Controlling the Diffusion of Multidrug-Resistant Organisms in Intensive Care Units
Semin Respir Crit Care Med 2019; 40: 558-568 DOI: 10.1055/s-0039-1696980The prevalence of multidrug-resistant organisms (MDROs) in intensive care units (ICUs) is increasing worldwide, with very large variations across countries, microorganisms, and settings. Emerging MDR gram-negative bacteria and fungi raise particular concerns that require improved prevention and control strategies. Vertical approaches are mainly based on screening and contact precautions and/or decolonization of MDRO carriers. On the other hand, horizontal strategies are not pathogen-specific and include standard precautions (i.e., hand hygiene), univer...
Source: Seminars in Respiratory and Critical Care Medicine - October 4, 2019 Category: Respiratory Medicine Authors: Kern éis, Solen Lucet, Jean-Christophe Tags: Review Article Source Type: research

Prevention of Intensive Care Unit-Acquired Pneumonia
This article will review recent studies that have challenged, refined, or complicated our understanding of how best to prevent ICU-acquired pneumonia. [...] 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 - October 4, 2019 Category: Respiratory Medicine Authors: Klompas, Michael Tags: Review Article Source Type: research

Invasive Pulmonary Aspergillosis in Nonimmunocompromised Hosts
Semin Respir Crit Care Med 2019; 40: 540-547 DOI: 10.1055/s-0039-1696968Invasive pulmonary aspergillosis (IPA) is a fungal infection that is the hallmark of severe cellular or complex immune alterations. Evidence that IPA can occur in nonimmunocompromised hosts is increasing. Actually, up to 1% of general intensive care unit (ICU) patients present positive samples with Aspergillus spp. Both colonization and invasive disease are associated with poor outcome. Unexpected IPA has also been reported in approximately 1% of critically ill patients who underwent postmortem biopsies. In nonimmunocompromised patients with acute resp...
Source: Seminars in Respiratory and Critical Care Medicine - October 4, 2019 Category: Respiratory Medicine Authors: Tudesq, Jean-Jacques Peyrony, Olivier Lemiale, Virginie Azoulay, Elie Tags: Review Article Source Type: research

Diagnosis and Treatment of Candidemia in the Intensive Care Unit
Semin Respir Crit Care Med 2019; 40: 524-539 DOI: 10.1055/s-0039-1693704Candidemia is the fourth most frequent health care-associated bloodstream infection, and the most frequent severe fungal infection developing in critically ill patients in intensive care units (ICUs). Diagnosis of candidemia in ICU patients is a complex task made of both early and late assessments involving both conventional diagnostic methods and novel rapid tests. Management strategies to optimize treatment of candidemia can be challenging and include starting early adequate therapy, use of an adequate dose and duration of therapy, de-escalating trea...
Source: Seminars in Respiratory and Critical Care Medicine - October 4, 2019 Category: Respiratory Medicine Authors: Bassetti, Matteo Giacobbe, Daniele R. Vena, Antonio Wolff, Michel Tags: Review Article Source Type: research

Management and Prevention of Central Venous Catheter-Related Infections in the ICU
Semin Respir Crit Care Med 2019; 40: 508-523 DOI: 10.1055/s-0039-1693705Central venous catheter-related bloodstream infections (CR-BSI) are a frequent event in the intensive care unit (ICU) setting. In contrast to other nosocomial infections, most risk factors for CR-BSI are linked to the device and can be prevented efficiently. Rates of CR-BSI higher than 1 per 1,000 catheter days are no longer acceptable. A continuous quality improvement program is effective to reduce them. Key elements of prevention of CR-BSI are hand hygiene, avoidance of insertion of unnecessary catheters, full sterile barrier precautions at insertion...
Source: Seminars in Respiratory and Critical Care Medicine - October 4, 2019 Category: Respiratory Medicine Authors: Buetti, Niccol ò Timsit, Jean-Fran çois Tags: Review Article Source Type: research

Bacterial Pneumonias in Immunocompromised Patients
Semin Respir Crit Care Med 2019; 40: 498-507 DOI: 10.1055/s-0039-1696961With the overall improvement in survival of cancer patients and the widespread use of novel immunotherapy drugs for malignant as well as nonmalignant diseases, the prevalence of immunosuppression is rising in the population. Immunocompromised patients are particularly exposed to pulmonary infections which remain a leading cause for acute hypoxic respiratory failure and intensive care unit admission. Although fungal or opportunistic infections are always a concern, bacterial pneumonia remains the most common cause of pulmonary infection, is associated w...
Source: Seminars in Respiratory and Critical Care Medicine - October 4, 2019 Category: Respiratory Medicine Authors: Van de Louw, Andry Mirouse, Adrien Peyrony, Olivier Lemiale, Virginie Azoulay, Elie Tags: Review Article Source Type: research

