American journal of respiratory and critical care medicine最新文献

{"title":"Deadly Countertops: An Urgent Need to Eliminate Silicosis among Engineered Stone Workers.","authors":"Amy Heinzerling, Robert Harrison, Jennifer Flattery, Jane C Fazio, Sheiphali Gandhi, Kristin J Cummings","doi":"10.1164/rccm.202410-2008VP","DOIUrl":"10.1164/rccm.202410-2008VP","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"557-559"},"PeriodicalIF":19.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12005022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rise in Lung Transplants for Coal Workers' Pneumoconiosis and Silicosis.","authors":"David J Blackley, Noemi B Hall, Jennifer Flattery, Drew A Harris, Kristin J Cummings, A Scott Laney","doi":"10.1164/rccm.202409-1767RL","DOIUrl":"10.1164/rccm.202409-1767RL","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"642-644"},"PeriodicalIF":19.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142976976","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":"Status of Sepsis Care in European Hospitals: Results from an International Cross-Sectional Survey.","authors":"Christian S Scheer, Evangelos J Giamarellos-Bourboulis, Ricard Ferrer, Evgeny A Idelevich, Djillali Annane, Antonio Artigas, Abdullah Tarik Aslan, Gabriella Bottari, Hjalmar R Bouma, Vladimir Černý, Renata Curić Radivojević, Konstantina Dakou, Ken Dewitte, Mohamed Elbahnasawy, Matthias Gründling, Mohan Gurjar, Johanna Hästbacka, Miltiadis Kyprianou, Said Laribi, Annmarie Lassen, Konstantin Lebedinskii, Jan Máca, Manu L N G Malbrain, Gianpaola Monti, Marlies Ostermann, Michael Osthoff, José-Artur Paiva, Michela Sabbatucci, Jakub Śmiechowicz, Mihai Gabriel Ştefan, Marcus Vollmer, Natalija Vuković, Kyriakos Zaragkoulias, Konrad Reinhart, Adam Linder, Daniela Filipescu","doi":"10.1164/rccm.202406-1167OC","DOIUrl":"10.1164/rccm.202406-1167OC","url":null,"abstract":"<p><p><b>Rationale:</b> Early detection, standardized therapy, adequate infrastructure, and strategies for quality improvement should constitute essential components of every hospital's sepsis plan. <b>Objectives:</b> To investigate the extent to which recommendations from the sepsis guidelines are implemented and the availability of infrastructure for the care of patients with sepsis in acute-care hospitals. <b>Methods:</b> A multidisciplinary cross-sectional questionnaire was used to investigate sepsis care in hospitals. This included the use of sepsis definitions, the implementation of sepsis guideline recommendations, diagnostic and therapeutic infrastructure, antibiotic stewardship, and quality improvement initiatives (QIIs) in hospitals. <b>Measurements and Main Results:</b> A total of 1,023 hospitals in 69 countries were included. Most of them, 835 (81.6%), were in Europe. Sepsis screening was used in 54.2% of emergency departments (EDs), 47.9% of wards, and 61.7% of ICUs. Sepsis management was standardized in 57.3% of EDs, 45.2% of wards, and 70.7% of ICUs. The implementation of comprehensive QIIs was associated with increased screening (EDs, +33.3%; wards, +44.4%; ICUs, +23.8% absolute difference) and increased standardized sepsis management (EDs, +33.6%; wards, +40.0%; ICUs, +17.7% absolute difference) compared with hospitals without QIIs. A total of 9.8% of hospitals had implemented ongoing QIIs, and 4.6% had invested in sepsis programs. <b>Conclusions:</b> The findings indicate that there is considerable room for improvement in a large number of mainly European hospitals, particularly with regard to early identification and standardized management of sepsis, the availability of guidelines, diagnostic and therapeutic infrastructure, and the implementation of QIIs. Further efforts are required to implement a more comprehensive and appropriate quality of care.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"587-599"},"PeriodicalIF":19.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12005017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Can We Learn from Differences in Hospitals' Sepsis Care?","authors":"Michael Klompas, Mitchell M Levy","doi":"10.1164/rccm.202501-0106ED","DOIUrl":"10.1164/rccm.202501-0106ED","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"546-547"},"PeriodicalIF":19.