Chest最新文献

{"title":"Implications of Global Lung Function Initiative Spirometry Reference Equations in Northeast Asian Patients With COPD.","authors":"Joon Young Choi, Chang-Hoon Lee, Hyonsoo Joo, Yun Su Sim, Jaechun Lee, Hyun Lee, Kwang Ha Yoo, Seoung Ju Park, Ju Ock Na, Yet Hong Khor","doi":"10.1016/j.chest.2024.08.048","DOIUrl":"10.1016/j.chest.2024.08.048","url":null,"abstract":"<p><strong>Background: </strong>Accurate spirometry interpretation is critical in the diagnosis and management of COPD. With increasing efforts for a unified approach by the Global Lung Function Initiative (GLI), this study evaluated the application of race-specific 2012 GLI and race-neutral 2022 GLI reference equations compared with Choi's reference equations, which is derived and widely used in South Korea, for spirometry interpretation in Northeast Asian patients with COPD.</p><p><strong>Research question: </strong>What are the effects of applying race-specific 2012 GLI, race-neutral 2022 GLI, and Choi's reference equations on the diagnosis, severity grade, and clinical outcome associations of COPD?</p><p><strong>Study design and methods: </strong>Serial spirometry data from the Korea COPD Subgroup Study (KOCOSS) consisting of 3,477 patients were used for reanalysis using 2012 GLI, 2022 GLI, and Choi's reference equations. The COPD diagnosis and severity categorization, associations with disease manifestations and health outcomes, and longitudinal trajectories of lung function were determined.</p><p><strong>Results: </strong>Although there was strong concordance in COPD diagnosis comparing 2012 GLI, and 2022 GLI reference equations with Choi's reference equations, a notable portion of patients were reclassified to milder disease severity (17.0% and 23.4% for 2012 GLI and 2022 GLI reference equations, respectively). Relationships between FEV₁ % predicted values calculated using 2012 GLI, 2022 GLI, and Choi's equations with clinical outcomes including dyspnea severity, exercise capacity, health-related quality of life, and frequency of exacerbations remain consistently significant. Similar annual decline rates of FEV₁ and FVC % predicted were observed among the reference equations used, except for slower annual decline rate of FEV₁ in Choi's equation compared with 2022 GLI race-neutral equation.</p><p><strong>Interpretation: </strong>Application of GLI reference equations for spirometry interpretation in Northeast Asian patients with COPD has potential implications on disease severity grade for clinical management and trial participation, and maintains consistent significant relationships with key disease outcomes.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280927","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":"Incidence, Risk Factors, and Long-Term Outcomes for Extubation Failure in ICU in Patients With Obesity: A Retrospective Analysis of a Multicenter Prospective Observational Study.","authors":"Audrey De Jong, Mathieu Capdevila, Yassir Aarab, Matthieu Cros, Joris Pensier, Ines Lakbar, Clément Monet, Hervé Quintard, Raphael Cinotti, Karim Asehnoune, Jean-Michel Arnal, Christophe Guitton, Catherine Paugam-Burtz, Paer Abback, Armand Mekontso-Dessap, Karim Lakhal, Sigismond Lasocki, Gaetan Plantefeve, Bernard Claud, Julien Pottecher, Philippe Corne, Carole Ichai, Nicolas Molinari, Gerald Chanques, Laurent Papazian, Elie Azoulay, Samir Jaber","doi":"10.1016/j.chest.2024.07.171","DOIUrl":"10.1016/j.chest.2024.07.171","url":null,"abstract":"<p><strong>Background: </strong>To our knowledge, no large observational study has compared the incidence and risk factors for extubation failure within 48 h and during ICU stay in the same cohort of unselected critically ill patients with and without obesity.</p><p><strong>Research question: </strong>Which are the incidence and risk factors of extubation failure in patients with and without obesity?</p><p><strong>Study design and methods: </strong>In this prospective multicenter observational FREE-REA study in 26 ICUs, the primary objective was to compare the incidence of extubation failure within 48 h in patients with and without obesity. Secondary objectives were to describe and to identify the independent specific risk factors for extubation failure, using first a logistic regression model and second a decision tree analysis.