2,211 results match your criteria Clinics in Chest Medicine[Journal]


Asthma.

Clin Chest Med 2019 Mar;40(1):xiii-xiv

Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, NB21, Cleveland, OH 44195, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ccm.2018.12.001DOI Listing

Diet and Metabolism in the Evolution of Asthma and Obesity.

Clin Chest Med 2019 Mar 19;40(1):97-106. Epub 2018 Dec 19.

Division of Pulmonary and Critical Care, Department of Medicine, University of Colorado, Denver, CO 80045, USA; Allergy & Asthma Clinic, Anschutz 1635 Aurora Court, 6th Floor, Aurora, CO 80045, USA.

Obesity is a major risk factor for asthma. This association appears related to altered dietary composition and metabolic factors that can directly affect airway reactivity and airway inflammation. This article discusses how specific changes in the western diet and metabolic changes associated with the obese state affect inflammation and airway reactivity and reviews evidence that interventions targeting weight, dietary components, lifestyle, and metabolism might improve outcomes in asthma. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355154PMC

Microbiome in Mechanisms of Asthma.

Clin Chest Med 2019 Mar 19;40(1):87-96. Epub 2018 Dec 19.

Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724-5030, USA.

The lung and gut microbiome are factors in asthma risk or protection. Relevant elements of the microbiome within both niches include the importance of the early life window for microbiome establishment, the diversity of bacteria, richness of bacteria, and effect of those bacteria on the local epithelium and immune system. Mechanisms of protection include direct anti-inflammatory action or induction of non-type 2 inflammation by certain bacterial colonies. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.006DOI Listing

Nonallergic Triggers and Comorbidities in Asthma Exacerbations and Disease Severity.

Clin Chest Med 2019 Mar 19;40(1):71-85. Epub 2018 Dec 19.

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

Asthma triggers are exogenous or endogenous factors that could worsen asthma acutely to cause an exacerbation, or perpetuate chronic symptoms and airflow limitation. Because it is well known that recent asthma exacerbations and poor symptom control are strong predictors of future disease activity, it is not surprising that the number of (allergic or nonallergic) asthma triggers in the environment correlates with the disease-related quality of life. There is a need to identify and avoid specific triggers as the centerpiece of disease management, especially in those with heightened sensitivity to certain factors. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S02725231183011
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http://dx.doi.org/10.1016/j.ccm.2018.10.005DOI Listing
March 2019
7 Reads

Systematic Approach to Asthma of Varying Severity.

Clin Chest Med 2019 Mar 19;40(1):59-70. Epub 2018 Dec 19.

University of Wisconsin School of Medicine and Public Health, K4/914 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-9988, USA.

Asthma is a serious global health issue and asthma guidelines recommend a stepwise approach to management with goals to achieve control and minimize future risk. Prior to escalation of pharmacotherapy, steps to confirm accurate diagnosis as well as address comorbidities and triggers are critical to effective asthma management. This article provides readers with a structured approach to evaluation and management of asthma of varying severity. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.004DOI Listing

Modulation of Bronchomotor Tone Pathways in Airway Smooth Muscle Function and Bronchomotor Tone in Asthma.

Clin Chest Med 2019 Mar 19;40(1):51-57. Epub 2018 Dec 19.

Department of Medicine, Rutgers Institute for Translational Medicine and Science, Rutgers University, State University of New Jersey, 89 French Street, Room 4210, New Brunswick, NJ 08901, USA.

Airway smooth muscle is the primary cell mediating bronchomotor tone. The milieu created in the asthmatic lung modulates airway smooth muscle contractility and relaxation. Experimental findings suggest intrinsic abnormalities in airway smooth muscle derived from patients with asthma in comparison with airway smooth muscle from those without asthma. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.003DOI Listing

Proinflammatory Pathways in the Pathogenesis of Asthma.

Clin Chest Med 2019 Mar;40(1):29-50

Department of Pathobiology, Respiratory Institute, Cleveland Clinic Lerner College of Medicine, CWRU, 9500 Euclid Avenue, NB2-85, Cleveland, OH 44195, USA.

