Inhaled Dornase alfa (Pulmozyme) as a noninvasive treatment of atelectasis in mechanically ventilated patients.

BACKGROUND: Lobar or segmental collapse of the lung in mechanically ventilated patients is a common occurrence in the intensive care unit. Management is labor and time intensive and not highly effective. METHODS: We conducted a randomized, placebo-controlled, double-blind pilot study to determine whether nebulized Dornase alfa improves radiologic and clinical outcomes in ventilated patients with lobar atelectasis. Drug or placebo was administered twice daily until extubation, death, or transfer. The primary outcome was the total chest x-ray score: secondary outcomes of interest were oxygenation, lung compliance, and rate of extubation over the first 5 days. The groups consisted of 14 intervention patients and 16 control patients. RESULTS: There were no significant differences in "Total Chest X-Ray Score" or compliance over the 5 days of study. There was an improvement in oxygenation for the intervention group at day 5 (P = .03). In addition, this group was less likely to remain intubated over the first 24 hours of the study, a difference that did not persist over the course of the study. CONCLUSIONS: Dornase alfa does not improve the appearance of atelectasis on chest radiographs, or the "Total Chest X-Ray Score" over the first 5 days of treatment in mechanically ventilated patients. The intervention group's higher rate of extubation during the first 24 hours as well as its improved oxygenation on day 5 were likely chance findings given the multiple potential confounders for extubation and low study power.

Expenditures associated with preventive healthcare.

BACKGROUND: The Office of Disease Prevention and Health Promotion emphasizes the use of preventive healthcare interventions to "increase quality and years of healthy life". The objective of this study is to evaluate over a 1-year period the total individual healthcare expenditures based upon the likelihood of the person utilizing preventive healthcare measures. METHODS: We analyzed data from the 1998 Medical Expenditure Panel Survey (MEPS) to compare healthcare expenditures of respondents who have and have not followed generally accepted preventive healthcare measures including influenza vaccination, blood pressure checkup, prostate examination, cholesterol determination, and mammography. RESULTS: In general, respondents who lacked evidence of pursuing accepted preventive healthcare practices had lower overall healthcare expenditures in 1998 compared to those who pursued such practices. Specifically, they had lower expenditures for office-based visits and for prescriptions. CONCLUSIONS: People who pursue accepted preventive healthcare measures spent more for their total healthcare over a given year.

Aircraft cabin air recirculation and symptoms of the common cold.

CONTEXT: In recent years, new commercial aircraft have been designed to recirculate approximately 50% of the cabin air to increase fuel efficiency. Some older aircraft use only fresh air. Whether air recirculation increases the transmission of infectious disease is unknown; some studies have demonstrated higher rates of the common cold among persons working in buildings that recirculate air. OBJECTIVE: To evaluate the role of air recirculation as a predictor of postflight upper respiratory tract infections (URIs). DESIGN, SETTING, AND PARTICIPANTS: A natural experiment conducted among 1100 passengers departing the San Francisco Bay area in California and traveling to Denver, Colo, during January through early April 1999, and who completed a questionnaire in the boarding area and a follow-up telephone interview 5 to 7 days later. Forty-seven percent traveled aboard airplanes using 100% fresh air for ventilation, and 53% traveled aboard aircraft that recirculated cabin air. MAIN OUTCOME MEASURE: Incidence of reporting new URI symptoms within 1 week of the flight. RESULTS: Passengers on airplanes that did and did not recirculate air had similar rates of postflight respiratory symptoms. The rates of reporting a cold were 19% vs 21% (P =.34); a runny nose and a cold, 10% vs 11%, (P =.70); and an aggregation of 8 URI symptoms, 3% in both groups (P>.99). Results were similar after statistical adjustment for potential confounders. CONCLUSION: We found no evidence that aircraft cabin air recirculation increases the risk for URI symptoms in passengers traveling aboard commercial jets.