American journal of respiratory and critical care medicine最新文献

{"title":"How Can We Ensure Accessible and High-Quality Specialist Care for Pulmonary Hypertension Patients?","authors":"Jay Suntharalingam, Mark R Toshner, Kathy Blacker, Luke S Howard, David G Kiely","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"None"},"PeriodicalIF":19.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Resilience of the Human Lungs: Evolution, Smoke, and Disease.","authors":"Joan B Soriano, Francesca Polverino","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"None"},"PeriodicalIF":19.3,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Patient-Important Upper Gastrointestinal Bleeding.","authors":"Adam M Deane, François Lauzier, Neill K J Adhikari, François Lamontagne, Diane Heels-Ansdell, Lehana Thabane, David Williamson, Salmaan Kanji, Jeffrey F Barletta, Simon Finfer, Yaseen Arabi, Marlies Ostermann, John C Marshall, Nicole L Zytaruk, Miranda Hardie, Naomi E Hammond, Gordon Guyatt, Kyle C White, Karen E A Burns, Joanna C Dionne, Paul J Young, Deborah J Cook","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Rationale: </strong>Patient-important gastrointestinal bleeding is an endpoint developed by patients and family members; however, risk factors for this outcome are unknown.</p><p><strong>Objective: </strong>To identify risk factors for patient-important upper gastrointestinal bleeding among invasively ventilated adults.</p><p><strong>Methods: </strong>This pre-planned regression analysis of an international trial database evaluated baseline and time-varying risk factors in the preceding 3 days for patient-important upper gastrointestinal bleeding, accounting for illness severity and the competing risk of death.</p><p><strong>Measurements and main results: </strong>Patient-important upper gastrointestinal bleeding occurred in the ICU among 131 of 4,821 (2.7%) patients. Baseline APACHE II score (Hazard Ratio [HR] 1.24 [95%CI 1.12, 1.37] per 5-point increase), and the following were associated with greater risk of patient-important bleeding: inotropes or vasopressors (HR 2.05 [1.35, 3.12]), severe thrombocytopenia (platelet count <50 × 10⁹/L) (HR 2.21 [1.24, 3.94]) and platelet inhibitor drugs (HR 1.69 [1.11, 2.56]). A lower bleeding risk was associated with pantoprazole (HR 0.36 [0.25, 0.54]) and enteral nutrition (HR 0.81 [0.68, 0.97]) for every 500 mL/day increase. There was no interaction between enteral nutrition and pantoprazole (interaction p value=0.94). Allocation to pantoprazole was associated with a lower risk of patient-important upper gastrointestinal bleeding irrespective of the volume of enteral nutrition (HR 0.36 [0.22, 0.58] for 500ml/day, and HR 0.36 [0.18, 0.72] for no enteral nutrition). The association of enteral nutrition and bleeding was similar with pantoprazole (HR 0.82 [0.63, 1.07]) or without pantoprazole (HR 0.81 [0.66, 1.00]).</p><p><strong>Conclusions: </strong>Several factors are associated with the risk of patient-important upper gastrointestinal bleeding during invasive ventilation.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"None"},"PeriodicalIF":19.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of New Intrapulmonary Shunts in Pulmonary Arterial Hypertension Treated with Sotatercept.","authors":"Stephen Mitchell, Romina Gomez, Akshay Mathavan, Akash Mathavan, Saminder Kalra, Andrew Bryant, Ali Ataya","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"None"},"PeriodicalIF":19.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of Pre-Pandemic Lung Function and Structure with COVID-19 Outcomes: The C4R Study.","authors":"Pallavi P Balte,John S Kim,Yifei Sun,Nori Allen,Elsa Angelini,Alexander Arynchyn,R Graham Barr,Michael Blaha,Russell Bowler,Jeff Carr,Shelley A Cole,David Couper,Ryan T Demmer,Margaret Doyle,Mitchell Elkind,Raúl San José Estépar,Olga Garcia-Bedoya,Suresh Garudadri,Nadia N Hansel,Emilia A Hermann,Eric A Hoffman,Stephen M Humphries,Gary M Hunninghake,Robert Kaplan,Jerry A Krishnan,Andrew Laine,Joyce S Lee,David A Lynch,Barry Make,Kunihiro Matsushita,Will McKleroy,Yuan-I Min,Sneha N Naik,George O'Connor,Olivia O'Driscoll,Eyal Oren,Anna J Podolanczuk,Wendy S Post,Tess Pottinger,Elizabeth Regan,Annie Rusk,Mary Salvatore,David A Schwartz,Benjamin Smith,Daniela Sotres-Alvarez,Jason G Umans,Ramachandran S Vasan,George Washko,Sally Wenzel,Prescott Woodruff,Vanessa Xanthakis,Victor E Ortega,Elizabeth C Oelsner","doi":"10.1164/rccm.202408-1656oc","DOIUrl":"https://doi.org/10.1164/rccm.202408-1656oc","url":null,"abstract":"RATIONALEIncreased risk of COVID-19 hospitalization and death has been reported among patients with clinical