Adherence to sleep apnea therapy and use of lipid-lowering drugs: a study of the healthy-user effect.

Background: Evidence that continuous positive airway pressure (CPAP) reduces cardiovascular morbidity comes largely from observational studies. This association may be confounded if CPAP adherents are healthier in ways not measured by investigators. We assessed whether patients adhering to lipid-lowering medications were more adherent to CPAP.

Plasma levels of receptor for advanced glycation end products, blood transfusion, and risk of primary graft dysfunction.

Rationale: The receptor for advanced glycation end products (RAGE) is an important marker of lung epithelial injury and may be associated with impaired alveolar fluid clearance. We hypothesized that patients with primary graft dysfunction (PGD) after lung transplantation would have higher RAGE levels in plasma than patients without PGD.

Objectives: To test the association of soluble RAGE (sRAGE) levels with PGD in a prospective, multicenter cohort study.

Effect of work-hours regulations on intensive care unit mortality in United States teaching hospitals.

Objectives: : To examine the association of the resident work-hours reform with mortality for patients in medical and surgical intensive care units. The United States instituted restrictions on resident work-hours in July 2003. The clinical impact of this reform on critically ill patients is unknown.

Patient attitudinal and behavioral factors associated with warfarin non-adherence at outpatient anticoagulation clinics.

Background: Warfarin is an anticoagulant effective in preventing stroke, but it has a narrow therapeutic range requiring optimal adherence to achieve the most favorable effects.

Purpose: The goal of this study was to examine specific patient factors that might help explain warfarin non-adherence at outpatient anticoagulation clinics.

Method: In a prospective cohort study of 156 adults, we utilized logistic regression analyses to examine the relationship between the five Treatment Prognostics scales from the Millon Behavioral Medicine Diagnostic (MBMD), as well as three additional MBMD scales (Depression, Future Pessimism, and Social Isolation), and daily warfarin non-adherence assessed using electronic medication event monitoring systems caps over a median of 139 days.

Neighborhood of residence is associated with daily adherence to CPAP therapy.

Study Objectives: Adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea is poor. Risk factors for nonadherence are not well understood but may reflect individual or neighborhood socioeconomic factors. We sought to determine the association of socioeconomic status and initial CPAP adherence.

The structure of critical care transfer networks.

Rationale: Moving patients from low-performing hospitals to high-performing hospitals may improve patient outcomes. These transfers may be particularly important in critical care, where small relative improvements can yield substantial absolute changes in survival.

Objective: To characterize the existing critical care network in terms of the pattern of transfers.

Central airways obstruction due to Aspergillus fumigatus after lung transplantation.

Aspergillus fumigatus may affect immunocompromised lung transplant patients in many ways. We report a new pulmonary manifestation of A fumigatus in 3 patients who underwent bilateral lung transplantation. All 3 subjects developed rapid decreases in pulmonary function and were found to have large central airways obstruction with thick plugs of mucus, heavily laden with Aspergillus species.

Validation study of an automated electronic acute lung injury screening tool.

OBJECTIVE The authors designed an automated electronic system that incorporates data from multiple hospital information systems to screen for acute lung injury (ALI) in mechanically ventilated patients. The authors evaluated the accuracy of this system in diagnosing ALI in a cohort of patients with major trauma, but excluding patients with congestive heart failure (CHF). DESIGN Single-center validation study.

A simple clinical predictive index for objective estimates of mortality in acute lung injury.

Objective: We sought to develop a simple point score that would accurately capture the risk of hospital death for patients with acute lung injury (ALI).

Design: This is a secondary analysis of data from two randomized trials. Baseline clinical variables collected within 24 hours of enrollment were modeled as predictors of hospital mortality using logistic regression and bootstrap resampling to arrive at a parsimonious model.

Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock.

Principle: Serum lactate is a potentially useful biomarker to risk-stratify patients with severe sepsis; however, it is plausible that elevated serum lactate is simply a manifestation of clinically apparent organ dysfunction and/or shock (i.e., refractory hypotension).

