During the 2020 Spring Festival in China, the outbreak of a novel coronavirus, named COVID‐19 by ... more During the 2020 Spring Festival in China, the outbreak of a novel coronavirus, named COVID‐19 by WHO, brought on a worldwide panic. According to the clinical data of infected patients, radiologic evidence of lung edema is common and deserves clinical attention. Lung edema is a manifestation of acute lung injury (ALI) and may progress to hypoxemia and potentially acute respiratory distress syndrome (ARDS). Patients diagnosed with ARDS have poorer prognosis and potentially higher mortality. Although no effective treatment is formally approved for COVID‐19 infection, support of ventilation with oxygen therapy and sometimes mechanical ventilation is often required. Treatment with systemic and/or local glucocorticoids might be helpful to alleviate the pulmonary inflammation and edema, which may decrease the development and/or consequences of ARDS. In this article, we focus on the lung edema and ALI of patients with this widely transmitted COVID‐19 infection in order to provide clinical indications and potential therapeutic targets for clinicians and researchers.
American Journal of Infection Control, Jun 1, 1992
The Occupational Safety and Health Administration has proposed monitoring employee compliance wit... more The Occupational Safety and Health Administration has proposed monitoring employee compliance with universal precautions, as recommended by the Centers for Disease Control. Our respiratory care department, following a four-step system development plan, has developed and implemented a universal precautions monitoring system that is easy to adapt to any health care department. The results from monitoring can be used for educational planning, quality assurance purposes, and employee performance reviews.
654 BRIEF REPORTS revealed increased muscularity of the right pulmonary arterial tree, consistent... more 654 BRIEF REPORTS revealed increased muscularity of the right pulmonary arterial tree, consistent with Health and Edwards6 grade I changes. Similar findings were seen on the biopsy specimen from the left lung, Our 15 patients represent the largest single series of children with ...
Purpose of review This review summarizes current understanding of the pathophysiology of cardioge... more Purpose of review This review summarizes current understanding of the pathophysiology of cardiogenic pulmonary edema, its causes and treatment. Recent findings The pathobiology and classification of pulmonary edema is more complex than the hydrostatic vs. permeability dichotomy of the past. Mechanisms of alveolar fluid clearance and factors that affect the clearance rate are under intensive study to find therapeutic strategies. Patients need early stabilization of oxygenation and ventilation, preferably with high-flow nasal cannula oxygen or noninvasive ventilation whereas the diagnostic cause is quickly sought with echocardiography and other testing. Summary Treatments must be initiated early, whereas evaluation still is occurring and requires multimodality intervention. The general treatment of cardiogenic pulmonary edema includes diuretics, possibly morphine and often nitrates. The appropriate use of newer approaches – such as, nesiritide, high-dose vasodilators, milrinone, and vasopressin receptor antagonists – needs larger clinical trials.
The sleep apnea syndromes have attracted the interest of physicians and scientists in many differ... more The sleep apnea syndromes have attracted the interest of physicians and scientists in many different disciplines because the disorders involve the physiology of sleep, the control of respiration, the function of the upper airway, and the clinical sequelae upon cardiac, pulmonary, and psycholo gical function. Over the eight years since this subject was last reviewed here (1 ), the pathophysiology of obstructive sleep apnea has become better understood. A variety of new treatments are now available. However, our clinical knowledge of the syndrome and its natural history have changed little. The high prevalence ofthese syndromes and related disorders such as snoring is only beginning to be apparent. This chapter reviews current understanding of these syndromes, with particular emphasis on recent advances, and highlights questions for future investigation. First, we consider normal upper airway function and the control of breathing during sleep. Then, we apply this information to a consideration of the pathophysi ology, clinical features, and treatment of sleep apnea syndromes. NORMAL APPLIED PHYSIOLOGY OF SLEEP
Severe acute lung injury, also known as the adult respiratory distress syndrome (ARDS), is a dyna... more Severe acute lung injury, also known as the adult respiratory distress syndrome (ARDS), is a dynamic and explosive clinical syndrome which exacts a mortality of approximately 50%. The criteria for the diagnosis of severe acute lung injury include five principal elements: hypoxemia despite high concentrations of supplemental oxygen, diffuse pulmonary infiltrates on chest radiographs, decreased lung compliance, appropriate antecedent history, and the absence of congestive heart failure. Identifying an appropriate antecedent history requires consideration of a diverse group of etiologies which may injure alveolar structures via either the air-lung or blood-lung interface. The management of patients with acute lung injury should be approached with four principal goals: (1) cardiopulmonary resuscitation and stabilization; (2) rapid identification and elimination of the cause of lung injury; (3) achieving adequate tissue oxygen delivery and support of other end-organs; and (4) prevention, recognition, and aggressive treatment of any complications that develop during the course of therapy. Recent observations have suggested that conventional methods of positive-pressure ventilation may indirectly injure alveolar tissue, thereby perpetuating lung injury. Furthermore, the optimal use of fluid and hemodynamic support remains controversial. Thus, controlled clinical trials are necessary to develop oxygenation, ventilatory, and hemodynamic support strategies which optimize recovery and minimize further injury and to define the role of newer pharmacologic agents in the prevention and treatment of acute lung injury.
