4041. COPD Assessment Test in Bronchiectasis: Minimum Clinically Important Difference and Psychometric Validation: A Prospective Study.
作者: David De la Rosa Carrillo.;Casilda Olveira.;Marta García-Clemente.;Rosa-María Girón-Moreno.;Rosa Nieto-Royo.;Annie Navarro-Rolon.;Concepción Prados-Sánchez.;Oriol Sibila.;Miguel-Ángel Martínez-García.
来源: Chest. 2020年157卷4期824-833页
Health-related quality of life (QoL) is one of the most important end points in bronchiectasis (BE). However, the majority of health-related QoL questionnaires are time-consuming or not validated in BE. The COPD Assessment Test (CAT) is an easy-to-use questionnaire. The objective of this study was to perform a complete validation of the CAT in BE.
4042. Impact of the New Pulmonary Hypertension Definition on Heart Transplant Outcomes: Expanding the Hemodynamic Risk Profile.
作者: Todd C Crawford.;Peter J Leary.;Charles D Fraser.;Alejandro Suarez-Pierre.;J Trent Magruder.;William A Baumgartner.;Kenton J Zehr.;Glenn J Whitman.;S Carolina Masri.;Farooq Sheikh.;Teresa De Marco.;Bradley A Maron.;Kavita Sharma.;Nisha A Gilotra.;Stuart D Russell.;Brian A Houston.;Bhavadharini Ramu.;Ryan J Tedford.
来源: Chest. 2020年157卷1期151-161页
At the recent 6th World Symposium on Pulmonary Hypertension (PH), the definition of PH was redefined to include lower pulmonary artery pressures in the setting of elevated pulmonary vascular resistance (PVR). However, the relevance of this change to subjects with PH due to left-heart disease as well as the preoperative assessment of heart transplant (HT) recipients is unknown.
4043. Accuracy of Xpert MTB/RIF Ultra for the Diagnosis of Pleural TB in a Multicenter Cohort Study.
作者: Guirong Wang.;Shuqi Wang.;Xinting Yang.;Qing Sun.;Guanglu Jiang.;Mailing Huang.;Fengmin Huo.;Yifeng Ma.;Xiaoyou Chen.;Hairong Huang.
来源: Chest. 2020年157卷2期268-275页
The Xpert MTB/RIF (Xpert) assay has greatly improved the diagnosis of TB and identification of resistance to rifampicin (RIF). However, sensitivity of Xpert remains poor for pleural fluid detection. This study evaluated the performance of the novel next-generation Xpert MTB/RIF Ultra (Xpert Ultra) in comparison with Xpert for pleural TB diagnosis.
4044. Critically Ill Patients With HIV: 40 Years Later.
The development of combination antiretroviral therapies (cARTs) in the mid-1990s has dramatically modified the clinical presentation of critically ill, HIV-infected patients. Most cART-treated patients aging with controlled HIV replication are currently admitted to the ICU for non-AIDS-related events, mostly bacterial pneumonia and exacerbation of comorbidities, variably affected by chronic HIV infection (COPD, cardiovascular diseases, or solid neoplasms). Today, Pneumocystis jirovecii pneumonia, cerebral toxoplasmosis, TB, and other severe opportunistic infections only occur in patients with unknown viral status, limited access to cART, viral resistance, or compliance issues. Acute respiratory failure, neurological disorders, and sepsis remain the main conditions that lead HIV-infected patients to the ICU, although admissions for liver diseases or acute kidney injury are increasing. Case fatality dropped substantially over the past decades, reaching figures of HIV-uninfected critically ill patients with similar demographic characteristics, comorbidities, and level of organ dysfunctions. Several other facets of critical care management have evolved in this population, including diagnostic procedures, cART management at the acute phase of critical illness, and ethical considerations. The goal of this narrative review was to depict the current evidence and emerging challenges for the management of critically ill, HIV-infected patients, almost 40 years following the onset of the AIDS epidemic.
4045. The Neurokinin-1 Receptor Antagonist Orvepitant Is a Novel Antitussive Therapy for Chronic Refractory Cough: Results From a Phase 2 Pilot Study (VOLCANO-1).
作者: Jaclyn Smith.;David Allman.;Huda Badri.;Robert Miller.;Julie Morris.;Imran Satia.;Andrew Wood.;Michael K Trower.
来源: Chest. 2020年157卷1期111-118页
Substance P and the neurokinin-1 (NK-1) receptor are implicated in chronic refractory cough pathophysiology. We assessed the efficacy and safety of orvepitant, a brain-penetrant NK-1 antagonist, in an open-label study in CRC patients with chronic refractory cough.
