Automated Blood Pressure Control
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1713083Arterial pressure management is a crucial task in the operating room and intensive care unit. In high-risk surgical and in critically ill patients, sustained hypotension is managed with continuous infusion of vasopressor agents, which most commonly have direct α agonist activity like phenylephrine or norepinephrine. The current standard of care to guide vasopressor infusion is manual titration to an arterial pressure target range. This approach may be improved by using automated systems that titrate vasopressor infusions to maintain a target pressure. In this arti...
Source: Seminars in Respiratory and Critical Care Medicine - August 3, 2020 Category: Respiratory Medicine Authors: Rinehart, Joseph Lee, Sean Saugel, Bernd Joosten, Alexandre Tags: Review Article Source Type: research

Invasive Mechanical Ventilation in Chronic Obstructive Pulmonary Disease Exacerbations
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1714396Chronic obstructive pulmonary disease (COPD) continues to be an important cause of morbidity, mortality, and health care costs worldwide. Although there exist some heterogeneity between patients, the course of COPD is characterized by recurrent acute exacerbations, which are among the most common causes of medical admission to hospital. Patients with frequent exacerbations have accelerated lung function decline, worse quality of life, and greater mortality. Therefore, interest is growing in assessing the effectiveness of interventions used to treat exacerbations. The pr...
Source: Seminars in Respiratory and Critical Care Medicine - August 3, 2020 Category: Respiratory Medicine Authors: Pe ñuelas, Óscar Frutos-Vivar, Fernando Mancebo, Jordi Tags: Review Article Source Type: research

Prevention and Management of Delirium in the Intensive Care Unit
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1710572Delirium is a debilitating form of brain dysfunction frequently encountered in the intensive care unit (ICU). It is associated with increased morbidity and mortality, longer lengths of stay, higher hospital costs, and cognitive impairment that persists long after hospital discharge. Predisposing factors include smoking, hypertension, cardiac disease, sepsis, and premorbid dementia. Precipitating factors include respiratory failure and shock, metabolic disturbances, prolonged mechanical ventilation, pain, immobility, and sedatives and adverse environmental conditions imp...
Source: Seminars in Respiratory and Critical Care Medicine - August 3, 2020 Category: Respiratory Medicine Authors: Mart, Matthew F. Williams Roberson, Shawniqua Salas, Barbara Pandharipande, Pratik P. Ely, E. Wesley Tags: Review Article Source Type: research

Comorbidities and Readmissions in Survivors of Acute Hypercapnic Respiratory Failure
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1710074Chronic obstructive pulmonary disease (COPD) is defined by chronic airflow obstruction, but is presently considered as a complex, heterogeneous, and multicomponent disease in which comorbidities and extrapulmonary manifestations make important contributions to disease expression. COPD-related hospital readmission. In particular frequent intensive care unit (ICU) readmissions for exacerbations represent a major challenge and place a high burden on patient outcomes and health-related quality of life, as well as on the healthcare system.In this narrative review, we first a...
Source: Seminars in Respiratory and Critical Care Medicine - August 3, 2020 Category: Respiratory Medicine Authors: Adler, Dan Cavalot, Giulia Brochard, Laurent Tags: Review Article Source Type: research

Nonantibiotic Pharmacological Treatment of Severe Chronic Obstructive Pulmonary Disease Exacerbations
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1714379Severe, acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a rapid deterioration of the respiratory symptoms of patients with COPD, requiring hospital admission and escalation of pharmacological and nonpharmacological care including the more severe cases of respiratory failure and admission to an intensive care unit (ICU). These events severely impact patients' quality of life and prognosis. This review will describe the nonantibiotic, pharmacological treatment options available for critically ill patients with AECOPD. The aim of treatment is to a...
Source: Seminars in Respiratory and Critical Care Medicine - July 29, 2020 Category: Respiratory Medicine Authors: Vasques, Francesco Camporota, Luigi Barrett, Nicholas A. Tags: Review Article Source Type: research

Chronic Obstructive Pulmonary Disease and Lung Transplantation
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1714250Lung transplantation (LTx) has been a viable option for patients with end-stage chronic obstructive pulmonary disease (COPD), with more than 20,000 procedures performed worldwide. Survival after LTx lags behind most other forms of solid-organ transplantation, with median survival for COPD recipients being a sobering 6.0 years. Given the limited supply of suitable donor organs, not all patients with end-stage COPD are candidates for LTx. We discuss appropriate criteria for accepting patients for LTx, as well as contraindications and exclusionary criteria. In the first ye...
Source: Seminars in Respiratory and Critical Care Medicine - July 29, 2020 Category: Respiratory Medicine Authors: Greer, Mark Welte, Tobias Tags: Review Article Source Type: research

