Chest最新文献

{"title":"Changes in Lung Function and Mortality Risk in Patients With Idiopathic Pulmonary Fibrosis.","authors":"Justin M Oldham, Megan L Neely, Daniel M Wojdyla, Mridu Gulati, Peide Li, Divya C Patel, Scott M Palmer, Jamie L Todd","doi":"10.1016/j.chest.2025.02.018","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.018","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease associated with lung function decline and high mortality.</p><p><strong>Research question: </strong>What are the associations between thresholds of lung function decline and the risk of mortality in patients with IPF?</p><p><strong>Study design and methods: </strong>The Idiopathic Pulmonary Fibrosis-Prospective Outcomes Registry enrolled patients with IPF that was diagnosed or confirmed at the enrolling center within the prior 6 months. Associations between time to first decline in FVC or diffusing capacity of the lungs for carbon monoxide (Dlco) of ≥ 2% predicted, ≥ 5% predicted, and ≥ 10% predicted (and ≥ 15% predicted for Dlco) and risk of subsequent death or lung transplant was assessed using Cox proportional hazards models with a time-dependent covariate. Models were unadjusted or adjusted for FVC and Dlco % predicted, age, sex, smoking status, BMI, antifibrotic treatment (yes or no), and oxygen use at enrollment.</p><p><strong>Results: </strong>Among 1,001 patients, median follow-up time was 38.4 months. Significant associations were observed between all thresholds of decline in FVC and Dlco % predicted and the risk of death or lung transplant in unadjusted and adjusted analyses. In adjusted analyses, absolute declines in FVC of ≥ 2% predicted, ≥ 5% predicted, and ≥ 10% predicted were associated with 1.8-fold, 2.3-fold, and 2.7-fold increases in the risk of subsequent death or lung transplant, whereas absolute declines in Dlco of ≥ 2% predicted, ≥ 5% predicted, ≥ 10% predicted, and ≥ 15% predicted were associated with 2.0-fold, 1.4-fold, 1.5-fold, and 1.9-fold increases in the risk of subsequent death or lung transplantation, respectively. For Dlco, but not FVC, the increase in risk generally was greater for patients meeting a threshold based on a relative rather than an absolute decline.</p><p><strong>Interpretation: </strong>Even small declines in FVC and Dlco % predicted inform prognosis in patients with IPF.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristic Pulmonary Impedance With Exercise Detects Abnormal Pulmonary Vascular Response and Uncoupling in Pulmonary Hypertension Resulting From Heart Failure With Preserved Ejection Fraction.","authors":"Christopher G Lechuga, Farhan Raza, Mitchel J Colebank, Claudia E Korcarz, Aimee T Broman, Jens C Eickhoff, Naomi C Chesler","doi":"10.1016/j.chest.2025.02.019","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.019","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hypertension (PH) resulting from heart failure with preserved ejection fraction (PH-HFpEF) can lead to right ventricular-pulmonary arterial (RV-PA) uncoupling despite normal steady hemodynamics (eg, pulmonary vascular resistance). Unsteady hemodynamics, quantified by characteristic pulmonary impedance (Z_C), may be useful in differentiating those patients with PH-HFpEF who have sufficient coupling from those who have insufficient coupling. We hypothesized that abnormal pulsatile hemodynamics with exercise, quantified by Z_C, precisely detect abnormal cardiopulmonary function in PH-HFpEF.</p><p><strong>Research question: </strong>Can Z_C with exercise detect abnormal pulmonary vascular response and RV-PA uncoupling in PH-HFpEF?</p><p><strong>Study design and methods: </strong>Our approach was pilot tested in a small cohort of patients with PH-HFpEF (n = 8), precapillary PH (n = 5), and no PH (n = 2) who underwent rest-exercise (every 25 W)-recovery testing with repeated measurements of characteristic impedance (Z_C, from invasive cardiopulmonary exercise and echocardiography for pulmonary vascular pressure flow) and coupling (end systolic elastance [E_es] to effective arterial elastance [E_a] ratio, from right ventricle [RV] pressure-volume loops). Analysis included disease-specific autoregressive correlation structure of order 1 (for repeated measures in time-series analysis).