There are multiple proinflammatory pathways in the pathogenesis of asthma. These include both innate and adaptive inflammation, in addition to inflammatory and physiologic responses mediated by eicosanoids. An important component of the innate allergic immune response is ILC2 activated by interleukin (IL)-33, thymic stromal lymphopoietin, and IL-25 to produce IL-5 and IL-13. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364573PMC
March 2019
2 Reads

The Future of Asthma Care: Personalized Asthma Treatment.

Clin Chest Med 2019 Mar;40(1):227-241

Asthma UK, 18 Mansell Street, London E1 8AA, UK.

Although once considered a single disease entity, asthma is now known to be a complex inflammatory disease engaging a range of causal pathways. The most frequent forms of asthma are identified by sputum/blood eosinophilia and activation of type 2 inflammatory pathways involving interleukins-3, -4, -5, and granulocyte-macrophage colony-stimulating factor. The use of diagnostics that identify T2 engagement linked to the selective use of highly targeted biologics has opened up a new way of managing severe disease. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.013DOI Listing
March 2019
2 Reads

The Use of Geographic Data to Improve Asthma Care Delivery and Population Health.

Clin Chest Med 2019 Mar 20;40(1):209-225. Epub 2018 Dec 20.

Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 125 Nashua Street, Suite 920, Boston MA 02114, USA.

The authors examine uses of geographic data to improve asthma care delivery and population health and describe potential practice changes and areas for future research. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.012DOI Listing

Bronchial Thermoplasty.

Clin Chest Med 2019 Mar;40(1):193-207

Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, CT 06520, USA. Electronic address:

Bronchial thermoplasty is an advanced therapy for severe asthma. It is a bronchoscopic procedure in which radiofrequency energy is applied to the airway wall, resulting in decreased airway smooth muscle burden. Human trials have shown that bronchial thermoplasty may reduce asthma exacerbations and improve quality of life in patients with severe uncontrolled asthma. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.015DOI Listing
March 2019
2 Reads

Immunomodulators and Biologics: Beyond Stepped-Care Therapy.

Clin Chest Med 2019 Mar;40(1):179-192

Department of Allergy and Clinical Immunology, Cleveland Clinic, Respiratory Institute, 9500 Euclid Avenue - A90, Cleveland, OH 44195, USA. Electronic address:

This review highlights recent data concerning efficacy and safety of biological agents that are currently approved by Food and Drug Administration (FDA), as well as several agents that will likely soon be FDA approved, for management of properly selected patients with severe persistent asthma that is poorly or not well controlled despite "stepped care" management according to best evidence. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.011DOI Listing

Asthma and Corticosteroid Responses in Childhood and Adult Asthma.

Clin Chest Med 2019 Mar;40(1):163-177

Division of Allergy and Immunology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address:

Corticosteroids are the most effective treatment for asthma; inhaled corticosteroids (ICSs) are the first-line treatment for children and adults with persistent symptoms. ICSs are associated with significant improvements in lung function. The anti-inflammatory effects of corticosteroids are mediated by both genomic and nongenomic factors. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355159PMC

Asthma over the Adult Life Course: Gender and Hormonal Influences.

Clin Chest Med 2019 Mar 20;40(1):149-161. Epub 2018 Dec 20.

National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA. Electronic address:

Asthma is a common disorder that affects genders differently across the life span. Earlier in life, it is more common in boys. At puberty, asthma becomes more common and often more severe in girls and women. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.009DOI Listing

Three Major Efforts to Phenotype Asthma: Severe Asthma Research Program, Asthma Disease Endotyping for Personalized Therapeutics, and Unbiased Biomarkers for the Prediction of Respiratory Disease Outcome.

Clin Chest Med 2019 Mar;40(1):13-28

Department of Respiratory Medicine F5-152, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands.

The SARP, ADEPT, and U-BIOPRED programs are all significant efforts in characterizing asthma and reporting clusters that will assist in designing personalized therapies for asthma, and especially severe asthma. Key aspects of the design of these programs are summarized and major findings are reported in this review. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.016DOI Listing

Life Cycle of Childhood Asthma: Prenatal, Infancy and Preschool, Childhood, and Adolescence.

