34,845 results match your criteria Chest[Journal]


The Effect of Tumor Size and Histology on Outcomes Following Segmentectomy vs. Lobectomy for Clinically Node-negative Non-small Cell Lung Cancer.

Chest 2020 Jul 8. Epub 2020 Jul 8.

Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.

Background: The interaction between tumor size and the comparative prognosis of lobar and sublobar resection has been poorly defined.

Research Question: The purpose of this study was to characterize the relationship between tumor size and the receipt of segmentectomy or lobectomy in association with overall survival in patients with clinically node-negative non-small cell lung cancer (NSCLC).

Study Design: and Methods: The 2004-2015 National Cancer Database (NCDB) was queried for patients with cT1-3N0M0 NSCLC who underwent segmentectomy or lobectomy without neoadjuvant therapy or missing survival data. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.066DOI Listing

CHEST Reviews: Addressing reduced laboratory-based pulmonary function testing during a pandemic.

Chest 2020 Jul 8. Epub 2020 Jul 8.

University of Toronto, Department of Medicine, Canada; Division of Respirology, Department of Medicine, Toronto General Hospital, University Health Network, Canada; University of Toronto, Department of Medicine, Canada.

To reduce the spread of SARS-CoV-2, many pulmonary function testing (PFT) laboratories have been closed or have significantly reduced their testing capacity. As these mitigation strategies may be necessary for the next 6-18 months to prevent recurrent peaks in disease prevalence, fewer objective measurements of lung function will alter the diagnosis and care of patients with chronic respiratory diseases. PFTs, which include spirometry, lung volumes, and diffusion capacity measurement, are essential to the diagnosis and management of patients with asthma, COPD, and other chronic lung conditions. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.065DOI Listing

Impact of a multimodal telemonitoring intervention on CPAP adherence in symptomatic low-cardiovascular risk sleep apnea: a randomized controlled trial.

Chest 2020 Jul 5. Epub 2020 Jul 5.

Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France.

Background: One of the major challenges in treating obstructive sleep apnea (OSA) is to achieve adequate continuous positive airway pressure (CPAP) adherence. Telemonitoring has the potential to provide individualized management and early recognition of problems during treatment.

Research Question: What is the effect of a multimodal telemonitoring intervention on treatment adherence, quality of life and functional status in symptomatic OSA patients with low cardiovascular risk?

Study Design: and Methods: In a multicenter, randomized controlled trial, newly diagnosed OSA patients were randomly assigned to multimodal telemonitoring for 6 months versus usual care (UC). Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.613DOI Listing

Incidence, risk factors, and effects on outcome of ventilator-associated pneumonia in patients with traumatic brain injury. Analysis of a large, multicenter, prospective, observational longitudinal study.

Chest 2020 Jul 4. Epub 2020 Jul 4.

School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy. Electronic address:

Background: No large prospective data are available on ventilator-associated pneumonia (VAP) in patients with traumatic brain injury (TBI).

Research Question: To evaluate the incidence, timing and risk factors of VAP after TBI and its effect on patients' outcome.

Study Design: and Methods: Analysis of the CENTER-TBI dataset, a large, multicenter, prospective, observational study including TBI patients admitted to European intensive care units (ICU), mechanically ventilated for ≥48 hours, and with an ICU length of stay (LOS) ≥72 hours. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.064DOI Listing

Standardized Management for Hypoxemic Respiratory Failure and ARDS: Systematic Review & Meta-analysis.

Chest 2020 Jul 3. Epub 2020 Jul 3.

Department of Critical Care Medicine, University of Calgary and Alberta Health Services, ICU Administration - Ground Floor - McCaig Tower, Foothills Medical Center, 3134 Hospital Drive NW, Calgary, Alberta, Canada T2N 5A1; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

Background: Treatment of hypoxemic respiratory failure (HRF) and Acute Respiratory Distress Syndrome (ARDS) is complex. Standardized management of HRF and ARDS may improve adherence to evidence informed practice and improve outcomes.

Research Question: To examine the effect of standardized management compared to usual care on survival in HRF and ARDS patients. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.611DOI Listing

Tools to promote shared decision making in lung cancer screening using low-dose computerized tomography: a systematic review.

