American journal of respiratory and critical care medicine最新文献

{"title":"Humidified Noninvasive Ventilation versus High-Flow Therapy to Prevent Reintubation in Obese Patients: A Randomized Clinical Trial.","authors":"Gonzalo Hernández, Jose Dianti, Irene Paredes, Francisco Moran, Margarita Marquez, Angel Calle, Laura Colinas, Gadea Alonso, Pilar Carneiro, Guillermo Morales, Fernando SuarezSipmann, Alfonso Canabal, Ewan Goligher, Oriol Roca","doi":"10.1164/rccm.202403-0523OC","DOIUrl":"https://doi.org/10.1164/rccm.202403-0523OC","url":null,"abstract":"<p><strong>Background: </strong>The optimal strategy to prevent reintubation in obese patients remains uncertain. We aimed to determine whether noninvasive ventilation (NIV) with active humidification is superior to high-flow nasal cannula (HFNC) in preventing reintubation in obese patients at intermediate risk.</p><p><strong>Methods: </strong>Randomized controlled trial in two intensive care units in Spain (June 2020‒June 2021). We included patients ready for planned extubation with a body mass index (BMI) >30 and ≤3 risk factors for reintubation. Patients with hypercapnia at the end of the spontaneous breathing trial were excluded. Patients were randomized to undergo NIV with active humidification or HFNC for 48 hours after extubation. The primary outcome was reintubation rate within 7 days after extubation. As a secondary analysis, we performed a post hoc Bayesian analysis using three different priors.</p><p><strong>Results: </strong>Of 144 patients (median age, 61 [p25-p75 61-67] years; 65 [45%] men), 72 received NIV and 72 HFNC. Reintubation was required in 17 (23.6%) patients receiving NIV and in 24 (33.3%) patients receiving HFNC (difference between groups 9.7 (95%CI: -4.9 ‒ 24.4)). All the secondary analysis showed non-significant differences. In the exploratory Bayesian analysis, the probability of a reduction in reintubation with NIV was 99% (data-driven prior), 90% (minimally informative prior), or 89% (skeptical prior).</p><p><strong>Conclusions: </strong>Among adult obese critically ill patients at intermediate risk for extubation failure, the rate of reintubation was not significantly lower with NIV than with HFNC. Nevertheless, there is a risk for underpowered results. Clinical trial registration available at www.</p><p><strong>Clinicaltrials: </strong>gov, ID: NCT04125342.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602799","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":"Response Bias for Modified Borg 0-10 Numerical Categories without Verbal Descriptors During Assessment of Exertional Symptoms.","authors":"Rachelle Aucoin, Magnus Ekström, Pei Zhi Li, Jean Bourbeau, Wan C Tan, Dennis Jensen","doi":"10.1164/rccm.202406-1206RL","DOIUrl":"https://doi.org/10.1164/rccm.202406-1206RL","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602801","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":"Targeting Autotaxin and LPA in Pulmonary Fibrosis: Admilparant's Positive Results Show Continued Promise.","authors":"Philip L Molyneaux, Paolo Spagnolo","doi":"10.1164/rccm.202410-2018ED","DOIUrl":"https://doi.org/10.1164/rccm.202410-2018ED","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602802","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":"Fruits Hanging on the Branches of Lung: Pulmonary Epithelioid Hemangioendothelioma.","authors":"Min-Li Lv, Qiang Gao, Yantao Huang, Jian-Quan Zhong","doi":"10.1164/rccm.202405-1011IM","DOIUrl":"https://doi.org/10.1164/rccm.202405-1011IM","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602796","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":"Airway Disease Modeling with Gene-edited Human Basal Cell Transplantation.","authors":"Andrew C Berical, Hirofumi Kiyokawa, Mary Lou Beermann, Daniel Wallman, Gabrielle Cherfane, Victoria Dunphy, Jiehong Pan, Andrew Tilston-Lunel, Xaralabos Varelas, Amjad Horani, Steven L Brody, Darrell N Kotton, Finn J Hawkins","doi":"10.1164/rccm.202406-1110RL","DOIUrl":"https://doi.org/10.1164/rccm.202406-1110RL","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602793","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":"Unsupervised Classification of the Host Response Identifies Dominant Pathobiological Signatures of Sepsis in Sub-Saharan Africa.","authors":"Matthew J