Annals of the American Thoracic Society最新文献

{"title":"\"From the moment I started standing again, I was worried about falls\": Fear of Falling in ICU Survivors over 12 Months.","authors":"Selina M Parry, Sze-Ee Soh, Peter E Morris, Jane St Larkin, Megan M Hosey, Alisha A da Silva, Emily K Alexander, Madeline Wells, Nicole K Elsegood, Emma G Kinnersly, Lisa J Beach, Kirby P Mayer, Cristino C Oliveira, Jennifer L McGinley, Zudin Puthucheary, Linda Denehy, Catherine Granger","doi":"10.1513/AnnalsATS.202503-314OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202503-314OC","url":null,"abstract":"<p><strong>Rationale: </strong>Post Intensive Care Syndrome is a significant challenge for survivors of critical illness. However, little is understood about fear of falls - the concern for falls.</p><p><strong>Objective: </strong>This study sought to quantify the prevalence of fear of falls within the first year after hospital discharge and identify factors associated with high fear of falls.</p><p><strong>Methods: </strong>Mixed methods approach. Fear of falls was assessed using the Falls Efficacy Scale International short form questionnaire with participants dichotomised into low/moderate (7-12) and high fear of falls (13-28). Persistence was defined as high fear of falls across at least two assessment time points. Data were also collected on physical parameters, frailty, cognition, mood, quality of life and physical activity levels. Participants were assessed at hospital discharge, 3, 6, and 12 months.</p><p><strong>Results: </strong>A high fear of falls was reported in 66 participants in the first 12 months with 41% reporting persistent high fear. High fear primarily commenced at hospital discharge (79%). Hospital discharge factors associated with reduced odds of experiencing high fear of falls in the first 12 months were: higher cognition, strength; physical function; balance; and health-related quality of life. Whereas increased odds of experiencing high fear were: older age, comorbidities; ICU-delirium; frailty; delayed quadriceps time to peak force and mental health impairments. The final multivariate model found that ICU survivors who had ICU delirium were more likely to have high fear of falls (OR 4.67; 95%CI: 1.18-18.48) whilst those with better balance were less likely to do so (OR 0.83, 95%CI 0.74-0.94). High fear of falls was not predictive of physical activity or function at 6 months however it was a significant predictor of depression. Qualitative data highlighted participant concern for further incapacitation through injury and loss of independence. Perceived causes were reduced strength, balance and fatigue. Participants described strategies they adopted to reduce their risk of falling including environmental scanning, gait aid use, and slow deliberate movement.</p><p><strong>Conclusions: </strong>Fear of falls is a significant and persistent challenge for ICU survivors. Modifiable discharge factors exist such as strength, physical function/balance, ICU-related delirium and mood which may be the target of future post hospital interventions.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Implementing a Standardized Risk Stratification and Triage Workflow for an Established Pulmonary Embolism Response Team.","authors":"Hussein J Hassan, Ryan G Belecanech, Peter J Leary, Gray R Lyons, Clifford R Weiss, Jennifer C Yui, Hamza Aziz, Bo S Kim, David N Hager, Todd M Kolb","doi":"10.1513/AnnalsATS.202412-1301OC","DOIUrl":"10.1513/AnnalsATS.202412-1301OC","url":null,"abstract":"<p><p><b>Rationale:</b> The pulmonary embolism response team (PERT) model was developed to facilitate multispecialty decision-making and expedite therapeutic interventions for patients with pulmonary embolism (PE). PERT implementation has previously been associated with survival benefit in some studies, although specific workflow components that confer survival benefit have not been identified. <b>Objectives:</b> To measure the effects of PERT workflow revisions based upon risk stratification on clinical outcomes in an existing PERT. <b>Methods:</b> As a quality improvement initiative, we implemented three specific workflow interventions to an existing PERT program at an academic medical center: <i>1</i>) designating triage responsibility to a specific group of providers; <i>2</i>) assigning guideline-based risk stratification to all calls at triage; and <i>3</i>) establishing intensive care unit admission guidelines on the basis of risk stratification. We used electronic medical records to review clinical outcomes for all PERT calls for 2 years after implementing the revised workflow and compared these with outcomes for the preceding 2-year period. We used logistic regression to compare the odds of in-hospital mortality before and after the workflow revision, with multiple models adjusted for