Chest 2020 Jul 3. Epub 2020 Jul 3.

Meyers Primary Care Institute, Worcester, MA, United States; Department of Family Medicine and Community Health, University of Massachusetts Medical School.

Background: Decisions about lung cancer screening are inherently complex and create a need for methods to convey the risks and benefits of screening to patients.

Research Question: What kind of decision aids or tools are available to support shared-decision making for lung cancer screening? What is the current evidence for the effectiveness, acceptability and feasibility of those tools?

Study Design: and Methods: We conducted a systematic review of studies and searched PubMed, MEDLINE, EMBASE, Cochrane Clinical Trials Register and ClinicalTrials.gov from inception to December 2019 for studies that evaluated the effectiveness and acceptability of tools to promote shared decision making for patients considering lung cancer screening. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.610DOI Listing

Association between nocturnal hypoxemia and cancer incidence in patients investigated for obstructive sleep apnea. Data from a large multicenter French cohort.

Chest 2020 Jul 3. Epub 2020 Jul 3.

Department of Respiratory and Sleep Medicine, Angers University hospital, Angers, France; INSERM Unit 1063, Angers, France. Electronic address:

Background: Previous studies have yielded inconsistent findings regarding the association between obstructive sleep apnea (OSA) and cancer in humans.

Research Question: Is there an association between indices of sleep-disordered breathing severity and cancer incidence in patients investigated for suspected OSA?

Study Design And Methods: Data from a large multicenter cohort of cancer-free patients investigated for OSA were linked to health administrative data to identify new-onset cancer. Kaplan-Meier survival analysis and Cox proportional-hazards models were used to evaluate the association of cancer incidence with OSA severity and nocturnal hypoxemia. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.055DOI Listing

Effect of antiviral therapy on the outcome of mechanically ventilated patients with herpes simplex virus type 1 in bronchoalveolar lavage fluid: a retrospective cohort study.

Chest 2020 Jul 3. Epub 2020 Jul 3.

Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany. Electronic address:

Background: Herpes simplex virus type 1 (HSV-1) is frequently detected in the bronchoalveolar lavage fluid (BAL) of mechanically ventilated patients.

Research Question: The aim of the study was to investigate whether antiviral therapy is associated with improved overall survival within 30 days.

Study Design: Retrospective cohort study in 4 intensive care units (ICUs) between 01/2011 and 12/2017. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.056DOI Listing

Mixed Venous Oxygen Saturation is a Better Prognosticator than Cardiac Index in Pulmonary Arterial Hypertension.

Chest 2020 Jul 3. Epub 2020 Jul 3.

Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address:

Background: European Society of Cardiology and European Respiratory Society (ESC/ERS) guidelines include thermodilution cardiac index (TDCI) and mixed venous oxygen saturation (SvO) as two of the three hemodynamic determinations used in risk assessment of patients with pulmonary arterial hypertension (PAH). SvO may be a better measurement than TDCI to assess prognosis in patients with either idiopathic or heritable PAH.

Research Question: What is the concordance between TDCI and SvO ESC/ERS risk group allocation and their prognostic value in patients with PAH?

Study Design: and methods: In this retrospective study, we assessed correlation between SvO and TDCI in patients with idiopathic and heritable PAH. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.053DOI Listing

Clinical and Genetic Spectrum of Children with Primary Ciliary Dyskinesia in China.

Chest 2020 Jul 2. Epub 2020 Jul 2.

Department of Otolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China. Electronic address:

Background: Primary ciliary dyskinesia (PCD) is a heterogeneous disease with a diverse clinical and genetic spectrum among populations worldwide. Few cases of pediatric PCD have been reported from China.

Methods: Clinical characteristics, laboratory findings, and genetic results obtained for 81 patients with PCD were retrospectively reviewed at a single center in China. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.045DOI Listing

Systemic Capillary Leak Syndrome secondary to Covid-19.

Chest 2020 Jul 2. Epub 2020 Jul 2.

