Chest

BACKGROUND: Moderate to severe depressive symptoms occur in up to one-third of patients at one year after Intensive Care Unit (ICU) discharge, negatively impacting patient outcomes. We evaluated patient and caregiver factors associated with the development of these symptoms. METHODS: Using the RECOVER Program (Phase 1) cohort of 391 patients from ten medical/surgical university-affiliated ICUs across Canada, we determined the association between patient depressive symptoms (captured by the Beck Depression Inventory II [BDI-II]), patient characteristics (age, sex, socioeconomic status, Charlson Score, ICU length of stay [LOS]), Functional Independence Measure (FIM) motor subscale score, and caregiver characteristics (Caregiver Assistance Scale [CAS] and Center for Epidemiologic Studies Depression Scale [CES-D]), using linear mixed models at time points 3, 6, and 12 months...

Burnout syndrome is an increasingly common phenomenon which threatens our critical care workforce and the wellbeing of its members. Burnout syndrome can be conceived of as a workforce manifestation of chronic workload and workforce capacity imbalance. We explore the role of workload management tools that can address workload as a compliment to the resilience-based countermeasures that seek to increase worker capacity. We were able to use step-wise increment in the volume of documentation-related tasks that occurred at the time of electronic health record (EHR) implementation to investigate the relation of workload and burnout...

BACKGROUND: Medical malpractice data can be leveraged to understand specialty-specific risk. METHODS: Malpractice claims were examined from the Comparative Benchmarking System (2007-2016), a national database containing >30% of claim data in the United States. Claims were identified with either internal medicine or pulmonary/critical care (PCC) physicians as primary provider involved in the harm. Claim characteristics were compared by specialty and care setting (inpatient vs outpatient) and multiple regression was performed to predict claim payment...

Group 2 innate lymphoid cells (ILC2s) are increasingly recognized as a key controller of type 2 inflammation, and are well known to be highly elevated in human airway type 2 inflammatory diseases including allergic rhinitis, chronic rhinosinusitis with nasal polyps and asthma. ILC2-mediated production of type 2 cytokines initiates and amplifies airway inflammation via activation of eosinophils, B cells, mast cells, macrophages, fibroblasts and epithelial cells in these diseases. ILC2s require three major signals to fully activate and robustly produce type 2 cytokines...

BACKGROUND: To guide rational antibiotic selection in community-onset pneumonia, we previously derived and validated a novel prediction tool, the Drug-Resistance in Pneumonia (DRIP) score. In 2015 DRIP was integrated into an existing electronic clinical decision support tool for pneumonia (ePNa). METHODS: We conducted a quasi-experimental, pre-post implementation study of ePNa with DRIP (2015) vs ePNa with HCAP logic (2012) in emergency department patients admitted with community-onset pneumonia to four U...

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BACKGROUND: Pleural biopsies in patients with suspected malignant pleural mesothelioma (MPM) are often inconclusive featuring fibrosis, resulting in repeat diagnostic procedures. Confocal laser endomicroscopy (CLE) enables real-time imaging on a cellular level. We investigated pleural CLE imaging as a biopsy guidance technique to distinguish malignant from benign pleural disease. METHODS: Prospective, multi-center study in patients with (suspected) MPM based on (PET)-CT imaging who were scheduled for pleural biopsies...

BACKGROUND: Human epidermal growth factor 2 (HER2) is a potential driver oncogene. Although HER2-targeted precision therapy has been tested in non-small cell lung cancer (NSCLC), the demographic characteristics of HER2-positive NSCLC have not been systematically defined. METHODS: Patients with pathologically confirmed stage IIIB/IV or recurrent NSCLC, Eastern Cooperative Oncology Group performance status 0 to 2, were prospectively registered. HER2 immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) assays were performed to screen patients...

BACKGROUND: The long-term risks of thromboembolism and mortality are unknown in patients who survived after newly diagnosed atrial fibrillation (AF) during critical care. METHODS: By using the Korean National Health Insurance Service database, we identified 30,869 adults who survived for more than 6 months after newly diagnosed AF during critical care (ICU-AF), 269,751 controls with non-ICU AF (AF-controls), and 439,868 controls without AF (No-AF) from 2005 to 2013...

BACKGROUND: Fibrotic interstitial lung diseases (ILDs) are highly morbid chronic disorders that frequently occur in working age individuals. We aimed to determine workplace productivity loss, its determinants, and its estimated costs in patients with fibrotic ILD. METHODS: Patients with idiopathic pulmonary fibrosis, chronic hypersensitivity pneumonitis, idiopathic non-specific interstitial pneumonia, or unclassifiable ILD were identified from the six-centre CAnadian REgistry for Pulmonary Fibrosis...

There is controversy around the use of blood eosinophil levels as a biomarker of exacerbation risk and responsiveness of patients to inhaled corticosteroids (ICS). Patients in stable COPD with GOLD II-IV were enrolled in an observational multicentre trial. Concordance was defined as blood eosinophil values persistently lower than or persistently higher than the absolute cut-off points 150 cells/μL, 300 cells/μL, or the percentage cut-off points 2%, 3% and 4%. Discordance was obtained when the blood eosinophil values varied between any two visits...

