Heart & Lung最新文献_第6页

Personalized ventilation adjustment in ARDS: A systematic review and meta-analysis of image, driving pressure, transpulmonary pressure, and mechanical power ARDS 中的个性化通气调整：图像、驱动压力、跨肺压力和机械动力的系统回顾和荟萃分析

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-08-30 DOI: 10.1016/j.hrtlng.2024.08.013

Javier Muñoz MD, PhD , Jamil Antonio Cedeño MD , Galo Francisco Castañeda MD , Lourdes Carmen Visedo MD

Background

Acute Respiratory Distress Syndrome (ARDS) necessitates personalized treatment strategies due to its heterogeneity, aiming to mitigate Ventilator-Induced Lung Injury (VILI). Advanced monitoring techniques, including imaging, driving pressure, transpulmonary pressure, and mechanical power, present potential avenues for tailored interventions.

Objective

To review some of the most important techniques for achieving greater personalization of mechanical ventilation in ARDS patients as evaluated in randomized clinical trials, by analyzing their effect on three clinically relevant aspects: mortality, ventilator-free days, and gas exchange.

Methods

Following PRISMA guidelines, we conducted a systematic review and meta-analysis of Randomized Clinical Trials (RCTs) involving adult ARDS patients undergoing personalized ventilation adjustments. Outcomes were mortality (primary end-point), ventilator-free days, and oxygenation improvement.

Results

Among 493 identified studies, 13 RCTs (n = 1255) met inclusion criteria. No personalized ventilation strategy demonstrated superior outcomes compared to traditional protocols. Meta-analysis revealed no significant reduction in mortality with image-guided (RR 0.88, 95 % CI 0.70–1.11), driving pressure-guided (RR 0.61, 95 % CI 0.29–1.30), or transpulmonary pressure-guided (RR 0.85, 95 % CI 0.58–1.24) strategies. Ventilator-free days and oxygenation outcomes showed no significant differences.

Conclusion

Our study does not support the superiority of personalized ventilation techniques over traditional protocols in ARDS patients. Further research is needed to standardize ventilation strategies and determine their impact on mechanical ventilation outcomes.

背景急性呼吸窘迫综合征（ARDS）因其异质性而需要个性化的治疗策略，旨在减轻呼吸机诱发的肺损伤（VILI）。方法根据 PRISMA 指南，我们对涉及接受个性化通气调整的成年 ARDS 患者的随机临床试验 (RCT) 进行了系统回顾和荟萃分析。结果在 493 项已确定的研究中，有 13 项 RCT（n = 1255）符合纳入标准。与传统方案相比，没有一项个性化通气策略显示出更优越的结果。Meta 分析显示，图像引导（RR 0.88，95 % CI 0.70-1.11）、驱动压力引导（RR 0.61，95 % CI 0.29-1.30）或经肺压力引导（RR 0.85，95 % CI 0.58-1.24）策略均未显著降低死亡率。结论我们的研究并不支持个性化通气技术在 ARDS 患者中优于传统方案。我们的研究并不支持个性化通气技术在 ARDS 患者中优于传统方案，还需要进一步的研究来规范通气策略并确定其对机械通气结果的影响。

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引用次数: 0

Evaluation of upper extremity functional capacity and activities of daily living in patients with heart failure: A cross-sectional study 评估心力衰竭患者的上肢功能和日常生活活动能力：横断面研究

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-08-30 DOI: 10.1016/j.hrtlng.2024.08.014

Zelal Apaydin , Rengin Demir , Rustem Mustafaoglu , Umit Yasar Sinan , Hidayet Ozan Arabaci , Mehmet Serdar Kucukoglu

Background

Considering the limitations in activities of daily living (ADL) and the impact of improvements in patients with heart failure (HF), appropriate assessment of upper extremity functional capacity and ADL is important.

Objectives

To evaluate upper extremity functional capacity and ADL in patients with HF and compare them with healthy controls.

Methods

This study included 30 HF patients and healthy controls. Upper extremity functional capacity was assessed with the 6-Minute Pegboard Ring Test (6PBRT), ADL by the Londrina protocol, exercise capacity by 6-Minute Walk Test (6MWT), peripheral muscle strength by hand dynamometer, and dyspnea by Modified Medical Research Council Scale (MMRC). For performance tests, pre-test (resting) and post-test (after performance) values were also measured.

Results

Patients with HF with ejection fraction ≤50 % and controls were similar in terms of age (52.63±6.2 and 50.03±6.5 years, respectively) and gender (25 females for each group) (p > 0.05). Patients showed a statistically significant increase in total test time in the Londrina protocol and fewer rings moved in 6PBRT (p < 0.0001). The post-test dyspnea (p = 0.03) and pre-test arm fatigue (p < 0.0001) were observed to be higher in patients in the Londrina protocol. There was a statistically significant group by time interaction in the patients’ pre- and post-test lower heart rate (F= 4.80, p = 0.03), post-test dyspnea (p < 0.0001), and post-test arm fatigue (p = 0.005) were observed to be higher in patients in 6PBRT.

Conclusions

The evidence showed a decrease in upper extremity functional capacity in patients with HF. Patients required more time to perform their ADLs compared with healthy controls.