</p><p><strong>Results: </strong>Of 1,370 extubation procedures analyzed, 288 (21%) were performed in patients with obesity and 1,082 (79%) in patients without obesity. The incidence of extubation failure within 48 h among patients with or without obesity was 23 of 288 (8.0%) vs 118 of 1,082 (11%), respectively (unadjusted OR, 0.71; 95% CI, 0.45-1.13; P = .15); alongside patients with obesity receiving significantly more noninvasive ventilation [87 of 288 (30%) vs 233 of 1,082 (22%); P = .002] and physiotherapy [165 of 288 (57%) vs 527 of 1,082 (49%); P = .02] than patients without obesity. Risk factors for extubation failure also differed according to obesity status: female sex (adjusted OR, 4.88; 95% CI, 1.61-13.9; P = .002) and agitation before extubation (adjusted OR, 6.39; 95% CI, 1.91-19.8; P = .001) in patients with obesity, and absence of strong cough before extubation (adjusted OR, 2.38; 95% CI, 1.53-3.84; P = .0002) and duration of invasive mechanical ventilation before extubation (adjusted OR, 1.03/d; 95% CI, 1.01-1.06; P = .01) in patients without obesity. The decision tree analysis found similar risk factors.</p><p><strong>Interpretation: </strong>Our findings indicate that anticipation and application of preventive measures for patients with obesity before and after extubation led to similar rate of extubation failure among patients with and without obesity.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT02450669; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055054","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":"Phosphodiesterase 5 Inhibitor Treatment Is Associated With Improved Survival in Pulmonary Hypertension Associated With COPD in the Pulmonary Vascular Research Institute GoDeep Meta-Registry.","authors":"Khodr Tello, Athiththan Yogeswaran, Raphael W Majeed, David G Kiely, Allan Lawrie, Evan Brittain, Jeffrey S Annis, Horst Olschewski, Gabor Kovacs, Paul M Hassoun, Aparna Balasubramanian, Ziad Konswa, Andrew J Sweatt, Roham T Zamanian, Martin R Wilkins, Luke Howard, Alexandra Arvanitaki, George Giannakoulas, Hector R Cajigas, Robert Frantz, Paul G Williams, Marlize Frauendorf, Kurt Marquardt, Tobiah Antoine, Meike Fuenderich, Manuel Richter, Friedrich Grimminger, Hossein-Ardeschir Ghofrani, Jochen Wilhelm, Werner Seeger","doi":"10.1016/j.chest.2024.08.016","DOIUrl":"10.1016/j.chest.2024.08.016","url":null,"abstract":"<p><strong>Background: </strong>Patients with COPD frequently demonstrate pulmonary hypertension (PH). Severe PH in patients with COPD, identified by pulmonary vascular resistance (PVR) of > 5 Wood units (WU), is closely linked to impaired transplant-free survival. The impact of PH-targeting pharmacotherapy in this context remains unclear.</p><p><strong>Research question: </strong>Is PH-targeted therapy associated with improved transplant-free survival in patients with COPD and PH?</p><p><strong>Study design and methods: </strong>This study included Pulmonary Vascular Research Institute GoDeep meta-registry patients with COPD and PH and available right heart catheterization at diagnosis. We investigated PH-targeted therapy prevalence and its association with transplant-free survival using diverse statistical methods, including Cox regression and subgroup analyses based on PH severity, comorbidities, and pulmonary function test results. Immortal time bias was addressed through a landmark approach.</p><p><strong>Results: </strong>As of December 2023, the GoDeep meta-registry included 26,981 patients (28% in PH group 1, 13% in PH group 2, 12% in PH group 3, 10% in PH group 4, 2% in PH group 5, 26% undefined, and 9% control participants). Of these, 836 patients had a diagnosis of COPD with PH and were included in this analysis, with median age of 66 years (59-73 years), FEV₁ of 51% predicted (34%-69% predicted), mPAP of 35 mm Hg (28-44 mm Hg), PVR of 5 WU (4-8 WU), cardiac index of 2.5 L/min/m² (2.0-2.9 L/min/m²), and mostly World Health Organization functional class III were included. Five-year transplant-free survival was 42%, significantly worse than in group 1 PH. A multivariable Cox proportional hazards model identified PVR, but not FEV₁, as a major predictor of outcome. Four hundred eighteen patients (50%) received phosphodiesterase 5 inhibitor (PDE5i) therapy, which was associated with significantly reduced mortality: hazard ratio of 0.65 (0.57-0.75) for the entire cohort of patients with COPD and PH and of 0.83 (0.74-0.94) when performing landmark analysis. This PDE5i effect was reproduced robustly when performing subgroup analyses for patients with moderate to severe PH, various comorbidities, and supplemental oxygen requirement and when assessing the impact of unobserved confounders.</p><p><strong>Interpretation: </strong>Patients with COPD and PH exhibit poor transplant-free survival, with PVR being a predictor of mortality. In this meta-registry, PDE5i therapy was associated with a significant reduction in mortality across all tested models.