The Diagnosis and Management of Acute Pulmonary Embolism in 2021: Evolving Strategies
Semin Respir Crit Care Med 2021; 42: 169-170 DOI: 10.1055/s-0041-1725058 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - March 30, 2021 Category: Respiratory Medicine Authors: Tapson, Victor F. Tags: Preface Source Type: research

Trends in Mortality of Acute Pulmonary Embolism
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1725059Despite substantial advances in the diagnosis and management, pulmonary embolism (PE) continues to be a significant cause of mortality. In this article, we provide a concise overview of the evolution of worldwide mortality trends related to PE. Despite the data being derived mainly from observational studies, there is a clear trend toward decreasing mortality over time from PE. Whether this truly represents a treatment effect or is more related to increased diagnosis of small PEs is not fully clear. Modern approaches to PE management such as the PE response teams have t...
Source: Seminars in Respiratory and Critical Care Medicine - March 10, 2021 Category: Respiratory Medicine Authors: Ho, An Thi Nhat Bellamy, Nelly Naydenov, Soophia K. Tags: Review Article Source Type: research

Venous Thromboembolism: Genetics and Thrombophilias
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1723937Venous thromboembolism (VTE) is a major cause of morbidity and mortality throughout the world. Up to one half of patients who present with VTE will have an underlying thrombophilic defect. This knowledge has led to a widespread practice of testing for such defects in patients who develop VTE. However, identifying a hereditary thrombophilia by itself does not necessarily change outcomes or dictate therapy. Furthermore, family history of VTE by itself can increase an asymptomatic person's VTE risk several-fold, independent of detecting a known inherited thrombophilia. In ...
Source: Seminars in Respiratory and Critical Care Medicine - March 10, 2021 Category: Respiratory Medicine Authors: Gaddh, Manila Rosovsky, Rachel P. Tags: Review Article Source Type: research

Advances in the Management of Acute Venous Thromboembolism and New Therapeutic Agents
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1723953Important advances in the understanding and management of venous thromboembolism (VTE) have enhanced our ability to diagnose, prevent, and treat VTE. In this narrative review, we discuss how recent advances in the understanding and management of VTE are changing practice, highlight ongoing unmet needs in VTE management, and outline how novel therapeutic targets with little or no influence on hemostasis may help address these unmet needs. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of con...
Source: Seminars in Respiratory and Critical Care Medicine - February 18, 2021 Category: Respiratory Medicine Authors: Stevens, Hannah McFadyen, James Chan, Noel Tags: Review Article Source Type: research

Direct Oral Anticoagulants in the Treatment of Venous Thromboembolism: Use in Patients with Advanced Renal Impairment, Obesity, or Other Weight-Related Special Populations
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1723952There are currently more than 7 million patients taking a direct oral anticoagulant (DOAC), with more new prescriptions per year than warfarin. Despite impressive efficacy and safety data for the treatment of venous thromboembolism, patients with obesity or advanced renal impairment represented a small portion of the patients enrolled in the phase 3 clinical trials. Therefore, to evaluate the potential use of DOACs in these special populations, clinicians need to have an understanding of the pharmacokinetics and pharmacodynamics of these agents in these settings. Since ...
Source: Seminars in Respiratory and Critical Care Medicine - February 18, 2021 Category: Respiratory Medicine Authors: Dobesh, Paul P. Kernan, Molly M. Lueshen, Jenni J. Tags: Review Article Source Type: research

High-Risk Pulmonary Embolism: Embolectomy and Extracorporeal Membrane Oxygenation
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1722868Pulmonary embolism (PE) is a common medical condition associated with significant morbidity and mortality. It is the third most common cause of death in the United States. Historically, surgery for PE was associated with a high mortality rate, and this led to a significant decrease in the volume of operations being performed. However, significant improvements in patient selection and outcomes for surgical pulmonary embolectomy (SPE) at the end of the 20th century led to a renewed interest in the procedure. SPE was historically reserved for patients presenting with acute...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2021 Category: Respiratory Medicine Authors: Murray, John L. Zapata, David Keeling, William B. Tags: Review Article Source Type: research

