Pub Date : 2025-01-21DOI: 10.1164/rccm.202404-0816oc
Peter J Leary,Rachel J Le,Sumeet Panjabi,John Hartney,Amit Goyal,Charlotte Ward,Dwaipayan Mukherjee,Nathan Hatton,Samuel G Rayner,Hayley D Germack,John J Ryan
RATIONALEGuidelines recommend patients with pulmonary arterial hypertension (PAH) be referred to pulmonary hypertension (PH) centers, but little is known about where care is actually delivered in the United States (US).OBJECTIVESTo use prescription patterns to estimate the proportion of PAH care delivered at US PH centers and explore factors associated with location of care.METHODSThis retrospective study analyzed claims from the Komodo database in adults who received ≥1 PAH prescription between March 2021 and February 2022. A PH center was defined as accredited (Pulmonary Hypertension Association accreditation), high-volume (≥10 patients receiving parenteral prostacyclin), or a composite including either definition.MEASUREMENTS AND MAIN RESULTSAnalyses included 12,137 patients. Only 37.1% of patients received PAH-specific prescriptions from PH centers. A minority of patients on monotherapy (31.8%) received prescriptions from PH centers. A greater fraction of patients on triple therapy (61.8%) received prescriptions from PH centers. Patients on monotherapy were less likely to receive prescriptions from a PH center if they were older, male, had a higher comorbidity burden, had Medicaid, resided in the South or West, or lived in a 3-digit ZIP code without a PH center. Fewer characteristics were associated with PH center-based care for patients on dual or triple therapy; however, ZIP code and insurance status were associated with center-based care for these patients.CONCLUSIONSA minority of US patients received PAH-specific prescription from a PH center. This potential guideline discordance warrants further exploration and may require guidelines to be revisited or the health system to adapt.
{"title":"Location of Care Delivery for Pulmonary Arterial Hypertension in the United States.","authors":"Peter J Leary,Rachel J Le,Sumeet Panjabi,John Hartney,Amit Goyal,Charlotte Ward,Dwaipayan Mukherjee,Nathan Hatton,Samuel G Rayner,Hayley D Germack,John J Ryan","doi":"10.1164/rccm.202404-0816oc","DOIUrl":"https://doi.org/10.1164/rccm.202404-0816oc","url":null,"abstract":"RATIONALEGuidelines recommend patients with pulmonary arterial hypertension (PAH) be referred to pulmonary hypertension (PH) centers, but little is known about where care is actually delivered in the United States (US).OBJECTIVESTo use prescription patterns to estimate the proportion of PAH care delivered at US PH centers and explore factors associated with location of care.METHODSThis retrospective study analyzed claims from the Komodo database in adults who received ≥1 PAH prescription between March 2021 and February 2022. A PH center was defined as accredited (Pulmonary Hypertension Association accreditation), high-volume (≥10 patients receiving parenteral prostacyclin), or a composite including either definition.MEASUREMENTS AND MAIN RESULTSAnalyses included 12,137 patients. Only 37.1% of patients received PAH-specific prescriptions from PH centers. A minority of patients on monotherapy (31.8%) received prescriptions from PH centers. A greater fraction of patients on triple therapy (61.8%) received prescriptions from PH centers. Patients on monotherapy were less likely to receive prescriptions from a PH center if they were older, male, had a higher comorbidity burden, had Medicaid, resided in the South or West, or lived in a 3-digit ZIP code without a PH center. Fewer characteristics were associated with PH center-based care for patients on dual or triple therapy; however, ZIP code and insurance status were associated with center-based care for these patients.CONCLUSIONSA minority of US patients received PAH-specific prescription from a PH center. This potential guideline discordance warrants further exploration and may require guidelines to be revisited or the health system to adapt.","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"28 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1164/rccm.202406-1162oc