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055056","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":"Diagnosis and Prevention of Invasive Fungal Infections in the Immunocompromised Host.","authors":"Abdul Wahab, David Sanborn, Paschalis Vergidis, Raymund Razonazole, Hemang Yadav, Kelly M Pennington","doi":"10.1016/j.chest.2024.08.046","DOIUrl":"10.1016/j.chest.2024.08.046","url":null,"abstract":"<p><strong>Topic importance: </strong>The prevalence of invasive fungal infections (IFIs) has risen in the past 3 decades, attributed to advancements in immune-modulatory therapies used in transplantation, rheumatology, and oncology.</p><p><strong>Review findings: </strong>Organisms that cause IFI evade the host's natural defenses or at opportunities of immunologic weakness. Infections occur from inhalation of potentially pathogenic organisms, translocation of commensal organisms, or reactivation of latent infection. Organisms that cause IFI in immunocompromised populations include Candida species, Cryptococcus species, environmental molds, and endemic fungi. Diagnosis of these infections is challenging due to slow organism growth and fastidious culture requirements. Moreover, fungal biomarkers tend to be nonspecific and can be negatively impacted by prophylactic antifungals. Antibody-based tests are not sensitive in immunocompromised hosts making antigen-based testing necessary. Risk reduction of IFI is guided by pathogen avoidance, removal or minimization of immune-suppressing factors, and pharmacologic prophylaxis in select hosts.</p><p><strong>Summary: </strong>Understanding the complex interplay between the immune system and opportunistic fungal pathogens plays a key role in early diagnosis and prevention.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153219","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":"Choosing the Right Biologic for the Right Patient With Severe Asthma.","authors":"Simon Couillard, David J Jackson, Ian D Pavord, Michael E Wechsler","doi":"10.1016/j.chest.2024.08.045","DOIUrl":"10.1016/j.chest.2024.08.045","url":null,"abstract":"<p><p>In this instalment of the How I Do It series on severe asthma, we tackle the clinical conundrum of choosing the right biologic for the right patient with severe asthma. With 6 biologics now approved for use in this area comprising 4 different targeting strategies (anti-Ig E: omalizumab; anti-IL-5 and anti-IL-5-receptor: mepolizumab, reslizumab, and benralizumab; anti-IL-4-receptor: dupilumab; anti-thymic stromal lymphopoietin: tezepelumab), this question is increasingly complex. Recognizing that no head-to-head trial has compared biologics, we based our review on the expected effects of inhibiting different aspects of type 2 airway inflammation, supported whenever possible by clinical trial and real-world data. We use 4 variations of a case of severe uncontrolled asthma to develop concepts and considerations introduced in the previous installment (\"Workup of Severe Asthma\") and discuss pregnancy-related, biomarker-related, comorbidity-related, and corticosteroid dependency-related considerations when choosing a biologic. The related questions of deciding when, why, and how to switch from one biologic to another also are discussed. Overall, we consider that the choice of biologics should be based on the available clinical trial data for the desired efficacy outcomes, the biomarker profile of the patient, safety profiles (eg, when pregnancy is considered), and opportunities to target 2 comorbidities with 1 biologic. Using systemic and airway biomarkers (blood eosinophils and exhaled nitric oxide) and other phenotypic characteristics, we suggest a framework to facilitate therapeutic decision-making. Post hoc studies and new comparative studies are needed urgently to test this framework and to determine whether it allows us to make other clinically useful predictions.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153220","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":"Single vs Double Lung Transplantation in Older Adults: A Propensity-Matched Analysis.","authors":"Noah Weingarten, Atul C Mehta, Marie Budev, Usman Ahmad, James Yun, Kenneth McCurry, Haytham Elgharably","doi":"10.1016/j.chest.2024.08.044","DOIUrl":"10.1016/j.chest.2024.08.044","url":null,"abstract":"<p><strong>Background: </strong>Single lung transplantation (SLT) is associated with worse long-term outcomes than bilateral lung transplantation (BLT), but often is performed in older adults at risk of not tolerating BLT.</p><p><strong>Research question: </strong>How do the outcomes of SLT and BLT compare among older adult recipients?