University of Florida Health, Gainesville FL. Electronic address:

Systemic capillary leak syndrome is a rare disorder characterized by dysfunctional inflammatory response, endothelial dysfunction, and extravasation of fluid from the vascular space to the interstitial space leading to shock, hemoconcentration, hypoalbuminemia and subsequent organ failure. The condition may be idiopathic or secondary to an underlying cause, which can include viral infections. Here we describe a patient with acute COVID-19 infection who presented with hemoconcentration, shock and hypoalbuminemia. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332444PMC

Development of Learning Curves for Bronchoscopy Results of a Multicentre Study of Pulmonary Trainees.

Chest 2020 Jul 2. Epub 2020 Jul 2.

Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada.

Background: There are currently no reference standards for the development of competency in bronchoscopy.

Research Question: The aims of this study were to 1) develop learning curves for bronchoscopy skill development and 2) estimate the number of bronchoscopies required to achieve competence.

Study Design And Methods: Trainees from seven North American academic centers were enrolled at the beginning of their Pulmonology training. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.046DOI Listing

BAL inflammatory markers can predict pulmonary exacerbations in children with cystic fibrosis.

Chest 2020 Jul 2. Epub 2020 Jul 2.

Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Australia; Telethon Kids Institute, Perth, Australia.

Background: Pulmonary exacerbations in cystic fibrosis are characterized by airway inflammation and may cause irreversible lung damage. Early identification of such exacerbations may facilitate early initiation of treatment, thereby potentially reducing long-term morbidity.

Research Question: Is it possible to predict pulmonary exacerbations in children with cystic fibrosis using inflammatory markers obtained from bronchoalveolar lavage (BAL) fluid?

Study Design: and Methods: A longitudinal analysis of children aged 0-7 years included in the Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF) study between 2005 and 2015. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.044DOI Listing

Airway clearance techniques in bronchiectasis: Analysis from the United States Bronchiectasis and NTM Research Registry.

Chest 2020 Jul 2. Epub 2020 Jul 2.

Department of Pulmonology, OHSU School of Medicine, Portland, OR; Department of Infectious Disease, OHSU School of Medicine, Portland, OR.

Background: In patients with bronchiectasis, airway clearance techniques (ACTs) are important management strategies.

Research Question: The primary objective was to describe differences in patients with bronchiectasis and productive cough who utilized ACTs and those who did not. Secondary objectives included assessment of bronchiectasis exacerbation frequency and change in pulmonary function at one-year follow-up. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.050DOI Listing

Two immunocompromised patients with diffuse alveolar hemorrhage as a complication of severe COVID-19.

Chest 2020 Jul 2. Epub 2020 Jul 2.

Department of Internal Medicine, Rheumatology and Immunology, medius Klinik Kirchheim, Academic Teaching Hospital University of Tübingen, Kirchheim unter Teck, Germany.

Diffuse alveolar hemorrhage (DAH) is a severe and potentially life-threatening disease manifestation. Besides autoimmune diseases such as anti-neutrophil cytoplasmatic antibody (ANCA) associated vasculitis and anti-glomerular basement membrane (anti-GBM) syndrome pulmonary viral infections are also known to be culprits of DAH. The coronavirus disease 2019 (COVID-19) pandemic confronts healthcare providers all around the world with an unprecedented number of viral lung infections with a great variance in symptoms and severity. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7331533PMC

Certificate of Added Qualification in Advanced Diagnostic Bronchoscopy.

Authors:
Ali I Musani

Chest 2020 Jul 2. Epub 2020 Jul 2.

University of Colorado Ringgold standard institution - Medicine, 12631 E 17th Ave , Aurora, Colorado 80045, United States.

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http://dx.doi.org/10.1016/j.chest.2020.06.043DOI Listing

Enhanced Drug and Device Development by Targeting "Relief of Dyspnea".

Chest 2020 Jun 30. Epub 2020 Jun 30.

Jacobs School of Medicine, University at Buffalo, State University of New York, Buffalo, NY.

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http://dx.doi.org/10.1016/j.chest.2020.04.040DOI Listing

Mechanisms of exercise limitation and prevalence of pulmonary hypertension in pulmonary Langerhans cell histiocytosis.

