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Further research needed before removal of morphine from the therapeutic armoury for breathlessness 在将吗啡从治疗呼吸困难的药物中移除之前,还需要进一步的研究
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2025-11-06 DOI: 10.1016/s2213-2600(25)00389-3
Miriam J Johnson, Sabrina Bajwah, Nazia Chaudhuri, David C Currow, Marie T Fallon
No Abstract
没有抽象的
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引用次数: 0
A paradigm shift in corticosteroid therapy for sarcoidosis: a World Association of Sarcoidosis and Other Granulomatous Disorders Position Paper, endorsed by the Americas Association of Sarcoidosis and Other Granulomatous Disorders 结节病皮质类固醇治疗的范式转变:由美洲结节病和其他肉芽肿疾病协会批准的世界结节病和其他肉芽肿疾病协会立场文件
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2025-11-06 DOI: 10.1016/s2213-2600(25)00338-8
For over seven decades, oral corticosteroids have been the cornerstone of sarcoidosis management. Oral corticosteroids suppress sarcoidosis inflammati…
70多年来,口服皮质类固醇一直是结节病治疗的基石。口服糖皮质激素抑制结节病炎症…
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引用次数: 0
US lung cancer report suggests years of encouraging progress under threat from health agency cuts 美国肺癌报告显示,多年来令人鼓舞的进展受到卫生机构削减的威胁
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2025-11-06 DOI: 10.1016/s2213-2600(25)00402-3
Tony Kirby
No Abstract
没有抽象的
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引用次数: 0
Towards a new treatment era in sarcoidosis 迈向结节病治疗新时代
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2025-11-06 DOI: 10.1016/s2213-2600(25)00391-1
Katie Bechman, James Galloway, Surinder S Birring
No Abstract
没有抽象的
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引用次数: 0
Climate change and tuberculosis: an analytical framework 气候变化与结核病:一个分析框架
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2025-10-30 DOI: 10.1016/s2213-2600(25)00329-7
Matthew J Saunders, Delia Boccia, Palwasha Y Khan, Lara Goscé, Antonio Gasparrini, Rebecca A Clark, Julia M Pescarini, Salome Charalambous, Lelisa Fekadu, Fernanda Dockhorn da Costa Johansen, Irina Vasilyeva, Gopalan Narendran, Tao Li, Norbert Ndjeka, Richard G White, Rein M G J Houben, Matteo Zignol, Nebiat Gebreselassie, Christopher Finn McQuaid
Climate change is likely to exacerbate a range of determinants that drive tuberculosis, the world's leading cause of death from a single infectious agent. However, tuberculosis is often neglected in wider climate health discussions. Commissioned by WHO, we developed an analytical framework outlining potential causal relationships between climate change and tuberculosis. We drew on existing knowledge of tuberculosis determinants, identified determinants likely to be sensitive to the effects of climate change, and conceptualised the mechanistic pathways through which these effects might occur. We collated evidence for these pathways, but found no studies directly linking climate change and tuberculosis, warranting research to build evidence for action. Nevertheless, the available indirect evidence supports the existence of plausible causal links between climate change and tuberculosis. This evidence highlights the need to consider tuberculosis as a climate-sensitive disease, and include tuberculosis in climate risk adaptation and mitigation programmes, and climate-resilient funding and response mechanisms. Only through urgent research and comprehensive action can we address this overlooked intersection and ensure that climate change does not become a barrier to ending the global tuberculosis epidemic.
气候变化可能会加剧导致结核病的一系列决定因素,结核病是世界上单一传染性病原体导致死亡的主要原因。然而,在更广泛的气候健康讨论中,结核病往往被忽视。受世卫组织委托,我们制定了一个分析框架,概述了气候变化与结核病之间的潜在因果关系。我们利用结核病决定因素的现有知识,确定了可能对气候变化影响敏感的决定因素,并概念化了这些影响可能发生的机制途径。我们整理了这些途径的证据,但没有发现将气候变化和结核病直接联系起来的研究,因此有必要通过研究来建立行动证据。然而,现有的间接证据支持气候变化与结核病之间存在似是而非的因果关系。这一证据突出表明,需要将结核病视为一种气候敏感疾病,并将结核病纳入气候风险适应和缓解方案以及气候适应型供资和应对机制。只有通过紧急研究和全面行动,我们才能解决这一被忽视的交叉点,并确保气候变化不会成为结束全球结核病流行的障碍。
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引用次数: 0
Remission in chronic cough: an achievable target? 慢性咳嗽缓解:一个可实现的目标?
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2025-10-28 DOI: 10.1016/s2213-2600(25)00361-3
Ewan C Mackay, Peter S P Cho, Surinder S Birring, James H Hull
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引用次数: 0
FeNO or no FeNO in COPD? 慢性阻塞性肺病患者是否有FeNO ?
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2025-10-28 DOI: 10.1016/s2213-2600(25)00368-6
Huib A M Kerstjens, Maarten van den Berge
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引用次数: 0
Redefining outcomes in asthma—remission and beyond 重新定义哮喘缓解及以后的结果
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2025-10-14 DOI: 10.1016/s2213-2600(25)00367-4
No Abstract
没有抽象的
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引用次数: 0
Deep sedation in the ICU: at what cost? 重症监护病房的深度镇静:成本是多少?
