Chest最新文献

{"title":"Impact of Empirical Treatment Recommendations From 2017 European Guidelines for Nosocomial Pneumonia.","authors":"Davide Calabretta, Catia Cilloniz, Albert Gabarrus, Ana Motos, Flavia Galli, Miquel Ferrer, Laia Fernandez-Barat, Andrea Palomeque, Giovanni Mistraletti, Mauro Panigada, Cristina Pitart, Mateu Espasa, Ignacio Martin-Loeches, Antoni Torres","doi":"10.1016/j.chest.2024.10.021","DOIUrl":"10.1016/j.chest.2024.10.021","url":null,"abstract":"<p><strong>Background: </strong>The management of nosocomial pneumonia represents a major challenge in the ICU. European guidelines from 2017 proposed an algorithm for the prescription of empirical antimicrobial treatment based on medical history, local ecology, and severity (ie, presence or absence of septic shock). We assessed this algorithm's usefulness by comparing outcomes with and without guideline adherence in a population at high risk of multiresistance and mortality.</p><p><strong>Research question: </strong>Are the recommendations of the latest European guidelines effective in reducing the incidence of adverse outcomes in patients with nosocomial pneumonia admitted to the ICU?</p><p><strong>Study design and methods: </strong>We retrospectively analyzed data from a prospective cohort of 507 patients from 6 ICUs in our center. To minimize bias, we only included patients with microbiologically confirmed pneumonia. The primary outcome was 28-day mortality. Secondary outcomes were 90-day mortality, ICU mortality, inadequate treatment, treatment failure, and overtreatment.</p><p><strong>Results: </strong>In total, 315 patients met the inclusion criteria. Outcomes were comparable in the groups with and without guideline adherence, except for overtreatment, which was higher when guidelines were followed (42.5% vs 66.3%; P < .001). In the subgroup without septic shock treated according to guidelines, reductions were noted in both ICU mortality (28.8% vs 14.5%; P = .031) and adjusted 28-day mortality (hazard ratio, 3.07; 95% CI, 1.13-7.85; P = .027). By contrast, no benefit was observed when patients presented with septic shock at diagnosis.</p><p><strong>Interpretation: </strong>The European guideline treatment algorithm has proven to be effective in reducing mortality in patients without septic shock but not in those with septic shock at the time of diagnosis. Future studies should clarify whether adjustments need to be made to improve outcomes in patients with septic shock.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495983","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":"Clinical and Prognostic Differences in Mild to Moderate COPD With and Without Emphysema.","authors":"Huajing Yang, Yuqiong Yang, Fengyan Wang, Chengyu Miao, Zizheng Chen, Shanshan Zha, Xueping Li, Jiawei Chen, Aiqi Song, Rongchang Chen, Zhenyu Liang","doi":"10.1016/j.chest.2024.10.020","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.020","url":null,"abstract":"<p><strong>Background: </strong>The clinical and prognostic characteristics of mild-to-moderate chronic obstructive pulmonary disease (COPD) with and without emphysema remain inadequately investigated.</p><p><strong>Research question: </strong>Do the clinical and prognostic characteristics differ between mild- to-moderate COPD with and without emphysema?</p><p><strong>Study design and methods: </strong>We obtained clinical data of 989 participants with mild-to-moderate COPD from the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). They were categorized into two groups based on their baseline %LAA_-950 of less than 5% on CT scans: those with emphysema (EC group) and those without emphysema (NEC group). Linear mixed-effects models were utilized to assess the differences in the decline of lung function, health-related quality of life, and quantitative CT indices between these two groups. Zero-inflated negative binomial regressions were employed to evaluate the rates of acute respiratory exacerbations between the groups.</p><p><strong>Results: </strong>Among participants with mild-to-moderate COPD, 428 (43.3%) exhibited emphysema on CT scans. The annual decline in FEV₁ was -56.1 mL/year for the EC group and -46.9 mL/year for the NEC group, with a non-significant between-group difference of 9.1 mL/year (95% CI, -24.0 to 5.7 mL/year). The rate of emphysema progression in the EC group was significantly lower than in the NEC group (-0.173%; 95% CI, -0.252 to -0.094). The EC group also showed a more pronounced annual increase in the SGRQ score (0.9 points) compared to the NEC group. The EC group had a higher rate of acute respiratory exacerbations (0.36 per person-year) than the NEC group (0.25 per person-year), with a rate ratio of 1.42 (95% CI, 1.27 to 1.54).