Chest
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Review Practice Guideline
"Management of Community-Acquired Pneumonia in Immunocompromised Adults: A Consensus Statement Regarding Initial Strategies".
Community-acquired pneumonia (CAP) guidelines have improved the treatment and outcomes of patients with CAP, primarily by standardization of initial empirical therapy. But current society-published guidelines exclude immunocompromised patients. ⋯ This document offers general suggestions for the initial treatment of the immunocompromised patient who arrives at the hospital with pneumonia.
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Meta Analysis
High flow nasal cannula in the immediate post-operative period: a systematic review and meta-analysis.
Studies have demonstrated that high-flow nasal cannula (HFNC) prevents intubation in acute hypoxic respiratory failure when compared with conventional oxygen therapy (COT). However, the data examining routine HFNC use in the immediate postoperative period are less clear. ⋯ With evidence of moderate certainty, prophylactic HFNC reduces reintubation and escalation of respiratory support compared with COT in the immediate postoperative period after cardiothoracic surgery. This effect is likely driven by patients who are at high risk and/or obese. These findings support postoperative prophylactic HFNC use in the patients who are at high risk and/or obese undergoing cardiothoracic surgery.
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Multicenter Study Observational Study
Utilization of Lung Cancer Screening in the Medicare Fee-for-Service Population.
A number of organizations, including the US Preventive Services Task Force (USPSTF), recommend lung cancer screening (LCS) with low-dose CT (LDCT) imaging for high-risk current and former smokers. In 2015, Medicare issued a decision to cover LCS as a preventive health benefit; however, utilization by the Medicare population has not been thoroughly examined. ⋯ The early adoption of LCS among Medicare beneficiaries was low. Our results suggest geographic and racial disparities in screening use, with populations in the South and those of nonwhite race/ethnicity being screened with lower frequency. Further work is needed to improve LCS uptake and ensure consistent use by all at-risk populations.
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Multicenter Study
Patterns and impact of arterial CO2 management in patients with Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE study.
Considerable variability exists regarding CO2 management in early ARDS, with the impact of arterial CO2 tension on management and outcomes poorly understood. ⋯ No evidence was found for benefit or harm with hypercapnia. Of concern, ICU mortality was higher with sustained hypocapnia in mild to moderate ARDS.