Carmen A T Reep,Evert-Jan Wils,Lucas M Fleuren,Alexander Breskin,Giacomo Bellani,John G Laffey,Laurent J Brochard,Tài Pham,Leo Heunks,
RATIONALEIn critically ill patients receiving invasive mechanical ventilation, switching from controlled to assisted ventilation is a crucial milestone towards ventilator liberation. The optimal timing for switching to assisted ventilation has not been studied.OBJECTIVESOur objective was to determine whether a strategy of early as compared to delayed switching affects the duration of invasive mechanical ventilation, ICU length of stay, and mortality.METHODSWe conducted a target trial emulation using the prospective, global WEAN SAFE dataset. Patients were eligible for switching if still on controlled mechanical ventilation, not receiving neuromuscular blockers, and PaO2/FiO2 ratio >150 mmHg. We compared an "early switching" strategy (switch within one day after reaching switching eligibility criteria) to a "delayed switching" strategy (switch one or more days after reaching the switching eligibility criteria). Primary outcome was the 28-day cumulative incidence of successful extubation. Secondary outcomes included 28-day and 90-day ICU discharge and ICU mortality.MEASUREMENTS AND MAIN RESULTS1489 patients met the switching eligibility criteria. The early switch group had, on average, 4 additional days of being successfully extubated over the 28-day period (95% CI: 3, 6; P<0.001) compared to the delayed group, with a higher difference in cumulative incidence of successful extubation at day 28 (7%; 95% CI: 0, 13; P=0.04). Early switching was associated with an 11% higher cumulative incidence of ICU discharge at day 28 (95% CI: 7, 18; P<0.001) and an average of 7 additional days discharged from the ICU over the 90-day period (95% CI: 4, 12; P<0.001) compared to delayed switching. ICU mortality rates did not differ between the strategies.CONCLUSIONSEarly switching from controlled to assisted ventilation is associated with shorter duration of invasive mechanical ventilation and ICU stay compared to delayed switching.
{"title":"Early vs. Delayed Switching from Controlled to Assisted Ventilation: A Target Trial Emulation.","authors":"Carmen A T Reep,Evert-Jan Wils,Lucas M Fleuren,Alexander Breskin,Giacomo Bellani,John G Laffey,Laurent J Brochard,Tài Pham,Leo Heunks,","doi":"10.1164/rccm.202406-1162oc","DOIUrl":"https://doi.org/10.1164/rccm.202406-1162oc","url":null,"abstract":"RATIONALEIn critically ill patients receiving invasive mechanical ventilation, switching from controlled to assisted ventilation is a crucial milestone towards ventilator liberation. The optimal timing for switching to assisted ventilation has not been studied.OBJECTIVESOur objective was to determine whether a strategy of early as compared to delayed switching affects the duration of invasive mechanical ventilation, ICU length of stay, and mortality.METHODSWe conducted a target trial emulation using the prospective, global WEAN SAFE dataset. Patients were eligible for switching if still on controlled mechanical ventilation, not receiving neuromuscular blockers, and PaO2/FiO2 ratio >150 mmHg. We compared an \"early switching\" strategy (switch within one day after reaching switching eligibility criteria) to a \"delayed switching\" strategy (switch one or more days after reaching the switching eligibility criteria). Primary outcome was the 28-day cumulative incidence of successful extubation. Secondary outcomes included 28-day and 90-day ICU discharge and ICU mortality.MEASUREMENTS AND MAIN RESULTS1489 patients met the switching eligibility criteria. The early switch group had, on average, 4 additional days of being successfully extubated over the 28-day period (95% CI: 3, 6; P<0.001) compared to the delayed group, with a higher difference in cumulative incidence of successful extubation at day 28 (7%; 95% CI: 0, 13; P=0.04). Early