Annals of the American Thoracic Society最新文献

{"title":"Association of Standardized Liberation Trials and Duration of Venovenous Extracorporeal Membrane Oxygenation in Patients with Acute Respiratory Failure.","authors":"Ricardo Teijeiro-Paradis, Laveena Munshi, Niall D Ferguson, Kuan Liu, Eddy Fan","doi":"10.1513/AnnalsATS.202412-1252OC","DOIUrl":"10.1513/AnnalsATS.202412-1252OC","url":null,"abstract":"<p><p><b>Rationale:</b> There is a paucity of evidence around strategies to liberate patients from venovenous (VV) extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. <b>Objectives:</b> The primary aim of this study was to determine if adopting standardized liberation trials (SLTs) for VV ECMO is associated with the duration of ECMO. The secondary aim was to identify factors associated with unsafe liberation and the effects of unsafe liberation on mortality to intensive care unit (ICU) discharge. <b>Methods:</b> This was a single-center retrospective cohort study of patients on VV ECMO for severe respiratory failure comparing endpoints between intervention (SLT) and control (no SLT) periods. <b>Results:</b> A total of 262 patients were included in the study, 13% (35 of 262) received SLTs, and 150 patients were decannulated from ECMO. Implementing SLTs was strongly associated with the duration of VV ECMO to first successful liberation trial (hazard ratio [HR], 1.88 [95% confidence interval (CI), 1.16 to 3.06]; <i>P</i> = 0.01) and decannulation (HR, 1.92 [95% CI, 1.0 to 3.06]; <i>P</i> = 0.01) without increasing the frequency of unsafe liberation (21% [5 of 23] with SLTs vs. 19% [24 of 127] without SLTs; odds ratio [OR], 1.19 [95% CI, -0.4 to 3.5]; <i>P</i> = 0.7). Unsafe liberation was strongly associated with ICU mortality (HR, 4.15 [95% CI, 1.24 to 13.9]; <i>P</i> = 0.02). Factors associated with unsafe liberation were respiratory rate (OR, 1.49 per 5 breaths/min increase [95% CI, 1.07 to 2.08]; <i>P</i> = 0.02) and ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (OR, 0.73 per 30 mm Hg increase [95% CI, 0.57 to 0.93]; <i>P</i> = 0.01) immediately before decannulation. <b>Conclusions:</b> Incorporating SLTs was significantly associated with the duration of VV ECMO, without increasing the frequency of unsafe liberation. Unsafe liberation was associated with increased ICU mortality.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"897-904"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560216","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":"Why Women Appear to Have Better Outcomes When Undergoing Screening for Lung Cancer.","authors":"Gerard A Silvestri, Ralph C Ward, Raewyn J Scott, Hormuzd Katki, Rebecca Landy, Robert P Young","doi":"10.1513/AnnalsATS.202408-863OC","DOIUrl":"10.1513/AnnalsATS.202408-863OC","url":null,"abstract":"<p><p><b>Rationale:</b> Randomized controlled trials (RCTs) of lung cancer (LC) screening (LCS) using computed tomography (CT) documented LC mortality reductions between 7.2% and 29.2%, compared with a chest radiograph (CXR). Women appear to have a greater reduction than men. <b>Objectives:</b> We sought to determine why women appear to have better outcomes from LCS compared with men. <b>Methods:</b> We used a secondary analysis of the National Lung Screening Trial, an RCT comparing CXR with CT among screen-eligible individuals ages 55-74 years. Descriptive statistics and a competing risk proportional hazards model that included an interaction between sex and screening arm were used to examine differences in screening outcomes by sex. <b>Results:</b> Of 31,530 men and 21,922 women, 648 (2.1%) and 373 (1.7%) died of LC during the study, respectively. Overall mortality was higher in men: 2,771 (8.8%) versus 1,198 (5.5%). In an adjusted competing cause of death analysis, the LC mortality subdistribution hazard ratio (sHR) favoring CT was significant in women (sHR = 0.74; 95% confidence interval [CI] = 0.6-0.9; <i>P</i> = 0.003) but not men (sHR = 0.91; 95% CI = 0.78-1.06; <i>P</i> = 0.24). The interaction between screening arm and sex was not significant (<i>P</i> = 0.1). Chronic obstructive pulmonary disease and heart disease, which are more prevalent in men, were independently associated with LC death. LC deaths were consistently greater in the CT arm (vs. the CXR arm), for preexisting COPD and diabetes mellitus in men, but not women. Of those with LC, women in the CT arm had 53.7% prevalence of adenocarcinoma (AD) histology, whereas women in the CXR arm and men in both arms had approximately 36-41% AD prevalence. However, there was no overall difference between sexes in the screening difference for AD lethality. <b>Conclusion:</b> Women in the National Lung Screening Trial had a greater reduction in LC mortality that, although not statistically significant, could be the result of more prevalent comorbid disease in men, which contributed to greater all-cause and LC mortality.