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Cardiopulmonary Effects of Increased Mixed Venous Saturation During Veno-Venous ECMO. 静脉-静脉 ECMO 期间混合静脉饱和度增加对心肺的影响。
IF 19.3 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-29 DOI: 10.1164/rccm.202409-1756LE
Ajay Kumar Jha
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引用次数: 0
Normalization of Oscillating Flow Pattern on Transcranial Duplex Colour-coded Doppler. 经颅双工彩色编码多普勒振荡血流模式的正常化。
IF 19.3 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-29 DOI: 10.1164/rccm.202404-0801IM
Andriy Katyukha, Jeffrey M Singh, Hannah Wozniak, Ghislaine Douflé
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引用次数: 0
What Is RSV Infection in Adults? 什么是成人 RSV 感染?
IF 24.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-24 DOI: 10.1164/rccm.202410-2054st
Tina V Hartert,Kathleen A Hiltz
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引用次数: 0
Serum Immunoglobulin G Levels Are Associated with Risk for Exacerbations: An Analysis of SPIROMICS. 血清免疫球蛋白 G 水平与病情恶化风险有关:SPIROMICS 分析。
IF 24.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-23 DOI: 10.1164/rccm.202311-2184oc
Michael Burnim,Nirupama Putcha,David LaFon,Han Woo,Antoine Azar,Lars Groenke,Martin Stampfli,Alexander Schaub,Ashraf Fawzy,Aparna Balasubramanian,Neal Fedarko,Christopher B Cooper,Russell P Bowler,Alejandro Comellas,Jerry A Krishnan,MeiLan K Han,David Couper,Stephen P Peters,M Bradley Drummond,Wanda O'Neal,Robert Paine,Gerard Criner,Fernando J Martinez,Jeffrey L Curtis,Graham Barr,Yvonne J Huang,Prescott Woodruff,Mark Dransfield,Nadia N Hansel
RATIONALESerum Immunoglobulin G (IgG) deficiency is associated with morbidity in chronic obstructive pulmonary disease (COPD) but it is unclear whether concentrations in the lower end of the normal range still confer risk.OBJECTIVESTo determine if levels above traditional cutoffs for serum IgG deficiency are associated with exacerbations among current and former smokers with or at risk for COPD.MEASUREMENTS AND MAIN RESULTSFormer and current smokers in SPIROMICS (n=1,497) were studied, n=1,026 with and n=471 at risk for COPD. In a subset (n=1,031), IgG subclasses were measured. Associations between total IgG or subclasses and prospective exacerbations were evaluated with multivariable models adjusting for demographics, current smoking, smoking history, FEV1% predicted, inhaled corticosteroids, and serum IgA.RESULTSThe 35th percentile (1225 mg/dL in this cohort) of IgG was the best cutoff by Akaike Information Criterion (AIC). Below this, there was increased exacerbation risk (IRR 1.28, 95% CI 1.08-1.51). Among subclasses, IgG1 and IgG2 below 35th percentile (354 and 105 mg/dL, respectively) were both associated with increased risk of severe exacerbation (IgG1: IRR 1.39, 95% CI 1.06-1.84; IgG2: IRR 1.50, 95% CI 1.14-1.1.97). These associations remained significant when additionally adjusting for history of exacerbations.CONCLUSIONSLower serum IgG is prospectively associated with exacerbations in individuals with or at risk for COPD. Among subclasses, lower IgG1 and IgG2 are prospectively associated with severe exacerbations. The optimal IgG cutoff was substantially higher than traditional cutoffs for deficiency, suggesting subtle impairment of humoral immunity may be associated with exacerbations.