Suspected Acute Pulmonary Embolism: Gestalt, Scoring Systems, and Artificial Intelligence
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1723936Pulmonary embolism (PE) remains a diagnostic challenge in 2021. As the pathology is potentially fatal and signs and symptoms are nonspecific, further investigations are classically required. Based on the Bayesian approach, clinical probability became the keystone of the diagnostic strategy to rule out PE in the case of a negative testing. Several clinical probability assessment methods are validated: gestalt, the Wells score, or the revised Geneva score. While the debate persists as to the best way to assess clinical probability, its assessment allows for the good inter...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2021 Category: Respiratory Medicine Authors: Douillet, Delphine Roy, Pierre-Marie Penaloza, Andrea Tags: Review Article Source Type: research

The Pulmonary Embolism Response Team: Why and How?
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1722963Treatment of patients with intermediate and high-risk pulmonary embolism (PE) is a controversial area. Many therapeutic options exist, and deciding on appropriate treatment can be difficult. In addition, multiple specialties are often involved in the care of PE patients. To better organize the response to serious PE patients, several hospitals and academic centers throughout the world have created pulmonary embolism response teams (PERTs). The goal of a PERT is to have a single multidisciplinary team of experts in thromboembolic disease, who can respond rapidly to patie...
Source: Seminars in Respiratory and Critical Care Medicine - February 16, 2021 Category: Respiratory Medicine Authors: Channick, Richard N. Tags: Review Article Source Type: research

Risk Stratification in Acute Pulmonary Embolism: The Latest Algorithms
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1722898Pulmonary embolism (PE) is a common clinical entity, which most clinicians will encounter. Appropriate risk stratification of patients is key to identify those who may benefit from reperfusion therapy. The first step in risk assessment should be the identification of hemodynamic instability and, if present, urgent patient consideration for systemic thrombolytics. In the absence of shock, there is a plethora of imaging studies, biochemical markers, and clinical scores that can be used to further assess the patients' short-term mortality risk. Integrated prediction models...
Source: Seminars in Respiratory and Critical Care Medicine - February 6, 2021 Category: Respiratory Medicine Authors: Triantafyllou, Georgios A. O'Corragain, Oisin Rivera-Lebron, Belinda Rali, Parth Tags: Review Article Source Type: research

Aggressive Therapy for Acute Pulmonary Embolism: Systemic Thrombolysis and Catheter-Directed Approaches
This article reviews current clinical evidence and societal guidelines for the use of systemic and catheter-directed thrombolysis for treatment of acute PE. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle 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 - February 6, 2021 Category: Respiratory Medicine Authors: Todoran, Thomas M. Petkovich, Bradley Tags: Review Article Source Type: research

Evaluating the Right Ventricle in Acute and Chronic Pulmonary Embolism: Current and Future Considerations
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1722290The right ventricle (RV), due to its morphologic and physiologic differences, is susceptible to sudden increase in RV afterload, as noted in patients with acute pulmonary embolism (PE). Functional impairment of RV function is a stronger presage of adverse outcomes in acute PE than the location or burden of emboli. While current iterations of most clinical prognostic scores do not incorporate RV dysfunction, advancements in imaging have enabled more granular and accurate assessment of RV dysfunction in acute PE. RV enlargement and dysfunction on imaging is noted only in ...
Source: Seminars in Respiratory and Critical Care Medicine - February 6, 2021 Category: Respiratory Medicine Authors: Singh, Siddharth Lewis, Michael I. Tags: Review Article Source Type: research

Prevention of Venous Thromboembolism in Acutely Ill Medical Patients: A New Era
This article aims to review the latest concepts in predicting and preventing VTE and discuss the new era of extended thromboprophylaxis in hospitalized medically ill patients. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle 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 - February 6, 2021 Category: Respiratory Medicine Authors: MacDougall, Kira Spyropoulos, Alex C. Tags: Review Article Source Type: research

