Annals of the American Thoracic Society
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Editorial Comment
Toward a Renascence of Physical Diagnosis in the Intensive Care Unit.
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The American Thoracic Society (ATS) previously published standards for Flexible Airway Endoscopy (FAE) in children in the American Review of Respiratory Diseases in 1992 [1]. Since that time there have been significant advances in the field with expansion in the use of FAE for diagnostic and therapeutic purposes. ⋯ The technical standards describe the equipment, personnel, competencies, and procedures necessary for pediatric FAE. This summary is prepared for practicing clinicians.
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Prognostic models can inform management decisions for patients requiring prolonged mechanical ventilation. The ProVent score was developed to predict one-year mortality in these patients. External evaluation of such models is needed before they are adopted for routine use. ⋯ The modified ProVent model was accurate in our cohort. This supports its geographic and temporal generalizability. It can also accurately identify patients at risk of one-year mortality at day 14 of mechanical ventilation, but additional confirmation is required. Further studies should explore the implications of adopting the model into routine use. 347 words .
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Research that applies an unreliable definition for transfusion-related acute lung injury (TRALI) may draw false conclusions about its risk factors and biology. The effectiveness of preventive strategies may decrease as a consequence. However, the reliability of the consensus TRALI definition is unknown. ⋯ The epidemiology of TRALI varies when applying two plausible definitions of acute respiratory distress syndrome onset time to severely injured trauma patients. A TRALI definition that standardizes acute respiratory distress syndrome onset time might improve reliability and align efforts to understand epidemiology, biology, and prevention.
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Measures of unstable ventilatory control (loop gain) can be obtained directly from the periodic breathing duty ratio on polysomnography in patients with Cheyne-Stokes respiration/central sleep apnea and can predict the efficacy of continuous positive airway pressure (CPAP) therapy. ⋯ In this pilot study, loop gain was higher for patients with complex sleep apnea in whom central apneas persisted after 1 month of CPAP therapy (nonresponders). Loop gain measurement may enable an a priori determination of those who need alternative modes of positive airway pressure.