Chest最新文献

{"title":"Understanding the determinants and outcomes of education in pulmonary rehabilitation: moving towards person-centered care.","authors":"M Aurora Mendes,Guilherme Rodrigues,Daisy J A Janssen,Martijn A Spruit,Alda Marques","doi":"10.1016/j.chest.2025.01.005","DOIUrl":"https://doi.org/10.1016/j.chest.2025.01.005","url":null,"abstract":"TOPIC IMPORTANCEEducation and psychosocial support are essential components of pulmonary rehabilitation (PR). However, the delivery of education often follows a one-size-fits-all approach, with individual factors that influence learning rarely considered. Moreover, education-related outcomes are frequently overlooked in PR assessments, and inconsistent use of these outcomes has limited our understanding of the impact of education on people with chronic respiratory diseases. There is a clear need for practical guidance to identify key learning determinants and define which education-related outcomes in PR should be targeted to optimize the intervention and establish quality standards.REVIEW FINDINGSCognitive function, health literacy, psychological status, and social connection can impact an individual's ability to learn. Without proper consideration and assessment, these factors can otherwise become barriers to education and effective self-management. Education in PR should aim to a) improve individuals' knowledge, to foster informed and active participants; b) develop their skills, to enable autonomy and competence; and c) enhance their confidence, to apply this knowledge and skills in daily life.SUMMARYThis review emphasizes the importance of person-centered education in PR, provides a framework for understanding which education-related outcomes to target, and highlights the need for future research to enhance this essential component.","PeriodicalId":9782,"journal":{"name":"Chest","volume":"32 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991738","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 High Intrathoracic Pressure in Patients With Obesity Undergoing Right Heart Catheterization.","authors":"Gaurav Manek, Shaoxiong Zhang, Eduard Krishtopaytis, Apostolos Perelas, Ghaleb Khirfan, Deborah Paul, David Toth, James E Lane, Robert L Chatburn, Umur Hatipoğlu, Adriano R Tonelli","doi":"10.1016/j.chest.2024.12.034","DOIUrl":"10.1016/j.chest.2024.12.034","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977867","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":"Ventilator-Associated Pneumonia in Low- and Middle-Income vs High-Income Countries: The Role of Ventilator Bundle, Ventilation Practices, and Health Care Staffing.","authors":"Marko Nemet, Cameron Gmehlin, Marija Vukoja, Yue Dong, Ognjen Gajic, Aysun Tekin","doi":"10.1016/j.chest.2025.01.002","DOIUrl":"10.1016/j.chest.2025.01.002","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) rates are higher in low- and middle-income countries (LMICs) than in high-income countries (HICs).</p><p><strong>Research question: </strong>Could differences in ventilator bundle adherence, ventilation practices, and critical care staffing be driving variations in VAP risk between LMICs and HICs?</p><p><strong>Study design and methods: </strong>This secondary analysis of the multicenter, international Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) study included mechanically ventilated patients at risk for VAP from 11 LMICs and 5 HICs. We included oral care, head-of-bed elevation, spontaneous breathing assessments, and sedation breaks in the ventilator bundle. Staffing was assessed by the number of physicians and nurses per bed. Multivariable analyses were adjusted for severity, baseline characteristics, and checklist implementation. The primary outcome was VAP development.</p><p><strong>Results: </strong>Among 2,253 patients, 1,755 were from LMICs and 498 from HICs. Compared with HICs, patients from LMICs were younger, had lower comorbidity burden, and were less severely ill. Lower country income level was independently associated with VAP development (adjusted OR [aOR], 2.11; 95% CI, 1.37-3.24). Ventilator bundle adherence was not significantly associated with VAP. Increased total duration of ventilation was associated with an increased risk of VAP (aOR, 1.04; 95% CI, 1.03-1.05), whereas higher nursing (aOR, 0.88; 95% CI, 0.79-0.98) and physician staffing ratios (aOR, 0.69; 95% CI, 0.50-0.87) were associated with lower VAP rates.</p><p><strong>Interpretation: </strong>Patients in LMICs have a 2-fold higher risk of VAP, independent of bundle adherence. Prolonged mechanical ventilation was an independent predictor of VAP, whereas higher staffing ratios were associated with decreased risk for VAP development. Unmeasured factors (eg, infrastructure, infection control practices) may explain the higher VAP rates in LMICs.