Chest最新文献

{"title":"Reduced Risk of Lung Cancer Associated With Sodium-Glucose Cotransporter-2 Inhibitors in Patients With COPD and Type 2 Diabetes Mellitus.","authors":"Danbee Kang, Jung-Wan Yoo, Myeongcheol Lee, Dae Hun Ryu, Hyun Myung Kang, Sun Hye Shin, Juhee Cho, Hye Yun Park","doi":"10.1016/j.chest.2026.07.5208","DOIUrl":"10.1016/j.chest.2026.07.5208","url":null,"abstract":"<p><strong>Background: </strong>COPD is associated with an increased risk of lung cancer, and type 2 diabetes mellitus (T2DM) is a common comorbidity in patients with COPD. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have pleiotropic effects beyond glucose lowering. However, their association with lung cancer risk in patients with COPD and T2DM remains uncertain.</p><p><strong>Research question: </strong>Is SGLT2 inhibitor initiation associated with a lower risk of incident lung cancer in patients with COPD and T2DM?</p><p><strong>Study design and methods: </strong>We conducted a nationwide population-based cohort study using the National Health Insurance Database, including adults ≥ 40 years of age with COPD and T2DM who initiated SGLT2 inhibitors or sulfonylureas between September 2014 and December 2023. The primary outcome was incident lung cancer. Secondary outcomes included severe COPD exacerbation and all-cause mortality.</p><p><strong>Results: </strong>Among 14,927 patients (5,651 receiving SGLT2 inhibitors and 9,276 receiving sulfonylureas), 234 incident lung cancer events occurred during a median follow-up of 2.97 years. The 4-year cumulative incidence of lung cancer was 1.6% in the SGLT2 inhibitor group and 2.7% in the sulfonylurea group. Initiation of SGLT2 inhibitors was associated with a lower risk of incident lung cancer compared with initiation of sulfonylureas (inverse probability of treatment weighting [IPTW] hazard ratio [HR], 0.73; 95% CI, 0.60-0.90). SGLT2 inhibitor use also was associated with reduced risk of severe COPD exacerbations (IPTW HR, 0.77; 95% CI, 0.71-0.83) and all-cause mortality (IPTW HR, 0.81; 95% CI, 0.75-0.88).</p><p><strong>Interpretation: </strong>Our results show that in this nationwide cohort of patients with COPD and T2DM, initiation of SGLT2 inhibitors was associated with lower risks of lung cancer, COPD exacerbation, and all-cause mortality compared with initiation of sulfonylureas.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599597","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":"Starting Extracorporeal Membrane Oxygenation: A Review of the Ethical Issues and Recommended Approach.","authors":"Katie M Moynihan, Bryan Siegel, Birgitta Sujdak Mackiewicz, Roxanne Kirsch, Bryanna Moore","doi":"10.1016/j.chest.2026.07.5210","DOIUrl":"10.1016/j.chest.2026.07.5210","url":null,"abstract":"<p><p>Unique features of extracorporeal membrane oxygenation (ECMO) contribute to ethical dilemmas and decisional complexity. Initiation of ECMO is a growing challenge for providers, families, and centers. We offer 4 practical recommendations for ethically supported, informed decision-making regarding starting ECMO. Recommendations draw on clinical experience, existing literature, and ethical frameworks, and they distinguish between offering ECMO and initiating ECMO within the broader concept of starting ECMO. First, to offer ECMO, clinicians first should determine that support is technically feasible and medically indicated, offering plausible therapeutic benefit by allowing time for recovery or effects of disease-directed therapies. Clinicians have an ethical imperative to make comprehensively reasoned, individualized, and fair decisions. As a result, ECMO decision-making should follow a robust, structured process aligned with principles of procedural fairness to mitigate barriers to high-quality deliberation. If ECMO is offered, clinicians should incorporate patient and family values into the decision to initiate ECMO, providing clinical recommendations within shared decision-making. Second, clinicians must expand consideration of informed consent beyond a single time point. Clinicians should engage in frequent, iterative conversations to achieve informed consent-grounded in the principle of respect for persons-throughout the ECMO course. Clinicians should emphasize ECMO as a temporary, goal-directed intervention during consent discussions to set clear expectations. Third, when ECMO is not offered, the team should document and, as appropriate, communicate the rationale to patients, surrogate decision-makers, and families. Fourth, institutions should establish processes, including a forum to resolve disagreements and measures to capture and share organizational experience, and should promote institutional accountability.