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What's new in pulmonary and critical care medicine

What's new in pulmonary and critical care medicine
Authors:
April F Eichler, MD, MPH
Geraldine Finlay, MD
Literature review current through: Mar 2022. | This topic last updated: Apr 20, 2022.

The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.

COPD

Duration of IV antibiotics for acute pulmonary exacerbation of CF (November 2021)

The optimal duration of intravenous (IV) antibiotics in patients with cystic fibrosis (CF) is unknown. In a randomized study of adults with CF and an acute pulmonary exacerbation, 277 patients with early robust response were randomized to a 10- or 14-day course of antibiotics, and 705 slower responders were randomized to a 14- or 21-day course [1]. Within both groups, mean FEV1 change from baseline, improvements in symptoms score, rates of treatment failure, and drug-induced toxicity were similar regardless of the duration of antibiotics. These findings are likely applicable to children with CF and support our suggestion for a 10-day course of IV antibiotics for patients with an early robust response to therapy, and a 14-day course for those with a slower response to therapy. A longer course of antibiotics may be warranted for patients requiring intensive care and those who experience a CF exacerbation despite a recent course of IV antibiotics. (See "Cystic fibrosis: Treatment of acute pulmonary exacerbations", section on 'Duration of treatment'.)

CRITICAL CARE

Socioeconomic disadvantage contributes to symptoms after ICU admission (April 2022)

Whether socioeconomic factors contribute to the development of chronic physical or psychological symptoms associated with post-intensive care unit syndrome (PICS) was recently described. In one report of over 500 intensive care unit hospitalizations in older adults (>65 years), socioeconomic disadvantage (as defined by dual eligibility for Medicare-Medicaid) was associated with a 28 percent increase in physical disability and a 10-fold increase in the risk of transitioning to dementia, compared with older adults who were less disadvantaged [2]. Specific socioeconomic issues that contribute to this disparity are unclear and need further study. (See "Post-intensive care syndrome (PICS)", section on 'Risk factors'.)

High-flow oxygen in patients with COVID-19 (April 2022)

For patients with COVID-19 and acute hypoxemic respiratory failure, use of advanced noninvasive modalities (such as oxygen through high-flow nasal cannula [HFNC] or noninvasive ventilation) is a commonly used strategy to reduce the need for intubation. In a randomized trial of 220 such patients, intubations rates were lower with oxygen delivery through HFNC compared with standard low flow delivery [3]. HFNC also reduced time to clinical recovery, but the mortality difference was not statistically significant. Despite excluding several medical comorbidities, this trial supports our suggestion to use HFNC as an option for noninvasive oxygenation in individuals with COVID-19 who have advanced oxygen needs. (See "COVID-19: Respiratory care of the nonintubated hypoxemic adult (supplemental oxygen, noninvasive ventilation, and intubation)", section on 'Noninvasive modalities'.)

Corticosteroid regimens for COVID-19-related organizing pneumonia (April 2022)

Data to support the use of corticosteroids in patients who develop organizing pneumonia as a complication of COVID-19 are limited. In a recent open-label randomized trial, improvements in respiratory symptoms, lung imaging, and pulmonary function were reported, with no difference in outcomes between high- and low-dose prednisolone regimens (40 mg/day for one week, 30 mg/day for one week, 20 mg/day for two weeks, 10 mg/day for two weeks versus 10 mg/day for six weeks) [4]. These data support the efficacy of low-dose corticosteroid regimens in patients with COVID-19-related organizing pneumonia, although placebo-controlled randomized trials are needed to better inform this treatment decision. (See "COVID-19: Evaluation and management of adults following acute viral illness", section on 'Management'.)

Predictive model for acute kidney injury following cardiac surgery (March 2022)

A model has been proposed to predict the development of acute kidney injury (AKI) following cardiac surgery. The derivation model used basic metabolic panel laboratory values from over 58,000 adult patients who underwent cardiac surgery [5]. The model had excellent predictive discrimination for moderate to severe AKI within 72 hours after surgery (area under the curve [AUC] 0.876) and similarly performed well in the validation cohort (AUC 0.860). Further data are needed to determine whether such a model improves clinical outcomes before it can be routinely used in the clinical setting. (See "Postoperative complications among patients undergoing cardiac surgery", section on 'Renal dysfunction'.)

