Annals of the American Thoracic Society最新文献

{"title":"Eliciting Patient Preferences for Pragmatic Critical Care Trials: A Qualitative Study.","authors":"Jessica A Palakshappa, Megan L Rischall, Ashley E Strahley, Alexa E Cecil, Matthew E Prekker, Brian E Driver, Brianna H Denny, Kevin W Gibbs","doi":"10.1513/AnnalsATS.202410-1122OC","DOIUrl":"10.1513/AnnalsATS.202410-1122OC","url":null,"abstract":"<p><p><b>Rationale:</b> Conducting pragmatic comparative effectiveness trials in critically ill populations poses distinct challenges. Knowledge gaps exist in how to best conduct pragmatic research while demonstrating respect for critically ill patients and their families. <b>Objectives:</b> To engage patients with lived critical care experience to elicit their perspectives on <i>1</i>) decisions related to the design and conduct of pragmatic comparative effectiveness trials in acute and critical care settings and <i>2</i>) subsequent notification of pragmatic trial participation. <b>Methods:</b> We conducted a qualitative research study using the principles of reflexive thematic analysis. An interview guide was developed by investigators with expertise in qualitative methodology, critical care, emergency medicine, and pragmatic comparative effectiveness trials; this guide used two research study examples to elicit feedback from participants. Using a purposive sampling technique to ensure the inclusion of diverse perspectives, we recruited a convenience sample of patients from two hospitals during a hospitalization for a critical illness or injury. Interviews with participants were conducted via telephone after discharge, audio recorded, and transcribed verbatim. A codebook was developed inductively, and coding was performed in duplicate. Emerging themes were reviewed and validated with the larger research team. <b>Results:</b> A total of 20 interviews were completed, and saturation was achieved. Findings were organized into four themes: <i>1</i>) trust and past care experiences influence patient receptivity to pragmatic comparative effectiveness research, <i>2</i>) familiarity with research influences patient comfort and willingness to participate, <i>3</i>) altruism and a desire to contribute to research knowledge motivate patient participation in research, and <i>4</i>) the experience of critical illness influences patient receptivity to the research process. <b>Conclusions:</b> Patients with a lived experience of critical illness are generally supportive of pragmatic comparativeness effectiveness trials in the emergency or critical care setting. The factors influencing patient receptivity identified in this study highlight opportunities for investigators, healthcare leaders, and regulators to better align with patients in the future design and conduct of pragmatic comparative effectiveness trials.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1027-1034"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627239","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":"The Rare Use of Respiratory Protective Equipment by Workers on Prominent Home Improvement Programs.","authors":"Andrew H Stephen, Debasree Banerjee","doi":"10.1513/AnnalsATS.202412-1257VP","DOIUrl":"10.1513/AnnalsATS.202412-1257VP","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"973-974"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143813097","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":"Echocardiographic Measure of Right Ventricular-Pulmonary Arterial Coupling Predicts Survival in Lung Cancer.","authors":"Zvonimir A Rako, Michael Cekay, Athiththan Yogeswaran, Selin Yildiz, Philipp F Arndt, Nils Kremer, Simon Schäfer, Patrick Janetzko, Bruno R Thal, Chris M Mummert, Johanna K Franken, Henrik Soethe, Hannah F Werner, Rio Dumitrascu, Friedrich Grimminger, Hossein A Ghofrani, Soni S Pullamsetti, Werner Seeger, Robert Naeije, Rajkumar Savai, Bastian Eul, Khodr Tello","doi":"10.1513/AnnalsATS.202409-949OC","DOIUrl":"10.1513/AnnalsATS.202409-949OC","url":null,"abstract":"<p><p><b>Rationale:</b> Echocardiographic indicators of pulmonary hypertension have been reported to predict decreased survival in patients with lung cancer. <b>Objectives:</b> We tested the hypothesis that this may be associated with impaired right ventricular (RV)-systolic pulmonary arterial pressure (sPAP) coupling. <b>Methods:</b> This prospective observational study included 220 outpatients with non-small cell lung cancer examined using Doppler, strain, and three-dimensional echocardiography before starting therapy. Of the included patients, 41% were women, and the median age was 68 years (interquartile range, 61-74 yr). Prediction of one-year overall survival was assessed using univariable analysis followed by multivariate Cox regression, receiver operating characteristic curves and Kaplan-Meier analyses. <b>Results:</b> Median sPAP was within the limits of normal (31 mm Hg [interquartile range, 26-36 mm Hg]); 30% of the patients had sPAP ≥ 35 mm Hg. In univariable