Pneumonic versus Nonpneumonic Exacerbations of Chronic Obstructive Pulmonary Disease
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1702196Patients with chronic obstructive pulmonary disease (COPD) often suffer acute exacerbations (AECOPD) and community-acquired pneumonia (CAP), named nonpneumonic and pneumonic exacerbations of COPD, respectively. Abnormal host defense mechanisms may play a role in the specificity of the systemic inflammatory response. Given the association of this aspect to some biomarkers at admission (e.g., C-reactive protein), it can be used to help to discriminate AECOPD and CAP, especially in cases with doubtful infiltrates and advanced lung impairment. Fever, sputum purulence, chill...
Source: Seminars in Respiratory and Critical Care Medicine - July 29, 2020 Category: Respiratory Medicine Authors: Crisafulli, Ernesto Manco, Alessandra Ferrer, Miquel Huerta, Arturo Micheletto, Claudio Girelli, Domenico Clini, Enrico Torres, Antoni Tags: Review Article Source Type: research

Physical Therapy and Rehabilitation in Chronic Obstructive Pulmonary Disease Patients Admitted to the Intensive Care Unit
This article discusses the key considerations for respiratory management of patients requiring invasive mechanical ventilation, providing an evidence-based summary of commonly used interventions. It will also explore the evidence to support the introduction of early and structured programs of rehabilitation to support recovery in both the short and the long term, as well as active mobilization, which includes strategies to minimize or prevent physical loss through early retraining of both peripheral and respiratory muscles. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJourn...
Source: Seminars in Respiratory and Critical Care Medicine - July 28, 2020 Category: Respiratory Medicine Authors: Mart í, Joan Daniel McWilliams, David Gimeno-Santos, Elena Tags: Review Article Source Type: research

Noninvasive Ventilation and High-Flow Nasal Therapy Administration in Chronic Obstructive Pulmonary Disease Exacerbations
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1712101Noninvasive ventilation (NIV) is considered to be the standard of care for the management of acute hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease exacerbation. It can be delivered safely in any dedicated setting, from emergency rooms to high dependency or intensive care units and wards. NIV helps improving dyspnea and gas exchange, reduces the need for endotracheal intubation, and morbidity and mortality rates. It is therefore recognized as the gold standard in this condition. High-flow nasal therapy helps improving ventilatory ef...
Source: Seminars in Respiratory and Critical Care Medicine - July 28, 2020 Category: Respiratory Medicine Authors: Ferrer, Miquel Torres, Antoni Tags: Review Article Source Type: research

COPD in the Intensive Care Unit
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1714082 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - July 28, 2020 Category: Respiratory Medicine Authors: Torres, Antoni Ferrer, Miguel Tags: Preface Source Type: research

Other Respiratory Viruses as a Cause of Community-Acquired Pneumonia
Semin Respir Crit Care Med 2020; 41: 579-591 DOI: 10.1055/s-0040-1710537Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. There is growing appreciation of the burden of noninfluenza viral pathogens in CAP. Due to multiple factors including pneumococcal vaccination programs, declining rates of cigarette smoking, an aging population, and increasingly sensitive diagnostic tests, respiratory viruses are now the most common pathogens detected in CAP, outpacing Streptococcus pneumoniae. Noninfluenza respiratory pathogens are widely accepted as causal pathogens in CAP including in immunocom...
Source: Seminars in Respiratory and Critical Care Medicine - July 6, 2020 Category: Respiratory Medicine Authors: Walter, James M. Tags: Review Article Source Type: research

Nocardia spp.: A Rare Cause of Pneumonia Globally
Semin Respir Crit Care Med 2020; 41: 538-554 DOI: 10.1055/s-0040-1708816Members of the Nocardia genus are ubiquitous in the environment. These aerobic, gram-positive organisms can lead to life-threatening infection, typically in immunocompromised hosts such as solid organ transplant recipients or those receiving immunosuppressive medications for other reasons. This current review discusses the microbiology of nocardiosis, risk factors for infection, clinical manifestations, methods for diagnosis, and treatment. Nocardiosis primarily affects the lung but may also cause skin and soft tissue infection, cerebral abscess, blood...
Source: Seminars in Respiratory and Critical Care Medicine - July 6, 2020 Category: Respiratory Medicine Authors: Lynch, Joseph P. Reid, Gail Clark, Nina M. Tags: Review Article Source Type: research

Endemic Fungi Presenting as Community-Acquired Pneumonia: A Review
Semin Respir Crit Care Med 2020; 41: 522-537 DOI: 10.1055/s-0040-1702194In endemic areas, dimorphic fungal infections due to Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides posadasii/immitis account for up to 30% of cases of community-acquired pneumonia. Because respiratory manifestations are often indistinguishable from common bacterial causes of pneumonia, the diagnosis of pulmonary histoplasmosis, blastomycosis, and coccidioidomycosis is often delayed and associated with antibiotics overuse. In addition to being highly endemic to certain regions of North America, dimorphic fungi have global significan...
Source: Seminars in Respiratory and Critical Care Medicine - July 6, 2020 Category: Respiratory Medicine Authors: Azar, Marwan M. Malo, Joshua Hage, Chadi A. Tags: Review Article Source Type: research