</p><p><strong>Interpretation: </strong>Mild-to-moderate COPD with emphysema did not have accelerated rates of decline in FEV₁, but they experienced significantly worsen health-related quality of life and a higher rate of acute respiratory exacerbations. The non-emphysema subtype demonstrated increased emphysema progression.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495982","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":"Association Between Thrombus Histopathology and Hemodynamic Outcomes Among Patients With Chronic Thromboembolic Pulmonary Hypertension Undergoing Pulmonary Endarterectomy.","authors":"Louisa A Mounsey, Daniel Alape Moya, Cameron Wright, Nathaniel Langer, James R Stone, Richard Channick, Alexandra K Wong, Josanna Rodriguez-Lopez, Alison S Witkin","doi":"10.1016/j.chest.2024.10.018","DOIUrl":"10.1016/j.chest.2024.10.018","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). Although most have normalization of pulmonary artery (PA) pressures, development of residual pulmonary hypertension (RPH) is challenging to predict.</p><p><strong>Research question: </strong>Among patients with CTEPH undergoing PEA, is there a relationship between specimen histopathology and postoperative hemodynamics?</p><p><strong>Study design and methods: </strong>In this single-center retrospective cohort study, patients with CTEPH who underwent PEA were classified by thrombus chronicity: organized (chronic), organizing (subacute), or mixed (combined organizing and organized). Change in mean PA pressure, pulmonary vascular resistance (PVR), and transpulmonary gradient (TPG) were examined by thrombus organization. Associations with RPH were assessed with multivariable logistic regression.</p><p><strong>Results: </strong>A total of 163 patients were identified: 34% had organized thrombi, 17% had organizing thrombi, and 49% had mixed thrombi. Pre-PEA mean TPG and PVR were highest in the mixed group (TPG: 37 mm Hg [29-42]; PVR: 8.7 Wood units [interquartile range (IQR), 5.6-11.2]) compared with the organized (TPG: 30 mm Hg [24-38]; PVR: 6.2 Wood units [IQR, 4.2-8.8]) and organizing (TPG: 24 mm Hg [19-37]; PVR: 4.2 Wood units [IQR, 3.5-9.2]) groups (TPG: P = .05; PVR: P = .01). The adjusted change in mean PA pressure among the mixed group was -19.8 mm Hg (-21.7 to -17.8), significantly greater than -16.2 mm Hg (-18.4 to -14.1) in the organized group and -14.1 mm Hg (-17.3 to -10.9) in the organizing group (P = .004). Fifty-two patients (32%) had RPH. Mixed thrombus organization was associated with lower odds of RPH (OR, 0.35; 95% CI, 0.14-0.85; P = .02), whereas preoperative mean PA pressure (OR, 1.10; 95% CI, 1.06-1.16; P < .001) and age (OR, 1.04; 95% CI, 1.01-1.07; P = .02) were associated with higher odds of RPH.</p><p><strong>Interpretation: </strong>Patients with mixed thrombi were less likely to have RPH, suggesting there may be an optimum time to perform PEA after the clot has mostly organized, but prior to development of irreversible small vessel disease.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495981","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":"A Comparison of GOLD and STAR Severity Stages in Individuals With COPD Undergoing Pulmonary Rehabilitation.","authors":"Pasquale Ambrosino, Michele Vitacca, Giuseppina Marcuccio, Antonio Spanevello, Nicolino Ambrosino, Mauro Maniscalco","doi":"10.1016/j.chest.2024.10.013","DOIUrl":"10.1016/j.chest.2024.10.013","url":null,"abstract":"<p><strong>Background: </strong>Alongside the recognized Global Initiative for Obstructive Lung Disease (GOLD) classification, the Staging of Airflow Obstruction by Ratio (STAR) severity scheme has been proposed for categorizing COPD.</p><p><strong>Study question: </strong>What are the agreement and utility of the GOLD and STAR classifications in patients with severe COPD entering the rehabilitation setting?</p><p><strong>Study design and methods: </strong>Medical records were reviewed in this multicenter retrospective study, examining key functional variables and their changes in a large cohort of patients with COPD undergoing pulmonary rehabilitation.