No benefit for prophylactic antiseizure medication in adults after resuscitation from cardiac arrest (March 2022)

Whether prophylactic antiseizure medication benefits adult survivors of cardiac arrest who are at risk of seizures is unclear and clinical practice varies. In a recent open-label trial of 172 adults who had rhythmic and periodic electroencephalographic (RP-EEG) patterns that indicate significant brain injury following resuscitation from cardiac arrest, poor neurologic outcome (severe disability, coma, or death) at three months was not significantly different for those assigned to prophylactic antiseizure medication and standard care compared with standard care alone (90 versus 92 percent, respectively); approximately 80 percent of patients died by three months in both groups [6]. These findings suggest that antiseizure medications do not reduce adverse neurologic outcomes or death in patients resuscitated from cardiac arrest who have RP-EEG and support our current practice of not using prophylactic antiseizure medication. (See "Intensive care unit management of the intubated post-cardiac arrest adult patient", section on 'Prophylaxis'.)

Fluid resuscitation with saline or buffered crystalloid in adults (March 2022, Modified March 2022)

The choice between normal saline (NS) and a buffered salt solution (BSS) for initial fluid resuscitation in adults is debated. Recent large trials have failed to show superiority of one over the other [7-9]. In a new meta-analysis of six randomized trials with low risk of bias in nearly 35,000 adults requiring fluid resuscitation, BSS led to small and statistically nonsignificant reductions in both 90-day mortality (risk ratio [RR] 0.96, 95% CI 0.91-1.01) and acute kidney injury (RR 0.96, 95% CI 0.89-1.02) compared with NS [10]. Many of the trials had limitations including poor recruitment, low volumes of administered fluid, and unavailable data. In addition, the two types of fluids have differing advantages and disadvantages depending on blood chemistries and volume status. We suggest that the choice between fluids be individualized and re-evaluated following initial resuscitation. (See "Treatment of severe hypovolemia or hypovolemic shock in adults", section on 'Choosing between 0.9 percent saline and buffered crystalloid'.)

Noninvasive respiratory support for patients with COVID-19 and acute hypoxemic respiratory failure (February 2022)

In patients with COVID-19 and acute hypoxemic respiratory failure despite conventional oxygen therapy, the best approach to escalation of noninvasive respiratory support is unknown. In a randomized, multicenter trial of over 1200 patients with acute hypoxemic respiratory failure due to COVID-19, continuous positive airway pressure (CPAP), but not high flow oxygen via nasal cannula (HFNC), reduced intubation rates compared with conventional oxygen (33 versus 41 percent) [11]. Thirty-day mortality was not significantly different for either modality compared with conventional oxygen. However, important limitations of this study include the open-label design, early cessation of the trial, and high crossover between groups. For patients with COVID-19 who have increasing oxygen needs and do not have conditions best treated with noninvasive ventilation (NIV; hypercapnic respiratory failure due to an exacerbation of chronic obstructive pulmonary disease or acute cardiogenic pulmonary edema), we trial NIV (CPAP or bilevel positive airway pressure), HFNC, or cycle between both until patients demonstrate improvement or deterioration. The tolerability of the device and patient comfort often determine the best modality. (See "COVID-19: Respiratory care of the nonintubated hypoxemic adult (supplemental oxygen, noninvasive ventilation, and intubation)", section on 'Choosing oxygen via high-flow nasal cannulae versus noninvasive ventilation'.)

Prolonged duration of symptoms in COVID-19 ICU survivors (February 2022)

The duration of symptoms following COVID-19 is unclear. A recent study reported that three-quarters of intensive care unit COVID-19 survivors had physical symptoms at one year. These included physical weakness (39 percent), joint symptoms (26 percent), and myalgia (21 percent) [12]. Mental symptoms were reported by 26 percent and cognitive symptoms by 16 percent of survivors. These symptoms are consistent with post-intensive care syndrome (PICS) and need to be addressed during recovery from COVID-19. (See "COVID-19: Evaluation and management of adults following acute viral illness", section on 'Persistent symptoms'.)

