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Scott J Millington, Manoj M Lalu, Michel Boivin, Seth Koenig
The insertion of a subclavian central venous catheter is generally associated with a high rate of success and a favorable risk profile. The use of ultrasound for procedural guidance has been demonstrated to further increase the rate of success and reduce the risk of specific mechanical complications, especially in patients with difficult surface anatomy. Many individual ultrasound techniques have been described in the literature; this article presents a systematic approach for incorporating these tools into bedside practice and includes a series of illustrative figures and narrated video presentations to demonstrate the techniques described...
January 2, 2019: Chest
Christopher L Carroll, Neha S Dangayach, Roozehra Khan, W Graham Carlos, Ilana Harwayne-Gidansky, Harpreet Singh Grewal, Brandon Seay, Steven Q Simpson, Tamas Szakmany
No abstract text is available yet for this article.
December 27, 2018: Chest
Abebaw M Yohannes, Sheila Dryden, Nicola A Hanania
BACKGROUND: We examined the validity and responsiveness of the Depression, Anxiety and Stress Scale (DASS-21) in patients with chronic obstructive pulmonary disease (COPD) following an eight-week pulmonary rehabilitation program (PRP). METHODS: 557 patients with clinically stable COPD completed an eight-week outpatient multidisciplinary PRP, comprising 2-hours (1-hour exercise and 1-hour education) per/week. Anxiety, exercise capacity, quality of life, and dyspnea were measured pre- and post-PRP, utilizing the anxiety inventory for respiratory disease (AIR), incremental shuttle walk test (ISWT), St...
December 27, 2018: Chest
Denis Chemla, David Boulate, Jason Weatherald, Edmund M T Lau, Pierre Attal, Laurent Savale, David Montani, Elie Fadel, Olaf Mercier, Olivier Sitbon, Marc Humbert, Philippe Hervé
BACKGROUND: The golden ratio (Phi, Φ = 1.618) is a proportion that has been found in many phenomena in nature including the cardiovascular field. We tested the hypothesis that the systolic over mean pulmonary artery pressure ratio (sPAP/mPAP) and the mean over diastolic pressure ratio (mPAP/dPAP) may match Φ in patients with pulmonary arterial hypertension (PAH) and in controls. METHODS: In the first, theoretical part of the study, we discussed why our hypothesis is consistent with three known hemodynamic features of the pulmonary circulation: (1) the 0...
December 27, 2018: Chest
Ashraf Fawzy, Nirupama Putcha, Carrie P Aaron, Russell P Bowler, Alejandro P Comellas, Christopher B Cooper, Mark T Dransfield, Meilan K Han, Eric A Hoffman, Richard E Kanner, Jerry A Krishnan, Wassim W Labaki, Robert Paine, Laura M Paulin, Stephen P Peters, Robert Wise, R Graham Barr, Nadia N Hansel
BACKGROUND: Aspirin use in COPD has been associated with reduced all-cause mortality in meta-regression analysis with few equivocal studies. However, aspirin's effect on COPD morbidity is unknown. METHODS: Self-reported daily aspirin use was obtained at baseline from SPIROMICS participants with COPD (FEV1 /FVC<70%). Acute exacerbations of COPD (AECOPD) were prospectively ascertained through quarterly structured telephone questionnaires up to 3 years and categorized as moderate (symptoms treated with antibiotics or oral corticosteroids) or severe (requiring emergency department visit or hospitalization)...
December 26, 2018: Chest
Parker Crutchfield, Tyler S Gibb, Michael James Redinger, Dan Ferman, John Livingstone
No abstract text is available yet for this article.
December 19, 2018: Chest
Jaspal Singh, Ronald F Sing
Percutaneous dilatational tracheotomy (PDT) has become increasingly popular and gained widespread acceptance. The modern PDT procedure has also evolved to whereby it can be safely performed by surgeons and non-surgeons in the intensive care unit (ICU). Moreover, bedside PDT has proven clinical outcomes and can save hospital resources. As such, PDT performed in the ICU is now a widely-performed procedure, often being the tracheostomy procedure of choice. Today, many pulmonologists and intensivists who can utilize bedside PDT do not perform this procedure; it is conceivable this practice may expand especially amongst pulmonologists and intensivists...
December 12, 2018: Chest
Sameer K Avasarala, Lutz Freitag, Atul C Mehta
No abstract text is available yet for this article.