背景考虑到心力衰竭（HF）患者日常生活活动（ADL）的限制和改善的影响，对上肢功能能力和ADL进行适当的评估非常重要。 Objectives To evaluate upper extremity functional capacity and ADL in patients with HF and compare them with healthy controls.Methods这项研究纳入了30名HF患者和健康对照组。用 6 分钟钉板环测试（6PBRT）评估上肢功能能力，用 Londrina 方案评估日常活动能力，用 6 分钟步行测试（6MWT）评估运动能力，用手测力计评估外周肌力，用改良医学研究委员会量表（MMRC）评估呼吸困难。结果射血分数≤50%的房颤患者与对照组在年龄（分别为（52.63±6.2）岁和（50.03±6.5）岁）和性别（每组 25 名女性）方面相似（P >；0.05）。在 Londrina 方案中，患者的总测试时间明显增加，而在 6PBRT 中，移动的环数较少（p < 0.0001）。测试后呼吸困难（p = 0.03）和测试前手臂疲劳（p < 0.0001）在隆德里纳方案的患者中更高。6PBRT患者在测试前和测试后心率降低（F=4.80，P=0.03）、测试后呼吸困难（P< 0.0001）和测试后手臂疲劳（P=0.005）方面均高于6PBRT患者。与健康对照组相比，患者需要更多的时间来完成日常活动。

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引用次数: 0

Heart failure related fatigue: An exploratory analysis of serum osmolality from the national health and nutrition examination survey 与心力衰竭有关的疲劳对全国健康与营养状况调查血清渗透压的探索性分析

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-08-24 DOI: 10.1016/j.hrtlng.2024.08.012

Christine R. Hoch PhD, RN, ACNS-BC , N. Jennifer Klinedinst PhD, RN, MPH, FAHA , Karen Larimer PhD, ACNP-BC, FAHA , Stephen S. Gottlieb MD

Background

Fatigue is a prominent symptom of heart failure (HF). However, underlying mechanisms remain poorly understood. Fluid volume status has been suggested as a physiologic mechanism of HF-related fatigue. Serum osmolality may fluctuate with changes in volume status associated with neurohormonal dysregulation. The relationship of fatigue to serum osmolality has not been assessed in adults with HF.

Objectives

Describe the relationship between serum osmolality and fatigue in adults with HF.

Methods

We analyzed two waves of cross-sectional data from the National Health and Nutrition Examination Survey (2015–2016 and 2017–2018). Adults who self-reported having HF without select co-morbid conditions known to contribute to fatigue were included. Data were weighted to provide US national estimates, and complex sample design used for analyses. Sequential logistic regression was used to isolate the effect of serum osmolality on the odds of having fatigue.

Results

Data from the sample represented 1.4 million Americans with HF (58.5 % male; median age 68 years), of whom 1,001,589 (67.9 %) reported fatigue. Participants with fatigue had lower serum osmolality compared to those without fatigue (t = -3.04, p = .009). Higher serum osmolality was associated with 8.8 % lower odds of experiencing fatigue when controlling for sex and body mass index (OR = 0.912, p = .007, CI 0.857 - 0.972).

Conclusions

HF-related fatigue is associated with lower serum osmolality. Low serum osmolality may indicate excess volume and the presence of a heightened neurohormonal response, both of which may influence fatigue. Alternatively, serum osmolality may directly affect other physiologic changes that may contribute to fatigue.

背景疲劳是心力衰竭（HF）的一个突出症状。然而，人们对其潜在机制仍知之甚少。体液容量状态被认为是 HF 相关疲劳的生理机制之一。血清渗透压可能会随着与神经激素失调相关的容量状态变化而波动。我们分析了国家健康与营养调查的两波横截面数据（2015-2016 年和 2017-2018 年）。我们纳入了自我报告患有高血压且未合并已知会导致疲劳的疾病的成年人。数据经过加权处理，以提供美国全国估计值，并采用复杂样本设计进行分析。结果样本数据代表了 140 万患有高血压的美国人（58.5% 为男性；中位年龄为 68 岁），其中 1,001,589 人（67.9%）报告有疲劳感。与无疲劳感的参与者相比，有疲劳感的参与者血清渗透压较低（t = -3.04，p = .009）。在控制性别和体重指数的情况下，血清渗透压越高，出现疲劳的几率就会降低 8.8%（OR = 0.912，p = .007，CI 0.857 - 0.972）。低血清渗透压可能表明血容量过多和神经荷尔蒙反应增强，这两者都可能影响疲劳。另外，血清渗透压也可能直接影响其他可能导致疲劳的生理变化。

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引用次数: 0

Outcomes of Covid-19 among patients with ischemic heart disease: A propensity matched analysis 缺血性心脏病患者服用 Covid-19 后的疗效：倾向匹配分析

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-08-24 DOI: 10.1016/j.hrtlng.2024.08.010

Mirza Faris Ali Baig MD , Aravind Dilli Babu MBBS , Bengt Herweg MD , Debbie A. Rinde-Hoffman MD, FACC

Background

Prior research has linked cardiovascular diseases with higher COVID-19 mortality and worse hospital outcomes, particularly in severe heart failure. Large population-based data regarding the impact of pre-existing ischemic heart disease (IHD) on COVID-19 outcomes is not well established.

Objective

To study the impact of COVID-19 infection on IHD hospital mortality and other outcomes.

Methods

The study included a patient cohort from the 2020 and 2021 National Inpatient Sample (NIS) database. Propensity score matching was used to match the study cohort (COVID-19 with IHD) to controls (COVID-19 without IHD) using a 1:1 matching ratio. The outcomes analyzed were in-hospital mortality, rates of acute kidney injury (AKI), acute myocardial injury (AMI), cardiogenic shock, cardiac arrest, mechanical ventilation, tracheal intubation, pulmonary embolism (PE), ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and total hospitalization charges.