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590664","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":"Using Historical Blood Eosinophil Counts to Guide Treatment Decisions in Patients With COPD.","authors":"Mona Bafadhel, Fernando J Martinez, Gerard J Criner, Donald P Tashkin, Michael E Wechsler, MeiLan K Han, Dave Singh","doi":"10.1016/j.chest.2026.06.060","DOIUrl":"10.1016/j.chest.2026.06.060","url":null,"abstract":"<p><p>Up to 40% of patients with COPD have evidence of elevated eosinophil counts ≥ 300 cells/mL at some point during their disease. Blood eosinophil counts (BECs) are a biomarker that can identify patients with COPD and type 2 inflammation who are candidates for add-on inhaled corticosteroids (ICS) or biologic therapy. Evidence from real-world and clinical trial data shows variation in BECs over time in patients with COPD and type 2 inflammation. This How I Do It article discusses factors that can influence eosinophil counts, reviews how the use of historical eosinophil counts can inform treatment decisions, and provides practical considerations for identifying underlying type 2 inflammation in patients with COPD in the clinic. Currently, there is no consensus on what constitutes \"low\" or \"high\" BEC in COPD or the frequency or number of eosinophil measurements needed to effectively guide disease management. Based on our experience from the clinic and available literature, we propose 4 broad phenotypic groups of patients with COPD: those with BECs predominantly ≥ 300 cells/μL, intermittently ≥ 300 cells/μL, within an intermediate range of 100 to 300 cells/μL, and those with BECs predominantly < 100 cells/μL. Identifying these patterns can help with more precise stratification for pharmacologic interventions, such as adding inhaled corticosteroids or biologic therapies. Although single BEC measurements are easy to obtain and often sufficient to identify patients with COPD and high levels of type 2 inflammation, when interpreted alongside clinical characteristics, repeated BECs may be able to support a more personalized approach to COPD care.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590721","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":"Sex-Specific Machine Learning Improves Prediction of Incident and Prevalent COPD.","authors":"Kalysta Makimoto, Benjamin M Smith, Joseph M Reinhardt, Cameron J Hague, James C Hogg, Jean Bourbeau, Wan C Tan, Miranda Kirby","doi":"10.1016/j.chest.2026.07.5207","DOIUrl":"10.1016/j.chest.2026.07.5207","url":null,"abstract":"<p><strong>Background: </strong>CT imaging with machine learning can predict incident and prevalent COPD; however, it is unknown if sex-specific models improve performance.</p><p><strong>Research question: </strong>Do sex-specific machine learning models using CT imaging-derived disease features improve prediction of incident and prevalent COPD and identify sex-specific predictors?</p><p><strong>Study design and methods: </strong>Canadian Cohort Obstructive Lung Disease (CanCOLD) study participants underwent baseline CT imaging and spirometry at baseline and follow-up. Models predicted incident and prevalent COPD using demographics and CT imaging features (lung density, texture, and shape and airway shape) for the combined-sex, male-only, and female-only data sets and externally tested in the Subpopulations and Intermediate Outcome Measures in COPD (SPIROMICS) study. Performance was evaluated using area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>The study included 1,283 participants from the CanCOLD study and 1,840 participants from the SPIROMICS study. For incident COPD, the female-only model outperformed the male-only and combined-sex models in internal tests (AUC, 0.86 vs 0.76 and 0.78; P < .05) and external tests (AUC, 0.83 vs 0.71 and 0.77; P < .05). For prevalent COPD, the female-only model again outperformed the male-only and combined-sex models in internal tests (AUC, 0.84 vs 0.78 and 0.78; P < .01) and external tests (AUC, 0.84 vs 0.70 and 0.73; P < .05). Female-only models selected parenchymal texture and lung shape features not selected in combined-sex models, whereas male-only models selected airway-based features.</p><p><strong>Interpretation: </strong>Our results show that sex-specific models outperform combined-sex models for identifying those with and at risk of COPD, particularly in female patients, by capturing different disease-relevant features. These findings highlight that combined-sex models can obscure sex-specific biology, and adopting sex-specific prediction strategies may improve early detection and risk stratification and may allow for treatment targeting.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590680","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":"Acute Effects of Oxygen Supplementation on Quadriceps Neuromuscular Fatigue in Patients With COPD and Chronic Respiratory Failure.","authors":"Mara Paneroni, Michele Vitacca, Carla Simonelli, Laura Spinello, Armando Coccia, Federica Amitrano, Giovanni D'Addio, Beatrice Salvi, Massimo Venturelli","doi":"10.1016/j.chest.2026.07.5206","DOIUrl":"10.1016/j.chest.2026.07.5206","url":null,"abstract":"<p><strong>Background: </strong>Patients with COPD and chronic respiratory failure (CRF) receiving long-term oxygen therapy experience exaggerated quadriceps neuromuscular fatigue (NMF). In this context, the effect of oxygen therapy on NMF remains unclear.