Chest最新文献

{"title":"The Burden of Air Pollution Exposure on Chronic Respiratory Disease.","authors":"Jesse D Berman, Arianne K Baldomero","doi":"10.1016/j.chest.2024.06.3778","DOIUrl":"https://doi.org/10.1016/j.chest.2024.06.3778","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"166 5","pages":"901-903"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615765","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":"Redefining Echocardiographic Pulmonary Artery Measurements: Insights Into the Presence of Pulmonary Hypertension.","authors":"Dinu V Balanescu, Garvan C Kane","doi":"10.1016/j.chest.2024.08.029","DOIUrl":"https://doi.org/10.1016/j.chest.2024.08.029","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"166 5","pages":"919-920"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615829","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":"Identifying the Best Method for Performing a Spontaneous Breathing Trial.","authors":"Pablo Cardinal-Fernández, Luis Collazo, Julio Villanueva","doi":"10.1016/j.chest.2024.07.153","DOIUrl":"https://doi.org/10.1016/j.chest.2024.07.153","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"166 5","pages":"904-905"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615805","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":"Lung Microbiome: How to Appreciate and Apply It to Clinical Practice.","authors":"Margaret Gleeson, Padraic Ridge, Imran Sulaiman","doi":"10.1016/j.chest.2024.06.3777","DOIUrl":"https://doi.org/10.1016/j.chest.2024.06.3777","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"166 5","pages":"925-927"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615814","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":"Liang En Wee, Janice Yu Jin Tan, Calvin J Chiew, John Arputhan Abisheganaden, Sanjay H Chotirmall, David Chien Boon Lye, Kelvin Bryan Tan","doi":"10.1016/j.chest.2024.06.3789","DOIUrl":"https://doi.org/10.1016/j.chest.2024.06.3789","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"166 5","pages":"e167-e168"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615834","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 Spontaneous Breathing Trial Methods and Reintubation in Adult Critically Ill Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.","authors":"Mariachiara Ippolito, Salvatore Sardo, Vincenzo Francesco Tripodi, Nicola Latronico, Elena Bignami, Antonino Giarratano, Andrea Cortegiani","doi":"10.1016/j.chest.2024.06.3773","DOIUrl":"10.1016/j.chest.2024.06.3773","url":null,"abstract":"<p><strong>Background: </strong>Reintubation is associated with higher risk of mortality. There is no clear evidence on the best spontaneous breathing trial (SBT) method to reduce the risk of reintubation.</p><p><strong>Research question: </strong>Are different methods of conducting SBTs in critically ill patients associated with different risk of reintubation compared with T-tube?</p><p><strong>Study design and methods: </strong>We conducted a systematic review and Bayesian network meta-analysis of randomized controlled trials investigating the effects of different SBT methods on reintubation. We surveyed PubMed, MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials databases from inception to January 26, 2024. The surface under the cumulative ranking curve (SUCRA) was used to determine the likelihood that an intervention was ranked as the best. Pairwise comparisons were also investigated by frequentist meta-analysis. Certainty of the evidence was assessed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach.</p><p><strong>Results: </strong>A total of 22 randomized controlled trials were included, for a total of 6,196 patients. The network included nine nodes, with 13 direct pairwise comparisons. About 71% of the patients were allocated to T-tube and pressure support ventilation without positive end-expiratory pressure, with 2,135 and 2,101 patients, respectively. The only intervention with a significantly lower risk of reintubation compared with T-tube was high-flow oxygen (HFO) (risk ratio, 0.23; 95% credibility interval, 0.09-0.51; moderate quality evidence). HFO was associated with the highest probability of being the best intervention for reducing the risk of reintubation (81.86%; SUCRA, 96.42), followed by CPAP (11.8%; SUCRA, 76.75).</p><p><strong>Interpretation: </strong>In this study, HFO SBT was associated with a lower risk of reintubation compared with other SBT methods. The results of our analysis should be considered with caution due to the low number of studies that investigated HFO SBTs and potential clinical heterogeneity related to cointerventions. Further trials should be performed to confirm the results on larger cohorts of patients and to assess specific subgroups.</p><p><strong>Trial registration: </strong>PROSPERO; No.: CRD42023449264; URL: https://www.crd.york.ac.uk/prospero/.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1020-1034"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141533719","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":"Effective Behaviors of Leaders During Clinical Emergencies: A Qualitative Study of Followers' Perspectives.","authors":"Trevor C Steinbach, Ann L Jennerich, Başak Çoruh","doi":"10.1016/j.chest.2024.05.011","DOIUrl":"10.1016/j.chest.2024.05.011","url":null,"abstract":"<p><strong>Background: </strong>To manage a clinical emergency effectively, physicians need well-developed leadership skills, yet limited structured leadership training is available for critical care trainees. To develop an effective curriculum, leadership competencies must first be defined.</p><p><strong>Research question: </strong>During clinical emergencies, what leadership behaviors do followers value?</p><p><strong>Study design and methods: </strong>We conducted qualitative interviews with members of multidisciplinary critical care teams at a large academic health system, with participants including resident physicians, nurses, and respiratory therapists (N = 15). Thematic analysis was used to categorize leadership behaviors that followers perceived to be effective.</p><p><strong>Results: </strong>We identified three themes related to leadership during clinical emergencies: control, collaboration, and common understanding. Participants described behaviors they believed resulted in both effective and ineffective leadership. For effective leaders, control, the most dominant theme, included behaviors that clearly established roles for the leader and followers, allowing the leader to guide care during a clinical emergency. Collaboration referenced the ability of a leader to maintain a collegial environment. Finally, common understanding reflected a leader's ability to manage communication in a way that fostered a shared mental model across team members.