Chest
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We conducted a scoping review to provide an overview of the evidence of point-of-care lung ultrasound (LUS) in emergency medicine. By emphasizing clinical topics, time trends, study designs, and the scope of the primary outcomes, we provide a map for physicians and researchers to guide their future initiatives. ⋯ Observational diagnostic studies have been produced in abundance, leaving a paucity of research exploring clinical utility. Notably, research exploring whether LUS causes changes to clinical decisions is imperative before further research is made into patient benefits.
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Atrial arrhythmia (AA) are common in patients with pulmonary hypertension (PH) and contribute to morbidity and mortality. Given the growing PH population, it is important to understand the pathophysiology, clinical impact, and management of AA in PH. ⋯ This review highlights the epidemiology and pathophysiology of AA in patients with PH, describes the relationship between AA and RV dysfunction, and discusses current management practices. We outline our institutional approach and offer directions for future investigation.
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Diagnosis of interstitial lung diseases (ILD) can be challenging, and the identification of an associated connective tissue disease (CTD) is crucial to estimate prognosis and establish the optimal treatment approach. Diagnostic delay, limited expertise and fragmented care are barriers that impede the delivery of comprehensive healthcare for patients with rare, complex and multiorgan diseases such as CTD and ILD. In this article we present our perspective on the interdisciplinary diagnosis and interprofessional treatment of patients with ILD and suspected CTD or CTD at risk for ILD. ⋯ Furthermore, we focus on specific benefits and challenges of joint interdisciplinary and interprofessional patient consultations. The importance of rheumatology and pulmonology assessments in specific patient populations is emphasized. Finally, we explore future directions and discuss potential strategies to improve care delivery for patients with CTD-ILD.
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Practice Guideline
Use of Intravenous Albumin: A Guideline from the International Collaboration for Transfusion Medicine Guidelines.
Albumin is commonly employed across a wide range of clinical settings to improve hemodynamics, facilitate fluid removal, and manage complications of cirrhosis. The International Collaboration for Transfusion Medicine Guidelines developed guidelines for the use of albumin in patients requiring critical care, undergoing cardiovascular surgery, kidney replacement therapy, or experiencing complications of cirrhosis. ⋯ There are currently few evidence-based indications that support the routine use of albumin in clinical practice to improve patient outcomes. This guideline provides clinicians with actionable recommendations on the use of albumin.
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Risk stratification is the cornerstone of the management of pulmonary arterial hypertension (PAH). Current ESC/ERS guidelines recommend using the COMPERA 3-strata risk model at baseline, and the COMPERA 2.0 4-strata model at follow-up. However, the guidelines did not take into consideration other available risk scores such as REVEAL Lite 2. ⋯ Our analysis showed that REVEAL Lite 2 was better at baseline at discriminating risk in our patient population. Future guidelines should consider including REVEAL Lite 2 in the management algorithm to help clinicians to make informed decisions. Further analysis in larger cohorts could help validate these findings.