Three-step program of caregiver support for the dying patient (February 2022)

The optimal approach to support caregivers of dying patients in the intensive care unit (ICU) is unknown. One study described a successful approach with a three-step, physician-driven, nurse-aided support strategy for 875 relatives of patients dying in the ICU [13]. The first step was an end-of-life conversation, the second was a physical presence of health care personnel in the room during the dying process, and the third was a meeting to express condolences after death. Compared with standard care, at six months, the three-step program reduced the number of relatives with prolonged grief (PG) symptoms (21 versus 15 percent) and the median prolonged grief-13 questionnaire score (19 versus 21). This study supports the practice of a structured system designed to improve communication and empathy to caregivers of the dying in the ICU but may not be generalizable. (See "Withholding and withdrawing ventilatory support in adults in the intensive care unit".)

Target temperature after sudden cardiac arrest in adults (December 2021)

For patients who survive sudden cardiac arrest (SCA) and have an indication for targeted temperature management (TTM), the optimal temperature is unknown. Two studies have recently addressed this issue:

In a network meta-analysis of 10 randomized trials (over 4200 patients) survival with good function was similar for patients regardless of targeted temperature after SCA, including deep hypothermia (31 to 32°C), moderate hypothermia (33 to 34°C), mild hypothermia (35 to 36°C), or normothermia (37 to 37.8°C) [14]. However, moderate and deep hypothermia were associated with a higher incidence of arrhythmia when compared with normothermia (OR 1.45, and OR 3.58, respectively).

In a randomized trial of over 700 patients, not included in the above meta-analysis, no survival benefit or difference in neurologic outcomes was reported when a temperature of either 31°C (deep hypothermia) or 34°C (moderate hypothermia) was targeted for 24 hours after SCA [15]. There were no differences among the groups for adverse events except for a higher rate of deep vein thrombosis in those receiving deep hypothermia (4 versus 8 percent). However, the study may have been underpowered to detect a difference between the groups.

These trials suggest that deep hypothermia may not be beneficial for patients with SCA, although patients with severe neurologic injury were excluded from these and other trials. Until data support select target temperatures for specific subgroups, we advise individualizing targets for patients with SCA between the range of 33 and 37.5°C. (See "Intensive care unit management of the intubated post-cardiac arrest adult patient", section on 'Setting the target temperature'.)

Updated difficult airway guidelines for adults and children (December 2021)

The American Society of Anesthesiologists has updated its difficult airway guidelines for both adult and pediatric patients and created new algorithms (algorithm 1 and algorithm 2) and infographics. The new guidelines stress prioritizing oxygenation throughout airway management; confirming ventilation with end tidal CO2 regardless of the airway device used; and limiting attempts with each device or technique to three, with one more attempt by a more experienced operator [16]. The new guidelines also provide robust guidance for extubation. (See "Management of the difficult airway for general anesthesia in adults", section on 'Importance of an algorithmic approach'.)

Updated Surviving Sepsis Campaign guidelines (November 2021)

Recent adult guidelines were issued by the Surviving Sepsis Campaign [17]. Major changes with the 2016 guidelines included a preference for balanced salt solutions as the initial resuscitation fluid, a recommendation to not delay vasopressors while waiting for central venous access, and the administration of intravenous hydrocortisone to patients with ongoing septic shock. Additional changes included a recommendation against the administration of vitamin C as well as support for the early identification and treatment of mental, emotional, and physical ailments in survivors of sepsis. (See "Evaluation and management of suspected sepsis and septic shock in adults".)

INTERSTITIAL LUNG DISEASE

Screening females with tuberous sclerosis for lymphangioleiomyomatosis (October 2021)

Adult females with tuberous sclerosis complex (TSC) have a high prevalence of lymphangioleiomyomatosis (LAM), a progressive cystic lung disorder that affects approximately 25 percent of patients at age 18 years and 80 percent at age 40 years. Based on this high prevalence, recent guidelines from the International TSC Consensus Guidelines group suggest screening asymptomatic females with TSC who were 18 years and older using low-dose noncontrast chest computed tomography (CT) [18]. If the CT does not reveal LAM cysts, it is repeated every 5 to 10 years. This guidance supports our current screening practices. (See "Tuberous sclerosis complex associated lymphangioleiomyomatosis in adults", section on 'Screening for TSC-LAM'.)