4046. Bronchoscope-Related "Superbug" Infections.
Several recent cases associating cleaned and high-level disinfected duodenoscopes with outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) and related multidrug-resistant organisms (MDROs) may cause bronchoscopists, pulmonologists, and other stakeholders to inquire about the effectiveness of today's practices for reprocessing flexible bronchoscopes. The primary objectives of this study were to address this question and investigate the risk of bronchoscopes transmitting infections of CRE and related MDROs. The published literature and the US Food and Drug Administration's medical device database of adverse events were searched beginning in 2012, when endoscopy first emerged as a recognized risk factor for transmission of CRE. The Internet was also searched during this same time frame to identify other relevant cases. Several cases associating reprocessed bronchoscopes with infections of CRE or a related MDRO were identified. This study's findings suggest that bronchoscopes may pose an underrecognized potential for transmission of CRE and related MDROs, warranting greater public awareness, enhanced preventive measures, and updated reprocessing guidance. This study's data also suggest that the cleaning and high-level disinfection of bronchoscopes performed in accordance with published guidelines and manufacturer instructions may not always be sufficiently effective to eliminate this risk. Several factors were identified that can adversely affect a bronchoscope's reprocessing and pose a risk of transmission of these multidrug-resistant bacteria, including use of a damaged or inadequately serviced bronchoscope, and formation of an inaccessible biofilm. Recommendations are provided to improve the safety of flexible bronchoscopes, including supplementing their reprocessing with an enhanced measure such as sterilization when warranted, and strict adherence to a periodic servicing and maintenance schedule consistent with the bronchoscope manufacturer's instructions.
4047. Extremes of Age Decrease Survival in Adults After Lung Transplant.
作者: Carli J Lehr.;Eugene H Blackstone.;Kenneth R McCurry.;Lucy Thuita.;Wayne M Tsuang.;Maryam Valapour.
来源: Chest. 2020年157卷4期907-915页
Age has been implicated as a factor in the plateau of long-term survival after lung transplant.
4048. Assessment of Diaphragm Function and Pleural Pressures During Thoracentesis.
作者: Yunuen Aguilera Garcia.;Atul Palkar.;Seth J Koenig.;Mangala Narasimhan.;Paul H Mayo.
来源: Chest. 2020年157卷1期205-211页
This prospective observational study reports on diaphragm excursion, velocity of diaphragm contraction, and changes in pleural pressure that occur with thoracentesis.
4049. Eligibility for Lung Volume Reduction Surgery in Patients With COPD Identified in a UK Primary Care Setting.
作者: Hannah R Whittaker.;Olivia Connell.;Jennifer Campbell.;Amany F Elbehairy.;Nicholas S Hopkinson.;Jennifer K Quint.
来源: Chest. 2020年157卷2期276-285页
Although lung volume reduction surgery (LVRS) improves survival in appropriately selected patients with COPD, few procedures are performed. The National Institute for Health and Care Excellence has recommended a more systematic approach to identifying potential candidates. We investigated LVRS referrals from a UK primary care population and aimed to establish an accurate estimate of eligible patients and determine a strategy for identifying potential candidates systematically.
4050. Accuracy of Several Lung Ultrasound Methods for the Diagnosis of Acute Heart Failure in the ED: A Multicenter Prospective Study.
作者: Aurélien Buessler.;Tahar Chouihed.;Kévin Duarte.;Adrien Bassand.;Matthieu Huot-Marchand.;Yannick Gottwalles.;Alice Pénine.;Elies André.;Lionel Nace.;Déborah Jaeger.;Masatake Kobayashi.;Stefano Coiro.;Patrick Rossignol.;Nicolas Girerd.
来源: Chest. 2020年157卷1期99-110页
Early appropriate diagnosis of acute heart failure (AHF) is recommended by international guidelines. This study assessed the value of several lung ultrasound (LUS) strategies for identifying AHF in the ED.
4051. Managing Massive Hemoptysis.
Massive hemoptysis is a medical emergency with high mortality presenting several difficult diagnostic and therapeutic challenges. The origin of bleeding and underlying etiology often is not immediately apparent, and techniques for management of this dangerous condition necessitate an expedient response. Unlike hemorrhage in other circumstances, a small amount of blood can rapidly flood the airways, thereby impairing oxygenation and ventilation, leading to asphyxia and consequent cardiovascular collapse. Of paramount importance is early control of the patient's airway and immediate isolation of hemorrhage in an attempt to localize and control bleeding. A coordinated team response is essential to guarantee the best chances of patient survival. Prompt control of the airway and steps to limit the spread of hemorrhage take precedence. Bronchial artery embolization, rigid and flexible bronchoscopy, and surgery all serve as potential treatment options to provide definitive control of hemorrhage. Several adjunctive therapies described in recent years may also assist in the control of bleeding; however, their role is less defined in life-threatening hemoptysis and warrants additional studies. In this concise review, we emphasize the steps necessary for a systematic approach in the management of life-threatening hemoptysis.
4052. Lung Hyperlucency: A Clinical-Radiologic Algorithmic Approach to Diagnosis.
作者: Sujith V Cherian.;Francis Girvin.;David P Naidich.;Stephen Machnicki.;Kevin K Brown.;Jay H Ryu.;Nishant Gupta.;Vishisht Mehta.;Rosa M Estrada-Y-Martin.;Mangala Narasimhan.;Margarita Oks.;Suhail Raoof.