Clin Chest Med 2019 Mar 20;40(1):125-147. Epub 2018 Dec 20.

Division of Pediatric Pulmonology, Allergy, Immunology and Sleep Medicine, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Children's Lung Foundation, 2109 Adelbert Road, BRB 827, Cleveland, OH 44106, USA.

Asthma is a heterogeneous developmental disorder influenced by complex interactions between genetic susceptibility and exposures. Wheezing in infancy and early childhood is highly prevalent, with a substantial minority of children progressing to established asthma by school age, most of whom are atopic. Adolescence is a time of remission of symptoms with persistent lung function deficits. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.008DOI Listing
March 2019
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The Exposome and Asthma.

Clin Chest Med 2019 Mar 20;40(1):107-123. Epub 2018 Dec 20.

Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, CWRU School of Medicine, 9500 Euclid Avenue/A90, Cleveland, OH 4419, USA. Electronic address:

This article on exposome and asthma focuses on the interaction of patients and their environments in various parts of their growth, development, and stages of life. Indoor and outdoor environments play a role in pathogenesis via levels and duration of exposure, with genetic susceptibility as a crucial factor that alters the initiation and trajectory of common conditions such as asthma. Knowledge of environmental exposures globally and changes that are occurring is necessary to function effectively as medical professionals and health advocates. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.017DOI Listing

Practical and Conceptual Considerations for the Primary Prevention of Asthma.

Clin Chest Med 2019 Mar 19;40(1):1-11. Epub 2018 Dec 19.

Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, T-1218 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232-2650, USA. Electronic address:

Asthma is among the most common chronic diseases worldwide and is a significant contributor to the global health burden, highlighting the urgent need for primary prevention. This article outlines several practical and conceptual challenges that accompany primary prevention efforts. It advocates for improved predictive modeling to identify those at high-risk of developing asthma using automated algorithms within electronic medical records systems and explanatory modeling to refine understanding of causal pathways. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.10.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355160PMC

Respiratory Infections: An Ongoing Challenge with a Promising Future.

Clin Chest Med 2018 Dec;39(4):xv-xvi

Pulmonary and Critical Care Medicine, New York Presbyterian/Weill Cornell Medical College, 425 East 61st Street, 4th Floor, New York, NY 10065, USA. Electronic address:

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https://linkinghub.elsevier.com/retrieve/pii/S02725231183009
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http://dx.doi.org/10.1016/j.ccm.2018.09.001DOI Listing
December 2018
3 Reads

Personalizing the Management of Pneumonia.

Clin Chest Med 2018 Dec;39(4):871-900

Pulmonary Critical Care and Sleep Medicine, Center for Pulmonary Infection Research and Treatment, Yale University, 300 Cedar Street, TACS441, New Haven, CT 06520-8057, USA. Electronic address:

Pneumonia is a highly prevalent disease with considerable morbidity and mortality. However, diagnosis and therapy still rely on antiquated methods, leading to the vast overuse of antimicrobials, which carries risks for both society and the individual. Furthermore, outcomes in severe pneumonia remain poor. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.08.008DOI Listing
December 2018
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New Antibiotics for Pneumonia.

Clin Chest Med 2018 Dec;39(4):853-869

Infectious Diseases Clinic, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Colugna Street, Udine 33100, Italy.

Delayed antimicrobial prescriptions and inappropriate treatment can lead to poor outcomes in pneumonia. In nosocomial infections, especially in countries reporting high rates of antimicrobial resistance, the presence of multidrug-resistant gram-negative and gam-positive bacteria can limit options for adequate antimicrobial treatment. New antibiotics, belonging to known classes of antimicrobials or characterized by novel mechanisms of actions, have recently been approved or are under development. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.08.007DOI Listing
December 2018
14 Reads

Optimizing Antibiotic Administration for Pneumonia.