</p><p><strong>Results: </strong>A total of 1,516 participants (33.7% female participants; median age, 72.0 years) were included in the analysis. Compared with GOLD, the use of the STAR classification resulted in a different disease severity category for 53.4% of patients. An unweighted Cohen's kappa of 0.25 and a Bangdiwala B value of 0.24 indicated a fair agreement between the 2 classifications. Higher weighted agreement measures (0.47 and 0.78, respectively) suggested that discrepancies between the classifications mainly occurred for contiguous stages. GOLD exhibited superior discrimination between stages for chronic respiratory failure, whereas STAR exhibited better performance in detecting hyperinflation. In terms of their application within pulmonary rehabilitation settings, GOLD exhibited superior performance compared with STAR in identifying the minimal clinically important difference in 6-minute walking distance and modified Medical Research Council score. Accordingly, GOLD but not STAR acted as an independent predictor for achieving a minimal clinically important difference in modified Medical Research Council score (OR, 1.48; 95% CI, 1.12-1.94; P = .005) and also independently predicted changes in the Braden scale score (β = 0.154; P = .004).</p><p><strong>Interpretation: </strong>STAR exhibits a more uniform gradation of disease severity and enhanced performance in detecting hyperinflation, but our preliminary findings do not endorse its utilization in the rehabilitation setting.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":11.3,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459119","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":"A one-year weight management programme for difficult-to-treat asthma with obesity: a randomised controlled study.","authors":"Varun Sharma, Helen Clare Ricketts, Louise McCombie, Naomi Brosnahan, Luisa Crawford, Lesley Slaughter, Anna Goodfellow, Femke Steffensen, Rekha Chaudhuri, Michael E J Lean, Douglas C Cowan","doi":"10.1016/j.chest.2024.09.042","DOIUrl":"https://doi.org/10.1016/j.chest.2024.09.042","url":null,"abstract":"<p><strong>Background: </strong>Obesity-associated asthma results in increased morbidity and mortality. We report one-year asthma outcomes with the Counterweight-Plus weight management programme (CWP) compared to usual care (UC) in a single-centre, randomised, controlled trial in patients with difficult-to-treat asthma and obesity.</p><p><strong>Research question: </strong>Can CWP use result in improved asthma control and quality of life compared to UC at one-year in patients with difficult-to-treat asthma and obesity?</p><p><strong>Study design and methods: </strong>We randomised (1:1 CWP:UC) adults with difficult-to-treat asthma and body mass index ≥30kg/m². CWP with dietitian support: 12-week total diet replacement phase (850kcal/day low-energy formula); food reintroduction and maintenance phases up to one-year. Outcomes include Asthma Control Questionnaire (ACQ-6), Asthma Quality of Life Questionnaire (AQLQ) and healthcare usage. Minimal clinically important difference (MCID) is 0.5 for ACQ-6 and AQLQ.</p><p><strong>Results: </strong>Of 36 recruited, 29 attended at 52-weeks: 13 CWP, 16 UC. CWP resulted in greater weight change (median -14kg [IQR -15, -9]) compared to UC (2kg [-7, 8]; p=0.015) at 52-weeks. A greater proportion achieved MCID with CWP vs UC in AQLQ (71% vs 6% respectively; p<0.001). No between-group differences were observed in ACQ-6. Median exacerbation frequency reduced over 52-weeks with CWP from 4 (IQR 2, 5) to 0 (0, 2) (p<0.001), though no between-group difference was observed. 70% of the CWP group lost ≥10% body weight and had improvement in ACQ-6 (mean difference -1.1, 95%CI -1.9, -0.3; p=0.018) and AQLQ (1.2, 95%CI 0.4, 2.1; p=0.011) across 52-weeks.</p><p><strong>Interpretation: </strong>Use of a dietitian-supported weight management programme results in sustained weight-loss and is a potential treatment for obesity in asthma. CWP resulted in a higher proportion achieving MCID improvement in AQLQ compared to UC. Within group differences in AQLQ and exacerbation frequency suggest potential with CWP. These encouraging signals justify a larger sample study to further assess asthma-related outcomes.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459132","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":"A one-year weight management programme for difficult-to-treat asthma with obesity: a randomised controlled study.","authors":"Varun Sharma,Helen Clare Ricketts,Louise McCombie,Naomi Brosnahan,Luisa Crawford,Lesley Slaughter,Anna Goodfellow,Femke Steffensen,Rekha Chaudhuri,Michael E J Lean,Douglas C Cowan","doi":"10.1016/j.chest.2024.09.042","DOIUrl":"https://doi.org/10.1016/j.chest.2024.09.042","url":null,"abstract":"BACKGROUNDObesity-associated asthma results in increased morbidity and mortality. We report one-year asthma outcomes with the Counterweight-Plus weight management programme (CWP) compared to usual care (UC) in a single-centre, randomised, controlled