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An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome For all patients with ARDS, the recommendation is strong for mechanical ventilation using lower tidal volumes (4–8 ml/kg predicted body weight) and lower inspiratory pressures (plateau pressure , 30 cm H2O) (moderate confidence in effect estimates). For patients with severe ARDS, the recommendation is strong for prone positioning for more than 12 h/d (moderate confidence in effect estimates). For patients with moderate or severeARDS, the recommendation is strong against routine use of high-frequency oscillatory ventilation (high confidence in effect estimates) and conditional for higher positive end-expiratory pressure (moderate confidence in effect estimates) and recruitment maneuvers (low confidence in effect estimates). Additional evidence is necessary to make a definitive recommendation for or against the use of extracorporeal membrane oxygenation in patients with severe ARDS.
COPD-OSA Overlap Syndrome The recognition of co-existing OSA in COPD patients has important clinical relevance as the management of patients with overlap syndrome is different from COPDalone, and the survival of overlap patients not treated with nocturnal positive airway pressure is significantly inferior to those overlap patients appropriately treated.
Severe eosinophilic asthma: a roadmap to consensus Adult-onset asthma patients with a high blood eosinophil count (⩾0.3×109 per L) have been found to have a distinct phenotype of severe asthma with frequent exacerbations and poor prognosis Persistent airflow limitation and distal inflammation with air trapping are common in these patients, as is upper airway pathology such as chronic rhinosinusitis with nasal polyposis .
Targeted therapy in the management of severe asthma patients High T2 High esinophil count and HIGH igE They are responsive to corticosteriods and biological Low T2 Normal esnophil count and normal IgE THEY ARE POOR TO STERIODS AND POOR RESPONSE TO BIOLOGICALS
What is a chest infection and what causes it? Acute bronchitis This is an infection of the large airways in the lungs (bronchi). Acute bronchitis is common and is often due to a viral infection. Infection with a germ (bacterium) is a less common cause. Pneumonia This is a serious infection of the lung. Treatment with medicines called antibiotics is usually needed. How common are chest infections? Chest infections are very common, especially during the autumn and winter. They often occur after a cold or flu. Anyone can get a chest infection but they are more common in: Young children and the elderly. People who smoke. People with long-term chest problems such as asthma. What are the symptoms of a chest infection? The main symptoms are a chesty cough, breathing difficulties and chest pain. You may also have headaches and have a high temperature (fever). The symptoms of an infection of the large airways (bronchi) in the lungs (acute bronchitis) and a serious lung infection (pneumonia) may be similar; however, pneumonia symptoms are usually more severe
Diagnostic Yield and Complications of Transbronchial Lung Cryobiopsy for Interstitial Lung Disease. A Systematic Review and Metaanalysis The diagnostic accuracy of transbronchial lung cryobiopsy cannot be determined given the absence of studies directly comparing cryobiopsy diagnoses with diagnoses derived from surgical lung biopsies interpreted within multidisciplinary discussions. The histopathological and multidisciplinary discussion-based diagnostic yield of transbronchial cryobiopsy appears high, but with variable frequencies of complications dominated by pneumothorax and moderate-to-severe hemorrhage.
The Treatment of Diabetes Through Improved Quality of Sleep about half of those who suffer from Type 2 diabetes suffer from obstructive sleep apnea, independent of obesity, as was previously unknown. existence of sleep apnea in diabetics creates insulin resistance and increased fasting glucose without regard to whether the patient also suffers from obesity. That is, if you suffer from sleep apnea, and it remains untreated the insulin that is vital to your quality of life, may not be working to its full potential. Further, the more severe the sleep apnea, the greater the degree of increased resistance to insulin and fasting glucose we find in your body. This validates the idea that a correlation exists between diabetes and sleep apnea. This correlation requires that treatment for diabetes be done in combination with treatment for sleep apnea so as to achieve the best results.
Use of Biological Agents in Asthma: Despite advances in asthma initiatives, there continues to be a large population of patients with severe asthma whose condition remains uncontrolled despite the use of inhaled combination corticosteroids and long-acting beta-agonist treatment. For this population, which may include as many as one-third of all patients with asthma, biological therapy is often a treatment consideration in specialist clinics.
severe obstructive sleep apnea was associated with depressive symptoms, especially among those who also had excessive daytime sleepiness
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