Q Fever (Coxiella Burnetii)
Semin Respir Crit Care Med 2020; 41: 509-521 DOI: 10.1055/s-0040-1710594Q fever is a zoonotic infectious disease caused by the Coxiella burnetii bacterium. It is an obligate intracellular pathogen with a high infection capacity that proliferates exclusively in an acidified medium, forming a lysosome-like vacuole. It presents a peculiar phenomenon called “antigenic phase variation,” produced by a modification in the complexity of the membrane lipopolysaccharides. Q fever can be found worldwide and presents variable clinical features and geographical distribution. It mostly affects people in rural areas who are i...
Source: Seminars in Respiratory and Critical Care Medicine - July 6, 2020 Category: Respiratory Medicine Authors: Espa ña, Pedro Pablo Uranga, Ane Cill óniz, Catia Torres, Antoni Tags: Review Article Source Type: research

Melioidosis: A Neglected Cause of Community-Acquired Pneumonia
Semin Respir Crit Care Med 2020; 41: 496-508 DOI: 10.1055/s-0040-1710570Melioidosis, caused by the facultative intracellular gram-negative pathogen Burkholderia pseudomallei, is an emerging cause of community-acquired pneumonia across the tropics. The majority of patients present with pneumonia with or without sepsis, but localized and asymptomatic infection is also well recognized. Recent modeling and epidemiological studies have demonstrated the widespread presence of B. pseudomallei in otherwise unrecognized regions with a predicted mortality of 90,000 deaths worldwide. Innovative environmental studies are also uncoveri...
Source: Seminars in Respiratory and Critical Care Medicine - July 6, 2020 Category: Respiratory Medicine Authors: Virk, Harjeet Singh Mukhopadhyay, Chiranjay Wiersinga, W. Joost Tags: Review Article Source Type: research

Emerging Resistance of Gram Negative Pathogens in Community-Acquired Pneumonia
Semin Respir Crit Care Med 2020; 41: 480-495 DOI: 10.1055/s-0040-1709137In recent decades, there has been a growing interest about the role of gram negative bacteria in community-acquired pneumonia (CAP), especially Pseudomonas aeruginosa, Enterobacteriaceae, and Acinetobacter baumannii. The prevalence of these pathogens differs largely according to the local ecology and the geographical location. Identifying gram negative bacteria, and in particular resistant gram negative bacteria, is of paramount importance in patients with CAP because these pathogens are associated with higher clinical severity and unfavorable outcomes...
Source: Seminars in Respiratory and Critical Care Medicine - July 6, 2020 Category: Respiratory Medicine Authors: Amati, Francesco Restrepo, Marcos I. Tags: Review Article Source Type: research

Community-Acquired Pneumonia: A Global Perspective
Semin Respir Crit Care Med 2020; 41: 453-454 DOI: 10.1055/s-0040-1713003 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - July 6, 2020 Category: Respiratory Medicine Authors: Wunderink, Richard G. Feldman, Charles Tags: Preface Source Type: research

Invasive Pulmonary Aspergillosis in Chronic Obstructive Pulmonary Disease Exacerbations
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1702210Nowadays, reports in the literature support that patients with severe chronic obstructive pulmonary disease (COPD) are at higher risk to develop invasive pulmonary aspergillosis (IPA). However, the interpretation of Aspergillus-positive cultures from the airways in critically ill COPD is still a challenge. Indeed, as the patient could be merely colonized, tissue samples are required to ascertain IPA diagnosis but they are rarely obtained before death. Consequently, diagnosis is often only suspected on the basis of a combination of three elements: clinical characteristic...
Source: Seminars in Respiratory and Critical Care Medicine - June 29, 2020 Category: Respiratory Medicine Authors: Bulpa, Pierre Duplaquet, Fabrice Dimopoulos, George Vogelaers, Dirk Blot, Stijn Tags: Review Article Source Type: research

Cutaneous Sarcoidosis
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1713130Sarcoidosis is a chronic, multisystem, inflammatory disorder of unknown etiology that is characterized by noncaseating granulomas that impair normal organ functioning. Sarcoidosis predominantly affects the lungs, but the skin is often cited as the second most frequently involved organ. Cutaneous manifestations of sarcoidosis are highly variable and ongoing research seeks to better understand the relationship between clinical morphology and disease prognosis. Skin findings in patients with sarcoidosis can be “specific,” in which sarcoidal granulomas infiltrat...
Source: Seminars in Respiratory and Critical Care Medicine - June 27, 2020 Category: Respiratory Medicine Authors: Caplan, Avrom Rosenbach, Misha Imadojemu, Sotonye Tags: Review Article Source Type: research