Clin Chest Med 2018 Dec;39(4):837-852

Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA; Division of Infectious Diseases, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA. Electronic address:

Pneumonia, including community-acquired bacterial pneumonia, hospital-acquired bacterial pneumonia, and ventilator-acquired bacterial pneumonia, carries unacceptably high morbidity and mortality. Despite advances in antimicrobial therapy, emergence of multidrug resistance and high rates of treatment failure have made optimization of antibiotic efficacy a priority. This review focuses on pharmacokinetic and pharmacodynamic approaches to antibacterial optimization within the lung environment and in the setting of critical illness. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.08.006DOI Listing
December 2018
4 Reads

Aerosol Therapy for Pneumonia in the Intensive Care Unit.

Clin Chest Med 2018 Dec;39(4):823-836

Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, Paris Cedex 13 75651, France; Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Paris, France. Electronic address:

Antibiotic aerosolization in patients with ventilator-associated pneumonia (VAP) allows very high concentrations of antimicrobial agents in the respiratory secretions, far more than those achievable using the intravenous route. However, data in critically ill patients with pneumonia are limited. Administration of aerosolized antibiotics might increase the likelihood of clinical resolution, but no significant improvements in important outcomes have been consistently documented. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.08.005DOI Listing
December 2018
17 Reads

Is Zero Ventilator-Associated Pneumonia Achievable?: Practical Approaches to Ventilator-Associated Pneumonia Prevention.

Clin Chest Med 2018 Dec;39(4):809-822

Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8052, St Louis, MO 63110, USA. Electronic address:

Ventilator-associated pneumonia (VAP) remains a significant clinical entity with reported incidence rates of 7% to 15%. Given the considerable adverse consequences associated with this infection, VAP prevention became a core measure required in most US hospitals. Many institutions implemented effective VAP prevention bundles that combined head of bed elevation, hand hygiene, chlorhexidine oral care, and subglottic drainage. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.08.004DOI Listing
December 2018
8 Reads

Management of Ventilator-Associated Pneumonia: Guidelines.

Clin Chest Med 2018 Dec;39(4):797-808

Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198, USA.

Two recent major guidelines on diagnosis and treatment of ventilator-associated pneumonia (VAP) recommend consideration of local antibiotic resistance patterns and individual patient risks for resistant pathogens when formulating an initial empiric antibiotic regimen. One recommends against invasive diagnostic techniques with quantitative cultures to determine the cause of VAP; the other recommends either invasive or noninvasive techniques. Both guidelines recommend short-course therapy be used for most patients with VAP. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.08.002DOI Listing
December 2018
9 Reads

How Can We Distinguish Ventilator-Associated Tracheobronchitis from Pneumonia?

Clin Chest Med 2018 Dec;39(4):785-796

Department of Anaesthesia and Critical Care Medicine, St. James's Hospital, James's Street, Dublin 8, Ireland; Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, James's Street, Dublin 8, Ireland; Trinity Centre for Health Sciences, James's Street, Dublin 8, Ireland. Electronic address:

Ventilator-associated tracheobronchitis (VAT) might represent an intermediate process between lower respiratory tract colonization and ventilator-associated pneumonia (VAP), or even a less severe spectrum of VAP. There is an urgent need for new concepts in the arena of ventilator-associated lower respiratory tract infections. Ideally, the gold standard of care is based on prevention rather than treatment of respiratory infection. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.08.003DOI Listing
December 2018
4 Reads

Airway Devices in Ventilator-Associated Pneumonia Pathogenesis and Prevention.

Clin Chest Med 2018 Dec;39(4):775-783

CHU Lille, Critical Care Center, bd du Pr Leclercq, Lille F-59000, France; Lille University, Medicine School, 1 Place de Verdun, Lille F-59000, France. Electronic address:

Airway devices play a major role in the pathogenesis of microaspiration of contaminated oropharyngeal and gastric secretions, tracheobronchial colonization, and ventilator-associated pneumonia (VAP) occurrence. Subglottic secretion drainage is an effective measure for VAP prevention, and no routine change of ventilator circuit. Continuous control of cuff pressure, silver-coated tracheal tubes, low-volume low-pressure tracheal tubes, and the mucus shaver are promising devices that should be further evaluated by large randomized controlled trials. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S02725231183008
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http://dx.doi.org/10.1016/j.ccm.2018.08.001DOI Listing
December 2018
8 Reads

Health Care-Associated Pneumonia: Is It Still a Useful Concept?

