Journal CHEST®
Effects of the Combination of Pimavanserin and Atomoxetine on OSA Severity
By Ludovico Messineo, PhD, and colleagues
Ato-pima taken 4.5 hours before bedtime reduced OSA severity by 42% compared with placebo, although patients remained with moderate OSA. Ato-pima also improved hypoxic burden, arousal burden, arousal intensity, loop gain, and collapsibility, without change in arousal threshold. Although sleep efficiency improved, daytime sleepiness (Epworth Sleepiness Scale) and sleep quality (visual analog scale) were not improved. Investigators were able to identify which patients were more likely to respond to therapy. For our patients with OSA, data from this study represents a meaningful addition to our therapeutic toolkit as we move toward more personalized treatment of OSA.
Commentary by Sreelatha Naik, MD, FCCP, Member of the CHEST Physician Editorial Board
CHEST® Critical Care
Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass Grafting
By Jon-Emile S. Kenny, MD, and colleagues
The article by Kenny and colleagues highlights the promising clinical utility of noninvasive carotid artery corrected flow time (ccFTD) as a surrogate for detecting stroke volume changes in patients who have undergone a coronary artery bypass grafting. Currently, accurate assessment of fluid responsiveness (FR) requires either invasive right heart catheterization or intermittent, operator-dependent imaging modalities such as point-of-care ultrasound. This study demonstrates that ccFTD measured using a wireless, wearable Doppler device accurately identified a ≥10% increase in stroke volume with high sensitivity (100%) and strong overall diagnostic performance (AUC up to 0.89).
Significantly, the authors found that a hands-free, continuous, operator-independent method can reliably assess FR in real time. This capability potentially offers ICU clinicians a dynamic, physiologic tool for guiding early goal-directed fluid resuscitation, without relying on static measures or invasive lines. If validated in larger and more diverse patient populations, this approach could significantly change how fluid management and hemodynamic monitoring are performed following cardiac surgery and across critical care settings.
Commentary by Timothy J. Kinsey, DMSc, PA-C, FCCP, Member of the CHEST Physician Editorial Board
CHEST® Pulmonary
Reevaluating the Role of Bronchoscopy Prior to Bronchial Artery Embolization in Nonintubated Patients With Hemoptysis Due to Bronchiectasis and Chronic Pulmonary Infection
By Takashi Nishihara, MD, and colleagues
Bronchiectasis and chronic pulmonary infections are strong predisposing risk factors for the development of mild to potentially life-threatening hemoptysis. With increased access to CT scans for radiographic evaluation, the role of bronchoscopy in localizing the source of hemorrhage prior to definitive intervention with bronchial artery embolization (BAE) is no longer clear. In this retrospective cohort study of 93 nonintubated patients, pre-BAE bronchoscopic evaluation of hemoptysis offered little to no benefit in planning the laterality and extent of arterial embolization for clinically significant hemoptysis due to bronchiectasis and chronic pulmonary infection. If CT scan imaging did not clarify the potential source(s) of bleeding, bronchoscopy was most effective, however, when performed within 48 hours of the last episode of hemoptysis.
While case-by-case evaluations should still be made, this study overall does not support the routine use of bronchoscopy in nonintubated patients prior to BAE for hemoptysis caused by bronchiectasis and chronic pulmonary infections.
Commentary by Michael Marll, MD, Member of the CHEST Physician Editorial Board
