Chest
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Indeterminate randomized controlled trials (RCTs) in ARDS may arise from sample size misspecification, leading to abandonment of efficacious therapies. ⋯ Reporting of sample size estimations was inconsistent in ARDS RCTs, and misspecification of CER and ATE was common. Prognostic enrichment strategies in ARDS RCTs based on all-cause mortality are unlikely to be successful. Bayesian methods can be used to prioritize interventions for future effectiveness RCTs.
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Meta Analysis
Reproducibility of Maximum Respiratory Pressure Assessment: A Systematic Review and Metanalysis.
Accurate assessment of maximum respiratory pressure is vital when tracking disease progression and devising treatment strategies. Previous studies indicate a learning effect when undertaking maximum respiratory pressure measurements. The extent of this learning effect and methodologies undertaken to mitigate this learning effect have not been investigated systematically. ⋯ Inspiratory muscles warm-up procedures induce higher increases in maximum inspiratory pressure in comparison with single and repeated testing sessions of maximum respiratory pressure in healthy individuals. Warm-up protocols are more effective to obtain the maximum performance of inspiratory muscles in one testing session in comparison with other methods.
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Meta Analysis
Body Mass Index and Treatment Response in Patients with Pulmonary Arterial Hypertension: A Meta-Analysis.
Obesity is increasingly prevalent in pulmonary arterial hypertension (PAH) but is associated with improved survival, creating an "obesity paradox" in PAH. It is unknown if the improved outcomes could be attributable to obese patients deriving a greater benefit from PAH therapies. ⋯ Patients with overweight and obesity had lower baseline 6MWD and worse WHO functional class than patients with normal weight with PAH. Higher BMI did not modify the treatment response for change in 6MWD, but it attenuated the treatment response for WHO functional class. PAH trials should include participants representative of all weight groups to allow for assessment of treatment heterogeneity and mechanisms.
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Previous studies regarding the prevalence of frailty in patients with lung cancer and mortality in frail patients with lung cancer are inconsistent and require clarification. ⋯ The prevalence of frailty in lung cancer is 45%, which has a significant negative impact on survival of patients with lung cancer. These results highlight the importance of measuring frailty, which provides important prognostic information, and may provide opportunities for interventions to improve outcomes in patients with lung cancer.
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Practice Guideline Meta Analysis
Thromboprophylaxis in Patients with COVID-19. A Brief Update to the CHEST Guideline and Expert Panel Report.
Patients hospitalized with COVID-19 often exhibit markers of a hypercoagulable state and have an increased incidence of VTE. In response, CHEST issued rapid clinical guidance regarding prevention of VTE. Over the past 18 months the quality of the evidence has improved. We thus sought to incorporate this evidence and update our recommendations as necessary. ⋯ Advances in care for patients with COVID-19 have improved overall outcomes. Despite this, rates of VTE in these patients remain elevated. Critically ill patients should receive standard thromboprophylaxis for VTE, and moderately ill patients with a low bleeding risk might benefit from therapeutic heparin. We see no role for intermediate dose thromboprophylaxis in either setting.