lung disease.OBJECTIVETo test the association of objective measures of pre-pandemic lung function and structure with COVID-19 outcomes in US adults.METHODSPre-pandemic obstruction (FEV1/FVC<0.70) and restriction (FEV1/FVC≥0.7, FVC<80%) were defined based on the most recent spirometry exam conducted in 11 prospective US general population-based cohorts. Severe obstruction was classified by FEV1<50%. Percent emphysema, percent high attenuation areas (HAA), and interstitial lung abnormalities (ILA) were defined on computed tomography (CT) in a subset. Incident COVID-19 was ascertained via questionnaires, serosurvey, and medical records from 2020-2023, and classified as severe (hospitalized or fatal) or non-severe. Cause-specific hazards models were adjusted for socio-demographics, anthropometry, smoking, comorbidities, and COVID-19 vaccination status.MEASUREMENTS AND MAIN RESULTSAmong 29,323 participants (mean age, 67 years), there were 748 severe incident COVID-19 cases over median follow-up of 17.3 months from March 1, 2020. Greater hazards of severe COVID-19 were associated with severe obstruction (vs normal, aHR=2.11;95%CI:1.02-1.27), restriction (vs normal, aHR=1.40;95%CI:1.12-1.76), and percent emphysema (highest vs lowest quartile, aHR= 1.64;95%CI:1.03-2.61), but not greater HAA or ILAs. COVID-19 vaccination provided greater absolute risk reduction in these groups. Results were similar in participants without smoking, obesity, or clinical cardiopulmonary disease.CONCLUSIONSPre-pandemic severe spirometric obstruction, spirometric restriction, and greater percent emphysema lung on CT were associated with risk of severe COVID-19. These findings support enhanced COVID-19 risk mitigation for individuals with impaired lung health and warrant further mechanistic studies on interactions of lung function, structure, and vulnerability to acute respiratory illnesses. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"29 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjusting the P/F-Ratio for BMI in Acute Hypoxemic Respiratory Failure Mitigates but Does Not Eliminate the Obesity Paradox.","authors":"Philipp Simon,David Petroff,Andrew J Simpkin,Tài Pham,Giacomo Bellani,John G Laffey,Hermann Wrigge","doi":"10.1164/rccm.202411-2173rl","DOIUrl":"https://doi.org/10.1164/rccm.202411-2173rl","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"108 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based Emergency Tracheal Intubation.","authors":"Stephanie C DeMasi, Jonathan D Casey, Matthew W Semler","doi":"10.1164/rccm.202411-2165CI","DOIUrl":"https://doi.org/10.1164/rccm.202411-2165CI","url":null,"abstract":"<p><p>Millions of critically ill adults undergo tracheal intubation in an emergency department or intensive care unit each year, nearly 40% of whom experience hypoxemia, hypotension, or cardiac arrest during the procedure. Over the last two decades, a series of randomized trials have evaluated the tools, techniques, devices, and drugs used to perform emergency tracheal intubation to determine which interventions improve outcomes and which are ineffective or harmful. Results of these trials have demonstrated that: preoxygenation with noninvasive ventilation and administration of positive pressure ventilation between induction and laryngoscopy prevent hypoxemia during intubation; video laryngoscopy facilitates successful intubation on the first attempt and may prevent esophageal intubation; use of a stylet is superior to intubation with an endotracheal tube alone and is comparable to use of a bougie; and administration of a fluid bolus before induction does not prevent hypotension. Many additional decisions clinicians face during emergency tracheal intubation are not yet informed by rigorous evidence. Randomized trials must continue to examine systematically each aspect of this common and high-risk procedure to improve patient outcomes and bring forth an era of evidence-based emergency tracheal intubation. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Argon Plasma Coagulation Combined with Human Fibrin Sealant under Medical Thoracoscopy in the Closure of Bronchopleural Fistula.","authors":"Rui Xu,Kaige Wang,Weimin Li,Dan Liu","doi":"10.1164/rccm.202406-1198im","DOIUrl":"https://doi.org/10.1164/rccm.202406-1198im","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"39 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Prophylactic and Therapeutic Doses of Anticoagulation for Acute Chest Syndrome in Sickle Cell Disease: The TASC Randomized Clinical Trial.","authors":"Armand Mekontso Dessap,Anoosha Habibi,Jean-Benoît Arlet,Muriel Fartoukh,Laurent Guerin,Constance Guillaud,Damien Roux,Johanna