Chest 2020 Jun 29. Epub 2020 Jun 29.

Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. Electronic address:

Background: Pulmonary Langerhans cell histiocytosis (PLCH) determines reduced exercise capacity. The speculated mechanisms of exercise impairment in PLCH are ventilatory and cardiocirculatory limitations, including pulmonary hypertension (PH).

Research Question: What are the mechanisms of exercise limitation, the exercise capacity and the prevalence of dynamic hyperinflation (DH) and PH in PLCH?

Study Design And Methods: In a cross-sectional study, PLCH patients underwent an incremental treadmill cardiopulmonary exercise test with an evaluation of DH, pulmonary function tests, and transthoracic echocardiography. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.609DOI Listing

PROPHETIC: Prospective Identification of Pneumonia in Hospitalized Patients in the Intensive Care Unit.

Chest 2020 Jun 29. Epub 2020 Jun 29.

Duke University, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA.

Background: Pneumonia is the leading infection-related cause of death. Using simple clinical criteria and contemporary epidemiology to identify patients at high risk of nosocomial pneumonia should enhance prevention efforts and facilitate development of new treatments in clinical trials.

Research Question: What are the clinical criteria and contemporary epidemiology trends helpful in identifying patients at high risk of nosocomial pneumonia?

Study Design And Methods: Within the intensive care units of 28 United States hospitals, we conducted a prospective cohort study among adults hospitalized more than 48 hours and considered high risk for pneumonia (defined as treatment with invasive or noninvasive ventilatory support or high levels of supplemental oxygen). Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.034DOI Listing

High flow nasal cannula in the immediate post-operative period: a systematic review and meta-analysis.

Chest 2020 Jun 29. Epub 2020 Jun 29.

Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. Electronic address:

Background: Recent studies have demonstrated that high flow nasal cannula (HFNC) prevents intubation in acute hypoxic respiratory failure when compared to conventional oxygen therapy (COT). However, the data examining routine HFNC use in the immediate post-operative period is less clear.

Research Question: Is routine HFNC use superior to COT or non-invasive ventilation (NIV) in preventing intubation in post-operative patients?

Study Design: and Methods: We comprehensively searched databases (MEDLINE, EMBASE, Web of Science) to identify randomized controlled trials (RCTs) that compared the effect of HFNC use to COT or NIV in the immediate post-operative period on reintubation, escalation of respiratory support, hospital mortality, ICU and hospital length of stay, post-operative hypoxemia and treatment complications. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.038DOI Listing

Deterioration of Nighttime Respiratory Mechanics in Chronic Obstructive Pulmonary Disease: Impact of Bronchodilator Therapy.

Chest 2020 Jun 27. Epub 2020 Jun 27.

Department of Medicine, Queen's University, Kingston, Canada; Division of Respiratory Medicine, Queen's University, Kingston, Canada. Electronic address:

Background: Chronic Obstructive Pulmonary Disease (COPD) is associated with nighttime respiratory symptoms, poor sleep quality, and increased risk of nocturnal mortality. Overnight deterioration of inspiratory capacity (IC) and forced expiratory volume in 1 second (FEV) have previously been documented. However, the precise nature of this deterioration and mechanisms by which evening bronchodilators may mitigate this have not been studied. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.033DOI Listing

Association of Cigarette Type and Nicotine Dependence in Patients Presenting for Lung Cancer Screening.

Chest 2020 Jun 27. Epub 2020 Jun 27.

Thoracic Oncology Research Group, Medical University of South Carolina, Charleston, SC; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.

Background: Over decades, there have been several alterations to cigarettes, including the addition of filters and flavoring. Despite this, lung cancer remains the leading cause of cancer-related death in the US. We aimed to examine the association of type of cigarette on nicotine dependence in the setting of lung cancer screening. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.608DOI Listing

Mental Health Care During and After the ICU: A Call to Action.

Chest 2020 Jun 26. Epub 2020 Jun 26.

Department of Pediatrics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.

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http://dx.doi.org/10.1016/j.chest.2020.06.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319916PMC

Diagnosing EVALI in the Time of COVID-19.

