Clinics in Chest Medicine (CLIN CHEST MED)

Journal description

Each issue of Clinics in Chest Medicine reviews new diagnostic and management techniques for a single clinical problem--and makes them simple to apply. Its concise, comprehensive, and its editors and authors are respected experts.

Current impact factor: 2.17

Impact Factor Rankings

2015 Impact Factor Available summer 2015
2013 / 2014 Impact Factor 2.168
2012 Impact Factor 2.066
2011 Impact Factor 3.284
2010 Impact Factor 3.11
2009 Impact Factor 2.505
2008 Impact Factor 2.357
2007 Impact Factor 1.858
2006 Impact Factor 1.991
2005 Impact Factor 1.456
2004 Impact Factor 1.65
2003 Impact Factor 1.308
2002 Impact Factor 2.026
2001 Impact Factor 1.891
2000 Impact Factor 1.627
1999 Impact Factor 2.042
1998 Impact Factor 1.316
1997 Impact Factor 1.307
1996 Impact Factor 1.133
1995 Impact Factor 1.105
1994 Impact Factor 1.027
1993 Impact Factor 0.972
1992 Impact Factor 1.785

Impact factor over time

Impact factor

Additional details

5-year impact 2.75
Cited half-life 7.80
Immediacy index 0.28
Eigenfactor 0.00
Article influence 0.93
Website Clinics in Chest Medicine website
Other titles Clinics in chest medicine
ISSN 0272-5231
OCLC 5433901
Material type Periodical, Internet resource
Document type Journal / Magazine / Newspaper, Internet Resource

