Annals of the American Thoracic Society最新文献

{"title":"Federal Research Funding for Child Lung Health and Disease.","authors":"Bria M Coates, Hara Levy, Phyllis Dennery, Thomas J Mariani","doi":"10.1513/AnnalsATS.202504-430VP","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202504-430VP","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786103","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":"Role of Acetaminophen in Intensive Care Unit Delirium Prevention: A Retrospective Cohort Study.","authors":"Somnath Bose, Béla-Simon Paschold, Tahereh Shamsi, Lars Kaiser, Joris Pensier, Guanqing Chen, Van Nguyen, Siddhartha Reddy Janga, Alka Behera, Daniel Talmor, Balachundhar Subramaniam, Maximilian S Schaefer","doi":"10.1513/AnnalsATS.202506-683OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202506-683OC","url":null,"abstract":"<p><strong>Rationale: </strong>Pain and systemic inflammation are two factors associated with delirium, and subsequent adverse outcomes in Intensive Care Unit (ICU) patients. Acetaminophen might be effective in mitigating delirium incidence but has been poorly studied outside the postoperative population.</p><p><strong>Objective: </strong>This study investigated the association between acetaminophen administration and the incidence of ICU delirium.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in a tertiary-level hospital, including adult patients admitted to any ICU for ≥48 hours between 2015 and 2024. The primary exposure was acetaminophen administration (≥2g/day). Primary outcome was the incidence of ICU delirium, determined from Confusion Assessment Method-ICU assessments recorded every 12 hours as part of clinical care. Multivariate logistic regression was applied, and fractional polynomial modeling was conducted to study the association between the proportion of time under the effect of acetaminophen and the proportion of time experiencing delirium.</p><p><strong>Results: </strong>Out of 17,818 patients included, 5,332 (29.9%) received acetaminophen during their ICU stay. 5,438 (30.5%) patients developed delirium. Acetaminophen was associated with a reduced incidence of delirium (Odd Ratios [ORadj] 0.66, 95%CI 0.59-0.73, Absolute Risk Difference [ARDadj] -6.0%, 95%CI -7.5% to -4.5%, p<0.001). There was a dose-dependent association between the time under the effect of acetaminophen (p<0.001) and a reduced time experiencing delirium, plateauing at coverage levels ≥40%.</p><p><strong>Conclusion: </strong>Acetaminophen is associated with a clinically significant reduction of ICU delirium in unselected critically ill patients. Furthermore, the proportion of time under the effect of acetaminophen is inversely associated with the proportion of time experiencing delirium. These hypothesis generating results should be validated in a randomized controlled trial.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786104","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":"Clinical and System-Level Factors Driving Donor Lung Utilization Decisions: A Qualitative Study.","authors":"Brittany Koons, James D Mendez, Michaela R Anderson, Edward Cantu, Matthew Hartwig, Christian Merlo, Krishna Pandya, Emily Vail, Jonathan P Singer, Jason D Christie","doi":"10.1513/AnnalsATS.202411-1175OC","DOIUrl":"10.1513/AnnalsATS.202411-1175OC","url":null,"abstract":"<p><p><b>Rationale:</b> Key knowledge gaps exist in understanding what drives donor utilization decisions and contributes to the significant variability in organ offer acceptance rates. Defining and addressing the factors that explain variability in organ offer acceptance rates across U.S. transplant centers is a key area of need. <b>Objectives:</b> To identify the clinical and system-level factors that influence donor evaluation and graft acceptance decisions by lung transplant clinicians. <b>Methods:</b> We conducted semistructured interviews with lung transplant clinicians who actively participate in donor evaluation calls and make donor utilization decisions at a U.S. transplant center between December 2022 and September 2023. Interviews were thematically analyzed. <b>Results:</b> From 12 interviews with lung transplant pulmonologists (<i>n</i> = 6) and surgeons(<i>n</i> = 6) across eight different centers, we identified four main themes that represent distinct layers of influence on donor decision-making: <i>1</i>) variability in donor factors considered acceptable for transplant (i.e., donor age, smoking history, oxygenation, imaging) and how to consider donation after cardiac death donor offers; <i>2</i>) the complexity of matching critically ill and difficult-to-match (i.e., highly sensitized, rare blood type) candidates with offered organs; <i>3</i>) the influence of provider training and experience on decision-making; and <i>4</i>) the impact of multiple system factors, including organ allocation, transplant center experience, resources, logistics, donor data availability, donor management strategies, and collaboration with organ procurement organization staff. <b>Conclusions:</b> Our findings offer insight into clinical practice variability, identify areas that may be improved by policy change, highlight opportunities to improve clinical training, and identify directions for future research.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1155-1164"},"PeriodicalIF":5.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12329325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694748","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":"Overview of Peripheral Vasopressor Use in an Academic Health System.","authors":"Daniel Shyu, Nicholas E Ingraham, Christopher A Linke, Lianne Siegel, Jared A Larson, Anna R Benson, Kathryn M Pendleton","doi":"10.1513/AnnalsATS.202411-1135OC","DOIUrl":"10.1513/AnnalsATS.202411-1135OC","url":null,"abstract":"<p><p><b>Rationale:</b> Despite historical concerns for tissue injury from extravasation, studies suggest that peripheral administration of vasopressors is safe. However, peripheral vasopressor use remains variable. <b>Objectives:</b> To characterize the use of peripheral vasopressors over time, identify variability in use, and assess outcomes associated with their use. <b>Methods:</b> We conducted a retrospective cohort study of adult patients admitted to 10 hospitals in Minnesota (October 2020-October 2023) who received any vasopressors. Patients receiving vasopressors initially through a peripheral intravenous catheter were compared with those receiving vasopressors initially through central access. Safety, efficacy, and use patterns across hospitals and providers were studied. <b>Results:</b> A total of 9,493 patients received vasopressors, including 3,734 with peripheral initiation and 5,759 with central initiation. Thirty-one (0.8%) of the 3,734 patients with peripheral vasopressors received phentolamine for extravasation events, with one receiving a surgical consultation for tissue necrosis. Community hospitals had the highest use of peripheral vasopressors (50.7%), and academic medical centers had the lowest use (27.6%). Initiation of vasopressors peripherally was not associated with increased hospital (adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97), 90-day (aOR, 0.92; 95% CI, 0.83-1.02), or 1-year mortality (aOR, 1.0; 95% CI, 0.91-1.11). Significant variation in use of peripheral vasopressors was observed across providers. <b>Conclusions:</b> Peripheral vasopressors were commonly and safely used in our 10-hospital health system, particularly in the community hospitals. Peripheral initiation of vasopressors was not associated with increased mortality at 90 days, but it was associated with decreased hospital length of stay. Variation in peripheral vasopressor use was found across hospitals and providers.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1201-1209"},"PeriodicalIF":5.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12329328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694755","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":"Sleep-disordered Breathing in Patients with Chronic Obstructive Pulmonary Disease: Prevalence and Outcomes.","authors":"Jose M Marin, Joan B Soriano, Marta Marin-Oto, Juan P De-Torres, Luis M Seijo, Carlos Cabrera, Ingrid Solanes, Cristina Martinez, Nuria Toledo-Pons, Nuria Feu, Carlos Amado, Laura Vigil, Bartolome R Celli, Ciro Casanova","doi":"10.1513/AnnalsATS.202501-030OC","DOIUrl":"10.1513/AnnalsATS.202501-030OC","url":null,"abstract":"<p><p><b>Rationale:</b> The prevalence of obstructive sleep apnea (OSA) or nocturnal hypoxemia without OSA (i.e., isolated nocturnal hypoxemia [iNH]) and its impact on the natural history of chronic obstructive pulmonary disease (COPD) are unclear. <b>Objective:</b> We determined the prevalences of OSA and iNH in patients with COPD and their contribution to all-cause mortality and COPD