Purpose of review: Studies have illustrated that the healthy human microbiome (i.e. the communities of microbes, their genomic content and interaction with the host) plays a role in the maintenance of immune homeostasis. Perturbation of these communities is an emerging characteristic of an increasing number of inflammatory diseases.
The goal of this article is to review the current literature on both respiratory and gut microbiomes and their established relationship with allergy and asthma.
Recent findings: Multiple studies have demonstrated airway microbiota dysbiosis, characterized by Proteobacteria expansion in the lower airways, to be a consistent trait of established adult asthma. Members of this phylum are associated with disease features such as bronchial hyperreactivity or corticos...
Democrats vs Republicans, Coke vs Pepsi, Yankees vs Red Sox, and pressure vs volume control. Okay, maybe pressure vs volume shouldn't be on the same list as the others, but for intensivists it might as well. We have talked about if for decades. There are "true believers" in one mode or another and the issue never seems settled. In a paper published online in a May issue of Chest, another group of authors took a stab at providing an evidence-based resolution to this debate.
Their approach to the question was ambitious and novel. Anyone who reads the critical care literature knows that it is difficult to find differences in clinical outcomes when comparing modes of ventilation. The study authors knew that they would have to look at physiologic outcomes as surrogates. In so doing they developed a physiologic quality assessment to screen studies for inclusion in their meta-analysis—a fairly novel idea. Others should look to do the same because it's important that we have an agreed-upon method for combining physiologic data and determining best practices. They also provide a nice, concise review of the nuances to each mode of ventilation, complete with figures of wave forms.
As for their results and conclusions, it would be too much to expect that they would provide a resolution to the debate. They found very little difference between pressure and volume modes of ventilation, regardless of the outcome examined. It seems clear that an insufficient flow rate during volume control can increase work of breathing in comparison with pressure control, in which the patient can control flow. However, if the flow rate is increased in the volume mode, there is no difference in work of breathing between modes. There was little evidence for differences between modes in gas exchange, compliance/elastance, or hemodynamics. ...
The British Thoracic Society (BTS) guideline for the management of adults with community acquired pneumonia (CAP) published in 2009 was compared with the 2014 National Institute for Health and Care Excellence (NICE) Pneumonia Guideline.
Of the 36 BTS recommendations that overlapped with NICE recommendations, no major differences were found in 31, including those covering key aspects of CAP management: timeliness of diagnosis and treatment, severity assessment and empirical antibiotic choice. Of the five BTS recommendations where major differences with NICE were identified, one related to antibiotic duration in low and moderate severity CAP, two to the timing of review of patients and two to legionella urinary antigen testing. ...