Chest
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Multicenter Study
Clinical prognosis of non-massive central and non-central pulmonary embolism: a registry-based cohort study.
Whether the localization of nonmassive pulmonary embolism (PE) is associated with the short-term and long-term prognosis of patients remains unknown. Our aim was to characterize associations of nonmassive PE localization with risks of recurrent VTE, major bleeding, and mortality during and after anticoagulation. ⋯ In nonmassive PE, central localization of PE is associated with greater risk of recurrent VTE after anticoagulation cessation. However, the low magnitude of this association and the absence of association after unprovoked PE suggest that the clinical relevance of this finding is limited and that the duration of anticoagulation should not be tailored to PE localization after nonmassive unprovoked PE.
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Exhaled breath temperature (EBT) is a new noninvasive method for the study of inflammatory respiratory diseases with a potential to reach clinical practice. However, few studies are available regarding the validation of this method, and they were mainly derived from small, pediatric populations; thus, the range of normal values is not well established. The aim of this study was to measure EBT values in an Italian population of 298 subjects (mean age, 45.2 ± 15.5 years; 143 male subjects; FEV1, 97.2% ± 5.8%; FVC, 98.4% ± 3.9%) selected from 867 adult volunteers to define reference values in healthy subjects and to analyze the influence of individual and external variables on this parameter. ⋯ In a large population of healthy subjects who never smoked, these data provide reference values for measuring EBT as a basis for future studies. Our results are contribute to the promotion of EBT from "bench" to "bedside."
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Practice Guideline
Management of children with chronic wet cough and protracted bacterial bronchitis: CHEST Guideline and Expert Panel Report.
Wet or productive cough is common in children with chronic cough. We formulated recommendations based on systematic reviews related to the management of chronic wet cough in children (aged ≤ 14 years) based on two key questions: (1) how effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? and (2) when should children be referred for further investigations? ⋯ Compared with the 2006 Cough Guidelines, there is now high-quality evidence for some, but not all, aspects of the management of chronic wet cough in specialist settings. However, further studies (particularly in primary health) are required.
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Practice Guideline
Use of management pathways or algorithms in children with chronic cough: CHEST Guideline and Expert Panel Report.
Using management algorithms or pathways potentially improves clinical outcomes. We undertook systematic reviews to examine various aspects in the generic approach (use of cough algorithms and tests) to the management of chronic cough in children (aged ≤ 14 years) based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format. ⋯ Compared with the 2006 Cough Guidelines, there is now high-quality evidence that in children aged ≤ 14 years with chronic cough (> 4 weeks' duration), the use of cough management protocols (or algorithms) improves clinical outcomes, and cough management or testing algorithms should differ depending on the associated characteristics of the cough and clinical history. A chest radiograph and, when age appropriate, spirometry (pre- and post-β2 agonist) should be undertaken. Other tests should not be routinely performed and undertaken in accordance with the clinical setting and the child's clinical symptoms and signs (eg, tests for tuberculosis when the child has been exposed).
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Observational Study
Clinical predictors of hospital mortality differ between direct and indirect acute respiratory distress syndrome.
Direct (pulmonary) and indirect (extrapulmonary) ARDS are distinct syndromes with important pathophysiologic differences. The goal of this study was to determine whether clinical characteristics and predictors of mortality differ between direct or indirect ARDS. ⋯ Despite lower severity of illness and fewer organ failures, patients with direct ARDS had mortality rates similar to patients with indirect ARDS. Factors previously associated with mortality during ARDS were only associated with mortality in direct ARDS. These findings suggest that direct and indirect ARDS have distinct features that may differentially affect risk prediction and clinical outcomes.