Publisher details

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Rapidly growing mycobacteria (RGM) include a diverse group of species. We address the treatment of the most commonly isolated RGM-M abscessus complex, M fortuitum, and M chelonae. The M abscessus complex is composed of 3 closely related species: M abscessus senso stricto (hereafter M abscessus), M massiliense, and M bolletii. Most studies address treatment of M abscessus complex, which accounts for 80% of lung disease caused by RGM and is the second most common RGM to cause extrapulmonary disease (after M fortuitum). The M abscessus complex represent the most drug-resistant nontuberculous mycobacteria and are the most difficult to treat. Copyright © 2015 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 03/2015; 36(1):67-78. DOI:10.1016/j.ccm.2014.10.004
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    ABSTRACT: The incidence of pulmonary nontuberculous mycobacterial disease is increasing. Despite aggressive medical therapy, a subset of patients will experience treatment failure or suffer disabling or life-threatening symptoms. The use of anatomic lung resection in addition to optimal medical management may, in select cases, result in improved clinical outcomes. More data are needed to confirm this approach. For those with nontuberculous mycobacterial infection, treatment in a multidisciplinary setting including surgeons familiar with operative techniques specific to infectious lung disease will improve patient care. Copyright © 2015 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 03/2015; 36(1):117-122. DOI:10.1016/j.ccm.2014.11.004
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    ABSTRACT: Nontuberculous mycobacteria (NTM) are important emerging cystic fibrosis (CF) pathogens. Factors including the steady aging of the CF population, the apparent increase of NTM in the environment, and the potential for patient-to-patient transmission, may contribute to increased acquisition. Diagnosis of NTM disease is challenging due to disease overlap; thus, comprehensive care of the CF patient must be optimized to assess the clinical impact of the NTM (indolent versus active), and to improve response to treatment. The development of a CF-specific approach to the diagnosis and treatment of NTM infection is a research priority for the CF community. Copyright © 2015 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 03/2015; 36(1):101-115. DOI:10.1016/j.ccm.2014.11.003
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    ABSTRACT: Immunosuppression predisposes the host to development of pulmonary infections, which can lead to respiratory failure and the development of acute respiratory distress syndrome (ARDS). There are multiple mechanisms by which a host can be immunosuppressed and each is associated with specific infectious pathogens. Early invasive diagnostic modalities such as fiber-optic bronchoscopy with bronchoalveolar lavage, transbronchial biopsy, and open lung biopsy are complementary to serologic and noninvasive studies and assist in rapidly establishing an accurate diagnosis, which allows initiation of appropriate therapy and may improve outcomes with relative safety. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 12/2014; DOI:10.1016/j.ccm.2014.08.008
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    ABSTRACT: Our ability to define appropriate molecular targets for preclinical development and develop better methods needs to be improved, to determine the clinical value of novel acute respiratory distress syndrome (ARDS) agents. Clinical trials must have realistic sample sizes and meaningful end points and use the available observation and meta-analytical data to inform design. Biomarker-driven studies or defined ARDS subsets should be considered to categorize specific at-risk populations most likely to benefit from a new treatment. Innovations in clinical trial design should be pursued to improve the outlook for future interventional trials in ARDS. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 12/2014; DOI:10.1016/j.ccm.2014.08.009
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    ABSTRACT: This article discusses obesity, its contribution to clinical outcomes, and the current literature on nutrition. More than one third of Americans are obese. Literature suggests that, among critically ill patients, the relationship between obesity and outcomes is complex. Obese patients may be at greater risk of developing acute respiratory distress syndrome (ARDS) than normal weight patients. Although obesity may confer greater morbidity in intensive care, it seems to decrease mortality. ARDS is a catabolic state; patients demonstrate a profound inflammatory response, multiple organ dysfunction, and hypermetabolism, often with malnutrition. The concept of pharmaconutrition has emerged. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 12/2014; DOI:10.1016/j.ccm.2014.08.005
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    ABSTRACT: The development and severity of acute respiratory distress syndrome (ARDS) are closely related to dysregulated inflammation, and the duration of ARDS and eventual outcomes are related to persistent inflammation and abnormal fibroproliferation. Corticosteroids are potent modulators of inflammation and inhibitors of fibrosis that have been used since the first description of ARDS in attempts to improve outcomes. There is no evidence that corticosteroids prevent the development of ARDS among patients at risk. High-dose and short-course treatment with steroids does not improve the outcomes of patients with ARDS. Additional studies are needed to recommend treatment with steroids for ARDS. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 12/2014; DOI:10.1016/j.ccm.2014.08.014
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    ABSTRACT: Acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in critically ill patients. Over the past several decades, alcohol abuse and cigarette smoke exposure have been identified as risk factors for the development of ARDS. The mechanisms underlying these relationships are complex and remain under investigation but are thought to involve pulmonary immune impairment and alveolar epithelial and endothelial dysfunction. This review summarizes the epidemiologic data supporting links between these exposures and ARDS susceptibility and outcomes and highlights key mechanistic investigations that provide insight into the pathways by which each exposure is linked to ARDS. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 12/2014; DOI:10.1016/j.ccm.2014.08.003
