Chest

BACKGROUND: One of the major challenges in treating obstructive sleep apnea (OSA) is to achieve adequate continuous positive airway pressure (CPAP) adherence. Telemonitoring has the potential to provide individualized management and early recognition of problems during treatment. RESEARCH QUESTION: What is the effect of a multimodal telemonitoring intervention on treatment adherence, quality of life and functional status in symptomatic OSA patients with low cardiovascular risk? STUDY DESIGN: and Methods: In a multicenter, randomized controlled trial, newly diagnosed OSA patients were randomly assigned to multimodal telemonitoring for 6 months versus usual care (UC)...

BACKGROUND: No large prospective data are available on ventilator-associated pneumonia (VAP) in patients with traumatic brain injury (TBI). RESEARCH QUESTION: To evaluate the incidence, timing and risk factors of VAP after TBI and its effect on patients' outcome. STUDY DESIGN: and Methods: Analysis of the CENTER-TBI dataset, a large, multicenter, prospective, observational study including TBI patients admitted to European intensive care units (ICU), mechanically ventilated for ≥48 hours, and with an ICU length of stay (LOS) ≥72 hours...

BACKGROUND: Treatment of hypoxemic respiratory failure (HRF) and Acute Respiratory Distress Syndrome (ARDS) is complex. Standardized management of HRF and ARDS may improve adherence to evidence informed practice and improve outcomes. RESEARCH QUESTION: To examine the effect of standardized management compared to usual care on survival in HRF and ARDS patients. METHODS: MEDLINE, EMBASE, Cochrane, CINAHL, Scopus, and Web-of-Science were searched (inception to 2018)...

BACKGROUND: Decisions about lung cancer screening are inherently complex and create a need for methods to convey the risks and benefits of screening to patients. RESEARCH QUESTION: What kind of decision aids or tools are available to support shared-decision making for lung cancer screening? What is the current evidence for the effectiveness, acceptability and feasibility of those tools? STUDY DESIGN: and Methods: We conducted a systematic review of studies and searched PubMed, MEDLINE, EMBASE, Cochrane Clinical Trials Register and ClinicalTrials...

BACKGROUND: Previous studies have yielded inconsistent findings regarding the association between obstructive sleep apnea (OSA) and cancer in humans. RESEARCH QUESTION: Is there an association between indices of sleep-disordered breathing severity and cancer incidence in patients investigated for suspected OSA? STUDY DESIGN AND METHODS: Data from a large multicenter cohort of cancer-free patients investigated for OSA were linked to health administrative data to identify new-onset cancer...

BACKGROUND: Herpes simplex virus type 1 (HSV-1) is frequently detected in the bronchoalveolar lavage fluid (BAL) of mechanically ventilated patients. RESEARCH QUESTION: The aim of the study was to investigate whether antiviral therapy is associated with improved overall survival within 30 days. STUDY DESIGN: Retrospective cohort study in 4 intensive care units (ICUs) between 01/2011 and 12/2017. METHODS: All mechanically ventilated adult patients with a respiratory tract infection with positive polymerase chain reaction testing for HSV-1 in the BAL were included...

BACKGROUND: European Society of Cardiology and European Respiratory Society (ESC/ERS) guidelines include thermodilution cardiac index (TDCI) and mixed venous oxygen saturation (SvO2 ) as two of the three hemodynamic determinations used in risk assessment of patients with pulmonary arterial hypertension (PAH). SvO2 may be a better measurement than TDCI to assess prognosis in patients with either idiopathic or heritable PAH. RESEARCH QUESTION: What is the concordance between TDCI and SvO2 ESC/ERS risk group allocation and their prognostic value in patients with PAH? STUDY DESIGN: and methods: In this retrospective study, we assessed correlation between SvO2 and TDCI in patients with idiopathic and heritable PAH...

BACKGROUND: Primary ciliary dyskinesia (PCD) is a heterogeneous disease with a diverse clinical and genetic spectrum among populations worldwide. Few cases of pediatric PCD have been reported from China. METHODS: Clinical characteristics, laboratory findings, and genetic results obtained for 81 patients with PCD were retrospectively reviewed at a single center in China. Genetic sequencing was conducted using whole-exome screening. RESULTS: Patient median age at diagnosis was 7...

Systemic capillary leak syndrome is a rare disorder characterized by dysfunctional inflammatory response, endothelial dysfunction, and extravasation of fluid from the vascular space to the interstitial space leading to shock, hemoconcentration, hypoalbuminemia and subsequent organ failure. The condition may be idiopathic or secondary to an underlying cause, which can include viral infections. Here we describe a patient with acute COVID-19 infection who presented with hemoconcentration, shock and hypoalbuminemia...