Results

A total of 2,532,652 patients met the inclusion criteria (1,199,008 females [47.3 %), predominantly Caucasian 1,456,203 (57.5 %); mean [SD] age 63, (5.4), including 29,315 (1.1 %) patients with a history of IHD. Following propensity matching, 4,772 COVID-19 patients with and without IHD were matched. IHD patients had higher rates of AMI (adjusted odds ratio (aOR) 3.75, 95 % CI 3.27–4.31, p < 0.001), cardiogenic shock (aOR 2.89, 95 % CI 1.60–5.19, p < 0.001), VT (aOR 3.26, 95 % CI 2.48–4.29, p < 0.001), and VF (aOR 2.23, 95 % CI 1.25–3.99, p < 0.001). The odds ratios of in-hospital mortality, AKI, PE, mechanical ventilation, tracheal intubation, and resource use were not significantly different.

Conclusion

A history of IHD does not impact COVID-19 mortality but increases the risk of in-hospital cardiac complications.

背景先前的研究表明，心血管疾病与较高的 COVID-19 死亡率和较差的住院预后有关，尤其是对严重心力衰竭而言。目标研究 COVID-19 感染对 IHD 住院死亡率和其他预后的影响。方法该研究纳入了来自 2020 年和 2021 年全国住院患者样本 (NIS) 数据库的患者队列。采用倾向得分匹配法将研究队列（感染 IHD 的 COVID-19）与对照组（未感染 IHD 的 COVID-19）进行匹配，匹配比例为 1:1。分析的结果包括院内死亡率、急性肾损伤 (AKI)、急性心肌损伤 (AMI)、心源性休克、心脏骤停、机械通气、气管插管、肺栓塞 (PE)、室性心动过速 (VT)、心室颤动 (VF)、住院时间 (LOS) 和住院总费用。结果共有 2,532,652 名患者符合纳入标准（1,199,008 名女性[47.3%]，1,456,203 名白种人（57.5%）；平均 [SD] 年龄 63 岁（5.4），包括 29,315 名（1.1%）有心肌梗死病史的患者。经过倾向匹配后，4772 名患有和未患有 IHD 的 COVID-19 患者进行了配对。IHD 患者发生急性心肌梗死（调整后的几率比 (aOR) 3.75，95 % CI 3.27-4.31，p < 0.001）、心源性休克（aOR 2.89，95 % CI 1.60-5.19，p < 0.001）、VT（aOR 3.26，95 % CI 2.48-4.29，p < 0.001）和 VF（aOR 2.23，95 % CI 1.25-3.99，p < 0.001）的几率更高。院内死亡率、AKI、PE、机械通气、气管插管和资源使用的几率没有显著差异。

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引用次数: 0

Pleural effusions identified by thoracic ultrasound predict poor quality of life in patients with acute decompensated heart failure 胸腔超声确定的胸腔积液预示着急性失代偿性心力衰竭患者的生活质量较差

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-08-17 DOI: 10.1016/j.hrtlng.2024.08.008

Erick Joel Rendón-Ramírez , Víctor Manuel Fraga-Enríquez , Perla Rocío Colunga-Pedraza , Homero Nañez-Terreros , Ramiro Flores-Ramírez , Fernando Canseco , José M Porcel , Edgar Francisco Carrizales-Sepúlveda

Introduction

Pleural effusion (PE) is a common manifestation of acute decompensated heart failure (ADHF); however, its influence on the quality of life (QoL) is unknown.

Objectives

To identify whether PE detected using thoracic ultrasound (TUS) is associated with poorer QoL in patients with ADHF and a reduced ejection fraction (≤40 %).

Methods

We conducted a prospective, longitudinal, descriptive, observational, single-center study at a university hospital in Mexico. We included participants with a reduced left ventricular ejection fraction who were admitted for ADHF. We performed TUS and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) within the first 48 h of hospitalization.

Results

Forty patients with ADHF (30 males and 10 females; mean age, 51.24 ± 16.942 years) were included in this study. The participants were categorized into two groups: those with (n = 25, 62.5 %) or without (n = 15, 37.5 %) PE on TUS. We found a statistically significant association between the presence of PEs and a worse perception of QoL. The mean MLHFQ score in the group of patients with PEs was 40 points, compared to 12 points in the group without PEs (p < 0.001). Poorer QoL was associated with a higher quantity of pleural fluid, as evidenced by the greater number of intercostal spaces occupied by the PE (p < 0.001).

Conclusions

Patients with ADHF and a reduced ejection fraction who present with PE have a worse perception of QoL than patients without PE.

目的在射血分数降低（≤40%）的急性失代偿性心力衰竭（ADHF）患者中，确定使用胸部超声波（TUS）检测到的胸腔积液是否与较差的 QoL 有关。方法我们在墨西哥的一家大学医院开展了一项前瞻性、纵向、描述性、观察性的单中心研究。我们纳入了因 ADHF 而入院的左心室射血分数降低的患者。我们在入院后的 48 小时内进行了 TUS 和明尼苏达心力衰竭患者生活问卷调查（MLHFQ）。参与者分为两组：TUS显示有PE（25人，62.5%）或无PE（15人，37.5%）。我们发现，存在 PE 与 QoL 感知较差之间存在统计学意义上的显著关联。有 PE 患者组的平均 MLHFQ 得分为 40 分，而无 PE 患者组的平均 MLHFQ 得分为 12 分（p < 0.001）。较差的生活质量与较多的胸腔积液有关，PE占据的肋间隙越多就证明了这一点（p < 0.001）。