Chest 2020 Jun 26. Epub 2020 Jun 26.

University of Utah Health, Salt Lake City, UT; Intermountain Healthcare, Division of Pulmonary & Critical Care Medicine, Salt Lake City, UT.

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http://dx.doi.org/10.1016/j.chest.2020.06.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319621PMC

Co-infection with Multiple Nontuberculous Mycobacteria as a Possible Exacerbating Factor in Pulmonary Nontuberculous Mycobacteriosis: Clone Library Analysis Using the 16S rRNA Gene.

Chest 2020 Jun 26. Epub 2020 Jun 26.

Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

Background: Mycobacterial culture is the gold standard for diagnosis of nontuberculous Mycobacterium (NTM) infections. However, this method is not suitable for detection of co-infection with different NTMs.

Research Question: Is clone library analysis of bronchoalveolar lavage fluid (BALF) useful for detection of NTM phylotypes, including multiple NTM phylotypes, in pulmonary NTM infections?

Study Design And Methods: BALF samples obtained from 120 patients with suspected pulmonary NTM infections were retrospectively evaluated using the mycobacterial culture and clone library methods between July 2010 and August 2016. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.027DOI Listing

Recurrence Prophylaxis in Secondary Spontaneous Pneumothorax: A Nationwide Readmission Database Analysis.

Chest 2020 Jun 26. Epub 2020 Jun 26.

Department of Pulmonology and Critical Care, Geisinger Medical Center, Danville, PA, USA.

Background: Secondary spontaneous pneumothorax (SSP) is defined as a pneumothorax presenting as a complication of underlying lung disease. Due to the high recurrence rate and the possibility of life-threatening complications, same-admission recurrence prophylaxis (SARP) following the first occurrence of SSP is recommended by many experts. The rate of SARP in SSP admissions has not been reported. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.032DOI Listing

EVIDENCE FOR EXPANDING INVASIVE MEDIASTINAL STAGING FOR PERIPHERAL T1 LUNG TUMORS.

Chest 2020 Jun 26. Epub 2020 Jun 26.

Division of Pulmonary and Critical Care, University of Vermont Medical Center, Burlington VT, USA. Electronic address:

Background: Guidelines recommend invasive mediastinal staging for patients with non-small cell lung cancer and a "central" tumor. However, there is no consensus definition for central location. As such, the decision to perform invasive staging largely remains on an empirical foundation. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.607DOI Listing

How I Do It: Ultrasound-guided Internal Jugular and Femoral Central Venous Catheter Insertion.

Chest 2020 Jun 26. Epub 2020 Jun 26.

Montefiore Medical Center / Albert Einstein College of Medicine, New York, NY USA.

Central venous catheterization is routinely performed in the intensive care unit to obtain venous access for hemodynamic monitoring, parenteral nutritional support, hemodialysis, and delivery of fluids & vasoactive medications. While central venous catheters can be lifesaving, their insertion is not without risk. Historically, central veins were accessed using landmark-based techniques, but the medical literature strongly supports the use of ultrasound guidance. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.026DOI Listing

Changes in self-rated health after sepsis in older adults: A retrospective cohort study.

Chest 2020 Jun 25. Epub 2020 Jun 25.

Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI. Electronic address:

Background: As more individuals survive sepsis, there is an urgent need to understand its effects on patient-reported outcomes.

Research Question: What is the effect of sepsis on self-rated health, and what role, if any, does functional disability play in mediating this effect?

Study Design: and Methods: We conducted a survey- and administrative claims-based retrospective cohort study using the US Health and Retirement Study, a nationally representative cohort-based survey of older adults in the United States, from years 2000 through 2016. We matched Medicare beneficiaries hospitalized with sepsis in 2000-2008 to non-hospitalized individuals. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.606DOI Listing
June 2020
7.483 Impact Factor

Chest CT Imaging Signature of COVID-19 Infection: In Pursuit of the Scientific Evidence.

Chest 2020 Jun 25. Epub 2020 Jun 25.

Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD.