Influenza Infections and Emergent Viral Infections in Intensive Care Unit
In this study, we aim to analyze the current evidence and findings associated with influenza and other emergent viral infections, namely, herpes simplex virus type 1 (HSV-1), Epstein-Barr virus (EBV), and cytomegalovirus (CMV).Among medical conditions, community-acquired respiratory infections are the most frequent reason for ventilatory support in ICUs. Community-acquired pneumonia in a severe form including the need of invasive mechanical ventilation and/or vasopressors is associated with high mortality rates. However, after the pandemic that occurred in 2009 by H1N1 influenza, the number of cases being admitted to ICUs ...
Source: Seminars in Respiratory and Critical Care Medicine - October 4, 2019 Category: Respiratory Medicine Authors: Cantan, Ben Luyt, Charles-Edouard Martin-Loeches, Ignacio Tags: Review Article Source Type: research

Pharmacokinetics/Pharmacodynamics of β-Lactams and Therapeutic Drug Monitoring: From Theory to Practical Issues in the Intensive Care Unit
Semin Respir Crit Care Med 2019; 40: 476-487 DOI: 10.1055/s-0039-1693498Despite therapeutic advances over recent decades, the mortality rate for sepsis and septic shock is still approximately 25% worldwide. Early administration of appropriate intravenous antibiotics in the right dose is one of the cornerstones of treatment of sepsis. β-Lactam antibiotics are the most commonly prescribed in critically ill patients, and dosages that do not achieve specific pharmacokinetic/pharmacodynamic targets may increase the likelihood of treatment failure and even emergence of antibiotic resistance. Fluctuations in physiological pa...
Source: Seminars in Respiratory and Critical Care Medicine - October 4, 2019 Category: Respiratory Medicine Authors: Williams, Paul Cotta, Menino Osbert Roberts, Jason A. Tags: Review Article Source Type: research

Biomarkers of Infection: Are They Useful in the ICU?
Semin Respir Crit Care Med 2019; 40: 465-475 DOI: 10.1055/s-0039-1696689Biomarkers are increasingly used in patients with serious infections in the critical care setting to complement clinical judgment and interpretation of other diagnostic and prognostic tests. The main purposes of such blood markers are (1) to improve infection diagnosis (i.e., differentiation between bacterial vs. viral vs. fungal vs. noninfectious), (2) to help in the early risk stratification and thus provide prognostic information regarding the risk for mortality and other adverse outcomes, and (3) to optimize antibiotic tailoring to individual needs...
Source: Seminars in Respiratory and Critical Care Medicine - October 4, 2019 Category: Respiratory Medicine Authors: Heilmann, Eva Gregoriano, Claudia Schuetz, Philipp Tags: Review Article Source Type: research

Novel Approaches to Hasten Detection of Pathogens and Antimicrobial Resistance in the Intensive Care Unit
Semin Respir Crit Care Med 2019; 40: 454-464 DOI: 10.1055/s-0039-1693160Antibiotic resistance is recognized as a key determinant of outcome in patients with serious infections influencing empiric antibiotic practices especially for critically ill patients. Within the intensive care unit (ICU), nosocomial infections and increasingly community-onset infections are caused by multidrug-resistant bacteria. Escalating rates of antibiotic resistance adds substantially to the morbidity, mortality, and cost related to infections treated in the ICU. Both gram-positive organisms, such as methicillin-resistant Staphylococcus aureus an...
Source: Seminars in Respiratory and Critical Care Medicine - October 4, 2019 Category: Respiratory Medicine Authors: Guillamet, M. Cristina Vazquez Burnham, Jason P. Kollef, Marin H. Tags: Review Article Source Type: research

Early Antimicrobial Therapy for Sepsis: Does Each Hour Really Count?
Semin Respir Crit Care Med 2019; 40: 447-453 DOI: 10.1055/s-0039-1694970For the last decades, the timing of antimicrobial therapy has remained a hotly debated topic in sepsis as well as other infectious diseases like community-acquired pneumonia (CAP) or bacterial meningitis (CABM). In CAP, a relationship between the time to antibiotic administration and mortality was found only in the largest cohort, but all these studies were retrospective and of low quality. In CABM, the level of evidence remains also limited, but there is now a good body of evidence linking the delay to antibiotic administration to unfavorable outcome....
Source: Seminars in Respiratory and Critical Care Medicine - October 4, 2019 Category: Respiratory Medicine Authors: Guery, Benoit Calandra, Thierry Tags: Review Article Source Type: research

A Practical Approach to Clinical Antibiotic Stewardship in the ICU Patient with Severe Infection
Semin Respir Crit Care Med 2019; 40: 435-446 DOI: 10.1055/s-0039-1693995Patients with severe infections are often treated with multiple courses of antibiotics in the intensive care unit (ICU), making the ICU a true antibiotic hotspot. The increasing incidence of multidrug resistance worldwide emphasizes the need for continued efforts in developing and implementing antibiotic stewardship programs. Using a pragmatic approach for the bedside clinical team, this review will highlight different key moments for antibiotic decision making throughout the course of the antibiotic treatment in patients with severe infections. We wil...
Source: Seminars in Respiratory and Critical Care Medicine - October 4, 2019 Category: Respiratory Medicine Authors: Fierens, Jan Depuydt, Pieter O. De Waele, Jan J. Tags: Review Article Source Type: research