Determinants and Management of the Post –Pulmonary Embolism Syndrome
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1722964Acute pulmonary embolism (PE) is not only a serious and potentially life-threatening disease in the acute phase, in recent years it has become evident that it may also have a major impact on a patient's daily life in the long run. Persistent dyspnea and impaired functional status are common, occurring in up to 50% of PE survivors, and have been termed the post-PE syndrome (PPES). Chronic thromboembolic pulmonary hypertension is the most feared cause of post-PE dyspnea. When pulmonary hypertension is ruled out, cardiopulmonary exercise testing can play a central role in ...
Source: Seminars in Respiratory and Critical Care Medicine - February 6, 2021 Category: Respiratory Medicine Authors: Boon, Gudula J.A.M. Huisman, Menno V. Klok, Frederikus A. Tags: Review Article Source Type: research

COVID-19 and Its Implications for Thrombosis and Anticoagulation
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1722992Venous thromboembolism, occlusion of dialysis catheters, circuit thrombosis in extracorporeal membrane oxygenation (ECMO) devices, acute limb ischemia, and isolated strokes, all in the face of prophylactic and even therapeutic anticoagulation, are features of novel coronavirus disease 2019 (COVID-19) coagulopathy. It seems well established at this time that a COVID-19 patient deemed sick enough to be hospitalized, should receive at least prophylactic dose anticoagulation. However, should some hospitalized patients have dosage escalation to intermediate dose? Should some...
Source: Seminars in Respiratory and Critical Care Medicine - February 6, 2021 Category: Respiratory Medicine Authors: Berkman, Samuel A. Tapson, Victor F. Tags: Review Article Source Type: research

Pulmonary Embolism in Pregnancy
Semin Respir Crit Care Med DOI: 10.1055/s-0041-1722867Even though venous thromboembolism is a leading cause of maternal mortality in high-income countries, there are limited high-quality data to assist clinicians with the management of pulmonary embolism in this patient population. Diagnosis, prevention, and treatment of pregnancy-associated pulmonary embolism are complicated by the need to consider fetal, as well as maternal, well-being. Recent studies suggest that clinical prediction rules and D-dimer testing can reduce the need for diagnostic imaging in a subset of patients. Low-molecular-weight heparin is the preferred...
Source: Seminars in Respiratory and Critical Care Medicine - February 6, 2021 Category: Respiratory Medicine Authors: Bates, Shannon M. Tags: Review Article Source Type: research

Artificial Intelligence in the Intensive Care Unit
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1719037The diffusion of electronic health records collecting large amount of clinical, monitoring, and laboratory data produced by intensive care units (ICUs) is the natural terrain for the application of artificial intelligence (AI). AI has a broad definition, encompassing computer vision, natural language processing, and machine learning, with the latter being more commonly employed in the ICUs. Machine learning may be divided in supervised learning models (i.e., support vector machine [SVM] and random forest), unsupervised models (i.e., neural networks [NN]), and reinforcem...
Source: Seminars in Respiratory and Critical Care Medicine - November 5, 2020 Category: Respiratory Medicine Authors: Greco, Massimiliano Caruso, Pier F. Cecconi, Maurizio Tags: Review Article Source Type: research

Challenges in Critical Care
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1719038 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 - November 3, 2020 Category: Respiratory Medicine Authors: Vincent, Jean-Louis Artigas, Antonio Tags: Preface Source Type: research

Noninvasive Monitoring in the Intensive Care Unit
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1718387There has been considerable development in the field of noninvasive hemodynamic monitoring in recent years. Multiple devices have been proposed to assess blood pressure, cardiac output, and tissue perfusion. All have their own advantages and disadvantages and selection should be based on individual patient requirements and disease severity and adjusted according to ongoing patient evolution. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  F...
Source: Seminars in Respiratory and Critical Care Medicine - October 16, 2020 Category: Respiratory Medicine Authors: De Backer, Daniel Vincent, Jean-Louis Tags: Review Article Source Type: research

