Karen Laframboise - Academia.edu (original) (raw)
Papers by Karen Laframboise
Chest, Oct 1, 2005
Page 1. INTERLEUKIN 2 INCREASES ALVEOLAR FLUID CLEAR-ANCE IN ISOLATED RAT LUNGS Makoto Sugita MD*... more Page 1. INTERLEUKIN 2 INCREASES ALVEOLAR FLUID CLEAR-ANCE IN ISOLATED RAT LUNGS Makoto Sugita MD* Zheng Wang MD Sumiko Maeda MD Motoyasu Sagawa MD Jin Xu MD Toshishige Shibamoto MD Tsutomu ...
Chest, Nov 1, 2000
Background: Methacholine-induced bronchoconstriction is associated with significant hypoxemia, wh... more Background: Methacholine-induced bronchoconstriction is associated with significant hypoxemia, which can be assessed noninvasively by transcutaneous oxygen tension and pulse oximetry. Objectives: To assess the value of the monitoring of finger pulse oximetry during routine methacholine challenges in a clinical pulmonary function laboratory with regard to both safety and the possibility that a significant fall in oxygen saturation as measured by pulse oximetry (SpO 2) might be a useful surrogate for determining the response to methacholine. Methods: Two hundred consecutive patients undergoing diagnostic methacholine challenges in the pulmonary function laboratory of a tertiary-care, university-based referral hospital were studied. Methacholine challenges were performed by the standardized 2-min tidal breathing technique, and the ⌬FEV 1 was calculated from the lowest postsaline solution inhalation to the lowest postmethacholine inhalation value. SpO 2 was measured immediately prior to each spirogram, and the ⌬SpO 2 was measured from the lowest postsaline solution inhalation value to the lowest postmethacholine inhalation value. We examined the data for safety (ie, any SpO 2 value < 90). Based on previous reports, we used a ⌬SpO 2 of > 3 as significant and looked at the sensitivity, specificity, and positive and negative predictive values for ⌬SpO 2 > 3 vis-à-vis a fall in FEV 1 of > 15%. Results: There were 119 nonresponders (⌬FEV 1 , < 15%) and 81 responders. The baseline FEV 1 percent predicted was slightly but significantly lower in the responders (responders [؎ SD], 91.6 ؎ 15%; nonresponders, 96.4 ؎ 14%; p < 0.05). ⌬SpO 2 was 3.1 ؎ 1.6 in the responders and 1.6 ؎ 1.8 in the nonresponders (p < 0.001). There was a single recording in one patient of SpO 2 < 90 (88). A ⌬SpO 2 > 3 had a sensitivity of 68%, a specificity of 73%, a positive predictive value of 63%, and negative predictive value of 77% for a fall in FEV 1 > 15%. Conclusions: Pulse oximetry is not routinely useful for safety monitoring during methacholine challenge. ⌬SpO 2 is not helpful in predicting a positive spirometric response to methacholine. However, the negative predictive value is adequate to allow the ⌬SpO 2 to be used as an adjunct in assessing a negative result of a methacholine test in patients who have difficulty performing spirometry.
Chest, Dec 1, 2001
STUDY OBJECTIVES Validation of test-shortening procedures for the 2-min tidal breathing methachol... more STUDY OBJECTIVES Validation of test-shortening procedures for the 2-min tidal breathing methacholine challenge method. DESIGN Retrospective chart review. SETTING Tertiary-care university clinical pulmonary function laboratory. PATIENTS One thousand subjects aged 10 to 85 years (mean +/- SD, 44.5 +/- 16.0 years), 44.5% male, referred for methacholine challenge. INTERVENTION Two-minute tidal breathing methacholine challenge was performed, with both physician and technician access to published test-shortening procedures. MEASUREMENTS AND RESULTS There were 315 positive test results (provocative concentration of methacholine causing a 20% fall in FEV(1) [PC(20)] < or = 8 mg/mL) and 685 negative test results. The subjects with positive test results were less likely to be male (39.1 vs 47.5%; p < 0.02) and had lower FEV(1) (91.8 +/- 14.9% predicted vs 97.2 +/- 13.9% predicted; p < 0.001). The average starting PC(20) was between 0.5 mg/mL and 1.0 mg/mL; the most common PC(20) was 1 mg/mL (67%). There were 431 skipped concentrations in 380 subjects. The mean number of methacholine inhalations was 3.7 +/- 1.1 (3.9 +/- 0.1 for negative test results vs 3.3 +/- 1.2 for positive test results; p < 0.001). Eighteen subjects had a > or = 20% FEV(1) fall on the first inhalation, and 11 subjects had a > or = 20% FEV(1) fall after a skipped concentration. In only one case (0.1%) an FEV(1) fall > or = 40% on the first concentration was reported, compared with no cases after a skipped concentration and seven cases with a > or = 40% FEV(1) fall after a routine doubling dose step-up. CONCLUSIONS The 2-min tidal breathing methacholine test in clinical practice can be safely shortened to an average of less than four inhalations using starting concentrations based on FEV(1), asthma medication, and clinical features, and by occasionally omitting concentrations.