analysis, one-year overall survival was associated with RV systolic function and probability of pulmonary hypertension. In multivariate Cox regression, only RV global longitudinal strain (GLS):sPAP ratio (hazard ratio [HR], 8.76 [95% confidence interval (CI), 1.24-61.82]; <i>P</i> = 0.03), forced expiratory volume in 1 second (HR, 0.98 [95% CI, 0.96-1.00]; <i>P</i> = 0.03) and Eastern Cooperative Oncology Group performance status <2 (HR, 0.34 [95% CI, 0.17-0.68]; <i>P</i> = 0.003) independently predicted survival. The optimal receiver operating characteristic curve-derived RV GLS:sPAP cutoff to predict survival was -0.54%/mm Hg. Among patients in Union for International Cancer Control (UICC) stage 4, those with impaired RV-arterial coupling (RV GLS:sPAP > -0.54%/mm Hg) had worse survival than those with maintained RV-arterial coupling (HR, 2.89 [95% CI, 1.55-5.42]; <i>P</i> < 0.001); the latter subgroup had similar survival compared with patients in UICC stage 3 (HR, 0.65 [95% CI, 0.35-1.20]; <i>P</i> = 0.17). <b>Conclusions:</b> RV GLS:sPAP ratio as an echocardiographic measure of RV-arterial coupling adds to prognostication by UICC status in non-small cell lung cancer. Clinical trial registered with www.clinicaltrials.gov (NCT04467333).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1071-1078"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560277","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":"Comparison of High-Flow Nasal Cannula and Conventional Oxygen Therapy for High Risk Patients During Bronchoscopy Examination: A Multicenter Randomized Controlled Trial.","authors":"Hao Qin, Jie Li, Jun Wang, Yu-Guang Yang, Guo-Qiang Jing, Rong-Zhang Chen, Wei Tan, Yong-Qi Zhang, Tian Li, Jun-Ci Yang, Bing Dai, Qin Wang, Yang Jiao, Yang Xia, Hai-Dong Huang, Qiang Li, Yu-Chao Dong, Chong Bai, Wei Zhang","doi":"10.1513/AnnalsATS.202410-1109OC","DOIUrl":"10.1513/AnnalsATS.202410-1109OC","url":null,"abstract":"<p><p><b>Rationale:</b> Despite the increasing use of high-flow nasal cannula (HFNC) oxygen therapy during endoscopy examination, its impact on high-risk patients remains uncertain. <b>Objectives:</b> We aimed to compare HFNC and conventional oxygen therapy (COT) during nasal bronchoscopy in patients at high risk for desaturation (morbid obesity, narrow trachea, or baseline hypoxemia and/or hypercapnia). <b>Methods:</b> In this multicenter randomized controlled trial, patients scheduled for bronchoscopy and presenting with any high-risk factors were randomly assigned to receive HFNC or COT after providing written consent. Vital signs, pulse oximetry (Sp_O₂), and transcutaneous carbon dioxide were continuously monitored. The occurrence of desaturation (Sp_O₂ ⩽ 90% lasted >10 s), frequency of examination interruption, and treatment escalation were compared between groups. <b>Results:</b> Of 148 initially enrolled patients, 6 withdrew, leaving 72 and 70 in the HFNC and COT groups, respectively. Most of the patients had airway stenosis. HFNC significantly reduced desaturation occurrence during bronchoscopy (34.7% vs. 61.4%; <i>P</i> = 0.016), with fewer instances of examination interruption (26.4% vs. 58.6%; <i>P</i> < 0.001) and less frequent treatment escalation (30.6% vs. 57.1%; <i>P</i> = 0.001). During the examination, the lowest Sp_O₂ was higher with HFNC (94% [interquartile range, 87-98%] vs. 87.5% [79-93%]; <i>P</i> = 0.001), whereas the highest transcutaneous carbon dioxide was lower (64.6 [56.8-70.1] vs. 68.3 [62.3-77.0] mm Hg; <i>P</i> = 0.04). No significant differences were observed regarding the time to the first desaturation, bronchoscopy withdrawal, durations of desaturation and bronchoscopy examination, or occurrence of other adverse events between groups. <b>Conclusions:</b> In a high-risk population with predominant airway stenosis, HFNC significantly reduced desaturation occurrence, examination interruption, and treatment escalation during nasal bronchoscopy examination in high risk patients. Clinical trial registered with www.chictr.org.cn (ChiCTR2100055038).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1018-1026"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665684","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":"When Good Intentions Meet Predictive Uncertainty: Prognostication in the ICU.","authors":"Sara Booth, Jennifer P Stevens","doi":"10.1513/AnnalsATS.202506-622ED","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202506-622ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546475","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":"Navigating beyond an Occluded Airway.","authors":"Mae Leef, Nikolina Madjer, Danielle Gratza, Christopher G Bentsen, Abdul Hamid Alraiyes","doi":"10.1513/AnnalsATS.202410-1078CC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202410-1078CC","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 7","pages":"1084-1087"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546478","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":"Imaging, Pulmonary Function, and Histopathologic Findings of Persistent Fibrosis in a Longitudinal Cohort 3-Years after COVID-19.","authors":"Scarlett O Murphy, Claire F McGroder, Mary M Salvatore, Belinda M D'Souza, Kathleen M Capaccione, Anjali Saqi, Faisal Shaikh, Shannon Benesh, David Zhang, Matthew R Baldwin, Christine Kim Garcia","doi":"10.1513/AnnalsATS.202501-049OC","DOIUrl":"10.1513/AnnalsATS.202501-049OC","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Survivors of severe COVID-19 frequently have persistent radiologic abnormalities beyond one year. Scant data exists for long-term outcomes of COVID-19.