4036. Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019: CHEST Guideline and Expert Panel Report.
作者: Lisa K Moores.;Tobias Tritschler.;Shari Brosnahan.;Marc Carrier.;Jacob F Collen.;Kevin Doerschug.;Aaron B Holley.;David Jimenez.;Gregoire Le Gal.;Parth Rali.;Philip Wells.
来源: Chest. 2020年158卷3期1143-1163页
Emerging evidence shows that severe coronavirus disease 2019 (COVID-19) can be complicated by a significant coagulopathy, that likely manifests in the form of both microthrombosis and VTE. This recognition has led to the urgent need for practical guidance regarding prevention, diagnosis, and treatment of VTE.
4037. Unplanned Admission to the ICU: A Qualitative Study Examining Family Member Experiences.
作者: Ann L Jennerich.;Mara R Hobler.;Rashmi K Sharma.;Ruth A Engelberg.;J Randall Curtis.
来源: Chest. 2020年158卷4期1482-1489页
Transfers to the ICU from acute care are common, and it is essential to understand how family members of critically ill patients experience these transitions of care.
4038. Risk Factors and Prevention of Pneumocystis jirovecii Pneumonia in Patients With Autoimmune and Inflammatory Diseases.
作者: Amine Ghembaza.;Mathieu Vautier.;Patrice Cacoub.;Valérie Pourcher.;David Saadoun.
来源: Chest. 2020年158卷6期2323-2332页
Patients with autoimmune and/or inflammatory diseases (AIIDs) are prone to serious infectious complications such as Pneumocystis jirovecii pneumonia (PJP). In non-HIV patients, the prognosis is poorer, and diagnostic tests are of lower sensitivity. Given the low incidence of PJP in AIIDs, with the exception of granulomatosis with polyangiitis, and the non-negligible side effects of chemoprophylaxis, routine prescription of primary prophylaxis is still debated. Absolute peripheral lymphopenia, high doses of corticosteroids, combination with other immunosuppressive agents, and concomitant lung disease are strong predictors for the development of PJP and thus should warrant primary prophylaxis. Trimethoprim-sulfamethoxazole is considered first-line therapy and is the most extensively used drug for PJP prophylaxis. Nevertheless, it may expose patients to side effects. Effective alternative drugs such as atovaquone or aerosolized pentamidine could be used when trimethoprim-sulfamethoxazole is not tolerated or contraindicated. No standard guidelines are available to guide PJP prophylaxis in patients with AIIDs. This review covers the epidemiology, risk factors, and prevention of pneumocystis in the context of AIIDs.
4039. Power Outage: An Ignored Risk Factor for COPD Exacerbations.
作者: Wangjian Zhang.;Scott C Sheridan.;Guthrie S Birkhead.;Daniel P Croft.;Jerald A Brotzge.;John G Justino.;Neil A Stuart.;Zhicheng Du.;Xiaobo X Romeiko.;Bo Ye.;Guanghui Dong.;Yuantao Hao.;Shao Lin.
来源: Chest. 2020年158卷6期2346-2357页
COPD is the third leading cause of death in the United States, with 16 million Americans currently experiencing difficulty with breathing. Power outages could be life-threatening for those relying on electricity. However, significant gaps remain in understanding the potential impact of power outages on COPD exacerbations.
4040. Performance and Interpretation of Invasive Hemodynamic Exercise Testing.
Exertional dyspnea is a common complaint for patients seen in pulmonary, cardiac, and general medicine clinics, and elucidating the cause is often challenging, particularly when physical examination, echocardiography, radiography, and pulmonary function test results are inconclusive. Invasive cardiopulmonary exercise testing has emerged as the gold standard test to define causes of dyspnea and exertional limitation in this population. In this review, we describe the methods for performing and interpreting invasive cardiopulmonary exercise testing, with particular attention to the hemodynamic and blood sampling data as they apply to patients being evaluated for heart failure and pulmonary hypertension.
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