December 11, 2018: Chest
Antonello D'Andrea, Anna Agnese Stanziola, Rajan Saggar, Rajeev Saggar, Simona Sperlongano, Marianna Conte, Michele D'Alto, Francesco Ferrara, Luna Gargani, Patrizio Lancellotti, Eduardo Bossone
BACKGROUND: The most important determinant of long term survival in idiopathic pulmonary fibrosis (IPF) patients is the adaptation of the right ventricle (RV) to the increased pulmonary vascular resistance. Our aim was to explore RV contractile reserve during stress echocardiography (SE) in early stage IPF. METHODS: 50 early stage IPF patients and 50 healthy controls underwent rest and SE, including RV 2-dimensional Speckle Tracking Echocardiography (2DSTE). At peak exertion blood gas analysis and spirometry were also assessed...
December 10, 2018: Chest
Vincent Lau, Fran Priestap, Yves Landry, Ian Ball, Robert Arntfield
INTRODUCTION: Critical care transesophageal echocardiography (ccTEE) performed by intensivists is increasingly used to investigate cardio-respiratory failure in the intensive care unit (ICU). Validation of the accuracy of TEE in the hands of intensivists remains largely unknown. In this study, we sought to characterize the diagnostic accuracy of ccTEE. METHODS: & Materials: Two-center, retrospective comparison between TEE studies performed and interpreted by intensivists and cardiology-led TEE or transthoracic exam (TTE) performed and/or interpreted by cardiologists...
December 10, 2018: Chest
Thomas S Metkus, Steven P Schulman, Joseph E Marine, Shaker M Eid
BACKGROUND: The incidence of complications and the outcomes of temporary transvenous pacemaker (TTP) placement in the modern era are not well established. METHODS: To determine the current incidence of pericardial complications and the outcomes of patients undergoing TTP, we performed an analysis using the National Inpatient Sample (NIS), which is a US national database of hospital admissions. We identified all patients who underwent TTP using ICD-9 codes. We constructed a multivariate logistic regression model for a primary outcome of pericardial tamponade and another for a primary outcome of in-hospital mortality...
December 10, 2018: Chest
John J Marini
Lobar atelectasis (or collapse) is an exceedingly common, rather predictable and potentially pathogenic companion to many forms of acute illness, post-operative care, and chronic debility. Readily diagnosed by routine chest imaging and bedside ultrasound, the consequences from lobar collapse may be minor or serious, depending on extent, mechanism, patient vulnerability, abruptness of onset, effectiveness of hypoxic vasoconstriction and compensatory reserves. Measures taken to reduce secretion burden, assure adequate secretion clearance, maintain upright positioning, reverse lung compression and sustain lung expansion accord with a logical physiologic rationale...
December 5, 2018: Chest
Michel A Cramer Bornemann, Carlos H Schenck, Mark W Mahowald
This review of Sleep-Related Violence reports the nature of the underlying sleep-suspected conditions encountered and helps establish the spectrum of sleep-related behaviors resulting in forensic consequences. This information may begin to bridge the gap between the differing medical and legal concepts of automatisms (complex motor behaviors occurring in the absence of conscious awareness and therefore without culpability). Increasingly, sleep medicine professionals are asked by legal professionals whether a sleep-related condition could possibly have played a role in a forensic-related event...
November 22, 2018: Chest
Steven D Nathan, Ulrich Costabel, Ian Glaspole, Marilyn K Glassberg, Lisa H Lancaster, David J Lederer, Carlos A Pereira, Benjamin Trzaskoma, Elizabeth A Morgenthien, Susan L Limb, Athol U Wells
BACKGROUND: Declines in percent predicted forced vital capacity (% predicted FVC), declines in 6-minute walk distance (6MWD), and respiratory hospitalizations are events associated with disease progression and mortality in idiopathic pulmonary fibrosis (IPF). The incidence of multiple events in the same patient over 12 months of pirfenidone treatment is unknown. METHODS: Patients who received pirfenidone 2403 mg/day (n = 623) or placebo (n = 624) in the ASCEND (Study 016; NCT01366209) and CAPACITY (Studies 004 and 006; NCT00287716 and NCT00287729) phase III trials were included in this post hoc analysis...
November 22, 2018: Chest
Jean-Louis Pépin, Ingrid Jullian-Desayes, Marc Sapène, Erika Treptow, Marie Joyeux-Faure, Meriem Benmerad, Sébastien Bailly, Yves Grillet, Bruno Stach, Philippe Richard, Patrick Lévy, Jean-François Muir, Renaud Tamisier
BACKGROUND: The management of patients with high cardiovascular risk and OSA must target not only improving adherence to CPAP, but should also include strategies aimed at reducing BP and increasing physical activity. The study aims to evaluate the effectiveness of an integrated intervention using remote patient telemonitoring in reducing BP in high cardiovascular risk patients with OSA. METHODS: In a multicenter, open, randomized trial, patients with OSA were randomly assigned at CPAP initiation to usual care or multimodal telemonitoring for 6 months...