</p><p><strong>Results: </strong>Metrics of steady pulmonary hemodynamics with exercise changed in a similar fashion in the two disease groups. In contrast, at rest in PH-HFpEF (vs precapillary PH), Z_C was low (0.22 [0.14] mm Hg/L/min vs 0.70 [0.20] mm Hg/L/min; P < .0001) and E_es to E_a ratio was high (1.10 [0.36] vs 0.58 [0.22]; P = .0007). During exercise in PH-HFpEF, Z_C increased and E_es to E_a ratio decreased, but both remained unchanged in precapillary PH. In PH-HFpEF, a significant negative correlation was found between Z_C and E_es to E_a ratio (slope, -0.96; r² = 0.18; P < .0001) that was absent in precapillary PH (slope, -0.20; r² = 0.11; P = .53).</p><p><strong>Interpretation: </strong>Despite the small sample size, RV-PA uncoupling with exercise was significantly negatively correlated with Z_C in PH-HFpEF, which was not evident in precapillary PH, suggesting that abnormal exercise pulsatile hemodynamics are key to RV failure in left heart disease.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deciphering the role of FDG-PET/CT in the management of sarcoidosis.","authors":"Ryan Donnelly, Alessandro N Franciosi, Sarah H Forde, Michael McDermott, Michael P Keane, David J Murphy, Emmet E McGrath, Cormac McCarthy","doi":"10.1016/j.chest.2025.02.017","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.017","url":null,"abstract":"<p><strong>Background: </strong>Fluoro-2-deoxyglucose-18 (FDG) positron emission tomography (PET/CT) has utility in identifying sites of active sarcoidosis. However, the role of FDG-PET/CT in predicting treatment response and guiding therapy outside of cardiac disease is yet to be completely understood.</p><p><strong>Research question: </strong>Do physicians agree on the utility of FDG-PET/CT in sarcoid cases, and do they agree on the appropriate treatment response, based on the associated reports?</p><p><strong>Study design and methods: </strong>Physicians respondents were presented with a series of anonymised sarcoidosis case vignettes. The perceived utility of FDG-PET/CT in each case, as well as the ultimate treatment decision following provision of FDG-PET/CT results was assessed. Inter-rater agreement was assessed overall and per case vignette specialty using Gwet's Agreeability Coefficient (AC1).</p><p><strong>Results: </strong>Respondents (n=215) were predominantly respiratory physicians (86.78%) experienced in sarcoidosis management (94.39%), and a third of whom had >20 years' experience (32.66%). Pulmonary sarcoidosis case vignettes had the lowest rates of FDG-PET/CT endorsement among surveyed subspecialties (38 - 64%). Overall inter-rater agreement was assessed among physicians who positively endorsed an FDG-PET/CT. Treatment rationalisation based on FDG-PET/CT report was near-chance agreement for pulmonary AC1=0.178 (N=217, 95% CI 0.125- 0.234, p=0.07) and multisystem AC1=0.296 (N=168, 95% CI 0.066 - 0.477, p=0.41) cases, while agreement was highest for cases of cardiac sarcoidosis AC1=0.797 (N=374, 95% CI 0.759 - 0.838, p=<0.05).</p><p><strong>Interpretation: </strong>Our results indicate a low agreement between physicians regarding their management of pulmonary sarcoidosis following FDG-PET/CT. This highlights a need for further research and clarity over the role of FDG-PET/CT in the therapeutic management of pulmonary sarcoidosis.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the Causal Effect of Double-Blind Peer Review for a Pulmonary, Critical Care, and Sleep Medicine Journal.","authors":"Hayley B Gershengorn, Kelly C Vranas, Colin R Cooke, Christopher G Slatore, Stephanie M Levine","doi":"10.1016/j.chest.2025.02.016","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.016","url":null,"abstract":"<p><strong>Background: </strong>Double-blind peer review (DBPR, reviewers blinded to author identities and vice-versa) aims to reduce biases. DBPR's effectiveness has not been studied in pulmonary, critical care, and sleep journals.</p><p><strong>Research question: </strong>What was the causal effect on bias of DBPR at CHEST?</p><p><strong>Study design and methods: </strong>From January 2020 - June 2022, CHEST and Annals of the American Thoracic Society (AATS) used single-blind peer review (reviewers concealed from authors only); in July 2022, CHEST switched to DBPR. We estimated the causal effect of DBPR on manuscript acceptance at CHEST using AATS as a control. Our co-primary exposures were first and last author gender; secondarily, we considered author residence in English fluent countries. To estimate DBPR's differential impact by exposure, we constructed multivariable regression models with triple interaction terms (e.g., author gender X CHEST vs AATS X pre- vs post-DBPR), all component factors (e.g., author gender), paired interactions (e.g., author gender X CHEST vs AATS), and covariables (year, topic).