Optimal Sedation and Pain Management: A Patient- and Symptom-Oriented Paradigm
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1716736In the critically ill patient, optimal pain and sedation management remains the cornerstone of achieving comfort, safety, and to facilitate complex life support interventions. Pain relief, using multimodal analgesia, is an integral component of any orchestrated approach to achieve clinically appropriate goals in critically ill patients. Sedative management, however, remains a significant challenge. Subsequent studies including most recent randomized trials have failed to provide strong evidence in favor of a sedative agent, a mode of sedation or ancillary protocols such...
Source: Seminars in Respiratory and Critical Care Medicine - September 20, 2020 Category: Respiratory Medicine Authors: Shehabi, Yahya Al-Bassam, Wisam Pakavakis, Adrian Murfin, Brendan Howe, Belinda Tags: Review Article Source Type: research

Management and Challenges of Severe Traumatic Brain Injury
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1716493Traumatic brain injury (TBI) is the leading cause of death and disability in trauma patients, and can be classified into mild, moderate, and severe by the Glasgow coma scale (GCS). Prehospital, initial emergency department, and subsequent intensive care unit (ICU) management of severe TBI should focus on avoiding secondary brain injury from hypotension and hypoxia, with appropriate reversal of anticoagulation and surgical evacuation of mass lesions as indicated. Utilizing principles based on the Monro–Kellie doctrine and cerebral perfusion pressure (CPP), a surrog...
Source: Seminars in Respiratory and Critical Care Medicine - September 10, 2020 Category: Respiratory Medicine Authors: Rakhit, Shayan Nordness, Mina F. Lombardo, Sarah R. Cook, Madison Smith, Laney Patel, Mayur B. Tags: Review Article Source Type: research

Metabolic and Endocrine Challenges
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1713084This review aims to provide an overview of metabolic and endocrine challenges in the setting of intensive care medicine. These are a group of heterogeneous clinical conditions with a high degree of overlap, as well as nonspecific signs and symptoms. Several diseases involve multiple organ systems, potentially causing catastrophic dysfunction and death. In the majority of cases, endocrine challenges accompany other organ failures or manifest as a complication of prolonged intensive care unit stay and malnutrition. However, when endocrine disorders present as an isolated ...
Source: Seminars in Respiratory and Critical Care Medicine - September 2, 2020 Category: Respiratory Medicine Authors: Martucci, Gennaro Bonicolini, Eleonora Parekh, Dhruv Thein, Onn Shaun Scherkl, Mario Amrein, Karin Tags: Review Article Source Type: research

Life-Threatening Hemoptysis
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1714386Life-threatening hemoptysis (LTH) is any amount of hemoptysis that causes significant hemodynamic decompensation or respiratory distress which may lead to death if left untreated. While the amount of hemoptysis that qualifies as massive hemoptysis has continued to be debated, any amount between 100 to 1,000 mL/day is considered significant. Up to 15% cases of hemoptysis are LTH and need urgent life-saving intervention. Understanding of pulmonary vascular anatomy is of paramount importance to manage LTH. The goal of treatment lies in airway protection, appropriate...
Source: Seminars in Respiratory and Critical Care Medicine - August 29, 2020 Category: Respiratory Medicine Authors: Deshwal, Himanshu Sinha, Ankur Mehta, Atul C. Tags: Review Article Source Type: research

Vasopressor Therapy in the Intensive Care Unit
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1710320After fluid administration for vasodilatory shock, vasopressors are commonly infused. Causes of vasodilatory shock include septic shock, post-cardiovascular surgery, post-acute myocardial infarction, postsurgery, other causes of an intense systemic inflammatory response, and drug -associated anaphylaxis. Therapeutic vasopressors are hormones that activate receptors—adrenergic: α1, α2, β1, β2; angiotensin II: AG1, AG2; vasopressin: AVPR1a, AVPR1B, AVPR2; dopamine: DA1, DA2. Vasopressor choice and dose vary widely because of patient and physici...
Source: Seminars in Respiratory and Critical Care Medicine - August 19, 2020 Category: Respiratory Medicine Authors: Russell, James A. Gordon, Anthony C. Williams, Mark D. Boyd, John H. Walley, Keith R. Kissoon, Niranjan Tags: Review Article Source Type: research

