C-Reactive Protein in Pneumonia

Abstract

confusion in the air when attempting to interpret the numerous noncomparative studies that examine the value of markedly different pleurodesis modalities studied in aggregate populations with diverse under-lying respiratory conditions. Considering the impor-tance of spontaneous pneumothorax for patients with COPD, multicenter trials akin to those recently completed for lung volume reduction surgery are needed. Anticipating that such trials will be many years from conception to completion—if they occur at all—we need formal decision analyses to weigh the relative value of different management approaches 18 as have been performed for primary spontaneous pneumothorax. 19 Such analyses are especially impor-tant considering the opinion of some pleural experts that the risk of talc-induced acute lung injury does not justify its use. 20 Meanwhile, we are left with our previously stated and less-than-satisfying recommendation to individ-ualize care based on the available techniques at local institutions that match best-reported clinical out-comes. 21 Albeit necessary with our present state of knowledge, such recommendations further entrench practice variation, delay implementation of best clin-ical practices, and perpetuate our clinical confusion.