Chest
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Observational Study
Role of Left Ventricular Dysfunction in Systemic Sclerosis-related Pulmonary Hypertension.
In systemic sclerosis (SSc), pulmonary hypertension remains a significant cause of morbidity and mortality. Although conventionally classified as group 1 pulmonary arterial hypertension, systemic sclerosis-related pulmonary hypertension (SSc-PH) is a heterogeneous disease. The contribution of left-sided cardiac disease in SSc-PH remains poorly understood. ⋯ LV dysfunction is common in SSc-PH. Patients with SSc-PH and LV dysfunction by LV GLS have increased all-cause mortality. This suggests that LV GLS may be helpful in identifying underlying LV dysfunction and in risk assessment of patients with SSc-PH.
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Multicenter Study Observational Study
Characteristics and prognosis factors of Pneumocystis jirovecii pneumonia according to underlying disease: a retrospective multicentre study.
Pneumocystis jirovecii pneumonia (PcP) remains associated with high rates of mortality, and the impact of immunocompromising underlying disease on the clinical presentation, severity, and mortality of PcP has not been adequately evaluated. ⋯ Among patients who were HIV-negative, long-term corticosteroid prior to PcP diagnosis was independently associated with increased 90-day mortality, specifically in patients with IMIDs. These results highlight both the needs for PcP prophylaxis in patients with IMIDs and to early consider PcP curative treatment in severe pneumonia among patients with IMIDs.
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Multicenter Study Observational Study
Extraneous Load, Patient Census, and Patient Acuity Correlate with Cognitive Load during Intensive Care Unit Rounds.
Cognitive load theory asserts that learning and performance degrade when cognitive load exceeds working memory capacity. This is particularly relevant in the learning environment of ICU rounds, when multidisciplinary providers integrate complex decision-making and teaching in a noisy, high-stress environment prone to cognitive distractions. ⋯ Increased extraneous load, new patients, and patient acuity were associated with higher cognitive load during ICU rounds. These results can help direct how the ICU rounding structure may be modified to reduce workload and optimize provider learning and performance.
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Randomized Controlled Trial
High vs. low PEEP in ARDS patients exhibiting intense inspiratory effort during assisted ventilation: a randomized cross-over trial.
Positive end-expiratory pressure (PEEP) can potentially modulate inspiratory effort (ΔPes), which is the major determinant of self-inflicted lung injury. ⋯ The impact of high PEEP on ΔPes and lung stress is interindividually variable according to different effects on the respiratory system and lung compliance resulting from alveolar overinflation. High PEEP may help mitigate the risk of self-inflicted lung injury solely if it increases lung/respiratory system compliance.
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Observational Study
Increased burden of pertussis among adolescents and adults with asthma or COPD in the US, 2007-2019.
Individuals with chronic respiratory illnesses may be at higher risk of pertussis infection and severe pertussis than those without. ⋯ Among these insured individuals, asthma or COPD increased the risk for pertussis disease and complications vs the general population. COPD and asthma exacerbations were observed most frequently within 30 days of receiving a pertussis diagnosis and remained elevated, suggesting a long-term effect of pertussis in the COPD cohort.