switching was associated with an 11% higher cumulative incidence of ICU discharge at day 28 (95% CI: 7, 18; P<0.001) and an average of 7 additional days discharged from the ICU over the 90-day period (95% CI: 4, 12; P<0.001) compared to delayed switching. ICU mortality rates did not differ between the strategies.CONCLUSIONSEarly switching from controlled to assisted ventilation is associated with shorter duration of invasive mechanical ventilation and ICU stay compared to delayed switching.","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"98 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1164/rccm.202409-1802rl
Ya Xiao,Runxue Ma,Ce Liu,Huanhuan Wei,Baofeng Zhou,Chunyan Gui,Bo Yang,Yunshan Cao,Kai Zhang,Bin Luo
{"title":"Insights into Pulmonary Heart Disease at High Altitude: Hypoxia and PM2.5 Interactions.","authors":"Ya Xiao,Runxue Ma,Ce Liu,Huanhuan Wei,Baofeng Zhou,Chunyan Gui,Bo Yang,Yunshan Cao,Kai Zhang,Bin Luo","doi":"10.1164/rccm.202409-1802rl","DOIUrl":"https://doi.org/10.1164/rccm.202409-1802rl","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"32 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Novel Therapies for Sleep Disorder Breathing.","authors":"Gonzalo Labarca,Dana Saleh,Anunya Hiranrattana,Eric Heckman","doi":"10.1164/rccm.202408-1542rr","DOIUrl":"https://doi.org/10.1164/rccm.202408-1542rr","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"46 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1164/rccm.202411-2308ed
Adrian Ceccato,Oscar Peñuelas,Antonio Artigas
{"title":"Dynamics of Subphenotypes in Critical Illness: When the Tick-Tock of the Clock Counts.","authors":"Adrian Ceccato,Oscar Peñuelas,Antonio Artigas","doi":"10.1164/rccm.202411-2308ed","DOIUrl":"https://doi.org/10.1164/rccm.202411-2308ed","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"107 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1164/rccm.202410-1891LE
Huajian Shan, Peixin Liu, Xiao Wang
{"title":"Bone-Specific Manifestations of Spondylothoracic Dysostosis in Jarcho-Levin Syndrome.","authors":"Huajian Shan, Peixin Liu, Xiao Wang","doi":"10.1164/rccm.202410-1891LE","DOIUrl":"https://doi.org/10.1164/rccm.202410-1891LE","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1164/rccm.202412-2431vp
Andy Bush,Ian D Pavord
{"title":"Stop the Asthma Treatment Elevator, We Need to Get Off!","authors":"Andy Bush,Ian D Pavord","doi":"10.1164/rccm.202412-2431vp","DOIUrl":"https://doi.org/10.1164/rccm.202412-2431vp","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"128 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1164/rccm.202412-2418LE
Wilfredo De Jesús-Rojas, Alberto Santiago Cornier
{"title":"Reply to Shan <i>et al.</i>: Bone-Specific Manifestations of Spondylothoracic Dysostosis in Jarcho-Levin Syndrome.","authors":"Wilfredo De Jesús-Rojas, Alberto Santiago Cornier","doi":"10.1164/rccm.202412-2418LE","DOIUrl":"https://doi.org/10.1164/rccm.202412-2418LE","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1164/rccm.202408-1599vp
Amin Adibi,Mohsen Sadatsafavi,Emily P Brigham,Surya P Bhatt
{"title":"Is Achieving a Fully Race-Neutral Approach to Lung Function Classification Even Possible?","authors":"Amin Adibi,Mohsen Sadatsafavi,Emily P Brigham,Surya P Bhatt","doi":"10.1164/rccm.202408-1599vp","DOIUrl":"https://doi.org/10.1164/rccm.202408-1599vp","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"37 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-16DOI: 10.1164/rccm.202410-1959pp
Kostas A Papavassiliou,Amalia A Sofianidi,Vassiliki A Gogou,Georgios Marinos,Athanasios G Papavassiliou
{"title":"NSCLC to SCLC Transformation: A Clinical Challenge.","authors":"Kostas A Papavassiliou,Amalia A Sofianidi,Vassiliki A Gogou,Georgios Marinos,Athanasios G Papavassiliou","doi":"10.1164/rccm.202410-1959pp","DOIUrl":"https://doi.org/10.1164/rccm.202410-1959pp","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"5 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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