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Respiratory System Dynamics
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1770058While static mechanical forces govern resting lung volumes, dynamic forces determine tidal breathing, airflow, and changes in airflow and lung volume during normal and abnormal breathing. This section will examine the mechanisms, measurement methodology, and interpretation of the dynamic changes in airflow and lung volume that occur in health and disease. We will first examine how the total work of breathing can be described by the parameters of the equation of motion, which determine the pressure required to move air into and out of the lung. This will include a detail...
Source: Seminars in Respiratory and Critical Care Medicine - July 10, 2023 Category: Respiratory Medicine Authors: Kaminsky, David A. Cockcroft, Donald W. Davis, Beth E. Tags: Review Article Source Type: research

Expert Review on Nonsurgical Management of Parapneumonic Effusion: Advances, Controversies, and New Directions
Semin Respir Crit Care Med 2023; 44: 468-476 DOI: 10.1055/s-0043-1769095Parapneumonic effusion and empyema are rising in incidence worldwide, particularly in association with comorbidities in an aging population. Also driving this change is the widespread uptake of pneumococcal vaccines, leading to the emergence of nonvaccine-type pneumococci and other bacteria. Early treatment with systemic antibiotics is essential but should be guided by local microbial guidelines and antimicrobial resistance patterns due to significant geographical variation. Thoracic ultrasound has emerged as a leading imaging technique in parapneumoni...
Source: Seminars in Respiratory and Critical Care Medicine - July 10, 2023 Category: Respiratory Medicine Authors: Fitzgerald, Deirdre B. Polverino, Eva Waterer, Grant W. Tags: Review Article Source Type: research

COVID-19-Related Pleural Diseases
Semin Respir Crit Care Med 2023; 44: 437-446 DOI: 10.1055/s-0043-1769616Coronavirus disease 2019 (COVID-19)-related pleural diseases are now well recognized. Since the beginning of the pandemic, increasing cases of pleural diseases including pneumothorax, pneumomediastinum, and pleural effusion with severe COVID-19 infection have attracted the attention of physicians and are not incidental or due to barotrauma. The complicated course of COVID-19 illness highlights the complex pathophysiological underpinnings of pleural complications. The management of patients with pneumothorax and pneumomediastinum is challenging as the m...
Source: Seminars in Respiratory and Critical Care Medicine - July 10, 2023 Category: Respiratory Medicine Authors: Iqbal, Beenish Rahman, Najib M. Hallifax, Rob J. Tags: Review Article Source Type: research

Preface: Pleural Diseases Series
Semin Respir Crit Care Med 2023; 44: 415-416 DOI: 10.1055/s-0043-1769613 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 10, 2023 Category: Respiratory Medicine Authors: Lee, Y. C. Gary Fitzgerald, Deirdre B. Tags: Preface Source Type: research

Management of Pulmonary Arterial Hypertension
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1770118Pulmonary arterial hypertension (PAH) is a rare pulmonary vascular disease characterized by progressive pulmonary arterial remodeling, increased pulmonary vascular resistance, right ventricular dysfunction, and reduced survival. Effective therapies have been developed that target three pathobiologic pathways in PAH: nitric oxide, endothelin-1, and prostacyclin. Approved therapies for PAH include phosphodiesterase type-5 inhibitors, soluble guanylate cyclase stimulators, endothelin receptor antagonists, prostacyclin analogs, and prostacyclin receptor agonists. Management...
Source: Seminars in Respiratory and Critical Care Medicine - June 27, 2023 Category: Respiratory Medicine Authors: Weatherald, Jason Varughese, Rhea A. Liu, Jonathan Humbert, Marc Tags: Review Article Source Type: research

Pulmonary Physiology and Medicine of Diving
This article provides an overview of the physiologic challenges to the respiratory system during diving, with or without breathing apparatus, and outlines possible health risks and hazards unique to the underwater environment. The underlying pathologic mechanisms of dive-related injuries are reviewed, with an emphasis on pulmonary physiology and pathophysiology. [...] 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 - June 27, 2023 Category: Respiratory Medicine Authors: Tetzlaff, Kay Tags: Review Article Source Type: research

Management of Acutely Decompensated Pulmonary Hypertension
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1770119Pulmonary arterial hypertension is a severe life-threatening condition associated with increased pulmonary vascular resistance and resulting right heart dysfunction. Admission to intensive care unit with acutely decompensated right heart failure is a significant negative prognostic event with a high risk of multisystem organ dysfunction and death. Presentations are heterogenous and may combine signs of both diastolic and systolic dysfunction complicating management. Renal dysfunction is often present, but other organ systems can be involved resulting in findings such as...
Source: Seminars in Respiratory and Critical Care Medicine - June 27, 2023 Category: Respiratory Medicine Authors: Savale, Laurent Kularatne, Mithum Roche, Anne Pichon, J érémie Baron, Audrey Boucly, Athena ïs Sitbon, Olivier Humbert, Marc Tags: Review Article Source Type: research

Arterial Blood Gases and Acid-Base Regulation
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1770341Disorders of acid-base status are common in the critically ill and prompt recognition is central to clinical decision making. The bicarbonate/carbon dioxide buffer system plays a pivotal role in maintaining acid-base homeostasis, and measurements of pH, PCO2, and HCO3 - are routinely used in the estimation of metabolic and respiratory disturbance severity. Hypoventilation and hyperventilation cause primary respiratory acidosis and primary respiratory alkalosis, respectively. Metabolic acidosis and metabolic alkalosis have numerous origins, that include alterations ...
Source: Seminars in Respiratory and Critical Care Medicine - June 27, 2023 Category: Respiratory Medicine Authors: Sanghavi, Sarah F. Swenson, Erik R. Tags: Review Article Source Type: research