Chronic Obstructive Pulmonary Disease in the Intensive Care Unit: Antibiotic Treatment of Severe Chronic Obstructive Pulmonary Disease Exacerbations
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1708837Patients who suffer from chronic obstructive pulmonary disease (COPD) often experience deterioration of baseline respiratory symptoms, acute exacerbations of COPD (AECOPD), that become more frequent with disease progression. Based on symptom severity, approximately 20% of these patients will require hospitalization. The most common indicators for intensive care unit (ICU) admission have been found to be worsening or impending respiratory failure and hemodynamic instability. Bacterial and viral bronchial infections are the causative triggers in the majority of COPD exace...
Source: Seminars in Respiratory and Critical Care Medicine - August 10, 2020 Category: Respiratory Medicine Authors: Gupta, Nita Haley, Ryan Gupta, Ashish Sethi, Sanjay Tags: Review Article Source Type: research

Radiographic and Histopathologic Features in Sarcoidosis: A Pictorial Display
Semin Respir Crit Care Med 2020; 41: 758-784 DOI: 10.1055/s-0040-1712534Sarcoidosis is a multisystemic granulomatous disorder that can affect virtually any organ. However, pulmonary and thoracic lymph node involvement predominates; abnormalities on chest radiographs are present in 80 to 90% of patients with sarcoidosis. High-resolution computed tomographic (HRCT) scans are superior to chest X-rays in assessing extent of disease, and some CT features may discriminate an active inflammatory component (which may be amenable to therapy) from fibrosis (for which therapy is not indicated). Typical findings on HRCT include micron...
Source: Seminars in Respiratory and Critical Care Medicine - August 9, 2020 Category: Respiratory Medicine Authors: Shaikh, Faisal Abtin, Fereidoun G. Lau, Ryan Saggar, Rajan Belperio, John A. Lynch, Joseph P. Tags: Review Article Source Type: research

Screening Sarcoidosis Patients for Occult Disease
Semin Respir Crit Care Med 2020; 41: 741-757 DOI: 10.1055/s-0040-1709496As sarcoidosis may involve any organ, sarcoidosis patients should be evaluated for occult disease. Screening for some organ involvement may not be warranted if it is unlikely to cause symptoms, organ dysfunction, or affect clinical outcome. Even organ involvement that affects clinical outcome does not necessarily require screening if early detection fails to change the patient's quality of life or prognosis. On the other hand, early detection of some forms of sarcoidosis may improve outcomes and survival. This manuscript describes the approach to scree...
Source: Seminars in Respiratory and Critical Care Medicine - August 9, 2020 Category: Respiratory Medicine Authors: Judson, Marc A. Tags: Review Article Source Type: research

Nonlife-Threatening Sarcoidosis
Semin Respir Crit Care Med 2020; 41: 733-740 DOI: 10.1055/s-0040-1710371Sarcoidosis is a systemic granulomatous disease of unknown etiology. The outcome is quite variable and is mainly related to persistent inflammatory processes and the development of fibrosis. Many prognostic factors have been described, but the disease evolution is not yet entirely known. The nonthreatening course is characterized by spontaneous involution or stability after treatment withdrawal. Löfgren's syndrome is a subset within the spectrum of sarcoidosis phenotypes, composed of acute onset of fever, bilateral hilar lymphadenopathy, erythema ...
Source: Seminars in Respiratory and Critical Care Medicine - August 9, 2020 Category: Respiratory Medicine Authors: Castro, Marina Dornfeld Cunha Pereira, Carlos Alberto de Castro Tags: Review Article Source Type: research

Advanced Pulmonary Sarcoidosis
Semin Respir Crit Care Med 2020; 41: 700-715 DOI: 10.1055/s-0040-1709495At least 5% of sarcoidosis patients die from their disease, usually from advanced pulmonary sarcoidosis. The three major problems encountered in advanced pulmonary sarcoidosis are pulmonary fibrosis, pulmonary hypertension, and respiratory infections. Pulmonary fibrosis is the result of chronic inflammation, but other factors including abnormal wound healing may be important. Sarcoidosis-associated pulmonary hypertension (SAPH) is multifactorial including parenchymal fibrosis, vascular granulomas, and hypoxia. Respiratory infections can be cause by str...
Source: Seminars in Respiratory and Critical Care Medicine - August 9, 2020 Category: Respiratory Medicine Authors: Gupta, Rohit Baughman, Robert P. Tags: Review Article Source Type: research

