Chest (CHEST)

Publications in this journal

• Article: The Stage Classification of Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Detterbeck FC, Postmus PE, Tanoue LT. Chest. 2013 May;143(5 Suppl):e191S-210S. doi: 10.1378/chest.12-2354.

  Detterbeck fc, postmus pe, tanoue lt
  Chest 05/2013; 143(5 suppl):191s-210s.
• Article: Heterogeneous pulmonary phenotypes associated with mutations in the thyroid transcription factor gene NKX2-1.

  Hamvas A, Deterding RR, Wert SE, White FV, Dishop MK, Alfano DN, Halbower AC, Planer B, Stephan MJ, Uchida DA, Williames LD, Rosenfeld JA, Lebel RR, Young LR, Cole FS, Nogee LM
  Chest 02/2013;
• Article: Link between short sleep and obesity in humans: a matter of age?

  Benedict C
  Chest 01/2013;
• Article: Cardiac Workload in Patients With Sleep-Disordered Breathing Early After Acute Myocardial InfarctionSleep Apnea and Cardiac Workload

  Andrea Hetzenecker, Stefan Buchner, Tanja Greimel, Anna Satzl, Andreas Luchner, Kurt Debl, Oliver Husser, Okka W Hamer, Claudia Fellner, Günter A J Riegger, Michael Pfeifer, Michael Arzt
  Chest 01/2013; 143(5):1294-1301.
• Article: Risk Factor Stratification for COPD Exacerbation in an Outpatient Population Resulting in Acute Healthcare Resource Utilization

  MD Furqan Shoaib Siddiqi, MD Rachael Hauser, MD Peg Bicker, MD Jennifer Jackson
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  ABSTRACT: PURPOSE: COPD is the fourth leading cause of death in the United States. The average cost of COPD exacerbation ranges from $7242 to $44,904 depending on severity. Primary care physicians can play critical roles in controlling the risk factors for COPD exacerbation in the outpatient population and reduce the economic burden on healthcare. METHODS: A total of 89 patients (47% of eligible patients) between the ages 18 and 75 with an established diagnosis of COPD were selected from the clinic registry. Patient interviews and chart reviews were done to determine age, gender, GOLD staging, current management, smoking status, and pulmonary rehabilitation in last 2 years. The primary outcome was healthcare resource utilization for COPD exacerbation in the past 6 months, including hospitalizations, ER visits, acute office visits, and calls to the physician office for antibiotics. Regression analysis was calculated to determine the association of risk factors with the primary outcomes. The study was powered at 80%. RESULTS: A total of 62% of patients were males and 41% had GOLD stage 2 COPD. Multivariate analysis showed that patients who were not on appropriate treatment were more likely to have utilized healthcare resources in the past 6 months (P<0.005). GOLD Stage, smoking status, age, and gender did not show a statistically significant association with utilization of healthcare resources. Only 8% of patients were referred for pulmonary rehabilitation. CONCLUSIONS: Being on appropriate treatment is the single most important factor that determines the risk of acute exacerbations of COPD. Despite its well documented benefits in COPD patients, pulmonary rehabilitation was extremely underutilized by primary care physicians. CLINICAL IMPLICATIONS: Primary care physicians can play a significant role in reducing the healthcare financial burden by using appropriate treatment for COPD as outlined by the ACP/ACCP/ATS/ERS guidelines. Pulmonary rehabilitation, if utilized, has proven effects in improving symptoms.
  Chest 10/2012; 142:4.
• Article: Decreased Renal Function and the Prevalence of Obstructive Sleep Apnea: More Data Are Needed

  Aibek E. Mirrakhimov
  Chest 10/2012;
• Article: Malnutrition in Critically Ill Children and Its Impact on Their Clinical Course

