Adding omalizumab to the therapy of adolescents with persistent uncontrolled moderate--severe allergic asthma.

OBJECTIVE: This study aimed to evaluate the effectiveness of omalizumab among adolescents with moderate-severe allergic asthma inadequately controlled with inhaled corticosteroids. PATIENTS AND METHODS: Data from patients 12 to 17 years of age were pooled from 5 placebo-controlled registration trials of omalizumab. Impact on asthma control was assessed by need for rescue bursts of oral corticosteroids, lung function, symptom scores, and unscheduled office visits. RESULTS: In adolescents (n = 146), addition of omalizumab decreased mean number of rescue bursts (0.3 vs 0.9) versus placebo; relative risk 0.47 (95% confidence interval [CI], 0.22-0.99; P = .047). At study conclusion, mean forced expiratory volume in 1 second increased 268 mL (13.8%) in omalizumab-treated subjects versus 98 mL (5.5%) for placebo (least squares mean treatment difference 146 mL [95% CI, 19.4-272.6; P = .024]). Omalizumab significantly improved asthma symptom scores and reduced unscheduled office visits. CONCLUSION: Omalizumab added to baseline therapy improves measures of asthma control in adolescents with persistent moderate-severe allergic asthma.

Implementation of guidelines for preoperative laboratory investigations in patients scheduled to undergo elective surgery.

OBJECTIVE: To assess the impact on preoperative laboratory investigations in elective surgery after the implementation of guidelines for ordering such tests. DESIGN: A retrospective chart audit. SETTING: A university teaching hospital. PATIENTS: The charts of 903 patients who underwent an elective surgical procedure from each surgical specialty except cardiovascular and thoracic. INTERVENTIONS: Implementation of guidelines for preoperative laboratory investigations. MAIN OUTCOME MEASURES: Impact on the preoperative use of laboratory investigations after implementation of the guidelines as well as patient morbidity and mortality. RESULTS: The mean number of preoperative laboratory investigations done per patient decreased from 4.65 before implementation of the guidelines to 4.18 after (p < 0.001). There was no apparent adverse impact on patient morbidity or mortality. CONCLUSION: Implementation of guidelines for preoperative laboratory investigations for elective surgery resulted in a reduction in the number of tests without adverse impact on patient morbidity or mortality.

Pathophysiology and implications for treatment of acute respiratory distress syndrome.

Acute respiratory distress syndrome is a complex group of signs and symptoms caused by direct or indirect lung injury. In spite of decades of research, it is still associated with a high mortality rate. Pathogenesis of this disease is related to alveolar endothelial and epithelial cell injury and associated release and sequestration of inflammatory mediators and cells, including cytokines and neutrophils, respectively. Pharmacologic interventions have been largely unsuccessful, and ventilation strategies to support oxygenation while limiting ventilator associated lung injury have not demonstrated any significant reductions in the mortality rate. However, novel therapies are in development, based on the knowledge of the pathologic processes of acute respiratory distress syndrome. In this article an overview of the disease process and mediator involvement is presented, followed by a review of pharmacologic and ventilation treatments currently in use or under study.