The Journal of Heart and Lung Transplantation, 2019
Canadian respiratory journal : journal of the Canadian Thoracic Society
Pulmonary embolism is a common condition. Some patients subsequently develop chronic thromboembol... more Pulmonary embolism is a common condition. Some patients subsequently develop chronic thromboembolic pulmonary hypertension (CTEPH). Many care gaps exist in the diagnosis and management of CTEPH patients including lack of awareness, incomplete diagnostic assessment, and inconsistent use of surgical and medical therapies. A representative interdisciplinary panel of medical experts undertook a formal clinical practice guideline development process. A total of 20 key clinical issues were defined according to the patient population, intervention, comparator, outcome (PICO) approach. The panel performed an evidence-based, systematic, literature review, assessed and graded the relevant evidence, and made 26 recommendations. Asymptomatic patients postpulmonary embolism should not be screened for CTEPH. In patients with pulmonary hypertension, the possibility of CTEPH should be routinely evaluated with initial ventilation/perfusion lung scanning, not computed tomography angiography. Pulmonar...
CHEST Journal, 2005
Page 1. INTERLEUKIN 2 INCREASES ALVEOLAR FLUID CLEAR-ANCE IN ISOLATED RAT LUNGS Makoto Sugita MD*... more Page 1. INTERLEUKIN 2 INCREASES ALVEOLAR FLUID CLEAR-ANCE IN ISOLATED RAT LUNGS Makoto Sugita MD* Zheng Wang MD Sumiko Maeda MD Motoyasu Sagawa MD Jin Xu MD Toshishige Shibamoto MD Tsutomu ...
Canadian respiratory journal : journal of the Canadian Thoracic Society
Pulmonary embolism is a common condition. Some patients subsequently develop chronic thromboembol... more Pulmonary embolism is a common condition. Some patients subsequently develop chronic thromboembolic pulmonary hypertension (CTEPH). Many care gaps exist in the diagnosis and management of CTEPH patients including lack of awareness, incomplete diagnostic assessment, and inconsistent use of surgical and medical therapies. A representative interdisciplinary panel of medical experts undertook a formal clinical practice guideline development process. A total of 20 key clinical issues were defined according to the patient population, intervention, comparator, outcome (PICO) approach. The panel performed an evidence-based, systematic, literature review, assessed and graded the relevant evidence, and made 26 recommendations. Asymptomatic patients postpulmonary embolism should not be screened for CTEPH. In patients with pulmonary hypertension, the possibility of CTEPH should be routinely evaluated with initial ventilation/perfusion lung scanning, not computed tomography angiography. Pulmonar...
Canadian respiratory journal : journal of the Canadian Thoracic Society
Obesity rates are increasing worldwide, particularly in North America. The impact of obesity on t... more Obesity rates are increasing worldwide, particularly in North America. The impact of obesity on the outcome of critically ill patients is unclear. A prospective observational cohort study of consecutive patients admitted to a tertiary critical care unit in Canada between January 10, 2008 and March 31, 2009 was conducted. Exclusion criteria were age <18 years, admission <24 h, planned cardiac surgery, pregnancy, significant ascites, unclosed surgical abdomen and brain death on admission. Height, weight and abdominal circumference were measured at the time of intensive care unit (ICU) admission. Coprimary end points were ICU mortality and a composite of ICU mortality, reintubation, ventilator-associated pneumonia, line sepsis and ICU readmission. Subjects were stratified as obese or nonobese, using two separate metrics: body mass index (BMI) ≥30 kg⁄m2 and a novel measurement of 75th percentile for waist-to-height ratio (WHR). Among 449 subjects with a BMI ≥18.5 kg⁄m2, both BMI a...
