Annals of the American Thoracic Society最新文献

{"title":"Minimally Invasive Repair of a Cervical Aerocele.","authors":"Alma V Burbano, Kai Swenson, Adnan Majid, Pavan Mallur","doi":"10.1513/AnnalsATS.202403-263CC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202403-263CC","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 2","pages":"298-301"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070285","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":"Propofol, Triglycerides, and Acute Pancreatitis: A Multicenter Epidemiologic Analysis.","authors":"Kiyan Heybati, Jiawen Deng, Guozhen Xie, Keshav Poudel, Fangwen Zhou, Zeeshan Rizwan, Caitlin S Brown, Christopher T Acker, Ognjen Gajic, Hemang Yadav","doi":"10.1513/AnnalsATS.202407-781OC","DOIUrl":"10.1513/AnnalsATS.202407-781OC","url":null,"abstract":"<p><p><b>Rationale:</b> Propofol is one of the first-line sedative-hypnotic agents for critically ill adults requiring mechanical ventilation. Although propofol can elevate triglyceride levels, and the latter is a risk factor for pancreatitis, the association between propofol and acute pancreatitis is unclear. <b>Objectives:</b> We sought to determine the clinical impact and potential associations between propofol infusion, hypertriglyceridemia, and acute pancreatitis. <b>Methods:</b> This is an observational multicenter study of adults (⩾18 yr old) who were admitted to an intensive care unit, who required mechanical ventilation and received continuous propofol infusion for at least 24 hours. The primary outcomes were the frequency of hypertriglyceridemia (>400 mg/dl) and acute pancreatitis. Further analyses were done to determine the clinical impact of elevated triglyceride levels (i.e., sedation changes) and risk factors for pancreatitis development. <b>Results:</b> Of 11,828 patients included, 33.2% (<i>n</i> = 3,922) had triglyceride levels measured, of whom 21.7% (<i>n</i> = 851) had hypertriglyceridemia at 4.5 days (SD = 6.8) after propofol initiation. Of those still requiring sedation, 70.4% (<i>n</i> = 576/818) received alternative sedatives after developing hypertriglyceridemia. Pancreatitis occurred in 1.2% of patients (<i>n</i> = 47/3,922) and was more frequent in those with hypertriglyceridemia (3.2%, 27/851; vs. 0.7%, 20/3,071; <i>P</i> < 0.001). After adjustment for potential confounding variables, each 100 mg/dl increase in triglyceride levels was associated with an 11% increase in risk of pancreatitis. Propofol dose was not associated with pancreatitis development. <b>Conclusions:</b> Acute pancreatitis is uncommon in patients receiving propofol infusion, and it occurs over a wide range of triglyceride levels, indicating a multifactorial pathophysiology. Hypertriglyceridemia frequently prompts the use of alternative sedatives. Further study is needed to determine how to best monitor and treat hypertriglyceridemia in critically ill patients receiving propofol infusion.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"235-246"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407336","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":"Postdeployment Respiratory Health: It's Not Always the Lungs.","authors":"Aaron B Holley, Michael J Morris","doi":"10.1513/AnnalsATS.202409-945LE","DOIUrl":"10.1513/AnnalsATS.202409-945LE","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"309-310"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789722","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":"Discrepancy between Functional Outcomes and Perceived Health Post-Intensive Care Unit: A Prospective Cohort Study.","authors":"Lucy L Porter, Koen S Simons, Alison E Turnbull, Stijn Corsten, Brigitte Westerhof, Thijs C D Rettig, Esther Ewalds, Inge Janssen, Crétien Jacobs, Susanne van Santen, Monika C Kerckhoffs, Margaretha C E van der Woude, Johannes G van der Hoeven, Marieke Zegers, Mark van den Boogaard","doi":"10.1513/AnnalsATS.202405-564OC","DOIUrl":"10.1513/AnnalsATS.202405-564OC","url":null,"abstract":"<p><p><b>Rationale:</b> Despite functional impairments, intensive care unit (ICU) survivors can perceive their quality of life as acceptable. <b>Objectives:</b> To investigate discrepancies between calculated health, based on self-reported physical, mental, and cognitive functioning and perceived health, 1 year after ICU admission. <b>Methods:</b> Data from an ongoing prospective multicenter cohort study, MONITOR-IC, were used. Patient-reported physical, mental, and cognitive functioning and perceived health (EuroQol visual analog scale; range, 0-100) 1 year post-ICU of patients admitted to 1 of 11 participating ICUs between July 2016 and September 2021 were analyzed. The relationship between functional outcomes and perceived health was modeled using linear regression. Calculated health for each patient was estimated using this model and compared with patients' perceived health, the difference reflecting a discrepancy. On the basis of a minimal clinically important difference of 8 points, three groups were defined: patients who rated their health better than calculated (positive discrepancy), patients who rated their health worse than calculated (negative discrepancy), and patients whose perceived health was concordant with their calculated health. <b>Results:</b> A total of 2,545 patients were analyzed, of whom 45.0% (<i>n</i> = 1,146) showed a discrepancy between calculated and perceived health. Patients with a negative discrepancy rated their health significantly lower (median, 50; interquartile range, 36-66) than patients with a positive discrepancy (median, 84; interquartile range, 75-90). Importantly, there were no significant differences in physical, mental, and cognitive functioning between patients with a negative versus positive discrepancy. Patients with a negative discrepancy had a higher education level and were more often unemployed. <b>Conclusions:</b> One year post-ICU, almost half of ICU survivors showed a discrepancy between calculated health and perceived health.