Difficult-to-Treat Antibiotic-Resistant Gram-Negative Pathogens in the Intensive Care Unit: Epidemiology, Outcomes, and Treatment
Semin Respir Crit Care Med 2019; 40: 419-434 DOI: 10.1055/s-0039-1696662Antibiotic resistance among gram-negative pathogens is a world-wide problem that poses a constant threat to patients in the intensive care unit and a therapeutic challenge for the intensivist. Furthermore, the substantial economic burden and increased mortality associated with infections due to highly resistant gram-negative pathogens exacerbate these challenges. Understanding the mechanisms, epidemiology, and risk factors for these infections is paramount to the successful control of outbreaks and for guiding therapy which often entails use of antibio...
Source: Seminars in Respiratory and Critical Care Medicine - October 4, 2019 Category: Respiratory Medicine Authors: Strich, Jeffrey R. Kadri, Sameer S. Tags: Review Article Source Type: research

Serious Infections in the ICU: Evolving Concepts in Management and Prevention
Semin Respir Crit Care Med 2019; 40: 417-418 DOI: 10.1055/s-0039-1696663 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 - October 4, 2019 Category: Respiratory Medicine Authors: Chastre, Jean Luyt, Charles-Edouard Wolff, Michel Tags: Preface Source Type: research

Advances and Controversies in Thoracentesis and Medical Thoracoscopy
Semin Respir Crit Care Med 2019; 40: 410-416 DOI: 10.1055/s-0039-1694034Pleural effusions are common and associated with high morbidity and mortality. Whereas thoracentesis can assist in achieving a diagnosis or therapy, advances in education and in the technique may prevent morbidity associated with the procedure. Medical thoracoscopy is often useful for undiagnosed effusions, as well as for therapeutic purposes. There is much enthusiasm about techniques for biopsies that extend beyond forceps. These include biopsies using a diathermic knife as well as cryoprobes. Similarly, adhesiolysis or other techniques to improve the...
Source: Seminars in Respiratory and Critical Care Medicine - September 16, 2019 Category: Respiratory Medicine Authors: Puchalski, Jonathan Tags: Review Article Source Type: research

Pleural Disease in Women
Semin Respir Crit Care Med 2019; 40: 402-409 DOI: 10.1055/s-0039-1695050There are several pleural diseases that occur either predominantly or exclusively in females. Most of these entities are related to obstetric or gynecological conditions. In this article, we will provide an overview of Meigs' syndrome, ovarian hyperstimulation syndrome, endometriosis, catamenial pneumothorax, catamenial hemothorax, pleural effusions that occur in the peripartum period, lymphangioleiomyomatosis, and malignant pleural effusions related to breast cancer. As most of these diagnoses are rare, considerable expertise is required to identify, ...
Source: Seminars in Respiratory and Critical Care Medicine - September 16, 2019 Category: Respiratory Medicine Authors: Argento, Angela Christine Gillespie, Colin T. Tags: Review Article Source Type: research

What's the Score? Do Pleural Effusion Clinical Scoring Systems Help in Management of Disease?
Semin Respir Crit Care Med 2019; 40: 394-401 DOI: 10.1055/s-0039-1695058Pleural effusion is a common condition, affecting over 3,000 people per million population every year. More than 50 causes of pleural effusions are known, including pleural infection and malignant pleural disease. These conditions place a large burden on healthcare systems with one-fourth of patients with pleural infection having a length of hospital stay of more than 1 month. Malignant pleural effusion represents advanced malignant disease with a correspondingly high mortality. Prognostic models using clinical information in combination with bl...
Source: Seminars in Respiratory and Critical Care Medicine - September 16, 2019 Category: Respiratory Medicine Authors: Grendelmeier, Peter Rahman, Najib M. Tags: Review Article Source Type: research

Chest Tube Drainage Devices
Semin Respir Crit Care Med 2019; 40: 386-393 DOI: 10.1055/s-0039-1694769Placement of a chest tube drains intrapleural fluid and air. The tube should be attached to a drainage system, such as one-, two-, or three-compartment devices, a one-way (Heimlich) valve for ambulatory drainage, a digital system, or a vacuum bottle. The frequently employed three-compartment systems, currently integrated disposable units, allow adjustment of negative pressure or no suction (water seal), and include an air leak meter on the water seal chamber to be used for demonstrating and quantifying air leak. These readings are subjective and prone ...
Source: Seminars in Respiratory and Critical Care Medicine - September 16, 2019 Category: Respiratory Medicine Authors: Toth, Jennifer W. Reed, Michael F. Ventola, Lauren K. Tags: Review Article Source Type: research