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12005019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143527823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic ¹¹C-PABA PET/CT for Visualizing Pulmonary <i>Mycobacteroides abscessus</i> Infections.","authors":"Yuderleys Masias-Leon, Carlos E Ruiz-Gonzalez, Oscar J Nino-Meza, Medha Singh, Mona O Sarhan, Xueyi Chen, Kelly Flavahan, Amy Kronenberg, Elizabeth W Tucker, Joel S Freundlich, Martin A Lodge, Laurence S Carroll, Nicole Parrish, Noah Lechtzin, Sanjay K Jain","doi":"10.1164/rccm.202409-1792OC","DOIUrl":"https://doi.org/10.1164/rccm.202409-1792OC","url":null,"abstract":"<p><strong>Rationale: </strong><i>Mycobacteroides abscessus</i> infections affect immunocompromised patients and those with underlying pulmonary disease. Conventional imaging cannot distinguish <i>M. abscessus</i> infections from underlying pulmonary disease or sterile inflammation, requiring invasive procedures for definitive diagnosis.</p><p><strong>Objective: </strong>We evaluated ¹¹C-<i>para</i>-aminobenzoic acid (¹¹C-PABA), a chemically identical radioanalog of PABA, to detect and localize infections due to <i>M. abscessus</i>.</p><p><strong>Methods: </strong><i>In vitro</i> uptake assays were performed to test the metabolism and accumulation of PABA into <i>M. abscessus</i> reference and clinical isolates. Dynamic ¹¹C-PABA positron emission tomography (PET) was performed in a mouse model of <i>M. abscessus</i> pulmonary infection and in a patient with microbiologically-confirmed <i>M. abscessus</i> pulmonary infection (NCT05611905).</p><p><strong>Main results: </strong>¹¹C-PABA was intracellularly metabolized by <i>M. abscessus</i> to ¹¹C-7,8-dihydropteroate. Additionally, and the reference and all thirteen randomly chosen clinical isolates, including three resistant to trimethoprim-sulfamethoxazole, rapidly accumulated PABA. No PABA accumulation was noted by heat-inactivated bacteria or mammalian cells. Dynamic ¹¹C-PABA PET in a mouse model of <i>M. abscessus</i> pulmonary infection rapidly distinguished infection from sterile inflammation and also accurately monitored response to antibiotic treatment. Finally, dynamic ¹¹C-PABA PET in a 33-year-old female with cystic fibrosis and microbiologically confirmed <i>M. abscessus</i> pulmonary infection was safe and demonstrated significantly higher and sustained PET uptake in the affected lesions.</p><p><strong>Conclusions: </strong>¹¹C-PABA PET is an innovative, clinically-translatable, noninvasive, bacteria-specific diagnostic to differentiate <i>M. abscessus</i> infections from underlying pulmonary disease in patients. This tool could also help in monitoring treatment responses and enable precision medicine approaches for patients with complicated infections. 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/).</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735565","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 a New Longitudinal Ordinal Outcome for Clinical Trials in ECMO Patients.","authors":"Ary Serpa Neto, Lisa Higgins, Elizabeth Lorenzi, Lindsay Berry, Elizabeth Ryan, Stephane Heritier, Shannah Anderson, Judit Orosz, Aidan Burrell, Zoe McQuilten, Priya Nair, Carol L Hodgson","doi":"10.1164/rccm.202408-1582OC","DOIUrl":"https://doi.org/10.1164/rccm.202408-1582OC","url":null,"abstract":"<p><strong>Rationale: </strong>Randomised clinical trials in intensive care often prioritize disease-focused outcomes rather than patient-centred outcomes.</p><p><strong>Objective: </strong>To report and evaluate the 'Daily Organ Support for patients on extracorporeal membrane oxygenation (ECMO)', the DOSE outcome. This is a new longitudinal ordinal outcome for clinical trials in patients receiving ECMO.