  Hilda Diaz-Escalera, Anabel Puig-Ramos, Alicia Fernandez-Sein, Gilberto Puig-Ramos, Ricardo Garcia De-Jesus
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  ABSTRACT: PURPOSE: Malnutrition has shown to be associated with increased morbidity and mortality in both children and adults, including a higher risk of infections due to poor immune defense, wound healing problems, longer dependency on mechanical ventilation and longer hospital stay. In this study we evaluated the prevalence of acute and chronic malnutrition and their impact on clinical outcomes in patients admitted to the Pediatric Intensive Care Unit (PICU) of the University Pediatric Hospital. METHODS: We retrospectively analyzed the records of 101 consecutive admissions to PICU from 01/01/10 to 07/31/10. Patients less than 48 hours of admission were excluded. Acute malnutrition was defined as weight-for-height (WFH) < 2 SD or less than 5th percentile and chronic malnutrition was defined as height-for-age (HFA) < 2 SD or less than 5th percentile. RESULTS: Chronic malnutrition was observed in 22% of patients admitted to PICU, whereas only 6% of the admissions had acute malnutrition. Respiratory pathology was the most common admission diagnosis among malnourished patients. Neither acute nor chronic malnutrition affect length of hospital stay, mortality rate or use of inotropics. Patients with chronic malnutrition showed a trend toward spending more days on mechanical ventilation support. CONCLUSIONS: This study showed a significant incidence of chronic malnutrition in patients admitted to PICU for respiratory problems. We will expand the study period to one year to increase the number of patients evaluated to identify co-morbidities and correlate their impact in chronic malnutrition and prolonged intensive care therapy. We will also include in the analysis patients admitted to the PICU at the San Jorge Children's Hospital for the same study period to determine the malnutrition status of these patients and what is their impact on patient's clinical course. CLINICAL IMPLICATIONS: Knowing the nutritional status of critically ill children may help physicians to predict if patients are going to spend more time on mechanical ventilation as well if they will have a greater morbidity and mortality.
  Chest 10/2012; 142((4_MeetingAbstracts)):760A.
• Article: Tracheotomy Placement in Pediatrics: Indications, Timing, and Complications

  Ricardo García-De Jesús, Anabel Puig-Ramos, Carlos J. Ocasio López, Ingrid Mercedes
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  ABSTRACT: PURPOSE: There are no recognized standardized timing intervals for tracheotomy placement in children. We evaluated the indications and clinical outcomes of children undergoing a tracheotomy placement admitted to the Pediatric Intensive Care Unit at the University Pediatric Hospital from 2006 to 2010. METHODS: We conducted a retrospective medical records review of patients admitted to our Pediatric Critical Care Unit (PICU) at the University Pediatric Hospital from 2006 to 2010. We evaluated primary diagnosis, age, indication for tracheotomy placement, timing of the procedure, length of stay (LOS) and mortality related to the procedure. RESULTS: During the study period there were a total of 63 tracheotomies performed. The most common indication identified was chronic respiratory failure, with primary diagnosis related to pulmonary diseases and neurological problems. Patients that required a tracheotomy placement were one year old or younger (44%) and had prolonged stay at the PICU. There was no mortality associated to the tracheotomy placement. CONCLUSIONS: Early Identification of the risk factors for tracheotomy placement on patients with increased LOS (>15 days) and chronic respiratory problems or severe neurological compromise, may provide information about what is the better timing for tracheotomy placement in children admitted to the PICU. CLINICAL IMPLICATIONS: Although there are advances in pediatric critical care that have led to increased survival rates in neonatal and pediatric patients, there is no recognized standardized timing intervals for tracheostomy placement in children. Knowing the risk factors of patients admitted to the PICU that required a tracheotomy placement will give us guidelines about the age and diagnosis to determine the perfect timing for the procedure to improve patients clinical course and reduce PICU lenght of stay.
  Chest 10/2012; 142((4_MeetingAbstracts)):771A.
• Article: Distribution and prognostic validity of the new GOLD grading classification

  Soriano JB, Alfageme I, Almagro P, Casanova C, Esteban C, Soler-Cataluña JJ, de Torres JP, Martinez-Camblor P, Miravitlles M, Celli BR
  Chest 09/2012;
• Article: Probiotics in United Airways Disease

  Rashmi Ranjan Das
  Chest 01/2011; 140(4):1090-100.
• Article: 2009 influenza A(H1N1) infection and associated myocardial dysfunction.

  Rashmi Ranjan Das
  Chest 01/2011; 139(6):1545-6.
• Article: Case Series and Literature Review of Multiple Nodular Sarcoidosis

  Sameer Ur Rehman, Nadia Sharif, Javed Ahmed Khan, Ali Bin Sarwar Zubairi
  Chest 01/2011;
• Article: Video-Assisted Thoracic Surgery for Primary Spontaneous Hemopneumothorax: 20-year Follow-up

  Calvin SH Ng, randolph HL Wong, Eugene CL Yeung, Micky WT Kwok, Innes YP Wan, Song Wan, Anthony PC Yim, Malcolm J Underwood
  Chest 01/2011; 140:837A.
• Article: Childhood respiratory illness, lung function at age 14 and change in lung function between ages 14 and 50 years

  P W G Tennant, G J Gibson, M S Pearce
  Chest 01/2010;
• Article: PROGNOSTIC FACTORS IN CRITICALLY ILL PATIENTS WITH SEPTIC SHOCK ADMITTED TO AN ONCOLOGICAL INTENSIVE CARE UNIT