Pleurodesis
Semin Respir Crit Care Med 2019; 40: 375-385 DOI: 10.1055/s-0039-1693997Symptomatic pleural disease, specifically malignant pleural effusion, refractory benign pleural effusion, and pneumothoraces are common diseases that often require therapeutic interventions. The spectrum of management strategies often includes selection of a chemical pleurodesis agent administered in combination with an indwelling pleural catheter or chest tube.Additionally, there is a role for minimally invasive techniques which include medical thoracoscopy or more advanced video-assisted thoracoscopic approaches. Ongoing clinical trials continue to e...
Source: Seminars in Respiratory and Critical Care Medicine - September 16, 2019 Category: Respiratory Medicine Authors: Lamb, Carla Li, Andrew Thakkar, Dhaval Lee, Pyng Tags: Review Article Source Type: research

Medical and Surgical Management of Empyema
Semin Respir Crit Care Med 2019; 40: 361-374 DOI: 10.1055/s-0039-1694699Infection of the pleural space is an ancient and common clinical problem, the incidence which is on the rise. Advances in therapy now present clinicians of varying disciplines with an array of therapeutic options ranging from thoracentesis and chest tube drainage (with or without intrapleural fibrinolytic therapies) to video-assisted thoracic surgery (VATS) or thoracotomy. A framework is provided to guide decision making, which involves weighing multiple factors (clinical history and presentation, imaging characteristics, comorbidities); multidisciplin...
Source: Seminars in Respiratory and Critical Care Medicine - September 16, 2019 Category: Respiratory Medicine Authors: Godfrey, Mark S. Bramley, Kyle T. Detterbeck, Frank Tags: Review Article Source Type: research

Malignant Mesothelioma: Has Anything Changed?
Semin Respir Crit Care Med 2019; 40: 347-360 DOI: 10.1055/s-0039-1693406Malignant pleural mesothelioma is a rare cancer associated with asbestos exposure and portends a dismal prognosis. Its worldwide incidence has been increasing, and treatment options are currently suboptimal and noncurative. However, since the turn of the century, several encouraging steps have been made toward improving outcomes for mesothelioma patients. An increased understanding of disease pathophysiology has led to more accurate diagnosis and staging, and the establishment of the standard of care first-line pemetrexed/platin doublet chemotherapy re...
Source: Seminars in Respiratory and Critical Care Medicine - September 16, 2019 Category: Respiratory Medicine Authors: Kim, Roger Y. Sterman, Daniel H. Haas, Andrew R. Tags: Review Article Source Type: research

Molecular Testing on Pleural Fluid Samples
We describe the evolving field of molecular pleural fluid analysis in the setting of malignant disease as an active area of investigation with both diagnostic and therapeutic implications. [...] 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 - September 16, 2019 Category: Respiratory Medicine Authors: Oh, Scott Ronaghi, Reza Cai, Guoping Tags: Review Article Source Type: research

Management of Malignant Pleural Effusions —What Is New
Semin Respir Crit Care Med 2019; 40: 323-339 DOI: 10.1055/s-0039-1698285Malignant pleural effusion (MPE) is a common and challenging problem. Patients affected by MPE have a poor prognosis and suffer from breathlessness and impaired quality of life. The management of MPE has barely changed for many decades; however, recent research has driven new paradigms in the diagnosis and treatment of MPE and stimulated novel concepts that are being evaluated in many ongoing studies. This review provides an overview of recent advances in the diagnosis of MPE, including new cytopathology and imaging techniques, and the landmark studies...
Source: Seminars in Respiratory and Critical Care Medicine - September 16, 2019 Category: Respiratory Medicine Authors: Thomas, Rajesh Roy, Bapti Maldonado, Fabien Lee, Y.C. Gary Tags: Review Article Source Type: research

Pneumothorax —Time for New Guidelines?
Semin Respir Crit Care Med 2019; 40: 314-322 DOI: 10.1055/s-0039-1693499Pneumothorax is a common pathology, but optimal management strategies are not yet defined. There are significant differences in international guidelines and therefore variation in clinical practice.There is increasing interest in pneumothorax research, particularly primary spontaneous pneumothorax (PSP), with evidence of lung abnormalities in this group without clinically apparent lung disease and recently completed clinical trials aiming to optimize management. The most robust evidence base is that of the equivalence of needle aspiration and chest tub...
Source: Seminars in Respiratory and Critical Care Medicine - September 16, 2019 Category: Respiratory Medicine Authors: Hallifax, Rob Janssen, Julius P. Tags: Review Article Source Type: research

Physiologic Basis of Symptoms in Pleural Disease
Semin Respir Crit Care Med 2019; 40: 305-313 DOI: 10.1055/s-0039-1693648Pleural effusions are commonly encountered and have a significant impact on the respiratory system. The reported effect of thoracentesis on physiologic parameters including oxygenation, lung volumes, and respiratory mechanics is variable likely owing to studies with a small, heterogeneous population of patients.Most patients who are short of breath from pleural effusion experience relief following drainage due to improvement in the length–tension relationship of the respiratory muscles. An observed increase in oxygenation following thoracentesis ...
Source: Seminars in Respiratory and Critical Care Medicine - September 16, 2019 Category: Respiratory Medicine Authors: DeBiasi, Erin M. Feller-Kopman, David Tags: Review Article Source Type: research

