Chest最新文献

{"title":"Usefulness of Cross-Lagged Panel Models for Clinical Research.","authors":"Christophe Gauld, Raoul P P P Grasman, Sébastien Bailly","doi":"10.1016/j.chest.2024.12.013","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.013","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 6","pages":"1537-1540"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282662","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":"Spontaneous Resolution in Autoimmune Pulmonary Alveolar Proteinosis: A Case Series.","authors":"Shrimukta Sahoo, Puneet Saxena, Akhil K Ravi, Saurabh Tiwari, Valliappan Muthu, Ravi Charan Avala, Vishwanath Gella, Raghava Rao Gandra, Robin Choudhary","doi":"10.1016/j.chest.2025.01.030","DOIUrl":"10.1016/j.chest.2025.01.030","url":null,"abstract":"<p><p>Pulmonary alveolar proteinosis (PAP) is a rare lung condition characterized by the accumulation of proteinaceous material within the alveoli. The acquired form is often autoimmune, driven by autoantibodies against granulocyte-macrophage colony-stimulating factor. Presentation of autoimmune PAP may range from incidental detection in asymptomatic patients to advanced respiratory failure. Treatment typically involves whole lung lavage or granulocyte-macrophage colony-stimulating factor therapy in symptomatic patients; spontaneous resolution is rare in severe cases. Here, we report 3 cases of autoimmune PAP who presented with resting hypoxia and exhibited spontaneous resolution without significant treatment. All 3 cases had a history of occupational inhalational exposure to noxious gases, and they improved following sustained cessation of exposure. We hypothesize that occupational or environmental noxious inhalation exposure may have a role in disease expression in some cases of autoimmune PAP, and such cases may show spontaneous resolution following cessation of the offending exposure.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 6","pages":"e177-e181"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282659","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":"Ventilator-Associated Pneumonia in Low- and Middle-Income vs High-Income Countries: The Role of Ventilator Bundle, Ventilation Practices, and Health Care Staffing.","authors":"Marko Nemet, Cameron G Gmehlin, Marija Vukoja, Yue Dong, Ognjen Gajic, Aysun Tekin","doi":"10.1016/j.chest.2025.01.002","DOIUrl":"10.1016/j.chest.2025.01.002","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) rates are higher in low- and middle-income countries (LMICs) than in high-income countries (HICs).</p><p><strong>Research question: </strong>Could differences in ventilator bundle adherence, ventilation practices, and critical care staffing be driving variations in VAP risk between LMICs and HICs?</p><p><strong>Study design and methods: </strong>This secondary analysis of the multicenter, international Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) study included mechanically ventilated patients at risk for VAP from 11 LMICs and 5 HICs. We included oral care, head-of-bed elevation, spontaneous breathing assessments, and sedation breaks in the ventilator bundle. Staffing was assessed by the number of physicians and nurses per bed. Multivariable analyses were adjusted for severity, baseline characteristics, and checklist implementation. The primary outcome was VAP development.</p><p><strong>Results: </strong>Among 2,253 patients, 1,755 were from LMICs and 498 from HICs. Compared with HICs, patients from LMICs were younger, had lower comorbidity burden, and were less severely ill. Lower country income level was independently associated with VAP development (adjusted OR [aOR], 2.11; 95% CI, 1.37-3.24). Ventilator bundle adherence was not significantly associated with VAP. Increased total duration of ventilation was associated with an increased risk of VAP (aOR, 1.04; 95% CI, 1.03-1.05), whereas higher nursing (aOR, 0.88; 95% CI, 0.79-0.98) and physician staffing ratios (aOR, 0.69; 95% CI, 0.50-0.87) were associated with lower VAP rates.</p><p><strong>Interpretation: </strong>Our results show that patients in LMICs have a 2-fold higher risk of VAP, independent of bundle adherence. Prolonged mechanical ventilation was an independent predictor of VAP, whereas higher staffing ratios were associated with decreased risk for VAP development. Unmeasured factors (eg, infrastructure, infection control practices) may explain the higher VAP rates in LMICs.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1628-1638"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977889","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":"High Normocapnia and Better Functional Outcome in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation After Out-of-Hospital Cardiac Arrest.","authors":"Junichi Izawa, Shunsuke Kimata, Sho Komukai, Masashi Okubo, Akihiro Sakai, Tetsuhisa Kitamura, Yutaka Yamaguchi","doi":"10.1016/j.chest.2025.01.010","DOIUrl":"10.1016/j.chest.2025.01.010","url":null,"abstract":"<p><strong>Background: </strong>The optimal target for Paco₂ remains uncertain in patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) after out-of-hospital cardiac arrest (OHCA).