Authors:
Grant W Waterer

Clin Chest Med 2018 Dec;39(4):765-773

University of Western Australia, Royal Perth Hospital, Level 4, MRF Building, GPO Box X2213, Perth 6847, Australia; Northwestern University, Chicago, IL, USA. Electronic address:

"Health care-associated pneumonia (HCAP) was introduced into guidelines because of concerns about the increasing prevalence of drug-resistant pathogens (DRPs) not covered by standard empirical therapy. We now know that DRPs are very localized phenomena with low rates in most sites. Although HCAP risk factors are associated with a higher mortality, this is driven by comorbidities rather than the pathogens. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.07.009DOI Listing
December 2018
7 Reads

Adjunctive Therapies for Community-Acquired Pneumonia.

Clin Chest Med 2018 Dec;39(4):753-764

Pneumology Department, Respiratory Institute (ICR), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), SGR 911 - Ciber de Enfermedades Respiratorias (CIBERES), ICREA Academia, Villarroel 170, Barcelona 08036, Spain; Department of Pneumology, Hospital Clinic of Barcelona, Villarroel 140, Barcelona 08036, Spain. Electronic address:

The use of adjuvant therapies for community-acquired pneumonia is still in development. Combinations of antibiotics with macrolides seem to be the best option when there is no risk of resistance. The use of corticosteroids is the treatment of choice in patients with severe pneumonia and a high inflammatory response who do not present contraindications for these drugs. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.07.008DOI Listing
December 2018
2 Reads

Vaccines to Prevent Pneumococcal Community-Acquired Pneumonia.

Clin Chest Med 2018 Dec;39(4):733-752

Department of Respiratory Medicine, University Medical Center Utrecht, PO-Box 85500, Utrecht 3508 GA, The Netherlands.

Streptococcus pneumoniae is the most frequent pathogen in community-acquired pneumonia and also causes invasive diseases like bacteremia and meningitis. Young children and elderly are especially at risk for pneumococcal diseases and are, therefore, eligible for pneumococcal vaccination in most countries. This reviews provides an overview of the current epidemiology of pneumococcal infections, history and evidence of available pneumococcal polysaccharide and conjugate vaccines, and current recommendations. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.07.007DOI Listing
December 2018
12 Reads

Guidelines to Manage Community-Acquired Pneumonia.

Clin Chest Med 2018 Dec;39(4):723-731

Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, 240 East Huron Street, McGaw M-336, Chicago, IL 60611, USA. Electronic address:

Few guidelines have greater acceptance than that for management of community-acquired pneumonia (CAP). Despite this, areas remain controversial, and new challenges continue to emerge. Current guidelines differ from those of northern European countries predominantly in need for macrolide combination with β-lactams for hospitalized, non-intensive care unit patients. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.07.006DOI Listing
December 2018
8 Reads

Influenza and Viral Pneumonia.

Clin Chest Med 2018 Dec;39(4):703-721

Division of Infectious Diseases, University of Louisville, Med Center One, 501 E. Broadway Suite 100, Louisville, KY 40202, USA.

Influenza and other respiratory viruses are commonly identified in patients with community-acquired pneumonia, hospital-acquired pneumonia, and in immunocompromised patients with pneumonia. Clinically, it is difficult to differentiate viral from bacterial pneumonia. Similarly, the radiological findings of viral infection are nonspecific. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.07.005DOI Listing
December 2018
3 Reads

The Role of Biomarkers in the Diagnosis and Management of Pneumonia.