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引用次数: 0

Optimizing outcomes: Impact of palliative care consultation timing in the cardiovascular intensive care unit 优化疗效：心血管重症监护病房姑息关怀咨询时机的影响

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-08-13 DOI: 10.1016/j.hrtlng.2024.08.011

Sant Kumar MD , Hunter VanDolah BS , Ahmed Daniyaal Rasheed MD , Serenity Budd MS , Kelley Anderson PhD RN FNP , Alexander I. Papolos MD , Benjamin B.Kenigsberg M , Narayana Sarma V. Singam MD , Anirudh Rao MD , Hunter Groninger MD FAAHPM

Background

ICU patients and their families experience significant stress due to illness severity and prognostic uncertainty, making palliative care (PC) integral for symptom management, family support, and end-of-life care goals. The impact of PC in the Cardiac Intensive Care Unit (CICU) remains unstudied.

Objective

We explore the impact of early palliative care consultation (PCC) on patient outcomes in the CICU, including mortality, length of stay, and family meeting frequency.

Methods

This retrospective study at MedStar Washington Hospital Center included 209 adult patients admitted to the CICU between December 2021 and June 2022 receiving PCC. We compared outcomes between those receiving early (<72 h) and late (>72 h) PCC, including mortality, length of stay, and family meeting frequency. Statistical analysis included Wilcoxon rank sum tests, Chi-squared tests, Fisher's exact test, and Poisson regression models.

Results

The study included 209 patients admitted to the (M age = 68 years, SD = 14; 45 % female; 62 % Black, 30 % White) who received PCC, most (79 %) within 72 h. Early PCC was associated with shorter CICU stays (median, 3 vs. 5.5 days; p = 0.005). Early PCC patients had higher odds of family meetings (IRR=3.59; p < 0.001) and experienced a change in code status sooner (median 1 day vs. 3 days, p < 0.001). Late PCC patients were more likely to undergo tracheostomy (13.6% vs. 2.4 %; p = 0.007), cardioversion (9.1% vs. 1.8 %; p = 0.037), and have PEG tubes placed (13.6% vs. 2.4 %; p = 0.007).

Conclusions

Early PCC in the CICU is associated with shorter CICU stays, fewer procedures, and more frequent family meetings.

背景由于疾病的严重性和预后的不确定性，重症监护病房（CICU）的患者及其家属承受着巨大的压力，因此姑息关怀（PC）对于症状管理、家庭支持和临终关怀目标而言是不可或缺的。我们探讨了早期姑息治疗咨询（PCC）对 CICU 患者预后的影响，包括死亡率、住院时间和家属会面频率。方法这项在 MedStar 华盛顿医院中心进行的回顾性研究纳入了 2021 年 12 月至 2022 年 6 月期间入住 CICU 并接受姑息治疗咨询的 209 名成人患者。我们比较了接受早期（72 小时）和晚期（72 小时）PCC 患者的治疗效果，包括死亡率、住院时间和家属会面频率。统计分析包括 Wilcoxon 秩和检验、Chi-squared 检验、费雪精确检验和泊松回归模型。结果该研究纳入了 209 名接受 PCC 的住院患者（中位年龄 = 68 岁，SD = 14；45 % 为女性；62 % 为黑人，30 % 为白人），其中大多数（79 %）在 72 小时内接受了 PCC。早期 PCC 患者与家人会面的几率更高（IRR=3.59；p <0.001），并且更早经历代码状态的改变（中位数为 1 天 vs. 3 天，p <0.001）。晚期 PCC 患者更有可能接受气管造口术（13.6% 对 2.4%；p = 0.007）、心脏电复律（9.1% 对 1.8%；p = 0.037）和放置 PEG 管（13.6% 对 2.4%；p = 0.007）。

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引用次数: 0

Predictors of COVID-19 severity in autoimmune disease patients: A retrospective study during full epidemic decontrol in China 自身免疫性疾病患者 COVID-19 严重程度的预测因素：中国疫情全面控制期间的回顾性研究

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-08-13 DOI: 10.1016/j.hrtlng.2024.08.009

Li-Ming Chen , Jian-Bin Li , Rui Wu

Background

Early identification of risk factors for adverse COVID-19 progression in patients with autoimmune diseases is crucial for patient management, but data on the Chinese population are scarce.

Objectives

The purpose of this study was to identify predictors of severe COVID-19 in patients using blood cell ratios, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and other inflammatory markers.

Methods

A retrospective study of 855 patients (746 females; median age 49 years) with autoimmune diseases and concurrent COVID-19 was conducted from December 2022 to February 2023 at the Rheumatology and Immunology Department of the First Affiliated Hospital of Nanchang University. Disease severity was assessed according to the 8th edition of the National Health Commission of the People's Republic of China's COVID-19 Diagnosis and Treatment Guidelines. The clinical classification criteria group mild and moderate cases as nonsevere cases and severe and critical cases as severe cases. A multivariate logistic regression model was established to evaluate the relationships between COVID-19 severity and demographic characteristics, comorbidities, medication use, and laboratory findings.

Results

The PLR, NLR, and SII were significantly greater in the severe COVID-19 group than in the nonsevere group (all P < 0.05). In addition to classical independent clinical risk factors, increases in the PLR (OR: 1.004, 95 % CI: 1.001∼1.007, p = 0.001), NLR (OR: 1.180, 95 % CI: 1.041∼1.337, p = 0.010), and SII (OR: 0.999, 95 % CI: 0.998∼1.000, p = 0.005) were identified as risk factors for severe COVID-19 in patients with autoimmune diseases. After adjusting for clinical risk factors, the PLR (AUC: 0.592 vs. 0.865; P < 0.05), NLR (AUC: 0.670 vs. 0.866; P < 0.05), and SII (AUC: 0.616 vs. 0.864; P < 0.05) demonstrated higher predictive values.

