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Overview of Rheumatoid Arthritis-Associated Interstitial Lung Disease and Its Treatment Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-03-14 Janelle Vu Pugashetti, Joyce S. Lee
Interstitial lung disease (ILD) is a common pulmonary complication of rheumatoid arthritis (RA), causing significant morbidity and mortality. Optimal treatment for RA-ILD is not yet well defined. Reliable prognostic indicators are largely byproducts of prior ILD progression, including low or decreasing forced vital capacity and extensive or worsening fibrosis on imaging. In the absence of validated
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New Guidelines for Severe Community-acquired Pneumonia Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-03-01 Davide Calabretta, Ignacio Martìn-Loeches, Antoni Torres
In 2023, the new European guidelines on severe community-acquired pneumonia, providing clinical practice recommendations for the management of this life-threatening infection, characterized by a high burden of mortality, morbidity, and costs for the society. This review article aims to summarize the principal evidence related to eight different questions covered in the guidelines, by also highlighting
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Long-Term Outcomes in Severe Community-Acquired Pneumonia Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-02-23 Francesco Carella, Stefano Aliberti, Anna Stainer, Antonio Voza, Francesco Blasi
Community-acquired pneumonia (CAP) is globally one of the major causes of hospitalization and mortality. Severe CAP (sCAP) presents great challenges and need a comprehensive understanding of its long-term outcomes. Cardiovascular events and neurological impairment, due to persistent inflammation and hypoxemia, contribute to long-term outcomes in CAP, including mortality. Very few data are available
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Definition, Epidemiology, and Pathogenesis of Severe Community-Acquired Pneumonia Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-02-08 Rodrigo Cavallazzi, Julio A. Ramirez
The clinical presentation of community-acquired pneumonia (CAP) can vary widely among patients. While many individuals with mild symptoms can be managed as outpatients with excellent outcomes, there is a distinct subgroup of patients who present with severe CAP. In these cases, the mortality rate can reach approximately 25% within 30 days and even up to 50% within a year. It is crucial to focus attention
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Risk of Multidrug-Resistant Pathogens in Severe Community-Acquired Pneumonia Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-02-01
Severe community-acquired pneumonia (SCAP) is difficult to treat when caused by difficult-to-treat (DTR) pathogens because of limited treatment options and poorer clinical outcomes. Over time, several predictive scoring systems based on risk factors for infection with multidrug resistant pathogens have been developed. We reviewed the available tools for identifying DTR pathogens as the cause of SCAP
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Antibiotic Strategies for Severe Community-Acquired Pneumonia Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-02-01 Matteo Bassetti, Daniele R. Giacobbe, Laura Magnasco, Alberto Fantin, Antonio Vena, Nadia Castaldo
Despite advancements in health systems and intensive care unit (ICU) care, along with the introduction of novel antibiotics and microbiologic techniques, mortality rates in severe community-acquired pneumonia (sCAP) patients have not shown significant improvement. Delayed admission to the ICU is a major risk factor for higher mortality. Apart from choosing the appropriate site of care, prompt and appropriate
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Pulmonary Aspergillosis in People with Cystic Fibrosis Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-01-29 C. Schwarz, P.N. Eschenhagen, J.G. Mainz, T. Schmidergall, H. Schuette, E. Romanowska
In the last decade, fungal respiratory diseases have been increasingly investigated for their impact on the clinical course of people with cystic fibrosis (CF), with a particular focus on infections caused by Aspergillus spp. The most common organisms from this genus detected from respiratory cultures are Aspergillus fumigatus and Aspergillus terreus, followed by Aspergillus flavus, Aspergillus niger
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Radiological Diagnosis of Pulmonary Aspergillosis Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-01-29
Imaging plays an important role in the various forms of Aspergillus-related pulmonary disease. Depending on the immune status of the patient, three forms are described with distinct imaging characteristics: invasive aspergillosis affecting severely immunocompromised patients, chronic pulmonary aspergillosis affecting less severely immunocompromised patients but suffering from a pre-existing structural
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Aspergillus and the Lung Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-01-29