Journal of Clinical and Translational Science, 2018
The fifth in a 5-part series on the clinical and translational sciences educational pipeline, thi... more The fifth in a 5-part series on the clinical and translational sciences educational pipeline, this paper focuses on strategies for developing leadership capacity among senior faculty and administrators responsible for clinical and translational science (CTS) research. Although progression in academic rank recognizes scientific excellence in research or scholarship, neither disciplinary training nor experience alone prepare senior faculty for the leadership challenges they inevitably face. Yet these faculty are increasingly responsible for multidisciplinary teams working within complex organizations with unclear or conflicting incentives that demand innovation. In academic health centers with Clinical and Translational Science Awards (CTSAs), investing in leadership often includes career development support in the CTSA education and training pillar programs. Only a few CTSAs have taken an intentional approach to developing senior leadership capacity, however, and still fewer have foc...
During the 2020 Spring Festival in China, the outbreak of a novel coronavirus, named COVID‐19 by ... more During the 2020 Spring Festival in China, the outbreak of a novel coronavirus, named COVID‐19 by WHO, brought on a worldwide panic. According to the clinical data of infected patients, radiologic evidence of lung edema is common and deserves clinical attention. Lung edema is a manifestation of acute lung injury (ALI) and may progress to hypoxemia and potentially acute respiratory distress syndrome (ARDS). Patients diagnosed with ARDS have poorer prognosis and potentially higher mortality. Although no effective treatment is formally approved for COVID‐19 infection, support of ventilation with oxygen therapy and sometimes mechanical ventilation is often required. Treatment with systemic and/or local glucocorticoids might be helpful to alleviate the pulmonary inflammation and edema, which may decrease the development and/or consequences of ARDS. In this article, we focus on the lung edema and ALI of patients with this widely transmitted COVID‐19 infection in order to provide clinical indications and potential therapeutic targets for clinicians and researchers.
American Journal of Infection Control, Jun 1, 1992
The Occupational Safety and Health Administration has proposed monitoring employee compliance wit... more The Occupational Safety and Health Administration has proposed monitoring employee compliance with universal precautions, as recommended by the Centers for Disease Control. Our respiratory care department, following a four-step system development plan, has developed and implemented a universal precautions monitoring system that is easy to adapt to any health care department. The results from monitoring can be used for educational planning, quality assurance purposes, and employee performance reviews.
654 BRIEF REPORTS revealed increased muscularity of the right pulmonary arterial tree, consistent... more 654 BRIEF REPORTS revealed increased muscularity of the right pulmonary arterial tree, consistent with Health and Edwards6 grade I changes. Similar findings were seen on the biopsy specimen from the left lung, Our 15 patients represent the largest single series of children with ...
