James F Gruden, David P Naidich, Stephen C Machnicki, Stuart L Cohen, Francis Girvin, Suhail Raoof
No abstract text is available yet for this article.
November 5, 2019: Chest
Priya Agarwala, Steve H Salzman
No abstract text is available yet for this article.
November 2, 2019: Chest
Momen M Wahidi, Felix Jf Herth, Alexander Chen, George Cheng, Lonny Yarmus
Interventional Pulmonology (IP) has evolved over the last decade from an obscure subspecialty in pulmonary medicine to a recognized discipline offering advanced consultative and procedural services to patients with thoracic malignancy, anatomical airway diseases and pleural pathology. Innovative Interventions are now also available for diseases not traditionally treated procedurally such as asthma and emphysema. The IP field has established certification examinations and training standards for IP training programs in an effort to enhance training quality and ensure competency...
October 31, 2019: Chest
Kevin P Fennelly, Carlos Acuna-Villaorduna, Edward Jones-Lopez, William G Lindsley, Donald Milton
Pulmonary infections are important causes of global morbidity and mortality, but diagnostics are often limited by the ability to collect specimens easily, safely and in a cost-effective manner. We review recent advances in the collection of infectious aerosols from patients with tuberculosis and with influenza. Although this research has been focused on assessing the infectious potential of such patients, we propose that these methods have the potential to lead to the use of patient-generated microbial aerosols as non-invasive diagnostic tests of disease as well as tests of infectiousness...
October 31, 2019: Chest
Lonny Yarmus, Jason Akulian, Momen Wahidi, Alex Chen, Jennifer P Steltz, Sam L Solomon, Diana Yu, Fabien Maldonado, Jose Cardenas-Garcia, Daniela Molena, Hans Lee, Anil Vachani
BACKGROUND: and Purpose: The capability of bronchoscopy in the diagnosis of peripheral pulmonary nodules (PPN) remains limited. Despite decades of effort, recent evidence suggests that the diagnostic accuracy for electromagnetic navigational bronchoscopy (EMN) and radial EBUS approach only 50%. New developments in robotic bronchoscopy (RB) may offer improvements in the assessment of PPN. STUDY DESIGN: and Methods: A prospective single blinded randomized controlled comparative study to assess success in localization and puncture of PPN utilizing an ultrathin bronchoscope with radial EBUS (UTB-rEBUS) vs EMN vs RB in a human cadaver model of PPN <2cm was performed...
October 31, 2019: Chest
John S Kim, Michaela R Anderson, Anna J Podolanczuk, Steven M Kawut, Matthew A Allison, Ganesh Raghu, Karen Hinckley-Stuckovsky, Eric A Hoffman, Russell P Tracy, R Graham Barr, David J Lederer, Jon T Giles
BACKGROUND: Adipokines have inflammatory and fibrotic properties that may be critical in interstitial lung disease (ILD). We examined associations of serum adipokine levels with computed tomography (CT)-based measures of subclinical ILD and lung function among community-dwelling adults. METHODS: A subset of the original Multi-Ethnic Study of Atherosclerosis cohort (n=1,968) had adiponectin, leptin, and resistin measured during follow-up visits (2002-2005). We used regression models to examine associations of adiponectin, leptin, and resistin levels with 1) high attenuation areas (HAA) from CT scans (2004-2005, n=1,144), 2) interstitial lung abnormalities (ILA) from CT scans (2010-2012, n=872), and 3) forced vital capacity (FVC) from spirometry (2004-2006, n=1,446)...
October 31, 2019: Chest
Grant E MacKinnon, Evan L Brittain
Mobile health (mHealth) technologies are modernizing medicine by affording greater patient engagement, monitoring, outreach, and healthcare delivery. The cardiopulmonary fields have led the integration of mHealth into clinical practice and research. mHealth technologies in these areas include smartphone applications, wearable devices, and hand-held devices, among others, and provide real-time monitoring of numerous important physiologic measurements and other key parameters. Use of mHealth-compatible devices has increased in recent years, and age and socioeconomic gaps of ownership are narrowing...
