Rafael Paez, Michael N Kammer, Nicole T Tanner, Samira Shojaee, Brent E Heideman, Tobias Peikert, Meridith L Balbach, Wade T Iams, Boting Ning, Marc E Lenburg, Christopher Mallow, Lonny Yarmus, Kwun M Fong, Stephen Deppen, Eric L Grogan, Fabien Maldonado
TOPIC IMPORTANCE: Lung cancer is the leading cause of cancer related deaths. Early detection and diagnosis are critical as survival decreases with advanced stages. Approximately 1.6 million nodules are incidentally detected every year on chest computed tomography in the United States. This number of nodules identified is likely much larger after accounting for screening detected nodules. Most of these nodules, whether incidentally or screening-detected, are benign. Despite this, many patients undergo unnecessary invasive procedures to rule out cancer as our current stratification approaches are suboptimal, particularly for intermediate probability nodules...
May 25, 2023: Chest
Athanasios G Kaditis, James Acton, Connie Fenton, Leila Kheirandish-Gozal, Zarah Ner, Rebekah Nevel, David Gozal, Adrienne Ohler
BACKGROUND: Introduction of novel therapies for cystic fibrosis (CF), raises the question whether traditional treatments can be withdrawn. Nebulized hypertonic saline (HS) could potentially be discontinued in patients receiving Dornase alfa (DA). RESEARCH QUESTION: In the pre-modulator era, did people with CF who were F508del homozygous (CFF508del ) and received DA and HS have better preserved lung function than those treated with DA only? STUDY DESIGN: Retrospective analysis of CF Foundation Patient Registry data (2006-2014)...
May 25, 2023: Chest
Gilgamesh Eamer, Christopher A Povolo, Jo-Anne Petropoulos, Arto Ohinmaa, Lisa Vanhouwelingen
BACKGROUND: Primary spontaneous pneumothorax (PSP) has several commonly used management strategies: observation, aspiration, and chest tube (CT). Economic modelling of pooled data comparing techniques has not been performed. RESEARCH QUESTION: Based on studies from the past 20 years, approach to management of PSP delivers the highest utility? STUDY DESIGN AND METHODS: A systematic review of PSP management strategies (observation, aspiration or CT) was conducted in Medline and EMBASE from January 1, 2000 to April 10, 2020...
May 18, 2023: Chest
Rianne de Vries, Niloufar Farzan, Timon Fabius, Frans H C De Jongh, Patrick M C Jak, Eric G Haarman, Erik Snoey, Johannes C C M In 't Veen, Yennece W F Dagelet, Anke-Hilse Maitland-Van Der Zee, Annelies Lucas, Michel M Van Den Heuvel, Marguerite Wolf-Lansdorf, Mirte Muller, Paul Baas, Peter J Sterk
BACKGROUND: Patients with COPD are at high risk of developing lung cancer, but no validated predictive biomarkers have been reported to identify these patients. Molecular profiling of exhaled breath by electronic nose (eNose) technology may qualify for early detection of lung cancer in COPD patients. RESEARCH QUESTION: Can eNose technology be used for prospective detection of early lung cancer in COPD patients? STUDY DESIGN AND METHODS: BreathCloud is a real-world multicenter, prospective follow-up study using diagnostic and monitoring visits in day-to-day clinical care of patients with a standardized diagnosis of asthma, COPD or lung cancer...
May 18, 2023: Chest
Amit Chopra, Peter Doelken, Kurt Hu, John T Huggins, Marc A Judson
TOPIC IMPORTANCE: Pressure-dependent pneumothorax is a common clinical event, often occurring after pleural drainage in patients with visceral pleural restriction, partial lung resection or lobar atelectasis from bronchoscopic lung volume reduction or an endobronchial obstruction. This type of pneumothorax and air leak is clinically inconsequential. Failure to appreciate the benign nature of such air leaks may result in unnecessary pleural procedures or prolonged hospital stays. REVIEW FINDINGS: This review suggests that identification of a pressure-dependent pneumothorax is clinically important, as the air leak that results is not related to a lung injury that requires repair but rather to a physiologic consequence of a pressure gradient...
