critically ill. ⋯ The majority of internal medicine critical care program directors who recently responded to an e-mail survey reported that they have changed their approach to teaching endotracheal intubation, driven largely by the adoption of video laryngoscopy for upper airway visualization. Nevertheless, despite widespread availability, video laryngoscopy is used uncommonly as the primary visualization device for intubation at the programs represented by the respondents to this survey.
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Randomized Controlled Trial Multicenter Study
Abdominal and general adiposity and level of asthma control in adults with uncontrolled asthma.
Abdominal adiposity may be an important risk factor for uncontrolled asthma in adults, controlling for general obesity. Whether the relationship, if present, is explained by other factors (e.g., asthma onset age, sex, and/or coexisting conditions) is unclear. ⋯ Abdominal adiposity by waist-to-height ratio and poor sleep quality correlated with poorer asthma control in adults with uncontrolled asthma, after controlling for BMI and sociodemographics. These results warrant replication in larger studies of diverse populations. Clinical trial registered with www.clinicaltrials.gov (NCT 01725945).
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Multicenter Study Comparative Study
Use and outcomes associated with long-acting bronchodilators among patients hospitalized for chronic obstructive pulmonary disease.
Long-acting β-adrenergic agonists and long-acting anticholinergic agents are recommended for the management of patients with stable chronic obstructive pulmonary disease (COPD); however, their role in the acute setting is uncertain. ⋯ Despite a lack of evidence, LABDs are commonly prescribed to patients hospitalized for exacerbations of COPD but are not associated with better clinical or economic outcomes. Clinical trials are needed to determine the optimal use of these medications in the acute care setting.
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Review Case Reports
Physiological and management implications of obesity in critical illness.
Obesity is highly prevalent in the United States and is becoming increasingly common worldwide. The anatomic and physiological changes that occur in obese individuals may have an impact across the spectrum of critical illness. Obese patients may be more susceptible to hypoxemia and hypercapnia. ⋯ Logistical issues such as blood pressure cuff sizing, ultrasound assistance for procedures, diminished quality of some imaging modalities, and capabilities of hospital equipment such as beds and lifts are important considerations. Despite the physiological alterations and logistical challenges involved, it is not clear whether obesity has an effect on mortality or long-term outcomes from critical illness. Effects may vary by type of critical illness, obesity severity, and obesity-associated comorbidities.