1461. An Unexpected Cause of Lung Disease Identified After Lung Transplantation.
作者: Alyssa Self.;Kamyar Afshar.;Aarya Kafi.;Gordon Yung.;Eugene Golts.;Christine M Lin.
来源: Chest. 2023年164卷4期e111-e115页
A 54-year-old woman with systemic lupus erythematosus with associated interstitial lung disease (ILD) presented to the lung transplant clinic for assessment of candidacy for transplantation. She was initially diagnosed with ILD based on clinical and radiographic features (never underwent lung biopsy). In addition, she had associated mixed group I/III pulmonary arterial hypertension. The patient had no family history of pulmonary disease and had never used tobacco and did not have a history of illicit drug use. She was maintained on systemic immunosuppression with hydroxychloroquine, mycophenolate mofetil, and nintedanib for ILD as well as inhaled treprostinil, sildenafil, and macitentan for pulmonary arterial hypertension. Given her progressive symptoms on maximal medical therapy, she was referred for consideration to undergo lung transplantation.
1462. A 68-Year-Old Patient With Dyspnea and Hypoxemia After Total Hip Arthroplasty.
作者: Vasilios Tzilas.;Ioannis Roussis.;Katianna Sakellaropoulou.;Serafeim Chrysikos.;Georgios Hillas.;Jay H Ryu.
来源: Chest. 2023年164卷4期e107-e110页
A 68-year-old patient with obesity (BMI, 4 7 kg/m2) was transferred to the ED of our hospital because of dyspnea and pronounced hypoxemia. The patient underwent total right hip arthroplasty in an outside hospital because of osteoarthritis; there was no history of trauma. After 48 h, she experienced dyspnea with severe hypoxemia. The next day she was transferred to our hospital. Her history was notable for arterial hypertension and depression, but not heart failure. Her medications included candesartan (16 mg once daily) and sertraline (100 mg once daily). Perioperatively, she received enoxaparin 4.000 International Units subcutaneously once daily. There was no family history of respiratory diseases. The patient currently smokes (50 pack-years) with no recent increase in her habit and denied vaping, alcohol consumption, illicit drug use, and any home or occupational exposures. Prior to surgery, the family of the patient reported that she maintained modest mobility despite her osteoarthritis and was able to fulfill her daily activities. Interestingly, she reported a similar event of severe dyspnea and hypoxemia after total knee arthroplasty 3 years earlier; however, no further details were available.
1463. A 17-Year-Old Male With Hypoxemia After Long-Bone Fracture.
An otherwise healthy 17-year-old male patient presented to a periphery hospital with a compound fracture of the right distal tibia and fibula after a traumatic accident on a ski trip. He was treated empirically with IV cefazolin before undergoing open reduction with internal fixation with intramedullary nail for surgical fixation. Postoperatively, he became febrile, tachypneic, and hypoxemic, requiring up to 6 L/min supplemental oxygen by nasal prongs. He reported mild chest discomfort but denied productive cough, hemoptysis, or calf tenderness. Because of nonresolving oxygen demands, on postoperative day (POD) 4, he was transferred to a tertiary care center for further management.
1476. Do-Not-Resuscitate Orders by COVID-19 Status Throughout the First Year of the COVID-19 Pandemic.
At the beginning of the COVID-19 pandemic, whether performing CPR on patients with COVID-19 would be effective or increase COVID-19 transmission to health care workers was unclear.
1477. Modification of Endotypic Traits in OSA by the Carbonic Anhydrase Inhibitor Sulthiame.
作者: Erik Hoff.;Christian Strassberger.;Ding Zou.;Ludger Grote.;Kaj Stenlöf.;Jan Hedner.
来源: Chest. 2024年165卷3期704-715页
The carbonic anhydrase inhibitor sulthiame reduces OSA severity, increases overnight oxygenation, and improves sleep quality. Insights into how sulthiame modulates OSA pathophysiologic features (endotypic traits) adds to our understanding of the breathing disorder itself, as well as the effects of carbonic anhydrases in respiratory regulation.
1478. Low Tidal Volume Ventilation Is Poorly Implemented for Patients in North American and United Kingdom ICUs Using Electronic Health Records.
Low tidal volume ventilation (LTVV; < 8 mL/kg predicted body weight [PBW]) is a well-established standard of care associated with improved outcomes. This study used data collated in multicenter electronic health record ICU databases from the United Kingdom and the United States to analyze the use of LTVV in routine clinical practice.
1479. Using Trajectories of Bedside Vital Signs to Identify COVID-19 Subphenotypes.
作者: Sivasubramanium V Bhavani.;Chad Robichaux.;Philip A Verhoef.;Matthew M Churpek.;Craig M Coopersmith.
来源: Chest. 2024年165卷3期529-539页
Trajectories of bedside vital signs have been used to identify sepsis subphenotypes with distinct outcomes and treatment responses. The objective of this study was to validate the vitals trajectory model in a multicenter cohort of patients hospitalized with COVID-19 and to evaluate the clinical characteristics and outcomes of the resulting subphenotypes.
1480. Prevalence, Risk Factors, Clinical Features, and Outcome of Influenza-Associated Pulmonary Aspergillosis in Critically Ill Patients: A Systematic Review and Meta-Analysis.
作者: Lawrence Y Lu.;Hui Min Lee.;Andrew Burke.;Gianluigi Li Bassi.;Antoni Torres.;John F Fraser.;Jonathon P Fanning.
来源: Chest. 2024年165卷3期540-558页
Influenza-associated pulmonary aspergillosis (IAPA) increasingly is being reported in critically ill patients. We conducted this systematic review and meta-analysis to examine the prevalence, risk factors, clinical features, and outcomes of IAPA.
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