</p><p><strong>Results: </strong>We included 4,651 manuscripts (CHEST: 3,494; AATS: 1,157) sent for peer-review; 4,645 (99.9%) had identifiable author gender. From 2020-2024, CHEST submissions (compared to AATS) were less frequently authored by women (first: 38.7% vs 45.5%, SMD = 0.14; last: 23.9% vs 31.2% SMD = 0.16) or people from English fluent countries (first: 56.0% vs 77.7%, SMD = 0.47; last: 57.9% vs 79.0%, SMD = 0.47), and acceptance rates were lower (30.7% vs 48.4%, SMD = 0.37). After adjustment, no difference was appreciated in DBPR's impact on acceptance for women vs men authors (first: -7.4 [95% CI: -20.9 - 6.0] percentage points, p=0.28; last: -10.1 [-25.1 - 5.0] percentage points, p=0.19). DBPR negatively impacted first (but not last) authors from English fluent countries (vs non-fluent: -16.8 [-32.1 - -1.6] percentage points, p=0.030).</p><p><strong>Interpretation: </strong>DBPR did not differentially impact authors by gender but did by presumed English fluency.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Yield and Synergistic Impact of Needle Aspiration and Forceps Biopsy with Electromagnetic Navigation Bronchoscopy for Peripheral Pulmonary Lesions (CONFIDENT-ENB): A Randomized Controlled Trial.","authors":"Yeon Wook Kim, Hyung-Jun Kim, Byoung Soo Kwon, Ye Jin Lee, Myung Jin Song, Sung Hyun Yoon, Sung Yoon Lim, Yeon Joo Lee, Jong Sun Park, Young-Jae Cho, Kyung Hee Lee, Jin-Haeng Chung, Yeon Bi Han, Fabien Maldonado, So Yeon Ahn, Youngmi Park, Dong-Hyun Joo, Jae Ho Lee, Choon-Taek Lee","doi":"10.1016/j.chest.2025.02.015","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.015","url":null,"abstract":"<p><strong>Background: </strong>Electromagnetic navigation bronchoscopy (ENB) is an advanced imaging-guided technique used to diagnose peripheral pulmonary lesions. However, the optimal strategy for selecting biopsy devices remains unclear.</p><p><strong>Research question: </strong>Does the combination of needle aspiration and forceps biopsy improve diagnostic yield compared with that using a single device alone?</p><p><strong>Study design and methods: </strong>We conducted a randomized crossover study during ENB performed under moderate sedation. This trial recruited participants with peripheral pulmonary lesions requiring biopsy who were eligible for elective ENB. ENB-guided needle aspiration and forceps biopsy were sequentially performed in a randomized order. The primary outcome was diagnostic yield, defined as the percentage of patients for whom the biopsy provided a specific diagnosis able to inform patient management. The diagnostic yield achieved by each biopsy modality individually and in combination was evaluated.</p><p><strong>Results: </strong>Between December 1, 2021, and November 13, 2023, 142 participants were enrolled and underwent the study procedures. Complete follow-up data were obtained for 140 participants. Diagnostic yield was 44.4% (63/142) for forceps biopsy, 51.4% (73/142) for needle aspiration (p=0.221 vs. forceps), and 66.9% (95/142) for the combination (p<0.001 vs. forceps alone, p<0.001 vs. needle alone). Sensitivities for malignancy were 58.3% (70/120) for needle aspiration and 47.5% (57/120) for forceps biopsy (p=0.074). The combination of the two modalities resulted in a significantly improved sensitivity of 71.7% (86/120) compared with either individual modality (p<0.001 vs. forceps alone and needle alone). Pneumothorax occurred in 3.5% (5/142) of patients, and 1.4% (2/142) developed pneumothorax requiring tube drainage.</p><p><strong>Interpretation: </strong>When performing ENB under moderate sedation, the combination of needle aspiration and forceps biopsy significantly improves the diagnostic yield and sensitivity for malignancy compared to each modality alone, with a favorable safety profile. These results indicate that a multimodal approach using needles and forceps is a valid diagnostic strategy for ENB.</p><p><strong>Clinical trial registration: </strong>NCT05110131.