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"925-933"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451282","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":"From Birth to Breathless: The Confluence of Early-Life Tobacco Exposure and Genetics in Idiopathic Pulmonary Fibrosis.","authors":"Kavitha C Selvan, Cathryn T Lee","doi":"10.1513/AnnalsATS.202503-361ED","DOIUrl":"10.1513/AnnalsATS.202503-361ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"826-827"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002047","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":"Adjustable Septal Buttons for the Management of Benign Acquired Tracheoesophageal Fistulas (with Video).","authors":"Alma V Burbano, Ernesto Casillas, Himmat Grewal, Adnan Majid","doi":"10.1513/AnnalsATS.202407-764CC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202407-764CC","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 6","pages":"934-937"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188632","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":"Cone-Beam Computed Tomography-guided, Robotic-assisted Bronchoscopy: A Novel Transcavitary Lung Biopsy Approach.","authors":"Joshua M Boster, S Michael Goertzen, Aristides J Armas Villalba, Roberto F Casal","doi":"10.1513/AnnalsATS.202411-1171CC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202411-1171CC","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 6","pages":"938-941"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188633","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 on Interventional Strategies for Children with Progressive Pulmonary Hypertension Despite Optimal Therapy.","authors":"Ryan D Coleman, Sarah P Cohen, Pirooz Eghtesady, R Mark Grady, David L S Morales, Don Hayes, Joseph K Ruminjo, W Graham Carlos","doi":"10.1513/AnnalsATS.202501-132AG","DOIUrl":"10.1513/AnnalsATS.202501-132AG","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"820-823"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736304","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":"Early-Life Exposure to Tobacco Smoke and the Risk of Idiopathic Pulmonary Fibrosis: A Population-Based Cohort Study.","authors":"Jiahao Zhu, Yifan Wang, Houpu Liu, Meng Wang, Jing Wang, Lilu Ding, Dan Zhou, Yingjun Li","doi":"10.1513/AnnalsATS.202409-906OC","DOIUrl":"10.1513/AnnalsATS.202409-906OC","url":null,"abstract":"<p><p><b>Rationale:</b> Tobacco smoking is a well-established risk factor for idiopathic pulmonary fibrosis (IPF), yet the influence of early-life tobacco exposure on future IPF risk remains poorly understood. <b>Objectives:</b> We sought to test the hypothesis that early-life tobacco exposure may elevate the risk of developing IPF, with this effect potentially modified by genetic susceptibility to IPF and mediated through accelerated biological aging. <b>Methods:</b> Using data from over 430,000 participants in the UK Biobank, we performed a prospective cohort study to examine the associations of maternal smoking around birth and age of smoking initiation with IPF risk. We evaluated the combined effects and interactions between early-life tobacco exposure and genetic susceptibility to IPF, which were quantified using polygenic risk scores. We assessed biological aging, as measured by telomere length and phenotypic age, as potential mediators in the associations between early-life tobacco exposure and IPF risk. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). <b>Results:</b> Maternal smoking around birth was associated with a higher risk of IPF (HR = 1.26; 95% CI = 1.11-1.43). Compared with never-smokers, individuals who initiated smoking in childhood (HR = 3.65; 95% CI = 3.02-4.41), adolescence (HR = 2.64; 95% CI = 2.28-3.05), and adulthood (HR = 2.09; 95% CI = 1.79-2.44) exhibited increased IPF risk (<i>P</i> for trend <0.001). An additive interaction was observed between age of smoking initiation and genetic risk for IPF. Individuals with high genetic risk, maternal smoking exposure, and childhood smoking initiation had a 16-fold greater risk of IPF (HR = 16.47; 95% CI = 9.57-28.32), compared with those with low genetic risk and no tobacco exposure. Telomere length and phenotypic age each mediated approximately 10% of the effect of maternal smoking on IPF, with weaker mediation effects observed for later ages of smoking initiation. <b>Conclusions:</b> Early-life tobacco exposure may elevate the risk of IPF, with effects modified by genetic susceptibility and partially mediated through accelerated biological aging.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"887-896"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070195","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":"Medication Nonadherence in Patients with Pulmonary Arterial Hypertension: The Pulmonary Hypertension Association Registry (PHAR).","authors":"Eric W Robbins, Kaitlin Bradley, David Badesch, Charles Burger, Amy M Chyboski, Teresa De Marco, Anna R Hemnes, Matthew Lammi, Stephen C Mathai, Lana Melendres-Groves, Farhan Raza, Jeffrey Sager, Oksana Shlobin, Thenappan Thenappan, Roham Zamanian, James Runo, Grayson L Baird, Corey E Ventetuolo","doi":"10.1513/AnnalsATS.202312-1083OC","DOIUrl":"10.1513/AnnalsATS.202312-1083OC","url":null,"abstract":"<p><p><b>Rationale:</b> Pulmonary arterial hypertension (PAH) is associated with significant morbidity and mortality. The extent of medication nonadherence in PAH is uncertain and may be linked to adverse outcomes. There has been a lack of multicenter, registry-based studies assessing medication nonadherence and patient-centered outcomes in PAH. <b>Objectives:</b> To determine the prevalence of self-reported nonadherence in Pulmonary Hypertension Association Registry (PHAR) participants with PAH or chronic thromboembolic pulmonary hypertension and the relationship of nonadherence with several patient-centered outcomes (mortality, hospitalization rates, emergency department visits, and health-related quality of life). <b>Methods:</b> Self-reported PAH medication nonadherence was captured at PHAR enrollment and during follow-up visits. Predictors of nonadherence were modeled using generalized estimating equations assuming a binary distribution. Outcomes associated with nonadherence were modeled using generalized estimating equations with a Poisson distribution. <b>Results:</b> A total of 1,543 patients were included, of whom 1,092 (70.8%) were female and 1,340 (86.8%) had PAH. The overall rate of any self-reported nonadherence was 6.1% (95% confidence interval [CI], 5.3-6.9). Predictors of nonadherence included self-reported male sex at birth (odds ratio [OR], 1.4; 95% CI, 1.0-1.9; <i>P</i> = 0.02), poverty (OR, 1.6; 95% CI, 1.2-2.3; <i>P</i> = 0.01), not being married or partnered (OR, 1.5; 95% CI, 1.1-1.9; <i>P</i> = 0.01), having Medicaid or no health insurance (OR, 2.1; 95% CI, 1.5-2.9; <i>P</i> < 0.001), and having completed high school but not having a college degree (OR, 1.7; 95% CI, 1.1-2.9; <i>P</i> < 0.001). PHAR participants who reported any nonadherence had 50.0% more emergency department visits (<i>P</i> < 0.001), 13.3% more hospital admissions (<i>P</i> = 0.03), and 61.9% more days hospitalized (<i>P</i> = 0.01). No relationship was observed between nonadherence and the type or number of PAH therapies or all-cause mortality. Participants reporting nonadherence had worse mean Short Form-12 scores (<i>P</i> < 0.001) and worse emPHasis-10 scores (<i>P</i> = 0.02). <b>Conclusions:</b> The rate of self-reported nonadherence in PHAR registrants was low but was associated with male sex and several social determinants of health. Although the complexity or type of PAH regimen did not appear to influence nonadherence, nonadherence was associated with numerous adverse patient-centered outcomes, including greater healthcare use and worse health-related quality of life. Because of limitations in the structure of the gathered data, relationships between exposure and outcomes were not temporally definitive; these observations warrant additional prospective studies.