Purpose of review This review summarizes current understanding of the pathophysiology of cardioge... more Purpose of review This review summarizes current understanding of the pathophysiology of cardiogenic pulmonary edema, its causes and treatment. Recent findings The pathobiology and classification of pulmonary edema is more complex than the hydrostatic vs. permeability dichotomy of the past. Mechanisms of alveolar fluid clearance and factors that affect the clearance rate are under intensive study to find therapeutic strategies. Patients need early stabilization of oxygenation and ventilation, preferably with high-flow nasal cannula oxygen or noninvasive ventilation whereas the diagnostic cause is quickly sought with echocardiography and other testing. Summary Treatments must be initiated early, whereas evaluation still is occurring and requires multimodality intervention. The general treatment of cardiogenic pulmonary edema includes diuretics, possibly morphine and often nitrates. The appropriate use of newer approaches – such as, nesiritide, high-dose vasodilators, milrinone, and vasopressin receptor antagonists – needs larger clinical trials.
The sleep apnea syndromes have attracted the interest of physicians and scientists in many differ... more The sleep apnea syndromes have attracted the interest of physicians and scientists in many different disciplines because the disorders involve the physiology of sleep, the control of respiration, the function of the upper airway, and the clinical sequelae upon cardiac, pulmonary, and psycholo gical function. Over the eight years since this subject was last reviewed here (1 ), the pathophysiology of obstructive sleep apnea has become better understood. A variety of new treatments are now available. However, our clinical knowledge of the syndrome and its natural history have changed little. The high prevalence ofthese syndromes and related disorders such as snoring is only beginning to be apparent. This chapter reviews current understanding of these syndromes, with particular emphasis on recent advances, and highlights questions for future investigation. First, we consider normal upper airway function and the control of breathing during sleep. Then, we apply this information to a consideration of the pathophysi ology, clinical features, and treatment of sleep apnea syndromes. NORMAL APPLIED PHYSIOLOGY OF SLEEP
Severe acute lung injury, also known as the adult respiratory distress syndrome (ARDS), is a dyna... more Severe acute lung injury, also known as the adult respiratory distress syndrome (ARDS), is a dynamic and explosive clinical syndrome which exacts a mortality of approximately 50%. The criteria for the diagnosis of severe acute lung injury include five principal elements: hypoxemia despite high concentrations of supplemental oxygen, diffuse pulmonary infiltrates on chest radiographs, decreased lung compliance, appropriate antecedent history, and the absence of congestive heart failure. Identifying an appropriate antecedent history requires consideration of a diverse group of etiologies which may injure alveolar structures via either the air-lung or blood-lung interface. The management of patients with acute lung injury should be approached with four principal goals: (1) cardiopulmonary resuscitation and stabilization; (2) rapid identification and elimination of the cause of lung injury; (3) achieving adequate tissue oxygen delivery and support of other end-organs; and (4) prevention, recognition, and aggressive treatment of any complications that develop during the course of therapy. Recent observations have suggested that conventional methods of positive-pressure ventilation may indirectly injure alveolar tissue, thereby perpetuating lung injury. Furthermore, the optimal use of fluid and hemodynamic support remains controversial. Thus, controlled clinical trials are necessary to develop oxygenation, ventilatory, and hemodynamic support strategies which optimize recovery and minimize further injury and to define the role of newer pharmacologic agents in the prevention and treatment of acute lung injury.
Journal of Clinical and Translational Science, 2018
The fifth in a 5-part series on the clinical and translational sciences educational pipeline, thi... more The fifth in a 5-part series on the clinical and translational sciences educational pipeline, this paper focuses on strategies for developing leadership capacity among senior faculty and administrators responsible for clinical and translational science (CTS) research. Although progression in academic rank recognizes scientific excellence in research or scholarship, neither disciplinary training nor experience alone prepare senior faculty for the leadership challenges they inevitably face. Yet these faculty are increasingly responsible for multidisciplinary teams working within complex organizations with unclear or conflicting incentives that demand innovation. In academic health centers with Clinical and Translational Science Awards (CTSAs), investing in leadership often includes career development support in the CTSA education and training pillar programs. Only a few CTSAs have taken an intentional approach to developing senior leadership capacity, however, and still fewer have foc...
Uploads
Papers by David Ingbar