November 22, 2018: Chest
Hyunjean Jung, Pil-Sung Yang, Eunsun Jang, Hee Tae Yu, Tae-Hoon Kim, Jae-Sun Uhm, Jong-Youn Kim, Hui-Nam Pak, Moon-Hyoung Lee, Boyoung Joung, Gregory Y H Lip
BACKGROUND: Chronic anticoagulation is recommended in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF). Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative to warfarin, but there are limited data to support their use in patients with HCM and AF. We sought to compare thromboembolic events, bleeding, and mortality between NOAC and warfarin in patients with HCM and AF. METHODS: From the Korean National Health Insurance Service (NHIS) database during the period from January 1, 2011 to December 31, 2016, we identified a warfarin-treated group of patients with HCM and AF (n = 955) who were compared with a 1:2 propensity-matched NOAC treated group (n = 1,504)...
November 22, 2018: Chest
Patrick J Strollo, Jan Hedner, Nancy Collop, Daniel G Lorch, Dan Chen, Lawrence P Carter, Yuan Lu, Lawrence Lee, Jed Black, Jean-Louis Pépin, Susan Redline
BACKGROUND: Excessive sleepiness (ES) is a common symptom of OSA, which often persists despite primary OSA therapy. This phase III randomized withdrawal trial evaluated solriamfetol (JZP-110) for the treatment of ES in adults with OSA. METHODS: After 2 weeks of clinical titration (n = 174) and 2 weeks of stable dose administration (n = 148), participants who reported improvement on the Patient Global Impression of Change (PGIC) and had numerical improvements on the Maintenance of Wakefulness Test (MWT) and Epworth Sleepiness Scale (ESS) were randomly assigned to placebo (n = 62) or solriamfetol (n = 62) for 2 additional weeks; 13% of participants did not enter the randomized withdrawal phase because of not meeting the criteria for improvement during the stable dose phase...
November 22, 2018: Chest
Kari R Gillmeyer, Ming-Ming Lee, Alissa P Link, Elizabeth S Klings, Seppo T Rinne, Renda Soylemez Wiener
BACKGROUND: The diagnosis of pulmonary arterial hypertension (PAH) is challenging, and there is significant overlap with the more heterogenous diagnosis of pulmonary hypertension (PH). Clinical and research efforts that rely on administrative data are limited by current coding systems that do not adequately reflect the clinical classification scheme. The aim of this systematic review is to investigate current algorithms to detect PAH using administrative data and to appraise the diagnostic accuracy of these algorithms against a reference standard...
November 22, 2018: Chest
Adrian Ceccato, Catia Cilloniz, Ignacio Martin-Loeches, Otavio T Ranzani, Albert Gabarrus, Leticia Bueno, Carolina Garcia-Vidal, Miquel Ferrer, Michael S Niederman, Antoni Torres
BACKGROUND: Antibiotic combinations that include macrolides have shown lower mortality rates than β-lactams in monotherapy or combined with fluoroquinolones in patients with community-acquired pneumonia (CAP). However, this effect has not been studied according to the levels of C-reactive protein (CRP) in CAP with identified microbial cause. OBJECTIVES: In patients with CAP and known microbial cause we aimed to evaluate 30 day mortality of a β-lactam plus macrolide (BL+M) compared to a fluoroquinolone alone with or without a β-lactam (FQ±BL) METHODS: We analysed a prospective observational cohort of patients with CAP admitted to Hospital Clinic of Barcelona between 1996 to 2016...
November 21, 2018: Chest
Elina Eleftheria Pliakos, Nikolaos Andreatos, Giannoula S Tansarli, Panayiotis D Ziakas, Eleftherios Mylonakis
BACKGROUND: The use of corticosteroids as adjunct treatment for community-acquired pneumonia (CAP) is associated with potential clinical benefits and the aim of this study was to evaluate the cost-effectiveness of this approach. METHODS: We constructed a decision-analytic model comparing the use of corticosteroids+antibiotics to that of placebo+antibiotics for the treatment of CAP. Cost-effectiveness was determined by calculating deaths averted and incremental cost-effectiveness ratios (ICER)...
November 15, 2018: Chest
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