CHEST Journal, 2001
Cockcroft, Donald W.; Marciniuk, Darcy D.; Hurst, Thomas S.; Cotton, David J.; Laframboise, Karen... more Cockcroft, Donald W.; Marciniuk, Darcy D.; Hurst, Thomas S.; Cotton, David J.; Laframboise, Karen F.; McNab, Brian D.; Skomro, Robert P.
CHEST Journal, 2002
... Ephraim Bar-Yishay, PhD. Institute of Pulmonology, Hadassah University Hospital Jerusalem, Is... more ... Ephraim Bar-Yishay, PhD. Institute of Pulmonology, Hadassah University Hospital Jerusalem, Israel. Correspondence to: Ephraim Bar-Yishay, PhD, Institute of ... Thorax 38,760-765. Abstract/FREE Full Text. ↵ Sears, MR, Jones, DT, Holdaway, MD, et al Prevalence of bronchial ...
CHEST Journal, 2000
Methacholine-induced bronchoconstriction is associated with significant hypoxemia, which can be a... more Methacholine-induced bronchoconstriction is associated with significant hypoxemia, which can be assessed noninvasively by transcutaneous oxygen tension and pulse oximetry. To assess the value of the monitoring of finger pulse oximetry during routine methacholine challenges in a clinical pulmonary function laboratory with regard to both safety and the possibility that a significant fall in oxygen saturation as measured by pulse oximetry (SpO(2)) might be a useful surrogate for determining the response to methacholine. Two hundred consecutive patients undergoing diagnostic methacholine challenges in the pulmonary function laboratory of a tertiary-care, university-based referral hospital were studied. Methacholine challenges were performed by the standardized 2-min tidal breathing technique, and the DeltaFEV(1) was calculated from the lowest postsaline solution inhalation to the lowest postmethacholine inhalation value. SpO(2) was measured immediately prior to each spirogram, and the DeltaSpO(2) was measured from the lowest postsaline solution inhalation value to the lowest postmethacholine inhalation value. We examined the data for safety (ie, any SpO(2) value &amp;amp;amp;lt; 90). Based on previous reports, we used a DeltaSpO(2) of &amp;amp;amp;gt; or = 3 as significant and looked at the sensitivity, specificity, and positive and negative predictive values for DeltaSpO(2) &amp;amp;amp;gt; or = 3 vis-à-vis a fall in FEV(1) of &amp;amp;amp;gt; or = 15%. There were 119 nonresponders (DeltaFEV(1), &amp;amp;amp;lt; 15%) and 81 responders. The baseline FEV(1) percent predicted was slightly but significantly lower in the responders (responders [+/- SD], 91.6 +/- 15%; nonresponders, 96.4 +/- 14%; p &amp;amp;amp;lt; 0.05). DeltaSpO(2) was 3.1 +/- 1.6 in the responders and 1.6 +/- 1.8 in the nonresponders (p &amp;amp;amp;lt; 0. 001). There was a single recording in one patient of SpO(2) &amp;amp;amp;lt; 90 (88). A DeltaSpO(2) &amp;amp;amp;gt; or = 3 had a sensitivity of 68%, a specificity of 73%, a positive predictive value of 63%, and negative predictive value of 77% for a fall in FEV(1) &amp;amp;amp;gt; or = 15%. Pulse oximetry is not routinely useful for safety monitoring during methacholine challenge. DeltaSpO(2) is not helpful in predicting a positive spirometric response to methacholine. However, the negative predictive value is adequate to allow the DeltaSpO(2) to be used as an adjunct in assessing a negative result of a methacholine test in patients who have difficulty performing spirometry.
