Chest最新文献

{"title":"Response.","authors":"Scott M Matson, M Kristen Demoruelle","doi":"10.1016/j.chest.2024.10.039","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.039","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"e105-e107"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613717","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":"Hasan M Al-Dorzi, Jesna Jose, Yaseen M Arabi","doi":"10.1016/j.chest.2024.11.022","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.022","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"e99-e101"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613720","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":"Bringing PERT to Pediatrics: Initial Experience and Outcomes of a Pediatric Multidisciplinary Pulmonary Embolism Response Team (PERT).","authors":"Mary P Dang, Anna Cheng, Jessica Garcia, Ying Lee, Mihir Parikh, Ali B V McMichael, Brian L Han, Sheena Pimpalwar, Elliot S Rinzler, Olivia L Hoffman, Sirine A Baltagi, Cindy Bowens, Abhay A Divekar, A Paige Davis Volk, Craig J Huang, Surendranath R Veeram Reddy, Yousef Arar, Ayesha Zia","doi":"10.1016/j.chest.2024.09.028","DOIUrl":"10.1016/j.chest.2024.09.028","url":null,"abstract":"<p><strong>Background: </strong>Multidisciplinary pulmonary embolism response teams (PERTs) streamline care of adults with life-threatening pulmonary embolism (PE). Given rarity of pediatric PE, developing a clinical, educational, and research PERT paradigm is a novel and underused concept in pediatrics.</p><p><strong>Research question: </strong>Is a PERT feasible in pediatrics, and does it improve PE care?</p><p><strong>Study design and methods: </strong>A strategy-to-execution proposal to launch a pediatric PERT was developed for institutional buy-in. Key stakeholders collectively implemented the PERT. Data were collected for the 2-year pre-PERT and post-PERT eras, and outcomes were compared.</p><p><strong>Results: </strong>PERT implementation took 12 months. Our PERT, led by hematology, is composed of pediatric experts in emergency medicine, critical care, interventional cardiology, anesthesiology, and interventional radiology. Data on 30 patients pre-PERT and 31 patients post-PERT were analyzed. Pre-PERT, 10% (3 of 30), 13% (4 of 30), 20% (6 of 30), and 57% (17 of 30), and post-PERT, 3% (1 of 31), 10% (3 of 31), 16% (5 of 31), and 71% (22 of 31) were categorized as high-risk, intermediate-low-risk, intermediate-high-risk, and low-risk PE, respectively. Post-PERT, there were 13 unique PERT activations. PERT was activated on all eligible patients with PE and, additionally, on four low-risk PEs. Time to echocardiogram was shorter post-PERT (4.7 vs 2 hours; P = .0147). Anticoagulation was ordered (90 vs 54 min; P = .003) and given sooner (154 vs 113 min; P = .049) post-PERT. There were no differences in time to reperfusion therapies (12 hours pre-PERT vs 8.7 hours post-PERT, P = .10). Five of six (83.3%) eligible (intermediate-high and high-risk) patients received reperfusion therapies in the post-PERT era compared to three of eight (37.5%) eligible patients in the pre-PERT era (P = .0001). There were no differences in major bleeding, mortality, or length of stay in either era.</p><p><strong>Interpretation: </strong>The pediatric PERT paradigm was successfully created and adopted locally. Our PERT enhanced access to experts, facilitated timely advanced therapies, and held value for low-risk PE. The University of Texas Southwestern Medical Center and Children's Medical Center pediatric PERT may serve as a best practice model for streamlining care for pediatric PE.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"851-862"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379138","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 Caregiver Strain and Emergency Health Care Resource Utilization in Survivors of Critical Illness.","authors":"Christie Docherty, Martin Shaw, Cheuk Yu Chim, Pamela MacTavish, Helen Devine, Peter O'Brien, Phil Lucie, Lucy Hogg, Laura Strachan, Tara Quasim, Joanne McPeake","doi":"10.1016/j.chest.2024.08.057","DOIUrl":"10.1016/j.chest.2024.08.057","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"768-771"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379140","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":"Graded Transthoracic Contrast Echocardiography After Pulmonary Arteriovenous Malformation Embolization: Can Chest CT Scan Be Avoided in Patients With a Low-Grade Shunt?","authors":"Josefien Hessels, Sjors Klompmaker, Daniel A F van den Heuvel, Sanne Boerman, Hans-Jurgen Mager, Marco C Post","doi":"10.1016/j.chest.2024.09.029","DOIUrl":"10.1016/j.chest.2024.09.029","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary arteriovenous malformations (PAVMs) are direct connections between the pulmonary artery and vein, creating a right-to-left shunt (RLS). Embolization is indicated to prevent complications. Guidelines recommend follow-up chest CT scans to confirm persistent occlusion and embolization of all treatable PAVMs. Graded transthoracic contrast echocardiography (TTCE) after PAVM embolization may offer a reliable alternative in a subgroup of patients while preventing radiation exposure.