BACKGROUND: Angiotensin peptides have been implicated in idiopathic pulmonary fibrosis (IPF) pathogenesis. Angiotensin modulators are used to treat arterial hypertension, a frequent comorbidity of IPF. This post hoc analysis evaluated associations of antihypertensive treatments with disease-related outcomes in IPF. METHODS: All patients randomized to placebo (n=624) in the CAPACITY and ASCEND studies were categorized by antihypertensive treatment at baseline. Outcomes of disease progression (first occurrence of ≥10% absolute decline in % predicted forced vital capacity, ≥50 m decline in 6-minute walk distance, or death) and all-cause mortality were assessed over 52 weeks...

BACKGROUND: Chronic bronchitis (CB) increases risk of COPD exacerbations. We have shown that the Saint George's Respiratory Questionnaire (SGRQ) CB definition identifies patients with a similar clinical phenotype as classically defined CB. Whether the SGRQ CB definition is a predictor of future COPD exacerbations is unknown. METHODS: We analyzed 7557 smokers with normal spirometry and GOLD 1-4 COPD in the COPDGene study with longitudinal follow-up data on exacerbations...

BACKGROUND: Infectious disease epidemiology has changed over time, reflecting improved clinical interventions and emergence of threats such as antimicrobial resistance. We investigated infectious disease hospitalizations in the United States during 2001-2014. METHODS: Using the National (Nationwide) Inpatient Sample, estimated rates of infectious disease hospitalizations were calculated. Infectious disease hospitalizations were defined as hospitalizations with a principal discharge diagnosis of an infectious disease...

Sleep-disordered breathing (SDB), including obstructive and central sleep apnea (OSA and CSA), is highly prevalent in patients with heart failure (HF). Multiple studies have shown this high prevalence in asymptomatic as well as symptomatic patients with reduced left ventricular ejection fraction (HFrEF), as well as those with preserved ejection fraction (HFpEF). The acute pathobiological consequences of OSA including exaggerated sympathetic activity, oxidative stress, and inflammation, eventually could lead to progressive left ventricular dysfunction, repeated hospitalization, and excessive mortality...

BACKGROUND: Lymphangioleiomyomatosis (LAM) is a destructive metastasizing neoplasm of the lung characterized by proliferation of LAM cells in specialized lung nodules. LAM cells are characterized by expression of the prometastatic and cancer-initiating hyaluronan receptor CD44v6, and loss of heterozygosity (LOH) of the Tuberous Sclerosis Complex (TSC) genes 1 and 2. The circulating neoplastic LAM cells are believed to be involved in metastasis. Because LAM cells display properties of neoplastic, metastatic, and stem cell-like cancer cells, we hypothesized that elevated aldehyde dehydrogenase (ALDH) activity, characteristic of cancer and stem cells, is a property of LAM cells...

BACKGROUND: Pulmonary rehabilitation (PR) improves exercise capacity and quality of life in people with chronic obstructive pulmonary disease (COPD), yet its effect upon anxiety and depression symptoms is less clear. Existing data is difficult to apply to clinical PR due to diverse interventions and comparators. This review evaluated the effectiveness of PR on anxiety and depression symptoms in people with COPD. METHODS: A systematic review and meta-analysis (PROSPERO CRD42018094172) was conducted according to PRISMA guidelines on randomised controlled trials comparing PR (≥4 weeks duration) to usual care...

BACKGROUND: Phototherapy is an alternative treatment for patients with localized non-small cell lung cancer who are unable to undergo surgical resection. However, phototherapy is currently limited to treatment of centrally located lung cancer, with the much larger proportion of peripheral lesions remaining inaccessible. There are also concerns over the accuracy of targeted laser treatment due to the need to exchange visualization and irradiation fibers during therapy, preventing the operator from confirming the final location of the irradiation fiber...

Correction of intravascular hypovolaemia is a key component of the prevention and management of acute kidney injury (AKI) but excessive fluid administration is associated with poor outcomes, including the development and progression of AKI. There is growing evidence that fluid administration should be individualised and take into account patient characteristics, nature of the acute illness and trajectories, and risks and benefits of fluids. Existing data support the preferential use of buffered solutions for fluid resuscitation of patients at risk of AKI who do not have hypochloraemia...

BACKGROUND: Whether gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough in children is controversial. Using the PICO format, we undertook 4 systematic reviews. For children with chronic cough (>4-weeks duration) and without underlying lung disease: (1) who do not have gastrointestinal GER symptoms, should empirical treatment for GERD be used? (2) with gastrointestinal GER symptoms, does treatment for GERD resolve the cough? (3) with or without gastrointestinal GER symptoms, what GER-based therapies should be used and for how long? (4) if GERD is suspected as the cause, what investigations and diagnostic criteria best determine GERD as the cause of the cough? METHODS: We used the CHEST Expert Cough Panel's protocol and American College of Chest Physicians (CHEST) methodological guidelines and GRADE framework...