Chest, 2004
Financial constraints and bed limitations frequently prevent admission of ill patients to a criti... more Financial constraints and bed limitations frequently prevent admission of ill patients to a critical care setting. We surveyed the use of treatment with noninvasive ventilation (NIV) in clinical practice by physicians in a tertiary care, university-based teaching hospital and compared our findings with published recommendations for the use of NIV. Data were collected prospectively on all patients with acute respiratory failure (ARF) for whom NIV was ordered over a 5-month period. The respiratory therapy department was responsible for administering NIV on written order by a physician. The respiratory therapist completed a survey form with patient tracking data for each initiation of NIV. The investigators then surveyed the clinical chart for clinical data. NIV was utilized for the treatment of ARF on 75 occasions during the 5-month period. Fourteen patients (18%) received NIV for a COPD exacerbation, and 61 patients (82%) received it for respiratory failure of other etiologies. NIV was initiated in the emergency department in 32% of patients, in a critical care setting in 27% of patients, in a ward observation unit in 23% of patients, and on a general medical or surgical ward in 18% of patients. Arterial blood gases (ABGs) were measured on 68 occasions prior to the initiation of NIV, and 51 patients had an ABG measurement within the first 6 h of treatment. The mean pH at baseline was 7.29, and 33% of patients had a baseline pH of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 7.25. Seven patients required endotracheal intubation (ETI) [13%], and there were 18 deaths (24%) with patients having do-not-resuscitate orders, accounting for 12 deaths. NIV is commonly used outside of a critical care setting. Our outcomes of ETI and death were similar to those cited in the literature despite less aggressive monitoring of these patients.
CHEST Journal, 2013
ABSTRACT Pulmonary EmbolismSESSION TYPE: Original Investigation SlidePRESENTED ON: Tuesday, Octob... more ABSTRACT Pulmonary EmbolismSESSION TYPE: Original Investigation SlidePRESENTED ON: Tuesday, October 29, 2013 at 04:30 PM - 05:30 PMPURPOSE: The clinical significance of isolated subsegmental pulmonary embolism (SSPE) has been questioned in recent years, while the ideal management has yet to be definitively elucidated.METHODS: In this retrospective cross-sectional study, we examine the management of SSPE over a three year period from January 1, 2010 to December 31, 2012, at a tertiary care centre in Saskatoon, Canada. From 2458 computed tomography scans, 520 (21%) were positive for pulmonary embolism. Of these positive scans, 70 were diagnosed as SSPE and 57 of those cases were reviewed as isolated SSPE. Cases were examined with respect to the circumstance within which SSPE developed, the management choices undertaken, and outcomes including recurrence, hemorrhage, or death.RESULTS: This study reveals that the majority, 41 patients (72%), were treated with anticoagulation, but that the remaining untreated population of 16 patients (28%) developed no significant outcomes related to recurrence of venous thromboembolism (VTE). In addition, there were no deaths recorded within 3 months of diagnosis in the untreated population without malignancy (12 patients). More importantly, the incidence of bleeding in the treated group (7%) was observed in comparison to the untreated population (0%), This rate of bleeding while anticoagulated for VTE is in agreement with that found in the literature.CONCLUSIONS: These results demonstrate that patients with isolated SSPE may have an unfavourable risk-benefit ratio with respect to anticoagulation. This allows for a discussion on the necessity of treatment for patients with SSPE by quantifying outcomes in both the treated and untreated population with this finding.CLINICAL IMPLICATIONS: Our results are consistent with the evolving sentiment that subsegmental pulmonary embolism may not require treatment with full anticoagulation, and provide further evidence that treatment, as well as its side effects, are not only significant, but may be avoided entirely in this population.DISCLOSURE: The following authors have nothing to disclose: James Ramsahai, Kewan Aboulhosn, Karen LaframboiseNo Product/Research Disclosure Information.
CHEST Journal, 2004
... A COMPARISON OF THE PREVALENCE AND IMPACT OF RESPIRATORY SYMPTOMS IN DEPLOYED ASTHMATICS AND ... more ... A COMPARISON OF THE PREVALENCE AND IMPACT OF RESPIRATORY SYMPTOMS IN DEPLOYED ASTHMATICS AND NON-ASTHMATICS Alexander S. Niven, MD*; Stuart A. Roop, MD; Bryce E. Calvin, MD; Lisa L. Zacher, MD; William Beaumont Army Medical Center, El ...