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977889","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":"Impact of Pulmonary Rehabilitation on Survival in People With Interstitial Lung Disease.","authors":"Leona M Dowman, Baruch Vainshelboim, Anne E Holland","doi":"10.1016/j.chest.2025.01.001","DOIUrl":"10.1016/j.chest.2025.01.001","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary rehabilitation (PR) is a beneficial intervention for people with interstitial lung disease (ILD); however, the effect of PR on survival is unclear. This study compared the survival outcomes in people with ILD who were allocated to PR vs those who were allocated to control in 2 published randomized controlled trials.</p><p><strong>Research question: </strong>Does participation in PR impact survival among people with ILD?</p><p><strong>Study design and methods: </strong>The combined data from the 2 previous randomized controlled trials of PR in ILD were included. Time from start of PR until date of death, lung transplantation, or censoring was calculated. Kaplan-Meir and Cox proportional hazard regression analysis were used to assess the impact of PR on survival. Baseline variables of age at time of PR, gender, FVC, 6-minute walk distance, exertional nadir oxyhemoglobin desaturation, and diagnosis of idiopathic pulmonary fibrosis were included as covariates.</p><p><strong>Results: </strong>Of the 182 participants with ILD (idiopathic pulmonary fibrosis: n = 87; males: n = 109; mean age ± SD, 69 ± 10; FVC % predicted ± SD, 76 ± 19; carbon monoxide transfer factor % predicted ± SD, 48 ± 16), death occurred in 62%, 6% were transplanted, 20% were alive, and 12% were lost to follow-up. Median survival for those who completed PR was 6.1 years (95% CI, 4.4-7.9) compared with 4.7 years (95% CI, 3.4-6.0) for those in the control group; however, this was not significantly different (log rank P = .70). After adjusting for baseline variables at 5 years, completion of PR was associated with a 44% lower risk of mortality (hazard ratio, 0.56; 95% CI, 0.36-0.88; P = .01). At 10 years, no difference in survival was observed between the PR and control group.</p><p><strong>Interpretation: </strong>Participation in PR among people with ILD may impact survival at 5 years. Along with clinical improvements after PR, the potential for a survival benefit further strengthens the importance of PR in the standard care of people with ILD.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977870","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":"Video vs Direct Laryngoscopy for Tracheal Intubation After Cardiac Arrest: A Secondary Analysis of the Direct vs Video Laryngoscope Trial.","authors":"Amelia L Muhs, Kevin P Seitz, Edward T Qian, Brant Imhoff, Li Wang, Matthew E Prekker, Brian E Driver, Stacy A Trent, Daniel Resnick-Ault, Steven G Schauer, Adit A Ginde, Derek W Russell, Sheetal Gandotra, David B Page, John P Gaillard, Lane M Smith, Andrew J Latimer, Steven H Mitchell, Nicholas J Johnson, Shekhar A Ghamande, Heath D White, Kevin W Gibbs, Jessica A Palakshappa, Derek J Vonderhaar, David R Janz, Micah R Whitson, Christopher R Barnes, Alon Dagan, Ari Moskowitz, Vijay Krishnamoorthy, James T Herbert, Michael D April, Aaron M Joffe, Jeremy P Walco, Christopher G Hughes, Jonathan K Shipley, Amelia W Maiga, Bradley D Lloyd, Stephanie C DeMasi, Wesley H Self, Todd W Rice, Matthew W Semler, Jonathan D Casey","doi":"10.1016/j.chest.2024.12.031","DOIUrl":"10.1016/j.chest.2024.12.031","url":null,"abstract":"<p><strong>Background: </strong>Airway management is a critical component of the care of patients experiencing cardiac arrest, but data from randomized trials on the use of video vs direct laryngoscopy for intubation in the setting of cardiac arrest are limited. Current American Heart Association guidelines recommend placement of an endotracheal tube either during CPR or shortly after return of spontaneous circulation, but do not provide guidance around intubation methods, including the choice of laryngoscope.</p><p><strong>Research question: </strong>Does use of video laryngoscopy improve the incidence of successful intubation on the first attempt, compared with use of direct laryngoscopy, among adults undergoing tracheal intubation after experiencing cardiac arrest?</p><p><strong>Study design and methods: </strong>This secondary analysis of the Direct vs Video Laryngoscope (DEVICE) trial compared video laryngoscopy vs direct laryngoscopy in the subgroup of patients who were intubated after cardiac arrest. The primary outcome was the incidence of successful intubation on the first attempt. Additional outcomes included the duration of laryngoscopy.