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    ABSTRACT: This article reviews the evolving definitions and epidemiology of the acute respiratory distress syndrome (ARDS) and highlights current efforts to improve identification of high-risk patients, thus to target prevention and early treatment before progression to ARDS. This information will be important for general practitioners and intensivists interested in improving the care of patients at risk for ARDS, and clinical researchers interested in designing clinical trials targeting the prevention and early treatment of acute lung injury. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 12/2014; DOI:10.1016/j.ccm.2014.08.002
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    ABSTRACT: Survivors of acute respiratory distress syndrome often sustain muscle wasting and functional impairment related to intensive care unit (ICU)-acquired weakness (ICUAW) and this disability may persist for years after ICU discharge. Early diagnosis in cooperative patients by physical examination is recommended to identify patients at risk for weaning failure and to minimize prolongation of risk factors for ICUAW. When possible, early rehabilitation in critically ill patients improves functional outcomes, likely by reducing disuse atrophy. Interventions designed to correct the functional impairment are lacking and further research to delineate the molecular pathways that give rise to ICUAW are needed. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 12/2014; DOI:10.1016/j.ccm.2014.08.016
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    ABSTRACT: Regenerative medicine has entered a rapid phase of discovery, and much has been learned in recent years about the lung's response to injury. This article first summarizes the cellular and molecular mechanisms that damage the alveolar-capillary barrier, producing acute respiratory distress syndrome (ARDS). The latest understanding of endogenous repair processes is discussed, highlighting the diversity of lung epithelial progenitor cell populations and their regulation in health and disease. Finally, the past, present, and future of exogenous cell-based therapies for ARDS is reviewed. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 12/2014; DOI:10.1016/j.ccm.2014.08.015
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    ABSTRACT: Given the high incidence and mortality of acute respiratory distress syndrome (ARDS) in critically ill patients, every practitioner needs a bedside approach both for early identification of patients at risk for ARDS and for the appropriate evaluation of patients who meet the diagnostic criteria of ARDS. Recent advances such as the Lung Injury Prediction score, the Early Acute Lung Injury score, and validation of the SpO2/Fio2 ratio for assessing the degree of hypoxemia are all practical tools to aid the practitioner in caring for patients at risk of ARDS. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 12/2014; DOI:10.1016/j.ccm.2014.08.007
  • Clinics in Chest Medicine 11/2014; DOI:10.1016/j.ccm.2014.09.001
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    ABSTRACT: Interest in the role of neuromuscular blocking agents (NMBAs) in the treatment of acute respiratory distress syndrome (ARDS) has been renewed since a recent randomized clinical trial showed a reduction in mortality associated with the use of NMBAs. However, the role of paralytics in a protective mechanical ventilation strategy should be detailed. This review summarizes data in the literature concerning the clinical effects of NMBAs on the outcome of patients with ARDS, in an attempt to explain some pathophysiologic hypotheses concerning their action and to integrate them into the overall management strategy for the mechanical ventilation of ARDS patients. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 11/2014; DOI:10.1016/j.ccm.2014.08.012
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    ABSTRACT: The early history of extracorporeal membrane oxygenation (ECMO) for adult patients with the acute respiratory distress syndrome (ARDS) evolved slowly over decades, a consequence of extracorporeal technology with high risk and unclear benefit. However, advances in component technology, accumulating evidence, and growing experience in recent years have resulted in a resurgence of interest in ECMO. Extracorporeal support, though currently lacking high-level evidence, has the potential to improve outcomes, including survival, in ARDS. In the near future, novel extracorporeal management strategies may, in fact, lead to a new paradigm in the approach to certain patients with ARDS. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 11/2014; DOI:10.1016/j.ccm.2014.08.013
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    ABSTRACT: The most common nontuberculous mycobacterial (NTM) lung pathogen, Mycobacterium avium complex (MAC), requires antibiotic treatment regimens that are long and often arduous. M kansasii is the slowly growing NTM pathogen with the most predictably successful treatment outcomes, whereas other slowly growing NTM pathogens such as M xeonpi, M szulgai, and M malmoense are less predictably responsive to antibiotic regimens. M simiae is the most difficult of the common slowly growing NTM pathogens to eradicate. Surgical intervention for slowly growing mycobacterial lung infection has proved beneficial for some patients, but the optimal candidates and timing for surgical intervention remain unknown. Copyright © 2015 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 11/2014; 36(1). DOI:10.1016/j.ccm.2014.10.005
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    ABSTRACT: Nontuberculous mycobacteria (NTM) infections are broadly classified as skin and soft tissue infections, isolated lung disease, and visceral or disseminated disease. The degree of underlying immune abnormalities varies between each classification. Skin and soft tissue infections are usually the result of iatrogenic or accidental inoculation of NTM in otherwise normal hosts. Visceral and disseminated NTM disease invariably occurs in individuals with more severe immunosuppression. Although the focus of this article is to discuss the pathogenesis of NTM lung disease, the risk factors of visceral/disseminated NTM disease are also summarized, as they provide insights into host-defense mechanisms against these organisms. Published by Elsevier Inc.
    Clinics in Chest Medicine 11/2014; 36(1). DOI:10.1016/j.ccm.2014.10.001