LUNG TRANSPLANTATION

ISHLT guidelines for lung transplant recipient selection (November 2021)

The International Society for Heart and Lung Transplantation (ISHLT) has updated their guidelines for selection of lung transplant recipients [19]. Careful donor selection is essential to optimize post-transplant results. Early referral for transplant evaluation is encouraged to allow time for a methodical evaluation and to address modifiable barriers to transplant. Clinical advances in transplantation mean that there are fewer absolute contraindications to lung transplant candidacy than prior guidelines. Risk factors that no longer represent absolute contraindications include BMI ≥35 kg/m2 and chest wall/spinal deformities; other contraindications (eg, malignancy, other vital organ dysfunction) are more precisely defined; and the relative contraindication of age >65 years has increased to >70 years. The new guidelines also update features that confer high risk of a poor outcome that may be manageable at selected centers and other factors that are unfavorable but may be acceptable when present in isolation. (See "Lung transplantation: General guidelines for recipient selection", section on 'Contraindications and risk factors for poor outcomes'.)

PULMONARY VASCULAR DISEASE

Mortality from pulmonary hypertension in thalassemia (April 2022)

Individuals with thalassemia are at risk for pulmonary hypertension due to a combination of risk factors, especially hemolysis and iron overload. A new study monitored 24 individuals with thalassemia who had right heart catheterization-documented pulmonary arterial hypertension (PAH) [20]. The median age was 46.5 years. During a median of four years of follow-up, 13 patients died, and 10 of the deaths were attributed to PAH. Survival strongly correlated with PAH therapy. Patients with thalassemia and PAH need routine monitoring and multidisciplinary treatment by clinicians with expertise in treating PAH [21]. (See "Management of thalassemia", section on 'Pulmonary hypertension'.)

Adjusted D-dimer targets for deep vein thrombosis (March 2022)

The optimal strategy to diagnose deep vein thrombosis (DVT) is unknown. One recent study described an approach that excluded DVT when the D-dimer was <1000 ng/mL (in patients with a low Wells pretest probability) or <500 ng/mL (in patients with a moderate clinical pretest probability) (calculator 1) [22]. Using this strategy, only 0.6 percent of those in whom DVT was excluded developed DVT during the three-month follow-up. In addition, it was estimated that this approach reduced the need for ultrasonography by almost 50 percent. However, this strategy was not directly compared with the traditional approach that uses a single cutoff D-dimer value of <500 ng/mL, and further study is needed before it can be routinely used for the diagnosis of patients with suspected DVT. (See "Clinical presentation and diagnosis of the nonpregnant adult with suspected deep vein thrombosis of the lower extremity", section on 'D-dimer'.)

Updated guidelines on venous thromboembolism management (January 2022)

Updated guidelines on the treatment of venous thromboembolism (VTE) were published by the American College of Chest Physicians (CHEST) [23]. Many recommendations are similar to those in the 2016 guideline but either expanded in scope or changed in strength of the recommendation. As new recommendations, for most patients with cancer-related VTE, CHEST suggests a direct oral anticoagulant (DOAC) rather than low molecular weight heparin. For select patients without cancer who require extended anticoagulation beyond the conventional period of three to six months, CHEST suggests low-intensity anticoagulation with a DOAC. While CHEST did not promote aspirin for VTE prevention, they suggest that it may reduce the risk of recurrence when compared with no therapy. (See "Overview of the treatment of lower extremity deep vein thrombosis (DVT)" and "Anticoagulation therapy for venous thromboembolism (lower extremity venous thrombosis and pulmonary embolism) in adult patients with malignancy" and "Selecting adult patients with lower extremity deep venous thrombosis and pulmonary embolism for indefinite anticoagulation".)

Comparison of protocols for the diagnosis of pulmonary embolism (January 2022)

The ideal strategy for diagnosing pulmonary embolism (PE) is unknown. One meta-analysis reported that protocols that used pretest probability (PTP) models, adjusted D-Dimer levels, and/or YEARs criteria excluded more cases of PE without imaging (high efficiency) [24]. However, they also had the highest failure rate (ie, more missed cases of VTE). In addition, such protocols did not perform uniformly across all subgroups, with the lowest efficiency observed in those who were 80 years of age or older and in patients with cancer. In patients with suspected PE, we prefer to use a conventional protocol that combines clinical PTP and unadjusted D-Dimer to direct imaging. Although this approach is associated with a higher rate of imaging, fewer cases of PE are missed and we value the role of imaging when looking for alternate causes of patients' symptoms. (See "Clinical presentation, evaluation, and diagnosis of the nonpregnant adult with suspected acute pulmonary embolism", section on 'Adjusted D-dimer'.)