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To characterize a longitudinal multiethnic cohort of COVID-19 survivors 3-years after infection, to identify clinical factors associated with post-COVID-19 fibrotic-like abnormalities, to describe changes in radiologic abnormalities at 4-months, 15-months, and 3-years, and to describe histopathological features of lung parenchyma from participants with fibrotic-like abnormalities at 3-years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;102 survivors of severe or critical COVID-19 (50% mechanically ventilated, all required oxygen supplementation) from a single-center, prospective, longitudinal, multi-ethnic cohort completed inspiratory and expiratory high resolution chest imaging, pulmonary function testing, and physical performance testing 3-years after hospitalization. Over 70% participated in earlier follow-up visits at 4-months and/or 15-months. Factors associated with persistent fibrotic-like abnormalities were examined using multivariable logistic regression with covariate balanced propensity scores to estimate adjusted associations. For subjects with more than one imaging study, changes in ground glass opacities, reticulations, and traction bronchiectasis were semi-quantitatively analyzed and qualitatively assessed. Five participants with post-COVID-19 fibrosis scores in the top quartile underwent transbronchial biopsy for histopathologic analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fibrotic-like abnormalities, including reticulations and traction bronchiectasis, were present in 61% of survivors of severe or critical COVID-19. In adjusted analyses, fibrotic-like abnormalities were positively associated with male sex, lower BMI, shorter leukocyte telomere length, increased severity of illness, and mechanical ventilation, and negatively associated with Black race. Participants with fibrotic-like abnormalities were more likely to have reduced diffusion capacity and reduced 6-minute walk distance. Reticulations, as assessed by semi-quantitative analysis, modestly improved across all time points, even between 15-months and 3-years. Qualitatively, most participants had stable fibrotic-like abnormalities across all time points with 9% improving from 15-months to 3-years and none worsening. Lung parenchyma from transbronchial biopsies of five individuals with elevated fibrotic scores showed small airways histopathology, consistent with air trapping during expiration, and infrequent interstitial thickening and fibrosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Despite modest improvements in radiologic fibrotic-like abnormalities 3-years after hospitalization, their continued presence and their association with reduced diffusion capacity and reduced walk distance highlight the long-term consequences of severe COVID-19, which may require further monitoring. ","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546472","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":"First Steps Toward Implementing Primary Care Obstructive Sleep Apnea Management in Rural West Virginia.","authors":"Aristotle G Leonhard, Lucas M Donovan","doi":"10.1513/AnnalsATS.202505-496ED","DOIUrl":"10.1513/AnnalsATS.202505-496ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 7","pages":"982-983"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546477","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 Pilot Clinical Trial to Assess the Effect of Intermittent Inhaled Nitric Oxide as Treatment of Nontuberculous Mycobacteria Lung Infection.","authors":"Rachel M Thomson, Andrew J Burke, Lucy C Morgan, Andrew A Colin","doi":"10.1513/AnnalsATS.202407-745RL","DOIUrl":"10.1513/AnnalsATS.202407-745RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1092-1097"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804785","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 Biomarker Testing in Advanced Non-Small Cell Lung Cancer: A Retrospective Analysis.","authors":"Brittany Duong, Ahmed Al-Ani, Lan Vu, Efstathia Polychronopoulou, Gisele Lombard, Roman Petrov, Yong-Fang Kuo, Shawn P E Nishi","doi":"10.1513/AnnalsATS.202410-1029RL","DOIUrl":"10.1513/AnnalsATS.202410-1029RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1088-1091"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058157","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}