Chest最新文献

{"title":"Managing a Critically Ill Patient With Pulmonary Arterial Hypertension.","authors":"Roxana Sulica, Teresa De Marco, Jean M Elwing, Sonia Bartolome, Namita Sood","doi":"10.1016/j.chest.2026.05.018","DOIUrl":"10.1016/j.chest.2026.05.018","url":null,"abstract":"<p><p>Management of critically ill patients with pulmonary hypertension presents significant clinical challenges. Regardless of the underlying etiology or chronicity of pulmonary hypertension, superimposed acute illness can precipitate decompensated right ventricular failure (RVF) and death. Hospitalization, particularly in the ICU, is associated with high mortality, with RVF serving as the direct or indirect cause in most cases. In this article, we will focus on the management of acute decompensated RVF in patients with known pulmonary arterial hypertension (PAH). ICU management of the patient with PAH with RVF centers on the recognition and treatment of potentially reversible precipitants for decompensation and supportive strategies to optimize right ventricular (RV) function. Key goals include maintaining adequate oxygenation and tissue perfusion, correcting electrolyte and other metabolic abnormalities, optimizing fluid balance and RV preload, enhancing RV contractility, and reducing RV afterload. Continuous monitoring of cardiac function is essential, as is identifying and treating potential complications (eg, arrhythmia, acute kidney injury). When RVF persists despite maximal medical therapy, extracorporeal life support may be considered as a bridge to recovery or transplantation. In patients with advanced disease, multidisciplinary discussions aligned with patient and family preferences should guide the goals of care. Integration of palliative care specialists to manage symptoms and support caregivers remains a critical component of comprehensive ICU management for patients with PAH.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"1260-1271"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148004598","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":"Targeting C5a, a Good Thing Gone Bad in Viral ARDS.","authors":"Martin Witzenrath","doi":"10.1016/j.chest.2026.06.014","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.014","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"987-989"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134554","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":"The Respiratory Muscles in Heart Failure With Preserved Ejection Fraction: A Hidden Tax on Exercise Tolerance.","authors":"Jeroen Molinger, Marat Fudim","doi":"10.1016/j.chest.2026.06.018","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.018","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"998-1000"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134665","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":"Severe Mental Illness and Cancer: Broad and Persistent Inequalities in Cancer Care.","authors":"Naomi Launders","doi":"10.1016/j.chest.2026.06.020","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.020","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"1016-1017"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134647","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":"Watch or Intervene?: Natural History and Treatment Decisions in Patients With Subsolid Lung Nodules.","authors":"Anne V Gonzalez, Douglas Arenberg","doi":"10.1016/j.chest.2026.06.045","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.045","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"1013-1015"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134851","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 Success in Chronic Cough: The Emerging Role of Cough Control.","authors":"Marta Dąbrowska, Elżbieta M Grabczak","doi":"10.1016/j.chest.2026.06.015","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.015","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"170 4","pages":"996-997"},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149135298","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":"Comparing the real-world effectiveness of oral corticosteroids and antifungals for the treatment of allergic bronchopulmonary aspergillosis in cystic fibrosis","authors":"Joanna Walsh, Jesse Y. Hsu, Erin Tully, Gina Hong","doi":"10.1016/j.chest.2026.09.085","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.085","url":null,"abstract":"Allergic bronchopulmonary aspergillosis (ABPA) is a complication of cystic fibrosis (CF) that often requires treatment. Oral corticosteroids (OCS) are the first-line therapy; however, antifungals alone or in combination with OCS are commonly used despite limited data supporting their role.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"14 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149087074","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":"Optimization of Pharmacist Medication Management and Mortality in the Intensive Care Unit.","authors":"Susan E Smith, Kelli R Henry, Mojdeh S Heavner, Zhetao Chen, Xianyan Chen, John W Devlin, David J Murphy, Greg S Martin, Marisha Burden, Brian Murray, Andrea Sikora","doi":"10.1016/j.chest.2026.09.027","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.027","url":null,"abstract":"<p><strong>Background: </strong>Medication-related morbidity due to inappropriate prescribing, delays in appropriate treatment, and adverse drug events contributes to ICU patient mortality. Comprehensive medication management (CMM) is a care standard provided by pharmacists in collaboration with the interprofessional team. Optimizing ICU pharmacist workload via the pharmacist-to-patient ratio while ensuring daily CMM may reduce mortality.