</p><p><strong>Research question: </strong>What is the impact of different Fio₂ levels on neuromuscular fatigue during intermittent isometric quadriceps exercise in a population with COPD and CRF?</p><p><strong>Study design and methods: </strong>Three intermittent isometric quadriceps tests, all at 80% of the time to exhaustion (TTE) at 30% of maximal voluntary contraction (MVC), were performed randomly in each patient with 3 different Fio₂ measurements: 21%, 30%, and 60%. TTE was evaluated previously by breathing Fio₂ at 21%. NMF was assessed through changes in MVC, twitch force quadriceps potentiated (Qtwpot), and voluntary activation (VA) after exercise (at peak, and at 30 seconds and 10 minutes after). Electromyography results were evaluated continuously.</p><p><strong>Results: </strong>We enrolled 20 patients (80.9% male; mean [SD] age, 71.80 [5.81] years; mean [SD] FEV₁ to FVC ratio, 39.56 [9.32]; mean [SD] residual volume, 206.49% [53.14%]). Mean (SD) MVC changes were -27.60% (9.50%), -24.35% (7.80%), and -22.00% (7.13%) for the 21%, 30%, and 60% tests, respectively (P = .0341), with differences between the 21% and 30% Fio₂ measurements (P = .032) and 21% and 60% tests (P = .032). Qtwpot showed mean (SD) changes of -31.10% (14.30%), -31.25% (16.70%), and -26.70% (16.10%) for the 21%, 30%, and 60% tests, respectively (P = .019), with differences between the 21% and 60% tests (P = .027) and the 30% and 60% tests (P = .014). VA decreased similarly across conditions (P = .211).</p><p><strong>Interpretation: </strong>Our results show that acute oxygen administration reduces quadriceps NMF in patients with COPD and CRF. These results highlight the role of oxygen availability in modulating NMF in this population. Future studies should investigate this effect during exercise training, as well as long-term consequences.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT05533957; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583448","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":"Effectiveness of the Adjuvanted Respiratory Syncytial Virus Prefusion F3 Vaccine in Preventing Major Adverse Cardiovascular Events and Severe Exacerbations of COPD and Asthma Among US Adults ≥ 60 Years of Age.","authors":"David Singer, Andrea Steffens, Elizabeth M La, Ami R Buikema, Emily K Horn, Katherine Theiss-Nyland, Maria João Fonseca, Susan I Gerber, Alison Kawai, Mary G Johnson, Rui Song, Sarah Hague, J Bradley Layton","doi":"10.1016/j.chest.2026.06.059","DOIUrl":"10.1016/j.chest.2026.06.059","url":null,"abstract":"<p><strong>Background: </strong>Observational studies have demonstrated real-world vaccine effectiveness (VE) of adjuvanted respiratory syncytial virus (RSV) prefusion F3 (RSVPreF3) vaccination against RSV-related hospitalizations among older adults.</p><p><strong>Research question: </strong>What is the VE of adjuvanted RSVPreF3 vaccination against major adverse cardiovascular events (MACEs), severe COPD exacerbations, and severe asthma exacerbations among US adults ≥ 60 years of age with underlying cardiovascular disease (CVD), COPD, and asthma, respectively?</p><p><strong>Study design and methods: </strong>A retrospective cohort study using Optum Research Database claims data assessed adjuvanted RSVPreF3 VE against MACE and against severe exacerbations of COPD and asthma (overall and RSV related) among populations with baseline CVD, COPD, and asthma, respectively. Between August 2023 and May 2024, vaccinated and unvaccinated adults ≥ 60 years of age were matched 1:4 on age, sex, insurance, and US state. Index date for vaccinated and matched unvaccinated patients was the same, assigned as vaccination date, with baseline characteristics assessed during 12 months before index and balanced via propensity score-based weighting. Outcomes were assessed 14 days after index to disenrollment, death, receipt of any RSV vaccination, or end of analysis period (May 31, 2024). Cox proportional hazards regression estimated hazard ratios within baseline disease populations, with VE calculated as (1 - hazard ratio) × 100%.</p><p><strong>Results: </strong>At baseline, 170,803 vaccinated and 699,177 unvaccinated individuals had CVD, 76,209 vaccinated and 286,406 unvaccinated individuals had COPD, and 53,636 vaccinated and 190,590 unvaccinated individuals had asthma. Among individuals with CVD, estimated VE was 65.0% (95% CI, 45.4%-77.6%) against RSV-related MACEs including mortality and 63.1% (95% CI, 41.8%-76.6%) against RSV-related MACEs not including mortality. Among individuals with COPD, VE was 74.4% (95% CI, 59.3%-83.9%) against RSV-related severe COPD exacerbations. In individuals with asthma, VE against RSV-related severe asthma exacerbations was 61.6% (95% CI, 9.1%-83.7%).