</p><p><strong>Results: </strong>Among the 1,417 patients in the DEVICE trial, 113 patients (7.9%) experienced cardiac arrest before intubation, of whom 48 patients were randomized to the video laryngoscopy group and 65 patients were randomized to the direct laryngoscopy group. Successful intubation on the first attempt occurred in 40 of 48 patients (83.3%) in the video laryngoscopy group and in 42 of 65 patients (64.6%) in the direct laryngoscopy group (absolute risk difference, 18.7 percentage points; 95% CI, 1.2-36.2 percentage points; P = .03). The mean duration of laryngoscopy was 48.0 seconds (SD, 37.3 seconds) in the video laryngoscope group and 98.0 seconds (SD, 122.4 seconds) in the direct laryngoscopy group (mean difference, -50.0 seconds; 95% CI, -86.8 to -13.3 seconds; P = .004).</p><p><strong>Interpretation: </strong>Among adults undergoing tracheal intubation after experiencing cardiac arrest, use of video laryngoscopy was associated with increased incidence of successful intubation on the first attempt and shortened duration of laryngoscopy, compared with use of direct laryngoscopy.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977893","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":"Low-Dose Melatonin for Prevention of Delirium in Patients Who Are Critically Ill: A Multicenter, Randomized, Placebo-Controlled Feasibility Trial.","authors":"Lisa D Burry, David R Williamson, Michael E Detsky, Francis Bernard, Jennifer Foster, Sangeeta Mehta, Ruxandra Pinto, Damon C Scales, Louise Rose","doi":"10.1016/j.chest.2024.12.030","DOIUrl":"10.1016/j.chest.2024.12.030","url":null,"abstract":"<p><strong>Background: </strong>Delirium is a common and serious syndrome of acute brain dysfunction associated with negative outcomes. Melatonin may have a role in delirium prevention for adults who are critically ill based on data from noncritically ill patient populations. Our objective was to assess the feasibility of a multicenter, randomized, placebo-controlled trial testing the hypothesis that low-dose melatonin prevents delirium in adults who are critically ill.</p><p><strong>Research question: </strong>Does low-dose melatonin prevent delirium in adults who are critically ill?</p><p><strong>Study design and methods: </strong>We conducted this 3-arm feasibility trial in 3 tertiary academic ICUs. Included participants were ≥ 18 years of age, confirmed free of delirium at enrollment, and anticipated to require a > 48-hour ICU stay. We randomized participants to nightly melatonin 0.5 mg, 2 mg, or placebo. Feasibility outcomes were protocol adherence and recruitment rates. Our primary feasibility target was ≥ 85% (± 5% margin of error) of drug doses administered as per protocol. Secondary objectives were to explore adverse drug effects, melatonin pharmacokinetics, and clinical outcomes.</p><p><strong>Results: </strong>We screened 2,259 patients and excluded 1,863 patients (82.5%), resulting in 396 eligible patients, of whom 71 provided consent, for a recruitment rate of 0.8 patients/mo/site. Median age was 60.5 years (interquartile range [IQR], 48-67 years), and median admission Sequential Organ Failure Assessment score was 7 (IQR, 3-10). Percentage drug administration protocol adherence per patient was a median of 100% (IQR, 92.3%-100%) or a mean of 88.7% (SD, 24.4%). Twenty-five protocol violations occurred, with no differences between groups. Fourteen patients (20%) experienced delirium during the study period and 25 patients (36%) experienced subsyndromal delirium, with no differences between study groups. No serious adverse effects were detected.</p><p><strong>Interpretation: </strong>Our trial protocol comparing 2 low doses of melatonin and placebo for delirium prevention in adults who are critically ill demonstrated feasibility for protocol adherence. However, trial eligibility rates were modest primarily because of delirium being present or the inability to screen. Consent rates also were low. This finding suggests that conducting delirium prevention trials that require delirium to be absent on enrolment is particularly challenging in the ICU.</p><p><strong>Clinical trial registry: </strong>ClinicalTrials.gov; No.: NCT02615340; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969705","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 Lung Function With Visceral Adiposity and Skeletal Muscle Mass Considering Myosteatosis.","authors":"Young Ju Jung, Min Jung Lee, Eun Hee Kim, Sung-Jin Bae, Hong-Kyu Kim","doi":"10.1016/j.chest.2024.12.018","DOIUrl":"10.1016/j.chest.2024.12.018","url":null,"abstract":"<p><strong>Background: </strong>Changes in body composition, including loss of muscle mass and obesity, adversely affect lung function.