The filamentous fungus Aspergillus causes a wide spectrum of diseases in the human lung, with Aspergillus fumigatus being the most pathogenic and allergenic subspecies. The broad range of clinical syndromes that can develop from the presence of Aspergillus in the respiratory tract is determined by the interaction between host and pathogen. In this review, an oversight of the different clinical entities
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Pathological Diagnosis of Pulmonary Aspergillosis Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-01-24 Henrik E. Jensen, Cecilie B. Becker
Pulmonary aspergillosis constitutes an increasingly prevalent and potentially fatal complex of mycotic diseases, caused by different species of Aspergillus. The broad spectrum of pathological manifestations associated with pulmonary aspergillosis necessitates a differentiation of commensalism from saprophytic colonization, hypersensitivity reactions, and true invasive infections, which highlights the
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Severe Community-Acquired Pneumonia in Immunocompromised Patients Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-01-24
Due to higher survival rates with good quality of life, related to new treatments in the fields of oncology, hematology, and transplantation, the number of immunocompromised patients is increasing. But these patients are at high risk of intensive care unit admission because of numerous complications. Acute respiratory failure due to severe community-acquired pneumonia is one of the leading causes of
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Viral Pneumonia: From Influenza to COVID-19 Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-01-16
Respiratory viruses are increasingly recognized as a cause of community-acquired pneumonia (CAP). The implementation of new diagnostic technologies has facilitated their identification, especially in vulnerable population such as immunocompromised and elderly patients and those with severe cases of pneumonia. In terms of severity and outcomes, viral pneumonia caused by influenza viruses appears similar
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Microbiological Diagnosis of Pulmonary Aspergillus Infections Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-01-16 Robina Aerts, Simon Feys, Toine Mercier, Katrien Lagrou
As microbiological tests play an important role in our diagnostic algorithms and clinical approach towards patients at-risk for pulmonary aspergillosis, a good knowledge of the diagnostic possibilities and especially their limitations is extremely important. In this review, we aim to reflect critically on the available microbiological diagnostic modalities for diagnosis of pulmonary aspergillosis and
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Treatment Failure and Clinical Stability in Severe Community-Acquired Pneumonia Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-01-15 Raúl Méndez, Paula González-Jiménez, Noé Mengot, Rosario Menéndez
Treatment failure and clinical stability are important outcomes in community-acquired pneumonia (CAP). It is essential to know the causes and risk factors for treatment failure and delay in reaching clinical stability in CAP. The study of both as well as the associated underlying mechanisms and host response are key to improving outcomes in pneumonia.
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Aspiration Pneumonia Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-01-11 Di Pan, Samuel Chung, Erik Nielsen, Michael S. Niederman
Aspiration pneumonia is a lower respiratory tract infection that results from inhalation of foreign material, often gastric and oropharyngeal contents. It is important to distinguish this from a similar entity, aspiration with chemical pneumonitis, as treatment approaches may differ. An evolving understanding of the human microbiome has shed light on the pathogenesis of aspiration pneumonia, suggesting
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Acute Invasive Pulmonary Aspergillosis: Clinical Presentation and Treatment Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-01-11 Jannes Heylen, Yuri Vanbiervliet, Johan Maertens, Bart Rijnders, Joost Wauters
Among all clinical manifestations of pulmonary aspergillosis, invasive pulmonary aspergillosis (IPA) is the most acute presentation. IPA is caused by Aspergillus hyphae invading the pulmonary tissue, causing either tracheobronchitis and/or bronchopneumonia. The degree of fungal invasion into the respiratory tissue can be seen as a spectrum, going from colonization to deep tissue penetration with angio-invasion
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Antifungal Resistance in Pulmonary Aspergillosis Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-01-09 Paul E. Verweij, Yinggai Song, Jochem B. Buil, Jianhua Zhang, Willem J.G. Melchers
Aspergilli may cause various pulmonary diseases in humans, including allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA), and acute invasive pulmonary aspergillosis (IPA). In addition, chronic colonization may occur in cystic fibrosis (CF). Aspergillus fumigatus represents the main pathogen, which may employ different morphotypes, for example, conidia, hyphal growth
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Biomarkers: Are They Useful in Severe Community-Acquired Pneumonia? Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-01-09
