American Thoracic Society Journal news tips for February 2005 (first issue)
SEVERE COMMUNITY-ACQUIRED PNEUMONIA PATIENTS IMPROVE SIGNIFICANTLY WITH HYDROCORTISONE INFUSION
In a study of 46 patients from six hospitals with severe community-acquired pneumonia, a 7-day course of low-dose hydrocortisone infusion hastened the resolution of the patients' pneumonia and prevented the development of life-threatening sepsis-related complications. The researchers infused hydrocortisone in 23 patients as an intravenous 200-mg bolus followed by infusion at a rate of 10 mg per hour for 7 days. Another group of 23 pneumonia patients received a placebo of sterile saline in an equal volume. In the control group, one patient admitted with septic shock died on Study Day 3, and nine patients developed delayed septic shock that was complicated by acute respiratory distress syndrome in four. One additional control patient developed septic shock after Day 8. In contrast, in the hydrocortisone group, the two patients who were admitted with septic shock were weaned off agents to increase their blood pressure (vasopressors) by Days 3 and 5; no other patient developed sepsis-related complications. Although mortality for patients admitted to an intensive care unit for severe community-acquired pneumonia is high (22 to 54 percent), survival to hospital discharge in the study patients was 100 percent in the hydrocortisone group, and 70 percent in the control group. The study appears in the first issue for February 2005 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
SILDENAFIL PROTECTS AGAINST ALTITUDE-INDUCED PULMONARY PROBLEMS
A drug commonly prescribed for male erectile dysfunction, sildenafil, is capable of protecting men against the development of high altitude-induced pulmonary hypertension, helps to improve pulmonary gas exchange, and limits altitude-induced hypoxemia (deficient oxygenation of the blood). Researchers measured the effects of oral sildenafil on altitude-induced pulmonary gas exchange in 6 normal subjects. The 6 men, along with 6 normal control subjects who received placebo, were exposed for 6 days to the physiologic effects of an altitude of 14,355 feet (4,350 meters). The treatment with three doses of 40 mg of sildenafil daily was started 6 to 8 hours after the study patients arrived at altitude, and maintained for 6 days. The investigators said that the men's systolic pulmonary artery pressure increased at altitude before treatment. It normalized in the sildenafil group, but remained elevated in the placebo subjects. Acute altitude induced hypoxemia leads to an adverse condition in which, at a minimum, overall well-being is compromised and patients suffer from a reduction in physical performance associated with acute mountain sickness. In addition, a patient's life can be threatened by high pulmonary arterial pressure and high altitude pulmonary edema, a serious acute condition that has a mortality rate of 44 percent among the untreated. The study appears in the first issue for February 2005 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
PATIENT SEGREGATION REDUCES RISK FROM MAJOR PATHOGEN THAT AFFECTS CYSTIC FIBROSIS PATIENTS
British investigators have effectively controlled the major transmissible pathogen that affects cystic fibrosis (CF) patients, Pseudomonas aeruginosa, by effectively segregating patients with transmissible disease during hospitalization at their dedicated CF facility. Researchers realized that despite their carefully designed center and strict hygiene rules, P. aeruginosa cross-infection still continued. (CF, an inherited lethal disease, causes certain glands to produce abnormal secretions that primarily affect the lungs and digestive tract. CF patients are especially susceptible to the gram-negative bacteria, P. aeruginosa, which has the potential to cause severe and possibly fatal infection in the lungs.) Of the 243 patients who attended this adult CF center, 176 had chronic P. aeruginosa. Patients who do not have P. aeruginosa infection attend outpatient clinic appointments on a different day than those who are infected. As inpatients, they are housed on the same CF ward, but in rooms with in-suite facilities. They are told not to socialize with other inpatients. According to the authors, since these measures were introduced, no P. aeruginosa-negative patients have developed infection with a transmissible strain. The research appears in the first issue for February 2005 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
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