</p><p><strong>Research question: </strong>What is the relationship between lung function, visceral adiposity, and skeletal muscle mass, considering myosteatosis measured using CT scans in middle-aged Korean adults?</p><p><strong>Study design and methods: </strong>We reviewed 15,827 participants (9,237 men and 6,590 women) with a mean (SD) age of 52.5 (8.3) years who underwent comprehensive health examinations, including abdominal CT imaging and spirometry. Selected CT scans were segmented automatically to quantify total abdominal muscle area (TAMA), visceral fat area (VFA), and subcutaneous fat area. Muscle quality was assessed by categorizing TAMA into 3 regions based on CT scan density: good-quality muscle (normal-attenuation muscle area [NAMA]), fatty muscle (low attenuation muscle area), and intermuscular and intramuscular fat areas. Low lung function was defined as FVC % predicted and FEV₁ < 80% predicted. Standardized residuals for CT scan-derived measurements, adjusted for age and BMI using linear regression, were calculated and stratified into quartiles for lung function comparison. Multivariate logistic regression was used to analyze associations between low lung function and variables.</p><p><strong>Results: </strong>NAMA was correlated positively with FVC and FEV₁, whereas VFA was correlated negatively with both. In men, low FVC and FEV₁ were associated significantly with lower NAMA and higher VFA. Among women with obesity (BMI ≥ 25 kg/m²), low FVC and FEV₁ were associated significantly with higher VFA and lower NAMA (FVC only); among women without obesity, low FVC and FEV₁ were associated negatively with NAMA.</p><p><strong>Interpretation: </strong>Lung function was associated significantly with visceral adiposity and skeletal muscle quality, which differed according to sex and BMI. Improving lung function may require tailored management, including reducing visceral fat, enhancing skeletal muscle quality based on CT scan-body composition analysis, or both.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945461","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":"Demystifying Volume Status: An Ultrasound-Guided Physiologic Framework.","authors":"Juliana Kan Yl, Shane Arishenkoff, Katie Wiskar","doi":"10.1016/j.chest.2024.12.026","DOIUrl":"10.1016/j.chest.2024.12.026","url":null,"abstract":"<p><strong>Topic importance: </strong>Accurate assessment of a patient's volume status is crucial in many conditions, informing decisions on fluid prescribing, vasoactive agents, and decongestive therapies. Determining a patient's volume status is challenging because of limitations in examination and investigations and the complexities of fluid homeostasis in disease states. Point-of-care ultrasound (POCUS) is useful in assessing hemodynamic parameters related to volume status, fluid responsiveness, and fluid tolerance. It requires understanding several physiologic concepts to interpret and integrate POCUS findings accurately into volume-related clinical decision-making.</p><p><strong>Review findings: </strong>The following concepts serve as a scaffold for a comprehensive volume status assessment: central venous pressure, right heart function, left heart assessment, extravascular volume, and venous congestion. POCUS allows us access to these hemodynamic and structural data points as an extension and refinement of the physical examination. Often, multiple POCUS applications are used, and findings must be integrated with the rest of the clinical evaluation. We illustrate this using three common scenarios: hypotension, hypoxia, and acute kidney injury. Clinicians must be aware of the strengths and weaknesses of findings in different physiologic states and the potential pitfalls of image acquisition and interpretation. Further studies are necessary to determine the benefits and clinical outcomes of a POCUS-directed volume status assessment.</p><p><strong>Summary: </strong>Volume status assessment is ubiquitous, yet is challenging to perform. This review summarizes foundational physiologic concepts relevant to volume status evaluation and highlights how multiorgan POCUS elucidates hemodynamic parameters that can be combined with the conventional clinical assessment to make fluid-related decisions.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945540","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 Subsolid Nodules: Upfront Surgery or Watchful Waiting?","authors":"Fenglan Li, Linlin Qi, Changfa Xia, Jianing Liu, Jiaqi Chen, Shulei Cui, Liyan Xue, Sainan Cheng, Xu Jiang, Jianwei Wang","doi":"10.1016/j.chest.2024.12.028","DOIUrl":"https://doi.org/10.1016/j.chest.2024.12.028","url":null,"abstract":"<p><strong>Background: </strong>Patients with pulmonary subsolid nodules (SSNs) of ≤ 2 cm in diameter and a consolidation to tumor ratio (CTR) of ≤ 0.25 have good postoperative prognoses, but their management remains controversial.