Clin Chest Med 2018 Dec;39(4):691-701

Division of Pulmonary, Critical Care, and Sleep Medicine, Rush University Medical Center, Rush Medical College, 1725 West Harrison Street Suite 054, Chicago, IL 60612, USA. Electronic address:

Biomarkers are used in the diagnosis, severity determination, and prognosis for patients with community-acquired pneumonia (CAP). Selected biomarkers may indicate a bacterial infection and need for antibiotic therapy (C-reactive protein, procalcitonin, soluble triggering receptor expressed on myeloid cells). Biomarkers can differentiate CAP patients who require hospital admission and severe CAP requiring intensive care unit admission. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.07.004DOI Listing
December 2018
13 Reads

The Lung Microbiome and Its Role in Pneumonia.

Clin Chest Med 2018 Dec;39(4):677-689

Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU Human Microbiome Program, New York University School of Medicine, New York, NY 10028, USA. Electronic address:

The use of next-generation sequencing and multiomic analysis reveals new insights on the identity of microbes in the lower airways blurring the lines between commensals and pathogens. Microbes are not found in isolation; rather they form complex metacommunities where microbe-host and microbe-microbe interactions play important roles on the host susceptibility to pathogens. In addition, the lower airway microbiota exert significant effects on host immune tone. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S02725231183008
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http://dx.doi.org/10.1016/j.ccm.2018.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221463PMC
December 2018
13 Reads

Inflammation and Pneumonia: Why Are Some More Susceptible than Others?

Authors:
Joseph P Mizgerd

Clin Chest Med 2018 Dec;39(4):669-676

Pulmonary Center, Boston University School of Medicine, 72 East Concord Street, Boston, MA 02115, USA. Electronic address:

Pneumonia is an important cause of morbidity and mortality. However, pneumonia is an unusual outcome of respiratory infection. Most of the time, microbes in the lung can be controlled by a combination of constitutive and recruited defense mechanisms. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221464PMC
December 2018
1 Read

Venous Thromboembolism: An Evolving Entity.

Clin Chest Med 2018 Sep 13;39(3):xv-xvi. Epub 2018 Jul 13.

Yale Pulmonary Vascular Disease Center, Section of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ccm.2018.06.001DOI Listing
September 2018
2 Reads

Surgical Management of Acute and Chronic Pulmonary Embolism.

Clin Chest Med 2018 Sep;39(3):659-667

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.

Surgical pulmonary embolectomy and pulmonary thromboendarterectomy are well-established treatment strategies for patients with acute and chronic pulmonary embolism, respectively. For both procedures, techniques and outcomes have evolved considerably over the past decades. Patients with massive and submassive acute pulmonary embolism are at risk for rapid decline owing to right ventricular failure and shock. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.04.017DOI Listing
September 2018
2 Reads

Catheter-Based Therapies for Pulmonary Emboli.

Authors:
Jeffrey S Pollak

Clin Chest Med 2018 Sep;39(3):651-658

Department of Radiology and Biomedical Imaging, Section of Vascular and Interventional Radiology, Yale University School of Medicine, PO Box 208042, 333 Cedar Street, New Haven, CT 06520-8042, USA. Electronic address:

More aggressive therapy for acute pulmonary embolism beyond anticoagulation is indicated in patients at higher risk for mortality and morbidity, namely those suffering from massive and possibly submassive disease. Catheter-based thrombolysis, catheter-based mechanical thrombus debulking, or combinations of these offer opportunities for rapid clot reduction and clinical improvement with a lower bleeding risk than systemic thrombolysis and perhaps greater efficacy. Optimal low-dose regimens for direct thrombolysis have not been defined just as optimal techniques and devices for mechanical therapy have not been developed, underscoring the need for further work. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.04.016DOI Listing
September 2018
2 Reads

Inferior Vena Cava Filters: Why, Who, and for How Long?

Clin Chest Med 2018 Sep;39(3):645-650

Vascular & Interventional Specialists, Charlotte Radiology, 700 East Morehead Street, Charlotte, NC 28202, USA.

Vena cava filters are implantable devices that are placed to trap thrombus originating in the lower extremities and prevent it from migrating to the lungs. In general, inferior vena cava (IVC) filters are indicated for patients who cannot receive anticoagulation. Other indications for IVC filtration are less clear, and guidelines vary. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.04.015DOI Listing
September 2018
9 Reads

Endovascular and Open Surgery for Deep Vein Thrombosis.