BACKGROUND: There are currently no reference standards for the development of competency in bronchoscopy. RESEARCH QUESTION: The aims of this study were to 1) develop learning curves for bronchoscopy skill development and 2) estimate the number of bronchoscopies required to achieve competence. STUDY DESIGN AND METHODS: Trainees from seven North American academic centers were enrolled at the beginning of their Pulmonology training. Performance during clinical bronchoscopies was assessed by supervising physicians using the Ontario Bronchoscopy Assessment Tool (OBAT)...

BACKGROUND: Pulmonary exacerbations in cystic fibrosis are characterized by airway inflammation and may cause irreversible lung damage. Early identification of such exacerbations may facilitate early initiation of treatment, thereby potentially reducing long-term morbidity. RESEARCH QUESTION: Is it possible to predict pulmonary exacerbations in children with cystic fibrosis using inflammatory markers obtained from bronchoalveolar lavage (BAL) fluid? STUDY DESIGN: and Methods: A longitudinal analysis of children aged 0-7 years included in the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) study between 2005 and 2015...

BACKGROUND: In patients with bronchiectasis, airway clearance techniques (ACTs) are important management strategies. RESEARCH QUESTION: The primary objective was to describe differences in patients with bronchiectasis and productive cough who utilized ACTs and those who did not. Secondary objectives included assessment of bronchiectasis exacerbation frequency and change in pulmonary function at one-year follow-up. STUDY DESIGN: and methods:Adult patients with bronchiectasis and productive cough in the United States Bronchiectasis and NTM Research Registry were included in the analyses...

Diffuse alveolar hemorrhage (DAH) is a severe and potentially life-threatening disease manifestation. Besides autoimmune diseases such as anti-neutrophil cytoplasmatic antibody (ANCA) associated vasculitis and anti-glomerular basement membrane (anti-GBM) syndrome pulmonary viral infections are also known to be culprits of DAH. The coronavirus disease 2019 (COVID-19) pandemic confronts healthcare providers all around the world with an unprecedented number of viral lung infections with a great variance in symptoms and severity...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Pulmonary Langerhans cell histiocytosis (PLCH) determines reduced exercise capacity. The speculated mechanisms of exercise impairment in PLCH are ventilatory and cardiocirculatory limitations, including pulmonary hypertension (PH). RESEARCH QUESTION: What are the mechanisms of exercise limitation, the exercise capacity and the prevalence of dynamic hyperinflation (DH) and PH in PLCH? STUDY DESIGN AND METHODS: In a cross-sectional study, PLCH patients underwent an incremental treadmill cardiopulmonary exercise test with an evaluation of DH, pulmonary function tests, and transthoracic echocardiography...

BACKGROUND: Pneumonia is the leading infection-related cause of death. Using simple clinical criteria and contemporary epidemiology to identify patients at high risk of nosocomial pneumonia should enhance prevention efforts and facilitate development of new treatments in clinical trials. RESEARCH QUESTION: What are the clinical criteria and contemporary epidemiology trends helpful in identifying patients at high risk of nosocomial pneumonia? STUDY DESIGN AND METHODS: Within the intensive care units of 28 United States hospitals, we conducted a prospective cohort study among adults hospitalized more than 48 hours and considered high risk for pneumonia (defined as treatment with invasive or noninvasive ventilatory support or high levels of supplemental oxygen)...

BACKGROUND: Recent studies have demonstrated that high flow nasal cannula (HFNC) prevents intubation in acute hypoxic respiratory failure when compared to conventional oxygen therapy (COT). However, the data examining routine HFNC use in the immediate post-operative period is less clear. RESEARCH QUESTION: Is routine HFNC use superior to COT or non-invasive ventilation (NIV) in preventing intubation in post-operative patients? STUDY DESIGN: and Methods: We comprehensively searched databases (MEDLINE, EMBASE, Web of Science) to identify randomized controlled trials (RCTs) that compared the effect of HFNC use to COT or NIV in the immediate post-operative period on reintubation, escalation of respiratory support, hospital mortality, ICU and hospital length of stay, post-operative hypoxemia and treatment complications...

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is associated with nighttime respiratory symptoms, poor sleep quality, and increased risk of nocturnal mortality. Overnight deterioration of inspiratory capacity (IC) and forced expiratory volume in 1 second (FEV1 ) have previously been documented. However, the precise nature of this deterioration and mechanisms by which evening bronchodilators may mitigate this have not been studied. RESEARCH QUESTION: To determine the effect of evening dosing of dual, long-acting bronchodilators on detailed nocturnal respiratory mechanics and inspiratory neural drive (IND)...

BACKGROUND: Over decades, there have been several alterations to cigarettes, including the addition of filters and flavoring. Despite this, lung cancer remains the leading cause of cancer-related death in the US. We aimed to examine the association of type of cigarette on nicotine dependence in the setting of lung cancer screening. METHODS: This is a secondary analysis of the American College of Radiology Imaging Network arm of the National Lung Screening Trial...