American journal of respiratory and critical care medicine最新文献

{"title":"Deep Learning Estimation of Small Airway Disease from Inspiratory Chest Computed Tomography: Clinical Validation, Repeatability, and Associations with Adverse Clinical Outcomes in Chronic Obstructive Pulmonary Disease.","authors":"Muhammad F A Chaudhary, Hira A Awan, Sarah E Gerard, Sandeep Bodduluri, Alejandro P Comellas, Igor Z Barjaktarevic, R Graham Barr, Christopher B Cooper, Craig J Galban, MeiLan K Han, Jeffrey L Curtis, Nadia N Hansel, Jerry A Krishnan, Martha G Menchaca, Fernando J Martinez, Jill Ohar, Luis G Vargas Buonfiglio, Robert Paine, Surya P Bhatt, Eric A Hoffman, Joseph M Reinhardt","doi":"10.1164/rccm.202409-1847OC","DOIUrl":"10.1164/rccm.202409-1847OC","url":null,"abstract":"<p><p><b>Rationale:</b> Quantifying functional small airway disease (fSAD) requires additional expiratory computed tomography (CT) scans, limiting clinical applicability. Artificial intelligence (AI) could enable fSAD quantification from chest CT scans at total lung capacity (TLC) alone (fSAD<sup>TLC</sup>). <b>Objectives:</b> To evaluate an AI model for estimating fSAD<sup>TLC</sup>, compare it with dual-volume parametric response mapping fSAD (fSAD<sup>PRM</sup>), and assess its clinical associations and repeatability in chronic obstructive pulmonary disease (COPD). <b>Methods:</b> We analyzed 2,513 participants from SPIROMICS (the Subpopulations and Intermediate Outcome Measures in COPD Study). Using a randomly sampled subset (<i>n</i> = 1,055), we developed a generative model to produce virtual expiratory CT scans for estimating fSAD<sup>TLC</sup> in the remaining 1,458 SPIROMICS participants. We compared fSAD<sup>TLC</sup> with dual-volume fSAD<sup>PRM</sup>. We investigated univariate and multivariable associations of fSAD<sup>TLC</sup> with FEV<sub>1</sub>, FEV<sub>1</sub>/FVC ratio, 6-minute-walk distance, St. George's Respiratory Questionnaire score, and FEV<sub>1</sub> decline. The results were validated in a subset of patients from the COPDGene (Genetic Epidemiology of COPD) study (<i>n</i> = 458). Multivariable models were adjusted for age, race, sex, body mass index, baseline FEV<sub>1</sub>, smoking pack-years, smoking status, and percent emphysema. <b>Measurements and Main Results:</b> Inspiratory fSAD<sup>TLC</sup> showed a strong correlation with fSAD<sup>PRM</sup> in SPIROMICS (Pearson's <i>R</i> = 0.895) and COPDGene (<i>R</i> = 0.897) cohorts. Higher fSAD<sup>TLC</sup> levels were significantly associated with lower lung function, including lower postbronchodilator FEV<sub>1</sub> (in liters) and FEV<sub>1</sub>/FVC ratio, and poorer quality of life reflected by higher total St. George's Respiratory Questionnaire scores independent of percent CT emphysema. In SPIROMICS, individuals with higher fSAD<sup>TLC</sup> experienced an annual decline in FEV<sub>1</sub> of 1.156 ml (relative decrease; 95% confidence interval [CI], 0.613-1.699; <i>P</i> < 0.001) per year for every 1% increase in fSAD<sup>TLC</sup>. The rate of decline in the COPDGene cohort was slightly lower at 0.866 ml/yr (relative decrease; 95% CI, 0.345-1.386; <i>P</i> < 0.001) per 1% increase in fSAD<sup>TLC</sup>. Inspiratory fSAD<sup>TLC</sup> demonstrated greater consistency between repeated measurements, with a higher intraclass correlation coefficient of 0.99 (95% CI, 0.98-0.99) compared with fSAD<sup>PRM</sup> (0.83; 95% CI, 0.76-0.88). <b>Conclusions:</b> Small airway disease can be reliably assessed from a single inspiratory CT scan using generative AI, eliminating the need for an additional expiratory CT scan. fSAD estimation from inspiratory CT correlates strongly with fSAD<sup>PRM</sup>, demonstrates a significant association with FEV<sub>1</sub> decline,","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"1185-1195"},"PeriodicalIF":19.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603542","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":"She Loves Me, She Loves Me Not: Do Biologics Decrease Glucocorticoid Morbidity in Adults with Severe T-Helper Cell Type 2 Asthma?","authors":"Benjamin Gaston,Andrew Bush","doi":"10.1164/rccm.202504-0927ed","DOIUrl":"https://doi.org/10.1164/rccm.202504-0927ed","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"11 1","pages":"1109-1110"},"PeriodicalIF":24.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533604","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":"How Can We Ensure Accessible and High-Quality Specialist Care for Patients with Pulmonary Hypertension?","authors":"Jay Suntharalingam, Mark R Toshner, Kathy Blacker, Luke S Howard, David G Kiely","doi":"10.1164/rccm.202502-0441LE","DOIUrl":"10.1164/rccm.202502-0441LE","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"1314-1315"},"PeriodicalIF":19.3,"publicationDate":"2025-07-01","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":"Visualizing Pulmonary <i>Mycobacteroides abscessus</i> Infections with ¹¹C Paraaminobenzoic Acid Positron Emission Tomography/Computed Tomography: A Journey, from Bench to Bedside.","authors":"Charles L Daley","doi":"10.1164/rccm.202505-1147ED","DOIUrl":"10.1164/rccm.202505-1147ED","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"1122-1124"},"PeriodicalIF":19.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207410","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":"July Highlight.","authors":"","doi":"10.1164/rccm.v211i7xxx","DOIUrl":"https://doi.org/10.1164/rccm.v211i7xxx","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"211 7","pages":"xxx-xxxiv"},"PeriodicalIF":19.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537781","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":"10.1164/rccm.202411-2165CI","url":null,"abstract":"<p><p>Millions of critically ill adults undergo tracheal intubation in an emergency department or ICU 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 examined which of the tools, techniques, devices, and drugs used to perform emergency tracheal intubation 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 with 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.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"1156-1164"},"PeriodicalIF":19.3,"publicationDate":"2025-07-01","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":"Ineffective Effort and Ventilation Heterogeneity Revealed by Four-Dimensional Computed Tomography.","authors":"Ken Tonai,Atsuko Shono,Hisashi Imahase,Shinshu Katayama","doi":"10.1164/rccm.202411-2180im","DOIUrl":"https://doi.org/10.1164/rccm.202411-2180im","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"3 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144521230","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":"Bronchoscopic Cryotherapy in Complicated Pulmonary Hydatid Cyst.","authors":"Srikant Kashinath Malegaonkar","doi":"10.1164/rccm.202410-2079im","DOIUrl":"https://doi.org/10.1164/rccm.202410-2079im","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"1 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144521227","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":"Reply to Melhorn and Couillard: Baseline Membrane Thickness in Asthma: Where Type-2 Inflammation Meets Remodeling?","authors":"Clarus Leung,John V Fahy","doi":"10.1164/rccm.202505-1245le","DOIUrl":"https://doi.org/10.1164/rccm.202505-1245le","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"27 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144521225","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":"Baseline Membrane Thickness in Asthma: Where Type-2 Inflammation Meets Remodeling?","authors":"James Melhorn,Simon Couillard","doi":"10.1164/rccm.202505-1106le","DOIUrl":"https://doi.org/10.1164/rccm.202505-1106le","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"6 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144521221","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}