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growing Up with Developmental Lung Diseases: A Review for the Adult Pulmonologist.","authors":"Yadira Rivera-Sanchez, Zachary W Blair, Tyler J Wall, Kara N Goss","doi":"10.1016/j.chest.2025.02.014","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.014","url":null,"abstract":"<p><strong>Topic importance: </strong>Improved childhood management strategies have decreased the early life morbidity and mortality of severe developmental lung disorders, such that an increasing number of individuals ultimately transition care to adult pulmonologists for management. Alternatively, individuals with milder malformations may present in adulthood or may have an increased risk for the development of more common adult pulmonary comorbidities such as chronic obstructive pulmonary disease or pulmonary hypertension. As such, there is a critical need for adult pulmonologists to understand how developmental lung disorders may impact respiratory morbidity over the lifespan.</p><p><strong>Review findings: </strong>There is growing recognition that abnormal lung development contributes to lung disease across the lifespan. This article reviews commonly encountered complex developmental lung diseases, including bronchopulmonary dysplasia, congenital diaphragmatic hernia, Down syndrome, and representative isolated airway and vascular anomalies. Their childhood and adult clinical presentations and co-morbidities will be discussed.</p><p><strong>Summary: </strong>This review aims to provide the adult pulmonologist with a framework for evaluating and managing individuals with developmental lung diseases.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Main Pulmonary Artery Diameter in Pulmonary Arterial Hypertension.","authors":"Jacob Y Cao, Rita-Maria Abdo, Nelson Wang, Nicholas Olsen, Kate Kearney, Kirby Wong, Edmund Lau, David Celermajer, Eugene Kotlyar, Rachael Cordina","doi":"10.1016/j.chest.2025.02.012","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.012","url":null,"abstract":"<p><strong>Background: </strong>Accurate risk stratification is critical aspect of pulmonary arterial hypertension (PAH) management. It is unclear whether main pulmonary artery (MPA) enlargement offers additional prognostic value to validated risk scores.</p><p><strong>Research question: </strong>Is MPA diameter prognostic in PAH, independent of the existing risk scores.</p><p><strong>Study design and methods: </strong>A retrospective review of PAH patients from two large referral centres was conducted. Baseline REVEAL 2.0, REVEAL Lite 2 and ESC/ERS scores were calculated. The primary endpoint was composite death, lung transplantation and right heart failure hospitalisation. Cox proportional hazards models were used for time-to-event analyses. Receiver-operator characteristic and net reclassification improvement analyses additionally assessed the prognostic value of MPA diameter.</p><p><strong>Results: </strong>351 patients were included. Baseline MPA diameter was 35.3 ± 7.1 mm. MPA grew by 0.4 ± 1.1 mm/year (1.1% baseline diameter). Over mean 4.0 ± 3.4 years follow up, 190 primary events occurred, and MPA diameter was a predictor (HR 1.06 per mm, 95% CI 1.04-1.07, p<0.001). MPA diameter remained an independent predictor after multivariable adjustments for the three risk scores, and their individual components. MPA growth rate also predicted the outcome (HR 1.79 per mm/year, 95% CI 1.52-2.11, p<0.001), independent of baseline MPA diameter. Area under the receiver-operator characteristic curve for the risk of the primary endpoint at one year was similar for MPA alone (0.72) compared to the three risk scores (0.72-0.75). Furthermore, using MPA in addition to REVEAL 2.0 resulted in risk reclassification in 23% of patients, mostly due to appropriate risk downgrading.</p><p><strong>Interpretation: </strong>MPA diameter is a significant independent predictor of adverse clinical events in PAH patients without congenital heart disease. It may potentially be a novel prognostic marker in addition to the existing risk scores.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of non-invasive ventilation before and after cardiac surgery for preventing cardiac and pulmonary complications: a clinical randomized trial.","authors":"Marion Goret, Kevin Pluchon, Raphaël Le Mao, Ali Badra, Jean-Ferréol Oilleau, Yohann Morvan, Marc Beaumont, Gwenaëlle Desanglois, Marie Guegan, Aude Barnier, Christophe Gut-Gobert, Cécile Tromeur, Christophe Leroyer, Jean-Noël Choplain, Ahmed Khalifa, Eric Bezon, Francis Couturaud","doi":"10.1016/j.chest.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.010","url":null,"abstract":"<p><strong>Background: </strong>The immediate postoperative period following heart surgery poses a substantial risk of life-threatening complications notably acute pulmonary and cardiac failure. Non-invasive ventilation (NIV) use may reduce the incidence of pulmonary and/or heart failure.