clinically relevant variables. <b>Results:</b> During the study period (2019-2023), there were 420 unique patient PERT activations with confirmed PE; 253 patients were managed using the revised workflow, and 167 patients were managed using the historical workflow. The proportion of patients meeting the primary endpoint of in-hospital death at 30 days after the workflow revisions was significantly lower than during the historical period (6.3% vs. 18.0%; <i>P</i> < 0.001). Logistic regression analysis demonstrated the revised-PERT workflow to have a protective effect against in-hospital mortality (odds ratio = 0.31; 95% confidence interval = 0.16-0.59; <i>P</i> < 0.001). This mortality benefit remained significant after adjustment for demographics, clinical factors, hemodynamic instability, Pulmonary Embolism Severity Index class, and stage in the Bova scoring system. The workflow revisions were also associated with increased use of advanced therapies but did not change the proportion of patients with major bleeding or length of stay in the intensive care unit or hospital. <b>Conclusions:</b> In an existing PERT program, implementation of three specific workflow revisions centered around risk stratification and level-of-care triage improved survival for patients with PE. These findings suggest that incorporation of a standardized approach and risk stratification are valuable components of the PERT response.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1484-1492"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive-Behavioral Treatment for Breathlessness in Lung Cancer: A Randomized Controlled Trial.","authors":"Stephen B Lo, Nicole A Arrato, Carolyn J Presley, Heather L McGinty, Michael W Otto, Barbara L Andersen","doi":"10.1513/AnnalsATS.202406-580OC","DOIUrl":"10.1513/AnnalsATS.202406-580OC","url":null,"abstract":"<p><p><b>Rationale:</b> Dyspnea (breathlessness) commonly impacts patients with lung cancer, worsening depression, anxiety, quality of life, and functioning. Current treatments are limited. <b>Objectives:</b> To test the acceptability, feasibility, and preliminary efficacy of \"Take a Breath\" (TAB), a novel cognitive-behavioral treatment for dyspnea. <b>Methods:</b> A randomized controlled trial compared TAB with standard of care (SOC) in patients with lung cancer reporting at least moderate dyspnea (<i>N</i> = 45). TAB consisted of five 1-hour weekly individual sessions employing exposure-based interventions paired with pulse oximetry biofeedback, psychoeducation, and behavioral skills (e.g., pursed lip breathing). The Client Satisfaction Questionnaire-8 measured acceptability. Accrual, treatment retention, and homework completion measured feasibility. Primary outcomes were the American Thoracic Society Dyspnea Scale (dyspnea-related functioning) and Cancer Dyspnea Scale (dyspnea-related effort, discomfort, and anxiety). Secondary outcomes included depression (Patient Health Questionnaire-9), health-related quality of life (12-item Short Form Health Survey), physical activity (International Physical Activity Questionnaire Short Form), and functional status (Karnofsky performance status). Measurements occurred at baseline, midtreatment (3 wk), post-treatment (6 wk), and 1-month follow-up. Robust mixed-effects modeling tested group × time interactions. <b>Results:</b> TAB was at least \"mostly satisfactory\" for 75% of participants. The accrual was 25.6%, with 60% completing all sessions and an 88.7% homework completion rate. Intention-to-treat analysis revealed greater improvements in TAB than SOC for dyspnea-related functioning (Cohen's <i>d = </i>0.82; <i>P</i> = 0.03) and anxiety (Cohen's <i>d = </i>0.87; <i>P</i> < 0.01) at post-treatment and follow-up. TAB outperformed SOC in improving depressive symptoms, health-related quality of life, sedentary time, and performance status over time (all <i>P</i> < 0.05). <b>Conclusions:</b> TAB yielded symptom, psychological, and functional improvements, establishing its readiness for further testing as the first comprehensive cognitive-behavioral treatment for dyspnea and related sequelae. Clinical trial registered with www.clinicaltrials.gov (NCT05304793).