Conclusion

Early prediction of severe COVID-19 in patients with autoimmune diseases can be achieved using the NLR, PLR, and SII.

背景早期识别自身免疫性疾病患者COVID-19不良进展的风险因素对患者管理至关重要，但有关中国人群的数据很少。目的本研究旨在利用血细胞比值，如中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、全身免疫炎症指数（SII）和其他炎症标志物，识别患者严重COVID-19的预测因素。方法 2022年12月至2023年2月，南昌大学第一附属医院风湿免疫科对855名患有自身免疫性疾病并同时患有COVID-19的患者（女性746人，中位年龄49岁）进行了回顾性研究。疾病严重程度根据中华人民共和国国家卫生健康委员会《COVID-19诊疗指南》第八版进行评估。临床分级标准将轻度和中度病例归为非重度病例，将重度和危重病例归为重度病例。结果 COVID-19 重症组的 PLR、NLR 和 SII 显著高于非重症组（P 均为 0.05）。除了传统的独立临床危险因素外，PLR（OR：1.004，95 % CI：1.001∼1.007，P = 0.001）、NLR（OR：1.180，95 % CI：1.041∼1.337，p = 0.010）和 SII（OR：0.999，95 % CI：0.998∼1.000，p = 0.005）被确定为自身免疫性疾病患者严重 COVID-19 的危险因素。在调整临床风险因素后，PLR（AUC：0.592 vs. 0.865；P <；0.05）、NLR（AUC：0.670 vs. 0.866；P <；0.05）和 SII（AUC：0.616 vs. 0.864；P <；0.05）显示出更高的预测价值。

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引用次数: 0

Association of arteriovenous fistulae with precapillary pulmonary hypertension – A single center retrospective analysis of invasive hemodynamic parameters 动静脉瘘与毛细血管前肺动脉高压的关联--对侵入性血液动力学参数的单中心回顾性分析。

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-08-07 DOI: 10.1016/j.hrtlng.2024.08.007

John Malin , Rasha Khan , Jose Manuel Martinez Manzano , Phuuwadith Wattanachayakul , Andrew Geller , Raul Leguizamon , Tara A John , Ian Mclaren , Alexander Prendergast , Simone A. Jarrett , Kevin Bryan Lo , Janani Rangaswami , Christian Witzke

Background

Pulmonary hypertension (pH) is a well-known complication among patients with chronic kidney disease (CKD). Arteriovenous fistulae (AVF) have been associated with pH mainly by increasing cardiac output. However, the burden of precapillary pH in individuals with CKD and an AVF is unclear.

Objectives

To better and more fully understand the mechanism and development of precapillary pH in patients with AVF, as well as the consequences of precapillary pH in these patients.

Methods

This was a large retrospective study of patients with CKD stage 4 or 5 who underwent right heart catheterization (RHC) from 2018 to 2023. The data were stratified according to the presence of AVF. To determine if AVF was independently associated with precapillary pH, we used a multivariable logistic regression analysis adjusting for demographics and potential comorbidities associated with precapillary pH, including diagnosis of chronic lung disease, obstructive sleep apnea, connective tissue disease, history of venous thromboembolism, chronic anemia, and heart failure.

Results

Of 651 patients with CKD4 or CKD5, 145 (22 %) had AVF and 506 (78 %) did not have AVF. Within the AVF group, the median age was 64 years (IQR 54–71), and they were predominantly males (61 %, n = 88) and African American (77 %, n = 111). A total of 31 % (n = 45) had evidence of precapillary pH, 30 % (n = 43) of combined pH, and 14 % (n = 20) of isolated postcapillary pH. Compared to the non-AVF group, precapillary pH was more likely in the AVF group (31% vs 17 %, p < 0.0001). On multivariable analysis, AVF was independently associated with precapillary pH (OR 2.47, CI 1.56–3.89; p < 0.0001). The median time from dialysis initiation to RHC date (and precapillary pH diagnosis) was 6 years (IQR 3–8).

Conclusion

Based on RHC findings, almost one-third of patients with CKD and AVF had precapillary pH. The presence of AVF was independently associated with precapillary pH.

背景：肺动脉高压（pH）是慢性肾脏病（CKD）患者众所周知的并发症。动静脉瘘（AVF）主要通过增加心输出量与肺动脉高压有关。然而，在患有慢性肾脏病和动静脉瘘的患者中，毛细血管前 pH 值的负担尚不清楚：目的：更好、更全面地了解动静脉瘘患者毛细血管前 pH 的机制和发展，以及毛细血管前 pH 对这些患者的影响：这是一项大型回顾性研究，研究对象为 2018 年至 2023 年接受右心导管检查（RHC）的 CKD 4 期或 5 期患者。根据是否存在 AVF 对数据进行了分层。为了确定 AVF 是否与毛细血管前 pH 值独立相关，我们使用了多变量逻辑回归分析，调整了人口统计学和与毛细血管前 pH 值相关的潜在合并症，包括慢性肺部疾病诊断、阻塞性睡眠呼吸暂停、结缔组织疾病、静脉血栓栓塞史、慢性贫血和心力衰竭：在 651 名 CKD4 或 CKD5 患者中，145 人（22%）患有动静脉瘘，506 人（78%）没有动静脉瘘。在 AVF 组中，中位年龄为 64 岁（IQR 54-71），主要为男性（61%，n = 88）和非裔美国人（77%，n = 111）。共有31%（n = 45）的人有毛细血管前pH值证据，30%（n = 43）的人有合并pH值证据，14%（n = 20）的人有孤立的毛细血管后pH值证据。与非动静脉瘘组相比，动静脉瘘组更有可能出现毛细血管前 pH（31% 对 17%，P < 0.0001）。多变量分析显示，动静脉瘘与毛细血管前 pH 值独立相关（OR 2.47，CI 1.56-3.89；P <0.0001）。从开始透析到 RHC 日期（以及毛细血管前 pH 值诊断）的中位时间为 6 年（IQR 3-8）：结论：根据 RHC 检查结果，近三分之一的 CKD 和 AVF 患者存在毛细血管前 pH 值。结论：根据 RHC 的结果，近三分之一的 CKD 和 AVF 患者存在毛细血管前 pH 值，AVF 的存在与毛细血管前 pH 值独立相关。