</p><p><strong>Research question: </strong>Is ICU pharmacist staffing, measured by the pharmacist-to-patient ratio and absence of CMM, associated with in-hospital mortality among critically ill adults?</p><p><strong>Study design and methods: </strong>Adults admitted to an ICU from 64 centers (in the United States, Jordan, and Saudi Arabia) were enrolled in a multicenter observational study that collected patient and team staffing data from August 2023-January 2025. The primary outcome was in-hospital mortality. The primary exposure was the pharmacist-to-patient ratio calculated per patient, averaged over the ICU stay. A secondary exposure was the absence of CMM for at least 1 day of the ICU stay. Multivariable generalized estimating equations (GEE) were used to estimate associations with in-hospital mortality, accounting for clustering by center and adjusting for patient-, ICU-, and hospital-level covariates.</p><p><strong>Results: </strong>Among 28,795 patients enrolled, the median (IQR) pharmacist-to-patient ratio was 1:17 (13-23). Each one-patient increase in the pharmacist-to-patient ratio was associated with a 1% increase in the odds of in-hospital mortality (Odds Ratio [OR] 1.01, 95% Confidence Interval [CI] 1.00-1.01, p=0.04). Patients who did not receive pharmacist-delivered CMM for at least 1 day of the ICU stay had 20% higher odds of in-hospital mortality (OR 1.20, 95% CI 1.03-1.40, p=0.02). Patients cared for at a pharmacist-to-patient ratio of 1:15.1-46 had 10% higher odds of mortality compared to those cared for at a ratio of 1:7-15 (OR 1.10, 95% CI 1.00-1.22).</p><p><strong>Interpretation: </strong>Increasing pharmacist-to-patient ratios and the absence of pharmacist CMM every day were both associated with increased in-hospital mortality.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079931","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 of Antifibrotic Dosing Patterns With Clinical Outcomes in Patients With Idiopathic Pulmonary Fibrosis in Real-World Data Sources.","authors":"Aparna C Swaminathan, Susanna R Stevens, Pooja Chopra, Peter Shrader, Eden Gebre, Scott M Palmer, Lisa M Wruck","doi":"10.1016/j.chest.2026.09.029","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.029","url":null,"abstract":"<p><strong>Background: </strong>Antifibrotic therapies nintedanib and pirfenidone slow lung function decline in patients with idiopathic pulmonary fibrosis (IPF). However, both medications are often poorly tolerated, leading to dose reductions and discontinuations in practice.</p><p><strong>Research question: </strong>How do antifibrotic dose changes (reductions or cessations) affect disease progression in IPF?</p><p><strong>Study design and methods: </strong>This retrospective study analyzed data for patients with IPF who initiated antifibrotic therapy using two US data sources: the multicenter Pulmonary Fibrosis Foundation Patient Registry (Registry) and Duke University Health System electronic health records (EHR). Antifibrotic dose groups were defined as full dose, reduced dose for ≥3 months, or stopped therapy for ≥3 months. Associations between antifibrotic dose group, a time-varying exposure, and IPF progression, defined as composite ≥10% decline in ppFVC, all-cause hospitalization, lung transplant, or death, were analyzed by Cox proportional-hazards models adjusted for demographics and lung function.</p><p><strong>Results: </strong>Over a median (25th/75th percentile) follow-up of 30.0 (17.5/30.0) months in the Registry and 14.0 (7.4/29.6) months in the EHR, 347/545 (63.7%) and 609/1,027 (59.3%) patients remained on full dose, respectively. Event rates for progression per 100 person-years in patients on full dose, reduced dose, or discontinuation were 39.74, 46.62, and 70.69, respectively, in the Registry and 44.82, 40.46, and 41.72 in the EHR. Time to progression did not differ significantly between patients who reduced or stopped antifibrotics and those who remained on full dose in the Registry (HR 1.17 [95% CI 0.90-1.52] for dose reduction, 1.51 [1.04-2.18] for discontinuation; P=.073) and EHR (HR 0.87 [0.69-1.09], 0.94 [0.66-1.36]; P=.476), respectively.</p><p><strong>Interpretation: </strong>Among patients with IPF, antifibrotic dose reductions and discontinuations were common, likely due to poor drug tolerability. Disease progression occurred in a substantial proportion of patients in both cohorts, regardless of antifibrotic dosing strategy, highlighting the ongoing need for more effective and better-tolerated IPF therapies.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079818","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":"Longitudinal analysis of key factors associated with health-related quality of life in childhood interstitial lung disease.","authors":"Matthias Griese, Srdjan Micic, Julia Carlens, Katharina Mauß-Schwarzer, Stella Bergemann, Pia Maier, Dora Krikovszky, Honorata Marczak, Joanna Lange, Katarzyna Krenke, Lutz Nährlich, Susanne Hämmerling, Alexander Moeller, Matthias Kappler, Nicolaus Schwerk, Elias Seidl","doi":"10.1016/j.chest.2026.09.084","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.084","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079910","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}