  Silvio A. Namendys-Silva, Julia Texcocano-Becerra, Angel Herrera-Gómez
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  ABSTRACT: PURPOSE: Sepsis is a common complication in cancer patients. The aim in the present study was identify factors associated with mortality in critically ill cancer patients with septic shock (SS). METHODS: Retrospective observational study. Interventions: None. Setting: Six-medical-surgical oncological Intensive Care Unit (ICU). Of 264 patients with cancer admitted to the ICU from January to October of 2007, 51 patients had SS. Values are expressed as mean and standard deviation for continuous variables or percentage for categorical variables. Univariate and multivariate logistic regression were used to identify factors associated with ICU mortality. The patients received treatment following the internationally accepted guidelines; The Surviving Sepsis Campaign. RESULTS: Twenty-eight were women (54.9%), with median age of 44 years, all patients, required mechanical ventilation, the median duration was 3.54 ± 4.25 days and the median length of stay in the ICU was 4.62 ± 5.51 days. The most common site of infection was the lung (26/51%). Thirty six patients (70.6%) had solid tumors and fifteen (29.4%) had hematological malignancies. The cancer status: 49% were newly diagnosed, 25.5% recurrent or progression, 23.5% no response to treatment and 2% complete remission of disease. The median SOFA score was 9.5 ± 3.5. The 88.2% of the patients had three or more organ dysfunctions (OD) on day of admission to ICU. By multivariable analysis, mortality was higher when the levels of positive end expiratory pressure (PEEP) were > 8 cmH2O (odds ratio: 9.73, 95% confidence interval: 1.42–66.62, p = 0.020)(Goodness of fit, Hosmer-Lemeshow, X2=5.59, p = 0.692). The mortality in the ICU was 60.7% and increased with the number of organs failing, especially when three or more organs failed (66.6%). CONCLUSION: Cancer patients admitted to the ICU with SS have a mortality rate similar to that reported for mixed populations, and it is particularly increased with levels of PEEP > 8 cmH2O.
  Chest 10/2009;
• Article: TO ASSESS SERUM URIC ACID AND LACTATE AS MARKER OF TISSUE HYPOXIC OXIDATIVE STRESS AMONG PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME

  Harmanjit S. Hira, Anuj Shukla, Anshu Singh
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  ABSTRACT: PURPOSE: Hypoxemia resulting among patients of obstructive sleep apnea syndrome (OSAS) increases purine catabolism and enhances anaerobic glycol sis, leading to elevated levels of uric acid and lactate. Studies assessing uric acid are available; however, serum levels of lactate had not been studied in patients of OSAS. METHODS: Twenty consecutive OSAS patients (OSAS group) who underwent night polysomnography (PSG) and 10 healthy controls (control group) in whom OSAS was ruled out participated in this study. Arterial blood samples were withdrawn for measuring serum uric acid (UA) and plasma lactate before and after PSG/sleep in respective groups. RESULTS: Mean value of serum UA before and after sleep among OSAS group were 7.54 ± 1.63 and 7.66 ± 2.1 mg/dl respectively and among control group were 5.38 ± 1.12 and 5.30 ± 1.43 respectively. Both values in OSAS group were higher than standard laboratory reference and significantly higher than control group (p 0.001 and 0.002). However, there was no significant overnight change in OSAS group (p 0.8).Mean value of plasma lactate before and after sleep among OSAS group were 1.74 ± 0.6 and 2.28 ± 0.98 mmol/L respectively and among control group were 1.46 ± 0.62 and 1.53 ± 0.89 mmol/L respectively. Both values in OSAS group were higher than standard laboratory reference. When compared with control group only difference between after sleep samples came to be significant (p 0.03). Also, overnight change in OSAS group for lactate was significant with p 0.02. Both serum UA and lactate levels had a positive correlation with degree of hypoxia measured by sleep time spent below 95% and 90% SaO2 with p < 0.05. CONCLUSION: UA and lactate both are positively correlated with degree of hypoxia in OSAS and are markers of hypoxic oxidative stress. Although UA elevated in OSAS, due to its slower metabolism, does not show overnight change in serum levels as seen with lactate. CLINICAL IMPLICATIONS: Measurement of serum lactate level among patients of OSAS is a better marker of overnight tissue hypoxic oxidative stress than UA.
  Chest 10/2009; 136(4):64S-b65S.
• Article: Some questions.

  Jack Coulehan
  Chest 12/2008; 134(5):1106.
• Source

  Available from: chestpubs.org

  Article: Grading improves transparency and quality.

  Kevin C Wilson
  Chest 12/2008; 134(5):1107; author reply 1108.