CHEST Journal, 2004
Page 1. PREVALENCE OF ADEQUATE BLOOD PRESSURE CONTROL IN A UNIVERSITY CARDIOLOGY OR GENERAL MEDIC... more Page 1. PREVALENCE OF ADEQUATE BLOOD PRESSURE CONTROL IN A UNIVERSITY CARDIOLOGY OR GENERAL MEDICINE CLINIC Glenn Gandelman, MD, MPH*; Wilbert S. Aronow, MD; Raja Varma, MD; New York ...
Chest, Oct 1, 2005
Page 1. INTERLEUKIN 2 INCREASES ALVEOLAR FLUID CLEAR-ANCE IN ISOLATED RAT LUNGS Makoto Sugita MD*... more Page 1. INTERLEUKIN 2 INCREASES ALVEOLAR FLUID CLEAR-ANCE IN ISOLATED RAT LUNGS Makoto Sugita MD* Zheng Wang MD Sumiko Maeda MD Motoyasu Sagawa MD Jin Xu MD Toshishige Shibamoto MD Tsutomu ...
Chest, Nov 1, 2000
Background: Methacholine-induced bronchoconstriction is associated with significant hypoxemia, wh... more Background: Methacholine-induced bronchoconstriction is associated with significant hypoxemia, which can be assessed noninvasively by transcutaneous oxygen tension and pulse oximetry. Objectives: To assess the value of the monitoring of finger pulse oximetry during routine methacholine challenges in a clinical pulmonary function laboratory with regard to both safety and the possibility that a significant fall in oxygen saturation as measured by pulse oximetry (SpO 2) might be a useful surrogate for determining the response to methacholine. Methods: Two hundred consecutive patients undergoing diagnostic methacholine challenges in the pulmonary function laboratory of a tertiary-care, university-based referral hospital were studied. Methacholine challenges were performed by the standardized 2-min tidal breathing technique, and the ⌬FEV 1 was calculated from the lowest postsaline solution inhalation to the lowest postmethacholine inhalation value. SpO 2 was measured immediately prior to each spirogram, and the ⌬SpO 2 was measured from the lowest postsaline solution inhalation value to the lowest postmethacholine inhalation value. We examined the data for safety (ie, any SpO 2 value < 90). Based on previous reports, we used a ⌬SpO 2 of > 3 as significant and looked at the sensitivity, specificity, and positive and negative predictive values for ⌬SpO 2 > 3 vis-à-vis a fall in FEV 1 of > 15%. Results: There were 119 nonresponders (⌬FEV 1 , < 15%) and 81 responders. The baseline FEV 1 percent predicted was slightly but significantly lower in the responders (responders [؎ SD], 91.6 ؎ 15%; nonresponders, 96.4 ؎ 14%; p < 0.05). ⌬SpO 2 was 3.1 ؎ 1.6 in the responders and 1.6 ؎ 1.8 in the nonresponders (p < 0.001). There was a single recording in one patient of SpO 2 < 90 (88). A ⌬SpO 2 > 3 had a sensitivity of 68%, a specificity of 73%, a positive predictive value of 63%, and negative predictive value of 77% for a fall in FEV 1 > 15%. Conclusions: Pulse oximetry is not routinely useful for safety monitoring during methacholine challenge. ⌬SpO 2 is not helpful in predicting a positive spirometric response to methacholine. However, the negative predictive value is adequate to allow the ⌬SpO 2 to be used as an adjunct in assessing a negative result of a methacholine test in patients who have difficulty performing spirometry.