</p><p><strong>Research question: </strong>Is the use of NIV before and after cardiac surgery associated with a lower rate of acute pulmonary and heart failure in patients at risk for post-operative complications?</p><p><strong>Study design and methods: </strong>We designed a prospective, randomized, monocentric trial comparing pre- and post-operative NIV in cardiac surgery to standard care. Adult patients classified at risk of post-operative cardiac or pulmonary failure were allocated to receive NIV for five days before and five days after surgery in addition to usual care versus usual care alone. The primary outcome was the composite of predefined and adjudicated cardio-respiratory failure at one month after cardiac surgery.</p><p><strong>Results: </strong>Two hundred and sixteen patients were included. During the one-month follow-up period after surgery, the composite outcome occurred in 59/107 (55.1%) patients in the NIV group and in 87/109 (79.8%) patients in the No-NIV group (RR 0.69 95%CI [0.57-0.84]; p<0.001). The benefit was persistent at three months. There was no difference between the two groups in terms of intubation need and length of hospital stay in cardiac and pulmonary surgery intensive care unit and in cardiac and pulmonary surgery unit.</p><p><strong>Interpretation: </strong>The use of NIV before and after cardiac surgery reduces the rate of cardiopulmonary failure after high-risk cardiac surgery.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glossopharyngeal Nerve Stimulation Stabilizes the Lateral Pharyngeal Wall and Ventilation in OSA: A Pilot Study.","authors":"David T Kent, John J Ceremsak, Yike Li, Pratyusha Yalamanchi, Kyle Mannion, David Zealear, Matthew S Shotwell, Megan E Hall, Christopher J Lindsell, Holly A Budnick, Silvana Bellotto, Katherine E Estes, Carol LeeAnn Wells, Alan R Schwartz","doi":"10.1016/j.chest.2025.02.009","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.009","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normosol-R versus Lactated Ringers in the Critically Ill: A Randomized Trial.","authors":"Edward T Qian, Ryan M Brown, Karen E Jackson, Li Wang, Joanna L Stollings, Robert E Freundlich, Jonathan P Wanderer, Edward D Siew, Gordon R Bernard, Wesley H Self, Jonathan D Casey, Todd W Rice, Matthew W Semler","doi":"10.1016/j.chest.2025.02.008","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.008","url":null,"abstract":"<p><strong>Background: </strong>Balanced crystalloid solutions may improve clinical outcomes compared to saline for some critically ill adults, but it is unclear whether differences in composition between balanced crystalloid solutions affect outcomes.</p><p><strong>Research question: </strong>Does the choice of balanced crystalloid solutions (Normosol-R versus lactated Ringers) impact acid-base status, organ function, or outcomes for critically ill adults?</p><p><strong>Study design and methods: </strong>This pragmatic, cluster-randomized, multiple-crossover trial at an academic medical center in the United States compared the use of Normosol-R versus lactated Ringers among critically ill adults. The primary outcome was the plasma bicarbonate concentration between enrollment and 7 days. Secondary outcomes included receipt of kidney replacement therapy and death by day 30.</p><p><strong>Results: </strong>Between June 1, 2018, and January 31, 2019, 2,084 patients were enrolled. The median age was 59 years, 1,006 patients (48.3%) were female, and the median Sequential Organ Failure Assessment score was 5 (interquartile range, 3-8). Bicarbonate concentration between enrollment and 7 days did not differ between the Normosol-R and lactated Ringers groups (mean difference, -0.12 mmol/dL; 95% confidence interval [CI], -0.61 to 0.36, p-value = 0.61). A total of 58 patients (6.0%) in the Normosol-R group and 47 patients (5.0%) in the lactated Ringers group received new kidney replacement therapy (absolute risk difference, 1.0%; 95%CI, -1.2% to 3.1%). Death by day 30 occurred in 172 patients (16.3%) in the Normosol-R group and 164 patients (16.0%) in the lactated Ringers group (absolute risk difference, 0.3%; 95%CI, -2.9% to 3.6%).</p><p><strong>Interpretation: </strong>Among critically ill adults, the use of Normosol-R for intravenous fluid therapy did not affect plasma bicarbonate concentrations or clinical outcomes, compared to lactated Ringers.</p><p><strong>Clinical trial registration number: </strong>NCT03537898.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}