</p><p><strong>Research question: </strong>Does upfront surgical intervention lead to higher survival than watchful waiting in patients with SSNs with diameter of ≤ 2 cm and CTR of ≤ 0.25?</p><p><strong>Study design and methods: </strong>Patients with SSNs who underwent thin-section CT scan examination between February 2005 and December 2018 were followed up retrospectively until December 2023 or until all-cause death or lung cancer recurrence or metastases. Patients were divided into observation and surgery groups and categorized further by the diameter and CTR of these SSNs. Event-free survival (EFS) was evaluated using Kaplan-Meier analysis, multivariable-adjusted Cox proportional hazards modeling, propensity score matching, and a noninferiority trial.</p><p><strong>Results: </strong>Data from 1,676 patients were included (surgery group, n = 1,122 [66.9%]; observation group, n = 554 [33.1%]), with a median EFS of 70.2 months (range, 0.3-213.6 months). Comparing the observation group with the surgery group, the 5-year EFS rates in category A (diameter ≤ 2 cm and CTR ≤ 0.25), category A1 (diameter ≤ 1 cm and CTR ≤ 0.25), category A2 (1 cm < diameter ≤ 2 cm and CTR ≤ 0.25), and the combined category (diameter ≤ 3 cm and CTR ≤ 0.5) were 100% vs 99.0%, 100% vs 99.6%, 100% vs 98.6%, and 100% vs 97.4%, respectively. In the above categories of SSNs, the EFS of the observation group was noninferior to that of the surgery group (P < .001 for noninferiority), and the results remained consistent after propensity score matching. Category A2 achieved the maximum hazard ratio of 0.0668, with corresponding 5-year EFS rates for the observation and surgery groups being 100% vs 93.3%, respectively.</p><p><strong>Interpretation: </strong>In patients with SSNs of ≤ 2 cm in diameter and CTR of ≤ 0.25, watchful waiting could be more appropriate than upfront surgical intervention.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439989","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 Famotidine on Outcomes in Pulmonary Arterial Hypertension: A Randomized Controlled Trial.","authors":"Peter J Leary, Samuel G Rayner, Kelley R H Branch, Laurie Hogl, Nancy M Liston, Lia M Barros, Jessi Prout, Stephanie Nolley, Jonathan Buber, David D Ralph, Jeffrey L Probstfield","doi":"10.1016/j.chest.2024.12.029","DOIUrl":"10.1016/j.chest.2024.12.029","url":null,"abstract":"<p><strong>Background: </strong>Adaptation of the right ventricle is a key determinant of outcomes in pulmonary arterial hypertension (PAH). Despite a compelling rationale to develop targeted therapies for the right ventricle in PAH, no such treatments exist. H₂-receptor antagonism is a potential myocardial-focused paradigm in heart failure.</p><p><strong>Research question: </strong>Do H₂-receptor antagonists improve outcomes in patients with PAH?</p><p><strong>Study design and methods: </strong>We conducted a 24-week, single-center, 1:1 randomized, double-masked, placebo-controlled trial of the H₂-receptor antagonist famotidine in patients with a diagnosis of PAH. The primary outcome was change in 6-minute walk distance (6MWD) at 24 weeks. Secondary end points included B-type natriuretic peptide levels, New York Heart Association functional class, right ventricular parameters, health-related quality of life, and escalation in PAH-focused care.</p><p><strong>Results: </strong>From May 2019 through July 2023, 80 participants were randomized with 79 receiving study drug. No significant difference in the primary outcome of 6MWD at 24 weeks was found, with an increase of 4.7 m seen in the placebo arm vs a decrease of 17.0 m in the famotidine arm (P = .24). Also no differences were found in secondary end points at 24 weeks. Study drug was well tolerated, and safety profiles were similar between arms. Adherence and study conduct were good overall. Participants with methamphetamine-associated PAH were similar in all aspects to the study participants more broadly.</p><p><strong>Interpretation: </strong>The results of this trial do not support the routine use of famotidine 20 mg/d as an adjunct therapy for the treatment of PAH. The findings of the Repurposing a Histamine Antagonist to Benefit Patients With Pulmonary Hypertension trial argue against the practice of avoiding participants with methamphetamine-associated PAH in randomized clinical trials of novel therapies.</p><p><strong>Clinical trial registry: </strong>ClinicalTrials.gov; No.: NCT03554291; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945541","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}