Cardiac Sarcoidosis
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1712535Approximately 5% of patients with sarcoidosis will have clinically manifest cardiac involvement presenting with one or more of ventricular arrhythmias, conduction abnormalities, and heart failure. It is estimated that another 20 to 25% of pulmonary/systemic sarcoidosis patients have asymptomatic cardiac involvement (clinically silent disease). Cardiac presentations can be the first (and/or an unrecognized) manifestation of sarcoidosis in a variety of circumstances. Immunosuppression therapy (usually with corticosteroids) has been suggested for the treatment of clinicall...
Source: Seminars in Respiratory and Critical Care Medicine - June 27, 2020 Category: Respiratory Medicine Authors: Birnie, David H. Tags: Review Article Source Type: research

Health-Related Quality of Life in Sarcoidosis
This article provides a general overview of HRQoL in patients with sarcoidosis. It describes the various PROMs used to assess HRQoL in sarcoidosis and addresses the various factors that influence HRQoL in sarcoidosis. Specific attention is paid to fatigue, small fiber neuropathy, corticosteroid therapy, and other disease-specific factors that affect HRQoL in sarcoidosis. It also provides an insight into interventions that have been associated with improved HRQoL in sarcoidosis and offers suggestions for future research in this important area. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Artic...
Source: Seminars in Respiratory and Critical Care Medicine - June 24, 2020 Category: Respiratory Medicine Authors: Obi, Ogugua Ndili Tags: Review Article Source Type: research

The Great Masquerader: Tuberculosis Presenting as Community-Acquired Pneumonia
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1710583According to World Health Organization estimates, tuberculosis (TB) and lower respiratory tract infections (LRTIs) are both among the top 10 global causes of death. TB and community-acquired pneumonia (CAP), if mortality estimates are combined, would rank as the third most common cause of death globally. It is estimated that each year there are approximately 10 million new cases of TB that are associated with approximately 1.2 million deaths, and almost 450 million new episodes of LRTI (synonymous with CAP) with approximately 4 million associated deaths. Globally, Strep...
Source: Seminars in Respiratory and Critical Care Medicine - June 21, 2020 Category: Respiratory Medicine Authors: Dheda, Keertan Makambwa, Edson Esmail, Aliasgar Tags: Review Article Source Type: research

The Role of Streptococcus pneumoniae in CAP
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1702193With the notable exceptions of the United States and Canada in particular, the global burden of disease in adults due to invasive infection with the dangerous respiratory, bacterial pathogen, Streptococcus pneumoniae (pneumococcus) remains. This situation prevails despite the major successes of inclusion of polysaccharide conjugate vaccines (PCVs) in many national childhood immunization programs and associated herd protection in adults, as well as the availability of effective antimicrobial agents. Accurate assessment of the geographic variations in the prevalence of in...
Source: Seminars in Respiratory and Critical Care Medicine - June 13, 2020 Category: Respiratory Medicine Authors: Feldman, Charles Anderson, Ronald Tags: Review Article Source Type: research

Influenza Virus in Community-Acquired Pneumonia: Current Understanding and Knowledge Gaps
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1710584Influenza virus infection poses a heavy burden on global health and economics. With the advancement in viral pathogen detection methods, the role of virus infection in community-acquired pneumonia has been increasingly recognized. The disease spectrum of influenza ranges from asymptomatic infection to severe or even fatal illness. Progress has been made in recent years to identify risk factors including lymphopenia and hypoxia for influenza mortality. Immunopathology plays an important role in influenza pathogenesis. The disturbed homeostasis after virus infection consi...
Source: Seminars in Respiratory and Critical Care Medicine - June 10, 2020 Category: Respiratory Medicine Authors: Xu, Jiuyang Yu, Jiapei Yang, Luning Zhou, Fei Li, Hui Cao, Bin Tags: Review Article Source Type: research

Staphylococcus aureus Pneumonia in the Community
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1709992 Staphylococcus aureus is an emergent etiology of community-acquired pneumonia (CAP) over the past 2 decades, with severe community-acquired pneumonia (SCAP) caused by methicillin-resistant S. aureus (MRSA) leading to critical illness and death. S. aureus colonization is associated with a high incidence of pneumonia. Panton-Valentine leukocidin (PVL) is one of the most important virulence factors of S. aureus associated with serious complications. In recent years, community-associated MRSA (CA-MRSA) clones that caused infections in young adults and healthy individual...
Source: Seminars in Respiratory and Critical Care Medicine - June 10, 2020 Category: Respiratory Medicine Authors: He, Hangyong Wunderink, Richard G. Tags: Review Article Source Type: research