理论依据血清免疫球蛋白 G (IgG) 缺乏与慢性阻塞性肺病 (COPD) 的发病率有关,但尚不清楚正常范围下限的浓度是否仍会带来风险。测量和主要结果研究了 SPIROMICS(n=1,497)中的吸烟者(n=1,026)和有慢性阻塞性肺病风险的吸烟者(n=471)。在一个子集(n=1,031)中,对 IgG 亚类进行了测量。通过多变量模型评估了总 IgG 或亚类与前瞻性病情加重之间的关系,并对人口统计学、目前吸烟情况、吸烟史、预测 FEV1%、吸入皮质类固醇和血清 IgA 进行了调整。结果IgG 的第 35 百分位数(该队列中为 1225 mg/dL)是阿凯克信息标准 (Akaike Information Criterion, AIC) 的最佳临界值。低于此值,病情恶化风险增加(IRR 1.28,95% CI 1.08-1.51)。在亚类别中,IgG1 和 IgG2 低于第 35 百分位数(分别为 354 和 105 mg/dL)均与严重病情恶化风险增加有关(IgG1:IRR 1.39,95% CI 1.06-1.84;IgG2:IRR 1.50,95% CI 1.14-1.1.97)。结论在慢性阻塞性肺病患者或高危人群中,血清 IgG 较低与病情恶化前瞻性相关。在亚类中,较低的 IgG1 和 IgG2 可能与严重的病情加重有关。最佳的 IgG 临界值远高于传统的缺乏临界值,这表明体液免疫的细微损伤可能与病情加重有关。
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引用次数: 0
Primary Immunodeficiency in ICU: A Retrospective Multicentric Study. ICU 中的原发性免疫缺陷:一项多中心回顾性研究
IF 24.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-23 DOI: 10.1164/rccm.202405-0928rl
Lucile Duvaltier,Nizar Joher,Laurent Argaud,Antoine Guillon,Muriel Picard,Emmanuel Canet,Frédéric Pène,Anne-Fleur Haudebourg,Lucie Biard,Lara Zafrani
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引用次数: 0
Peer-Driven Intervention for Care Coordination and Adherence Promotion for Obstructive Sleep Apnea: A Randomized, Parallel-Group Clinical Trial. 针对阻塞性睡眠呼吸暂停的护理协调和依从性促进的同伴驱动干预:随机、平行小组临床试验。
IF 24.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-23 DOI: 10.1164/rccm.202309-1594oc
Sairam Parthasarathy,Christopher Wendel,Michael A Grandner,Patricia L Haynes,Stefano Guerra,Daniel Combs,Stuart F Quan
RATIONALEObstructive sleep apnea (OSA) is a common condition that is usually treated by continuous positive airway pressure (CPAP) therapy, but poor adherence is common and is associated with worse patient outcomes and experiences. Patient satisfaction is increasingly adopted as a quality indicator by healthcare systems.OBJECTIVEWe tested the hypothesis that peer-driven intervention effected through interactive voice-response(PDI-IVR) system leads to better patient satisfaction (primary outcome), care-coordination, and CPAP adherence when compared to active-control.METHODSWe performed a 6-month randomized, parallel-group, controlled trial with CPAP naïve patients recruited from four centers and CPAP-adherent patients who were trained to be mentors delivering support through an IVR system.MEASUREMENTS AND RESULTSIn 263 patients, intention-to-treat analysis global satisfaction for sleep-specific services was better in the intervention group (4.57+0.71 Likert scale score) than in the active-control group (4.10+1.13; P<0.001). CPAP adherence was greater in intervention group (4.5+0.2 hours/night; 62.0+3.0% of nights >4 hours usage) versus active-control group (3.7+0.2 hours/night; 51.4+3.0% of nights >4 hours usage; P=0.014 and P=0.023). When compared to active-control group, Patient Assessment of Chronic Illness Care ratings was moderately increased by an adjusted difference of 0.33+0.12 (P=0.009); Consumer Assessment of Healthcare Provider and Systems ratings was not different (adjusted difference of 0.46+0.26; P=0.076); and Client Perception of Coordination Questionnaire was mildly better in the intervention group (adjusted difference 0.15+0.07; P=0.035).CONCLUSIONPatient satisfaction with care delivery, CPAP adherence, and care-coordination was improved by peer-driven intervention through an IVR system. New payor policies compensating peer-support may enable implementation of this approach. Clinical trial registration available at www.CLINICALTRIALSgov, ID: NCT02056002.
理论依据阻塞性睡眠呼吸暂停(OSA)是一种常见疾病,通常采用持续气道正压(CPAP)疗法进行治疗,但患者依从性差的情况很常见,而且与患者的治疗效果和体验较差有关。我们测试了这样一个假设:与主动控制相比,通过交互式语音应答(PDI-IVR)系统进行同伴驱动干预能提高患者满意度(主要结果)、护理协调和 CPAP 依从性。方法 我们进行了一项为期 6 个月的随机平行组对照试验,试验对象是从 4 个中心招募的 CPAP 初学者和 CPAP 依从者,他们都经过培训,成为通过 IVR 系统提供支持的指导者。测量和结果 在 263 名患者中,通过意向治疗分析,干预组(4.57+0.71 的李克特量表评分)对睡眠特定服务的总体满意度(4.10+1.13;P4 小时使用时间)高于主动对照组(3.7+0.2 小时/晚;51.4+3.0% 的晚间使用时间大于 4 小时;P=0.014 和 P=0.023)。与积极对照组相比,患者对慢性病护理的评价略有增加,调整后差异为 0.33+0.12 (P=0.009);消费者对医疗保健提供者和系统的评价没有差异(调整后差异为 0.46+0.26;P=0.结论患者对护理服务、CPAP 依从性和护理协调的满意度在同伴通过 IVR 系统进行干预后有所提高。对同伴支持进行补偿的新付款政策可能会促进这种方法的实施。临床试验注册网址:www.CLINICALTRIALSgov,ID:NCT02056002。
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引用次数: 0
Resolution of Acute Lung Allograft Rejection Detected by Probe-based Confocal Laser Endomicroscopy. 探针共焦激光内窥镜检测到的急性肺移植排斥反应的缓解