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"255-262"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514509","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":"Comorbidities, Tobacco Exposure, and Geography: Added Risk Factors of Heat and Cold Wave-related Mortality among U.S. Veterans with Chronic Obstructive Pulmonary Disease.","authors":"Austin Rau, Arianne K Baldomero, Chris H Wendt, Gillian A M Tarr, Bruce H Alexander, Jesse D Berman","doi":"10.1513/AnnalsATS.202312-1089OC","DOIUrl":"10.1513/AnnalsATS.202312-1089OC","url":null,"abstract":"<p><p><b>Rationale:</b> Understanding the health risks associated with extreme weather events is needed to inform policies to protect vulnerable populations. <b>Objectives:</b> To estimate heat and cold wave-related mortality risks in a cohort of veteran patients with chronic obstructive pulmonary disease (COPD) and explore disparities among strata of comorbidities, tobacco exposure, and urbanicity. <b>Methods:</b> We designed a time-stratified case-crossover study among deceased patients with COPD between 2016 and 2021 in the Veterans Health Administration system. Distributed lag models with conditional logistic regression estimated incidence rate ratios of heat and cold wave-associated mortality risk from lag days 0 to 3 for heatwaves and lag days 0 to 7 for cold waves. Attributable risks (ARs) per 100,000 patients were also calculated. <b>Results:</b> Of the 377,545 deceased patients with COPD, the largest heatwave-related mortality risk was in patients with COPD and asthma (AR, 14,016; 95% confidence interval [CI], -326, 30,706) across lag days 0 to 3. The largest cold wave-related mortality burden was in patients with COPD with no other reported comorbidities (AR, 1,704; 95% CI, 759, 2,686) across lag days 0 to 7. Patients residing in urban settings had the greatest heatwave-related (AR, 1,062; 95% CI, 576, 1,559) and cold wave-related (AR, 1,261; 95% CI, 440, 2,105) mortality risk (across lag days 0 to 1 and 0 to 7, respectively). There were no differences in mortality risk by tobacco exposure. <b>Conclusions:</b> Our findings show that individuals with COPD are susceptible to heat and cold waves. This information can inform clinical practice and public health policy about the mortality risk vulnerable populations experience with respect to extreme weather conditions. Furthermore, our results may be used in the development and refinement of future extreme weather warning systems designed for public health purposes.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"200-207"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514508","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":"Summary for Clinicians: Clinical Practice Guideline for the Detection of Bronchiolitis Obliterans Syndrome after Pediatric Hematopoietic Stem Cell Transplant.","authors":"Pi Chun Cheng, Amisha Barochia, Shipra Rai, Samuel Goldfarb, Shivanthan Shanthikumar, Narayan P Iyer, Joseph K Ruminjo, Carey C Thomson","doi":"10.1513/AnnalsATS.202407-758AG","DOIUrl":"10.1513/AnnalsATS.202407-758AG","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"169-174"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514524","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":"Confronting the Fungus among Us in the Airways of People with Cystic Fibrosis.","authors":"Jessica Clarion, Jonathan D Cogen","doi":"10.1513/AnnalsATS.202411-1229ED","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202411-1229ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 2","pages":"183-184"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070231","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":"Artificial Intelligence and Large Language Models for the Management of Tobacco Dependence.","authors":"Ryan Chow, Sadia Jama, Aaron Cowan, Smita Pakhale","doi":"10.1513/AnnalsATS.202405-552RL","DOIUrl":"10.1513/AnnalsATS.202405-552RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"305-309"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649949","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 Real-World Effect of Early Screening for Palliative Care Criteria in a Medical Intensive Care Unit: An Instrumental Variable Analysis.","authors":"Chad H Hochberg, Rebecca A Gersten, Khyzer B Aziz, Margaret D Krasne, Li Yan, Alison E Turnbull, Daniel Brodie, Michelle Churchill, Danielle J Doberman, Theodore J Iwashyna, David N Hager","doi":"10.1513/AnnalsATS.202407-702OC","DOIUrl":"10.1513/AnnalsATS.202407-702OC","url":null,"abstract":"<p><p><b>Rationale:</b> Early identification of intensive care unit (ICU) patients likely to benefit from specialist palliative care could reduce the time such patients spend in the ICU receiving care inconsistent with their goals. <b>Objectives:</b> To evaluate the real-world effects of early screening for palliative care