Oziel,Stéphanie Ngo,Benjamin Carpentier,Marilucy Lopez-Sublet,Louis Affo,Giovanna Melica,Maryse Etienne-Julan,Isabelle Delacroix,François Lionnet,Gylna Loko,Daniel Da Silva,Marc Michel,Keyvan Razazi,Anaïs Charles-Nelson,Pablo Bartolucci,Ségolène Gendreau,Sandrine Katsahian,Bernard Maitre","doi":"10.1164/rccm.202409-1727oc","DOIUrl":"https://doi.org/10.1164/rccm.202409-1727oc","url":null,"abstract":"BACKGROUNDPatients with sickle cell disease hospitalised for acute chest syndrome (ACS) are at high risk of in situ pulmonary microthrombosis. We evaluated whether therapeutic anticoagulation could shorten ACS duration.METHODSTASC is a randomized, controlled, double-blind trial conducted in 12 French hospitals (December 2016-April 2021) in adult ACS patients with no initial thrombosis on chest computerised tomography with pulmonary angiogram. We randomised 172 patients (1:1) to receive either prophylactic or therapeutic doses of low-molecular-weight tinzaparin for 7 days. The primary efficacy outcome was time to ACS resolution. The primary safety outcome was major bleeding. Main secondary outcomes included parenteral opioids consumption, transfusion, mortality at hospital discharge, and hospital readmissions at 6 months.FINDINGSThe primary efficacy outcome, time to ACS resolution, analysed using a Cox model, was shorter with therapeutic anticoagulation than with prophylactic doses (hazard ratio 0.71; 95% CI: [0.51-0.99]; p=0.044). As a supplemental estimate, the restricted mean time to ACS resolution (over a 15-day horizon or discharge) was shorter with therapeutic doses (4.8±0.4 vs 6.1±0.5 days). The primary safety outcome (major bleeding) did not occur in either group. The cumulative dose of parenteral opioids was lower with therapeutic anticoagulation: (124 [80;272] vs 219 [65;378] mg morphine equivalent, difference: -96, 95%CI: -202 to -46, p=0.02). Other short- and long-term secondary outcomes were similar between groups.INTERPRETATIONIn adult patients with ACS, a therapeutic anticoagulation shortened ACS duration and reduced opioids consumption compared with prophylactic doses, without increasing bleeding risk. Clinical trial registration available at www.CLINICALTRIALSgov, ID: NCT02580773.","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"23 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proteomic Biomarkers of Survival in Non-IPF Interstitial Lung Disease.","authors":"Shehabaldin Alqalyoobi,Jennifer A Smith,Manoj V Maddali,Janelle Vu Pugashetti,Chad A Newton,John S Kim,Angela L Linderholm,Ching-Hsien Chen,Shwu-Fan Ma,Swaraj Bose,Susan Murray,Ayodeji Adegunsoye,Mary E Strek,Christine Kim Garcia,Paul J Wolters,Fernando J Martinez,Imre Noth,Justin M Oldham","doi":"10.1164/rccm.202407-1506oc","DOIUrl":"https://doi.org/10.1164/rccm.202407-1506oc","url":null,"abstract":"RATIONALEWhile idiopathic pulmonary fibrosis (IPF) has been widely studied, progressive non-IPF interstitial lung disease (ILD) remains poorly understood.OBJECTIVETo identify and validate proteomic biomarkers of non-IPF ILD survival.METHODSHigh-throughput proteomic data were generated using plasma collected as part of prospective registries at the Universities of California and Texas (discovery cohort, n=676) and PRECISIONS multi-omic study (validation cohort, n=616). Proteins associated with three-year transplant-free survival (TFS) were identified using multivariable Cox proportional hazards regression, and those associated with TFS after adjustment for false discovery were advanced for validation cohort testing. Pathway analysis was performed to identify molecular pathways unique to non-IPF ILD and shared with IPF.MAIN RESULTSOf 2925 proteins tested in the discovery cohort, 73 were associated with TFS, with 44 showing sustained TFS association in the validation cohort. The top TFS-associated proteins were amphiregulin (HR 2.51, 95% CI 2.07-3.04), integrin subunit beta 6 (HR 2.46; 95% CI 1.95-3.10) and keratin 19 (HR 1.70, 95% CI 1.47-1.98). All but one validated biomarkers showed consistent TFS association across non-IPF ILD subtypes. Pathway analysis identified several molecular pathways shared with IPF, along with three pathways unique to non-IPF ILD.CONCLUSIONSWe identified and validated novel prognostic protein biomarkers in non-IPF ILD, most of which showed consistent association across non-IPF ILD subtypes. While most biomarkers and molecular pathways identified were previously linked to IPF, several were unique to non-IPF ILD, suggesting that unique biology may contribute to progressive non-IPF ILD.","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"37 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}