trial in patients with difficult-to-treat asthma and obesity.RESEARCH QUESTIONCan CWP use result in improved asthma control and quality of life compared to UC at one-year in patients with difficult-to-treat asthma and obesity?STUDY DESIGN AND METHODSWe randomised (1:1 CWP:UC) adults with difficult-to-treat asthma and body mass index ≥30kg/m2. CWP with dietitian support: 12-week total diet replacement phase (850kcal/day low-energy formula); food reintroduction and maintenance phases up to one-year. Outcomes include Asthma Control Questionnaire (ACQ-6), Asthma Quality of Life Questionnaire (AQLQ) and healthcare usage. Minimal clinically important difference (MCID) is 0.5 for ACQ-6 and AQLQ.RESULTSOf 36 recruited, 29 attended at 52-weeks: 13 CWP, 16 UC. CWP resulted in greater weight change (median -14kg [IQR -15, -9]) compared to UC (2kg [-7, 8]; p=0.015) at 52-weeks. A greater proportion achieved MCID with CWP vs UC in AQLQ (71% vs 6% respectively; p<0.001). No between-group differences were observed in ACQ-6. Median exacerbation frequency reduced over 52-weeks with CWP from 4 (IQR 2, 5) to 0 (0, 2) (p<0.001), though no between-group difference was observed. 70% of the CWP group lost ≥10% body weight and had improvement in ACQ-6 (mean difference -1.1, 95%CI -1.9, -0.3; p=0.018) and AQLQ (1.2, 95%CI 0.4, 2.1; p=0.011) across 52-weeks.INTERPRETATIONUse of a dietitian-supported weight management programme results in sustained weight-loss and is a potential treatment for obesity in asthma. CWP resulted in a higher proportion achieving MCID improvement in AQLQ compared to UC. Within group differences in AQLQ and exacerbation frequency suggest potential with CWP. These encouraging signals justify a larger sample study to further assess asthma-related outcomes.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"82 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486353","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":"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":"<p><strong>Background: </strong>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.</p><p><strong>Research question: </strong>Identify perspectives of ICU clinicians on the value of the GTKMB in caring for ICU patients.</p><p><strong>Study design and methods: </strong>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.</p><p><strong>Results: </strong>We interviewed 38 participants in 6 focus groups including 10 nurses, 7 physicians, 6 advanced practice providers, 5 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.</p><p><strong>Interpretation: </strong>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.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":11.3,"publicationDate":"2024-10-18","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}

{"title":"Perspectives of clinicians on the value of the Get to Know Me board in the Intensive Care Unit.","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":"https://doi.org/10.1016/j.chest.2024.10.016","url":null,"abstract":"BACKGROUNDCritical illness can render patients at heightened risk of anonymity, loss of dignity and dehumanization. As 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, yet its widespread adoption has been challenging.RESEARCH QUESTIONIdentify perspectives of ICU clinicians on the value of the GTKMB in caring for ICU patients.STUDY DESIGN AND METHODSThis qualitative study used focus groups conducted via videoconference. We recruited stakeholders from multiprofessional teams across different ICU settings at a large U.S. quaternary care center. Thematic content analysis approach was performed to identify key themes and concepts.RESULTSWe interviewed 38 participants in 6 focus groups including 10 nurses, 7 physicians, 6 advanced practice providers, 5 rehabilitation therapists, a respiratory therapist, and a social worker. Themes highlighted the role of the GTKMB in multiple domains including a) humanizing care of the critically ill, b) fostering communication, c) connecting with families and d) guiding and facilitating care processes. Several sub- themes were identified for each category.INTERPRETATIONThe 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":"1 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486316","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":"A Comparison of GOLD and STAR Severity Stages in Individuals with Chronic Obstructive Pulmonary Disease Undergoing Pulmonary Rehabilitation.","authors":"Pasquale Ambrosino,Michele Vitacca,Giuseppina Marcuccio,Antonio Spanevello,Nicolino Ambrosino,Mauro Maniscalco","doi":"10.1016/j.chest.2024.10.013","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.013","url":null,"abstract":"BACKGROUNDAlongside