CHEST pulmonary最新文献

{"title":"Hemodynamic Risk Assessment by Thermodilution and Direct Fick Measurement of Cardiac Output in Pulmonary Hypertension","authors":"Adam J. Brownstein MD,&nbsp;Christopher B. Cooper MD, MS, PhD,&nbsp;Sonia Jasuja MD,&nbsp;Alexander E. Sherman MD,&nbsp;Rajan Saggar MD,&nbsp;Richard N. Channick MD","doi":"10.1016/j.chpulm.2024.100059","DOIUrl":"10.1016/j.chpulm.2024.100059","url":null,"abstract":"<div><h3>Background</h3><p>Accurate measurement of cardiac output (CO) is critical in the evaluation and monitoring of pulmonary hypertension (PH). We assessed the accuracy of thermodilution (TD) CO vs direct Fick (DF) CO among patients with PH and evaluated whether the method of CO measurement affected diagnosis or risk assessment.</p></div><div><h3>Research Question</h3><p>Does using Thermodilution CO as compared to Direct Fick CO alter hemodynamic risk status in PH?</p></div><div><h3>Study Design and Methods</h3><p>We included patients who had undergone a right heart catheterization with both TD CO and DF CO measurements at University of California, Los Angeles between January 2021 and January 2023. Based on the cardiac index, patients were classified into low-, intermediate-, or high-risk hemodynamic status according to the European Society of Cardiology/European Respiratory Society guidelines.</p></div><div><h3>Results</h3><p>The analysis included 116 patients with PH. Of the patients, 55% were on PH therapy at the time of catheterization. The median age was 59 years (25th-75th percentile, 50-69), and 63% were female. The median TD CO and DF CO were 4.6 L/min (25th-75th percentile, 3.6-6.0) and 5.3 L/min (25th-75th percentile, 4.2-7.0) (<em>P</em> = .007), respectively. Bland-Altman analysis revealed a mean bias of −0.64 L/min. Median DF pulmonary vascular resistance and TD pulmonary vascular resistance were 4.7 Wood units (25th-75th percentile, 2.7-6.6) and 5.6 Wood units (25th-75th percentile, 3.0-8.0), respectively. Among patients with a low TD cardiac index, almost 40% had a preserved DF cardiac index. There was 78% agreement between DF and TD hemodynamic risk status. Using TD over DF reclassified 8% of patients with precapillary PH (n = 101) from low-risk into intermediate- or high-risk hemodynamic status. TD had a sensitivity of 97% for appropriately risk stratifying patients into intermediate-/high-risk status but a specificity of 73%. Overall, there was a strong correlation between DF CO and TD CO (concordance correlation coefficient, 0.81; 25th-75th percentile, 0.74-0.86).</p></div><div><h3>Interpretation</h3><p>Hemodynamic risk status was concordant between TD and DF measurements in almost 80% of patients. Oxygen consumption measurement should be considered if available on index right heart catheterization in patients with PH to aid in hemodynamic risk stratification or in whom strict pulmonary vascular resistance calculations are required.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100059"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000254/pdfft?md5=7c84115efd909aac43ded18806113adf&pid=1-s2.0-S2949789224000254-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142172539","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":"Annual Adherence of Asian American Individuals in a Lung Cancer Screening Program Compared With Other Racial Groups","authors":"","doi":"10.1016/j.chpulm.2024.100051","DOIUrl":"10.1016/j.chpulm.2024.100051","url":null,"abstract":"<div><h3>Background</h3><p>Racial differences in lung cancer screening (LCS) eligibility and outcomes persist despite recent expansion of the US Preventive Services Task Force criteria and greater recognition of screening disparities.</p></div><div><h3>Research Question</h3><p>What is the annual screening adherence rate for US Preventive Services Task Force-eligible Asian American individuals receiving LCS through a centralized screening program?</p></div><div><h3>Study Design and Methods</h3><p>Individuals screened through a centralized LCS program were identified retrospectively using the Jefferson LCS Program Registry. Sociodemographic and clinical data were extracted from the prospectively maintained registry. Frequency statistics were compared by race including among Asian American subgroups, and multivariate logistic regression was carried out for annual adherence with LCS.</p></div><div><h3>Results</h3><p>Among 2,257 individuals in the study cohort, 122 participants (5.4%) self-identified their race as Asian American. Compared with other racial groups, Asian American individuals had significant differences in sex distribution, educational attainment, and insurance status. The most common Asian American race subgroups were Chinese American, Korean American, and Vietnamese American, and significant differences in cigarette smoking intensity were seen between these groups. Among currently smoking individuals, Asian American individuals reported interest in tobacco counseling and pharmacotherapy treatment at rates similar to those of other races. Asian American individuals had significantly lower odds of adherence (adjusted OR, 0.42; 95% CI, 0.26-0.69) with annual screening than other races, even after adjustment for age, sex, educational attainment, smoking status, and COPD.</p></div><div><h3>Interpretation</h3><p>Asian American individuals in our centralized LCS program have increased rates of lung cancer-related factors including low educational attainment, high smoking prevalence, low tobacco cessation, and low annual LCS adherence compared with other racial groups. This gap highlights the need for greater focus on culturally tailored early detection strategies for this underserved population.