Recurrence rates in subsegmental pulmonary embolism (December 2021)

In patients with subsegmental pulmonary embolism (SSPE), the incidence of venous thromboembolism (VTE) recurrence is unclear. Older retrospective studies suggested low recurrence rates [25-27]. A more recent and larger prospective study of 292 patients with SSPE and no evidence of deep venous thrombosis (DVT) who were managed without anticoagulation reported a recurrence rate of 3.1 percent at 90 days, which is higher than the expected rate in the general population (<1 percent) [28]. Rates were highest in those with multiple SSPE (5.7 percent) and older patients >65 years (5.5 percent). No fatalities were reported. This study supports our practice of routine anticoagulation for most patients with SSPE. (See "Treatment, prognosis, and follow-up of acute pulmonary embolism in adults", section on 'Patients with subsegmental PE'.)

YEARS plus age-adjusted D-Dimer to diagnose PE (December 2021)

In a recent randomized trial of over 1200 patients who were positive for pulmonary embolism (PE) rule out criteria (PERC) (table 1) and had a low or intermediate clinical probability of PE, further triage using YEARS criteria plus age-adjusted D-Dimer (intervention group) resulted in a 10 percent reduction in chest imaging and a 1.6-hour reduction in the emergency department (ED) stay without significantly impacting the three-month rate of venous thromboembolism (VTE) compared with age-adjusted D-Dimer alone (conventional group) [29]. While encouraging, the complexity of this protocol may not be practical in busy settings. We continue to use a simple protocol that uses the more conventional strategy of clinical pretest probability and unadjusted D-Dimer. Although this strategy leads to more imaging, we place value in chest imaging which can help explain patients' symptoms when PE is not found. (See "Clinical presentation, evaluation, and diagnosis of the nonpregnant adult with suspected acute pulmonary embolism", section on 'Adjusted D-dimer'.)

Choosing apixaban or rivaroxaban for venous thromboembolism (December 2021)

Although several direct oral anticoagulants (DOACs) are available for treating patients with venous thromboembolism (VTE), no randomized trials support choosing one over another. A recent retrospective study reported that among 37,000 new users of apixaban or rivaroxaban, apixaban was associated with lower rates of recurrent VTE (hazard ratio [HR] 0.77, 95% CI 0.69-0.87) and bleeding (HR 0.60, 95% CI 0.53-0.69) [30]. While these data favor apixaban, we continue to favor an individualized choice among DOACs that also take into consideration cost, availability, and preference for once- versus twice-daily dosing. (See "Venous thromboembolism: Anticoagulation after initial management", section on 'Efficacy' and "Direct oral anticoagulants (DOACs) and parenteral direct-acting anticoagulants: Dosing and adverse effects".)

SLEEP MEDICINE

Effects of rotating work shift direction on sleep and performance (November 2021)

Sleep duration and sleep quality are commonly affected in shift workers, and certain patterns of shift rotation may be more difficult than others. In a cohort study of 144 nurses working shifts that were either forward-rotating (ie, morning, then afternoon, then overnight) or backward-rotating, both schedules were associated with adverse performance, but levels of sleepiness and decrements in vigilance and reaction time were greater among those on a backward-rotating schedule [31]. These data confirm previous impressions that individuals may find it easier to adjust to forward-rotating shift schedules, particularly if the speed of rotation is slow (eg, >4 days per shift assignment). (See "Sleep-wake disturbances in shift workers", section on 'Sleep disturbances'.)

OTHER PULMONARY MEDICINE

CDC definition of post-acute COVID-19 (October 2021)

The Centers for Disease Control and Prevention (CDC) recently updated their definition of post-acute sequelae of SARS-CoV-2 infection (PASC; "long-COVID") [32]. While it was previously defined as "patients with a broad range of symptoms (physical and mental) that develop during or after COVID-19, continue for ≥4 weeks, and are not explained by an alternate diagnosis," the CDC further specified the duration of symptoms to include only those with symptoms for ≥2 months (ie, 3 months from the onset). (See "COVID-19: Evaluation and management of adults following acute viral illness", section on 'Terminology and stages of recovery'.)

