American journal of respiratory and critical care medicine最新文献

{"title":"Duration of antibiotic therapy in sepsis and severe infections in critically ill patients.","authors":"Jean-François Timsit, Jason A Roberts, Souha Kanj, Matteo Bassetti, Rafael Canton, Paul Dark, Robert Fowler, Angela Huttner, Marin H Kollef, Scott T Micek, Robert G Sawyer, Michael Thy, Dafna Yahav, Nick Daneman","doi":"10.1093/ajrccm/aamag458","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag458","url":null,"abstract":"<p><p>Antibiotic treatment duration in critically ill patients has undergone major reevaluation. Historically concerns for short therapy included a lower cure rate and emergence of resistance, whereas prolonged courses raised risks of microbiome disruption, superinfection, Clostridioides difficile colitis, and resistance. Defining optimal duration of therapy in sepsis and severe infections remains challenging due to heterogeneity in host immunity, pathogen virulence, infection site and source control. Mechanistic insights from microbiology and PK/PD highlight how bacterial inoculum, biofilms, mutant selection windows and altered drug distribution in critical illness influence bacterial clearance and resistance selection. Experimental models and PK-optimized dosing strategies underscore the potential to shorten therapy by accelerating pathogen eradication. Across a range of serious infections, randomized trials consistently show that short course therapy (<7 days) is noninferior to longer courses, including bacteremia, intra-abdominal infections and ventilator-associated pneumonia. Biomarker guided strategies-particularly procalcitonin-based algorithms-might further individualize duration of therapy and safely reduce exposure. Uncertainty remains for S. aureus bacteremia, infections caused by non-fermenting Gram-negative bacilli, difficult to treat multidrug-resistant organisms, invasive candidiasis and immunocompromised patients. Robust evidence supports markedly reduced duration of therapy for uncomplicated bloodstream infections after effective source control, intra-abdominal infections and ventilator-associated pneumonia. Infections involving retained prosthetic material or devices often require prolonged therapy or long-term suppressive regimens. Future research must include adequately powered trials across diverse populations, and evaluate rapid diagnostics, host-response profiling, and individualized response-guided strategies. Optimizing antibiotic duration in critically ill patients ultimately requires integrating mechanistic understanding, individual clinical evolution, and stewardship principles to balance potential efficacy and potential harm.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":21.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079366","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":"Quantitative Computed Tomography in Progressive Pulmonary Fibrosis: Data from a Sub-Study of the Double Blind, Randomized, Placebo-controlled INBUILD Trial.","authors":"Anand Devaraj, Peter M George, Olivier Joly, Jonathan Goldin, Eric S White, Carina Ittrich, Susanne Stowasser, Frank Risse","doi":"10.1093/ajrccm/aamag526","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag526","url":null,"abstract":"<p><strong>Rationale: </strong>Change in forced vital capacity (FVC) is an established endpoint in clinical trials in lung fibrosis, but more sensitive measures of structural deterioration are needed. Quantitative computed tomography (QCT) measurements predict FVC decline and mortality, but more information is needed on their prognostic value and response to therapy.</p><p><strong>Objectives: </strong>Evaluate the prognostic potential of quantitative CT measurements derived using University of California Los Angeles (UCLA) and e-Lung (Brainomix) algorithms, and effects of nintedanib on these measurements, in patients with progressive pulmonary fibrosis (PPF).</p><p><strong>Methods: </strong>Among patients with PPF in a sub-study of the INBUILD trial (N = 474), associations between UCLA quantitative ILD and lung fibrosis (QILD and QLF) scores, e-Lung total disease extent (TDE), reticulovascular score (RVS), and weighted RVS, and ILD progression were assessed.</p><p><strong>Measurements and main results: </strong>In the placebo group, higher baseline QCT scores were associated with a greater rate of decline in FVC (mL/year) over 52 weeks. The risk of decline in FVC % predicted ≥10% or death over 52 weeks was greater with QCT scores above vs below the median; differences in restricted mean survival time ranged from 40-65 days. Nintedanib had significant effects on changes in QILD score and e-Lung TDE at week 24 (relative difference versus placebo [%]: -7 [95% CI: -11, -2; p = 0.005] and -8 [-12, -4; p < 0.001], respectively) and week 52 (-7 [-12, -2; p < 0.05] for both).</p><p><strong>Conclusions: </strong>Quantitative CT methods can facilitate prediction of progression and assessment of the efficacy of drugs in clinical trials in patients with PPF.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":21.