Development and Maintenance of a Pleural Disease Service: Role of the “Pleurologist”
This article aims to look at the impact of current medical education paradigms, service structure, procedural education and role of the “pleurologist” in providing care to patients with pleural disease. [...] 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 - September 16, 2019 Category: Respiratory Medicine Authors: Cameron, Kelsey Teodoro, Dana Kasis, Azam Evison, Matthew Tags: Review Article Source Type: research

Pleural Diseases
Semin Respir Crit Care Med 2019; 40: 295-296 DOI: 10.1055/s-0039-1694966 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 - September 16, 2019 Category: Respiratory Medicine Authors: Puchalski, Jonathan Rahman, Najib M. Tags: Preface Source Type: research

Lung Disease in Antiphospholipid Syndrome
Semin Respir Crit Care Med 2019; 40: 278-294 DOI: 10.1055/s-0039-1683994Antiphospholipid syndrome (APS) is an acquired prothrombotic condition characterized by vascular thrombosis and/or obstetric complications, in the persistent positivity of circulating antiphospholipid antibodies (aPLs). The clinical spectrum of manifestations associated with aPL positivity is progressively expanding, including the description of several lung manifestations. The most common pulmonary involvement related to aPL positivity is pulmonary embolism (PE), which has been reported to occur in 14.1% of APS patients during disease course. PE ackno...
Source: Seminars in Respiratory and Critical Care Medicine - May 28, 2019 Category: Respiratory Medicine Authors: Maioli, Gabriella Calabrese, Giulia Capsoni, Franco Gerosa, Maria Meroni, Pier Luigi Chighizola, Cecilia Beatrice Tags: Review Article Source Type: research

Interstitial Pneumonia with Autoimmune Features and Undifferentiated Connective Tissue Disease
Semin Respir Crit Care Med 2019; 40: 271-277 DOI: 10.1055/s-0039-1684007In 2015, a multidisciplinary task force comprising pulmonologists, rheumatologists, pathologists, and radiologists representing the European Respiratory Society and American Thoracic Society published a diagnostic classification schema for individuals with interstitial lung disease and autoimmune features who did not meet criteria for a defined connective tissue disease. The term interstitial pneumonia with autoimmune features (IPAF) was applied. Classification criteria are often nonspecific, but up to 90% of subjects with IPAF have serological evidenc...
Source: Seminars in Respiratory and Critical Care Medicine - May 28, 2019 Category: Respiratory Medicine Authors: Chernau, Andrea K. Leone, Paolo M. Swigris, Jeffrey J. Tags: Review Article Source Type: research

Lung Diseases in Inflammatory Myopathies
Semin Respir Crit Care Med 2019; 40: 255-270 DOI: 10.1055/s-0039-1685187Lung involvement is the leading cause of mortality in inflammatory myopathy. A careful assessment of clinical and serologic manifestations especially myositis-associated autoantibodies allows precise classification of the different phenotypes of inflammatory myopathy and stratification of the risk of lung involvement. About three out of four patients with inflammatory myopathy develop interstitial lung disease (ILD), which represents the main cause of morbidity and mortality. In patients with a confirmed diagnosis of inflammatory myopathy, the approach...
Source: Seminars in Respiratory and Critical Care Medicine - May 28, 2019 Category: Respiratory Medicine Authors: Barba, Thomas Mainbourg, Sabine Nasser, Mouhamad Lega, Jean-Christophe Cottin, Vincent Tags: Review Article Source Type: research

Pulmonary and Bronchiolar Involvement in Sjogren's Syndrome
Semin Respir Crit Care Med 2019; 40: 235-254 DOI: 10.1055/s-0039-1688448Sjogren's syndrome (SS) is a chronic autoimmune disease characterized by mononuclear cells (principally lymphocytes) infiltrating exocrine glands (e.g., salivary and lacrimal glands), leading to destruction of exocrine epithelial cells and dryness of mucosal surfaces. Cardinal symptoms are dry eyes (xerophthalmia) and dry mouth (xerostomia). Extraglandular sites are affected in 30 to 40% of cases of SS (particularly neurological, kidneys, skin, and lungs). B cell hyperactivity, autoantibody production, and hypergammaglobulinemia are cardinal features o...
Source: Seminars in Respiratory and Critical Care Medicine - May 28, 2019 Category: Respiratory Medicine Authors: Chung, Augustine Wilgus, May Lin Fishbein, Gregory Lynch, Joseph P. Tags: Review Article Source Type: research

Pulmonary Complications of Systemic Lupus Erythematosus
Semin Respir Crit Care Med 2019; 40: 227-234 DOI: 10.1055/s-0039-1685537Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease characterized by the production of pathogenic autoantibodies and immune complexes and is responsible for significant morbidity and mortality through a wide range of clinical manifestations which can affect almost any organ. Pulmonary involvement is prevalent and seen in 50 to 70% of SLE patients and may even be the presenting feature in 4 to 5% of patients. By 10 years postdiagnosis, 12% will have accumulated an element of permanent lung damage. Pulmonary complications are broad and ...
Source: Seminars in Respiratory and Critical Care Medicine - May 28, 2019 Category: Respiratory Medicine Authors: Hannah, Jennifer R. D'Cruz, David P. Tags: Review Article Source Type: research

