The Deteriorating Patient: Therapies Including Lung Transplantation
Semin Respir Crit Care Med 2021; 42: 623-638 DOI: 10.1055/s-0041-1730946In this review paper, we discuss the characteristics that define severe bronchiectasis and which may lead to deterioration of noncystic fibrosis bronchiectasis. These characteristics were used to establish the current severity scores: bronchiectasis severity index (BSI), FACED, and E-FACED (exacerbation frequency, forced expiratory volume in 1 second, age, colonization, extension and dyspnea score). They can be used to predict mortality, exacerbation rate, hospital admission, and quality of life. Furthermore, there are different treatable traits that c...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Detailleur, Stephanie Vos, Robin Goeminne, Pieter Tags: Review Article Source Type: research

Airway Clearance and Mucoactive Therapies
Semin Respir Crit Care Med 2021; 42: 616-622 DOI: 10.1055/s-0041-1730922The respiratory system is constantly exposed to external pathogens but has different and effective defense systems. The pathophysiology of bronchiectasis affects the defense system considerably in that alterations occur in the airway that reduce its effectiveness in mucociliary clearance and the greater presence of mucins leads to the accumulation of more adherent and viscous mucus. One of the pillars of treatment of this disease should be improvement of mucociliary clearance and a decrease in the adherence and viscosity of the mucus. To this end, the ...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Mu ñoz Castro, Gerard Bala ñá Corberó, Ana Tags: Review Article Source Type: research

Long-Term Antibiotics in Bronchiectasis
Semin Respir Crit Care Med 2021; 42: 606-615 DOI: 10.1055/s-0041-1730945A significant proportion of bronchiectasis patients are chronically infected by potentially pathogenic microorganisms which may lead to frequent exacerbations and worse clinical outcomes. Current bronchiectasis guidelines recommend long-term inhaled antibiotics and/or oral macrolides as a part of patient management. In recent years, an increasing amount of evidence assessing the impact of these treatments on patient outcomes has been collected. Inhaled antibiotics have demonstrated significant improvements in sputum bacterial load, but their impact on ...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Suarez-Cuartin, Guillermo Hernandez-Argudo, Marta Perea, Lidia Sibila, Oriol Tags: Review Article Source Type: research

Bronchiectasis Exacerbations: Definitions, Causes, and Acute Management
Semin Respir Crit Care Med 2021; 42: 595-605 DOI: 10.1055/s-0041-1730944Pulmonary exacerbations (PExs) are events in the course of bronchiectasis which are defined as an increase in disease symptoms lasting a period of a few days. It is established that the tendency toward having PEx is stable throughout the course of the disease. Certain conditions were found to be associated with an increased risk of developing a PEx. Among these are chronic airway infection with Pseudomonas aeruginosa or Aspergillus species, concomitant airway diseases (asthma, chronic obstructive pulmonary disease, and chronic rhinosinusitis), genetic ...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Perl, Sivan Shteinberg, Michal Tags: Review Article Source Type: research

Pseudomonas aeruginosa in Bronchiectasis
Semin Respir Crit Care Med 2021; 42: 587-594 DOI: 10.1055/s-0041-1730921 Pseudomonas aeruginosa (PA) in patients with bronchiectasis (BE) is associated with a poor outcome and quality of life, and its presence is considered a marker of disease severity. This opportunistic pathogen is known for its ability to produce biofilms on biotic or abiotic surfaces and to survive environmental stress exerted by antimicrobials, inflammation, and nutrient or oxygen depletion. The presence of PA biofilms has been linked to chronic respiratory infection in cystic fibrosis but not in BE. There is considerable inconsistency in the repor...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Fern ández-Barat, Laia Alcaraz-Serrano, Victoria Amaro, Rosanel Torres, Antoni Tags: Review Article Source Type: research

Nontuberculous Mycobacteria
This article will provide a useful introduction and framework for clinicians involved in the management of bronchiectasis and NTM. It includes an overview of the epidemiology, pathogenesis, diagnosis, and management of NTM PD. We will address the challenges faced in the diagnosis of NTM PD and the importance of subspeciation in guiding treatment and follow-up, especially in Mycobacterium abscessus infections. The treatment of both Mycobacterium avium complex and M. abscessus, the two most common NTM species known to cause disease, will be discussed in detail. Elements of the recent ATS/ERS/ESCMID/IDSA NTM guidelines publis...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Tan, Shera Kasperbauer, Shannon Tags: Review Article Source Type: research

