Chest最新文献

{"title":"Effect of Admilparant, an LPA1 Antagonist, on Disease Progression in Pulmonary Fibrosis.","authors":"Michael Kreuter,Toby M Maher,Wim A Wuyts,Claudia Valenzuela,Mark Hamblin,Sinae Kim,Aditya Patel,Brandon Elpers,Luca Richeldi","doi":"10.1016/j.chest.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.chest.2025.04.003","url":null,"abstract":"BACKGROUNDIdiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) are chronic fibrosing interstitial lung diseases associated with irreversible loss of lung function and early mortality. Admilparant (BMS-986278) is an oral lysophosphatidic acid receptor 1 (LPA1) antagonist under development for treatment of IPF and PPF.RESEARCH QUESTIONHow does admilparant affect time to disease progression in patients with IPF or PPF?STUDY DESIGN AND METHODSIn a phase 2, randomized, double-blind, placebo-controlled study, parallel cohorts of patients with IPF or PPF were randomized separately 1:1:1 to receive 30-mg admilparant, 60-mg admilparant, or placebo twice daily for 26 weeks; background antifibrotics were allowed. The effect of admilparant vs placebo on time to disease progression was assessed post hoc. Disease progression was defined as a composite of relative decline of ≥10% in percentage of predicted forced vital capacity (ppFVC), acute exacerbation, all-cause hospitalization, and all-cause mortality. Subgroup analyses were performed based on median ppFVC at baseline. A Kaplan-Meier product-limit approach assessed time to first event of disease progression over 26 weeks.RESULTSIn total, 255 patients with IPF and 114 patients with PPF were included. Median ppFVC at baseline was 77.3% and 64.7% in the IPF and PPF cohorts, respectively. Treatment with 60-mg admilparant delayed time to disease progression over 26 weeks compared with placebo in both cohorts of patients (IPF: hazard ratio, 0.54 [95% CI, 0.31-0.95]; PPF: hazard ratio, 0.41 [95% CI, 0.18-0.90]). A similar trend was observed in the subgroup analysis of patients with ppFVC at baseline either below or above the median value. In both cohorts, the most frequent first event was relative decline of ≥10% in ppFVC; no deaths were reported as first progression events.INTERPRETATIONThese findings support further evaluation of admilparant as a therapeutic option for patients with IPF or PPF in phase 3 trials.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"101 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822756","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":"Effect of Ventilator Mode on Ventilator-Free Days in Critically Ill Adults: A Randomized Clinical Trial.","authors":"Kevin P Seitz, Bradley D Lloyd, Li Wang, Matthew S Shotwell, Edward T Qian, Amelia L Muhs, Roger K Richardson, J Craig Rooks, Vanessa Hennings-Williams, Claire E Sandoval, Whitney D Richardson, Tracy L Morgan, Amber N Thompson, Pamela G Hastings, Terry P Ring, Joanna L Stollings, Erica M Talbot, David J Krasinski, Bailey R DeCoursey, Tanya K Marvi, Stephanie C DeMasi, Kevin W Gibbs, Wesley H Self, Amanda S Mixon, Todd W Rice, Matthew W Semler, Jonathan D Casey","doi":"10.1016/j.chest.2025.03.024","DOIUrl":"10.1016/j.chest.2025.03.024","url":null,"abstract":"<p><strong>Background: </strong>Whether the choice of ventilator mode affects outcomes for critically ill patients is unknown.</p><p><strong>Research question: </strong>What are the effects of 3 common ventilator modes (volume control vs pressure control vs adaptive pressure control) on death and duration of mechanical ventilation among critically ill adults?</p><p><strong>Study design and methods: </strong>We conducted a pragmatic, cluster-randomized, crossover pilot trial among adults receiving invasive mechanical ventilation in a medical ICU between November 1, 2022, and July 31, 2023. Each month, patients in the participating unit were assigned to receive volume control, pressure control, or adaptive pressure control during continuous mandatory ventilation. The primary outcome was ventilator-free days through 28 days.