Update on Lung Cancer Screening
Semin Respir Crit Care Med 2020; 41: 447-452 DOI: 10.1055/s-0039-3400480Over the past 10 years, there has been substantial progress in the study and implementation of lung cancer screening using low-dose computed tomography (LDCT). The National Lung Screening Trial, the recently reported NELSON (NEderlands-Leuvens Longkanker Screenings ONderzoek) trial, and other European trials provide strong evidence for the efficacy of LDCT to reduce lung cancer mortality. This has resulted in the United State's Preventative Task Force and numerous professional medical societies adopting lung cancer screening recommendations. Despite th...
Source: Seminars in Respiratory and Critical Care Medicine - May 25, 2020 Category: Respiratory Medicine Authors: Brownlee, Andrew R. Donington, Jessica S. Tags: Review Article Source Type: research

Small Cell Lung Cancer: Advances in Diagnosis and Management
Semin Respir Crit Care Med 2020; 41: 435-446 DOI: 10.1055/s-0039-1700566Small cell lung cancer (SCLC) is an aggressive subtype of lung cancer characterized by rapid growth and early spread. It is a highly lethal disease that typically is diagnosed at a late stage. Surgery plays a very small role in this cancer, and management typically involves chemotherapy, delivered with thoracic radiation in early-stage disease. Platinum-based chemotherapy is initially very effective, inducing rapid and often deep responses. These responses, though, are transient, and upon relapse, SCLC is highly refractory to therapy. Immunotherapy has...
Source: Seminars in Respiratory and Critical Care Medicine - May 25, 2020 Category: Respiratory Medicine Authors: Chauhan, Ayushi F. Liu, Stephen V. Tags: Review Article Source Type: research

Targeted Therapy for Non-Small Cell Lung Cancer
This article aims to contextualize recent research and provide an updated summary of targeted therapies available for patients with NSCLC. With practitioners and clinical researchers in mind, we note standard of care therapies, important approvals, practice guidelines, and treatments in development. The first section discusses mutations in the epidermal growth factor receptor (EGFR) gene, and the second section examines rearrangements in the anaplastic lymphoma kinase (ALK) and ROS1 fusions. Finally, we explore the rarer molecular alterations in BRAF, RET, MET, HER2, and KRAS. Given the many available therapies, it is impo...
Source: Seminars in Respiratory and Critical Care Medicine - May 25, 2020 Category: Respiratory Medicine Authors: Noor, Zorawar S. Cummings, Amy L. Johnson, McKenna M. Spiegel, Marshall L. Goldman, Jonathan W. Tags: Review Article Source Type: research

Immunotherapy in Advanced Non-Small Cell Lung Cancer
Semin Respir Crit Care Med 2020; 41: 400-408 DOI: 10.1055/s-0040-1710077Traditionally, lung cancer has been treated as an immune-resistant disease with platinum-based chemotherapy serving as the first-line treatment for metastatic disease. The efficacy of immunotherapy has been established for patients with advanced lung cancer in clinical trials, and it has since become the standard of care for patients without targetable mutations, with or without chemotherapy. Previously, lung cancer patients experienced limited responses to immune-based therapy. As clinical trials continued to explore immunotherapy options with checkpo...
Source: Seminars in Respiratory and Critical Care Medicine - May 25, 2020 Category: Respiratory Medicine Authors: Huang, Joy Reckamp, Karen L. Tags: Review Article Source Type: research

Molecular Diagnostics in Non-Small Cell Lung Carcinoma
Semin Respir Crit Care Med 2020; 41: 386-399 DOI: 10.1055/s-0039-3399564Current clinical practice guidelines recognize EGFR, BRAF, ALK, and ROS1 as essential molecular biomarkers, and a host of other genetic alterations as emerging biomarkers for non-small cell lung carcinoma patients. The available approaches to detecting relevant alterations in these genes are diverse and often complementary. Laboratories have increasingly migrated away from a “single-gene test” approach, embracing assays that incorporate panels of genes capable of detecting a diverse set of alterations. The adoption of next generation sequen...
Source: Seminars in Respiratory and Critical Care Medicine - May 25, 2020 Category: Respiratory Medicine Authors: Sholl, Lynette M. Tags: Review Article Source Type: research

The State of the Science in Patient-Reported Outcomes for Patients with Lung Cancer
This article discusses the current state of the science in PRO research for patients with lung cancer, the cancer type with the highest incidence rate and the lowest survival rate worldwide. The discussion focuses on (1) PRO and survival; (2) electronic PRO reporting and interventions; (3) PROs and immunotherapy; (4) PRO, biomarkers, and precision health; (5) key issues in applying PROs in clinical trials; and (6) future directions for research. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  ...
Source: Seminars in Respiratory and Critical Care Medicine - May 25, 2020 Category: Respiratory Medicine Authors: Xiao, Canhua Hurst, Newton Movsas, Benjamin Tags: Review Article Source Type: research