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079403","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":"A GOLD Science Committee Report on Universal Longitudinal Spirometry: A New Paradigm.","authors":"MeiLan K Han, Shawn D Aaron, Dinh Bui, Bartolome R Celli, Emily DeBoer, Shyamali Dharmage, David M G Halpin, Fernando J Martinez, Obianuju B Ozoh, Dave Singh, Claus Vogelmeier, Jadwiga Wedzicha, Alvar Agusti","doi":"10.1093/ajrccm/aamag432","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag432","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":21.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079361","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":"Deep learning classification of radiologic pattern is associated with progression of interstitial lung abnormalities and with survival.","authors":"David Baraghoshi, Devlin Thieke, Hiroto Hatabu, Gary M Hunninghake, Jonathan Rose, Rachel Putman, Gunnar Gudmundsson, Vilmundur Gudnason, Joshua J Solomon, Soonho Yoon, David A Lynch, Stephen M Humphries","doi":"10.1093/ajrccm/aamag525","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag525","url":null,"abstract":"<p><strong>Rationale: </strong>Interstitial lung abnormalities (ILA) are common, but not all progress, highlighting the need for objective computed tomography (CT)-based biomarkers for risk stratification.</p><p><strong>Objective: </strong>To determine whether deep learning-based classification of usual interstitial pneumonia (UIP) is associated with fibrosis progression and survival in individuals with ILA.</p><p><strong>Methods: </strong>Baseline and follow-up CT scans from participants without clinically diagnosed interstitial lung disease in two large observational cohorts (COPDGene and AGES-Reykjavík) were analyzed using data-driven textural analysis (DTA) to quantify fibrosis and a deep learning-based classifier (MIL-UIP) to estimate UIP likelihood. Associations of baseline MIL-UIP with DTA trajectory and survival were evaluated using linear mixed and multivariable Cox models, respectively.</p><p><strong>Measurements and main results: </strong>Baseline MIL-UIP > 0.5 was associated with relative annual DTA increases of 13.41% (95% CI: 8.10%, 18.99%; p < 0.001) and 14.10% (95% CI: 5.06%, 23.91%; p = 0.002) in COPDGene and AGES-Reykjavík, respectively. Each 0.1-point increase in MIL-UIP was associated with relative rates of DTA change that were 1.10 percentage points higher (95% CI: 0.45, 1.74; p < 0.001) in COPDGene and 1.30 percentage points higher (95% CI: 0.17, 2.45; p = 0.025) in AGES-Reykjavík. MIL-UIP > 0.5 was associated with higher mortality in COPDGene (HR 1.61; 95% CI: 1.08, 2.38; p = 0.018) and AGES-Reykjavík (HR 1.62; 95% CI: 1.01, 2.61; p = 0.046). Baseline DTA and MIL-UIP were highly associated with visual assessments of ILA, UIP, and fibrosis progression.</p><p><strong>Conclusion: </strong>Automated assessment of UIP-like CT features is associated with fibrosis progression and mortality in individuals with ILA, supporting its potential use for risk stratification and clinical trials enrichment.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":21.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079334","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":"Ventilation uncertainties in CPR: who should do it, how to measure it when and how to perform it?","authors":"Laurie J Morrison, Markus B Skrifvars","doi":"10.1093/ajrccm/aamag522","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag522","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":21.7,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068862","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":"Advancing Understanding of Clean Heating Benefits: Respiratory Symptom Evidence Among Rural Adults","authors":"Weikai Dong,Qifeng Song,Qiang Wang","doi":"10.1093/ajrccm/aamag405","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag405","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"83 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049085","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 letter.","authors":"Kaibing Xue, Jill Baumgartner, Sam Harper, Yuanxun Zhang","doi":"10.1093/ajrccm/aamag406","DOIUrl":"10.1093/ajrccm/aamag406","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":21.7,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149057142","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":"Beyond Cleaner Air: Thermal Comfort and Non-Th2 Pathways in the Clean Heating Policy","authors":"Lei Pan,Zhe Chen,Jiahua Pan","doi":"10.1093/ajrccm/aamag404","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag404","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"23 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049087","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":"Low greenhouse gas emitting propellants: a new era for metered-dose inhalers","authors":"S Christina Sadreameli,Jared M Radbel,William B Feldman","doi":"10.1093/ajrccm/aamag513","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag513","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"18 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049086","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":"Multi-dimensional Monitoring of Respiratory Health Benefits from Clean Heating Policies","authors":"Qinhan Liu,Jun Li,Yaling Li","doi":"10.1093/ajrccm/aamag403","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag403","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"150 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049088","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}