criteria in a medical ICU. <b>Methods:</b> We performed a retrospective cohort study in adults admitted to the ICU using a causal inference approach with instrumental variable analysis. The intervention consisted of screening ICU admissions for palliative care trigger conditions and, if present, offering specialist palliative care consultation, which could be accepted or declined by the ICU. We evaluated specialist palliative care use in pre and postimplementation cohorts from the year before and after screening implementation began (October 2022). In the postimplementation cohort, we compared use of specialist palliative care in those who received early screening versus not. We then estimated the effect of early screening on the primary outcome of days to do-not-resuscitate (DNR) code status or ICU discharge, with death without a DNR order placed at the 99th percentile of the days to DNR or ICU discharge distribution. Secondary outcomes included: DNR order, ICU and hospital lengths of stay, hospice discharge, and mortality metrics. To address unmeasured confounding, we used two-stage least-squares instrumental variables analysis. The instrument, which predicts early screening, comprised weekend versus weekday admission and number of patients meeting palliative care criteria on a patient's ICU Days 1 and 2. <b>Results:</b> Among 1,282 postimplementation admissions, 626 (45%) received early screening, and 398 (28%) received specialty palliative consultation. Early receipt of specialist palliative care was higher in patients who received early screening versus not (17% vs. 1%; <i>P</i> < 0.001), and overall use of specialty palliative care was higher after versus before screening implementation (28% vs. 15%; <i>P</i> < 0.001). In the postimplementation cohort, there were no statistically significant effects of early screening on the primary outcome of days to DNR or ICU discharge (15% relative increase; 95% confidence interval, -11% to +48%) or other secondary outcomes. <b>Conclusions:</b> Despite significantly increased specialty palliative care consultation, there was no evidence that early screening for palliative care criteria affected time to DNR/ICU discharge or other secondary outcomes.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"247-254"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514526","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":"Quality Improvement Initiatives for Pleural Infection Managed with Intrapleural Therapy.","authors":"Riham Elmahboubi, Catherine Robitaille, Céline Dupont, Julie Dallaire, Marie Létourneau, Christian Sirois, David Valenti, Anne V Gonzalez, Stéphane Beaudoin","doi":"10.1513/AnnalsATS.202402-223QI","DOIUrl":"10.1513/AnnalsATS.202402-223QI","url":null,"abstract":"<p><p><b>Rationale:</b> Pleural infection is associated with significant mortality, and its management is complex. Little attention has been given to care-process metrics such as management delays, pleural drainage practices, and adequacy of intrapleural therapy administration despite their potential impact on outcomes. Audits revealed gaps in those care processes in our institution. <b>Objectives:</b> To assess the impact of quality-improvement initiatives on pleural effusion management in adults. <b>Methods:</b> We performed a retrospective comparison of patients treated with intrapleural therapy for pleural infection at the McGill University Health Center before (April 2013 to April 2016; <i>N</i> = 109) and after interventions (June 2020 to June 2021; <i>N</i> = 44). Interventions included a pleural drainage policy and order set, an intrapleural therapy protocol and preprinted order, implementation of intrapleural therapy administration by nurses, local pleural infection guideline development, and an online learning module for physicians. Major outcomes (length of stay, mortality, surgical treatment) and care-process metrics (management delays, pleural drainage practices, intrapleural therapy administration) were compared between the two periods. <b>Results:</b> After implementation of the interventions, in-hospital mortality and length of stay were unchanged, but the incidence of surgical management went from 14% to 0% (<i>P</i> = 0.01). Delays in drain insertion and intrapleural therapy initiation were not significantly different. Insertion of drains smaller than 12 F decreased from 51% to 7% (<i>P</i> < 0.001). Drain blockage decreased from 20% to 2% (<i>P</i> = 0.004). The incidence of additional drain insertion went from 62% to 48% (<i>P</i> = 0.12). After interventions, 70% of intrapleural therapy doses were given by nurses, the intrapleural therapy protocol was more often adequately followed, fewer doses were missed, and less extended therapy was prescribed. Complications related to drain insertion and intrapleural therapy were similar between the two periods. <b>Conclusions:</b> After the implementation of multifaceted quality improvement interventions for pleural infection including the involvement of nurses in pleural drain flushing and intrapleural therapy, improvements were observed in intrapleural therapy administration, chest drainage practices, and need for surgery. However, length of stay, mortality, and management delays were unchanged.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"285-291"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585097","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}