Local Ablative Therapies in Oligometastatic NSCLC: New Data and New Directions
This article provides an overview of oligometastatic and oligoprogressive disease in the setting of NSCLC and reviews the evidence supporting ablative treatment. Phase II randomized controlled trials and retrospective series suggest that ablative treatment of oligometastases may substantially improve progression-free survival and overall survival, and additional large randomized studies testing this hypothesis in a definitive context are ongoing. However, several challenges remain, including quantifying the possible benefits of ablative therapies for oligoprogressive disease and developing prognostic and predictive models ...
Source: Seminars in Respiratory and Critical Care Medicine - May 25, 2020 Category: Respiratory Medicine Authors: Lang, Pencilla Gomez, Daniel R. Palma, David A. Tags: Review Article Source Type: research

Immunotherapy and Radiation Therapy for Non-Small Cell Lung Cancer —A Stimulating Partnership
Semin Respir Crit Care Med 2020; 41: 360-368 DOI: 10.1055/s-0039-3399578Non-small cell lung cancer (NSCLC) is the most common subtype of lung cancer and the leading cause of cancer-related death. Although durable local control rates are high after surgical resection or definitive radiotherapy for early-stage disease, a substantial proportion of these patients eventually experience regional and/or distant failure and succumb to their metastatic disease. The discovery of immunotherapeutics and targeted biologics has revolutionized the treatment of locally advanced and metastatic disease, improving progression-free and overal...
Source: Seminars in Respiratory and Critical Care Medicine - May 25, 2020 Category: Respiratory Medicine Authors: Dams, Ritchell van Yuan, Ye Robinson, Clifford G. Lee, Percy Tags: Review Article Source Type: research

Enhanced Recovery after Thoracic Surgery
This article describes the tenets of enhanced recovery, the guidelines for ERP in lung surgery, and the University of Virginia experience with developing and implementing a program. The impact of these strategies on short-term patient outcomes and potential long-term benefits including influence on lung cancer-specific outcomes are reviewed. The opioid crisis is of utmost importance; this article will explore how ERPs may be a mitigating factor. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  ...
Source: Seminars in Respiratory and Critical Care Medicine - May 25, 2020 Category: Respiratory Medicine Authors: Martin, Linda W. Tags: Review Article Source Type: research

Surgery as a Component of Multimodality Care for Known Stage IIIA-N2 Non-small Cell Lung Cancer
Semin Respir Crit Care Med 2020; 41: 346-353 DOI: 10.1055/s-0039-1698436Locally advanced, stage IIIA-N2 Non-small cell lung cancer (NSCLC) represents a heterogeneous patient population. Considerable controversy exists as to the optimal management of these patients. Local therapy alone with a single modality, namely surgery or radiation, is associated with high recurrence rates and low overall survival. Consequently, multimodality treatment (chemotherapy, radiotherapy, with or without the utilization of surgery) has developed as a means of both local and systemic control for patients with stage IIIA-N2 NSCLC, and has led to...
Source: Seminars in Respiratory and Critical Care Medicine - May 25, 2020 Category: Respiratory Medicine Authors: Bograd, Adam J. Valli ères, Eric Tags: Review Article Source Type: research

VATS and Minimally Invasive Resection in Early-Stage NSCLC
This article focuses on the technique, outcomes, adaptation, and evolution of thoracoscopic lobectomy and other minimally invasive techniques in the treatment of lung cancer. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - May 25, 2020 Category: Respiratory Medicine Authors: Salfity, Hai Tong, Betty C. Tags: Review Article Source Type: research

Lung Cancer: Advances in Diagnosis and Management
Semin Respir Crit Care Med 2020; 41: 333-334 DOI: 10.1055/s-0040-1709995 Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - May 25, 2020 Category: Respiratory Medicine Authors: Lee, Percy Goldman, Jonathan Donington, Jessica S. Tags: Preface Source Type: research

Lung Volume Reduction in Pulmonary Emphysema
This article will review the data supporting these novel technologies. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - May 20, 2020 Category: Respiratory Medicine Authors: Garner, Justin L. Shah, Pallav L. Tags: Review Article Source Type: research

Middle East Respiratory Syndrome Coronavirus and Severe Acute Respiratory Syndrome Coronavirus
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1709160Emerging infectious diseases continue to be of a significant importance worldwide with the potential to cause major outbreaks and global pandemics. In 2002, the world had witnessed the appearance of the severe acute respiratory syndrome coronavirus in China which disappeared abruptly within 6 months. About a decade later, a new and emerging novel coronavirus named the Middle East respiratory syndrome coronavirus (MERS-CoV) was described in a patient from Saudi Arabia. These two coronaviruses shared multiple similarities in the epidemiology, clinical presentations, and p...
Source: Seminars in Respiratory and Critical Care Medicine - April 18, 2020 Category: Respiratory Medicine Authors: Al-Tawfiq, Jaffar A. Memish, Ziad A. Tags: Review Article Source Type: research