October 31, 2019: Chest
Nathan Schoettler, Mary E Strek
This review focuses on recent clinical and translational discoveries in severe and uncontrolled asthma that now enable phenotyping and personalized therapies in these patients. While asthma is common in both children and adults and typically responds to standard therapies, a subset of individuals with asthma experience severe and/or persistent symptoms despite appropriate therapies. Airflow obstruction leading to frequent symptoms requiring higher levels of controller therapy is the cardinal feature of severe asthma, but the underlying molecular mechanisms, or endotypes, are diverse and variable between individuals...
October 30, 2019: Chest
Christina Forstner, Vladimir Patchev, Gernot Rohde, Jan Rupp, Martin Witzenrath, Tobias Welte, Heinz Burgmann, Mathias W Pletz
BACKGROUND: Although blood cultures (BCs) are the gold standard for detecting bacteremia, the utility of BCs in patients with community-acquired pneumonia (CAP) is controversial. This study describes the proportion of patients with CAP and afebrile bacteremia and identifies the clinical characteristics predicting the necessity for BCs in afebrile patients. METHODS: Bacteremia rates were determined in 4349 CAP patients enrolled in the multi-national cohort study CAPNETZ and stratified by presence of fever at first patient contact...
October 26, 2019: Chest
Lisa-Mae S Williams, Gail R Walker, James W Loewenherz, Louis T Gidel
BACKGROUND: Despite evidence that low osmolar radiocontrast media is not associated with acute kidney injury, it is important to evaluate this association in critically ill patients with normal kidney function. MATERIALS AND METHODS: This was a retrospective observational study of 7,333 adults with an ICU stay at a six-hospital health system in South Florida. Patients who received contrast were compared with unexposed controls before and after propensity score (PS) matching derived from baseline characteristics, admission diagnoses, comorbidities and severity of illness...
October 25, 2019: Chest
Quentin Moyon, Samia Boussouar, Philippe Maksud, Jean-François Emile, Frédéric Charlotte, Nathalie Aladjidi, Grégoire Prévot, Jean Donadieu, Zahir Amoura, Philippe Grenier, Julien Haroche, Fleur Cohen Aubart
BACKGROUND: Destombes-Rosai-Dorfman disease (RDD) is a rare multisystemic histiocytosis. Pulmonary involvement during RDD is poorly described. Here, we aimed to examine the clinical features, radiological features, and outcomes of 15 patients with RDD with lung involvement. PATIENTS AND METHODS: The cases of RDD with lung involvement were extracted from the French National Histiocytosis registry. Efficacy of the MEK inhibitor cobimetinib in treating lung disease was evaluated with an 18 fluorodeoxyglucose positron emission topography (18 FDG PET) scanner and chest computed tomography (CT) scans...
October 24, 2019: Chest
Karoliny Dos Santos, Caroline J Lodge, Michael J Abramson, Bircan Erbas, Catherine M Bennett, Jennie Hui, Shyamali C Dharmage, Adrian J Lowe
BACKGROUND: While there is ongoing debate about the impact of early postnatal exposure to antibiotics on the development of asthma, the possibility that antibiotic exposure may impair lung function has not previously been examined. Furthermore, it is not clear if specific types of antibiotics may have a greater effect, or if children with genetic mutations in the oxidative stress response glutathione S-transferase (GST) superfamily may be at greater risk. METHODS: We collected parent-report of childhood antibiotic use from birth to 2 years, including type and indication, from a birth-cohort of 620 infants with a family history of allergy...
October 24, 2019: Chest
Scott J Millington, Ariel Hendin, Ariel L Shiloh, Seth Koenig
Peripheral intravenous (PIV) catheter insertion is the most commonly performed procedure in hospitals. Multiple patient factors can make PIV insertion challenging, and ultrasound guidance has been demonstrated to improve the rate of success in these difficult patients. This article outlines the suggested techniques for the ultrasound-guided insertion of PIV catheters, midline catheters, and peripherally inserted central catheters. Illustrative figures and narrative videos demonstrating these techniques are included...