Community acquired pneumonia (CAP) is a prevalent infectious disease often requiring hospitalization, although its diagnosis remains challenging as there is no gold standard test. In severe CAP, clinical and radiologic criteria have poor sensitivity and specificity, and microbiologic documentation is usually delayed and obtained in less than half of sCAP patients. Biomarkers could be an alternative
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Microbiology of Severe Community-Acquired Pneumonia and the Role of Rapid Molecular Techniques Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-01-09 Chiagozie I. Pickens, Catherine A. Gao, Luisa Morales-Nebreda, Richard G. Wunderink
The microbiology of severe community acquired pneumonia (SCAP) has implications on management, clinical outcomes and public health policy. Therefore, knowledge of the etiologies of SCAP and methods to identify these microorganisms is key. Bacteria including Streptococcus pneumoniae, Staphylococcus aureus and Enterobacteriaceae continue to be important causes of SCAP. Viruses remain the most commonly
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Chronic Pulmonary Aspergillosis as a Considerable Complication in Post-Tuberculosis Lung Disease Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2024-01-09 Matthias J. Neuböck, Gunar Günther, Aleksandra Barac, Jesper R. Davidsen, Christian B. Laursen, Ritesh Agarwal, Inderpaul S. Sehgal, Christoph Lange, Helmut J.F. Salzer, and for CPAnet#
Post-tuberculosis lung disease (PTLD) has only recently been put in the spotlight as a medical entity. Recent data suggest that up to 50% of tuberculosis (TB) patients are left with PTLD-related impairment after completion of TB treatment. The presence of residual cavities in the lung is the largest risk factor for the development of chronic pulmonary aspergillosis (CPA) globally. Diagnosis of CPA
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Chronic Pulmonary Aspergillosis: Clinical Presentation and Management Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-12-28 Terry J. Evans, AbdulAzeez Lawal, Chris Kosmidis, David W. Denning
Chronic pulmonary aspergillosis (CPA) refers to a number of clinical syndromes resulting from the presence and local proliferation of Aspergillus organisms in the lungs of patients with chronic lung disease. CPA is more common than was realized two decades ago. Recognition remains poor, despite recent studies from many countries highlighting the high prevalence in at-risk populations. In low- and middle-income
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Clinical Manifestation and Treatment of Allergic Bronchopulmonary Aspergillosis Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-12-28 Ritesh Agarwal, Valliappan Muthu, Inderpaul S. Sehgal
Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction to airway colonization by Aspergillus fumigatus in patients with asthma and cystic fibrosis. The pathophysiology of ABPA involves a complex interplay between the fungus and the host immune response, which causes persistent inflammation and tissue damage. Patients present with chronic cough, wheezing, and dyspnea due
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Antifungal Therapies for Aspergillus spp.: Present and Future Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-12-27 Gregory A. Eschenauer
Currently available and recommended options for the treatment of pulmonary aspergillosis include the triazoles, echinocandins, and amphotericin B products. These therapies have significant limitations. Only the azoles are available orally, but their use is often limited by toxicities, drug–drug interactions, pharmacokinetic variability, and emerging resistance. While the echinocandins are safe agents
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High Altitude Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-10-10 Marc Moritz Berger, Andrew M. Luks
With ascent to high altitude, barometric pressure declines, leading to a reduction in the partial pressure of oxygen at every point along the oxygen transport chain from the ambient air to tissue mitochondria. This leads, in turn, to a series of changes over varying time frames across multiple organ systems that serve to maintain tissue oxygen delivery at levels sufficient to prevent acute altitude
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Gas Exchange in the Lung Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-10-10 Johan Petersson, Robb W. Glenny
Gas exchange in the lung depends on tidal breathing, which brings new oxygen to and removes carbon dioxide from alveolar gas. This maintains alveolar partial pressures that promote passive diffusion to add oxygen and remove carbon dioxide from blood in alveolar capillaries. In a lung model without ventilation and perfusion (V̇AQ̇) mismatch, alveolar partial pressures of oxygen and carbon dioxide are
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The Pulmonary Vasculature Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-10-10 Susan R. Hopkins, Michael K. Stickland
The pulmonary circulation is a low-pressure, low-resistance circuit whose primary function is to deliver deoxygenated blood to, and oxygenated blood from, the pulmonary capillary bed enabling gas exchange. The distribution of pulmonary blood flow is regulated by several factors including effects of vascular branching structure, large-scale forces related to gravity, and finer scale factors related