the recognized Global Initiative for Obstructive Lung Disease (GOLD) classification, the STaging of Airflow obstruction by Ratio (STAR) severity scheme has been proposed for categorizing chronic obstructive pulmonary disease (COPD).STUDY QUESTIONWhat is the agreement and utility of the GOLD and STAR classifications in severe COPD patients entering the rehabilitation setting?STUDY DESIGN AND METHODSMedical records were reviewed in this multicenter retrospective study, examining key functional variables and their changes in a large cohort of COPD patients undergoing pulmonary rehabilitation (PR).RESULTSA total of 1,516 participants (33.7% females, median age 72.0 years) were included in the analysis. Compared to GOLD, the use of the STAR classification resulted in a different disease severity category for 53.4% of patients. An unweighted Cohen's κ of 0.25 and a Bangdiwala B value of 0.24 revealed a fair agreement between the two classifications. Higher weighted agreement measures (0.47 and 0.78, respectively) suggested that discrepancies between the classifications mainly occurred for contiguous stages. GOLD demonstrated superior discrimination between stages for chronic respiratory failure, while STAR exhibited better performance in detecting hyperinflation. In terms of their application within PR settings, GOLD exhibited superior performance compared to STAR in identifying the minimal clinically important difference (MCID) in 6-minute walking distance and modified Medical Research Council (mMRC) score. Accordingly, GOLD but not STAR acted as an independent predictor for achieving a MCID in mMRC (OR: 1.48; 95% CI: 1.12-1.94; P=0.005) and also independently predicted changes in Braden score (β=0.154; P=0.004).INTERPRETATIONSTAR shows a more uniform gradation of disease severity and enhanced performance in detecting hyperinflation but our preliminary findings do not endorse its utilization in the rehabilitation setting.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"29 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486352","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 Perioperative Pulmonary Artery Catheter Use on Clinical Outcomes Following Cardiac Surgery: A Nationwide Cohort Study.","authors":"Jae-Woo Ju,Jaeyeon Chung,Gang Heo,Youn Joung Cho,Yunseok Jeon,Karam Nam","doi":"10.1016/j.chest.2024.10.008","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.008","url":null,"abstract":"BACKGROUNDEvidence on the effectiveness of pulmonary artery catheters (PACs) in cardiac surgery is scarce.RESEARCH QUESTIONDoes perioperative PAC use decrease on 1-year all-cause mortality in patients undergoing cardiac surgery?STUDY DESIGN AND METHODSThis nationwide, population-based cohort study included all adult patients who underwent cardiac surgery in Korea between January 2011 and December 2020 using a Korean health insurance claim database. We compared the primary outcome, the risk of 1-year all-cause mortality, between patients with and without perioperative use of PACs (PAC and no-PAC groups, respectively) using logistic regression analysis after stabilized inverse probability of treatment weighting. A subgroup analysis was performed to determine whether the association varied according to the type of cardiac surgery and institutional case volume.RESULTSA total of 61,405 patients were analyzed. The PAC group had a significantly lower risk of 1-year all-cause mortality than that in the no-PAC group (adjusted odds ratio [OR], 0.81; 95% confidence interval [CI], 0.76-0.86). In the subgroup analysis, both the type of cardiac surgery and institutional case volume were identified as significant modifiers (all P for interaction<0.001). Specifically, the PAC group had a significantly lower risk of 1-year all-cause mortality following isolated off-pump coronary artery bypass grafting (adjusted OR, 0.54; 95% CI, 0.48-0.61) compared to the no-PAC group. PAC use was associated with a significant reduction in the risk of 1-year all-cause mortality in the lowest-case volume centers (<100 cases/year; OR, 0.70; 95% CI, 0.65-0.76).INTERPRETATIONPerioperative use of PACs was associated with a significant reduction in the risk of postoperative 1-year all-cause mortality. This association was predominantly driven by patients who underwent off-pump coronary artery bypass grafting and those who underwent cardiac surgery in less experienced centers.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"67 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451799","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}