May 13, 2023: Chest
Katherine J Myall, Alex G West, Jennifer L Martinovic, Jodie L Lam, Diana Roque, Zhe Wu, Toby M Maher, Philip L Molyneaux, Eui-Sik Suh, Brian D Kent
BACKGROUND: Obstructive sleep apnea (OSA) and nocturnal hypoxemia (NH) are common in patients with fibrotic interstitial lung disease (F-ILD), but their relationship with disease outcomes remains unclear. RESEARCH QUESTIONS: What is the relationship between NH and OSA and clinical outcomes in patients with F-ILD? STUDY DESIGN AND METHODS: Prospective observational cohort study of patients with F-ILD and without daytime hypoxemia. Subjects underwent home sleep study at baseline and were followed up for at least one year or until death...
May 13, 2023: Chest
Eveline C F Gerretsen, Aoben Chen, Jouke T Annema, Marleen Groenier, Erik H F M van der Heijden, Walther N K A van Mook, Frank W J M Smeenk
BACKGROUND: The implementation of simulation-based training (SBT) to teach flexible bronchoscopy (FB) skills to novice trainees has increased during the last decade. However, it is unknown whether SBT is effective to teach FB to novices and which instructional features contribute to training effectiveness. RESEARCH QUESTION: How effective is FB SBT and which instructional features contribute to training effectiveness? STUDY DESIGN AND METHODS: We searched Embase, Pubmed, Scopus and Web of Science for articles on FB SBT for novice trainees until November 10, 2022...
May 11, 2023: Chest
Nicholas A Bosch, Bijan Teja, Anica C Law, Hannah Wunsch, Allan J Walkey
No abstract text is available yet for this article.
May 9, 2023: Chest
Stephanie G Patterson, Celia K Lamb, Wu Gong, Jackson Resser, Christopher J Lindsell, Sara L Van Driest, Ryan J Stark
BACKGROUND: Delayed mortality in sepsis is often linked to a lack of resolution in the inflammatory cascade termed persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Limited research exists on PICS in pediatric patients with sepsis. RESEARCH QUESTION: What is the prevalence of pediatric persistent inflammation, immunosuppression, and catabolism syndrome (pPICS) in patients who died from sepsis-related mortalities and what associated pathogen profiles and co-morbidities did they have compared to those patients without? STUDY DESIGN AND METHODS: A retrospective study of a single institution using a de-identified database from 1997 to 2020 for all patients 21 years of age or less who died with culture-positive sepsis from a known source and who had laboratory data available were evaluated for the presence of pPICS...
May 8, 2023: Chest
Ross J Marriott, Bhajan Singh, Nigel McArdle, Ellie Darcey, Stuart King, Daniela Bond-Smith, Ayesha Reynor, William Noffsinger, Kim Ward, Sutapa Mukherjee, David R Hillman, Gemma Cadby
BACKGROUND: The relationship between obstructive sleep apnea (OSA) and cancer is unclear. RESEARCH QUESTION: What is the association between OSA and cancer prevalence and incidence in a large Western Australian (WA) sleep clinic cohort (N=20,289)? STUDY DESIGN AND METHODS: OSA severity was defined by apnea-hypopnea index (AHI) and nocturnal hypoxemia (duration and percentage at SpO2 <90%) measured by in-laboratory polysomnography. Measures of potential confounding included age, sex, body-mass-index (BMI), smoking, socioeconomic status (SES) and blood pressure...
May 5, 2023: Chest
Kerollos Nashat Wanis, Arin L Madenci, Sicheng Hao, Mira Moukheiber, Lama Moukheiber, Dana Moukheiber, Sulaiman Moukheiber, Jessica G Young, Leo Anthony Celi
BACKGROUND: Whether intubation should be initiated early in the clinical course of critically ill patients remains a matter of debate. Results from prior observational studies are difficult to interpret because of avoidable flaws including immortal time bias, inappropriate eligibility criteria, and unrealistic treatment strategies. RESEARCH QUESTION: Do treatment strategies that intubate patients early in their critical care admission improve 30-day survival compared to strategies that delay intubation? STUDY DESIGN AND METHODS: We estimated the effect of strategies that require early intubation of critically ill patients compared to those that delay intubation...
