Sigh Ventilation in Patients With Trauma: The SiVent Randomized Clinical Trial.

Importance: Among patients receiving mechanical ventilation, tidal volumes with each breath are often constant or similar. This may lead to ventilator-induced lung injury by altering or depleting surfactant. The role of sigh breaths in reducing ventilator-induced lung injury among trauma patients at risk of poor outcomes is unknown.

Constant Vt Ventilation and Surfactant Dysfunction: An Overlooked Cause of Ventilator-induced Lung Injury.

Ventilator-induced lung injury (VILI) is currently ascribed to volutrauma and/or atelectrauma, but the effect of constant Vt ventilation (CVtV) has received little attention. This Perspective summarizes the literature documenting that CVtV causes VILI and reviews the mechanisms by which it occurs. Surfactant is continuously inactivated, depleted, displaced, or desorbed as a function of the duration of ventilation, the Vt, the level of positive end-expiratory pressure (PEEP), and possibly the respiratory rate.

Impact of Proactive Integrated Care on Chronic Obstructive Pulmonary Disease.

Background: Up to 50% of chronic obstructive pulmonary disease (COPD) patients do not receive recommended care for COPD. To address this issue, we developed Proactive Integrated Care (Proactive iCare), a health care delivery model that couples integrated care with remote monitoring.

Methods: We conducted a prospective, quasi-randomized clinical trial in 511 patients with advanced COPD or a recent COPD exacerbation, to test whether Proactive iCare impacts patient-centered outcomes and health care utilization.

Prone position in ARDS patients: why, when, how and for whom.

In ARDS patients, the change from supine to prone position generates a more even distribution of the gas-tissue ratios along the dependent-nondependent axis and a more homogeneous distribution of lung stress and strain. The change to prone position is generally accompanied by a marked improvement in arterial blood gases, which is mainly due to a better overall ventilation/perfusion matching. Improvement in oxygenation and reduction in mortality are the main reasons to implement prone position in patients with ARDS.

Serum IgG Levels and Risk of COPD Hospitalization: A Pooled Meta-analysis.

Background: Hypogammaglobulinemia (serum IgG levels < 7.0 g/L) has been associated with increased risk of COPD exacerbations but has not yet been shown to predict hospitalizations.

Research Question: To determine the relationship between hypogammaglobulinemia and the risk of hospitalization in patients with COPD.

Opioid Utilization and Perception of Pain Control in Hospitalized Patients: A Cross-Sectional Study of 11 Sites in 8 Countries.

Background: Hospitalized patients are frequently treated with opioids for pain control, and receipt of opioids at hospital discharge may increase the risk of future chronic opioid use.

Objective: To compare inpatient analgesic prescribing patterns and patients' perception of pain control in the United States and non-US hospitals.

Design: Cross-sectional observational study.

Characteristics at the time of oxygen initiation associated with its adherence: Findings from the COPD Long-term Oxygen Treatment Trial.

Rationale: Characteristics associated with adherence to long-term oxygen therapy (LTOT) in COPD remain unclear.

Objectives: To identify patient characteristics at the time of oxygen initiation associated with its adherence.

Methods: We conducted a secondary analysis of data from 359 COPD participants assigned to oxygen in the Long-term Oxygen Treatment Trial.

Imaging in Acute Pyelonephritis: Utilization, Findings, and Effect on Management.

Objectives: To determine the frequency, timing, and types of imaging obtained in patients with a discharge diagnosis of acute pyelonephritis, and how often imaging findings affect therapy.

Methods: This was a retrospective chart review of 1062 adults with a diagnosis of acute pyelonephritis discharged from an urban, safety-net hospital between January 1, 2008 and December 31, 2012. From the 739 patients selected after exclusions, we determined the number and proportion of patients imaged within the first 24 hours of admission, stratified by risk factors for pyelonephritis complications, and the frequency of positive findings leading to invasive interventions.

Barriers to Early Hospital Discharge: A Cross-Sectional Study at Five Academic Hospitals.

Background: Understanding the issues delaying hospital discharges may inform efforts to improve hospital throughput.

Objective: This study was conducted to identify and determine the frequency of barriers contributing to delays in placing discharge orders.

Design: This was a prospective, cross-sectional study.

The Long-Term Oxygen Treatment Trial for Chronic Obstructive Pulmonary Disease: Rationale, Design, and Lessons Learned.

The Long-Term Oxygen Treatment Trial demonstrated that long-term supplemental oxygen did not reduce time to hospital admission or death for patients who have stable chronic obstructive pulmonary disease and resting and/or exercise-induced moderate oxyhemoglobin desaturation, nor did it provide benefit for any other outcome measured in the trial. Nine months after initiation of patient screening, after randomization of 34 patients to treatment, a trial design amendment broadened the eligible population, expanded the primary outcome, and reduced the goal sample size. Within a few years, the protocol underwent minor modifications, and a second trial design amendment lowered the required sample size because of lower than expected treatment group crossover rates.

Prevention of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline.

This document provides clinical recommendations for the prevention of chronic obstructive pulmonary disease (COPD) exacerbations. It represents a collaborative effort between the European Respiratory Society and the American Thoracic Society.Comprehensive evidence syntheses were performed to summarise all available evidence relevant to the Task Force's questions.

Postdischarge telephone calls by hospitalists as a transitional care strategy.

Objectives: To determine whether treating hospitalists can identify and address early postdischarge problems through a structured telephone call.

Study Design: Prospective cohort study.

Methods: We studied patients insured through a managed care program who were discharged from a general internal medicine service of a university-affiliated public safety net hospital (Denver Health Medical Center) between March 1, 2012, and October 31, 2013.

Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline.

This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles.