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    Tamponade: Hemodynamic and Echocardiographic Diagnosis.
    Chest 2017 Nov 11. Epub 2017 Nov 11.
    Division of Critical Care Medicine, University of British Columbia; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada. Electronic address:
    Cardiac tamponade is a medical emergency that can be readily reversed with timely recognition and appropriate intervention. The clinical diagnosis of cardiac tamponade requires synthesis of a constellation of otherwise non-specific features, based on an understanding of the underlying pathophysiology. Whereas echocardiographic examination is a central component of diagnosis, alone it is insufficient to establish the physiologic diagnosis of hemodynamically significant cardiac tamponade. Read More

    Use of Expired Air Carbon Monoxide Testing in Clinical Tobacco Treatment Settings.
    Chest 2017 Nov 11. Epub 2017 Nov 11.
    IQuit Smoking Program, Jersey City Medical Center, Jersey City, NY.
    Carbon Monoxide (CO) testing is considered an easy, non-invasive, and objective contribution to the assessment of smoking behavior, as CO is rapidly absorbed into the blood stream when lit cigarettes or cigars are inhaled. CO testing is a medically important, billable outpatient service that can contribute to sustainability of face-to-face tobacco use treatment services by clinicians. This article reviews research on the clinical use of CO testing to provide bio-medical feedback in assessing smoking behavior, on educating smokers on tobacco health effects, on assisting with treatment planning, and as a motivational tool to encourage people to become tobacco free. Read More

    Autoimmunity and COPD: clinical implications.
    Chest 2017 Nov 7. Epub 2017 Nov 7.
    Department of Biomedical Sciences, Faculty of Sciences and Engineering, University of Wolverhampton, UK.
    Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Long term cigarette smoking is the cause of more than 90% of COPD in Westernized countries. However, only a fraction of chronic heavy smokers develop symptomatic COPD by the age of 80 years. Read More

    Recurrent Pulmonary Aneurysms: Hughes-Stovin Syndrome on the Spectrum of Behçet Disease.
    Chest 2017 Nov;152(5):e99-e103
    Division of Pulmonology, Department of Medicine, Tygerberg Academic Hospital/Stellenbosch University, Cape Town, South Africa.
    In this report, we describe a male patient who presented with recurrent life-threatening hemoptysis due to the sequential formation of multiple pulmonary aneurysms. Both pulmonary artery coil embolization and right lower lobectomy were performed, with limited success. The patient experienced extensive bilateral femoral DVT extending into the inferior vena cava, with massive hemoptysis, fulfilling the diagnosis of Hughes-Stovin syndrome. Read More

    A 47-Year-Old Man With Recurrent Unilateral Pleural Effusion.
    Chest 2017 Nov;152(5):e121-e124
    University of Pennsylvania, Philadelphia, PA.
    Case Presentation: A 47-year-old man with a medical history of hypertension, diabetes, hyperlipidemia, and OSA presented with a 7- to 10-day history of progressively worsening dyspnea on exertion, with a walking distance of 60 feet. He had bilateral lower-extremity swelling and was prescribed furosemide without clinical improvement. At baseline, he used three pillows for sleeping. Read More

    A 53-Year-Old Man With a Bronchial Mass and Multiple Bone Lesions.
    Chest 2017 Nov;152(5):e115-e119
    Department of Pathology, The University of Texas-MD Anderson Cancer Center, Houston, TX.
    Case Presentation: A 53-year-old man was admitted with complaints of back pain of 3 months' duration along with numbness and weakness in his left upper and lower extremities. He denied any respiratory complaints or anorexia but did report an 11 kg weight loss over the last 3 months. He had no other significant medical history and denied any history of cigarette smoking or recreational drug use. Read More

    Diagnostic Value of Quantitative Chest CT Scan in a Case of Spontaneous Pneumothorax.
    Chest 2017 Nov;152(5):e109-e114
    Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
    An 18-year-old woman with no previous medical history presented to an outside hospital facility with acute chest pain. She had mild shortness of breath, particularly with exertion, for the prior 2 months. Read More

    HDAC2 suppresses IL17A-mediated airway remodeling in human and experimental modeling of COPD.
    Chest 2017 Nov 4. Epub 2017 Nov 4.
    Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Institute of Respiratory Diseases, Zhejiang University School of Medicine, Hangzhou, China; State Key Lab. for Respiratory Diseases, Guangzhou, China. Electronic address:
    Background: Airway remodeling is a central feature of chronic obstructive pulmonary disease (COPD), but the mechanisms underlying its development have not been fully elucidated.

    Objective: To determine whether histone deacetylase (HDAC) 2 protects against cigarette smoke (CS)-induced airway remodeling through IL17A-dependent mechanisms.

    Methods: Sputum samples and lung tissues were obtained from control subjects and patients with COPD. Read More

    Evaluation of Left Ventricular Diastolic Function by the Intensivist.
    Chest 2017 Nov 4. Epub 2017 Nov 4.
    Hofstra Northwell School of Medicine, 410 Lakeville Road, Suite 107 New Hyde Park, NY 11040. Electronic address:
    The assessment of left ventricular diastolic function is an important element of advanced critical care echocardiography. Standard methods of evaluating diastolic function that are routinely performed on an elective basis in the cardiology echocardiography laboratory may be difficult to apply in the critical care unit. In this article, we review methods of measuring diastolic function with echocardiography that are of relevance to the intensivist and present two options for measurement: the standard cardiology method and a simplified approach. Read More

    Non-invasive blood pressure monitoring in the critically ill: time to abandon the intra-arterial catheter?
    Chest 2017 Nov 3. Epub 2017 Nov 3.
    Service de réanimation médicale, Hôpital La Source, centre hospitalier régional, F-45067 Orléans, France. Electronic address:
    Although its reliability is often questioned, non-invasive blood pressure (NIBP) monitoring with an oscillometric arm cuff is widely used, even in shocked critically ill patients. When correctly implemented, modern arm NIBP devices actually can provide accurate and precise measurements of mean blood pressure as well as clinically meaningful information such as identification of hypo- and hypertensive patients and monitoring of response to therapy. Even in specific circumstances such as arrhythmia, hypotension, vasopressor infusion and possibly in obese patients, arm NIBP could be useful, contrary to widespread belief. Read More

    The Use of M mode Ultrasonography to Differentiate the Etiology of B lines.
    Chest 2017 Oct 26. Epub 2017 Oct 26.
    Background: The presence of B lines on lung ultrasonography is a characteristic feature of both cardiogenic pulmonary edema (CPE) and non cardiogenic alveolar interstitial syndrome (NCAIS), so their presence does not allow the clinician to differentiate between the two entities. Our study uses M mode ultrasonography of the pleura to differentiate cardiogenic pulmonary edema vs. non cardiogenic alveolar interstitial syndrome. Read More

    A Phase II Clinical Trial of Low-Dose Inhaled Carbon Monoxide in Idiopathic Pulmonary Fibrosis.
    Chest 2017 Oct 31. Epub 2017 Oct 31.
    Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medical College, New York, NY. Electronic address:
    Background: Preclinical studies have demonstrated that low-dose carbon monoxide (CO) can abrogate experimental lung fibrosis. To test the therapeutic role of inhaled CO, we designed a clinical study in patients with idiopathic pulmonary fibrosis (IPF).

    Methods: We conducted a multicenter, phase IIa, double-blinded, sham-controlled, clinical trial. Read More

    Conservative Management in Traumatic Pneumothoraces: An Observational Study.
    Chest 2017 Oct 25. Epub 2017 Oct 25.
    Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom;; North Bristol Lung Centre, Southmead Hospital, Bristol, United Kingdom.
    Background: Traumatic pneumothoraces are a common consequence of major trauma. Despite this, there is a paucity of literature regarding their optimal management, including the role of conservative treatment. The aim of this study was to assess the treatment, complications and outcomes of traumatic pneumothoraces in patients presenting to a Major Trauma Centre. Read More

    Internet-Based Monitoring in the Severe Asthma Research Program Identifies a Subgroup of Patients With Labile Asthma Control.
    Chest 2017 Oct 26. Epub 2017 Oct 26.
    Division of Pulmonary and Critical Care Medicine, Department of Medicine and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA. Electronic address:
    Background: We designed an Internet-Based Monitoring Systems (IBS) survey to facilitate monitoring of asthma symptoms and asthma exacerbations in the Severe Asthma Research Program (SARP). Our objective was to evaluate compliance with the IBS survey tool and to explore how data from an IBS tool can inform understanding of asthma phenotypes.

    Methods: We invited adult subjects in the SARP III cohort (N = 528) to complete a monthly IBS asthma control survey. Read More

    Classification of Cough As a Symptom in Adults and Management Algorithms: CHEST Guideline and Expert Panel Report.
    Chest 2017 Nov 9. Epub 2017 Nov 9.
    Institute for Voice and Swallowing, Baylor College of Medicine, Houston, TX.
    Background: We performed systematic reviews using the population, intervention, comparison, outcome (PICO) format to answer the following key clinical question: Are the CHEST 2006 classifications of acute, subacute and chronic cough and associated management algorithms in adults that were based on durations of cough useful?

    Methods: We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework. Data from the systematic reviews in conjunction with patient values and preferences and the clinical context were used to form recommendations or suggestions. Delphi methodology was used to obtain the final grading. Read More

    Pulmonary Nodules: A Small Problem for Many, Severe Distress for Some, and How to Communicate About It.
    Chest 2017 Oct 21. Epub 2017 Oct 21.
    Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA; The Pulmonary Center, Boston University School of Medicine, Boston, MA.
    Every year, millions of patients are diagnosed with pulmonary nodules, and as increasing numbers of people undergo lung cancer screening, even more patients will be found to have a nodule. The vast majority of patients cannot benefit from the detection of a pulmonary nodule because most are benign. Accordingly, it is important to develop strategies to minimize harm, in particular the distress of a "near-cancer" diagnosis. Read More

    Disease Severity Dependence of the Longitudinal Association Between CT Lung Density and Lung Function in Smokers.
    Chest 2017 Oct 21. Epub 2017 Oct 21.
    Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
    Background: In smokers, the lung parenchyma is characterized by inflammation and emphysema, processes that can result in local gain and loss of lung tissue. CT measures of lung density might reflect lung tissue changes; however, longitudinal data regarding the effects of CT lung tissue on FEV1 in smokers with and without COPD are scarce.

    Methods: The 15th percentile of CT lung density was obtained from the scans of 3,390 smokers who completed baseline and 5-year follow-up of the Genetic Epidemiology of COPD (COPDGene) study visits. Read More

    Sleep-Disordered Breathing in Pregnancy.
    Chest 2017 Oct 21. Epub 2017 Oct 21.
    Department of Medicine, Respiratory Division, McGill University, Montreal, Quebec.
    Emerging literature suggests that sleep-disordered breathing (SDB) worsens over the course of pregnancy and is associated with adverse maternal and fetal outcomes. Earlier studies, using mainly snoring as a surrogate marker for SDB, have shown an increase in the prevalence of SDB during pregnancy compared to the pregravid state. More recently, prospective observational studies using ascertainment of SDB with complete polysomnography have shown a prevalence ranging from ∼17-45% in the third trimester. Read More

    Clinical Course of Sarcoidosis in World Trade Center-Exposed Firefighters.
    Chest 2017 Oct 21. Epub 2017 Oct 21.
    Pulmonary Division, Department of Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY. Electronic address:
    Background: Sarcoidosis is believed to represent a genetically primed, abnormal immune response to an antigen exposure or inflammatory trigger, with both genetic and environmental factors playing a role in disease onset and phenotypic expression. In a population of firefighters with post-World Trade Center (WTC) 9/11/2001 (9/11) sarcoidosis, we have a unique opportunity to describe the clinical course of incident sarcoidosis during the 15 years' postexposure and, on average, 8 years following diagnosis.

    Methods: Among the WTC-exposed cohort, 74 firefighters with post-9/11 sarcoidosis were identified through medical records review. Read More

    Survival of Lung Transplant Candidates with COPD: BODE Score Reconsidered.
    Chest 2017 Oct 17. Epub 2017 Oct 17.
    Department of Medicine, Brigham and Women's Hospital.
    Background: The BMI, obstruction, dyspnea, and exercise capacity (BODE) score is used to inform prognostic considerations for lung transplantation for COPD, but it has not been validated in this context. A large proportion of mortality in COPD is attributable to comorbidities that could preclude transplant candidacy. We hypothesized that patients with COPD who are selected as transplant candidates experience better survival than traditional interpretation of BODE scores might indicate. Read More

    Defining the "Frequent Exacerbator" Phenotype in COPD: A Hypothesis-Free Approach.
    Chest 2017 Oct 17. Epub 2017 Oct 17.
    Centre hospitalier intercommunal de Créteil, Service Pneumologie, UPEC, Université Paris-Est, UMR S955, Créteil, France.
    Background: The COPD "frequent exacerbator" phenotype is usually defined by at least two treated exacerbations per year and is associated with a huge impact on patient health. However, existence of this phenotype and corresponding thresholds still need to be formally confirmed by statistical methods analyzing exacerbation profiles with no specific a priori hypothesis. The aim of this study was to confirm the existence of the frequent exacerbator phenotype with an innovative unbiased statistical analysis of prospectively recorded exacerbations. Read More

    The Relationship Between Tobacco Smoke Exposure and Airflow Obstruction in US Children: Analysis of the National Health and Nutrition Examination Survey (2007-2012).
    Chest 2017 Oct 14. Epub 2017 Oct 14.
    Department of Population Health, Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY.
    Background: It has been difficult to determine the individual impact of prenatal and postnatal childhood tobacco smoke exposure (TSE) on childhood lung function, as children are often exposed to both.

    Objective: The goal of this study was to determine the association between current TSE, as measured by using serum cotinine levels, and airflow obstruction (defined as the ratio of FEV1/FVC less than the lower limit of normal) while adjusting for self-reported prenatal TSE.

    Methods: Children aged 6 to 11 years who participated in the National Health and Nutrition Examination Survey (2007-2012) who had serum cotinine levels measured and spirometry performed were included. Read More

    Driving Pressure and Hospital Mortality in Patients Without ARDS: A Cohort Study.
    Chest 2017 Oct 14. Epub 2017 Oct 14.
    Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada.
    Background: Driving pressure (ΔP) is associated with mortality in patients with ARDS and with pulmonary complications in patients undergoing general anesthesia. Whether ΔP is associated with outcomes of patients without ARDS who undergo ventilation in the ICU is unknown. Our objective was to determine the independent association between ΔP and outcomes in mechanically ventilated patients without ARDS on day 1 of mechanical ventilation. Read More

    CORK Study in Cystic Fibrosis: Sustained Improvements in Ultra-Low-Dose Chest CT Scores After CFTR Modulation With Ivacaftor.
    Chest 2017 Oct 14. Epub 2017 Oct 14.
    Cork Cystic Fibrosis Centre, Cork University Hospital, University College, Cork, Ireland; HRB Clinical Research Facility, University College Cork, Cork, Ireland. Electronic address:
    Background: Ivacaftor produces significant clinical benefit in patients with cystic fibrosis (CF) with the G551D mutation. Prevalence of this mutation at the Cork CF Centre is 23%. This study assessed the impact of CFTR modulation on multiple modalities of patient assessment. Read More

    SIRS in the Time of Sepsis-3.
    Chest 2017 Oct 14. Epub 2017 Oct 14.
    Division of Pulmonary and Critical Care Medicine, University of Kansas, Kansas City, KS. Electronic address:
    Severe sepsis is a common, deadly, and diagnostically vexing condition. Recent recommendations for diagnosing sepsis, referred to as consensus guidelines, provide a definition of sepsis and remove the systemic inflammatory response syndrome (SIRS) as a component of the diagnostic process. A concise definition of sepsis is welcomed. Read More

    Relationship Between the Subcostal and Right Lateral Views of Inferior Vena Cava Collapse: Implications for Clinical Use.
    Chest 2017 Oct 12. Epub 2017 Oct 12.
    Department of Internal Medicine, Division of Pulmonary/Critical Care Medicine, Stony Brook University Hospital, Stony Brook, NY. Electronic address:
    Background: The collapsibility index of the inferior vena cava is traditionally visualized from the subcostal region in the sagittal plane, referred to here as cIVCSS. Alternatively, the collapsibility index of the inferior vena cava can be visualized from the right midaxillary line in the coronal plane, referred to here as cIVCRC. It is unclear whether values of cIVCRC are comparable with values of cIVCSS because the inferior vena cava collapses asymmetrically into an elliptical form, quantified as the flat ratio of the inferior vena cava (F-IVC). Read More

    COUNTERPOINT: Should All Initial Episodes of Hemoptysis Be Evaluated by Bronchoscopy? No.
    Chest 2017 Oct 10. Epub 2017 Oct 10.
    Medicine and Health Sciences, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, NY; Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY.

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