Ocular Sarcoidosis
Semin Respir Crit Care Med 2020; 41: 673-688 DOI: 10.1055/s-0040-1710536Sarcoidosis is one of the leading causes of inflammatory eye disease. Any part of the eye and its adnexal tissues can be involved. Uveitis and optic neuropathy are the main manifestations, which may require systemic treatment. Two groups of patients with sarcoid uveitis can be distinguished: one of either sex and any ethnicity in which ophthalmological findings are various and another group of elderly Caucasian women with mostly chronic posterior uveitis. Clinically isolated uveitis revealing sarcoidosis remains a strictly ocular condition in a large m...
Source: Seminars in Respiratory and Critical Care Medicine - August 9, 2020 Category: Respiratory Medicine Authors: S ève, Pascal Jamilloux, Yvan Tilikete, Caroline Gerfaud-Valentin, Mathieu Kodjikian, Laurent El Jammal, Thomas Tags: Review Article Source Type: research

Sarcoidosis-Associated Pulmonary Hypertension
Semin Respir Crit Care Med 2020; 41: 659-672 DOI: 10.1055/s-0040-1713615Pulmonary hypertension (PH) is a well-known complication of sarcoidosis, defined by a mean pulmonary artery pressure of ≥25 mm Hg. Since both PH and sarcoidosis are rare diseases, data on sarcoidosis-associated PH (SAPH) is retrieved mostly from small retrospective studies. Estimated prevalence of SAPH ranges from 3% in patients referred to a tertiary center up to 79% in patients awaiting lung transplant. Most patients with SAPH show advanced parenchymal disease as the underlying mechanism. However, some patients have disproportional elevated...
Source: Seminars in Respiratory and Critical Care Medicine - August 9, 2020 Category: Respiratory Medicine Authors: Huitema, Marloes P. Mathijssen, Harold Mager, Johannes J. Snijder, Repke J. Grutters, Jan C. Post, Marco C. Tags: Review Article Source Type: research

Hepatic Sarcoidosis: Current Concepts and Treatments
Semin Respir Crit Care Med 2020; 41: 652-658 DOI: 10.1055/s-0040-1713799Hepatic sarcoidosis is a relatively common manifestation of extrapulmonary sarcoidosis. It occurs in 20 to 30% of cases and is rarely severe. However, a cluster of patients may develop severe complications such as cirrhosis and portal hypertension. In this review, we describe the current knowledge of clinical, biological, pathological, and radiological features of liver involvement in sarcoidosis and discuss essential clues for management and treatment. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJourn...
Source: Seminars in Respiratory and Critical Care Medicine - August 9, 2020 Category: Respiratory Medicine Authors: Rossi, Geoffrey Ziol, Marianne Roulot, Dominique Valeyre, Dominique Mah évas, Matthieu Tags: Review Article Source Type: research

The Burden of Neurosarcoidosis: Essential Approaches to Early Diagnosis and Treatment
Semin Respir Crit Care Med 2020; 41: 641-651 DOI: 10.1055/s-0040-1710576Neurosarcoidosis (NS) is an often severe, destructive manifestation with a likely under-reported prevalence of 5 to 15% of sarcoidosis cases, and in its active phase demands timely treatment intervention. Clinical signs and symptoms of NS are variable and wide-ranging, depending on anatomical involvement. Cranial nerve dysfunction, cerebrospinal parenchymal disease, aseptic meningitis, and leptomeningeal disease are the most commonly recognized manifestations. However, non-organ-specific potentially neurologically driven symptoms, such as fatigue, cogn...
Source: Seminars in Respiratory and Critical Care Medicine - August 9, 2020 Category: Respiratory Medicine Authors: Voortman, Mareye Stern, Barney J. Saketkoo, Lesley Ann Drent, Marjolein Tags: Review Article Source Type: research