Post-COVID-19 symptoms not affected by vaccination (October 2021)

Some patients with persistent symptoms following COVID-19 are concerned that vaccination could exacerbate them. A recent study of 163 patients who had a heavy burden of post-COVID-19 symptoms at eight months reported that most patients' symptoms had either improved or remained unchanged one month after receiving either the BNT162b2 (Pfizer) or ChAdOx1 nCoV-19/AZD1222 (AstraZeneca) vaccine [33]. We continue to recommend vaccination in patients following COVID-19, regardless of the presence of persistent symptoms. (See "COVID-19: Vaccines", section on 'History of SARS-CoV-2 infection' and "COVID-19: Evaluation and management of adults following acute viral illness", section on 'Persistent symptoms'.)

Risk of GI bleeding with DOACs (October 2021)

Direct oral anticoagulants (DOACs) are generally preferred over warfarin in individuals with non-valvular atrial fibrillation or venous thromboembolism. A new study evaluated the risk of gastrointestinal (GI) bleeding in over 5000 individuals taking apixaban, rivaroxaban, or dabigatran [34]. Higher rates of GI bleeding were seen in individuals taking rivaroxaban (3.2 per 100 patient-years) than with the other agents (2.5 for apixaban and 1.9 for dabigatran). The once-daily dosing of rivaroxaban and higher peak levels may explain the higher bleeding risk; the other agents are dosed twice daily. These results may be a consideration when choosing among DOACs. (See "Direct oral anticoagulants (DOACs) and parenteral direct-acting anticoagulants: Dosing and adverse effects", section on 'Differences between factor Xa inhibitors'.)