Cummings, Julius J Lutwama, Nicholas Owor, Alin S Tomoiaga, Jesse E Ross, Moses Muwanga, Christopher Nsereko, Irene Nayiga, Stephen Kyebambe, Joseph Shinyale, Thomas Ochar, Moses Kiwubeyi, Rittah Nankwanga, Kai Nie, Hui Xie, Sam Miake-Lye, Bryan Villagomez, Jingjing Qi, Steven J Reynolds, Martina Cathy Nakibuuka, Xuan Lu, John Kayiwa, Mercy Haumba, Joweria Nakaseegu, Xiaoyu Che, Misaki Wayengera, Sankar Ghosh, Seunghee Kim-Schulze, W Ian Lipkin, Barnabas Bakamutumaho, Max R O'Donnell","doi":"10.1164/rccm.202407-1394OC","DOIUrl":"https://doi.org/10.1164/rccm.202407-1394OC","url":null,"abstract":"<p><strong>Rationale: </strong>The global burden of sepsis is concentrated in sub-Saharan Africa, where inciting pathogens are diverse and HIV co-infection is a major driver of poor outcomes. Biological heterogeneity inherent to sepsis in this setting is poorly defined.</p><p><strong>Objectives: </strong>To identify dominant pathobiological signatures of sepsis in sub-Saharan Africa and their relationship to clinical phenotypes, patient outcomes, and biological classifications of sepsis identified in high-income-countries (HICs).</p><p><strong>Methods: </strong>We analyzed two prospective cohorts of adults hospitalized with sepsis (severe infection with qSOFA score≥1) at disparate settings in Uganda (discovery cohort [Entebbe,urban], N=242; validation cohort [Tororo,rural], N=253). To identify pathobiological signatures in the discovery cohort, we applied unsupervised clustering to 173 soluble proteins reflecting key domains of the host response to severe infection. A random forest-derived classifier was used to predict signature assignment in the validation cohort.</p><p><strong>Measurements and main results: </strong>Two signatures (Uganda Sepsis Signature [USS]-1 and USS-2) were identified in the discovery cohort, distinguished by expression of proteins involved in myeloid cell and inflammasome activation, T cell co-stimulation and exhaustion, and endothelial barrier dysfunction. A five-protein classifier (AUROC 0.97) reproduced two signatures in the validation cohort with similar biological profiles. In both cohorts, USS-2 mapped to a more severe clinical phenotype associated with HIV and related immunosuppression, severe tuberculosis, and increased risk of 30-day mortality. Substantial biological overlap was observed between USS-2 and hyperinflammatory and reactive sepsis phenotypes identified in HICs.</p><p><strong>Conclusions: </strong>We identified prognostically-enriched pathobiological signatures among sepsis patients with diverse infections and high HIV prevalence in Uganda. Globally inclusive investigations are needed to define generalizable and context-specific mechanisms of sepsis pathobiology, with the goal of improving access to precision medicine treatment strategies.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602805","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":"Lung Protective Mechanical Ventilation in Severe Acute Brain Injured Patients.","authors":"Guanyu Yang","doi":"10.1164/rccm.202409-1809LE","DOIUrl":"https://doi.org/10.1164/rccm.202409-1809LE","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581644","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":"Balancing Act: Tailoring Ventilation Strategies in Acute Brain Injury.","authors":"Yun Xie, Ruilan Wang","doi":"10.1164/rccm.202409-1841LE","DOIUrl":"https://doi.org/10.1164/rccm.202409-1841LE","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581627","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 Yang and to Xie and Wang.","authors":"Luciana Mascia, Tommaso Tonetti","doi":"10.1164/rccm.202410-1926LE","DOIUrl":"https://doi.org/10.1164/rccm.202410-1926LE","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581649","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":"Increased BMP-Responsive Transcription Factors in Distinct Endothelial and Mesenchymal Cells in PAH.","authors":"Adam Michael Andruska, Rodrigo Cantu Valadez, Kenzo Ichimura, Pauline Chu, Tianyi Zhang, Katharina Schimmel, Lingli Wang, Aiqin Cao, Micheala A Aldred, Edda Spiekerkoetter","doi":"10.1164/rccm.202405-1039LE","DOIUrl":"https://doi.org/10.1164/rccm.202405-1039LE","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581639","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}