</p><p><strong>Interpretation: </strong>Our results show that adjuvanted RSVPreF3 vaccination may offer considerable protection against RSV-related MACEs and severe COPD and asthma exacerbation events in individuals with underlying CVD, COPD, and asthma.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577104","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 Sleep Apnea (OSA) in Pregnancy - An American College of Chest Physicians Clinical Practice Guideline.","authors":"Carolyn M D'Ambrosio,Claire Dust,Jennifer E Dominguez,Ashraf S Habib,Bilgay Izci-Balserak,Judette M Louis,Mariam Louis,Isabelle Malhamé,Gail Olson-Koutrouvelis,Sirimon Reutrakul,Laura Sanapo,Fidaa Shaib,Danielle Wilson,Janine R E Vintch,Christine Won,Ghada Boujeily","doi":"10.1016/j.chest.2026.06.058","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.058","url":null,"abstract":"BACKGROUNDObstructive sleep apnea (OSA) is associated with significant morbidity in pregnancy. There is minimal guidance available on how best to screen, diagnose, treat, and re-evaluate for OSA in pregnant patients. Considering the potentially adverse consequences of OSA in pregnancy if left untreated, we assembled a panel of experts to methodologically review the available literature and make evidence-based recommendations.METHODSRigorous methodology was applied to provide a trustworthy evidence-based guideline and expert panel report. Panelists developed key clinical questions utilizing the PICO (population, intervention, comparator, and outcome) format, addressing specific topics in OSA in pregnant individuals. MEDLINE (via PubMed) and the Cochrane Library were systematically searched for relevant literature and supplemented by manual searches. References were screened with study evaluation tools to assess for inclusion, extract meaningful data, and grade the level of evidence to support each recommendation or suggestion.RESULTSPICO questions related to screening, diagnosis, treatment, and follow up of OSA in pregnant patients resulted in nine conditional recommendations, made with the evidence available and with consensus of the expert panel. We recommend screening pregnant patients for OSA, either with a pregnancy specific screening questionnaire or a standard tool. For those at risk of OSA based on screening, either a home sleep test (HST) or in laboratory polysomnogram (PSG) is recommended for diagnosis. We recommend treatment for those with an apnea-hypopnea index (AHI) of 5-15 who have symptoms/sequelae or comorbidities, or those with an AHI ≥ 15 regardless of symptoms or comorbidities, preferably with auto-titrating positive airway pressure (APAP). Additionally, scheduled naps may be beneficial as an initial step in alleviating residual symptoms. Reassessment of OSA in the postpartum period is recommended in some patients.CONCLUSIONDue to low level of certainty, nine conditional recommendations were made in the screening, testing, and treatment of OSA in pregnancy.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"14 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539077","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":"Management of Adult Bronchiectasis: An American College of Chest Physicians Clinical Practice Guideline.","authors":"Rachel Thomson,Christina Thornton,Timothy Aksamit,Alan Barker,Ashwin Basavaraj,Lucy Burr,Adam T Hill,Julie Jarand,Annemarie L Lee,Mark Metersky,Lisa Moores,Kozo Morimoto,Anne O'Donnell,Maeve Smith,Ranjani Somayaji,Gregory Tino,Lindsy Frazer-Green","doi":"10.1016/j.chest.2026.06.057","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.057","url":null,"abstract":"BACKGROUNDBronchiectasis is a chronic respiratory condition involving a cycle of impaired mucociliary clearance, chronic infections, inflammation, and progressive airway destruction, leading to persistent cough with sputum production, dyspnea, and fatigue. Without appropriate management, patients can experience increased exacerbations, reduced quality of life, declining lung function, and increased mortality risk. Variability exists in clinical practice regarding treatment selection, highlighting the need for evidence-based guidance to optimize patient outcomes and standardize care delivery across healthcare settings.METHODSAn expert panel developed eight PICO-based questions addressing treatment of bronchiectasis in adults and conducted a systematic review. The panel applied the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to assess the certainty of evidence and to formulate and grade recommendations. A modified Delphi technique was used to reach consensus on the recommendations.RESULTSBased on 47 studies, the panel developed 13 