{"title":"Association of arteriovenous fistulae with precapillary pulmonary hypertension – A single center retrospective analysis of invasive hemodynamic parameters","authors":"John Malin , Rasha Khan , Jose Manuel Martinez Manzano , Phuuwadith Wattanachayakul , Andrew Geller , Raul Leguizamon , Tara A John , Ian Mclaren , Alexander Prendergast , Simone A. Jarrett , Kevin Bryan Lo , Janani Rangaswami , Christian Witzke","doi":"10.1016/j.hrtlng.2024.08.007","DOIUrl":"10.1016/j.hrtlng.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><p>Pulmonary hypertension (pH) is a well-known complication among patients with chronic kidney disease (CKD). Arteriovenous fistulae (AVF) have been associated with pH mainly by increasing cardiac output. However, the burden of precapillary pH in individuals with CKD and an AVF is unclear.</p></div><div><h3>Objectives</h3><p>To better and more fully understand the mechanism and development of precapillary pH in patients with AVF, as well as the consequences of precapillary pH in these patients.</p></div><div><h3>Methods</h3><p>This was a large retrospective study of patients with CKD stage 4 or 5 who underwent right heart catheterization (RHC) from 2018 to 2023. The data were stratified according to the presence of AVF. To determine if AVF was independently associated with precapillary pH, we used a multivariable logistic regression analysis adjusting for demographics and potential comorbidities associated with precapillary pH, including diagnosis of chronic lung disease, obstructive sleep apnea, connective tissue disease, history of venous thromboembolism, chronic anemia, and heart failure.</p></div><div><h3>Results</h3><p>Of 651 patients with CKD4 or CKD5, 145 (22 %) had AVF and 506 (78 %) did not have AVF. Within the AVF group, the median age was 64 years (IQR 54–71), and they were predominantly males (61 %, <em>n</em> = 88) and African American (77 %, <em>n</em> = 111). A total of 31 % (<em>n</em> = 45) had evidence of precapillary pH, 30 % (<em>n</em> = 43) of combined pH, and 14 % (<em>n</em> = 20) of isolated postcapillary pH. Compared to the non-AVF group, precapillary pH was more likely in the AVF group (31% vs 17 %, <em>p</em> < 0.0001). On multivariable analysis, AVF was independently associated with precapillary pH (OR 2.47, CI 1.56–3.89; <em>p</em> < 0.0001). The median time from dialysis initiation to RHC date (and precapillary pH diagnosis) was 6 years (IQR 3–8).</p></div><div><h3>Conclusion</h3><p>Based on RHC findings, almost one-third of patients with CKD and AVF had precapillary pH. The presence of AVF was independently associated with precapillary pH.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 260-264"},"PeriodicalIF":2.4,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The relationship between departmental culture and resuscitation-related moral distress among inpatient medical departments physicians and nurses 科室文化与住院部医生和护士与复苏相关的道德困扰之间的关系。

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-08-03 DOI: 10.1016/j.hrtlng.2024.07.001

Dorit Weill-Lotan RH, PhD , Freda Dekeyser-Ganz PhD, RN , Julie Benbenishty RN PhD

Background

While moral distress frequency and intensity have been reported among clinicians around the world, resuscitations have not been well documented as its source.

Objectives

to examine the relationship between intensity and frequency of resuscitation- related moral distress and departmental culture among nurses and physicians working in inpatient medical departments.

Methods

This was a cross-sectional, prospective study of medical inpatient department staff from three hospitals. Questionnaires included a demographic and work characteristics questionnaire, the Resuscitation-Related Moral Distress Scale (a revised version of the Moral Distress Scale measuring frequency and intensity of moral distress), and a Departmental Culture Questionnaire.

Results

64 physicians and 201 nurses (response rate 64 %) participated, with a mean of 8.4 (SD = 5.1) resuscitations in the previous 6 months. Highest moral distress frequency scores were reported for items related to family demands or having no medical decision related to life- saving interventions for dying patients. Highest moral distress intensity scores were found when appropriate care for deteriorating patients was not given due poor staffing and when witnessing a resuscitation that could have been prevented had the staff identified the deterioration on time. Most participants strongly agreed (n = 228, 86.0 %) that their department medical director considers it important for staff to determine patients’ end-of-life preferences and that quality of life is of the highest value.

Conclusions

Clinicians working in medical inpatient department suffer from moderate frequency and high intensity levels of resuscitation-related moral distress. There was a statistically significant association between intention to leave employment with resuscitation-related moral distress frequency and intensity.