</p><p><strong>Results: </strong>Among 566 patients included in the primary analysis, the median proportion of ventilator mode assessments in the assigned mode during the first 72 hours was 100% in each group. The median number of ventilator-free days was 23 days (interquartile range [IQR], 0-26 days) in the volume control group, 22 days (IQR, 0-26 days) in the pressure control group, and 24 days (IQR, 0-26 days) in the adaptive pressure control group (P = .60). The median tidal volume was similar among the 3 groups, but the percentage of breaths > 8 mL/kg of predicted body weight differed among the volume control (median, 4.0% [IQR, 0.0%-14.1%]), pressure control (median, 10.6% [IQR, 0.0%-31.5%]), and adaptive pressure control (median, 4.7% [IQR, 0.0%-19.2%]) groups.</p><p><strong>Interpretation: </strong>This pilot trial established the feasibility of conducting a cluster-randomized crossover trial of ventilator mode among critically ill adults receiving invasive mechanical ventilation and demonstrated differences in intermediate outcomes that warrant further investigation in a larger trial.</p><p><strong>Clinical trial regristation: </strong>ClinicalTrials.gov; No.: NCT05563779; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794613","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":"Investigating the Long-Term Effects of COVID-19 Infection on Health Care Utilization in Individuals With COPD.","authors":"Joseph Munn, Peter Austin, Clare Atzema, Stacey Butler, Candace McNaughton, Xuesong Wang, Andrea S Gershon","doi":"10.1016/j.chest.2025.02.043","DOIUrl":"10.1016/j.chest.2025.02.043","url":null,"abstract":"<p><strong>Background: </strong>Individuals with COPD are at elevated risk of severe outcomes following COVID-19 infection.</p><p><strong>Research question: </strong>Does COVID-19 have a long-term impact on health care utilization (HCU) for individuals with COPD?</p><p><strong>Study design and methods: </strong>This retrospective matched cohort study was conducted by using health administrative data from Ontario, Canada, between April 2020 and June 2022. Individuals with physician-diagnosed COPD who underwent COVID-19 polymerase chain reaction (PCR) testing were included. Patients positive and negative for COVID-19 were matched on age, sex, vaccination status, PCR test date, and a propensity score. Patients were followed up from the end of the acute infection period (12 weeks' post-PCR) until the study end date. Per-person per-year HCU rates were captured and compared. Analyses were stratified according to COVID-19 variant eras (Wild-Type/Alpha/Beta, Delta, and Omicron) and vaccination status (0, 1, 2, and ≥ 3).</p><p><strong>Results: </strong>A total of 31,540 matched pairs were identified. Mean age was 66.4 years, and 49.9% were male. Individuals with positive COVID-19 test results had 9% higher HCU rates than those who tested negative (rate ratio [RR], 1.09; 95% CI, 1.067-1.127). Stratifying according to variant, Wild-Type/Alpha/Beta and Omicron variants had 16% (RR, 1.16; 95% CI, 1.119-1.22) and 5% (RR, 1.051; 95% CI, 1.01-1.092) higher HCU rates, respectively. Individuals with ≥ 3 vaccinations did not have elevated rates of HCU (RR, 1.03; 95% CI, 0.981-1.081) compared with those who tested negative.</p><p><strong>Interpretation: </strong>Patients with COPD who were positive for COVID-19 had significantly greater long-term HCU usage. Although Omicron has been considered milder than previous variants, it was still associated with significantly elevated long-term HCU. Individuals with ≥ 3 vaccinations who tested positive for COVID-19 had HCU rates similar to those who tested negative, suggesting that vaccinations can reduce long-term HCU.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787989","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":"Patterns and Differences in Lung Cancer Treatment: United States, 2015-2020.","authors":"Christine M Kava, David A Siegel, Jin Qin, Susan A Sabatino, Reda Wilson, Manxia Wu","doi":"10.1016/j.chest.2024.10.033","DOIUrl":"10.1016/j.chest.2024.10.033","url":null,"abstract":"<p><strong>Background: </strong>Treatment for lung cancer can improve prognosis, but 5-year survival remains low at 26%. An examination of treatment using data with higher population coverage, and among a broader number of treatment modalities and individual characteristics, would provide greater insight into differences in lung cancer treatment.</p><p><strong>Research question: </strong>Among adults diagnosed with lung cancer, how does reported receipt of lung cancer treatment differ by sociodemographic characteristics?