Systemic Sclerosis Associated Interstitial Lung Disease: A Comprehensive Overview
Semin Respir Crit Care Med 2019; 40: 208-226 DOI: 10.1055/s-0039-1683431Interstitial lung disease (ILD) is a common complication of systemic sclerosis (SSc). SSc-ILD adversely impacts quality of life and is currently the leading cause of death in this multisystem disease. Identifying clinically significant SSc-ILD is critically important. Accurate staging and prognostication remain difficult; however, significant advances have been made in the last decade. Evidence supports the need to treat patients with extensive and/or progressive SSc-ILD, while only a subset of patients with limited ILD may require treatment. Research ...
Source: Seminars in Respiratory and Critical Care Medicine - May 28, 2019 Category: Respiratory Medicine Authors: Mackintosh, John A. Stainer, Anna Barnett, Joseph L. Renzoni, Elisabetta A. Tags: Review Article Source Type: research

Pulmonary Complications of Rheumatoid Arthritis
Semin Respir Crit Care Med 2019; 40: 194-207 DOI: 10.1055/s-0039-1683995Rheumatoid arthritis (RA) is a common chronic autoimmune disorder that characteristically causes joint inflammation and damage. In addition, many patients develop extraarticular manifestations which may cause significant comorbidity and premature mortality.Some respiratory tract involvement of the upper and lower airways and parenchymal disease features are unique to RA, including cricoarytenoid arthritis and RA pulmonary nodulosis, and others, especially the interstitial parenchymal involvement, occur in many other idiopathic and autoimmune diseases. ...
Source: Seminars in Respiratory and Critical Care Medicine - May 28, 2019 Category: Respiratory Medicine Authors: Farquhar, Hamish Vassallo, Robert Edwards, Adrienne L. Matteson, Eric L. Tags: Review Article Source Type: research

Multidisciplinary Evaluation in Patients with Lung Disease Associated with Connective Tissue Disease
Semin Respir Crit Care Med 2019; 40: 184-193 DOI: 10.1055/s-0039-1684020Multidisciplinary diagnosis is now viewed as the diagnostic reference standard in interstitial lung disease (ILD). This process consists of the integration of the evidence base with clinical reasoning in the formulation of a diagnosis and requires input from clinicians, radiologists, and, in selected cases, histopathologists. In ILD associated with connective tissue disease (CTD-ILD), multidisciplinary evaluation is especially helpful when CTD is suspected but cannot be diagnosed using strict criteria. In this context, the integration of systemic clini...
Source: Seminars in Respiratory and Critical Care Medicine - May 28, 2019 Category: Respiratory Medicine Authors: Wells, Athol Devaraj, Anand Renzoni, Elizabetta A. Denton, Christopher P. Tags: Review Article Source Type: research

Pulmonary Hypertension Associated with Connective Tissue Disease
Semin Respir Crit Care Med 2019; 40: 173-183 DOI: 10.1055/s-0039-1685214Pulmonary hypertension (PH) is common in most forms of connective tissue disease (CTD); the prevalent type of PH depends on the particular CTD. Thus, pulmonary arterial hypertension (PAH) is dominantly associated with scleroderma, while postcapillary PH is most common in rheumatoid arthritis and lung disease-associated PH is typically found in myositis and sarcoidosis.Considerable expertise is required to identify, diagnose, and manage CTD-PH, as the primary physicians providing the majority of care for this population, rheumatologists, need a good wor...
Source: Seminars in Respiratory and Critical Care Medicine - May 28, 2019 Category: Respiratory Medicine Authors: Fayed, Hossam Coghlan, J. Gerry Tags: Review Article Source Type: research

Computed Tomographic Imaging in Connective Tissue Diseases
We present a review of the high-resolution computed tomographic pulmonary features of CTD in the lung and their significance to the reporting radiologist. [...] 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 28, 2019 Category: Respiratory Medicine Authors: Barnett, Joseph Devaraj, Anand Tags: Review Article Source Type: research

Histology of Pulmonary and Bronchiolar Disorders in Connective Tissue Diseases
Semin Respir Crit Care Med 2019; 40: 147-158 DOI: 10.1055/s-0039-1684029Connective tissue diseases (CTDs) are a heterogeneous group of disorders, acquired or hereditary, involving an autoimmune-mediated inflammation of connective tissues in the whole body. Lung involvement is common with CTDs, and associated with significant morbidity and mortality. Each compartment of the lung may be affected, often simultaneously, depending on the type of CTD. In addition, the lung may show pathological changes related to treatment, such as infection, drug reaction, and neoplasia. A multidisciplinary approach to diagnose these patients i...
Source: Seminars in Respiratory and Critical Care Medicine - May 28, 2019 Category: Respiratory Medicine Authors: Brambilla, Cecilia Rice, Alexandra Nicholson, Andrew G. Tags: Review Article Source Type: research

