Cluster analysis identifies novel real-world lung disease-pulmonary hypertension subphenotypes: implications for treatment response.

Background: Clinical trials repurposing pulmonary arterial hypertension (PAH) therapies to patients with lung disease- or hypoxia-pulmonary hypertension (PH) (classified as World Health Organization Group 3 PH) have failed to show a consistent benefit. However, Group 3 PH clinical heterogeneity suggests robust phenotyping may inform detection of treatment-responsive subgroups. We hypothesised that cluster analysis would identify subphenotypes with differential responses to oral PAH therapy.

Socioeconomically disadvantaged veterans experience treatment delays for pulmonary arterial hypertension.

Prompt initiation of therapy after pulmonary arterial hypertension (PAH) diagnosis is critical to improve outcomes; yet delays in PAH treatment are common. Prior research demonstrates that individuals with PAH belonging to socially disadvantaged groups experience worse clinical outcomes. Whether these poor outcomes are mediated by delays in care or other factors is incompletely understood.

Organization of pulmonary hypertension care in non-expert care settings: Lessons learned from a multi-site study.

Objective: To examine how select Veterans Health Administration (VA) sites organized care for patients with pulmonary hypertension (PH), with a focus on describing existing practices and identifying unmet needs within the sites.

Data Sources And Study Setting: Semi-structured interviews across seven diverse VA sites.

Study Design: Qualitative multiple-site study.

Real-world use of inhaled treprostinil for lung disease-pulmonary hypertension: A protocol for patient evaluation and prescribing.

Inhaled treprostinil was approved recently for interstitial lung disease-pulmonary hypertension; however, efficacy in "real-world" populations is not known. We designed a protocol and report our experience evaluating 10 patients referred for therapy. Misdiagnosis at presentation was common; ultimately, three patients (30%) were prescribed drug.

Variation in Use of High-Flow Nasal Cannula and Noninvasive Ventilation Among Patients With COVID-19.

Background: The use of high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) for hypoxemic respiratory failure secondary to COVID-19 are recommended by critical-care guidelines; however, apprehension about viral particle aerosolization and patient self-inflicted lung injury may have limited use. We aimed to describe hospital variation in the use and clinical outcomes of HFNC and NIV for the management of COVID-19.

Methods: This was a retrospective observational study of adults hospitalized with COVID-19 who received supplemental oxygen between February 15, 2020, and April 12, 2021, across 102 international and United States hospitals by using the COVID-19 Registry.

Hospital Variation in Management and Outcomes of Acute Respiratory Distress Syndrome Due to COVID-19.

Objectives: To describe hospital variation in use of "guideline-based care" for acute respiratory distress syndrome (ARDS) due to COVID-19.

Design: Retrospective, observational study.

Setting: The Society of Critical Care Medicine's Discovery Viral Infection and

Patients: Adult patients with ARDS due to COVID-19 between February 15, 2020, and April 12, 2021.

Variation in Use of Repurposed Medications Among Patients With Coronavirus Disease 2019. From The Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 Registry Investigator Group.

Importance: At the start of the coronavirus disease 2019 pandemic, medications repurposed for management of coronavirus disease 2019 were used in the absence of clinical trial evidence.

Objectives: To describe the variation and evolution in use of repurposed medications for coronavirus disease 2019.

Design Setting And Participants: Observational cohort study of adults hospitalized with coronavirus disease 2019 between February 15, 2020, and April 12, 2021, across 76 United States and international hospitals within the Society of Critical Care Medicine's Discovery Viral Infection and Respiratory Illness Universal Study coronavirus disease 2019 registry.

Polymicrobial empyema; a novel case of .

Empyema or infection of the pleural space is a well described complication of pneumonia, however knowledge of culprit pathogens is still evolving. We report a novel case of empyema due to , a commensal of the oropharynx and female urogenital tract but previously undescribed cause of empyema We additionally review general pathogenesis of species within the pleural space. Familiarity with this unique pleural infection pathogen is important for selection of adequate antimicrobial therapy given the propensity of anaerobes such as species to disobey anatomic boundaries and recrudescence of infection in the absence of appropriate therapy.

Room for improvement in pulmonary capillary wedge pressure reporting: a review of hemodynamic tracings at a large academic medical center.

To describe the frequency with which pulmonary capillary wedge pressure measurements, obtained during right heart catheterization, are falsely elevated and to educate operators on techniques to improve accuracy of pulmonary capillary wedge pressure reporting. Failure to completely occlude pulmonary artery branch vessels during balloon inflation can lead to falsely elevated, "incomplete" pulmonary capillary wedge pressures. Balloon deflation prior to catheter retraction may result in catheter advancement into smaller branch vessels, yielding an inadvertent but more accurate alternative pulmonary capillary wedge pressure.

Spontaneous coronary artery dissection masquerading as Takotsubo cardiomyopathy: a case report.

Background: Although obstructive coronary artery disease (CAD) is the most likely cause of acute coronary syndromes (ACS), nearly one in 20 individuals with clinical myocardial infarction (MI) do not have obstructive CAD. For many such individuals, presentation of Takotsubo cardiomyopathy frequently mimics presentation of MI, though spontaneous coronary artery dissection (SCAD) is an increasingly recognized aetiology of MI in women.

Case Summary: This case report describes a woman with chest pain, found to have non-obstructive CAD on angiogram and left ventricular apical dysfunction on echocardiogram raising suspicion for Takotsubo cardiomyopathy.