Bronchiolitis and Bronchiolar Disorders
Semin Respir Crit Care Med 2020; 41: 311-332 DOI: 10.1055/s-0039-3402728Bronchioles are noncartilaginous small airways with internal diameter of 2 mm or less, located from approximately the eighth generation of purely air conducting airways (membranous bronchioles) down to the terminal bronchioles (the smallest airways without alveoli) and respiratory bronchioles (which communicate directly with alveolar ducts and are in the range of 0.5 mm or less in diameter). Bronchiolar injury, inflammation, and fibrosis may occur in myriad disorders including connective tissue diseases, inflammatory bowel diseases, lung ...
Source: Seminars in Respiratory and Critical Care Medicine - April 12, 2020 Category: Respiratory Medicine Authors: Ravaglia, Claudia Poletti, Venerino Tags: Review Article Source Type: research

Amyloid in the Lung
Semin Respir Crit Care Med 2020; 41: 299-310 DOI: 10.1055/s-0040-1708059Amyloidosis is the term given to abnormal deposition of misfolded precursor proteins at single or multiple sites, leading to organ dysfunction or clinical signs and symptoms. Pulmonary manifestations are nonspecific and may be associated with several amyloid protein subtypes, commonly AL (light chain) and AA (autoimmune) amyloids. Signs or symptoms of amyloid disease may often involve more of the clinical abnormalities of other affected organs than the lungs themselves. Radiologic pulmonary findings include septal and parenchymal ground glass or nodula...
Source: Seminars in Respiratory and Critical Care Medicine - April 12, 2020 Category: Respiratory Medicine Authors: Baqir, Misbah Roden, Anja C. Moua, Teng Tags: Review Article Source Type: research

Pulmonary Alveolar Proteinosis Syndrome
Semin Respir Crit Care Med 2020; 41: 288-298 DOI: 10.1055/s-0039-3402727Pulmonary alveolar proteinosis (PAP) is a syndrome characterized by progressive accumulation of pulmonary surfactant. This results in dyspnea, secondary pulmonary and systemic infection, and in some cases respiratory failure. PAP syndrome occurs in distinct diseases, classified according to pathogenetic mechanism; these include primary PAP (due to disruption of granulocyte-macrophage colony-stimulating factor [GM-CSF] signaling), secondary PAP (due to reduction in alveolar macrophage numbers/functions), and congenital PAP (due to disruption of surfacta...
Source: Seminars in Respiratory and Critical Care Medicine - April 12, 2020 Category: Respiratory Medicine Authors: Kelly, Alan McCarthy, Cormac Tags: Review Article Source Type: research

Pulmonary Alveolar Microlithiasis
Semin Respir Crit Care Med 2020; 41: 280-287 DOI: 10.1055/s-0040-1702211Pulmonary alveolar microlithiasis (PAM) is a rare, autosomal recessive disorder that is caused by mutations in SCL34A2 that encodes for the type IIb sodium-dependent phosphate cotransporter (Npt2b). The loss of Npt2b transporter function from alveolar epithelial cells results in failure to export inorganic phosphate from the alveolar lining fluid, which then accumulates, binds to calcium, and forms hydroxyapatite microliths. Radiographs and computed tomography of the chest demonstrate hyperdense infiltrates that are often quite dramatic and distinctive...
Source: Seminars in Respiratory and Critical Care Medicine - April 12, 2020 Category: Respiratory Medicine Authors: Shaw, Brian M. Shaw, Steven D. McCormack, Francis X. Tags: Review Article Source Type: research

Pulmonary Langerhans Cell Histiocytosis
Semin Respir Crit Care Med 2020; 41: 269-279 DOI: 10.1055/s-0039-1700996Pulmonary Langerhans cell histiocytosis (PLCH) is a diffuse cystic lung disease that is strongly associated with exposure to cigarette smoke. Recently, activating pathogenic mutations in the mitogen-activated protein kinase pathway have been described in the dendritic cells in patients with PLCH and have firmly established PLCH to be an inflammatory myeloid neoplasm. Disease course and prognosis in PLCH are highly variable among individual patients, ranging from spontaneous resolution to development of pulmonary hypertension and progression to terminal...
Source: Seminars in Respiratory and Critical Care Medicine - April 12, 2020 Category: Respiratory Medicine Authors: Shaw, Brian Borchers, Michael Zander, Dani Gupta, Nishant Tags: Review Article Source Type: research

Lymphangioleiomyomatosis
Semin Respir Crit Care Med 2020; 41: 256-268 DOI: 10.1055/s-0040-1702195Lymphangioleiomyomatosis (LAM) is a slow albeit progressive rare neoplastic disease featured with diffuse thin-walled cysts in lungs and angiomyolipomas in kidneys. LAM affects almost exclusively women and has one of the strongest gender predispositions of any extragenital human disease. Two forms of LAM present clinically, sporadic (S-LAM) and tuberous sclerosis complex-associated (TSC-LAM). TSC is an autosomal dominant genetic multisystems neoplastic disease. A high prevalence of LAM can be detected in adult female TSC patients. Tremendous progress h...
Source: Seminars in Respiratory and Critical Care Medicine - April 12, 2020 Category: Respiratory Medicine Authors: Xu, Kai-Feng Xu, Wenshuai Liu, Song Yu, Jane Tian, Xinlun Yang, Yanli Wang, Shao-Ting Zhang, Weihong Feng, Ruie Zhang, Tengyue Tags: Review Article Source Type: research