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Surgery and Anesthesia in Patients with Pulmonary Hypertension Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-09-20
Pulmonary hypertension is characterized by right ventricular impairment and a reduced ability to compensate for hemodynamic insults. Consequently, surgery can be challenging but is increasingly considered in view of available specific therapies and improved longer term survival. Optimal management requires a multidisciplinary patient-centered approach involving surgeons, anesthetists, pulmonary hypertension
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Extracorporeal Life Support in Pulmonary Hypertension: Practical Aspects Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-09-14 Marius M. Hoeper
Extracorporeal life support (ECLS), in particular veno-arterial extracorporeal membrane oxygenation, has emerged as a potentially life-saving treatment modality in patients presenting with pulmonary hypertension and right heart failure refractory to conventional treatment. Used mainly as a bridge to lung transplantation, ECLS is also being used occasionally as a bridge to recovery in patients with
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Pulmonary Hypertension Associated with Left Heart Disease Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-09-14 Claudia Baratto, Sergio Caravita, Jean-Luc Vachiéry
Pulmonary hypertension (PH) is a common complication of diseases affecting the left heart, mostly found in patients suffering from heart failure, with or without preserved left ventricular ejection fraction. Initially driven by a passive increase in left atrial pressure (postcapillary PH), several mechanisms may lead in a subset of patient to significant structural changes of the pulmonary vessels
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Medical Emergencies in Pulmonary Hypertension Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-08-18 Samuel Seitler, Konstantinos Dimopoulos, Sabine Ernst, Laura C. Price
The management of acute medical emergencies in patients with pulmonary hypertension (PH) can be challenging. Patients with preexisting PH can rapidly deteriorate due to right ventricular decompensation when faced with acute physiological challenges that would usually be considered low-risk scenarios. This review considers the assessment and management of acute medical emergencies in patients with PH
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Updated Hemodynamic Definition and Classification of Pulmonary Hypertension Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-08-18 Benoit Lechartier, Mithum Kularatne, Xavier Jaïs, Marc Humbert, David Montani
Pulmonary hypertension (PH) is a pathophysiological manifestation of a heterogeneous group of diseases characterized by abnormally elevated pulmonary arterial pressures diagnosed on right heart catheterization. The 2022 European Society of Cardiology (ESC) and European Respiratory Society (ERS) Guidelines for the diagnosis and treatment of PH provides a new hemodynamic definition to define PH by lowering
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Blood Gas Transport: Implications for O2 and CO2 Exchange in Lungs and Tissues Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-08-11 Peter D. Wagner
The well-known ways in which O2 and CO2 (and other gases) are carried in the blood were presented in the preceding chapter. However, what the many available texts about O2 and CO2 transport do not emphasize is why knowing how gases are carried in blood matters, and this second, companion, article specifically addresses that critical aspect of gas exchange physiology. During gas exchange, both at the
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Blood Gas Transport: Carriage of Oxygen and Carbon Dioxide in Blood Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-08-11 Peter D. Wagner
The ways in which oxygen (O2) and carbon dioxide (CO2) are carried in the blood are well known and well understood, with a plethora of textbooks, both general and lung specific, all presenting the topic in a very similar manner. This first of two companion chapters similarly summarizes this information. First, carriage of gases by physical solution is described, followed by discussion of O2, carbon
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Monographic Issue on Pulmonary Hypertension: Medical and Interventional Treatment for Chronic Thromboembolic Pulmonary Hypertension Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-08-11 Marion Delcroix, Catharina Belge, Geert Maleux, Laurent Godinas
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism. The reasons why clots do not resorb are incompletely understood, but the result is partial or complete fibrothrombotic obstruction of pulmonary arteries. A secondary microvasculopathy aggravates the pulmonary hypertension (PH) as a consequence of high flow and shear stress in the nonoccluded arteries
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Tissue Perfusion and Diffusion and Cellular Respiration: Transport and Utilization of Oxygen Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-08-04 Connie C. W. Hsia