exacerbations. <b>Methods:</b> At baseline, we performed home sleep apnea testing in the CHAIN (COPD History Assessment in Spain) study cohort. OSA was defined by an apnea-hypopnea index of ⩾15 events per hour, and iNH was defined by an oxygen saturation as measured by pulse oximetry <90% for >30% of the nocturnal recording time. During an observation time of 6.5 years, we evaluated the association of OSA or iNH with all-cause mortality using multivariable Cox regression models and with COPD exacerbations using negative binomial models. <b>Results:</b> Among 428 patients with COPD, OSA and nocturnal hypoxemia were ruled out in 41%, whereas 27% had iNH and 32% had OSA (i.e., COPD/OSA \"overlap syndrome\" [OVS]). OVS was independently associated with obesity as defined by a body mass index ⩾30 kg/m² and with severe COPD exacerbations (<i>P</i> < 0.01), whereas iNH was associated with lower forced expiratory volume in 1 second and lower resting arterial oxygen saturation. Compared with patients with COPD without OSA or iNH, those with untreated OVS had greater risks of mortality (hazard ratio, 1.74; 95% confidence interval, 1.03-2.94) and COPD exacerbations (incidence rate ratio, 1.44; 95% confidence interval, 1.05-2.03). <b>Conclusions:</b> OSA and iNH are frequent in patients with COPD, and the prevalences decrease or increase, respectively, with disease severity. Patients with COPD with untreated OVS but not with iNH had a greater risk of all-cause mortality and COPD exacerbations.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1227-1235"},"PeriodicalIF":5.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000202","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":"Applying Lung and Chest Wall Mechanics to Navigate Sudden Respiratory Deterioration.","authors":"Emily V Rose, Trevor C Steinbach","doi":"10.1513/AnnalsATS.202501-114CC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202501-114CC","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 8","pages":"1254-1259"},"PeriodicalIF":5.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762654","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":"Race-Specific versus Race-Neutral Pulmonary Function Predicted Values in Patients with Operable Lung Cancer.","authors":"Ravi Rajaram, Ajay Sheshadri, Aaron Baugh, Levi N Bonnell, Liang Li, Ara A Vaporciyan, Mark Block, Elizabeth A David, Robert H Habib, David E Ost","doi":"10.1513/AnnalsATS.202408-846OC","DOIUrl":"10.1513/AnnalsATS.202408-846OC","url":null,"abstract":"<p><p><b>Rationale:</b> Percent predicted forced expiratory volume in 1 second (FEV₁pp) is used for surgical risk assessment in patients with lung cancer. FEV₁pp is adjusted for race, despite concerns regarding inaccurate estimations of lung health. <b>Objectives:</b> To compare prediction of race-specific versus race-neutral FEV₁pp for pulmonary complications after lung cancer resection. <b>Methods:</b> Patients who underwent lung resection in the Society of Thoracic Surgeons General Thoracic Surgery Database were identified (2002-2008). We used Global Lung Initiative equations to derive race-specific and race-neutral FEV₁pp and compared their performance to predict pulmonary complications. Postoperative FEV₁pp was calculated with patients categorized into low- (>60%), intermediate- (30-60%), and high- (<30%) risk groups. <b>Results:</b> Of 24,276 patients, most were White (<i>n</i> = 21,130; 87.0%) or Black (<i>n</i> = 1,912; 7.9%). Race-specific equations reduced the mean FEV₁pp by 5.3% for White patients and increased it 6.2% for Black patients compared with race-neutral equations. Multivariate models using race-neutral FEV₁pp performed similarly to race-specific models in predicting pulmonary complications (sublobar resection: C-statistic 0.72; lobectomy: C-statistic 0.65; and bilobectomy/pneumonectomy: C-statistic 0.67; for both models) with similar adjusted odds ratios of FEV₁pp for both equation types. In 5,422 patients with calculable postoperative FEV₁pp, 617 (11.4%) were recategorized into a higher (<i>n</i> = 65) or lower (<i>n</i> = 552) risk group when using race-neutral equations. Of those moving into a lower-risk group, 98.0% were White. All patients reclassified into higher-risk groups were Black. <b>Conclusions:</b> Race-neutral FEV₁pp performed equally well as race-specific equations in predicting pulmonary complications and disentangled the effect of respiratory function from race on outcomes.