Impact of pulmonary artery pressure on exercise function in severe COPD.

Background: Although pulmonary hypertension commonly complicates COPD, the functional consequences of increased pulmonary artery pressures in patients with this condition remain poorly defined.

Methods: We conducted a cross-sectional analysis of a cohort of 362 patients with severe COPD who were evaluated for lung transplantation. Patients with pulmonary hemodynamics measured by cardiac catheterization and available 6-min walk test results were included.

Uncharted paths: hospital networks in critical care.

Wide variation between hospitals in the quality of critical care lead to many potentially avoidable deaths. Regionalization of critical care is a possible solution; regionalization has been implemented for trauma and neonatal intensive care, and it is under active discussion for medical and cardiac critical care. However, regionalization is only one possible approach to reorganizing critical care services.

Soluble p-selectin and the risk of primary graft dysfunction after lung transplantation.

Background: Platelet activation with subsequent neutrophilic adherence to the vasculature initiates ischemia-reperfusion injury. We hypothesized that higher plasma P-selectin levels reflecting platelet activation would therefore be associated with primary graft dysfunction (PGD) after lung transplantation.

Methods: In a prospective, multicenter cohort study of 376 patients who had undergone lung transplantation between 2002 and 2007, we measured soluble P-selectin levels before lung transplantation and at 6 and 24 h after lung reperfusion in 20 patients with grade III PGD (Pao(2)/fraction of inspired oxygen, < 200 mm Hg [with alveolar infiltrates seen on chest radiographs]) at 72 h after transplantation and 61 control subjects without PGD.

Risk factors for early primary graft dysfunction after lung transplantation: a registry study.

Background: Primary graft dysfunction (PGD) is a leading cause of early morbidity and mortality in lung transplantation. We sought to identify risk factors for PGD using the United Network for Organ Sharing/International Society for Heart and Lung Transplant (UNOS/ISHLT) Registry.

Methods: A total of 6984 lung transplants between 1994 and 2002 were available for analysis.

Critical illness outcomes in specialty versus general intensive care units.

Rationale: General intensive care units (ICUs) provide care across a wide range of diagnoses, whereas specialty ICUs provide diagnosis-specific care. Risk-adjusted outcome differences across such units are unknown.

Objectives: To determine the association between specialty ICU care and the outcome of critical illness.

Cognitive, mood and quality of life impairments in a select population of ARDS survivors.

Background And Objective: There is increasing evidence that survivors of ARDS may have impairments in cognitive function, mood and quality of life. This study investigated associations between cognitive impairment, mood disorders and quality of life in a select group of ARDS survivors.

Methods: A cross-sectional study was conducted to describe the specific impairments in cognitive function, mood and quality of life in a group of 79 self-selected ARDS survivors who contacted an Internet-based support site.

Lung transplant outcomes in white and African American recipients: special focus on acute and chronic rejection.

Background: The effects of lung transplant recipient race on post-transplant outcomes have not been adequately evaluated. This cohort study seeks to determine the characteristics of African American lung transplant recipients and the effects of African American race on post-transplant outcomes, particularly acute and chronic rejection, compared with white recipients, at a single center.

Methods: There were 485 first-time lung transplantations (431 white, 47 African American, 5 Hispanic and 2 Asian recipients) performed at the University of Pennsylvania between 1991 and 2006.

Primary graft dysfunction.

Primary graft dysfunction (PGD) is a severe form of ischemia/reperfusion acute lung injury that is a major cause of early morbidity and mortality after lung transplantation. Survivors of PGD have worse long-term lung function and an increased chance of developing bronchiolitis obliterans syndrome (BOS), the manifestation of chronic rejection. This review examines the current state of PGD research in the context of a recent consensus statement by the International Society for Heart and Lung Transplantation (ISHLT) designed to standardize the definition of PGD in clinical research efforts.