Clin Chest Med 2018 Sep;39(3):631-644

Section of Vascular Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar street, Boardman 204, New Haven, CT 06510, USA.

The surgical treatment of deep venous thrombosis (DVT) has significantly evolved and is focused on different strategies of early thrombus removal in the acute phase and deep venous recanalization or bypass in the chronic phase. Along with the use of anticoagulation agents, endovascular techniques based on catheter-directed thrombolysis and pharmacomechanical thrombectomy have been increasingly used in patients with acute extensive DVT. Patient selection is crucial to provide optimal outcomes and minimize complications. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S02725231183006
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http://dx.doi.org/10.1016/j.ccm.2018.04.014DOI Listing
September 2018
19 Reads

Pulmonary Embolism Response Team: Inpatient Structure, Outpatient Follow-up, and Is It the Current Standard of Care?

Clin Chest Med 2018 Sep;39(3):621-630

Division of Cardiology, Section of Vascular Medicine and Intervention, Department of Medicine, Massachusetts Hospital, 55 Fruit Street, Boston, MA 02114, USA.

Pulmonary Embolism Response Teams (PERTs) are being created around the United States to immediately and simultaneously bring together multiple specialists to determine the best course of action and coordinate clinical care for patients with severe pulmonary embolism (PE). The organization and structure of each PERT will depend on local clinical demands and resources. Creating a follow up clinic for PE patients after discharge from the hospital is an essential component of any PERT program. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.04.019DOI Listing
September 2018
12 Reads

Chronic Thromboembolic Pulmonary Hypertension: An Update.

Clin Chest Med 2018 Sep;39(3):605-620

CTEPH Program, UC San Diego Health, University of California, San Diego, 9300 Campus Point Drive #7381, La Jolla, CA 92037, USA.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive pulmonary vascular disease with significant morbidity. It is a result of an alternate natural history in which there is limited resolution of thromboemboli with pulmonary artery obstruction leading to pulmonary hypertension (PH). CTEPH requires a thorough clinical assessment including pulmonary hemodynamics and radiologic evaluation in addition to consultation with an expert center. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.04.018DOI Listing
September 2018
15 Reads

Hypercoagulability in Pulmonary Hypertension.

Clin Chest Med 2018 Sep;39(3):595-603

Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, 300 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA.

Pulmonary hypertension (PH) is divided into varied pathophysiological and etiologic groupings, as classified by the World Health Organization (WHO). Pulmonary arterial hypertension (PAH), which falls under WHO group 1 PH, is a progressive and potentially fatal disease characterized by a vasoconstrictive, proliferative, and thrombotic phenotype, which leads to increased pulmonary artery pressure, right heart failure, and death. Pathologically, in situ thromboses are found in the small distal pulmonary arteries. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.04.005DOI Listing
September 2018
4 Reads

An Update on the "Novel" and Direct Oral Anticoagulants, and Long-Term Anticoagulant Therapy.

Clin Chest Med 2018 Sep;39(3):583-593

Section of Hematology, Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA. Electronic address:

The mainstay of treatment of venous thromboembolism (VTE) is anticoagulation. Direct oral anticoagulants (DOAC) have revolutionized anticoagulation management, although their efficacy and safety in specialized populations such as antiphospholipid syndrome, advanced renal disease, cancer thrombosis, and geriatric patients remain uncertain. Concerns about bleeding risks of DOACs persist despite reassuring data in the literature and the development of specific antidotes. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S02725231183005
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http://dx.doi.org/10.1016/j.ccm.2018.04.010DOI Listing
September 2018
12 Reads

Aggressive Treatment of Intermediate-Risk Patients with Acute Symptomatic Pulmonary Embolism.

Clin Chest Med 2018 Sep;39(3):569-581

Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA.

Contemporary studies of acute pulmonary embolism (PE) have evaluated the role of thrombolytics in intermediate-risk PE. Significant findings are that thrombolytic therapy may prevent hemodynamic deterioration and all-cause mortality but increases major bleeding. Benefits and harms are finely balanced with no convincing net benefit from thrombolytic therapy among unselected patients. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.04.011DOI Listing
September 2018
3 Reads

Management of Low-Risk Pulmonary Embolism.