来源: Chest. 2020年157卷1期119-141页
Areas of diminished lung density are frequently identified both on routine chest radiographs and chest CT examinations. Colloquially referred to as hyperlucent foci of lung, a broad range of underlying pathophysiologic mechanisms and differential diagnoses account for these changes. Despite this, the spectrum of etiologies can be categorized into underlying parenchymal, airway, and vascular-related entities. The purpose of this review is to provide a practical diagnostic algorithmic approach to pulmonary hyperlucencies incorporating clinical history and characteristic imaging patterns to narrow the differential.
4053. Right Ventricular to Left Ventricular Ratio at CT Pulmonary Angiogram Predicts Mortality in Interstitial Lung Disease.
作者: Simon Bax.;Joseph Jacob.;Riaz Ahmed.;Charlene Bredy.;Konstantinos Dimopoulos.;Aleksander Kempny.;Maria Kokosi.;Gregory Kier.;Elisabetta Renzoni.;Philip L Molyneaux.;Felix Chua.;Vasilis Kouranos.;Peter George.;Colm McCabe.;Michael Wilde.;Anand Devaraj.;Athol Wells.;S John Wort.;Laura C Price.
来源: Chest. 2020年157卷1期89-98页
Patients with interstitial lung disease (ILD) may develop pulmonary hypertension (PH), often disproportionate to the severity of the ILD. The right ventricular to left ventricular diameter (RV:LV) ratio measured at CT pulmonary angiogram (CTPA) has been shown to provide valuable information in patients with pulmonary arterial hypertension and to predict death or deterioration in acute pulmonary embolism.
4054. A Randomized Trial of Nebulized Lignocaine, Lignocaine Spray, or Their Combination for Topical Anesthesia During Diagnostic Flexible Bronchoscopy.
作者: Sahajal Dhooria.;Shivani Chaudhary.;Babu Ram.;Inderpaul Singh Sehgal.;Valliappan Muthu.;Kuruswamy Thurai Prasad.;Ashutosh N Aggarwal.;Ritesh Agarwal.
来源: Chest. 2020年157卷1期198-204页
The optimal mode of delivering topical anesthesia during flexible bronchoscopy remains unknown. This article compares the efficacy and safety of nebulized lignocaine, lignocaine oropharyngeal spray, or their combination.
4055. Upper Airway Stimulation vs Positive Airway Pressure Impact on BP and Sleepiness Symptoms in OSA.
作者: Harneet K Walia.;Nicolas R Thompson.;Kingman P Strohl.;Michael D Faulx.;Tina Waters.;Alan Kominsky.;Nancy Foldvary-Schaefer.;Reena Mehra.
来源: Chest. 2020年157卷1期173-183页
Positive airway pressure (PAP) and upper airway stimulation (UAS) are approved OSA treatment options. Although the effect of PAP on improvement in BP and daytime sleepiness (defined according to the Epworth Sleepiness Scale [ESS]) has been established, the impact of UAS on BP remains unclear. This study hypothesized that PAP and UAS will confer improvements in BP and daytime sleepiness.
4056. Subtyping COPD by Using Visual and Quantitative CT Imaging Features.
作者: Jinkyeong Park.;Brian D Hobbs.;James D Crapo.;Barry J Make.;Elizabeth A Regan.;Stephen Humphries.;Vincent J Carey.;David A Lynch.;Edwin K Silverman.; .
来源: Chest. 2020年157卷1期47-60页
Multiple studies have identified COPD subtypes by using visual or quantitative evaluation of CT images. However, there has been no systematic assessment of a combined visual and quantitative CT imaging classification. We integrated visually defined patterns of emphysema with quantitative imaging features and spirometry data to produce a set of 10 nonoverlapping CT imaging subtypes, and we assessed differences between subtypes in demographic features, physiological characteristics, longitudinal disease progression, and mortality.
4057. Apneas of Heart Failure and Phenotype-Guided Treatments: Part One: OSA.
Sleep-disordered breathing (SDB), including OSA and central sleep apnea, is highly prevalent in patients with heart failure (HF). Multiple studies have reported this high prevalence in asymptomatic as well as symptomatic patients with reduced left ventricular ejection fraction (HFrEF), as well as in those with HF with preserved ejection fraction. The acute pathobiologic consequences of OSA, including exaggerated sympathetic activity, oxidative stress, and inflammation, eventually could lead to progressive left ventricular dysfunction, repeated hospitalization, and excessive mortality. Large numbers of observational studies and a few small randomized controlled trials have shown improvement in various cardiovascular consequences of SDB with treatment. There are no long-term randomized controlled trials to show improved survival of patients with HF and treatment of OSA. One trial of positive airway pressure treatment of OSA included patients with HF and showed no improvement in clinical outcomes. However, any conclusions derived from this trial must take into account several important pitfalls that have been extensively discussed in the literature. With the role of positive airway pressure as the sole therapy for SDB in HF increasingly questioned, a critical examination of long-accepted concepts in this field is needed. The objective of this review was to incorporate recent advances in the field into a phenotype-based approach to the management of OSA in HF.
|