Background: Chest CT may be used for the diagnosis of Coronavirus disease 2019 (COVID-19), but clear scientific evidence is lacking. Therefore, we systematically reviewed and meta-analyzed the chest CT imaging signature of COVID-19.

Research Question: ••••. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314684PMC

Patterns and impact of arterial CO management in patients with Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE study.

Chest 2020 Jun 23. Epub 2020 Jun 23.

School of Medicine, National University of Ireland Galway, Galway, Ireland; Dept of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Galway, Ireland; Lung Biology Group, Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, Biomedical Sciences Building, National University of Ireland Galway, Galway, Ireland. Electronic address:

Background: Considerable variability exists regarding CO management in early ARDS, with the impact of arterial CO tension on management and outcomes poorly understood.

Research Question: To determine the prevalence and impact of hypo- and hypercapnia on the management and outcomes of patients with early ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study, an international multicenter observational study.

Study Design And Methods: Our primary objective was to examine the prevalence of Day 1 and sustained (day 1 and 2) of hypocapnia (PaCO < 35mmHg), normocapnia (PaCO 35-45mmHg) and hypercapnia (PaCO > 45mmHg) in patients with ARDS. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.605DOI Listing

COVID-19 Pneumonia Hospitalizations Followed by Re-Presentation for Presumed Thrombotic Event.

Chest 2020 Jun 23. Epub 2020 Jun 23.

Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University Langone Health, New York, NY.

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http://dx.doi.org/10.1016/j.chest.2020.06.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309731PMC

Association of Palliative Care Use and Setting with Healthcare Utilization and Quality of Care at the End of Life Among Patients with Advanced Lung Cancer.

Chest 2020 Jun 23. Epub 2020 Jun 23.

Division of Pulmonary and Critical Care, Oregon Health & Science University; Portland, OR; Health Services Research & Development, VA Portland Health Care System; Portland, OR.

Background: Palliative care is associated with improved survival and quality of life among patients with lung cancer; however, its influence on healthcare utilization and quality of care is unclear.

Research Question: Is palliative care, and the setting in which it occurs, associated with healthcare resource utilization and quality of care among patients with advanced lung cancer?

Study Design And Methods: Retrospective cohort study of 23,142 patients with Stage IIIB/IV lung cancer in the VA HealthCare System between 2007-2013. Exposures included the receipt of specialist-delivered palliative care, and setting of the initial palliative care encounter (inpatient or outpatient) received after cancer diagnosis. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.018DOI Listing

Cigarette Smoking and ARDS After Blunt Trauma: The Influence of Changing Smoking Patterns and Resuscitation Practices.

Chest 2020 Jun 20. Epub 2020 Jun 20.

Department of Medicine, University of California San Francisco, San Francisco, CA; Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA; Department of Anesthesia, University of California San Francisco, San Francisco, CA; Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA.

Background: Cigarette smoking is associated with an increased risk of developing ARDS. However, it is unclear whether changes in smoking patterns or processes of care impact this relationship.

Research Question: Are changes in smoking and resuscitation patterns associated with changes in the relationship between smoking and ARDS?

Study Design And Methods: We conducted a prospective cohort study of critically injured adults with blunt trauma from 2005 - 2015. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.603DOI Listing

Expression quantitative trait methylation analysis reveals methylomic associations with gene expression in childhood asthma.

Chest 2020 Jun 19. Epub 2020 Jun 19.

Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address:

Background: Nasal (airway) epithelial methylation profiles have been associated with asthma, but the effects of such profiles on expression of distant cis-genes are largely unknown.

Research Question: To identify genes whose expression is associated with proximal and distal CpG probes (within 1 Mb), and to assess whether and how such genes are differentially expressed in atopic asthma.

Methods: Genome-wide expression quantitative trait methylation (eQTM) analysis in nasal epithelium from Puerto Rican subjects (aged 9 to 20 years) with (n=219) and without (n=236) asthma. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.601DOI Listing

Differences of SARS-CoV-2 Shedding Duration in Sputum and Nasopharyngeal Swab Specimens Among Adult Inpatients With COVID-19.

Chest 2020 Jun 20. Epub 2020 Jun 20.

Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China.

Background: The viral shedding duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not been fully defined. Consecutive detection of SARS-CoV-2 RNA from respiratory tract specimens is essential for determining duration of virus shedding and providing evidence to optimize the clinical management of coronavirus disease 2019 (COVID-19).

Research Question: What are the shedding durations of SARS-CoV-2 RNA in the upper and lower respiratory tract specimens? What are their associated risk factors?

Study Design And Methods: A total of 68 patients with COVID-19 admitted to Wuhan Taikang Tongji Hospital and Huoshenshan Hospital from February 10, 2020, to March 20, 2020, were recruited. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305751PMC

Respiratory Mechanics and Outcomes in Immunocompromised patients with ARDS - A secondary analysis of the EFRAIM study.

Chest 2020 Jun 19. Epub 2020 Jun 19.

Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA, USA.

Background: In view of the high mortality rate of immunocompromised patients with acute respiratory distress syndrome (ARDS), it is important to identify targets for improvement.

Research Question: This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs] and driving pressure [ΔPrs]).

Study Design And Methods: This study consisted of a predefined secondary analysis of the Efraim data. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.602DOI Listing

Not all septal defects are equal. Outcomes of Bilateral Lung Transplant with Cardiac Defect Repair vs. Combined Heart-Lung Transplant in Patients with Eisenmenger's Syndrome in the United States.

Chest 2020 Jun 18. Epub 2020 Jun 18.

Department of Surgery and Division of Cardiovascular Surgery, University of Pennsylvania, PA, USA. Electronic address:

Background: Thoracic transplantation is considered for patients with Eisenmenger's syndrome (ES) who have refractory right ventricular failure despite optimal therapy for pulmonary arterial hypertension. We compared the outcomes of bilateral lung transplant (BLT) with cardiac defect repair versus combined heart-lung transplant (HLT).

Research Question: Which is the most effective thoracic transplant strategy in patients with ES?

Study Design And Methods: We identified patients with ES who underwent thoracic transplantation from 1987 to 2018 from the UNOS database. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.597DOI Listing

Why Is Modeling COVID-19 So Difficult?

Chest 2020 Jun 19. Epub 2020 Jun 19.

Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH. Electronic address:

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http://dx.doi.org/10.1016/j.chest.2020.06.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303028PMC

Influenza Associated Aspergillosis: Nationwide Trends, Predictors and Outcomes from 2005-2014.

Chest 2020 Jun 18. Epub 2020 Jun 18.

Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA. Electronic address:

Background: Influenza-associated aspergillosis (IAA) has been increasingly reported in the literature in recent years, but contemporary large-scale data on the morbidity and mortality burden of IAA are lacking. Research question; To estimate the predictors, associations and outcomes of IAA in the U.S. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.010DOI Listing

Sleep-disordered Breathing and Free Fatty Acid Metabolism.

Chest 2020 Jun 18. Epub 2020 Jun 18.

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

Background: Sleep-disordered breathing (SDB) is independently associated with insulin resistance, glucose intolerance, and type 2 diabetes mellitus. However, the data on whether SDB alters metabolism of free fatty acids (FFA) are lacking.

Research Question: The primary objective of the current study was to characterize alterations in FFA metabolism across the spectrum of SDB severity. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.600DOI Listing

Life-threatening and Non-life-threatening Complications Associated with Coughing: A Scoping Review.

Chest 2020 Jun 18. Epub 2020 Jun 18.

The Division of Pulmonary, Allergy, and Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA.

Purpose: To update the section on complications associated with coughing in the 2006 CHEST cough guidelines to address 2 aims: systematically identify and thematically categorize the diverse complications of cough providing a guide for future studies and identify gaps in the literature for future research.

Methods: To guide our literature search, we asked the following key clinical question: What are the potential complications associated with the act of coughing that have been reported in infants, children, adolescents and adults? A scoping review was performed using PubMed and SCOPUS databases that were searched from their beginning until September 6, 2019.

Results: 247 publications met our inclusion criteria. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.012DOI Listing

Artificial Stone Silicosis: Removal From Exposure Is Not Enough.