背景：目的：研究在住院医疗部门工作的护士和医生中，与复苏相关的道德困扰的强度和频率与部门文化之间的关系：方法：这是一项横断面前瞻性研究，研究对象为三家医院的住院医护人员。问卷包括人口统计学和工作特征问卷、复苏相关道德压力量表（道德压力量表的修订版，测量道德压力的频率和强度）和科室文化问卷：64名医生和201名护士（应答率为64%）参加了调查，他们在过去6个月中平均进行了8.4次（标准差=5.1）复苏。与家属要求或对濒死病人的救生干预没有医疗决定有关的项目的道德困扰频率得分最高。精神痛苦强度得分最高的情况是，由于人员配备不足而未能对病情恶化的病人提供适当的护理，以及目睹了如果医护人员及时发现病情恶化本可以避免的抢救过程。大多数参与者都非常同意（n = 228，86.0 %）他们所在科室的医务主任认为工作人员必须确定病人的临终意愿，并认为生命质量是最重要的：结论：在内科住院部工作的临床医生遭受与复苏相关的精神痛苦的频率中等，强度较高。据统计，离职意向与复苏相关精神痛苦的频率和强度之间存在显著关联。

{"title":"The relationship between departmental culture and resuscitation-related moral distress among inpatient medical departments physicians and nurses","authors":"Dorit Weill-Lotan RH, PhD , Freda Dekeyser-Ganz PhD, RN , Julie Benbenishty RN PhD","doi":"10.1016/j.hrtlng.2024.07.001","DOIUrl":"10.1016/j.hrtlng.2024.07.001","url":null,"abstract":"<div><h3>Background</h3><p>While moral distress frequency and intensity have been reported among clinicians around the world, resuscitations have not been well documented as its source.</p></div><div><h3>Objectives</h3><p>to examine the relationship between intensity and frequency of resuscitation- related moral distress and departmental culture among nurses and physicians working in inpatient medical departments.</p></div><div><h3>Methods</h3><p>This was a cross-sectional, prospective study of medical inpatient department staff from three hospitals. Questionnaires included a demographic and work characteristics questionnaire, the Resuscitation-Related Moral Distress Scale (a revised version of the Moral Distress Scale measuring frequency and intensity of moral distress), and a Departmental Culture Questionnaire.</p></div><div><h3>Results</h3><p>64 physicians and 201 nurses (response rate 64 %) participated, with a mean of 8.4 (SD = 5.1) resuscitations in the previous 6 months. Highest moral distress frequency scores were reported for items related to family demands or having no medical decision related to life- saving interventions for dying patients. Highest moral distress intensity scores were found when appropriate care for deteriorating patients was not given due poor staffing and when witnessing a resuscitation that could have been prevented had the staff identified the deterioration on time. Most participants strongly agreed (<em>n</em> = 228, 86.0 %) that their department medical director considers it important for staff to determine patients’ end-of-life preferences and that quality of life is of the highest value.</p></div><div><h3>Conclusions</h3><p>Clinicians working in medical inpatient department suffer from moderate frequency and high intensity levels of resuscitation-related moral distress. There was a statistically significant association between intention to leave employment with resuscitation-related moral distress frequency and intensity.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 254-259"},"PeriodicalIF":2.4,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A systematic review and meta-analysis of the clinical benefits and adverse reactions of anti-fibrotics in non-IPF progressive fibrosing ILD 抗纤维化药物对非 IPF 进行性纤维化 ILD 的临床疗效和不良反应的系统综述和荟萃分析。

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung

Pub Date : 2024-07-31 DOI: 10.1016/j.hrtlng.2024.07.010

Woon Hean Chong MD, Dipika Agrawal MD, Ze Ying Tan MD, Sridhar Venkateswaran MD, Adeline Yit Ying Tan MD, Ching Yee Tan MD, Norris Chun Ang Ling MD, Noel Stanley Wey Tut Tay MD

Background

Anti-fibrotics can reduce restrictive impairment in idiopathic pulmonary fibrosis (IPF). However, its effectiveness in non-IPF progressive fibrosing interstitial lung disease (non-IPF PF-ILD) remains uncertain.

Objective

We assess the efficacy and safety of anti-fibrotics pirfenidone and nintedanib versus placebo among non-IPF PF-ILD adult patients.

Methods

Meta-analysis was performed using PubMed, SCOPUS, and Cochrane databases to identify randomized controlled trials (RCTs). At respective centers, non-IPF PF-ILD was defined as clinical and radiological findings inconsistent with IPF and greater than 5 % forced vital capacity (FVC) decline, worsening radiological fibrosis or respiratory symptoms.

Results

Among seven RCTs involving 1,816 non-IPF PF-ILD patients, anti-fibrotics significantly reduced decline in FVC from baseline in milliliters (MD -66.80milliliters; P < 0.01) and percent predicted (MD -1.80 %; P < 0.01) compared to placebo. However, severity of FVC decline was less than 10 % (P = 0.33) in both groups. No significant difference in the decline of 6MWD from baseline in meters (P = 0.19) while on anti-fibrotics, although those on pirfenidone had less decline in 6MWD (MD -25.12 m; P < 0.01) versus placebo. The rates of all-cause mortality (P = 0.34), all-cause hospitalization (P = 0.44), and hospitalization for respiratory etiology (P = 0.06) were comparable in both groups. Adverse events of nausea/vomiting (54.2 % vs. 20.3 %; P < 0.01), diarrhea (65.2 % vs. 27.6 %; P = 0.02), anorexia/weight loss (23.0 % vs. 7.7 %; P < 0.01), neurological disorders (20.8 % vs. 12.6 %; P < 0.01), and events requiring therapy discontinuation were higher (18.4 % vs. 9.9 %; P < 0.01) in the anti-fibrotic group. Other adverse events of skin (P = 0.18) and respiratory disorders (P = 0.20) were equal.