This article provides an overview of the journey of inspired oxygen after its uptake across the alveolar–capillary interface, and the interplay among tissue perfusion, diffusion, and cellular respiration in the transport and utilization of oxygen. The critical interactions between oxygen and its facilitative carriers (hemoglobin in red blood cells and myoglobin in muscle cells), and with other respiratory
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Heart–Lung Interactions Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-08-04 Natsumi Hamahata, Michael R. Pinsky
The pulmonary and cardiovascular systems have profound effects on each other. Overall cardiac function is determined by heart rate, preload, contractility, and afterload. Changes in lung volume, intrathoracic pressure (ITP), and hypoxemia can simultaneously change all of these four hemodynamic determinants for both ventricles and can even lead to cardiovascular collapse. Intubation using sedation depresses
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The Right Ventricle in Pulmonary Hypertension Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-07-24 Jeroen N. Wessels, Lucas R. Celant, Frances S. de Man, Anton Vonk Noordegraaf
The right ventricle plays a pivotal role in patients with pulmonary hypertension (PH). Its adaptation to pressure overload determines a patient's functional status as well as survival. In a healthy situation, the right ventricle is part of a low pressure, high compliance system. It is built to accommodate changes in preload, but not very well suited for dealing with pressure overload. In PH, right
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The Diagnostic Approach to Pulmonary Hypertension Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-07-24 Adam Torbicki, Marcin Kurzyna
The clinical presentation of pulmonary hypertension (PH) is nonspecific, resulting in significant delays in its detection. In the majority of cases, PH is a marker of the severity of other cardiopulmonary diseases. Differential diagnosis aimed at the early identification of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) who do require specific
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Perioperative Management in Pulmonary Endarterectomy Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-07-24 David P. Jenkins, Guillermo Martinez, Kiran Salaunkey, S. Ashwin Reddy, Joanna Pepke-Zaba
Pulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension (PH), provided lesions are proximal enough in the pulmonary vasculature to be surgically accessible and the patient is well enough to benefit from the operation in the longer term. It is a major cardiothoracic operation, requiring specialized techniques and instruments developed
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Management of Pulmonary Hypertension Associated with Chronic Lung Disease Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-07-24 Isabel Blanco, Fernanda Hernández-González, Agustín García, Rodrigo Torres-Castro, Joan A. Barberà
Pulmonary hypertension (PH) is a common complication of chronic lung diseases, particularly in chronic obstructive pulmonary disease (COPD) and interstitial lung diseases (ILD) and especially in advanced disease. It is associated with greater mortality and worse clinical course. Given the high prevalence of some respiratory disorders and because lung parenchymal abnormalities might be present in other
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Ventilation Mechanics Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-07-19 Ramon Farré, Daniel Navajas
A fundamental task of the respiratory system is to operate as a mechanical gas pump ensuring that fresh air gets in close contact with the blood circulating through the lung capillaries to achieve O2 and CO2 exchange. To ventilate the lungs, the respiratory muscles provide the pressure required to overcome the viscoelastic mechanical load of the respiratory system. From a mechanical viewpoint, the
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Pulmonary Function in Human Spaceflight Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-07-17 Jan Stepanek, Rebecca S. Blue, Desmond Connolly
Human spaceflight is entering a time of markedly increased activity fueled by collaboration between governmental and private industry entities. This has resulted in successful mission planning for destinations in low Earth orbit, lunar destinations (Artemis program, Gateway station) as well as exploration to Mars. The planned construction of additional commercial space stations will ensure continued
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End-of-Life and Palliative Care Issues for Patients Living with Pulmonary Arterial Hypertension: Barriers and Opportunities Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-07-17 Hyeon-Ju Ali, Sandeep Sahay
Pulmonary arterial hypertension (PAH) is a progressive, incurable disease that results in significant symptom burden, health care utilization, and eventually premature death. Despite the advancements made in treatment and management strategies, survival has remained poor. End-of-life care is a challenging issue in management of PAH, especially when patients are in younger age group. End-of-life care