REFERENCES

  1. Goss CH, Heltshe SL, West NE, et al. A Randomized Clinical Trial of Antimicrobial Duration for Cystic Fibrosis Pulmonary Exacerbation Treatment. Am J Respir Crit Care Med 2021; 204:1295.
  2. Jain S, Murphy TE, O'Leary JR, et al. Association Between Socioeconomic Disadvantage and Decline in Function, Cognition, and Mental Health After Critical Illness Among Older Adults : A Cohort Study. Ann Intern Med 2022.
  3. Ospina-Tascón GA, Calderón-Tapia LE, García AF, et al. Effect of High-Flow Oxygen Therapy vs Conventional Oxygen Therapy on Invasive Mechanical Ventilation and Clinical Recovery in Patients With Severe COVID-19: A Randomized Clinical Trial. JAMA 2021; 326:2161.
  4. Dhooria S, Chaudhary S, Sehgal IS, et al. High-dose versus low-dose prednisolone in symptomatic patients with post-COVID-19 diffuse parenchymal lung abnormalities: an open-label, randomised trial (the COLDSTER trial). Eur Respir J 2022; 59.
  5. Demirjian S, Bashour CA, Shaw A, et al. Predictive Accuracy of a Perioperative Laboratory Test-Based Prediction Model for Moderate to Severe Acute Kidney Injury After Cardiac Surgery. JAMA 2022; 327:956.
  6. Ruijter BJ, Keijzer HM, Tjepkema-Cloostermans MC, et al. Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest. N Engl J Med 2022; 386:724.
  7. Zampieri FG, Machado FR, Biondi RS, et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial. JAMA 2021.
  8. Zampieri FG, Machado FR, Biondi RS, et al. Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial. JAMA 2021; 326:830.
  9. Finfer S, Micallef S, Hammond N, et al. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. N Engl J Med 2022; 386:815.
  10. Hammond N, Zampieri F, Di Tanna G, Garside T et. Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis. NEJM Evidence 2022; https://doi.org10.1056/EVIDoa2100010.
  11. Perkins GD, Ji C, Connolly BA, et al. Effect of Noninvasive Respiratory Strategies on Intubation or Mortality Among Patients With Acute Hypoxemic Respiratory Failure and COVID-19: The RECOVERY-RS Randomized Clinical Trial. JAMA 2022; 327:546.
  12. Heesakkers H, van der Hoeven JG, Corsten S, et al. Clinical Outcomes Among Patients With 1-Year Survival Following Intensive Care Unit Treatment for COVID-19. JAMA 2022; 327:559.
  13. Kentish-Barnes N, Chevret S, Valade S, et al. A three-step support strategy for relatives of patients dying in the intensive care unit: a cluster randomised trial. Lancet 2022; 399:656.
  14. Fernando SM, Di Santo P, Sadeghirad B, et al. Targeted temperature management following out-of-hospital cardiac arrest: a systematic review and network meta-analysis of temperature targets. Intensive Care Med 2021; 47:1078.
  15. Le May M, Osborne C, Russo J, et al. Effect of Moderate vs Mild Therapeutic Hypothermia on Mortality and Neurologic Outcomes in Comatose Survivors of Out-of-Hospital Cardiac Arrest: The CAPITAL CHILL Randomized Clinical Trial. JAMA 2021; 326:1494.
  16. Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022; 136:31.
  17. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med 2021; 49:e1063.
  18. Northrup H, Aronow ME, Bebin EM, et al. Updated International Tuberous Sclerosis Complex Diagnostic Criteria and Surveillance and Management Recommendations. Pediatr Neurol 2021; 123:50.
  19. Leard LE, Holm AM, Valapour M, et al. Consensus document for the selection of lung transplant candidates: An update from the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2021; 40:1349.
  20. Pinto VM, Musallam KM, Derchi G, et al. Mortality in β-thalassemia patients with confirmed pulmonary arterial hypertension on right heart catheterization. Blood 2022; 139:2080.
  21. Wood JC. Pulmonary hypertension in thalassemia: a call to action. Blood 2022; 139:1937.
  22. Kearon C, De Wit K, Parpia s, et. al.. Diagnosis of deep vein thrombosis with D-dimer adjusted to clinical probability: prospective diagnostic management study. BMJ 2022; 376:e067378.
  23. Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. Chest 2021; 160:e545.
  24. Stals MAM, Takada T, Kraaijpoel N, et al. Safety and Efficiency of Diagnostic Strategies for Ruling Out Pulmonary Embolism in Clinically Relevant Patient Subgroups : A Systematic Review and Individual-Patient Data Meta-analysis. Ann Intern Med 2022; 175:244.
  25. Carrier M, Righini M, Le Gal G. Symptomatic subsegmental pulmonary embolism: what is the next step? J Thromb Haemost 2012; 10:1486.
  26. Stein PD, Goodman LR, Hull RD, et al. Diagnosis and management of isolated subsegmental pulmonary embolism: review and assessment of the options. Clin Appl Thromb Hemost 2012; 18:20.
  27. den Exter PL, van Es J, Klok FA, et al. Risk profile and clinical outcome of symptomatic subsegmental acute pulmonary embolism. Blood 2013; 122:1144.
  28. Le Gal G, Kovacs MJ, Bertoletti L, et al. Risk for Recurrent Venous Thromboembolism in Patients With Subsegmental Pulmonary Embolism Managed Without Anticoagulation : A Multicenter Prospective Cohort Study. Ann Intern Med 2022; 175:29.
  29. Freund Y, Chauvin A, Jimenez S, et al. Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial. JAMA 2021; 326:2141.
  30. Dawwas GK, Leonard CE, Lewis JD, Cuker A. Risk for Recurrent Venous Thromboembolism and Bleeding With Apixaban Compared With Rivaroxaban: An Analysis of Real-World Data. Ann Intern Med 2022; 175:20.
  31. Di Muzio M, Diella G, Di Simone E, et al. Comparison of Sleep and Attention Metrics Among Nurses Working Shifts on a Forward- vs Backward-Rotating Schedule. JAMA Netw Open 2021; 4:e2129906.
  32. World Health Organization. A clinical case definition of post-COVID-19 condition by a Delphi consensus, 6 October 2021. https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1 (Accessed on October 11, 2021).
  33. Arnold DT, Milne A, Samms E, et al. Symptoms After COVID-19 Vaccination in Patients With Persistent Symptoms After Acute Infection: A Case Series. Ann Intern Med 2021; 174:1334.
  34. Ingason AB, Hreinsson JP, Ágústsson AS, et al. Rivaroxaban Is Associated With Higher Rates of Gastrointestinal Bleeding Than Other Direct Oral Anticoagulants : A Nationwide Propensity Score-Weighted Study. Ann Intern Med 2021; 174:1493.
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References