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Highly accurate prediction of food challenge outcome using routinely available clinical data

Serum specific IgE or skin prick tests are less useful at levels below accepted decision points.

Objectives: We sought to develop and validate a model to predict food challenge outcome by using routinely collected data in a diverse sample of children considered suitable for food challenge.

Methods: The proto-algorithm was generated by using a limited data set from 1 service (phase 1). We retrospectively applied, evaluated, and modified the initial model by using an extended data set in another center (phase 2). Finally, we prospectively validated the model in a blind study in a further group of children undergoing food challenge for peanut, milk, or egg in the second center (phase 3). Allergen-specific models were developed for peanut, egg, and milk.

Results: Phase 1 (N = 429) identified 5 clinical factors associated with diagnosis of food allergy by food challenge. In phase 2 (N = 289), we examined the predictive ability of 6 clinical factors: skin prick test, serum specific IgE, total IgE minus serum specific IgE, symptoms, sex, and age. In phase 3 (N = 70), 97% of cases were accurately predicted as positive and 94% as negative. Our model showed an advantage in clinical prediction compared with serum specific IgE only, skin prick test only, and serum specific IgE and skin prick test (92% accuracy vs 57%, and 81%, respectively).

Conclusion: Our findings have implications for the improved delivery of food allergy–related health care, enhanced food allergy–related quality of life, and economized use of health service resources by decreasing the number of food challenges performed.

Recombinant Tissue Factor Pathway Inhibitor in Severe Community-Acquired Pneumonia: A Randomized Trial.

CONCLUSIONS: Tifacogin showed no mortality benefit in sCAP patients despite evidence of biological activity. The study does demonstrate the persistent unmet need for further interventions to improve mortality of sCAP and the feasibility of those studies.

Pseudomonas Aeruginosa Population Diversity and Turnover in Cystic Fibrosis Chronic Infections.

CONCLUSIONS: These results significantly advance our understanding of the within-host population biology of P. aeruginosa during infection of cystic fibrosis patients, and provide in vivo evidence for a link between pyocyanin production and patient morbidity.

Hypercapnic encephalopathy syndrome: A new frontier for non-invasive ventilation?

According to the classical international guidelines, non-invasive ventilation is contraindicated in hypercapnic encephalopathy syndrome (HES) due to the poor compliance to ventilatory treatment of confused/agitated patients and the risk of aspirative pneumonia related to lack of airways protection. As a matter of fact, conventional mechanical ventilation has been recommended as "golden standard" in these patients. However, up to now there are not controlled data that have demonstrated in HES the advantage of conventional mechanical ventilation vs non-invasive ventilation. In fact, patients with altered mental status have been systematically excluded from the randomised and controlled trials performed with non-invasive ventilation in hypercapnic acute respiratory failure.

Recent studies have clearly demonstrated that an initial cautious NPPV trial in selected HES patients may be attempt as long as there are no other contraindications and the technique is provided by experienced caregivers in a closely monitored setting where ETI is always readily available. The purpose of this review is to report the physiologic rationale, the clinical feasibility and the still open questions about the careful use of non-invasive ventilation in HES as first-line ventilatory strategy in place of conventional mechanical ventilation via endotracheal intubation.

Efficacy and comfort of volume-guaranteed pressure support in patients with chronic ventilatory failure of neuromuscular origin.

Volume-guaranteed pressure support (PSV-VTG) theoretically guarantees minute ventilation more effectively than older modes of non-invasive ventilation. The clinical effects of PSV-VTG were evaluated in patients with neuromuscular disease and chronic hypoventilation. PSV-VTG did not out-perform older ventilatory modes in terms of efficacy of gas exchange or comfort, and was associated with more patient-ventilator asynchronies.

ABSTRACT: Background and objective : Although non-invasive ventilation (NIV) is mostly used for the management of patients with neuromuscular disease, it remains unclear which ventilatory mode is associated with optimal patient-ventilator interaction and provides more effective gas exchange. The effects of volume-guaranteed pressure support (PSV-VTG) as compared with pressure support ventilation (PSV) and assisted pressure controlled ventilation (APCV) on breathing pattern and patient-ventilator synchrony during sleep, blood gases, and subjective comfort were evaluated in a group of stable patients with neuromuscular disease.

Methods : PSV-VTG, PSV, and APCV were applied in random order on three consecutive nights, during which cardio-respiratory monitoring was performed. Arterial blood gases were measured at the end of each ventilatory session. Evaluation of subjective sleep quality, comfort, and perception of patient-ventilator synchrony was performed using a ten-item visual analogue questionnaire.

Results : Twenty-eight patients were included in the study. The different ventilatory modes showed similar effects on breathing pattern during sleep, arterial blood gases, and degree of subjective comfort. Ineffective efforts were only observed during PSV-VTG and were inversely correlated with the variability of leaks (r = -0.61, P= 0.015). A greater number of prolonged inspirations was observed with PSV-VTG and PSV compared to APCV (P= 0.048 and 0.029, respectively). There were no correlations between patient comfort and physiological variables or ventilator setting.

Conclusions : PSV-VTG did not outperform older modes of ventilation in terms of efficacy on breathing pattern and blood gases. In addition, application of PSV-VTG was associated with a higher rate of patient-ventilator dyssynchrony.

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