Conclusion

The advent of anti-fibrotics offers alternative treatment to reduce lung function decline.

背景：抗纤维化药物可减轻特发性肺纤维化（IPF）的限制性损伤。然而，其对非 IPF 进行性纤维化间质性肺病（non-IPF PF-ILD）的疗效仍不确定：我们评估了抗纤维化药物吡非尼酮和宁替达尼与安慰剂在非 IPF PF-ILD 成年患者中的疗效和安全性：利用PubMed、SCOPUS和Cochrane数据库进行Meta分析，以确定随机对照试验（RCT）。在各研究中心，非 IPF PF-ILD 的定义是：临床和放射学检查结果与 IPF 不一致、用力呼吸容量（FVC）下降超过 5%、放射学纤维化或呼吸道症状恶化：在涉及1816名非IPF PF-ILD患者的七项研究中，与安慰剂相比，抗纤维化药物显著降低了FVC从基线下降的毫升数（MD -66.80毫升；P < 0.01）和预测百分比（MD -1.80%；P < 0.01）。不过，两组患者的 FVC 下降幅度均小于 10 %（P = 0.33）。与安慰剂相比，服用吡非尼酮的患者 6MWD 的下降幅度较小（MD -25.12 m；P <0.01），但服用抗纤维化药物的患者 6MWD 从基线下降的米数无明显差异（P = 0.19）。两组患者的全因死亡率（P = 0.34）、全因住院率（P = 0.44）和因呼吸系统病因住院率（P = 0.06）相当。恶心/呕吐（54.2% 对 20.3%；P < 0.01）、腹泻（65.2% 对 27.6%；P = 0.02）、厌食/体重减轻（23.0% 对 7.7%；P < 0.01）、神经系统紊乱（20.8 % vs. 12.6 %；P < 0.01）和需要中断治疗的事件在抗纤维化组更高（18.4 % vs. 9.9 %；P < 0.01）。皮肤（P = 0.18）和呼吸系统疾病（P = 0.20）等其他不良事件的发生率相同：抗纤维化药物的出现为减少肺功能衰退提供了替代治疗方法。

{"title":"A systematic review and meta-analysis of the clinical benefits and adverse reactions of anti-fibrotics in non-IPF progressive fibrosing ILD","authors":"Woon Hean Chong MD, Dipika Agrawal MD, Ze Ying Tan MD, Sridhar Venkateswaran MD, Adeline Yit Ying Tan MD, Ching Yee Tan MD, Norris Chun Ang Ling MD, Noel Stanley Wey Tut Tay MD","doi":"10.1016/j.hrtlng.2024.07.010","DOIUrl":"10.1016/j.hrtlng.2024.07.010","url":null,"abstract":"<div><h3>Background</h3><p>Anti-fibrotics can reduce restrictive impairment in idiopathic pulmonary fibrosis (IPF). However, its effectiveness in non-IPF progressive fibrosing interstitial lung disease (non-IPF PF-ILD) remains uncertain.</p></div><div><h3>Objective</h3><p>We assess the efficacy and safety of anti-fibrotics pirfenidone and nintedanib versus placebo among non-IPF PF-ILD adult patients.</p></div><div><h3>Methods</h3><p>Meta-analysis was performed using PubMed, SCOPUS, and Cochrane databases to identify randomized controlled trials (RCTs). At respective centers, non-IPF PF-ILD was defined as clinical and radiological findings inconsistent with IPF and greater than 5 % forced vital capacity (FVC) decline, worsening radiological fibrosis or respiratory symptoms.</p></div><div><h3>Results</h3><p>Among seven RCTs involving 1,816 non-IPF PF-ILD patients, anti-fibrotics significantly reduced decline in FVC from baseline in milliliters (MD -66.80milliliters; <em>P</em> < 0.01) and percent predicted (MD -1.80 %; <em>P</em> < 0.01) compared to placebo. However, severity of FVC decline was less than 10 % (<em>P</em> = 0.33) in both groups. No significant difference in the decline of 6MWD from baseline in meters (<em>P</em> = 0.19) while on anti-fibrotics, although those on pirfenidone had less decline in 6MWD (MD -25.12 m; <em>P</em> < 0.01) versus placebo. The rates of all-cause mortality (<em>P</em> = 0.34), all-cause hospitalization (<em>P</em> = 0.44), and hospitalization for respiratory etiology (<em>P</em> = 0.06) were comparable in both groups. Adverse events of nausea/vomiting (54.2 % vs. 20.3 %; <em>P</em> < 0.01), diarrhea (65.2 % vs. 27.6 %; <em>P</em> = 0.02), anorexia/weight loss (23.0 % vs. 7.7 %; <em>P</em> < 0.01), neurological disorders (20.8 % vs. 12.6 %; <em>P</em> < 0.01), and events requiring therapy discontinuation were higher (18.4 % vs. 9.9 %; <em>P</em> < 0.01) in the anti-fibrotic group. Other adverse events of skin (<em>P</em> = 0.18) and respiratory disorders (<em>P</em> = 0.20) were equal.</p></div><div><h3>Conclusion</h3><p>The advent of anti-fibrotics offers alternative treatment to reduce lung function decline.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 242-253"},"PeriodicalIF":2.4,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0