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1244-1253"},"PeriodicalIF":5.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736303","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":"Use of Nintedanib for the Treatment of Systemic Sclerosis-associated Interstitial Lung Disease at Expert Scleroderma Centers in the United States.","authors":"Yiming Luo, Shervin Assassi, Maureen D Mayes, Tracy M Frech, Virginia D Steen, Carrie Richardson, Lorinda Chung, Nora Sandorfi, John M VanBuren, Monica Harding, Jessica S Alvey, Brian Skaug, Zsuzsanna H McMahan, Kimberly S Lakin, Carleigh Zahn, Sonali J Bracken, Dorota J Lebiedz-Odrobina, Jerry A Molitor, Luke B Evnin, Duncan F Moore, Ankoor Shah, Flavia V Castelino, Elizabeth R Volkmann, Faye N Hant, Ashima Makol, Ami A Shah, Laura K Hummers, Jessica K Gordon, Dinesh Khanna, Elana J Bernstein","doi":"10.1513/AnnalsATS.202410-1045RL","DOIUrl":"10.1513/AnnalsATS.202410-1045RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1265-1269"},"PeriodicalIF":5.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12329330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058726","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":"Radiomics-based Prediction of Local Recurrence after Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer.","authors":"Chioma P Ogbonna, William G Breen, Pierre Le Noach, Srinivasan Rajagopalan, Logan J Hostetter, Fabien Maldonado, Brian J Bartholmai, Kenneth W Merrell, Tobias Peikert","doi":"10.1513/AnnalsATS.202410-1047OC","DOIUrl":"10.1513/AnnalsATS.202410-1047OC","url":null,"abstract":"<p><p><b>Rationale:</b> Stereotactic body radiation therapy (SBRT) represents an effective therapeutic strategy for early-stage non-small cell lung cancer (NSCLC); however, local and systemic recurrences represent ongoing challenges. Computed tomography (CT) radiomics-based risk models can potentially be used to predict the risk of local recurrence on pretreatment CT scans. <b>Objective:</b> Development of a radiomics model to predict local recurrence after SBRT in patients with NSCLC. <b>Methods:</b> This single-institution study includes a retrospective case-control training set (20 patients with local recurrence and 40 control subjects) and an independent validation set (198 consecutive cases) of patients with early-stage NSCLC treated with SBRT. Tumors were semiautomatically segmented, and 102 quantitative radiomic features, including texture, landscape, spatial, nodule shape, and nodule surface features, were extracted. These features were included in three separate multivariable models to predict the risk of recurrence on the basis of pre-SBRT, post-SBRT, and the difference between the pre-SBRT and post-SBRT scans (Delta model). The pre-SBRT model was subsequently validated in an independent validation set. <b>Results:</b> Thirteen independent variables were selected for the models using the Boruta algorithm. The sensitivity, specificity, and area under the curve of the pre-SBRT, post-SBRT, and Delta models were 85%, 90%, and 0.91; 85%, 92.5%, and 0.92; and 85%, 92.5%, and 0.94, respectively. The pre-SBRT model was validated in the independent validation set (area under the curve, 0.89; confidence interval, 0.83-0.92), because this model was believed to be the most useful to assist in individualized treatment planning. <b>Conclusions:</b> Radiomic analysis facilitated the development of three high-performing models predicting local recurrence using either pre-SBRT CT, post-SBRT CT, or the change between these two. We successfully validated the most clinically relevant model, the pre-SBRT model. Although this model needs further validation, it may facilitate individualized surveillance, treatment planning, and selection of adjuvant therapy.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1236-1243"},"PeriodicalIF":5.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031002","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 Overlap Syndrome Paradox: Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Care Doesn't Overlap.","authors":"Janna R Raphelson, Robert L Owens","doi":"10.1513/AnnalsATS.202506-617ED","DOIUrl":"10.1513/AnnalsATS.202506-617ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1138-1139"},"PeriodicalIF":5.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12329332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546473","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}