Balancing Altered Calcium Metabolism with Bone Health in Sarcoidosis
Semin Respir Crit Care Med 2020; 41: 618-625 DOI: 10.1055/s-0040-1713009Abnormal calcium metabolism in sarcoidosis patients can lead to hypercalcemia, hypercalciuria, and kidney stones. Hypercalcemia in sarcoidosis is usually due to increased activity of 1α-hydroxylase in macrophages of pulmonary granulomata, resulting in low levels of 25-hydroxyvitamin D and high levels of calcitriol. Vitamin D supplementation may be dangerous for some sarcoidosis patients and is recommended only for those with decreased 25-hydroxyvitamin D and reduced or normal calcitriol level. Diagnosis, treatment of osteoporosis, and maintenance...
Source: Seminars in Respiratory and Critical Care Medicine - August 9, 2020 Category: Respiratory Medicine Authors: Zhou, Ying Lower, Elyse E. Tags: Review Article Source Type: research

Overlap Syndromes in Sarcoidosis: Clinical Features and Outcomes
This article is intended to provide an overview of these presentations and the most commonly associated diseases, with attention to their prevalence, clinical features, and reciprocal impacts on disease outcomes. [...] 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 - August 9, 2020 Category: Respiratory Medicine Authors: James, W. Ennis Tags: Review Article Source Type: research

Sarcoidosis: Advances in Therapy
Semin Respir Crit Care Med 2020; 41: 605-606 DOI: 10.1055/s-0040-1714281 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 - August 9, 2020 Category: Respiratory Medicine Authors: Baughman, Robert P. Judson, Marc Tags: Preface Source Type: research

End-of-Life Issues in Intensive Care Units
This article presents a summary of the most common issues encountered by intensivists caring for patients around the end of their life. Topics explored are the practices around limitations of life-sustaining treatment, with specific mention to the thorny subject of assisted dying and euthanasia, as well as the difficulties encountered regarding the adoption of advance care directives in clinical practice and the importance of integrating palliative care in the everyday practice of critical-care physicians. The aim of this article is to enhance understanding around the complexity of EoL decisions, highlight the intricate cu...
Source: Seminars in Respiratory and Critical Care Medicine - August 8, 2020 Category: Respiratory Medicine Authors: Metaxa, Victoria Tags: Review Article Source Type: research

Elderly Patients in the Intensive Care Unit
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1710571Very old intensive care unit (ICU) patients, aged ≥ 80 years, are by no mean newcomers, but during the last decades their impact on ICU admissions has grown in parallel with the increase in the number of elderly persons in the community. Hence, from being a “rarity,” they have now become common and constitute one of the largest subgroups within intensive care, and may easily be the largest group in 20 years and make up 30 to 40% of all ICU admissions. Obviously, they are not admitted because they are old but because they are with various dis...
Source: Seminars in Respiratory and Critical Care Medicine - August 8, 2020 Category: Respiratory Medicine Authors: Flaatten, Hans Beil, Michael Guidet, Bertrand Tags: Review Article Source Type: research

Mesenchymal Stem/Stromal Cells Therapy for Sepsis and Acute Respiratory Distress Syndrome
Semin Respir Crit Care Med DOI: 10.1055/s-0040-1713422Sepsis and acute respiratory distress syndrome (ARDS) constitute devastating conditions with high morbidity and mortality. Sepsis results from abnormal host immune response, with evidence for both pro- and anti-inflammatory activation present from the earliest phases. The “proinflammatory” response predominates initially causing host injury, with later-phase sepsis characterized by immune cell hypofunction and opportunistic superinfection. ARDS is characterized by inflammation and disruption of the alveolar-capillary membrane leading to injury and lung dysfu...
Source: Seminars in Respiratory and Critical Care Medicine - August 5, 2020 Category: Respiratory Medicine Authors: Byrnes, Declan Masterson, Claire H. Artigas, Antonio Laffey, John G. Tags: Review Article Source Type: research

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 2, 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 2, 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 2, 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 2, 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 28, 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 28, 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 28, 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 27, 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 27, 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 27, 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 5, 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 5, 2020 Category: Respiratory Medicine Authors: Lynch, Joseph P. Reid, Gail Clark, Nina M. Tags: Review Article Source Type: research