Chest, Dec 1, 2001
STUDY OBJECTIVES Validation of test-shortening procedures for the 2-min tidal breathing methachol... more STUDY OBJECTIVES Validation of test-shortening procedures for the 2-min tidal breathing methacholine challenge method. DESIGN Retrospective chart review. SETTING Tertiary-care university clinical pulmonary function laboratory. PATIENTS One thousand subjects aged 10 to 85 years (mean +/- SD, 44.5 +/- 16.0 years), 44.5% male, referred for methacholine challenge. INTERVENTION Two-minute tidal breathing methacholine challenge was performed, with both physician and technician access to published test-shortening procedures. MEASUREMENTS AND RESULTS There were 315 positive test results (provocative concentration of methacholine causing a 20% fall in FEV(1) [PC(20)] < or = 8 mg/mL) and 685 negative test results. The subjects with positive test results were less likely to be male (39.1 vs 47.5%; p < 0.02) and had lower FEV(1) (91.8 +/- 14.9% predicted vs 97.2 +/- 13.9% predicted; p < 0.001). The average starting PC(20) was between 0.5 mg/mL and 1.0 mg/mL; the most common PC(20) was 1 mg/mL (67%). There were 431 skipped concentrations in 380 subjects. The mean number of methacholine inhalations was 3.7 +/- 1.1 (3.9 +/- 0.1 for negative test results vs 3.3 +/- 1.2 for positive test results; p < 0.001). Eighteen subjects had a > or = 20% FEV(1) fall on the first inhalation, and 11 subjects had a > or = 20% FEV(1) fall after a skipped concentration. In only one case (0.1%) an FEV(1) fall > or = 40% on the first concentration was reported, compared with no cases after a skipped concentration and seven cases with a > or = 40% FEV(1) fall after a routine doubling dose step-up. CONCLUSIONS The 2-min tidal breathing methacholine test in clinical practice can be safely shortened to an average of less than four inhalations using starting concentrations based on FEV(1), asthma medication, and clinical features, and by occasionally omitting concentrations.
The Journal of Heart and Lung Transplantation, 2019
Canadian respiratory journal : journal of the Canadian Thoracic Society
Pulmonary embolism is a common condition. Some patients subsequently develop chronic thromboembol... more Pulmonary embolism is a common condition. Some patients subsequently develop chronic thromboembolic pulmonary hypertension (CTEPH). Many care gaps exist in the diagnosis and management of CTEPH patients including lack of awareness, incomplete diagnostic assessment, and inconsistent use of surgical and medical therapies. A representative interdisciplinary panel of medical experts undertook a formal clinical practice guideline development process. A total of 20 key clinical issues were defined according to the patient population, intervention, comparator, outcome (PICO) approach. The panel performed an evidence-based, systematic, literature review, assessed and graded the relevant evidence, and made 26 recommendations. Asymptomatic patients postpulmonary embolism should not be screened for CTEPH. In patients with pulmonary hypertension, the possibility of CTEPH should be routinely evaluated with initial ventilation/perfusion lung scanning, not computed tomography angiography. Pulmonar...
CHEST Journal, 2005
Page 1. INTERLEUKIN 2 INCREASES ALVEOLAR FLUID CLEAR-ANCE IN ISOLATED RAT LUNGS Makoto Sugita MD*... more Page 1. INTERLEUKIN 2 INCREASES ALVEOLAR FLUID CLEAR-ANCE IN ISOLATED RAT LUNGS Makoto Sugita MD* Zheng Wang MD Sumiko Maeda MD Motoyasu Sagawa MD Jin Xu MD Toshishige Shibamoto MD Tsutomu ...
Canadian respiratory journal : journal of the Canadian Thoracic Society
Pulmonary embolism is a common condition. Some patients subsequently develop chronic thromboembol... more Pulmonary embolism is a common condition. Some patients subsequently develop chronic thromboembolic pulmonary hypertension (CTEPH). Many care gaps exist in the diagnosis and management of CTEPH patients including lack of awareness, incomplete diagnostic assessment, and inconsistent use of surgical and medical therapies. A representative interdisciplinary panel of medical experts undertook a formal clinical practice guideline development process. A total of 20 key clinical issues were defined according to the patient population, intervention, comparator, outcome (PICO) approach. The panel performed an evidence-based, systematic, literature review, assessed and graded the relevant evidence, and made 26 recommendations. Asymptomatic patients postpulmonary embolism should not be screened for CTEPH. In patients with pulmonary hypertension, the possibility of CTEPH should be routinely evaluated with initial ventilation/perfusion lung scanning, not computed tomography angiography. Pulmonar...
Canadian respiratory journal : journal of the Canadian Thoracic Society
Obesity rates are increasing worldwide, particularly in North America. The impact of obesity on t... more Obesity rates are increasing worldwide, particularly in North America. The impact of obesity on the outcome of critically ill patients is unclear. A prospective observational cohort study of consecutive patients admitted to a tertiary critical care unit in Canada between January 10, 2008 and March 31, 2009 was conducted. Exclusion criteria were age <18 years, admission <24 h, planned cardiac surgery, pregnancy, significant ascites, unclosed surgical abdomen and brain death on admission. Height, weight and abdominal circumference were measured at the time of intensive care unit (ICU) admission. Coprimary end points were ICU mortality and a composite of ICU mortality, reintubation, ventilator-associated pneumonia, line sepsis and ICU readmission. Subjects were stratified as obese or nonobese, using two separate metrics: body mass index (BMI) ≥30 kg⁄m2 and a novel measurement of 75th percentile for waist-to-height ratio (WHR). Among 449 subjects with a BMI ≥18.5 kg⁄m2, both BMI a...