Pulmonary Complications of Connective Tissue Disease
Semin Respir Crit Care Med 2019; 40: 145-146 DOI: 10.1055/s-0039-1688716 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 28, 2019 Category: Respiratory Medicine Authors: Wells, Athol Denton, Christopher P. Tags: Preface Source Type: research

Acute Respiratory Distress Syndrome: Cost (Early and Long-Term)
Semin Respir Crit Care Med 2019; 40: 137-144 DOI: 10.1055/s-0039-1685463Costs of care in the intensive care unit are a frequent area of concern in our current health care system. Utilization of critical care services in the United States, particularly near the end of life, has been steadily increasing and will continue to do so. Acute respiratory distress syndrome (ARDS) is a common and important complication of critical illness. Patients with ARDS frequently experience prolonged hospitalizations and consume significant health care resources. Many patients are discharged with functional limitations and require significant ...
Source: Seminars in Respiratory and Critical Care Medicine - May 6, 2019 Category: Respiratory Medicine Authors: Bice, Thomas Carson, Shannon S. Tags: Review Article Source Type: research

Clinical Strategies to Prevent Acute Respiratory Distress Syndrome
Semin Respir Crit Care Med 2019; 40: 129-136 DOI: 10.1055/s-0039-1683997Acute respiratory distress syndrome (ARDS) remains an important clinical entity in the intensive care unit with a significant impact on morbidity and mortality. Effective therapeutic interventions are limited; thus current research focus has shifted from treatment to the prevention of this pulmonary syndrome. In recent decades, a decrease in the incidence of ARDS has been observed and this reduction is largely due to preventive strategies including safe lung ventilation practices, avoidance of iatrogenic exposures, and improvement in care of predisposi...
Source: Seminars in Respiratory and Critical Care Medicine - May 6, 2019 Category: Respiratory Medicine Authors: Odeyemi, Yewande E. Herasevich, Svetlana Gong, Michelle N. Gajic, Ognjen O. Tags: Review Article Source Type: research

Extracorporeal Strategies in Acute Respiratory Distress Syndrome
Semin Respir Crit Care Med 2019; 40: 114-128 DOI: 10.1055/s-0039-1685191Despite the breadth of life-sustaining interventions available, mortality in patients with acute respiratory distress syndrome (ARDS) remains high. A greater appreciation of the potential iatrogenic injury associated with the use of mechanical ventilation has led clinicians and researchers to seek alternatives. Extracorporeal life support (ECLS) may be used to rescue patients with severely impaired gas exchange and provide time for injured lungs to recover while treating the underlying disease. In patients with ARDS, venovenous (VV) ECLS is commonly us...
Source: Seminars in Respiratory and Critical Care Medicine - May 6, 2019 Category: Respiratory Medicine Authors: Cavayas, Yiorgos Alexandros Thakore, Aneesh Fan, Eddy Tags: Review Article Source Type: research

Role of Pharmacologic Paralysis in Acute Respiratory Distress Syndrome
Semin Respir Crit Care Med 2019; 40: 101-113 DOI: 10.1055/s-0039-1683883The pharmacology and history of neuromuscular blockade in clinical care are complex, with multiple theoretical and observed potential benefits and potential harms. Past studies raised concern for long-term paresis, but more recent studies have not found evidence for harm, possibly due to changes in background care, neuromuscular blocking agent, and duration of blockade. Current use is highly variable, likely due to limited evidence for efficacy beyond short-term physiologic improvement and lingering concerns for harm. A recently completed large multice...
Source: Seminars in Respiratory and Critical Care Medicine - May 6, 2019 Category: Respiratory Medicine Authors: Syed, Ammar Kobzik, Alexander Huang, David T. Tags: Review Article Source Type: research

Prone Positioning in Acute Respiratory Distress Syndrome
Semin Respir Crit Care Med 2019; 40: 094-100 DOI: 10.1055/s-0039-1685180Prone positioning is nowadays considered as one of the most effective strategies for patients with severe acute respiratory distress syndrome (ARDS). The evolution of the pathophysiological understanding surrounding the prone position closely follows the history of ARDS. At the beginning, the focus of the prone position was the improvement in oxygenation attributed to a perfusion redistribution. However, the mechanisms behind the prone position are more complex. Indeed, the positive effects on oxygenation and CO2 clearance of the prone position are to ...
Source: Seminars in Respiratory and Critical Care Medicine - May 6, 2019 Category: Respiratory Medicine Authors: Gattinoni, Luciano Busana, Mattia Giosa, Lorenzo Macr ì, Matteo Maria Quintel, Michael Tags: Review Article Source Type: research