IF 24.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-23 DOI: 10.1164/rccm.202402-0306im
Don Hayes
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引用次数: 0
Blood Eosinophil Count: Lack of Stability and Association with Wheeze Attacks in Preschool Children. 血液嗜酸性粒细胞计数:学龄前儿童血液中嗜酸性粒细胞计数:缺乏稳定性以及与喘息发作的关系
IF 24.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-17 DOI: 10.1164/rccm.202406-1121rl
Andreas Perikleous,Sarah-Jane Bowen,Chris Griffiths,Ian Pavord,Mark Rosenthal,Louise Fleming,Andrew Bush
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引用次数: 0
Lung Ultrasound Score, Severity of Acute Lung Disease and Prolonged Mechanical Ventilation in Children. 儿童肺部超声波评分、急性肺病严重程度和长期机械通气。
IF 24.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-17 DOI: 10.1164/rccm.202404-0843oc
Ignacio Oulego-Erroz,María Del Pilar De Castro-Vecino,Rafael González-Cortés,Almudena Alonso-Ojembarrena,Antonio Rodríguez-Nuñez,Daniel Palanca-Arias,Úrsula Quesada-Ortega,Sonia Sanchiz-Cardenas,María Ángeles Murillo-Pozo,Jorge López-González,Pilar Sánchez-Yáñez,Juan Valencia-Ramos,Andrea Fernández-de la Ballina,Nuria Chaves-Caro,Raúl Borrego-Domínguez,María Sánchez-Porras,Manuel Rodríguez-Martínez,Pedro José Carballo-Martín,Lorena Bermúdez-Barrezueta,Javier Rodríguez-Fanjul,Ana Vivanco-Allende,Patricia Rodríguez-Campoy,Laia Vega-Puyal,Javier Gil-Antón,Idoia Sánchez-Martínez,Olivia Pérez-Quevedo,Marta Muñoyerro-Sesmero,Luisa Barón-González de Suso,Juan Mayordomo-Colunga
RATIONALELung ultrasound may be useful for prognostication of acute lung disease.OBJECTIVESTo assess whether the lung ultrasound score is associated with the severity of lung disease and may predict prolonged invasive mechanical ventilation in critically ill children.METHODSProspective observational multicenter study in children aged 1 month to 18 years who required respiratory support in the intensive care unit. Children with chronic parenchymal lung disease were excluded. The lung ultrasound score was obtained at 12 hours and 48-72 hours from admission. Prolonged invasive mechanical ventilation was defined as >7 consecutive days. Correlation of the lung ultrasound score with oxygenation as well as its prognostic accuracy for prolonged invasive mechanical ventilation were investigated.RESULTS538 children were included and 62 (11.5%) required prolonged mechanical ventilation. In these subjects, the lung ultrasound score was higher at 12 [24 (19-26) vs. 8 (3-14); p<0.001] and 48-72 hours [16 (10.5-22.5) vs. 6 (3-11) vs; p<0.001]. At 12 hours the lung ultrasound score correlated with oxygenation index [R2= 0.435 (95% CI: 0.293-0.566), rho coefficient -0.705, p<0.001] and oxygen saturation index [R2 0.499 (95% CI: 0.370-0.613), rho coefficient 0.651, p<0.001p<0.001]. To predict prolonged invasive mechanical ventilation, the lung ultrasound score at 12 hours had a good accuracy [AUROC=0.87 (95% CI: 0.81-0.93)] while its use in a multivariable model had an excellent accuracy both in derivation [AUROC=0.92 (95% CI: 0.89-0.95)] and internal validation [AUROC=0.91 (95% CI: 0.90-0.92)].CONCLUSIONIn critically ill children, the lung ultrasound score early after admission may predict prolonged invasive mechanical ventilation.
目的评估肺部超声波评分是否与肺部疾病的严重程度有关,并预测重症监护病房中需要呼吸支持的 1 个月至 18 岁儿童的有创机械通气时间。排除了患有慢性肺实质疾病的儿童。分别在入院 12 小时和 48-72 小时时进行肺部超声评分。有创机械通气时间超过连续 7 天定义为长期有创机械通气。研究了肺部超声评分与氧合的相关性及其对长期有创机械通气的预后准确性。在这些受试者中,12 小时[24 (19-26) vs. 8 (3-14); p<0.001]和 48-72 小时[16 (10.5-22.5) vs. 6 (3-11) vs; p<0.001]的肺部超声评分较高。12小时时,肺部超声评分与氧合指数[R2= 0.435 (95% CI: 0.293-0.566), rho系数 -0.705, p<0.001]和血氧饱和度指数[R2 0.499 (95% CI: 0.370-0.613), rho系数 0.651, p<0.001p<0.001]相关。在预测有创机械通气时间延长方面,12 小时时的肺部超声评分具有良好的准确性[AUROC=0.87 (95% CI: 0.81-0.93)],而将其用于多变量模型在推导方面也具有极佳的准确性[AUROC=0.结论 在重症儿童中,入院后早期肺部超声评分可预测有创机械通气时间的延长。
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引用次数: 0
Associations of Social Determinants and Community Resilience with Lung Cancer Incidence and Mortality in the US. 美国肺癌发病率和死亡率与社会决定因素和社区复原力的关系。
IF 24.7 1区 医学 Q1 CRITICAL CARE MEDICINE Pub Date : 2024-10-17 DOI: 10.1164/rccm.202404-0798le
Yu-Che Lee,Ko-Yun Chang,Mehdi Mirsaeidi
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引用次数: 0
期刊
American journal of respiratory and critical care medicine
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