CHEST Journal, 2001
Cockcroft, Donald W.; Marciniuk, Darcy D.; Hurst, Thomas S.; Cotton, David J.; Laframboise, Karen... more Cockcroft, Donald W.; Marciniuk, Darcy D.; Hurst, Thomas S.; Cotton, David J.; Laframboise, Karen F.; McNab, Brian D.; Skomro, Robert P.
CHEST Journal, 2002
... Ephraim Bar-Yishay, PhD. Institute of Pulmonology, Hadassah University Hospital Jerusalem, Is... more ... Ephraim Bar-Yishay, PhD. Institute of Pulmonology, Hadassah University Hospital Jerusalem, Israel. Correspondence to: Ephraim Bar-Yishay, PhD, Institute of ... Thorax 38,760-765. Abstract/FREE Full Text. ↵ Sears, MR, Jones, DT, Holdaway, MD, et al Prevalence of bronchial ...
CHEST Journal, 2000
Methacholine-induced bronchoconstriction is associated with significant hypoxemia, which can be a... more Methacholine-induced bronchoconstriction is associated with significant hypoxemia, which can be assessed noninvasively by transcutaneous oxygen tension and pulse oximetry. To assess the value of the monitoring of finger pulse oximetry during routine methacholine challenges in a clinical pulmonary function laboratory with regard to both safety and the possibility that a significant fall in oxygen saturation as measured by pulse oximetry (SpO(2)) might be a useful surrogate for determining the response to methacholine. Two hundred consecutive patients undergoing diagnostic methacholine challenges in the pulmonary function laboratory of a tertiary-care, university-based referral hospital were studied. Methacholine challenges were performed by the standardized 2-min tidal breathing technique, and the DeltaFEV(1) was calculated from the lowest postsaline solution inhalation to the lowest postmethacholine inhalation value. SpO(2) was measured immediately prior to each spirogram, and the DeltaSpO(2) was measured from the lowest postsaline solution inhalation value to the lowest postmethacholine inhalation value. We examined the data for safety (ie, any SpO(2) value &amp;amp;amp;lt; 90). Based on previous reports, we used a DeltaSpO(2) of &amp;amp;amp;gt; or = 3 as significant and looked at the sensitivity, specificity, and positive and negative predictive values for DeltaSpO(2) &amp;amp;amp;gt; or = 3 vis-à-vis a fall in FEV(1) of &amp;amp;amp;gt; or = 15%. There were 119 nonresponders (DeltaFEV(1), &amp;amp;amp;lt; 15%) and 81 responders. The baseline FEV(1) percent predicted was slightly but significantly lower in the responders (responders [+/- SD], 91.6 +/- 15%; nonresponders, 96.4 +/- 14%; p &amp;amp;amp;lt; 0.05). DeltaSpO(2) was 3.1 +/- 1.6 in the responders and 1.6 +/- 1.8 in the nonresponders (p &amp;amp;amp;lt; 0. 001). There was a single recording in one patient of SpO(2) &amp;amp;amp;lt; 90 (88). A DeltaSpO(2) &amp;amp;amp;gt; or = 3 had a sensitivity of 68%, a specificity of 73%, a positive predictive value of 63%, and negative predictive value of 77% for a fall in FEV(1) &amp;amp;amp;gt; or = 15%. Pulse oximetry is not routinely useful for safety monitoring during methacholine challenge. DeltaSpO(2) is not helpful in predicting a positive spirometric response to methacholine. However, the negative predictive value is adequate to allow the DeltaSpO(2) to be used as an adjunct in assessing a negative result of a methacholine test in patients who have difficulty performing spirometry.