Aspergillus-Associated Endophenotypes in Bronchiectasis
Semin Respir Crit Care Med 2021; 42: 556-566 DOI: 10.1055/s-0041-1730947Bronchiectasis is a chronic condition of global relevance resulting in permanent and irreversible structural airway damage. Bacterial infection in bronchiectasis is well studied; however, recent molecular studies identify fungi as important pathogens, either independently or in association with bacteria. Aspergillus species are established fungal pathogens in cystic fibrosis and their role is now increasingly being recognized in noncystic fibrosis bronchiectasis. While the healthy airway is constantly exposed to ubiquitously present Aspergillus conidia...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Jaggi, Tavleen Kaur Ter, Soo Kai Mac Aog áin, Micheál Chotirmall, Sanjay H. Tags: Review Article Source Type: research

Clinical and Radiological Phenotypes and Endotypes
Semin Respir Crit Care Med 2021; 42: 549-555 DOI: 10.1055/s-0041-1730894Bronchiectasis is a heterogenous disease with multiple etiologies and associated comorbidities. As bronchiectasis is a complex disease, it is unsound to think of it as a single disease particularly when the differing etiologies are likely to be driving bronchiectasis through initial divergent molecular pathways, known as endotypes, that phenotypically present as the same disease due to protracted airway inflammation, but revealing potential differing underlying mechanisms that may have disparity of drug responses. Improved understanding of the cellular...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Jos é, Ricardo J. Loebinger, Michael R. Tags: Review Article Source Type: research

Primary Ciliary Dyskinesia
This article examines prevalence, clinical features, diagnosis, and management of PCD highlighting recent advances in basic science and clinical care. [...] 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 - July 14, 2021 Category: Respiratory Medicine Authors: Shoemark, Amelia Harman, Katharine Tags: Review Article Source Type: research

Common Variable Immunodeficiency and Other Immunodeficiency Syndromes in Bronchiectasis
Semin Respir Crit Care Med 2021; 42: 525-536 DOI: 10.1055/s-0041-1730893Immunodeficiency represents a vast number of diseases and syndromes. Both primary and secondary forms of immunodeficiency are important contributors to the development of bronchiectasis. Primary immune deficiencies, in particular, are increasingly identified and defined as contributors. Specific immune deficiencies that are closely associated with bronchiectasis and as discussed in this article are common variable immunodeficiency, specific antibody deficiency, immunodeficiencies involving immunoglobulin E, DOCK8 immunodeficiency, phosphoglucomutase 3 ...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: McShane, Pamela J. Tags: Review Article Source Type: research

Diagnosis and Initial Investigation of Bronchiectasis
Semin Respir Crit Care Med 2021; 42: 513-524 DOI: 10.1055/s-0041-1730892Bronchiectasis refers to both the name of a disease and a single radiological appearance that may, or may not, be associated with disease. As chronic respiratory disease, bronchiectasis is characterized by a variable range of signs and symptoms that may overlap with other chronic respiratory conditions. The proper identification of bronchiectasis as a disease in both primary and secondary care is of paramount importance. However, a standardized definition of radiologically and clinically significant bronchiectasis is still missing. Disease heterogeneit...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Amati, Francesco Simonetta, Edoardo Pilocane, Tommaso Gramegna, Andrea Goeminne, Pieter Oriano, Martina Pascual-Guardia, Sergi Mantero, Marco Voza, Antonio Santambrogio, Martina Blasi, Francesco Aliberti, Stefano Tags: Review Article Source Type: research

Pathophysiology of Bronchiectasis
Semin Respir Crit Care Med 2021; 42: 499-512 DOI: 10.1055/s-0041-1730891Bronchiectasis is a complex, heterogeneous disorder defined by both a radiological abnormality of permanent bronchial dilatation and a clinical syndrome. There are multiple underlying causes including severe infections, mycobacterial disease, autoimmune conditions, hypersensitivity disorders, and genetic conditions. The pathophysiology of disease is understood in terms of interdependent concepts of chronic infection, inflammation, impaired mucociliary clearance, and structural lung damage. Neutrophilic inflammation is characteristic of the disease, wit...
Source: Seminars in Respiratory and Critical Care Medicine - July 14, 2021 Category: Respiratory Medicine Authors: Keir, Holly R. Chalmers, James D. Tags: Review Article Source Type: research

Bronchiectasis: Advances in Diagnosis and Treatment
Semin Respir Crit Care Med 2021; 42: 497-498 DOI: 10.1055/s-0041-1730903 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 - July 14, 2021 Category: Respiratory Medicine Authors: Chalmers, James D. Tags: Preface Source Type: research

Skin Cancers and Lung Transplant
This article will provide an overview of the risk factors for the development of cutaneous malignancies in organ transplant recipients as well as a detailed discussion of various immunosuppressant and prophylactic medications used in this patient population that contribute to the risk of developing cutaneous malignancies, with an emphasis on NMSC (cSCC and BCC) in lung transplant recipients. Finally, this article includes a discussion on the clinical and dermatologic management of this high-risk immunosuppressed population including a review of topical and systemic agents for field therapy of actinic damage and chemopreven...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Wilken, Reason Carucci, John Stevenson, Mary L. Tags: Review Article Source Type: research

