Chest
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Pediatric psychologist are essential staff in the pediatric intensive care unit (PICU). Their role in caring for critically ill children aligns with clinical practice guidelines for the mental health care needs of this population of patients. ⋯ We address relevant ways for critical care providers to understand the importance of evidence-based psychological care and advocate for the inclusion of psychologists on multidisciplinary PICU teams. As the critical care field continues to focus on an improved understanding of Post-Intensive Care Syndrome in pediatrics (PICS-p) and the psychological needs of critical care patients, it will be important to consider the vital roles of psychologists and to advocate for improved integration of mental health care in PICUs.
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The maternal mortality rate in the US is unacceptably high. However, the relative contribution of pregnancy to these outcomes is unknown. Studies comparing outcomes among pregnant versus non-pregnant critically ill patients show mixed results and are limited by small sample sizes. ⋯ In our large US cohort, critically ill pregnant women receiving MV or with sepsis had better survival than propensity score-matched, non-pregnant women. These findings must be interpreted in the context of likely residual confounding.
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Laryngeal dysfunction as a cause of chronic refractory cough (CRC) and episodic dyspnea is often missed which results in unnecessary testing and delays in diagnosis. Understanding laryngeal roles in breathing and airway protection can help to appreciate the propensity to laryngeal dysfunction with aging, chronic lung disease and sleep apnea. ⋯ Pulmonologists should incorporate assessment of laryngeal dysfunction during evaluation of CRC and dyspnea. Recognition of laryngeal hypersensitivity in patient with CRC can identify patients that can benefit from cough suppression therapies. Similarly, timely identification of inducible laryngeal obstruction can not only resolve episodic dyspnea but lessen need for unnecessary testing and treatments.
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Pulmonary hypertension (PH) is a heterogeneous disease with poor prognosis. Accurate risk stratification is essential for guiding treatment decisions in pulmonary arterial hypertension (PAH). While various risk models were developed for PAH, their comparative prognostic potential requires further exploration. Additionally, the applicability of risk scores in PH groups beyond group 1 remains to be investigated. ⋯ This comprehensive study with real-world data from 15 PH-centers showed that PAH-designed risk scores possess predictive power in a large PH cohort, whether considered as common group or calculated separately for each PH group (1-4) and various subgroups.
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The association between treatment outcome and the mortality of Mycobacterium avium complex (MAC) pulmonary disease (PD) with cavitary lesions is unclear. Here, we assessed the impact of culture conversion on mortality in patients with cavitary Mycobacterium avium complex pulmonary disease. ⋯ The mortality rate of patients with cavitary MAC-PD who did not achieve culture conversion was significantly higher than that of those with culture conversion.