</p><p><strong>Study design and methods: </strong>The Scientific Registry of Transplant Recipients database (2005-2022) was queried for lung transplant recipients 65 years of age or older. Patients were stratified by whether they underwent BLT or SLT and were propensity matched. Baseline characteristics and morbidity were compared with frequentist statistics. Survival was analyzed via Kaplan-Meier estimation. Risk factors for mortality were identified with Cox regression.</p><p><strong>Results: </strong>Of 9,904 included patients, 4,829 patients (48.8%) underwent SLT. Patients who underwent SLT had lower lung allocation scores (39.6 vs 40.6; P < .001), more interstitial lung disease (74.4% vs 64.6%; P < .001), and lower rates of bridging (0.7% vs 2.4%; P < .001). Groups did not differ significantly by sex, BMI, or donor characteristics. Propensity matching resulted in 2,539 patients in each group. On matched analysis, patients undergoing SLT had shorter lengths of stay (14 days vs 18 day), lower reintubation rates (14.7% vs 19.8%), and less postoperative dialysis use (4.2% vs 6.4%; P < .001 for all). Patients who underwent SLT had comparable survival at 30 days (97.6% vs 97.3%; P = .414) and 1 year (85.5% vs 86.3%; P = .496), but lower survival at 5 years (45.4% vs 53.4%; P < .001) on matched analysis. SLT was a risk factor for 5-year mortality (adjusted hazard ratio, 1.19; P < .001).</p><p><strong>Interpretation: </strong>In older adults, SLT is associated with less morbidity and comparable early survival relative to BLT, but lower 5-year survival. SLT is reasonable to perform in older adults at high risk of not tolerating BLT.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145289","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 Dyspnea on Adults With Respiratory Symptoms Without a Defined Diagnosis.","authors":"Jared Bierbrier, Emily Gerstein, George A Whitmore, Katherine L Vandemheen, Celine Bergeron, Louis-Philippe Boulet, Andreanne Cote, Stephen K Field, Erika Penz, R Andrew McIvor, Catherine Lemière, Samir Gupta, Paul Hernandez, Irvin Mayers, Mohit Bhutani, M Diane Lougheed, Christopher J Licskai, Tanweer Azher, Nicole Ezer, Martha Ainslie, Gonzalo G Alvarez, Sunita Mulpuru, Shawn D Aaron","doi":"10.1016/j.chest.2024.07.183","DOIUrl":"10.1016/j.chest.2024.07.183","url":null,"abstract":"<p><strong>Background: </strong>We investigated dyspnea; its associated risk factors; and its impact on health care utilization, quality of life, and work productivity in adults with undiagnosed respiratory symptoms.</p><p><strong>Research question: </strong>What is the impact of dyspnea in adults with undiagnosed respiratory symptoms?</p><p><strong>Study design and methods: </strong>This population-based study included 2,857 adults who were experiencing respiratory symptoms. These individuals had not been previously diagnosed with any lung conditions and were recruited from 17 Canadian centers using random digit dialing. Each participant underwent spirometry testing both before and after using a bronchodilator to determine if they met the diagnostic criteria for COPD, asthma, or preserved ratio impaired spirometry (PRISm), or if their spirometry results were normal. An age-matched control group (n = 231) was similarly recruited using random digit dialing. A dyspnea impact assessment score from 0 to 100 was produced using questions from the COPD Assessment Test and St. George's Respiratory questionnaire.</p><p><strong>Results: </strong>Individuals with PRISm (n = 172) reported more impactful dyspnea (mean score, 63.0; 95% CI, 59.5-66.4) than those with undiagnosed asthma (n = 265; mean score, 56.6; 95% CI, 53.9-59.3) or undiagnosed COPD (n = 330; mean score, 57.5; 95% CI, 55.1-59.9). All groups reported significantly more impactful dyspnea than the control group (mean score, 13.8; 95% CI, 11.8-15.7). Patient-specific risk factors including age, sex, BMI, smoking, and comorbidities explained 20.6% of the variation in dyspnea. An additional 12.4% of the variation was explained by disease classification and another 1.7% by the severity of lung function impairment assessed with spirometry. After adjusting for age, sex, and BMI, greater dyspnea impact was associated with increased health care utilization, lower quality of life, and reduced work productivity.</p><p><strong>Interpretation: </strong>Our findings showed that in community-based adults with undiagnosed respiratory symptoms, those identified with PRISm experienced the greatest impact of dyspnea. Dyspnea imposes burdens on the health care system and is associated with impaired quality of life and work productivity.