Expert Review on Spontaneous Pneumothorax: Advances, Controversies, and New Directions
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1769615For decades, there has been scanty evidence, most of which is of poor quality, to guide clinicians in the assessment and management of pneumothorax. A recent surge in pneumothorax research has begun to address controversies surrounding the topic and change the face of pneumothorax management. In this article, we review controversies concerning the etiology, pathogenesis, and classification of pneumothorax, and discuss recent advances in its management, including conservative and ambulatory management. We review the evidence base for the challenges of managing pneumothor...
Source: Seminars in Respiratory and Critical Care Medicine - June 15, 2023 Category: Respiratory Medicine Authors: Barton, Eleanor C. Maskell, Nick A. Walker, Steven P. Tags: Review Article Source Type: research

Malignant Pleural Effusions in the Era of Immunotherapy and Antiangiogenic Therapy
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1769092Malignant pleural effusions (MPE) have historically been associated with a poor prognosis, and patients often require a series of invasive procedures and hospitalizations that significantly reduce quality of life at the terminus of life. However, advances in the management of MPE have coincided with the era of immunotherapies, and to a lesser extent, antiangiogenic therapies for the treatment of lung cancer. Landmark studies have shown these drugs to improve overall survival and progression-free survival in patients with lung cancer, but a paucity of phase III trial dat...
Source: Seminars in Respiratory and Critical Care Medicine - June 12, 2023 Category: Respiratory Medicine Authors: Wong, Terrence Fuld, Alexander D. Feller-Kopman, David J. Tags: Review Article Source Type: research

Breathlessness with Pleural Effusion: What Do We Know?
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1769098Breathlessness is the most common symptom in individuals with pleural effusion and is often disabling. The pathophysiology of breathlessness associated with pleural effusion is complex. The severity of breathlessness correlates weakly with the size of the effusion. Improvements in ventilatory capacity following pleural drainage are small and correlate poorly with the volume of fluid drained and improvements in breathlessness. Impaired hemidiaphragm function and a compensatory increase in respiratory drive to maintain ventilation appear to be an important mechanism of br...
Source: Seminars in Respiratory and Critical Care Medicine - June 12, 2023 Category: Respiratory Medicine Authors: Muruganandan, Sanjeevan Mishra, Eleanor Singh, Bhajan Tags: Review Article Source Type: research

Intrapleural Anticancer Therapy for Malignant Pleural Diseases: Facts or Fiction?
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1769094Malignant pleural diseases involves both primary pleural malignancies (e.g., mesothelioma) as well as metastatic disease involving the pleura. The management of primary pleural malignancies remains a challenge, given their limited response to conventional treatments such as surgery, systemic chemotherapy, and immunotherapy. In this article, we aimed to review the management of primary pleural malignancy as well as malignant pleural effusion and assess the current state of intrapleural anticancer therapies. We review the role intrapleural chemotherapy, immunotherapy, and...
Source: Seminars in Respiratory and Critical Care Medicine - June 12, 2023 Category: Respiratory Medicine Authors: Agrawal, Abhinav Chaddha, Udit Shojaee, Samira Maldonado, Fabien Tags: Review Article Source Type: research

The Global Burden of Pleural Diseases
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1769614Pleural diseases include a spectrum of disorders broadly categorized into pneumothorax and pleural effusion. They often cause pain, breathlessness, cough, and reduced quality of life. The global burden of diseases reflects regional differences in conditions and exposures associated with pleural disease, such as smoking, pneumonia, tuberculosis, asbestos, cancer, and organ failure. Disease burden in high-income countries is overrepresented given the availability of data and disease burden in lower-income countries is likely underestimated. In the United States, in 2016, ...
Source: Seminars in Respiratory and Critical Care Medicine - June 1, 2023 Category: Respiratory Medicine Authors: Vakil, Erik Taghizadeh, Niloofar Tremblay, Alain Tags: Review Article Source Type: research

Expert Review on Contemporary Management of Common Benign Pleural Effusions
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1769096Heart failure (HF) and cirrhosis are frequently associated with pleural effusions (PEs). Despite their apparently benign nature, both HF-related effusions and hepatic hydrothorax (HH) have poor prognosis because they represent an advanced stage of the disease. Optimization of medical therapy in these two entities involve not only the use of diuretics, but also other pharmacological therapies. For instance, all HF patients with reduced or mildly reduced left ventricular ejection fraction can benefit from angiotensin receptor–neprilysin inhibitors, beta blockers, minera...
Source: Seminars in Respiratory and Critical Care Medicine - June 1, 2023 Category: Respiratory Medicine Authors: Porcel, Jos é M. Tags: Review Article Source Type: research

Indwelling Pleural Catheter: Management of Complications
Semin Respir Crit Care Med DOI: 10.1055/s-0043-1769093Multiple randomized clinical trials have established the advantages of indwelling pleural catheter (IPC) in the management of malignant pleural effusions, resulting in its widespread adoption in clinical practice. Complications can occur with IPC use and must be recognized and managed effectively. This review provides a comprehensive overview of IPC complications and their best care. Pain postinsertion or during drainage of IPC is easily manageable and must be distinguished from tumor-related chest wall pain. IPC-related infections require systemic antibiotics and often...
Source: Seminars in Respiratory and Critical Care Medicine - May 31, 2023 Category: Respiratory Medicine Authors: Sidhu, Calvin Davies, Helen E. Muruganandan, Sanjeevan Lui, Macy M. S. Lau, Estee P. M. Lee, Y. C. Gary Tags: Review Article Source Type: research