May 5, 2023: Chest
Nicholas A Kolaitis
TOPIC IMPORTANCE: Even though patients suffering from pulmonary arterial hypertension have multiple therapeutic options, the disease can be refractory despite appropriate management. In patients with end-stage pulmonary arterial hypertension, lung transplantation has the potential to both extend survival and improve health-related quality of life. Pulmonary arterial hypertension is the only major diagnostic indication for transplantation that is not a parenchymal pulmonary process, thus the care of these patients is unique...
May 5, 2023: Chest
Øyvind Jervan, Stacey Haukeland-Parker, Jostein Gleditsch, Mazdak Tavoly, Frederikus A Klok, Kjetil Steine, Hege Hølmo Johannessen, Martijn A Spruit, Dan Atar, René Holst, Anders Erik Astrup Dahm, Per Anton Sirnes, Knut Stavem, Waleed Ghanima
BACKGROUND: Persistent dyspnoea, functional limitations and reduced quality of life (QoL) are common after pulmonary embolism (PE). Rehabilitation is a potential treatment option, but the scientific evidence is limited. RESEARCH QUESTION: Does an exercise-based rehabilitation programme improve exercise capacity in PE survivors with persistent dyspnoea? STUDY DESIGN AND METHODS: We conducted a randomized controlled trial at two hospitals. Patients with persistent dyspnoea after PE diagnosed 6-72 months earlier, without cardiopulmonary comorbidities, were randomized 1:1 to either rehabilitation or control group...
May 4, 2023: Chest
Polina V Kukhareva, Haojia Li, Tanner J Caverly, Guilherme Del Fiol, Angela Fagerlin, Jorie M Butler, Rachel Hess, Yue Zhang, Teresa Taft, Michael C Flynn, Chakravarthy Reddy, Douglas K Martin, Salvador Rodriguez-Loya, Phillip B Warner, Kensaku Kawamoto
BACKGROUND: While low-dose computed tomography (LDCT) lung cancer screening (LCS) can reduce lung cancer mortality, it remains underutilized. Shared decision making (SDM) is recommended to assess the balance of benefits and harms for each patient. RESEARCH QUESTION: Do clinician-facing electronic health record (EHR) prompts and an EHR-integrated "Everyday" SDM tool designed to support routine incorporation of SDM into primary care improve LDCT ordering and completion? STUDY DESIGN AND METHODS: A pre-post intervention analysis was conducted in 30 primary care and 4 pulmonary clinics for visits with patients who met US Preventive Services Task Force criteria for LCS...
May 2, 2023: Chest
Praleene Sivapalan, Karen L Ellekjaer, Marie K Jessen, Tine S Meyhoff, Maria Cronhjort, Peter B Hjortrup, Jørn Wetterslev, Anders Granholm, Morten H Møller, Anders Perner
BACKGROUND: Intravenous (IV) fluids are recommended to adults with sepsis. However, the optimal strategy for IV fluid management in sepsis is unknown, and clinical equipoise exists. RESEARCH QUESTION: Do lower vs higher fluid volumes improve patient-important outcomes in adult patients with sepsis? STUDY DESIGN & METHODS: We updated a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials assessing lower vs higher IV fluid volumes in adult patients with sepsis...
May 2, 2023: Chest
Vanina Livi, Ilya Sivokozov, Jouke T Annema, Piero Candoli, Igor Vasilev, Tess Kramer, Marco Ferrari, Karan Madan, David Fielding, Septimiu Murgu, Alessandra Cancellieri, Lyudmila A Semyonova, Mariangela Puci, Giovanni Sotgiu, Rocco Trisolini
BACKGROUND: The ability of high-definition (HD) videobronchoscopy to detect airway involvement in sarcoidosis was not evaluated previously. RESEARCH QUESTION: What is the role of HD videobronchoscopy in the identification of sarcoidosis-associated airway abnormalities (AA)? What are the patterns of AA more commonly observed and more frequently associated with the detection of granulomas in endobronchial biopsy (EBB)? STUDY DESIGN AND METHODS: In this prospective, international, multicenter cohort study, consecutive patients with suspected sarcoidosis underwent airway inspection with a HD videobronchoscope and EBB using a standardized workflow...