Fungal Infection in Lung Transplantation
Semin Respir Crit Care Med 2021; 42: 471-482 DOI: 10.1055/s-0041-1729173Invasive fungal infections threaten lung transplant outcomes with high associated morbidity and mortality. Pharmacologic prophylaxis may be key to prevent posttransplant invasive fungal infections, but cost, adverse effects, and absorption issues are barriers to effective prophylaxis. Trends in fungal infection diagnostic strategies utilize molecular diagnostic methodologies to complement traditional histopathology and culture techniques. While lung transplant recipients are susceptible to a variety of fungal pathogens, Candida spp. and Aspergillus spp...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Kennedy, Cassie C. Pennington, Kelly M. Beam, Elena Razonable, Raymund R. Tags: Review Article Source Type: research

Mycobacteria: Selection of Transplant Candidates and Post –lung Transplant Outcomes
Semin Respir Crit Care Med 2021; 42: 460-470 DOI: 10.1055/s-0041-1727250 Mycobacterium is a large, clinically relevant bacterial genus made up of the agents of tuberculosis and leprosy and hundreds of species of saprophytic nontuberculous mycobacteria (NTM). Pathogenicity, clinical presentation, epidemiology, and antimicrobial susceptibilities are exceptionally diverse between species. Patients with end-stage lung disease and recipients of lung transplants are at a higher risk of developing NTM colonization and disease and of severe manifestations and outcomes of tuberculosis. Data from the past three decades have incre...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Friedman, Daniel Z.P. Doucette, Karen Tags: Review Article Source Type: research

Community-Acquired Respiratory Viruses Post –Lung Transplant
Semin Respir Crit Care Med 2021; 42: 449-459 DOI: 10.1055/s-0041-1729172Survival in lung transplant recipients (LTRs) lags behind heart, liver, and kidney transplant, in part due to the direct and indirect effects of infection. LTRs have increased susceptibility to infection due to the combination of a graft continually exposed to the outside world, multiple mechanisms for impaired mucus clearance, and immunosuppression. Community-acquired respiratory viral infections (CARVs) are common in LTRs. Picornaviruses have roughly 40% cumulative incidence followed by respiratory syncytial virus and coronaviruses. Although single-c...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Sweet, Stuart C. Tags: Review Article Source Type: research

The Impact of Resistant Bacterial Pathogens including Pseudomonas aeruginosa and Burkholderia on Lung Transplant Outcomes
Semin Respir Crit Care Med 2021; 42: 436-448 DOI: 10.1055/s-0041-1728797 Pseudomonas and Burkholderia are gram-negative organisms that achieve colonization within the lungs of patients with cystic fibrosis, and are associated with accelerated pulmonary function decline. Multidrug resistance is a hallmark of these organisms, which makes eradication efforts difficult. Furthermore, the literature has outlined increased morbidity and mortality for lung transplant (LTx) recipients infected with these bacterial genera. Indeed, many treatment centers have considered Burkholderia cepacia infection an absolute contraindication t...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Mitchell, Alicia B. Glanville, Allan R. Tags: Review Article Source Type: research

Antibody-Mediated Rejection and Lung Transplantation
Semin Respir Crit Care Med 2021; 42: 428-435 DOI: 10.1055/s-0041-1728796Antibody-mediated rejection (AMR) is now a widely recognized form of lung allograft rejection, with mounting evidence for AMR as an important risk factor for the development of chronic lung allograft dysfunction and markedly decreased long-term survival. Despite the recent development of the consensus diagnostic criteria, it remains a challenging diagnosis of exclusion. Furthermore, even after diagnosis, treatment directed at pulmonary AMR has been nearly exclusively derived from practices with other solid-organ transplants and other areas of medicine,...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Halverson, Laura P. Hachem, Ramsey R. Tags: Review Article Source Type: research

Acute Rejection in the Modern Lung Transplant Era
Semin Respir Crit Care Med 2021; 42: 411-427 DOI: 10.1055/s-0041-1729542Acute cellular rejection (ACR) remains a common complication after lung transplantation. Mortality directly related to ACR is low and most patients respond to first-line immunosuppressive treatment. However, a subset of patients may develop refractory or recurrent ACR leading to an accelerated lung function decline and ultimately chronic lung allograft dysfunction. Infectious complications associated with the intensification of immunosuppression can also negatively impact long-term survival. In this review, we summarize the most recent evidence on the ...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Renaud-Picard, Benjamin Koutsokera, Angela Cabanero, Michael Martinu, Tereza Tags: Review Article Source Type: research

