IF 9.5 1区医学

Chest Pub Date : 2025-02-01 Epub Date: 2024-09-03 DOI: 10.1016/j.chest.2024.08.040

Michael Insel, Tammer El Aini, Gregory Woodhead, Rebecca Wig, Saad Kubba, Guido Claessen, Erin Howden, Franz Rischard

{"title":"Post-Pulmonary Embolism Phenotypes Described by Invasive Cardiopulmonary Exercise Testing.","authors":"Michael Insel, Tammer El Aini, Gregory Woodhead, Rebecca Wig, Saad Kubba, Guido Claessen, Erin Howden, Franz Rischard","doi":"10.1016/j.chest.2024.08.040","DOIUrl":"10.1016/j.chest.2024.08.040","url":null,"abstract":"Background: Post-pulmonary embolism (PE) dyspnea is common. Existing noninvasive studies have demonstrated that post-PE dyspnea is associated with elevations in right ventricular (RV) afterload, dead space ventilation, and deconditioning. We aimed to use invasive cardiopulmonary exercise testing (iCPET) parameters in patients with post-PE dyspnea to identify unique physiologic phenotypes.Research question: Do distinct post-PE dyspnea physiologic phenotypes exist that are described with iCPET?Study design and methods: Patients were enrolled at the time of acute PE and through our pulmonary hypertension (PH) and dyspnea clinic. iCPET was performed if high suspicion existed for PH or if unexplained dyspnea was present. A hierarchical cluster analysis was performed to identify dyspnea phenotypes. iCPET parameters assessing pulmonary hemodynamics, ventilation, and peripheral oxygen use then were compared within and across each cluster and with iCPET control participants against peak oxygen consumed per minute.Results: One hundred seventy-three patients were enrolled. Sixty-seven patients underwent iCPET. All patients showed reductions in peak oxygen consumed per minute and peak cardiac index relative to control participants. Three clusters were identified. Cluster 1 was defined by having elevated RV afterload and impaired ventilatory efficiency. Cluster 2 was defined by elevated RV afterload with reductions in respiratory mechanics. Cluster 3 was defined by mild derangement in RV afterload with mild reductions in peak cardiac output.Interpretation: In this study, iCPET revealed significant heterogeneity in post-PE dyspnea. Three phenotypes were characterized by differences in RV afterload: ventilatory efficiency, respiratory mechanics, and peripheral oxygen use.","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"585-597"},"PeriodicalIF":9.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139445","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}

引用次数: 0

Perspectives of Clinicians on the Value of the Get to Know Me Board in the ICU. 临床医生对重症监护室 "认识我 "板块价值的看法。

IF 9.5 1区医学

Chest Pub Date : 2025-02-01 Epub Date: 2024-10-18 DOI: 10.1016/j.chest.2024.10.016

Sumera R Ahmad, Lori Rhudy, Amelia K Barwise, Mahmut C Ozkan, Ognjen Gajic, Lioudmila V Karnatovskaia

{"title":"Perspectives of Clinicians on the Value of the Get to Know Me Board in the ICU.","authors":"Sumera R Ahmad, Lori Rhudy, Amelia K Barwise, Mahmut C Ozkan, Ognjen Gajic, Lioudmila V Karnatovskaia","doi":"10.1016/j.chest.2024.10.016","DOIUrl":"10.1016/j.chest.2024.10.016","url":null,"abstract":"Background: Critical illness can render patients at heightened risk of anonymity, loss of dignity, and dehumanization. Because dehumanization results in significant patient distress, it is imperative to find ways to humanize care in the ICU. A Get to Know Me board (GTKMB) is a personal patient profile designed to bring the patient from anonymity; however, its widespread adoption has been challenging.Research question: Identify perspectives of ICU clinicians on the value of the GTKMB in caring for patients in the ICU.Study design and methods: This qualitative study used focus groups conducted via videoconference. We recruited stakeholders from multiprofessional teams across different ICU settings at a large US quaternary care center. Thematic content analysis approach was performed to identify key themes and concepts.Results: We interviewed 38 participants in six focus groups including 10 nurses, seven physicians, six advanced practice providers, five rehabilitation therapists, a respiratory therapist, and a social worker. Themes highlighted the role of the GTKMB in multiple domains including humanizing care of the critically ill, fostering communication, connecting with families, and guiding and facilitating care processes. Several subthemes were identified for each category.Interpretation: The GTKMB was considered important in fostering humanized caring in the ICU by diverse members of an interprofessional ICU team, helping to facilitate communication, establish family connection, and guide care.","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"561-570"},"PeriodicalIF":9.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459133","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}

引用次数: 0

Ensifentrine for COPD: Identifying the Patients Who Benefit.

IF 9.5 1区医学

Chest Pub Date : 2025-02-01 DOI: 10.1016/j.chest.2024.08.034

Rajat Suri, Sanjay Ramakrishnan

引用次数: 0

Is the Global Lung Function Initiative Race-Neutral Spirometry Reference Equation Ready for Clinical Use Around the World?

IF 9.5 1区医学

Chest Pub Date : 2025-02-01 DOI: 10.1016/j.chest.2024.10.001

Naoya Tanabe

引用次数: 0

Metagenomic Sequencing for Personalized Treatment in Pneumonia: Does Better Detection Lead to Better Outcomes?