</p><p><strong>Interpretation: </strong>During clinical emergencies, followers value leaders who assert themselves while also maintaining positive team interaction and encouraging an organized flow of information. Our findings provide a potential framework to develop a leadership curriculum for critical care trainees.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1141-1150"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261459","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":"Framework for Research Gaps in Pediatric Ventilator Liberation.","authors":"Samer Abu-Sultaneh, Narayan Prabhu Iyer, Analía Fernández, Lyvonne N Tume, Martin C J Kneyber, Yolanda M López-Fernández, Guillaume Emeriaud, Padmanabhan Ramnarayan, Robinder G Khemani","doi":"10.1016/j.chest.2024.05.012","DOIUrl":"10.1016/j.chest.2024.05.012","url":null,"abstract":"<p><strong>Background: </strong>The 2023 International Pediatric Ventilator Liberation Clinical Practice Guidelines provided evidence-based recommendations to guide pediatric critical care providers on how to perform daily aspects of ventilator liberation. However, because of the lack of high-quality pediatric studies, most recommendations were conditional based on very low to low certainty of evidence.</p><p><strong>Research question: </strong>What are the research gaps related to pediatric ventilator liberation that can be studied to strengthen the evidence for future updates of the guidelines?</p><p><strong>Study design and methods: </strong>We conducted systematic reviews of the literature in eight predefined Population, Intervention, Comparator, Outcome (PICO) areas related to pediatric ventilator liberation to generate recommendations. Subgroups responsible for each PICO question subsequently identified major research gaps by synthesizing the literature. These gaps were presented at an international symposium at the Pediatric Acute Lung Injury and Sepsis Investigators meeting in spring 2022 for open discussion. Feedback was incorporated, and final evaluation of research gaps are summarized herein. Although randomized controlled trials (RCTs) represent the highest level of evidence, the panel sought to highlight areas where alternative study designs also may be appropriate, given challenges with conducting large multicenter RCTs in children.</p><p><strong>Results: </strong>Significant research gaps were identified in six broad areas related to pediatric ventilator liberation. Several of these areas necessitate multicenter RCTs to provide definitive results, whereas other gaps can be addressed with multicenter observational studies or quality improvement initiatives. Furthermore, a need for some physiologic studies in several areas remains, particularly regarding newer diagnostic methods to improve identification of patients at high risk of extubation failure.</p><p><strong>Interpretation: </strong>Although pediatric ventilator liberation guidelines have been created, the certainty of evidence remains low and multiple research gaps exist that should be bridged through high-quality RCTs, multicenter observational studies, and quality improvement initiatives.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1056-1070"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141295619","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":"Role of Pathologic Single-Nodal and Multiple-Nodal Descriptors in Resected Non-Small Cell Lung Cancer.","authors":"Shinkichi Takamori, Atsushi Osoegawa, Asato Hashinokuchi, Takashi Karashima, Yohei Takumi, Miyuki Abe, Masafumi Yamaguchi, Tomoyoshi Takenaka, Tomoharu Yoshizumi, Junjia Zhu, Takefumi Komiya","doi":"10.1016/j.chest.2024.06.3797","DOIUrl":"10.1016/j.chest.2024.06.3797","url":null,"abstract":"<p><strong>Background: </strong>The eighth edition of lung cancer nodal staging assignment includes the location of lymph node metastasis, but does not include single-nodal and multiple-nodal descriptors.</p><p><strong>Research question: </strong>Do the single-nodal and multiple-nodal statuses stratify the prognosis of patients with non-small cell lung cancer (NSCLC)?</p><p><strong>Study design and methods: </strong>Using the National Cancer Database, we analyzed patients with pathologically staged N1 and N2 NSCLC. Nodal descriptors were classified into pathological single N1 (pSingle-N1), pathological multiple N1 (pMulti-N1), pathological single N2 (pSingle-N2), and pathological multiple N2 (pMulti-N2). Survival analysis was performed using the Kaplan-Meier method and multivariable Cox regression models.</p><p><strong>Results: </strong>In the general analysis cohort, 24,531, 22,256, 8,528, and 21,949 patients with NSCLC demonstrated pSingle-N1, pMulti-N1, pSingle-N2, and pMulti-N2 disease, respectively. Patients with pMulti-N1 and pMulti-N2 disease showed a shorter survival than those with pSingle-N1 and pSingle-N2 disease, respectively (hazard ratio, 1.22 [P < .0001] for N1 and 1.39 [P < .0001] for N2). After adjusting age, sex, and histologic findings, the hazard ratio for pSingle-N2 compared with pMulti-N1 disease was 1.05 (P = .0031). Patients with pN1 disease were categorized by metastatic lymph node count (1, 2, 3, ≥ 4), showing significant prognostic differences among groups (P < .0001). In the sensitivity analysis cohort (limited to R0 resection, lobectomy, or more; survival ≥ 30 days; ≥ 10 examined lymph nodes; and without neoadjuvant therapy; n = 34,904) and the external validation cohort (n = 708), analyses supported these results.</p><p><strong>Interpretation: </strong>Patients with NSCLC with one metastatic lymph node, whether in N1 or N2 stations, showed better survival than those with more than one lymph node involved. Patients with NSCLC with a single-skip N2 lymph node metastasis showed survival similar to patients with multiple N1 lymph nodes, and the number of lymph nodes involved in N1 resections up to four or more was sequentially prognostic.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1218-1228"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141615898","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":"Leadership in Emergency Teams: Time to Look Beyond \"The Leader\".","authors":"Sarah Janssens, Stuart Marshall","doi":"10.1016/j.chest.2024.06.008","DOIUrl":"https://doi.org/10.1016/j.chest.2024.06.008","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"166 5","pages":"913-915"},"PeriodicalIF":9.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615812","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}