Chronic Lung Allograft Dysfunction: Evolving Concepts and Therapies
Semin Respir Crit Care Med 2021; 42: 392-410 DOI: 10.1055/s-0041-1729175The primary factor that limits long-term survival after lung transplantation is chronic lung allograft dysfunction (CLAD). CLAD also impairs quality of life and increases the costs of medical care. Our understanding of CLAD continues to evolve. Consensus definitions of CLAD and the major CLAD phenotypes were recently updated and clarified, but it remains to be seen whether the current definitions will lead to advances in management or impact care. Understanding the potential differences in pathogenesis for each CLAD phenotype may lead to novel therapeu...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Amubieya, Olawale Ramsey, Allison DerHovanessian, Ariss Fishbein, Gregory A. Lynch, Joseph P. Belperio, John A. Weigt, S. Samuel Tags: Review Article Source Type: research

Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplant
Semin Respir Crit Care Med 2021; 42: 380-391 DOI: 10.1055/s-0041-1728795Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary technology capable of supporting cardiac and respiratory function in the presence of end-stage lung disease. Initial experiences using ECMO as a bridge to lung transplant (ECMO-BTLT) were characterized by high rates of ECMO-associated complications and poor posttransplant outcomes. More recently, ECMO-BTLT has garnered success in preserving patients' physiologic condition and candidacy prior to lung transplant due to technological advances and improved management. Despite recent growth, cl...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Stokes, John W. Gannon, Whitney D. Bacchetta, Matthew Tags: Review Article Source Type: research

Primary Graft Dysfunction
Semin Respir Crit Care Med 2021; 42: 368-379 DOI: 10.1055/s-0041-1728794Primary graft dysfunction (PGD) is a form of acute lung injury after transplantation characterized by hypoxemia and the development of alveolar infiltrates on chest radiograph that occurs within 72 hours of reperfusion. PGD is among the most common early complications following lung transplantation and significantly contributes to increased short-term morbidity and mortality. In addition, severe PGD has been associated with higher 90-day and 1-year mortality rates compared with absent or less severe PGD and is a significant risk factor for the s...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Natalini, Jake G. Diamond, Joshua M. Tags: Review Article Source Type: research

Pushing the Envelope for Donor Lungs
Semin Respir Crit Care Med 2021; 42: 357-367 DOI: 10.1055/s-0041-1729859The shortage of organ donors remains the major limiting factor in lung transplant, with the number of patients on the waiting list largely exceeding the number of available organ donors. Another issue is the low utilization rate seen in some types of donors. Therefore, novel strategies are continuously being explored to increase the donor pool. Advanced age, smoking history, positive serologies, and size mismatch are common criteria that decrease the rate of use when it comes to organ utilization. Questioning these limitations is one of the purposes of...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Abdelnour-Berchtold, Etienne Ali, Aadil Cypel, Marcelo Keshavjee, Shaf Tags: Review Article Source Type: research

The Lung Allocation Score and Its Relevance
Semin Respir Crit Care Med 2021; 42: 346-356 DOI: 10.1055/s-0041-1729541Lung transplantation in the United States, under oversight by the Organ Procurement Transplantation Network (OPTN) in the 1990s, operated under a system of allocation based on location within geographic donor service areas, wait time of potential recipients, and ABO compatibility. On May 4, 2005, the lung allocation score (LAS) was implemented by the OPTN Thoracic Organ Transplantation Committee to prioritize patients on the wait list based on a balance of wait list mortality and posttransplant survival, thus eliminating time on the wait list as a fact...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Lyu, Dennis M. Goff, Rebecca R. Chan, Kevin M. Tags: Review Article Source Type: research

Selection Criteria for Lung Transplantation: Controversies and New Developments
Semin Respir Crit Care Med 2021; 42: 329-345 DOI: 10.1055/s-0041-1728756Lung transplantation is an accepted therapeutic option for end-stage lung diseases. The imbalance between limited availability and vast need of donor organs necessitates careful selection of recipient candidates, ensuring the best possible utilization of the scarce resource of organs. Nonetheless, possible lung transplant candidates who could experience a meaningful improvement in survival and quality of life should not be excluded solely based on the complexity of their case. In this review, controversial issues or difficult limitations for lung trans...
Source: Seminars in Respiratory and Critical Care Medicine - May 24, 2021 Category: Respiratory Medicine Authors: Beeckmans, Hanne Bos, Saskia Vos, Robin Tags: Review Article Source Type: research

Lung Transplantation: Controversies and Evolving Concepts
Semin Respir Crit Care Med 2021; 42: 327-328 DOI: 10.1055/s-0041-1728793 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 - May 24, 2021 Category: Respiratory Medicine Authors: Belperio, John A. Palmer, Scott M. Tags: Preface Source Type: research

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