</p><p><strong>Study design and methods: </strong>We used 2015-2020 National Program of Cancer Registry data covering 89% of the US population to describe first-course treatment among people aged ≥ 20 years and diagnosed with lung and bronchus cancer. We performed multivariable logistic regression to examine associations between sociodemographic characteristics and treatment received.</p><p><strong>Results: </strong>Among 1,068,155 people diagnosed with lung cancer, 22% received surgery, 41% received chemotherapy, 40% received radiation, 13% received immunotherapy, and 75% received at least one of the four treatments. People who were aged ≥ 45 years (OR range, 0.08-0.67); were of American Indian or Alaska Native (OR, 0.82; 95% CI, 0.77-0.87), Black (OR, 0.82; 95% CI, 0.81-0.84), or Hispanic (OR, 0.80; 95% CI, 0.78-0.82) race/ethnicity; resided in a nonmetropolitan county (OR, 0.98; 0.96-0.99); resided in the bottom 25% (OR, 0.80; 95% CI, 0.78-0.81) and middle 50% (OR, 0.87; 95% CI, 0.86-0.88) of counties by economic status (considers unemployment rate, per capita market income, and poverty rate); and in the West US census region (OR, 0.95; 95% CI, 0.94-0.97) had significantly lower odds of receiving at least 1 of the 4 treatments.</p><p><strong>Interpretation: </strong>Chemotherapy and radiation were the most common types of first-course treatment reported. Receipt of at least one of the four treatments examined was lower among several groups, including certain racial and ethnic groups and those residing in counties with lower economic status. Future studies might further identify and intervene on factors underlying differences.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1218-1231"},"PeriodicalIF":9.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11985310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leveraging Patient Advocacy and Faith-Based Partnerships to Educate, Activate, and Prepare Black Communities to Be Screened for Lung Cancer.","authors":"Sydney J Lloyd, Kathy A Levy, Alana S Boyd, Joelle T Fathi","doi":"10.1016/j.chest.2024.11.030","DOIUrl":"10.1016/j.chest.2024.11.030","url":null,"abstract":"<p><p>Lung cancer is the second most common and the deadliest cancer for men and women in the United States. Historical and current-day injustices, implicit and explicit bias, stigma, social determinants, and disparities contribute to inequitable lung cancer-related health outcomes for Black people comparatively. Despite being a preventive health recommendation for more than a decade, the percentage of eligible individuals screened remains low. Burgeoning lung cancer screening programs have established capacity and opened access across the country, but screening rates remain exceedingly poor, especially among people of color. More intentional efforts must be made and socially conscious and population-specific methods must be undertaken to ensure all eligible individuals realize the benefits of screening. Partnerships between advocacy organizations for patients with lung cancer and faith-based organizations are a natural leverage point to educate, prepare, and empower Black health ministries to disseminate lung cancer-related health information to their faith communities. This How I Do It article shares an approach to community outreach and engagement in Black churches in the South, informed by established principles and best practices and the perspectives and skills only lived experiences can offer.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1243-1251"},"PeriodicalIF":9.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791179","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":"Prophylactic Antibiotics in Adults With Acute Brain Injury Who Are Invasively Ventilated in the ICU: A Systematic Review and Meta-Analysis.","authors":"Kathryn Hadley-Brown, Laura Hailstone, Roisin Devane, Tak Chan, Anthony Devaux, Joshua S Davis, Naomi Hammond, Qiang Li, Edward Litton, John Myburgh, Alexis Poole, Joseph Santos, Ian Seppelt, Steven Y C Tong, Andrew Udy, Balasubramanian Venkatesh, Paul J Young, Anthony P Delaney","doi":"10.1016/j.chest.2024.10.031","DOIUrl":"10.1016/j.chest.2024.10.031","url":null,"abstract":"<p><strong>Background: </strong>Lower respiratory tract infections are common in patients receiving invasive mechanical ventilation in an ICU after an acute brain injury and may have deleterious consequences.