CHEST Physician
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Advancements in nutritional management for critically ill patients
Nutrition plays an important role in the management and recovery of critically ill patients admitted to the ICU. Major guidelines recommend that critically ill patients should receive 1.2 to 2.0 g/kg/day of protein, with an emphasis on early (within 48 hours of ICU admission) enteral nutrition.1 2 3 In a randomized controlled trial involving 173…
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HALT early recognition is key
Hyperammonemia after lung transplantation (HALT) is a rare but serious complication occurring in 1% to 4% of patients with high morbidity and mortality. Typically presenting within 2 weeks post transplant, HALT manifests as elevated serum ammonia levels with symptoms ranging from encephalopathy to seizures and cerebral edema. Early recognition is crucial, as mortality rates can…
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New developments on the forefront of intermediate-risk pulmonary embolism
Patients with intermediate-risk pulmonary embolism (IRPE), or those with right ventricular dysfunction without overt hemodynamic instability, represent a heterogenous population with short-term mortality ranging from 2% to 17%.1 While systemic anticoagulation is the mainstay therapy, select individuals may benefit from more immediate reperfusion. Catheter-based therapies (CBT), including thrombus aspiration, fragmentation, or catheter-directed thrombolysis, have seen…
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Hospital to home tracheostomy care
Patients with tracheostomies require comprehensive planning to avoid adverse events. Technological improvement has enhanced our ability to support these patients with complex conditions in their home settings. However, clinical practice guidelines are lacking, and current practice relies on a consensus of expert opinions.1 2 3 Once a patient who has had a tracheostomy begins transitioning…
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OSA in pregnancy: Who to test, how to screen, and does treatment help?
The estimated prevalence of OSA in pregnancy ranges from 4% to 27% compared with 0.7% to 6.5% in nonpregnant, reproductive-age females, with an even higher prevalence in complicated pregnancies.1 The increased prevalence in pregnancy can be explained by physiologic changes impacting the upper airway such as increases in maternal blood volume and reductions in oncotic…
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APPs and POCUS: Overcoming credentialing challenges
Advanced practice providers (APPs) play an integral role in the care and management of patients both in the ICU and across the spectrum of health care. Due to reduced residency hours and the coming physician shortage, APPs are playing, and will continue to play, a greater role in the care and management of critically ill…
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Improving ILD diagnosis in primary care settings
Interstitial lung diseases (ILDs), with their many ubiquitous symptoms, are often hard to diagnose in patients. That’s why Amirahwaty Abdullah, MBBS, and Kavitha Selvan, MD, see value in educating clinicians on how to identify and diagnose ILD. Both Dr. Abdullah and Dr. Selvan received quality improvement grants from CHEST in October 2023 to do just…
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In memoriam: Dr. James E. Dalen
CHEST was recently informed of the death of former CHEST President, James E. Dalen, MD, MPH, Master FCCP. He served as CHEST President from 1985 to 1986. Dr. Dalen was a graduate of Washington State University. (His undergraduate education was temporarily interrupted when he served as a Corpsman in the Navy and Marines.) He held…
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Top reads from the CHEST journal portfolio – August 2024
Studying endotypes in sleep apnea, diagnostic testing in ILD, and inhaled corticosteroid use in children