Optimal Ventilator Strategies in Acute Respiratory Distress Syndrome
Semin Respir Crit Care Med 2019; 40: 081-093 DOI: 10.1055/s-0039-1683896Mechanical ventilation practices in patients with acute respiratory distress syndrome (ARDS) have progressed with a growing understanding of the disease pathophysiology. Paramount to the care of affected patients is the delivery of lung-protective mechanical ventilation which prioritizes tidal volume and plateau pressure limitation. Lung protection can probably be further enhanced by scaling target tidal volumes to the specific respiratory mechanics of individual patients. The best procedure for selecting optimal positive end-expiratory pressure (PEEP)...
Source: Seminars in Respiratory and Critical Care Medicine - May 6, 2019 Category: Respiratory Medicine Authors: Sklar, Michael C. Patel, Bhakti K. Beitler, Jeremy R. Piraino, Thomas Goligher, Ewan C. Tags: Review Article Source Type: research

Acute Respiratory Distress Syndrome: Respiratory Monitoring and Pulmonary Physiology
Semin Respir Crit Care Med 2019; 40: 066-080 DOI: 10.1055/s-0039-1685159The high prevalence of acute respiratory distress syndrome (ARDS), its morbidity and mortality continue to fare a huge burden in the intensive care unit. More than 40 years ago, experimental studies have highlighted that, albeit essential, mechanical ventilation could be harmful to lungs and more recently to the diaphragm. Despite life-saving advances in mechanical ventilation (such as low tidal-volume ventilation, neuromuscular blockers agents, or prone positioning), a recent international observational study reported that most ARDS patients were not ...
Source: Seminars in Respiratory and Critical Care Medicine - May 6, 2019 Category: Respiratory Medicine Authors: Coudroy, Remi Chen, Lu Pham, T ài Piraino, Thomas Telias, Irene Brochard, Laurent Tags: Review Article Source Type: research

Fluid Management in Acute Respiratory Distress Syndrome
Semin Respir Crit Care Med 2019; 40: 057-065 DOI: 10.1055/s-0039-1685206One of the defining features of acute respiratory distress syndrome (ARDS) is noncardiogenic pulmonary edema, resulting from increased permeability of the alveolar–capillary barrier and passage of protein-rich fluid into the interstitium and alveolar spaces. The loss of protein from the intravascular space disrupts the normal oncotic pressure differential and causes patients with ARDS to be particularly sensitive to the hydrostatic forces that correlate with intravascular volume. Conservative fluid management, in which diuretics are administered ...
Source: Seminars in Respiratory and Critical Care Medicine - May 6, 2019 Category: Respiratory Medicine Authors: Casey, Jonathan D. Semler, Matthew W. Rice, Todd W. Tags: Review Article Source Type: research

Pathophysiology and Management of Acute Respiratory Distress Syndrome in Obese Patients
Semin Respir Crit Care Med 2019; 40: 040-056 DOI: 10.1055/s-0039-1685179A rising prevalence of obesity is reported over time and throughout the world. At the same time, the acute respiratory distress syndrome (ARDS) remains an important public health problem, accounting for approximately 10% of intensive care unit admissions and leading to significant hospital mortality. Even in the absence of acute illnesses, obesity affects respiratory mechanics and gas exchange in the setting of a restrictive disease. In the presence of ARDS, obesity adds various challenges to a safe and effective management of respiratory support. Diff...
Source: Seminars in Respiratory and Critical Care Medicine - May 6, 2019 Category: Respiratory Medicine Authors: Umbrello, Michele Fumagalli, Jacopo Pesenti, Antonio Chiumello, Davide Tags: Review Article Source Type: research

Pathogenesis of Acute Respiratory Distress Syndrome
Semin Respir Crit Care Med 2019; 40: 031-039 DOI: 10.1055/s-0039-1683996Acute respiratory distress syndrome (ARDS) is a syndrome of acute respiratory failure caused by noncardiogenic pulmonary edema. Despite five decades of basic and clinical research, there is still no effective pharmacotherapy for this condition and the treatment remains primarily supportive. It is critical to study the molecular and physiologic mechanisms that cause ARDS to improve our understanding of this syndrome and reduce mortality. The goal of this review is to describe our current understanding of the pathogenesis and pathophysiology of ARDS. Fir...
Source: Seminars in Respiratory and Critical Care Medicine - May 6, 2019 Category: Respiratory Medicine Authors: Huppert, Laura A. Matthay, Michael A. Ware, Lorraine B. Tags: Review Article Source Type: research

Acute Respiratory Distress Syndrome Phenotypes
Semin Respir Crit Care Med 2019; 40: 019-030 DOI: 10.1055/s-0039-1684049The acute respiratory distress syndrome (ARDS) phenotype was first described over 50 years ago and since that time significant progress has been made in understanding the biologic processes underlying the syndrome. Despite this improved understanding, no pharmacologic therapies aimed at the underlying biology have been proven effective in ARDS. Increasingly, ARDS has been recognized as a heterogeneous syndrome characterized by subphenotypes with distinct clinical, radiographic, and biologic differences, distinct outcomes, and potentially distinct respo...
Source: Seminars in Respiratory and Critical Care Medicine - May 6, 2019 Category: Respiratory Medicine Authors: Reilly, John P. Calfee, Carolyn S. Christie, Jason D. Tags: Review Article Source Type: research