April 28, 2023: Chest
Lisa Hessels, Esther Speksnijder, Nienke Paternotte, Astrid van Huisstede, Willemien Thijs, Margot Scheer, Mariëlle van der Steen-Dieperink, Lieve Knarren, Joop P van Den Bergh, Kristien Winckers, Ronald Henry, Suat Simsek, Wim G Boersma
BACKGROUND: Despite the low rate of bacterial co-infection, antibiotics are very commonly prescribed in hospitalised COVID-19 patients. RESEARCH QUESTION: Does the use of a PCT-guided antibiotic protocol safely reduce the use of antibiotics in patients with a COVID-19 infection? STUDY DESIGN AND METHODS: In this multicentre cohort, 3 groups of COVID-19 patients were compared in terms of antibiotic consumption, namely one group treated based on a PCT-algorithm in one hospital (n=216) and 2 control groups, consisted of patients from the same hospital (n=57) and of patients from 3 similar hospitals (n=486) without PCT measurements during the same period...
April 26, 2023: Chest
Alessandro I C Leal, Dimitrios Mathios, Debbie Jakubowski, Jakob S Johansen, Anna Lau, Tony Wu, Stephen Cristiano, Jamie E Medina, Jillian Phallen, Daniel C Bruhm, Jacob Carey, Nicholas C Dracopoli, Stig E Bojesen, Robert B Scharpf, Victor E Velculescu, Anil Vachani, Peter B Bach
BACKGROUND: The diagnostic workup of individuals suspected of lung cancer can be complex and protracted because conventional symptoms of lung cancer have low specificity and sensitivity. RESEARCH QUESTION: Among individuals with symptoms of lung cancer, can a blood-based approach to analyze cell-free DNA fragmentation (the "DELFI score") enhance the evaluation for the possible presence of lung cancer? STUDY DESIGN AND METHODS: Adults were referred to Bispebjerg Hospital (Copenhagen, Denmark) for diagnostic evaluation of initial imaging anomalies, symptoms consistent with lung cancer...
April 26, 2023: Chest
Mithum Kularatne, Mélanie Eyries, Laurent Savale, Marc Humbert, David Montani
Heritable pulmonary arterial hypertension (PAH) is an uncommon cause of PAH and is associated most frequently with pathogenic variants of BMPR2. Prior studies have described abnormalities in pulmonary arterial, venous, and bronchial artery vessels associated with these pathogenic variants. In this series, we describe two patients who demonstrated pulmonary arteriovenous malformations (AVMs) and incidentally were identified by a next generation sequencing gene panel to carry variants of BMPR2 in the absence of PAH...
April 23, 2023: Chest
Miguel Ángel Martínez-García, Raúl Méndez, Casilda Olveira, Rosa Girón, Marta García-Clemente, Luis Máiz, Oriol Sibila, Rafael Golpe, Juan Luis Rodríguez-Hermosa, Esther Barreiro, Concepción Prados, Juan Luis Rodríguez-López, Grace Oscullo, Gonzalo Labarca, David de la Rosa
BACKGROUND: Although there is a proven relationship between the blood eosinophil count (BEC) and the severity of both asthma and chronic obstructive pulmonary disease, its relationship with bronchiectasis has not been well established. The objective of this study is to analyze the relationship between BEC and the severity, the number and severity of exacerbations, and patients' response to inhaled corticosteroids (IC) in bronchiectasis RESEARCH QUESTION: Is there an association between BEC, the number of exacerbations and severity of bronchiectasis, and inhaled corticosteroid treatment? STUDY DESIGN AND METHODS: This was a multicenter (43 centers), prospective and observational study derived from the Spanish Bronchiectasis Registry (RIBRON)...
April 21, 2023: Chest
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