Chest 2020 Jun 12. Epub 2020 Jun 12.

University of Illinois at Chicago School of Public Health, Chicago, IL.

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http://dx.doi.org/10.1016/j.chest.2019.11.029DOI Listing

Artificial Stone Silicosis: Rapid Progression Following Exposure Cessation.

Chest 2020 Jun 2. Epub 2020 Jun 2.

Public Health Service, Regional Directorate of the Department of Health and Families of Andalusia in Cádiz, Cádiz, Spain.

Background: Silicosis is rapidly emerging in high-income countries in relation to the replacement of natural stone with artificial stone, especially in the manufacturing and installation of kitchen and bathroom countertops. Progression of this form of silicosis following the cessation of exposure is unknown.

Research Question: The objective of this study was to determine the radiologic progression and lung function in individuals with artificial stone silicosis. Read More

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http://dx.doi.org/10.1016/j.chest.2020.03.026DOI Listing

Utilization of Lung Cancer Screening in the Medicare Fee-for-Service Population.

Chest 2020 Jun 17. Epub 2020 Jun 17.

Duke University Medical Center, Department of Radiology.

Background: A number of organizations, including the U.S. Preventative Services Task Force (USPSTF), recommend lung cancer screening (LCS) with low dose computed tomography (LDCT) for high-risk current and former smokers. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.592DOI Listing

Standardized reporting and management of suspicious findings on chest computed tomography is associated with improved lung cancer diagnosis in an observational study.

Chest 2020 Jun 17. Epub 2020 Jun 17.

Division of Research, Kaiser Permanente Northern California, Oakland, CA, U.S.A.

Background: Follow-up of chest computed tomography (CT) findings suspicious for lung cancer may be delayed because of inadequate documentation. Standardized reporting and follow-up may reduce time to diagnosis and care for lung cancer.

Study Design And Methods: We implemented a reporting system that standardizes tagging of chest CT reports by classifying pulmonary findings. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.595DOI Listing

Air pollution and systemic inflammation in patients with suspected obstructive sleep apnea living in an urban residential area.

Chest 2020 Jun 16. Epub 2020 Jun 16.

Leon Judah Blackmore Sleep Disorders Program, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Canadian Sleep and Circadian Network. Electronic address:

Background: Air pollution and obstructive sleep apnea (OSA) are independently associated with systemic inflammation, but it is unknown if these exposures interact to influence systemic inflammation.

Research Question: Our objective was to determine the relative importance of these factors and their combined potential to influence systemic inflammation in patients under assessment for sleep complaints.

Study Design And Methods: 315 patients contributed data including a questionnaire, polysomnogram and morning serum interleukin (IL) 6 and 10 concentrations. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.596DOI Listing

"Management of Community-Acquired Pneumonia in Immunocompromised Adults: A Consensus Statement Regarding Initial Strategies".

Chest 2020 Jun 16. Epub 2020 Jun 16.

Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Background: Community-acquired pneumonia (CAP) guidelines have improved the management and outcomes of patients with CAP, primarily by standardization of initial empiric therapy. But current society-published guidelines exclude immunocompromised patients.

Research Question: There is no concensus regarding the initial management of immunocompromised patients with suspected CAP. Read More

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http://dx.doi.org/10.1016/j.chest.2020.05.598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297164PMC
June 2020
7.483 Impact Factor

Bloodstream Infections and Delayed Antibiotic Coverage are Associated with Negative Hospital Outcomes in Hematopoietic Stem Cell Transplant Recipients.

Chest 2020 Jun 16. Epub 2020 Jun 16.

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO; Siteman Cancer Center, St. Louis, MO; Healthcare Innovation Lab, BJC HealthCare, St. Louis, MO. Electronic address:

Background: Bloodstream infections (BSI) are common after hematopoietic stem cell transplantation (HSCT), and associated with increased long-term morbidity and mortality. However, short-term outcomes related to BSI in this population remain unknown. More specifically, it is unclear whether choices related to empiric antimicrobials for potentially infected patients are associated with patient outcomes. Read More

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http://dx.doi.org/10.1016/j.chest.2020.06.011DOI Listing