Chest
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Comparative Study
Hospital-level variation in intensive care unit admission and critical care procedures for patients hospitalized for pulmonary embolism.
Variation in the use of ICUs for low-risk conditions contributes to health system inefficiency. We sought to examine the relationship between ICU use for patients with pulmonary embolism (PE) and cost, mortality, readmission, and procedure use. ⋯ Hospitals vary widely in ICU admission rates for acute PE without a detectable impact on mortality, cost, or readmission. Patients admitted to ICUs in higher-using hospitals received many critical care procedures less often, suggesting that these patients may have had weaker indications for ICU admission. Hospitals with greater ICU admission may be appropriate targets for improving efficiency in ICU admissions.
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Multicenter Study Comparative Study
Unique Predictors of Mortality in Patients With Pulmonary Arterial Hypertension Associated With Systemic Sclerosis in the Reveal Registry.
Patients with pulmonary arterial hypertension (PAH) associated with systemic sclerosis (SSc-APAH) experience higher mortality rates than patients with idiopathic disease and those with other connective tissue diseases (CTD-APAH). We sought to identify unique predictors of mortality associated with SSc-APAH in the CTD-APAH population. ⋯ Patients with SSc-APAH have higher mortality rates than patients with non-SSc-CTD-APAH. Identifying patients with SSc-APAH who are at a particularly high risk of death, including elderly men and patients with low baseline SBP or 6MWD, or markedly elevated mRAP or PVR, will enable physicians to identify patients who may benefit from closer monitoring and more aggressive treatment.
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Review Historical Article
Did We Finally Slay the Evil Dragon of Cigarette Smoking in the Late 20th Century?: Unfortunately, the Answer Is No-the Dragon Is Still Alive and Well in the 21st Century and Living in the Third World. Shame on Us!
If cigarettes were introduced as a new consumer product today, it is unlikely they would receive government regulatory approval. Cigarettes have proven biologic toxicities (carcinogenesis, atherogenesis, teratogenesis) and well-established causal links to human disease. Things were very different in 1913 when the R. ⋯ There is some good news. The 2003 Framework Convention on Tobacco Control, supported strongly by the American College of Chest Physicians, is the first global public health treaty of the new millennium. Many developed societies have begun planning to rid their countries of cigarettes in what is called the Endgame Strategy, and now is the time for the international medical community to help change tobacco policy to a worldwide endgame approach to rid all humanity of smoking-related diseases.
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Comparative Study
Heterogeneity of Specific Gas Volume Changes: A New Tool to Plan Lung Volume Reduction in COPD.
The aim of this work was to investigate if regional differences of specific gas volume (SVg) in the different regions (lobes and bronchopulmonary segments) in healthy volunteers and patients with severe emphysema can be used as a tool for planning lung volume reduction (LVR) in emphysema. ⋯ SVg variations within the lung are highly homogeneous in healthy subjects. Regions with low ΔSVg/ΔV (ie, more pronounced gas trapping) should be considered as target areas for LVR. Regions with negative values of ΔSVg/ΔV identify where collateral ventilation is present. HI is helpful to assess the patient in the different stages of disease and the effect of different LVR treatments.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Long-acting Bronchodilators and Arterial Stiffness in Patients with COPD: A Comparison of Fluticasone Furoate/Vilanterol with Tiotropium.
Increased arterial stiffness as measured by aortic pulse wave velocity (aPWV) predicts cardiovascular events and mortality and is elevated in patients with COPD. Prior investigation suggests that a long-acting β-agonist (LABA)/inhaled corticosteroid (ICS) lowers aPWV in patients with baseline aPWV ≥ 11 m/s. This study compared the effect of the ICS/LABA fluticasone furoate/vilanterol (FF/VI), 100/25 μg, delivered via the ELLIPTA dry powder inhaler, with tiotropium bromide (TIO), 18 μg, on aPWV. ⋯ No differences on aPWV were observed between FF/VI and TIO. However, further studies with a placebo arm are required to establish definitively whether long-acting bronchodilators lower aPWV. Both treatments demonstrated an acceptable tolerability profile.