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145288","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 Arterial Pressure Measurements at the Lower Leg: Evaluation of the Influence of Patient Position (Semi-Recumbent or Horizontal)-A prospective study.","authors":"Karim Lakhal, Alexia Audran, Gurvan Normand, Bertrand Rozec, Jérôme E Dauvergne, Thierry Boulain","doi":"10.1016/j.chest.2024.08.042","DOIUrl":"10.1016/j.chest.2024.08.042","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139444","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":"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":"<p><strong>Background: </strong>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.</p><p><strong>Research question: </strong>Do distinct post-PE dyspnea physiologic phenotypes exist that are described with iCPET?</p><p><strong>Study design and methods: </strong>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 (VO₂).</p><p><strong>Results: </strong>One hundred seventy-three patients were enrolled. Sixty-seven patients underwent iCPET. All patients showed reductions in peak VO₂ 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.</p><p><strong>Interpretation: </strong>iCPET revealed significant heterogeneity in post-PE dyspnea. Three phenotypes are characterized by differences in RV afterload: ventilatory efficiency, respiratory mechanics, and peripheral oxygen use.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-09-03","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}

{"title":"Performance of Risk Assessment Models for VTE in Patients Who Are Critically Ill Receiving Pharmacologic Thromboprophylaxis: A Post Hoc Analysis of the Pneumatic Compression for Preventing VTE Trial.","authors":"Hasan M Al-Dorzi, Hatim Arishi, Fahad M Al-Hameed, Karen E A Burns, Sangeeta Mehta, Jesna Jose, Sami J Alsolamy, Sheryl Ann I Abdukahil, Lara Y Afesh, Mohammed S Alshahrani, Yasser Mandourah, Ghaleb A Almekhlafi, Mohammed Almaani, Ali Al Bshabshe, Simon Finfer, Zia Arshad, Imran Khalid, Yatin Mehta, Atul Gaur, Hassan Hawa, Hergen Buscher, Hani Lababidi, Abdulsalam Al Aithan, Abdulaziz Al-Dawood, Yaseen M Arabi","doi":"10.1016/j.chest.2024.07.182","DOIUrl":"10.1016/j.chest.2024.07.182","url":null,"abstract":"<p><strong>Background: </strong>The diagnostic performance of the available risk assessment models for VTE in patients who are critically ill receiving pharmacologic thromboprophylaxis is unclear.</p><p><strong>Research question: </strong>For patients who are critically ill receiving pharmacologic thromboprophylaxis, do risk assessment models predict who would develop VTE or who could benefit from adjunctive pneumatic compression for thromboprophylaxis?</p><p><strong>Study design and methods: </strong>In this post hoc analysis of the Pneumatic Compression for Preventing VTE (PREVENT) trial, different risk assessment models for VTE (ICU-VTE, Kucher, Intermountain, Caprini, Padua, and International Medical Prevention Registry on VTE [IMPROVE] models) were evaluated. Receiver-operating characteristic curves were constructed, and the sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated. In addition, subgroup analyses were performed evaluating the effect of adjunctive pneumatic compression vs none on the study primary outcome.</p><p><strong>Results: </strong>Among 2,003 patients receiving pharmacologic thromboprophylaxis, 198 (9.9%) developed VTE. With multivariable logistic regression analysis, the independent predictors of VTE were Acute Physiology and Chronic Health Evaluation II score, prior immobilization, femoral central venous catheter, and invasive mechanical ventilation. All risk assessment models had areas under the curve < 0.60 except for the Caprini model (0.64; 95% CI, 0.60-0.68). The Caprini, Padua, and Intermountain models had high sensitivity (> 85%) but low specificity (< 20%) for predicting VTE, whereas the ICU-VTE, Kucher, and IMPROVE models had low sensitivities (< 15%) but high specificities (> 85%). The positive predictive value was low (< 20%) for all studied cutoff scores, whereas the negative predictive value was mostly > 90%. Using the risk assessment models to stratify patients into high- vs low-risk subgroups, the effect of adjunctive pneumatic compression vs pharmacologic prophylaxis alone did not differ across the subgroups (P_interaction > .05).</p><p><strong>Interpretation: </strong>The risk assessment models for VTE performed poorly in patients who are critically ill receiving pharmacologic thromboprophylaxis. None of the models identified a subgroup of patients who might benefit from adjunctive pneumatic compression.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT02040103; URL: www.</p><p><strong>Clinicaltrials: </strong>gov. ISRCTN44653506.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142131933","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}