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Control of Breathing Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-07-11 Jerome A. Dempsey, Joseph F. Welch
Substantial advances have been made recently into the discovery of fundamental mechanisms underlying the neural control of breathing and even some inroads into translating these findings to treating breathing disorders. Here, we review several of these advances, starting with an appreciation of the importance of V̇A:V̇CO2:PaCO2 relationships, then summarizing our current understanding of the mechanisms
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Exercise Physiology and Cardiopulmonary Exercise Testing Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-07-10 Kathy E. Sietsema, Harry B. Rossiter
Aerobic, or endurance, exercise is an energy requiring process supported primarily by energy from oxidative adenosine triphosphate synthesis. The consumption of oxygen and production of carbon dioxide in muscle cells are dynamically linked to oxygen uptake (V̇O2) and carbon dioxide output (V̇CO2) at the lung by integrated functions of cardiovascular, pulmonary, hematologic, and neurohumoral systems
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Respiratory System Dynamics Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-07-10 David A. Kaminsky, Donald W. Cockcroft, Beth E. Davis
While static mechanical forces govern resting lung volumes, dynamic forces determine tidal breathing, airflow, and changes in airflow and lung volume during normal and abnormal breathing. This section will examine the mechanisms, measurement methodology, and interpretation of the dynamic changes in airflow and lung volume that occur in health and disease. We will first examine how the total work of
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Expert Review on Nonsurgical Management of Parapneumonic Effusion: Advances, Controversies, and New Directions Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-07-10 Deirdre B. Fitzgerald, Eva Polverino, Grant W. Waterer
Parapneumonic effusion and empyema are rising in incidence worldwide, particularly in association with comorbidities in an aging population. Also driving this change is the widespread uptake of pneumococcal vaccines, leading to the emergence of nonvaccine-type pneumococci and other bacteria. Early treatment with systemic antibiotics is essential but should be guided by local microbial guidelines and
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COVID-19-Related Pleural Diseases Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-07-10 Beenish Iqbal, Najib M. Rahman, Rob J. Hallifax
Coronavirus disease 2019 (COVID-19)-related pleural diseases are now well recognized. Since the beginning of the pandemic, increasing cases of pleural diseases including pneumothorax, pneumomediastinum, and pleural effusion with severe COVID-19 infection have attracted the attention of physicians and are not incidental or due to barotrauma. The complicated course of COVID-19 illness highlights the
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Management of Pulmonary Arterial Hypertension Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-06-27 Jason Weatherald, Rhea A. Varughese, Jonathan Liu, Marc Humbert
Pulmonary arterial hypertension (PAH) is a rare pulmonary vascular disease characterized by progressive pulmonary arterial remodeling, increased pulmonary vascular resistance, right ventricular dysfunction, and reduced survival. Effective therapies have been developed that target three pathobiologic pathways in PAH: nitric oxide, endothelin-1, and prostacyclin. Approved therapies for PAH include phosphodiesterase
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Pulmonary Physiology and Medicine of Diving Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-06-27 Kay Tetzlaff
Pulmonary physiology is significantly altered during underwater exposure, as immersion of the body and increased ambient pressure elicit profound effects on both the cardiovascular and respiratory systems. Thoracic blood pooling, increased breathing gas pressures, and variations in gas volumes alongside ambient pressure changes put the heart and lungs under stress. Normal physiologic function and fitness
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Management of Acutely Decompensated Pulmonary Hypertension Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-06-27 Laurent Savale, Mithum Kularatne, Anne Roche, Jérémie Pichon, Audrey Baron, Athenaïs Boucly, Olivier Sitbon, Marc Humbert
Pulmonary arterial hypertension is a severe life-threatening condition associated with increased pulmonary vascular resistance and resulting right heart dysfunction. Admission to intensive care unit with acutely decompensated right heart failure is a significant negative prognostic event with a high risk of multisystem organ dysfunction and death. Presentations are heterogenous and may combine signs
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Arterial Blood Gases and Acid-Base Regulation Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-06-27 Sarah F. Sanghavi, Erik R. Swenson