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"830-837"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451277","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":"Site of Collapse during Drug-induced Sleep Endoscopy Is Associated with Polysomnographic Endotypic Traits.","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":"https://doi.org/10.1513/AnnalsATS.202408-871OC","url":null,"abstract":"<p><strong>Rationale: </strong>Both the site of upper airway collapse during drug-induced sleep endoscopy (DISE) and pathophysiological endotypic traits are associated with non-CPAP treatment outcomes for obstructive sleep apnea (OSA). Reduced hypoglossal nerve stimulation (HGNS) 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. Currently, the relationship between the site of upper airway collapse (structure) and pathophysiological endotypic traits (function) remains unknown.</p><p><strong>Methods: </strong>This retrospective cohort study examined 182 patients (median[95%CI], apnea-hypopnea index (AHI): 24.2[17.6,32.8], body-mass index (BMI): 27.8[25.2,30.5], age: 51.3[40.4,58.8]) who underwent in-laboratory polysomnography and DISE. All DISE studies were scored by one researcher, thereby avoiding inter-rater variability. Endotypic traits (loop gain, collapsibility, arousal threshold, and compensation) were estimated using routine polysomnography (Sands et al. AJRCCM 2018). Linear regression quantified differences in traits between DISE categories. Multivariable logistic regression quantified associations between DISE categories (dependent variable, with versus without a certain collapse type) and individual traits. Analyses were mutually adjusted for other endotypic traits.</p><p><strong>Results: </strong>CCCp was independently associated with greater collapsibility (Δ collapsibility = 9.8[4.6,15.0]%, p<0.001with vs. without CCCp, odds ratio = 6.9[95%CI:2.2,22.1] per 2SD 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 2SD [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]%, p=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 AHI and BMI, except for collapsibility and tongue base collapse. Loop gain was not associated with any site of collapse.</p><p><strong>Conclusions: </strong>Different sites of upper airway collapse manifest distinctly different pathophysiological traits in OSA patients. The greater collapsibility and lower arousal threshold seen with CCCp and reduced compensation with lateral wall collapse may help explain reduced non-CPAP treatment efficacy in these populations.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176357","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":"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":"https://doi.org/10.1513/AnnalsATS.202412-1245OC","url":null,"abstract":"<p><strong>Rationale: </strong>Chronic critical illness (CCI) results in high patient morbidity and mortality and imposes substantial burdens on families as surrogate decision-makers. Prior research has predominantly focused on families' decisional needs before tracheostomy in the ICU, despite CCI unfolding over weeks to months across multiple care transitions and settings.</p><p><strong>Objective: </strong>To characterize families' decision-making experiences and reflections along the continuum of CCI, across time and care transitions.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with family decision-makers of patients who received a tracheostomy for persistent respiratory failure after an acute illness, first within two weeks to six months after tracheostomy and again weeks to months later. We analyzed data using inductive and deductive analysis methods.</p><p><strong>Results: </strong>We interviewed 23 family decision-makers of 19 patients and identified five themes. 1) 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; 2) 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; 3) After tracheostomy, families accepted ongoing interventions to reach a post-acute facility, which represented hope for recovery; 4) After transitioning to a post-acute facility, families faced uncertainty about recovery expectations and made ongoing decisions focused on overcoming setbacks amidst the rollercoaster of CCI; 5) 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.</p><p><strong>Conclusions: </strong>We found critical problems in communication and support throughout the continuum of CCI. While 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 ICU-based '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. Word Count: 343/350 Primary Source of Funding: T32 HL 007563 (ACM).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176329","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}