Clin Chest Med 2018 Sep;39(3):561-568

Pulmonary and Critical Care Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Stop 9410, Lubbock, TX 79430, USA. Electronic address:

Pulmonary embolism remains a leading cause of morbidity and mortality in the United States. However, with improved recognition and diagnosis, the risk of death diminishes. The diagnosis depends on the clinician's suspicion. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.04.013DOI Listing
September 2018
9 Reads

The Value of Bedside Echocardiogram in the Setting of Acute and Chronic Pulmonary Embolism.

Clin Chest Med 2018 Sep;39(3):549-560

Division of Cardiology, University of North Carolina, 160 Dental Circle, CB #7075, Chapel Hill, NC 27599, USA. Electronic address:

Echocardiography is valuable in the evaluation and risk stratification of patients with acute and chronic pulmonary embolism (PE). Patients with acute PE who have echocardiographic evidence of right ventricular dilatation and/or right ventricular dysfunction have a worse prognosis. A minority of patients with acute PE can develop chronic thromboembolic pulmonary hypertension. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.04.008DOI Listing
September 2018
10 Reads

Challenges and Changes to the Management of Pulmonary Embolism in the Emergency Department.

Clin Chest Med 2018 Sep;39(3):539-547

Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Avenue, Suite 273, New Haven, CT 06519, USA.

The diagnosis and treatment of pulmonary embolism (PE) remains one of the great challenges of emergency medicine. The symptoms of PE are myriad, common, and nonspecific. Undertesting risks missing a potentially life-threatening illness, whereas overtesting adds cost, false-positive diagnoses, incidental findings, and potential adverse impacts from contrast and radiation. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.04.009DOI Listing
September 2018
3 Reads

Pregnancy and Pulmonary Embolism.

Clin Chest Med 2018 Sep;39(3):525-537

Department of Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, 146 West River Street, Suite 11C, Providence, RI 02904, USA. Electronic address:

Venous thromboembolism (VTE), referring to both deep vein thrombosis and pulmonary embolism, is a leading cause of death in the developed world during pregnancy. This increased risk is attributed to the Virchow triad, inherited thrombophilias, along with other standard risk factors, and continues for up to 6 to 12 weeks postpartum. During the peripartum period, women should be risk stratified and preventive measures should be initiated based on their risk. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.04.007DOI Listing
September 2018
3 Reads

Venous Thromboembolism in Special Populations: Preexisting Cardiopulmonary Disease, Cirrhosis, End-Stage Renal Disease, and Asplenia.

Clin Chest Med 2018 Sep;39(3):515-524

Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, UPMC Montefiore, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA. Electronic address:

Venous thromboembolism (VTE) is a common cause of morbidity and mortality. Presence of preexisting conditions, such as cardiopulmonary diseases, cirrhosis, renal dysfunction, and asplenia, commonly occurs in VTE patients. Moreover, these conditions often are risk factors for developing VTE. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.04.006DOI Listing
September 2018
3 Reads

Intraluminal Arterial Filling Defects Misdiagnosed as Pulmonary Emboli: What Else Could They Be?

Clin Chest Med 2018 Sep;39(3):505-513

Pulmonary and Critical Care Medicine, Geisinger, 100 North Academy Avenue, Danville, PA 17822-1334, USA.

Pulmonary artery filling defects can be observed in various pathologic processes other than pulmonary embolism, for example, nonthrombotic pulmonary embolism with biological and nonbiological materials and intrinsic pulmonary artery lesions. They have also been described in rare conditions, such as fibrosing mediastinitis and congenital absence or stenosis of pulmonary artery, and some pulmonary parenchymal and airway malignancies. Misdiagnosis is common owing to the relative rarity of these conditions. Read More

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http://dx.doi.org/10.1016/j.ccm.2018.04.004DOI Listing
September 2018
18 Reads
2.074 Impact Factor