Chest
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Improved treatments for cystic fibrosis (CF)-related lung disease have resulted in increased longevity, but also increased prevalence and severity of extrapulmonary manifestations of CF, treatment-related complications, age-related conditions, and psychosocial effects of longstanding chronic disease. Likewise, the recognition of mild CF phenotypes has changed the landscape of CF disease. This review outlines our current understanding of the common extrapulmonary complications of CF, as well as the changing landscape and future directions of the extrapulmonary complications experienced by patients with CF.
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Central sleep apnea (CSA) frequently coexists with heart failure and atrial fibrillation and contributes to cardiovascular disease progression and mortality. A transvenous phrenic nerve stimulation (TPNS) system has been approved for the first time by the Food and Drug Administration for the treatment of CSA. This system, remedē System (Zoll Medical, Inc.), is implanted during a minimally invasive outpatient procedure and has shown a favorable safety and efficacy profile. ⋯ In this article, we review the background and efficacy data of TPNS and briefly address relevant aspects of the clinical activities involved in a TPNS program. The article presents the status of coverage and reimbursement for this novel therapy. We also discuss the current approach to obtaining reimbursement from third-party payors during this transitional period of evaluation by Medicare and other insurers.
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Multicenter Study
Identification of Sputum Biomarkers Predictive of Pulmonary Exacerbations in Chronic Obstructive Pulmonary Disease.
Improved understanding of the pathways associated with airway pathophysiologic features in COPD will identify new predictive biomarkers and novel therapeutic targets. ⋯ Biomarker evaluation implicated pathways involved in mucus hydration, adenosine metabolism, methionine salvage, and oxidative stress in COPD airway pathophysiologic characteristics. Therapies that target these pathways may be of benefit in COPD, and a simple model adding sputum-soluble phase biomarkers improves prediction of pulmonary exacerbations.
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Randomized Controlled Trial
Aspirin as a Treatment for Acute Respiratory Distress Syndrome: a randomised placebo controlled clinical trial.
There is no pharmacologic treatment for ARDS. Platelets play an important role in the pathophysiology of ARDS. Preclinical, observational, and clinically relevant models of ARDS indicate aspirin as a potential therapeutic option. ⋯ Aspirin was well tolerated but did not improve OI or other physiological outcomes; a larger trial is not feasible in its current design.
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Multicenter Study
Drivers of Burnout Among Critical Care Providers: A Multicenter Mixed-Methods Study.
Critical care practitioners have some of the highest levels of burnout in health care. ⋯ High levels of burnout were identified through the MBI, but participants did not self-report high levels of burnout, suggesting a lack of awareness. Drivers of burnout were highly interconnected, but factors related to team dynamics and hospital culture were most prominent and shared across provider types. The shared drivers of burnout across multiple provider types highlights the need for interventions focused on team- and system-level drivers.