New Developments in the Pathogenesis of Pulmonary Cysts in Birt –Hogg–Dubé Syndrome
Semin Respir Crit Care Med 2020; 41: 247-255 DOI: 10.1055/s-0040-1708500Birt–Hogg–Dubé (BHD) syndrome is an autosomal dominant disorder caused by germline loss-of-function mutations in Folliculin gene (FLCN). BHD is characterized by lower lobe-predominant pulmonary cysts with risk of pneumothorax, benign skin tumors (fibrofolliculomas), and renal cell carcinoma, often of an unusual chromophobe/oncocytic hybrid histology. The FLCN protein functions in multiple signaling and metabolic pathways including positive regulation of mechanistic target of rapamycin complex 1 (mTORC1) activity via FLCN's GTPase (GA...
Source: Seminars in Respiratory and Critical Care Medicine - April 12, 2020 Category: Respiratory Medicine Authors: Kennedy, John C. Khabibullin, Damir Boku, Yoseph Shi, Wei Henske, Elizabeth P. Tags: Review Article Source Type: research

Hermansky –Pudlak Syndrome
Semin Respir Crit Care Med 2020; 41: 238-246 DOI: 10.1055/s-0040-1708088Hermansky–Pudlak syndrome (HPS) is a multisystemic autosomal recessive disorder characterized by oculocutaneous albinism, bleeding diathesis, and lethal pulmonary fibrosis (PF) in some HPS subtypes. During middle adulthood, ground-glass opacities, reticulation, and traction bronchiectasis develop with progression of PF. HPS is an orphan disease occurring in 1 in 500,000 to 1,000,000 individuals worldwide, though the prevalence is 1 in 1,800 in individuals with Puerto Rican heritage. Recessive mutations or disruptions in HPS genes alter the functi...
Source: Seminars in Respiratory and Critical Care Medicine - April 12, 2020 Category: Respiratory Medicine Authors: De Jesus Rojas, Wilfredo Young, Lisa R. Tags: Review Article Source Type: research

Familial Interstitial Lung Disease
Semin Respir Crit Care Med 2020; 41: 229-237 DOI: 10.1055/s-0040-1708054The interstitial lung diseases (ILDs) are a group of progressive disorders characterized by chronic inflammation and/or fibrosis in the lung. While some ILDs can be linked to specific environmental causes (i.e., asbestosis, silicosis), in many individuals, no culprit exposure can be identified; these patients are deemed to have “idiopathic interstitial pneumonia” (IIP). Family history is now recognized as the strongest risk factor for IIP, and IIP cases that run in families comprise a syndrome termed “familial interstitial pneumonia&r...
Source: Seminars in Respiratory and Critical Care Medicine - April 12, 2020 Category: Respiratory Medicine Authors: Kropski, Jonathan A. Tags: Review Article Source Type: research

Clinical Decision-Making in Hypersensitivity Pneumonitis: Diagnosis and Management
Semin Respir Crit Care Med 2020; 41: 214-228 DOI: 10.1055/s-0040-1701250This review provides an updated approach to the diagnosis and management of hypersensitivity pneumonitis (HP). The importance of using a multidisciplinary discussion to increase diagnostic and treatment confidence is emphasized. The role of Bayesian reasoning is highlighted throughout, underscoring the importance of hypothesis generation (differential diagnosis) and diagnostic test interpretation based on the probability of HP. Probability estimates of diagnostic certainty (i.e., a confident versus a working diagnosis) and treatment thresholds are care...
Source: Seminars in Respiratory and Critical Care Medicine - April 12, 2020 Category: Respiratory Medicine Authors: P érez, Evans R. Fernández Koelsch, Tilman Leone, Paolo M. Groshong, Steve D. Lynch, David A. Brown, Kevin K. Tags: Review Article Source Type: research

Thoracic Involvement in IgG4-Related Disease
Semin Respir Crit Care Med 2020; 41: 202-213 DOI: 10.1055/s-0039-1700995Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory disorder that has been recognized to involve virtually any organ in the body and typically manifests mass-like lesions (tumefactive). Although initial reports of this disease (autoimmune pancreatitis [AIP]) were described in the Japanese population, it has since been reported worldwide. It is most commonly seen in adults of middle age or older, more often men than women. The pathogenesis of IgG4-RD is largely unknown, but genetic factors, microorganisms, and autoimmunity are th...
Source: Seminars in Respiratory and Critical Care Medicine - April 12, 2020 Category: Respiratory Medicine Authors: Moura, Marta Casal Gripaldo, Ria Baqir, Misbah Ryu, Jay H. Tags: Review Article Source Type: research