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1579-1591"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 54-Year-Old Man with Recurrent Hemoptysis.","authors":"Swati Mehta, Marc A Judson, Amit Chopra","doi":"10.1513/AnnalsATS.202410-1021CC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202410-1021CC","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 10","pages":"1601-1604"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 Pandemic on Interstitial Lung Disease Healthcare Utilization and Outcomes: A Population Study in Alberta, Canada.","authors":"Jason Weatherald, Chuan Wen, Kerri Johannson, Paul E Ronksley, Jeffrey A Bakal, Michael K Stickland, Douglas P Gross, Grace Y Lam","doi":"10.1513/AnnalsATS.202412-1311RL","DOIUrl":"10.1513/AnnalsATS.202412-1311RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1605-1610"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Deployment-related Respiratory Diseases in Military Veterans.","authors":"Robert M Tighe, Le Roy Torres, Robert Miller","doi":"10.1513/AnnalsATS.202411-1126FR","DOIUrl":"10.1513/AnnalsATS.202411-1126FR","url":null,"abstract":"<p><p>Deployed military personnel often develop respiratory symptoms and disorders due to exposure to particulate matter such as dust, blast materials, and burn pit emissions. A range of deployment-related respiratory diseases have been reported, including toxic lung injury, eosinophilic pneumonia, asthma, chronic obstructive pulmonary disease, bronchiolitis, and interstitial lung disease. The Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Act of 222, which was enacted in 2022, expanded coverage of medical care for veterans and improved awareness of deployment-related respiratory diseases. This law added 23 diagnoses presumed to be connected to deployment but has failed to address issues related to the diagnosis of deployment-related respiratory disorders. Diagnosing some of the respiratory disorders associated with deployment can be challenging, as symptoms are often nonspecific. Veterans who present with respiratory symptoms should undergo a comprehensive assessment, including a detailed medical and exposure history, pulmonary function tests, imaging, and serologic screening for autoimmune disorders. A decision on whether a surgical lung biopsy should be performed should be made on a case-by-case basis on the basis of multidisciplinary review and an informed discussion with the patient. The clinical care team should discuss pharmacological and nonpharmacological treatment options with the patient and direct them to reliable sources of information. Long-term follow-up is essential to monitor for worsening of pulmonary function or symptoms. Further research is needed to characterize associations between deployment-related exposures and respiratory health outcomes and to inform better means of assessment and treatment of military veterans.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1445-1452"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptive Servo-Ventilation for Treatment-Emergent Central Sleep Apnea: The READ-ASV Registry.","authors":"Michael Arzt, Oliver Munt, Raphaela Kuebeck, Holger Woehrle, Raphael Heinzer, Adam V Benjafield, Jean-Louis Pepin","doi":"10.1513/AnnalsATS.202502-210OC","DOIUrl":"10.1513/AnnalsATS.202502-210OC","url":null,"abstract":"<p><p><b>Rationale:</b> Treatment-emergent central sleep apnea (TE-CSA) is the most common indication for adaptive servo-ventilation (ASV). Evidence on the effects of TE-CSA treatment on quality of life (QoL) is limited. <b>Objectives:</b> To test the hypotheses that patients with TE-CSA who have cardiovascular disease (CVD) would be less symptomatic than those with CVD and that the beneficial effects of ASV on QoL/sleepiness might be smaller in individuals with versus without CVD. <b>Methods:</b> ASV-naive adults with TE-CSA and an ASV prescription were included in this analysis of the READ-ASV (Registry on the Treatment of Central and Complex Sleep-Disordered Breathing with ASV). QoL (Functional Outcomes of Sleep Questionnaire [FOSQ]) and daytime sleepiness (Epworth Sleepiness Scale [ESS]) were assessed at baseline and 12-month follow up. <b>Results:</b> Of 452 patients with TE-CSA, 81% had CVD. Before treatment initiation, FOSQ and ESS scores were better in those with versus without CVD. On ASV, in the CVD and no CVD subgroups, median (interquartile range) FOSQ score significantly increased (+0.72 [-0.20 to +1.98], <i>P</i> < 0.001 and +0.90 [-0.12 to +2.29], <i>P</i> < 0.001, respectively), and the ESS score significantly decreased (-2.00 [-5.00 to 0.00], <i>P</i> < 0.001 and -3.00 [-6.75 to 0.00], <i>P</i> < 0.001); improvement magnitude was similar in both subgroups (<i>P</i> = 0.454 and <i>P</i> = 0.120). <b>Conclusions:</b> The majority of individuals with TE-CSA and an ASV therapy prescription had CVD. Although those with TE-CSA and CVD were less symptomatic than those without CVD, ASV had a positive effect on QoL and sleepiness in these individuals, as well as those without CVD. Clinical trial registered with www.clinicaltrials.gov (NCT03032029).