Disorders of acid-base status are common in the critically ill and prompt recognition is central to clinical decision making. The bicarbonate/carbon dioxide buffer system plays a pivotal role in maintaining acid-base homeostasis, and measurements of pH, PCO2, and HCO3 - are routinely used in the estimation of metabolic and respiratory disturbance severity. Hypoventilation and hyperventilation cause
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Expert Review on Spontaneous Pneumothorax: Advances, Controversies, and New Directions Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-06-15 Eleanor C. Barton, Nick A. Maskell, Steven P. Walker
For decades, there has been scanty evidence, most of which is of poor quality, to guide clinicians in the assessment and management of pneumothorax. A recent surge in pneumothorax research has begun to address controversies surrounding the topic and change the face of pneumothorax management. In this article, we review controversies concerning the etiology, pathogenesis, and classification of pneumothorax
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Malignant Pleural Effusions in the Era of Immunotherapy and Antiangiogenic Therapy Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-06-12 Terrence Wong, Alexander D. Fuld, David J. Feller-Kopman
Malignant pleural effusions (MPE) have historically been associated with a poor prognosis, and patients often require a series of invasive procedures and hospitalizations that significantly reduce quality of life at the terminus of life. However, advances in the management of MPE have coincided with the era of immunotherapies, and to a lesser extent, antiangiogenic therapies for the treatment of lung
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Breathlessness with Pleural Effusion: What Do We Know? Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-06-12 Sanjeevan Muruganandan, Eleanor Mishra, Bhajan Singh
Breathlessness is the most common symptom in individuals with pleural effusion and is often disabling. The pathophysiology of breathlessness associated with pleural effusion is complex. The severity of breathlessness correlates weakly with the size of the effusion. Improvements in ventilatory capacity following pleural drainage are small and correlate poorly with the volume of fluid drained and improvements
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Intrapleural Anticancer Therapy for Malignant Pleural Diseases: Facts or Fiction? Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-06-12 Abhinav Agrawal, Udit Chaddha, Samira Shojaee, Fabien Maldonado
Malignant pleural diseases involves both primary pleural malignancies (e.g., mesothelioma) as well as metastatic disease involving the pleura. The management of primary pleural malignancies remains a challenge, given their limited response to conventional treatments such as surgery, systemic chemotherapy, and immunotherapy. In this article, we aimed to review the management of primary pleural malignancy
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The Global Burden of Pleural Diseases Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-06-01 Erik Vakil, Niloofar Taghizadeh, Alain Tremblay
Pleural diseases include a spectrum of disorders broadly categorized into pneumothorax and pleural effusion. They often cause pain, breathlessness, cough, and reduced quality of life. The global burden of diseases reflects regional differences in conditions and exposures associated with pleural disease, such as smoking, pneumonia, tuberculosis, asbestos, cancer, and organ failure. Disease burden in
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Expert Review on Contemporary Management of Common Benign Pleural Effusions Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-06-01 José M. Porcel
Heart failure (HF) and cirrhosis are frequently associated with pleural effusions (PEs). Despite their apparently benign nature, both HF-related effusions and hepatic hydrothorax (HH) have poor prognosis because they represent an advanced stage of the disease. Optimization of medical therapy in these two entities involve not only the use of diuretics, but also other pharmacological therapies. For instance
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Indwelling Pleural Catheter: Management of Complications Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-05-31 Calvin Sidhu, Helen E. Davies, Sanjeevan Muruganandan, Macy M. S. Lui, Estee P. M. Lau, Y. C. Gary Lee
Multiple randomized clinical trials have established the advantages of indwelling pleural catheter (IPC) in the management of malignant pleural effusions, resulting in its widespread adoption in clinical practice. Complications can occur with IPC use and must be recognized and managed effectively. This review provides a comprehensive overview of IPC complications and their best care. Pain postinsertion
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New Markers for Management of Mesothelioma Semin. Respir. Crit. Care Med. (IF 3.2) Pub Date : 2023-05-30 Alistair Nash, Tina Firth née Phan, Jenette Creaney
In this review, we provide an update on the status of cancer biomarkers for the clinical management of pleural mesothelioma, an aggressive cancer associated with asbestos exposure. Mesothelioma can be difficult to diagnose, and response to treatment is transient, even with recently adopted immune checkpoint inhibitor (ICI) combinations. Identification of mesothelioma-specific biomarkers could facilitate