</p><p><strong>Research question: </strong>Are Paco₂ levels associated with functional outcomes in patients receiving VA-ECMO after OHCA?</p><p><strong>Study design and methods: </strong>This multicenter, registry-based observational study, conducted from 2014 to 2020, included adult patients with nontraumatic injury with OHCA and receiving VA-ECMO with Paco₂ levels measured within 6 hours of initiation (initial Paco₂ set) and 18 to 30 hours after initiation (24-hour Paco₂ set). Paco₂ levels were categorized into 5 groups: hypocapnia (< 30 mm Hg), low normocapnia (30 to < 40 mm Hg), high normocapnia (40 to < 50 mm Hg), mild hypercapnia (50 to < 60 mm Hg), and moderate to severe hypercapnia (≥ 60 mm Hg). The primary outcome was a favorable functional outcome at 30 days, analyzed by multivariable logistic regression. Paco₂ trajectories from initial to 24-hour levels were also explored.</p><p><strong>Results: </strong>A total of 1,454 and 572 patients were analyzed in the initial and 24-hour Paco₂ sets, respectively. Compared with high normocapnia, low normocapnia was associated with worse functional outcomes in both initial and 24-hour Paco₂ analyses, with adjusted ORs of 0.59 (95% CI, 0.38-0.89) for initial low normocapnia and 0.56 (95% CI, 0.33-0.95) for 24-hour low normocapnia. Other categories were similarly associated with worse functional outcomes in both Paco₂ analyses. In exploratory analyses, trajectories ending in high normocapnia demonstrated higher proportions of favorable functional outcome than those ending in low normocapnia, regardless of initial Paco₂ levels.</p><p><strong>Interpretation: </strong>In adult patients with nontraumatic injury with OHCA and receiving VA-ECMO, high normocapnia was associated with better functional outcomes than low normocapnia in both initial and 24-hour Paco₂ analyses. These findings suggest a hypothesis that maintaining high normocapnia levels, irrespective of initial Paco₂, may improve functional outcomes for patients undergoing VA-ECMO after OHCA.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1639-1650"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000806","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":"Beta-Blockers in Pulmonary Arterial Hypertension: Still an Evidence Gap.","authors":"Stavros Dimopoulos, Christos Kourek, Serafim Nanas","doi":"10.1016/j.chest.2025.01.040","DOIUrl":"https://doi.org/10.1016/j.chest.2025.01.040","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 6","pages":"e205-e206"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282651","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":"Noninvasive Ventilation for Cardiac Surgical Patients: Reducing Postoperative Complications.","authors":"Elizabeth S Tetteh","doi":"10.1016/j.chest.2025.03.011","DOIUrl":"https://doi.org/10.1016/j.chest.2025.03.011","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 6","pages":"1528-1529"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282654","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":"Pulmonary Rehabilitation in Interstitial Lung Disease: Improving How Patients Feel, Function-and Potentially Survive?","authors":"Sabina A Guler, Thomas F Riegler","doi":"10.1016/j.chest.2025.01.009","DOIUrl":"https://doi.org/10.1016/j.chest.2025.01.009","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 6","pages":"1523-1524"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282655","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":"Response.","authors":"Marcin Waligóra, Grzegorz Kopeć","doi":"10.1016/j.chest.2025.02.013","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.013","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 6","pages":"e206"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282658","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":"Ventilator-Associated Pneumonia: Bridging Global Disparities Through Standardized Definitions and Transparent Reporting.","authors":"Cristian C Serrano-Mayorga, Luis Felipe Reyes","doi":"10.1016/j.chest.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.chest.2025.02.005","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 6","pages":"1517-1519"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282663","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":"Stability of Fractional Exhaled Nitric Oxide and Its Relationship With Exacerbation in Patients Aged 6 Years or Older With Uncontrolled, Moderate-to-Severe Asthma.","authors":"William W Busse, Ian D Pavord, Michael E Wechsler, Ignacio J Davila, Arman Altincatal, Lucia de Prado Gomez, Xavier Soler, Harry Sacks, Juby A Jacob-Nara, Yamo Deniz, Paul J Rowe","doi":"10.1016/j.chest.2024.09.048","DOIUrl":"10.1016/j.chest.2024.09.048","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1541-1546"},"PeriodicalIF":9.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779518","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}