Background: Home exposure to high levels of house dust mite allergen has been shown to aggravate airways reactivity and asthma.
Objective: The purpose of this study was to determine whether specific ...house dust mite control measures could reduce exposure levels and asthma severity.
Methods: This double-blinded, randomized trial compared asthma progression over 1 year in children whose homes received standard environmental control intervention with those whose homes received aggressive intervention for dust mite elimination. The primary end point was doubling in PD
20 methacholine.
Results: Symptom scores and quality-of-life scores were similar for the standard and aggressive intervention groups. PD
20 methacholine doubling occurred in 9 members of the aggressive intervention group vs 4 control patients (
P < .05). Dust mite levels decreased in the aggressive intervention homes compared with the standard intervention homes (
P < .05).
Conclusion: Aggressive dust mite intervention decreased dust mite levels and improved bronchial hyperresponsiveness. (J Allergy Clin Immunol 1999;103:1069-74.)
Objective: The optimal resuscitation approach during the initial treatment of hypotensive trauma patients remains unknown, but some clinical trials have observed a survival benefit from restricting ...fluid administration prior to definitive hemorrhage control. We sought to characterize emergency medical services (EMS) protocols for the administration of intravenous fluids in this setting. Methods: Publicly accessible statewide EMS protocols for the treatment of hypotensive trauma patients were included and characterized by: 1) goal of fluid administration, 2) dosing strategy, 3) maximum dose, 4) type of fluid, and 5) specific protocols for head trauma, if present. Results: Of the 27 states with a publicly available, statewide protocol, 21 have a numeric systolic blood pressure (SBP) target for resuscitation. Of these, 16 describe a goal of maintaining SBP ≥90 mmHg with or without additional goals, three specify a goal that is less than 90 mmHg, and two specify a goal ≥100 mHg. Dosing strategies also vary and include both standard bolus strategies (200 mL, 250 mL, 500 mL, and 1 L with repeat) as well as weight-based strategies (20 mL/kg). Nine states specify a maximum dose of 2 L without medical control. Fifteen protocols recommend the use of normal saline, 1 recommends the use of lactated Ringer's, and 11 recommend the use of either normal saline or lactated Ringer's. Nine states have distinct protocols for patients with head trauma, all of which indicate maintaining a higher SBP than for trauma patients without head trauma. Conclusion: State EMS protocols for fluid administration for hypotensive trauma patients vary in regard to SBP goal, fluid dose, and fluid type. Clinical trials to determine the optimal use of intravenous fluids for hypotensive trauma patients are needed to define the optimal approach.