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100051"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000175/pdfft?md5=916692871b03fbf85f4c203e3deb0e29&pid=1-s2.0-S2949789224000175-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400628","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":"Strategies for the Management of a Pulmonary Function Laboratory","authors":"","doi":"10.1016/j.chpulm.2024.100055","DOIUrl":"10.1016/j.chpulm.2024.100055","url":null,"abstract":"<div><p>Pulmonary function tests (PFTs) are imperative to the diagnosis of people with respiratory symptoms and lung disease and to disease management. PFTs require expertise to obtain both high-quality tests and proficiency in test interpretation. In this review, we provide recommendations for obtaining high-quality test results in an efficient and cost-effective manner guided by available evidence and expert opinion. The medical director plays a critical role in pulmonary laboratory operations and ultimately is responsible for laboratory performance. Responsibilities of the medical director are reviewed and discussed. Quality control is an underappreciated part of the pulmonary laboratory that is that is necessary high-quality tests. What constitutes a complete PFT and the order that tests are performed may differ among laboratories. We suggest an approach to the performance of spirometry, bronchodilator-responsiveness testing, diffusing capacity, lung volumes, and tests of respiratory muscle strength that maximizes clinical usefulness and laboratory efficiency. Appropriate resources, time, and expertise are needed to run an efficient pulmonary function laboratory capable of performing high-quality testing.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100055"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000217/pdfft?md5=4f7005f26a875152a5911e191747e632&pid=1-s2.0-S2949789224000217-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140763880","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":"COUNTERPOINT: Liquid Markers for Risk Stratification of Pulmonary Nodules, Ready for Prime Time? Not Yet!","authors":"","doi":"10.1016/j.chpulm.2024.100070","DOIUrl":"10.1016/j.chpulm.2024.100070","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100070"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000369/pdfft?md5=f9b4708ae7e114b87decd25609fd33b7&pid=1-s2.0-S2949789224000369-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141390519","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 Qualitative Study Identifying the Potential Risk Mechanisms Leading to Hospitalization for Patients With Chronic Lung Disease","authors":"","doi":"10.1016/j.chpulm.2024.100060","DOIUrl":"10.1016/j.chpulm.2024.100060","url":null,"abstract":"<div><h3>Background</h3><p>Care management programs for chronic lung disease attempt to reduce hospitalizations, yet have not reliably achieved this goal. A key limitation of many programs is that they target patients with characteristics associated with hospitalization risk, but do not specifically modify the mechanisms that lead to hospitalization.</p></div><div><h3>Research Question</h3><p>What are the common mechanisms underlying known patient-level risk characteristics leading to hospitalizations for acute exacerbations of chronic lung disease?</p></div><div><h3>Study Design and Methods</h3><p>We conducted a qualitative study of patients admitted to the University of Pennsylvania Health System with acute exacerbations of chronic lung disease between January and September 2019. We interviewed patients, their family caregivers, and their inpatient and outpatient clinicians about experiences leading up to the hospitalization. We analyzed the interview transcripts using triangulation and abductive analytic methods.</p></div><div><h3>Results</h3><p>We conducted 69 interviews focused on the admission of 22 patients with a median age of 66 years (interquartile range, 60-70 years), of whom 16 patients (73%) were female and 14 patients (64%) were Black. We interviewed 22 patients, 14 caregivers, 19 inpatient clinicians, and 14 outpatient clinicians. We triangulated the available interview data for each patient admission and identified the underlying mechanisms of how several known patient characteristics associated with risk actually led to hospitalization. These mechanisms included limited capacity for home management of acute symptom changes, barriers to accessing care, chronic functional limitations, and comorbid behavioral health disorders. Importantly, many of the clinical, social, and behavioral mechanisms underlying hospitalizations were present for months or years before the symptoms that prompted inpatient care.</p></div><div><h3>Interpretation</h3><p>Care management programs should be built to target specific clinical, social, and behavioral mechanisms that directly lead to hospitalization. Upstream interventions that reduce hospitalization risk are possible given that many contributory mechanisms are present for months or years before the onset of acute exacerbations.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100060"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000266/pdfft?md5=9aaaa951c79ee63460936c5365e555be&pid=1-s2.0-S2949789224000266-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141026018","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":"Adapting the Tools of Our Trade","authors":"","doi":"10.1016/j.chpulm.2024.100048","DOIUrl":"10.1016/j.chpulm.2024.100048","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100048"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294978922400014X/pdfft?md5=1cc8501f0999a6eb9d2d64ca327addbb&pid=1-s2.0-S294978922400014X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140277756","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":"Tackling Comprehensive Asthma Education for Providers One Breath at a Time","authors":"","doi":"10.1016/j.chpulm.2024.100061","DOIUrl":"10.1016/j.chpulm.2024.100061","url":null,"abstract":"<div><h3>Background</h3><p>Exponential growth of knowledge in asthma has advanced the diagnosis and treatment of personalized, phenotype- and endotype-driven care in asthma leading to improved clinical outcomes. However, many knowledge and practice gaps persist among health care professionals. Microlearning has demonstrated efficacy in educational outcomes but is often limited by fragmentation and incomplete information. To integrate the benefits of microlearning into a comprehensive asthma curriculum that addresses knowledge gaps in this rapidly growing field, we built an extensive curriculum in bite-sized, “one breath at a time” portions for physicians managing asthma.