October 22, 2019: Chest
Lucas M Donovan, Aditi Shah, Ching Li Chai-Coetzer, Ferran Barbé, Najib T Ayas, Vishesh K Kapur
Constrained by a limited supply of specialized personnel, health systems face a challenge in caring for the large number of patients with obstructive sleep apnea (OSA). The complexity of this challenge is heightened by the varied clinical presentations of OSA and the diversity of treatment approaches. Innovations such as simplified home-based care models and the incorporation of non-specialist providers have shown promise in the management of uncomplicated patients, producing comparable outcomes to the resource intensive traditional approach...
October 19, 2019: Chest
Ann Wang, Ariel Hendin, Scott J Millington, Seth Koenig, Lewis A Eisen, Ariel L Shiloh
Arterial catheterization is frequently performed in intensive care units to facilitate hemodynamic monitoring and frequent blood sampling. Overall, arterial catheterization has high success and low complication rates, but in critically ill patients the incidence of failure is higher due to hypotension, peripheral edema, and obesity. Ultrasound guidance significantly increases the likelihood of successful cannulation and decreases complications compared to traditional landmark-based techniques. Multiple ultrasound techniques for radial and femoral arterial catheter insertion have been described; this article presents an approach for incorporating these tools into bedside practice, including illustrative figures and narrated video presentations to demonstrate the techniques described...
October 18, 2019: Chest
Robert L Joyner, Shawna Strickland, Ellen A Becker, Emily Ginier, Shane Keene, Kathy Rye, Carl F Haas
BACKGROUND: Access and quality of health care for cardiopulmonary disease in the United States ranks poorly compared to economically similar nations. No recent comprehensive assessment of the cardiopulmonary workforce is available. This systematic review was conducted to evaluate current published evidence about the workforce caring for persons with cardiopulmonary disease. METHODS: This systematic review followed PRISMA guidelines. Structured searches of medical databases were conducted to find studies published from 2006 through 2016...
October 14, 2019: Chest
Rizwan A Khan, Nauman A Khan, Seth R Bauer, Manshi Li, Abhijit Duggal, Xiaofeng Wang, Anita J Reddy
BACKGROUND: Initial fluid resuscitation volume for sepsis is controversial, particularly in patients at high baseline risk for complications. This study was designed to assess the association between 30mL/kg crystalloids and intubation in patients with sepsis or septic shock and heart failure, end stage renal disease or cirrhosis. METHODS: This propensity score-matched retrospective cohort study included patients with sepsis or septic shock admitted to a large medical intensive care unit...
October 14, 2019: Chest
Hilary E Faust, John P Reilly, Brian J Anderson, Caroline A G Ittner, Caitlyn M Forker, Peggy Zhang, Benjamin A Weaver, Daniel N Holena, Paul N Lanken, Jason D Christie, Nuala J Meyer, Nilam S Mangalmurti, Michael G S Shashaty
BACKGROUND: Critically ill patients who develop the acute respiratory distress syndrome (ARDS) have substantial associated morbidity and mortality. Circulating mitochondrial DNA (mtDNA) released during critical illness causes endothelial dysfunction and lung injury in experimental models. We hypothesized that elevated plasma mtDNA is associated with ARDS in critically ill trauma and sepsis patients. METHODS: We measured plasma mtDNA concentrations at emergency department presentation and approximately 48 hours later in separate prospective cohorts of critically ill trauma and sepsis patients...
October 14, 2019: Chest
Margaret A Miller, Niharika Mehta, Courtney Clark-Bilodeau, Ghada Bourjeily
No abstract text is available yet for this article.
October 14, 2019: Chest
Linsey E S de Groot, Marianne A van de Pol, Niki Fens, Barbara S Dierdorp, Tamara Dekker, Wim Kulik, Christof J Majoor, Jörg Hamann, Peter J Sterk, René Lutter
BACKGROUND: Loss of asthma control and asthma exacerbations are associated with increased sputum eosinophil counts. Yet, whether eosinophils, or indeed the also present neutrophils, actively contribute to the accompanying inflammation has not been investigated extensively. METHODS: 23 patients with mild to moderate asthma were included in a standardized prospective inhaled corticosteroid (ICS) withdrawal study, 22 of whom lost asthma control. We assessed various immune, inflammatory and oxidative stress parameters as well as markers of eosinophil and neutrophil activity in exhaled breath condensate, plasma and sputum collected at three phases: baseline, during loss of control and after recovery...
October 14, 2019: Chest
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