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1546-1553"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Epidemiology of Combined Pulmonary Fibrosis and Emphysema among Mid-Atlantic Veterans.","authors":"Daniel M Guidot, Danielle Seaman, Roy A Pleasants, Joel C Boggan, Armando Bedoya, Aparna C Swaminathan, Matthew L Maciejewski, Bhavika Kaul, Robert M Tighe","doi":"10.1513/AnnalsATS.202408-882OC","DOIUrl":"10.1513/AnnalsATS.202408-882OC","url":null,"abstract":"<p><p><b>Rationale:</b> Combined pulmonary fibrosis and emphysema (CPFE) is a unique phenotype with important prognosis and management implications in patients with idiopathic pulmonary fibrosis (CPFE-IPF) and other forms of fibrotic interstitial lung disease (CPFE-fILD). However, the epidemiology of CPFE is not well characterized, creating a barrier to clinical research needed to advance our understanding and management. <b>Objectives:</b> To investigate the incidence, prevalence, and long-term outcomes of CPFE among a regional cohort of veterans. <b>Methods:</b> We retrospectively reviewed records for veterans in the Veterans Affairs Mid-Atlantic Health Care Network (includes North Carolina and Virginia) with International Classification of Disease, Ninth Revision, codes for pulmonary fibrosis between January 1, 2008, and December 31, 2015. We stratified pulmonary fibrosis into IPF and fILD using diagnostic codes and chart review. We reviewed computed tomography reports and classified cases as having CPFE according to documented emphysema; a thoracic radiologist overread a subset of scans for validation. We calculated annual incidence and prevalence of CPFE and compared characteristics between veterans with CPFE and veterans with fibrosis without emphysema using chi-square tests, Mann-Whitney <i>U</i> tests, and paired <i>t</i> tests. We used Kaplan-Meier and Cox models to determine overall survival from diagnosis. <b>Results:</b> We identified 2,414 veterans with fILD. Among 1,880 veterans with IPF, 734 (39.0%) had CPFE-IPF; among 534 veterans with fILD, 194 (36.3%) had CPFE-fILD. Agreement between computed tomography reports and thoracic radiologist review was high (kappa = 0.78). Annual CPFE prevalence ranged from 71 to 100 per 100,000 veterans, and incidence ranged from 16 to 39 per 100,000 veterans. CPFE was associated with male sex, lower body mass index, greater tobacco history, higher forced vital capacity, reduced forced expiratory volume in 1 second/forced vital capacity ratio, reduced diffusing capacity of the lung for carbon monoxide, and increased oxygen use. CPFE was associated with increased mortality in unadjusted models. However, after adjustment for age, sex, and body mass index, CPFE was not associated with survival for CPFE-IPF versus IPF without emphysema (hazard ratio, 1.13; 95% confidence interval, 0.96-1.33) as well as CPFE-fILD versus fILD without emphysema (hazard ratio, 1.16, 95% confidence interval, 0.82-1.63). <b>Conclusions:</b> CPFE has a high incidence and prevalence among veterans with IPF and fILD and has a distinct phenotype with diagnostic and therapeutic implications. Further studies investigating diagnosis, treatment considerations, and long-term impacts in CPFE are merited.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1493-1503"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Site of Collapse during Drug-induced Sleep Endoscopy Is Associated with Polysomnographic Endotypic Traits: An Observational Study.","authors":"Sara Op de Beeck, Daniel Vena, Eli Van de Perck, Dwayne Mann, Ali Azarbarzin, Raichel M Alex, Marijke Dieltjens, Marc Willemen, Johan Verbraecken, Andrew Wellman, Scott A Sands, Olivier M Vanderveken","doi":"10.1513/AnnalsATS.202408-871OC","DOIUrl":"10.1513/AnnalsATS.202408-871OC","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Rationale:&lt;/b&gt; Both the site of upper airway collapse during drug-induced sleep endoscopy (DISE) and pathophysiological endotypic traits are associated with non-continuous positive airway pressure treatment outcomes for obstructive sleep apnea (OSA). Reduced hypoglossal nerve stimulation treatment efficacy has been associated with complete concentric collapse at the level of the palate (CCCp), lateral wall collapse, lower arousal threshold, and poor dilator muscle compensation. However, these predictors may not be independent. &lt;b&gt;Objective:&lt;/b&gt; Assess the relationship between the site of upper airway collapse (structure) and pathophysiological endotypic traits (function). &lt;b&gt;Methods:&lt;/b&gt; This retrospective cohort study examined 182 patients (median [95% confidence interval] apnea-hypopnea index, 24.2 [17.6, 32.8]; body mass index, 27.8 [25.2, 30.5]; age, 51.3 [40.4, 58.8] yr) who underwent in-laboratory polysomnography and DISE. All DISE studies were scored by one researcher, thereby avoiding interrater variability. Endotypic traits (loop gain, collapsibility, arousal threshold, and compensation) were estimated using routine polysomnography (Sands &lt;i&gt;et al&lt;/i&gt;., &lt;i&gt;Am J Respir Crit Care Med&lt;/i&gt; 2018;197:1187-1197). Linear regression quantified differences in traits between DISE categories. Multivariable logistic regression quantified associations between DISE categories (dependent variable, with vs. without a certain collapse type) and individual traits. Analyses were mutually adjusted for other endotypic traits. &lt;b&gt;Results:&lt;/b&gt; CCCp was independently associated with greater collapsibility (Δ collapsibility, 9.8 [4.6, 15.0]%; &lt;i&gt;P&lt;/i&gt; &lt; 0.001 with vs. without CCCp; odds ratio [OR], 6.9 [95% confidence interval, 2.2, 22.1] per 2-standard deviation [2 SD] increase in collapsibility [SD, 15.9%]) but a lower arousal threshold (Δ arousal threshold, -8.4 [-15.6, -1.2]%; OR, 5.4 [1.2, 24.2] per 2 SD [SD, 24.9%]). Conversely, complete tongue base collapse was associated with less severe collapsibility (Δ collapsibility, -5.9 [-10.2, -1.6]%; OR, 5.0 [1.4, 17.9]) but a higher arousal threshold (Δ arousal threshold, 7.6 [1.6, 13.5]%; OR, 5.7 [1.4, 23.5]). Complete lateral wall collapse was independently associated with reduced compensation (Δ compensation, -8.0 [-14.5, -1.5]%; &lt;i&gt;P&lt;/i&gt; = 0.018; OR, 3.6 [1.2, 10.4] per 2 SD [SD, 17.5%]), whereas epiglottic collapse was associated with greater compensation (Δ compensation, 8.1 [1.0, 15.3]%; OR, 5.8 [1.1, 31.2]). Findings persisted with additional adjustment for apnea-hypopnea index and body mass index, except for collapsibility and tongue base collapse. Loop gain was not associated with any site of collapse. &lt;b&gt;Conclusions:&lt;/b&gt; Different sites of upper airway collapse manifest distinctly different pathophysiological traits in patients with OSA. The greater collapsibility and lower arousal threshold seen with CCCp and reduced compensation with lateral wall collapse may help explain reduced non-continu","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1567-1578"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Families' Experiences Making Decisions across Time and Settings in Chronic Critical Illness.","authors":"Amanda C Moale, Chareeni E Kurukulasuriya, Mikhaila N Layshock, Svea Cheng, Robert M Arnold, Renee D Boss, Bryan J McVerry, Douglas B White, Judy C Chang","doi":"10.1513/AnnalsATS.202412-1245OC","DOIUrl":"10.1513/AnnalsATS.202412-1245OC","url":null,"abstract":"<p><p><b>Rationale:</b> Chronic critical illness (CCI) results in high patient morbidity and mortality rates and imposes substantial burdens on families as surrogate decision-makers. Prior research has predominantly focused on families' decisional needs before tracheostomy in the intensive care unit despite CCI unfolding over a period of weeks to months across multiple care transitions and settings. <b>Objective:</b> To characterize families' decision-making experiences and reflections along the continuum of CCI across time and care transitions. <b>Methods:</b> We conducted semistructured interviews with family decision-makers of patients who received a tracheostomy for persistent respiratory failure after an acute illness, first within 2 weeks to 6 months after tracheostomy and again weeks to months later. We analyzed data using inductive and deductive analysis methods. <b>Results:</b> We interviewed 23 family decision-makers of 19 patients and identified five themes. First, tracheostomy is most often presented as a \"needed\" procedure in the acute setting, leaving families with a sense of little choice and limited awareness of the broader, long-term care trajectory. Second, several families felt pressured to make a certain decision or judged when their decision opposed the team's recommendation, specifically if they perceived the recommendation as misaligned with the patient's goals. Third, after tracheostomy, families accepted ongoing interventions to reach a postacute facility, which represented hope for recovery. Fourth, after transitioning to a postacute facility, families faced uncertainty about recovery expectations and made ongoing decisions focused on overcoming setbacks amid the \"rollercoaster\" of CCI. Fifth, the passage of time with CCI made it increasingly difficult for families to remain physically and psychologically present, leading to a growing sense of passivity in decision-making and a loss of control over the patient's journey. <b>Conclusions:</b> We found critical problems in communication and support throughout the continuum of CCI. Although the framing of tracheostomy as a need with limited deliberation about long-term implications remains problematic, our findings emphasize that tracheostomy is only one of many decisions families face throughout CCI. Our data suggest shifting the focus from intensive care unit-based solely \"tracheostomy decision-making\" to longitudinal decisional support that extends across time and settings, enabling ongoing reassessment and decision-making based on the patient's evolving trajectory.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1539-1545"},"PeriodicalIF":5.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}