</p></div><div><h3>Research question</h3><p>Is creating an asthma curriculum online educational program with modules of microlearning feasible and useful in improving knowledge of clinicians?</p></div><div><h3>Study Design and Methods</h3><p>The CHEST Curriculum Pathway for Asthma was published online on the American College of Chest Physicians (CHEST) learning management site in September 2022. It was derived from existing asthma education at the CHEST organization and was vetted by asthma experts. Pretests and posttests, satisfaction surveys, and user engagement data were collected.</p></div><div><h3>Results</h3><p>In the first 6 months, 523 participants engaged with the CHEST Curriculum Pathway for Asthma. Participant satisfaction was high, and participants answered 68% of the knowledge pretest correctly and 82% of the posttest correctly. Participants completed 82.8% of the individual videos that they opened. Completion rates for each asthma chapter ranged from 22.6% to 57.9%.</p></div><div><h3>Interpretation</h3><p>This educational program is, to our knowledge, the first comprehensive microlearning online curriculum issued by a medical association on asthma. Our results suggest that the CHEST Curriculum Pathway for Asthma was effective in improving knowledge and had high user satisfaction. Comprehensive online educational programs broken into microlearning components may be useful in other topics in pulmonary medicine.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100061"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000278/pdfft?md5=36d1504b247ffeaf3e7dae6225b345e4&pid=1-s2.0-S2949789224000278-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141035240","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":"Dynamic Digital Radiography Pulmonary Function Testing","authors":"","doi":"10.1016/j.chpulm.2024.100052","DOIUrl":"10.1016/j.chpulm.2024.100052","url":null,"abstract":"<div><h3>Background</h3><p>Common diagnostic tests for pulmonary disorders include chest radiography and pulmonary function tests (PFTs). Although essential, these tests only offer a static assessment. Chest dynamic digital radiography (DDR) integrates lung and diaphragm motion in one study with limited radiation exposure. DDR is relatively easy to obtain, but barriers to its clinical adoption include time-consuming manual analysis and unclear correlation with PFTs.</p></div><div><h3>Research Question</h3><p>Can a machine learning pipeline automate DDR analysis? What is the strength of the relationship between PFT measures and automated DDR-based lung area measurements?</p></div><div><h3>Study Design and Methods</h3><p>PFT and DDR studies were obtained in 55 participants. We developed an analysis pipeline using convolutional neural networks capable of quantifying lung areas in DDR images to generate DDR-based PFTs (dPFTs). PFT and dPFT measures were correlated in patients with normal, obstructive, and restrictive lung physiology.</p></div><div><h3>Results</h3><p>We observed statistically significant (<em>P</em> &lt; 1 × 10^-6), strong correlations between dPFT areas and PFT volumes, including total lung capacity (<em>r</em> = 0.764), FEV₁ (<em>r</em> = 0.591), vital capacity (<em>r</em> = 0.763), and functional residual capacity (<em>r</em> = 0.756). Automated DDR and lung shape tracking revealed differences between normal, restrictive, and obstructive physiology using diaphragm curvature indices and strain analysis measurements. Linear regressions allowed for derivation of PFT values from dPFT measurements.</p></div><div><h3>Interpretation</h3><p>Statistically significant correlations found between dPFTs and PFTs suggest that dPFTs can act as a surrogate to PFTs when these are not available or unable to be performed. This study contributes to the potential integration of DDR as a reliable alternative to PFTs.</p></div>","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100052"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000187/pdfft?md5=9d2d97c098696dc1a1baf8a3c6ae782b&pid=1-s2.0-S2949789224000187-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400217","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":"POINT: Liquid Markers for Risk Stratification of Pulmonary Nodules, Ready for Prime Time? Yes!","authors":"","doi":"10.1016/j.chpulm.2024.100071","DOIUrl":"10.1016/j.chpulm.2024.100071","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100071"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000370/pdfft?md5=95f5260546ce40846f6351f049ffdf87&pid=1-s2.0-S2949789224000370-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141389423","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":"Critical Analysis of Hemodynamic Risk Assessment","authors":"Arif Albulushi MD ,&nbsp;Rawan Al Bulushi MD","doi":"10.1016/j.chpulm.2024.100085","DOIUrl":"10.1016/j.chpulm.2024.100085","url":null,"abstract":"","PeriodicalId":94286,"journal":{"name":"CHEST pulmonary","volume":"2 3","pages":"Article 100085"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949789224000515/pdfft?md5=56201a859709ccd1a4728451fda60728&pid=1-s2.0-S2949789224000515-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696462","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}