</p><p><strong>Research question: </strong>Can TTCE predict the need for additional embolotherapy in the postembolization population as accurately as it does in the treatment-naive population?</p><p><strong>Study design and methods: </strong>Since 2018, follow-up after PAVM embolization at our study institution includes both TTCE and chest CT scan after 6 to 12 months and every 3 to 5 years thereafter. Patients who underwent at least 1 follow-up TTCE and chest CT scan were included. The indication for additional embolotherapy was discussed in a multidisciplinary team meeting. The primary outcome was the indication for additional embolotherapy in each right-to-left shunt (RLS) grade. Additionally, the association between the RLS grade and indication for additional embolotherapy was investigated.</p><p><strong>Results: </strong>A total of 339 patients with 412 embolization procedures were included; median time to follow-up TTCE was 7.5 months. An RLS was present in 399 postembolization TTCEs (97%): RLS grade 1 in 93 patients (23%), grade 2 in 149 patients (36%) and grade 3 in 157 patients (38%). In patients with RLS grades 0 and 1, no treatable PAVMs were found on CT scan. In patients with RLS grades 2 and 3, 22 (15%) and 72 (46%) underwent additional embolization.</p><p><strong>Interpretation: </strong>This study shows chest CT scan might be withheld in patients with RLS grades 0 and 1 after PAVM embolization.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"842-850"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142388382","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 52-Year-Old Woman With Shortness of Breath and Left Lower Back Pain.","authors":"Faraz Badar, Harith Al-Ataby, Mohammed Al-Azzawi, Mohamed Omballi","doi":"10.1016/j.chest.2024.09.035","DOIUrl":"https://doi.org/10.1016/j.chest.2024.09.035","url":null,"abstract":"<p><strong>Case presentation: </strong>A 52-year-old woman presented to the clinic with progressively worsening shortness of breath associated with intermittent pleuritic left lower back pain for the past 6 months. The patient denied any cough, hemoptysis, fever, chills, or weight loss. She had a history of smoking cigarettes for more than 10 years but quit almost 20 years ago. An outpatient chest radiograph was obtained, and it suggested consolidation of the left lower lobe. The patient was treated empirically with amoxicillin-clavulanate for 2 weeks without improvement.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"e83-e87"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613635","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":"Rebuttal From Drs Dabbous and Mitchell.","authors":"Helene K Dabbous, Ron B Mitchell","doi":"10.1016/j.chest.2024.10.037","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.037","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"658-659"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613713","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":"Reintroducing the Advanced Practice Respiratory Therapist.","authors":"Kevin O'Neil","doi":"10.1016/j.chest.2024.11.005","DOIUrl":"https://doi.org/10.1016/j.chest.2024.11.005","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"642-644"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613715","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":"Factors Associated With VTE in Patients Who Are Critically Ill.","authors":"Guanyu Yang","doi":"10.1016/j.chest.2024.09.045","DOIUrl":"https://doi.org/10.1016/j.chest.2024.09.045","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"e99"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613647","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":"Obstructive Lung Disease in Osteogenesis Imperfecta: A Potential Model for Interstitial Lung Disease, COPD, and Asthma.","authors":"Carolyn Jordan Henderson, Burton L Lesnick","doi":"10.1016/j.chest.2024.10.034","DOIUrl":"https://doi.org/10.1016/j.chest.2024.10.034","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"167 3","pages":"645-646"},"PeriodicalIF":9.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613649","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}