</p><p><strong>Methods: </strong>Prospective, multicentre study in 28 hospitals in Australia and New Zealand. Adult patients admitted to a participating ICU between February 2019 and September 2023 and who underwent any type of ECMO were included. The DOSE outcome was created considering: 1) death; 2) on ECMO; 3) ventilated not on ECMO; 4) in ICU but not ventilated; 5) in hospital ward; and 6) discharged from the hospital. DOSE was developed in collaboration with consumers and other stakeholders, and validated against death and new disability at six months. Simulations were performed to compare the power obtained against 28-day mortality alone.</p><p><strong>Measurements and main results: </strong>Among 1375 patients who received ECMO (median age, 52 years; 34% female), at day 90, 42%, 29% and 66% of the patients receiving VA-, VV-ECMO, or eCPR were deceased, respectively. DOSE accurately predicted death and new disability at six months (area under the curve [AUC] > 0.800). With a sample size of 400 per arm and an odds ratio of 1.20, DOSE provided 56% more power than an analysis considering 28-day mortality alone (36% vs. 91%) in simulations of a two-arm clinical trial.</p><p><strong>Conclusions: </strong>The DOSE outcome performed well compared to a patient-centred outcome. Compared to 28-day mortality, DOSE provided more statistical power in a simulated two-arm clinical trial.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735547","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":"Mediastinal Malignant Perivascular Epithelioid Cell Tumor.","authors":"Xiaoyang Zhou, Wenyu Yang","doi":"10.1164/rccm.202411-2288IM","DOIUrl":"https://doi.org/10.1164/rccm.202411-2288IM","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735567","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 Hsiao and Chen: Refining the Concept of Disease Stability in COPD: Bridging Complexity and Clinical Practice.","authors":"Dave Singh","doi":"10.1164/rccm.202501-0290LE","DOIUrl":"https://doi.org/10.1164/rccm.202501-0290LE","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735570","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":"Right Ventricular Strain and Outflow Tract Velocity Time Integral Are Associated with Mortality in Critically Ill Patients with Pulmonary Embolism.","authors":"Manuel Ruiz-Bailén, Javier Hidalgo-Martín, José Ángel Ramos Cuadra, Julia Manetsberger, Maria Dolores Pola Gallego de Guzmán, Miguel Ángel Díaz-Castellanos, Patricia Casado-Santa-Bárbara, Johannes Dagomar Lohman, Antonio Cárdenas-Cruz, Fernando Clau-Terré, María Leyre Lavilla-Lerma","doi":"10.1164/rccm.202407-1433OC","DOIUrl":"https://doi.org/10.1164/rccm.202407-1433OC","url":null,"abstract":"<p><strong>Introduction: </strong>High-risk pulmonary thromboembolism (PE) is often fatal due to right ventricular heart failure. However, right ventricular echocardiographic parameters that are associated with adverse outcome in PE are incompletely characterized. Our objective was to evaluate if right ventricular global longitudinal strain (RVGLS) and right ventricular outflow tract velocity-time integral (RVOT VTI) might be indicators of mortality in PE.</p><p><strong>Methodology: </strong>This is an observational study with prospective inclusion from June 1999 to December 2023. Only patients with PE requiring intensive care medicine (ICU) admission were included. The study assessed mortality in the ICU and at 6 months of follow-up, as well as the development of heart failure. The independent variables included clinical and echocardiographic characteristics.</p><p><strong>Results: </strong>A total of 463 PE patients with a mean age of 62.3 ± 21.6 years were included in this study. The ICU and 6-month mortality were 18.4% and 20.7%, respectively. 