</p><p><strong>Research question: </strong>In adults with acute brain injury receiving invasive mechanical ventilation in an ICU, is the administration of prophylactic parenteral antibiotics, compared with placebo or usual care, associated with reduced mortality?</p><p><strong>Study design and methods: </strong>We conducted a systematic review and meta-analysis. We searched for randomized clinical trials in electronic databases, as well as unpublished trials. The primary outcome was hospital mortality, and secondary outcomes included the incidence of ventilator-associated pneumonia, ICU length of stay, and duration of mechanical ventilation. We used a random effects model to estimate the pooled risk ratio (RR) with corresponding 95% CI for binary outcomes and the mean difference (MD) with 95% CI for continuous outcomes. Certainty of evidence was evaluated using Grading of Recommendations Assessment Development and Evaluation methods.</p><p><strong>Results: </strong>One thousand seven hundred twenty-eight reports of studies were screened, with 7 randomized controlled trials recruiting 835 participants included. No trials were adjudicated as having a high risk of bias. The pooled estimated RR for mortality associated with the use of prophylactic antibiotics was 0.91 (95% CI, 0.70-1.17; P = .39; low certainty). The pooled estimated RR for ventilator-associated pneumonia was 0.56 (95% CI, 0.35-0.89; low certainty). The pooled estimated duration of mechanical ventilation for those allocated to prophylactic antibiotics compared with control participants (MD, -2.0 days; 95% CI, -6.1 to 2.1 days; very low certainty) and duration of ICU admission (MD, -2.2 days; 95% CI, -5.4 to 1.1 days; very low certainty) were similar.</p><p><strong>Interpretation: </strong>Current evidence from randomized clinical trials does not provide definitive evidence regarding the effect of prophylactic antibiotics on mortality in patients receiving invasive mechanical ventilation in the ICU.</p><p><strong>Clinical trial registry: </strong>International Prospective Register of Systematic Reviews; No.: CRD42023424732; URL: https://www.crd.york.ac.uk/prospero/.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1079-1089"},"PeriodicalIF":9.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567377","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":"Are Ground-Glass Nodules Sleeper Cells?","authors":"Mark M Hammer","doi":"10.1016/j.chest.2024.11.002","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.002","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 4","pages":"939-940"},"PeriodicalIF":9.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982168","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":"Having a \"Peek\" at Inhalation Techniques in COPD.","authors":"François Maltais, Andréanne Côté","doi":"10.1016/j.chest.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.chest.2025.01.006","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 4","pages":"920-922"},"PeriodicalIF":9.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976104","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":"Do Sex Disparities Impact Follower Perceptions of Leadership Styles During Clinical Emergencies?","authors":"Anupama Goyal, Stephanie Taylor","doi":"10.1016/j.chest.2024.11.034","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.034","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 4","pages":"e145-e146"},"PeriodicalIF":9.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981617","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":"Central Venous Minus Arterial CO₂ Partial Pressure and Its Ratio to Arterial Minus Central Venous Oxygen Content Are Misleading Surrogates for Tissue Perfusion and Oxygenation.","authors":"Arnaldo Dubin, Mario O Pozo","doi":"10.1016/j.chest.2024.12.004","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.004","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 4","pages":"923-925"},"PeriodicalIF":9.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977951","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}