Chest, 2004
Financial constraints and bed limitations frequently prevent admission of ill patients to a criti... more Financial constraints and bed limitations frequently prevent admission of ill patients to a critical care setting. We surveyed the use of treatment with noninvasive ventilation (NIV) in clinical practice by physicians in a tertiary care, university-based teaching hospital and compared our findings with published recommendations for the use of NIV. Data were collected prospectively on all patients with acute respiratory failure (ARF) for whom NIV was ordered over a 5-month period. The respiratory therapy department was responsible for administering NIV on written order by a physician. The respiratory therapist completed a survey form with patient tracking data for each initiation of NIV. The investigators then surveyed the clinical chart for clinical data. NIV was utilized for the treatment of ARF on 75 occasions during the 5-month period. Fourteen patients (18%) received NIV for a COPD exacerbation, and 61 patients (82%) received it for respiratory failure of other etiologies. NIV was initiated in the emergency department in 32% of patients, in a critical care setting in 27% of patients, in a ward observation unit in 23% of patients, and on a general medical or surgical ward in 18% of patients. Arterial blood gases (ABGs) were measured on 68 occasions prior to the initiation of NIV, and 51 patients had an ABG measurement within the first 6 h of treatment. The mean pH at baseline was 7.29, and 33% of patients had a baseline pH of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 7.25. Seven patients required endotracheal intubation (ETI) [13%], and there were 18 deaths (24%) with patients having do-not-resuscitate orders, accounting for 12 deaths. NIV is commonly used outside of a critical care setting. Our outcomes of ETI and death were similar to those cited in the literature despite less aggressive monitoring of these patients.
CHEST Journal, 2013
ABSTRACT Pulmonary EmbolismSESSION TYPE: Original Investigation SlidePRESENTED ON: Tuesday, Octob... more ABSTRACT Pulmonary EmbolismSESSION TYPE: Original Investigation SlidePRESENTED ON: Tuesday, October 29, 2013 at 04:30 PM - 05:30 PMPURPOSE: The clinical significance of isolated subsegmental pulmonary embolism (SSPE) has been questioned in recent years, while the ideal management has yet to be definitively elucidated.METHODS: In this retrospective cross-sectional study, we examine the management of SSPE over a three year period from January 1, 2010 to December 31, 2012, at a tertiary care centre in Saskatoon, Canada. From 2458 computed tomography scans, 520 (21%) were positive for pulmonary embolism. Of these positive scans, 70 were diagnosed as SSPE and 57 of those cases were reviewed as isolated SSPE. Cases were examined with respect to the circumstance within which SSPE developed, the management choices undertaken, and outcomes including recurrence, hemorrhage, or death.RESULTS: This study reveals that the majority, 41 patients (72%), were treated with anticoagulation, but that the remaining untreated population of 16 patients (28%) developed no significant outcomes related to recurrence of venous thromboembolism (VTE). In addition, there were no deaths recorded within 3 months of diagnosis in the untreated population without malignancy (12 patients). More importantly, the incidence of bleeding in the treated group (7%) was observed in comparison to the untreated population (0%), This rate of bleeding while anticoagulated for VTE is in agreement with that found in the literature.CONCLUSIONS: These results demonstrate that patients with isolated SSPE may have an unfavourable risk-benefit ratio with respect to anticoagulation. This allows for a discussion on the necessity of treatment for patients with SSPE by quantifying outcomes in both the treated and untreated population with this finding.CLINICAL IMPLICATIONS: Our results are consistent with the evolving sentiment that subsegmental pulmonary embolism may not require treatment with full anticoagulation, and provide further evidence that treatment, as well as its side effects, are not only significant, but may be avoided entirely in this population.DISCLOSURE: The following authors have nothing to disclose: James Ramsahai, Kewan Aboulhosn, Karen LaframboiseNo Product/Research Disclosure Information.
CHEST Journal, 2004
... A COMPARISON OF THE PREVALENCE AND IMPACT OF RESPIRATORY SYMPTOMS IN DEPLOYED ASTHMATICS AND ... more ... A COMPARISON OF THE PREVALENCE AND IMPACT OF RESPIRATORY SYMPTOMS IN DEPLOYED ASTHMATICS AND NON-ASTHMATICS Alexander S. Niven, MD*; Stuart A. Roop, MD; Bryce E. Calvin, MD; Lisa L. Zacher, MD; William Beaumont Army Medical Center, El ...
CHEST Journal, 2004
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