evidence-based recommendations addressing key management domains, including antibiotic treatment for acute exacerbations, duration and route of antibiotic therapy, long-term suppressive antibiotic and anti-inflammatory therapies, airway clearance strategies, management of hemoptysis and consideration of surgical resection in selected patients.CONCLUSIONSAll recommendations are conditional, primarily based on low-certainty evidence. Bronchiectasis research should aim to address many of the uncertainties in management, and priorities are identified within each PICO question. Accurate phenotyping and endotyping may help guide therapeutic decision-making and risk stratification. Treatment interventions must consider potential treatment burdens, including cost, and impact on quality of life. Finally, shared decision-making with patients utilizing a multidisciplinary approach is paramount.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"156 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539243","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":"Pulmonary Embolism Reporting and Data System (PE-RADS™) v2026 for the Diagnosis of Acute Pulmonary Embolism on CT and MR Angiography.","authors":"Lynne M Koweek, Prachi Agarwal, Shari B Brosnahan, Sanjeev Bhalla, Vivian Bishay, Paul Cronin, Christopher J François, Jay Giri, Diana E Litmanovich, Ann N Leung, Frances Mae West, Stefan L Zimmerman","doi":"10.1016/j.chest.2026.06.006","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.006","url":null,"abstract":"<p><p>Pulmonary embolism (PE), defined as blockage of the pulmonary arteries, is a common and serious condition that requires accurate diagnosis and standardized reporting. Noninvasive imaging is well established for the diagnosis and management of PE and is incorporated into multiple societal guidelines. However, specific technical recommendations for the optimal interpretation and standardized reporting of CT and MR angiography remain absent. Diagnostic imaging is used to identify the presence or absence of PE and to risk-stratify patients. Evolving treatment options can be considered once an acute clot is identified, the patient's status is defined, and the patient is referred for appropriate treatment in a timely manner. Patient management for PE often involves multiple care teams, and clear and consistent communication between care teams is critical to patient care. The goal of the Pulmonary Embolism Reporting and Data System (PE-RADS) is twofold: (a) to create a standard lexicon for the description of terms used for acute PE diagnosis at CT and MR angiography and (b) to develop a structured, hierarchical reporting system that incorporates anatomic and accessory findings to classify clot location and right heart imaging features in acute PE and to assist in determining the cardiovascular status of the patient to inform next-step management.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535512","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":"ECMO Ethics: A Call for Action.","authors":"Thomas V Cunningham,Joyeeta Dastidar,Anna Condella,Georgina Morley,Olivia Schuman,D Micah Hester","doi":"10.1016/j.chest.2026.06.056","DOIUrl":"https://doi.org/10.1016/j.chest.2026.06.056","url":null,"abstract":"TOPIC IMPORTANCEExtracorporeal membrane oxygenation (ECMO) is a relatively novel, intensive medical intervention. It is known to raise important yet unsettled ethical concerns.OVERVIEWWe established the ECMO Ethics Workgroup in 2021 to improve our understanding of these ethical issues and their possible resolutions. This paper explains the methods used to produce our insights and recommendations, which additional papers from the project elaborate upon in detail. Initially, over six months, the 37 group members described the full range of ethical issues in ECMO care they were familiar with from experience, interpretation of relevant scholarship, and in response to our discussions. After we identified five major ethical themes and several sub-themes for analysis, the group restructured into smaller writing groups. Each group performed narrative and meta-narrative reviews targeting the themes of experiencing ECMO, starting ECMO, stopping ECMO, specialist consultants involved in ECMO care, and \"other\" themes. In addition to summarizing our insights and recommendations regarding four of these themes, this paper recommends revising the common conceptualization of ECMO therapy in terms of \"bridges.\" To improve communication about ECMO care, we propose three categories of ECMO bridges, therapeutic, potentially therapeutic, and non-therapeutic, including the idea of \"bridge to palliative care\" in lieu of the concept of \"bridge to nowhere.\"","PeriodicalId":9782,"journal":{"name":"Chest","volume":"13 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462663","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}