386 patients were treated with thrombolysis. Multivariable analysis showed that the variables associated with ICU mortality were Pulmonary embolism severity index (PESI) (OR 1.241, 95% CI [1.037-1.587], p<0.001), RVGLS (OR 0.421, 95% CI [0.202-0.774], p<0.001), left atrial reservoir (εs) (OR 0.357, 95% CI [0.141-0.756], p<0.001), right atrial pump (εa) (OR 0.632, 95% CI [0.282-0.887]), the RVOT VTI (OR 0.678, 95% CI [0.321-0.881], p<0.001), and left ventricular outflow tract (LVOT) VTI (OR 0.782, 95% CI [0.413-0.912], p<0.001). Multivariable analysis found that the development of heart failure assessed at 6 months was associated with RVGLS (OR 0.538, 95% CI [0.182-0.785], p=0.001), left atrial strain (εa) (OR 0.313, 95% CI [0.21-0.721], p<0.001), right ventricular basal diameter (OR 1.173, 95% CI [1.018 - 1.892], p<0.001), pulmonary flow acceleration time in RVOT (OR 0.693, 95% CI [0.328 - 0.839], p<0.001), estimated pulmonary artery wedge pressure (PAWP) (OR 1.437, 95% CI [1.131- 2.274], p<0.001), and intracavitary thrombus (OR 1.223, 95% CI [1.117 - 1.973], p<0.001). The variables that were associated with 6-month mortality in the multivariable analysis were PESI (OR 1.029, 95% CI [1.012 - 1.377], p<0.001), RVGLS (OR 0.657, 95% CI [0.438-0.871], p<0.001), RVOT VTI (OR 0.324, 95% CI [0.102-0.541], p<0.001), right atrial pump (εa) (OR 0.352, 95% CI [0.193-0.721], p<0.001), and LVOT VTI (OR 0.814, 95% CI [0.281-0.948], p<0.001), all p-values <0.001.</p><p><strong>Conclusions: </strong>Among patients with PE in the ICU, right ventricular strain and RVOT VTI were associated with mortality in the ICU and at 6-month. Furthermore, right ventricular strain was independently associated with future heart failure. These data emphasize the clinical relevance of right ventricular parameters in prognosticating high-risk PE.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735572","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":"Dual αvβ6 and αvβ1 Inhibition Over 12 Weeks Reduces Active Type 1 Collagen Deposition in Individuals with Idiopathic Pulmonary Fibrosis: A Phase 2, Double-Blind, Placebo-controlled Clinical Trial.","authors":"Sydney B Montesi, Gregory P Cosgrove, Scott M Turner, Iris Y Zhou, Nikos Efthimiou, Antonia Susnjar, Ciprian Catana, Caroline Fromson, Annie Clark, Martin Decaris, Chris N Barnes, Éric A Lefebvre, Peter Caravan","doi":"10.1164/rccm.202410-1934OC","DOIUrl":"https://doi.org/10.1164/rccm.202410-1934OC","url":null,"abstract":"<p><p><b>Rationale:</b> Idiopathic pulmonary fibrosis (IPF) is characterized by excessive deposition of type 1 collagen. ⁶⁸Ga-CBP8, a type 1 collagen positron emission tomography (PET) probe, measures collagen accumulation and shows higher collagen deposition in patients with IPF. Bexotegrast (PLN-74809) is an oral, once-daily, dual-selective inhibitor of α_vβ₆ and α_vβ₁ integrins under late-stage evaluation for treatment of IPF. <b>Objectives:</b> Evaluate changes in type 1 collagen in the lungs of participants with IPF following treatment with bexotegrast. <b>Methods:</b> In this Phase 2 (NCT05621252), single-center, double-blind, placebo-controlled study, adults with IPF received bexotegrast 160mg or placebo for 12 weeks. Primary endpoint was the change in whole-lung standardized uptake value (SUV) of ⁶⁸Ga-CBP8 PET. Changes in lung dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters, forced vital capacity (FVC), cough severity, and biomarkers of collagen synthesis and progressive disease were also assessed. <b>Measurements and Main Results:</b> Of 10 participants, 7 received bexotegrast and 3 placebo. At Week 12, mean change from baseline in top quartile of ⁶⁸Ga-CBP8 whole-lung SUV was -1.2% with bexotegrast vs 6.6% with placebo; greatest mean changes were observed in subpleural lung regions in both groups (bexotegrast, -3.7%; placebo, 10.3%). DCE-MRI demonstrated numerically increased peak enhancement and faster contrast washout rate in bexotegrast-treated participants, suggesting improvements in lung microvasculature and decreased extravascular extracellular volume. Bexotegrast treatment resulted in numerical improvements in FVC, cough severity, and biomarker levels. <b>Conclusions:</b> The reduced uptake of ⁶⁸Ga-CBP8 in the lungs of participants with IPF indicates an antifibrotic effect of bexotegrast, suggesting the potential for favorable lung remodeling.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735549","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}