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2025-10-11 DOI: 10.1016/s2213-2600(25)00322-4
Mark van den Boogaard, Thomas Ottens
No Abstract
没有抽象的
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引用次数: 0
Association of medication-induced deep sedation and emotional distress during mechanical ventilation with loss of independent living: an observational cohort study 机械通气期间药物诱导的深度镇静和情绪困扰与独立生活丧失的关联:一项观察性队列研究
IF 76.2 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2025-10-11 DOI: 10.1016/s2213-2600(25)00264-4
Karuna Wongtangman, Felix Borngaesser, Maíra I Rudolph, Flora T Scheffenbichler, Michael E Kiyatkin, Ibraheem M Karaye, William J Sauer
<h3>Background</h3>Deep sedation can be used during invasive mechanical ventilation without proven indication to treat the signs and symptoms of emotional distress or insomnia. However, medication-induced deep sedation is associated with delayed recovery and increased mortality. We tested the hypothesis that medication-induced deep sedation, but not emotional distress, is associated with loss of independent living.<h3>Methods</h3>In this retrospective cohort study, we included adult patients (age ≥18 years) who lived independently before hospital admission and were mechanically ventilated for at least 24 h in any of 20 ICUs at an academic health system in the Bronx, New York (NY, USA), and adjacent counties. The primary exposure was the proportion of time spent in medication-induced deep sedation (defined as a Richmond Agitation Sedation Score of –3 to –5) within the first week of ICU admission. The secondary exposure was the proportion of time with indicators of emotional distress within the first week of ICU admission. The exposures were categorised as none, a low proportion, or a high proportion using the median (42·9% for medication-induced deep sedation and 10·7% for emotional distress) as the cutoff between low and high. The primary outcome was loss of independent living (defined as in-hospital death or postoperative discharge to a long-term skilled nursing facility). Modified Poisson regression with an a priori-defined confounder control model were used to assess the association between exposures and outcomes. Mediation analysis was done to evaluate whether patient mobilisation level during mechanical ventilation contributed to the association between deep sedation and loss of independent living.<h3>Findings</h3>Among 10 204 patients receiving invasive mechanical ventilation between Jan 30, 2016 and July 11, 2023, 6369 (62·4%) had a loss of independent living. The proportion of patients who received deep sedation was a mean 2·84-fold (SD 1·51) higher than the proportion of patients who had an order for deep sedation. 7289 (71·4%) patients had at least one episode of medication-induced deep sedation within the first week of mechanical ventilation in the ICU. A high proportion of medication-induced deep sedation was associated with an increased risk of loss of independent living (adjusted risk ratio [RR<sub>adj</sub>] 1·18 [95% CI 1·13–1·23], p<0·0001) compared with no medication-induced deep sedation. There were 30 022 documented episodes of emotional distress. Having a high proportion of emotional distress was associated with a decreased risk of loss of independent living (RR<sub>adj</sub> 0·88 [0·84–0·92], p<0·0001) compared with no emotional distress. Clinicians provided deeper sedation in response to emotional distress and during the night (p<0·0001 for both comparisons). Symptom control with antipsychotics or non-opioid analgesics was associated with a decreased risk of loss of independent living compared with no treatment (RR
背景:深度镇静可用于无证据适应症的有创机械通气期间治疗情绪困扰或失眠的体征和症状。然而,药物诱导的深度镇静与恢复延迟和死亡率增加有关。我们测试了药物诱导的深度镇静,而不是情绪困扰,与独立生活的丧失有关的假设。方法在这项回顾性队列研究中,我们纳入了住院前独立生活的成年患者(年龄≥18岁),这些患者在纽约布朗克斯(NY, USA)及其邻近县的一个学术卫生系统的20个icu中的任何一个icu中进行了至少24小时的机械通气。主要暴露是在ICU入院第一周内用于药物诱导深度镇静的时间比例(定义为Richmond搅拌镇静评分为-3至-5)。二次暴露是指患者在ICU入院第一周内出现情绪困扰指标的时间比例。使用中位数(药物诱导的深度镇静为42.9%,情绪困扰为10.7%)作为低和高之间的分界线,将暴露分为无暴露、低比例或高比例。主要结局是丧失独立生活(定义为住院死亡或术后出院到长期专业护理机构)。使用修正泊松回归和优先定义的混杂控制模型来评估暴露与结果之间的关系。进行中介分析以评估患者在机械通气期间的活动水平是否与深度镇静和独立生活丧失之间的关联有关。结果2016年1月30日至2023年7月11日接受有创机械通气的10204例患者中,6369例(62.5%)丧失独立生活能力。接受深度镇静的患者比例比接受深度镇静命令的患者比例平均高出2.84倍(SD为1.51)。7289例(71.4%)患者在ICU机械通气的第一周内至少发生一次药物诱导的深度镇静。与未使用药物诱导深度镇静相比,高比例的药物诱导深度镇静与独立生活丧失风险增加相关(调整风险比[RRadj] 1.18 [95% CI 1.13 - 1.23], p< 0.0001)。有30022次记录在案的情绪困扰。与无情绪困扰者相比,情绪困扰比例高与丧失独立生活风险降低相关(RRadj 0.88 [0.84 - 0.92], p< 0.0001)。临床医生在情绪困扰和夜间提供更深的镇静(p< 0.0001)。与未治疗相比,使用抗精神病药物或非阿片类镇痛药控制症状与丧失独立生活风险降低相关(RRadj 0.95 [0.91 - 0.99], p= 0.013)。患者在机械通气期间缺乏活动能力与独立生活丧失相关(RRadj 1.32 [1.28 - 1.36], p< 0.0001),并介导了深度镇静对独立生活丧失影响的32.5% (p< 0.0001)。在ICU的机械通气成人中,药物诱导深度镇静的时间比例与独立生活的丧失独立相关。较轻的镇静,允许识别情绪困扰和患者的活动,与较低的风险丧失独立生活有关。阿尔伯特·爱因斯坦医学院Montefiore医学中心麻醉科(美国纽约)。
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引用次数: 0
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Lancet Respiratory Medicine
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