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Clinical Guidelines for Pulmonary Medicine: Quality of Diagnostic and Therapeutic Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (20 September 2023) | Viewed by 13450

Special Issue Editor

Prof. Dr. Jörg Daniel Lëuppi

E-Mail Website
Guest Editor
1. University Clinic of Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
2. Faculty of Medicine, University of Basel, Klingelbergstrasse 61, CH-4056 Basel, Switzerland
Interests: COVID-19; lung function; asthma; chronic obstructive lung disease(COPD); pulmonary rehabilitation

Special Issue Information

Dear Colleagues,

Thanks to continuous high-quality research in pulmonology, many data concerning diagnostic and therapeutic management are available on a mouse-click. Dedicated task forces and global initiatives turn this evidence into guidelines, which allow physicians to practice evidence-based medicine on a daily basis. Especially during the COVID-19 pandemic, we have seen that translational medicine plays a big role in rapidly incorporating new research findings into practice.

Our common goal, to improve patients’ wellbeing, can only be achieved if clinical management follows high standards, and the benefits of research are brought “from bench to bedside”. Hence, we need to monitor to which extent our own strategies are turned into action. In this Special Issue, we would like to look into original research studies, reviews, and audits, which demonstrate the importance of translational medicine, evaluate the quality of diagnostic and therapeutic management (including new approaches), and identify possible shortcomings in pulmonary medicine. This will enable us to close the gap between what we know and what we practice.

Prof. Dr. Jörg Daniel Lëuppi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pulmonary medicine
  • translational medicine
  • therapeutic management
  • diagnostic management
  • audit
  • quality
  • guidelines
  • COVID-19
  • lung function
  • asthma
  • chronic obstructive lung disease (COPD)
  • pulmonary rehabilitation

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Published Papers (4 papers)

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Research

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17 pages, 1067 KiB  
Article
Diagnosis and Therapy of Community-Acquired Pneumonia in the Emergency Department: A Retrospective Observational Study and Medical Audit
by Giorgia Lüthi-Corridori, Andrea I. Roth, Maria Boesing, Fabienne Jaun, Philip E. Tarr, Anne B. Leuppi-Taegtmeyer and Jörg D. Leuppi
J. Clin. Med. 2024, 13(2), 574; https://doi.org/10.3390/jcm13020574 - 19 Jan 2024
Cited by 1 | Viewed by 2190
Abstract
Background: Despite advances in therapy, community-acquired pneumonia (CAP) is still associated with significant morbidity and mortality. Several studies conducted in different countries have reported suboptimal adherence to the guidelines. However, there are currently no available data on adherence to CAP guidelines specifically in [...] Read more.
Background: Despite advances in therapy, community-acquired pneumonia (CAP) is still associated with significant morbidity and mortality. Several studies conducted in different countries have reported suboptimal adherence to the guidelines. However, there are currently no available data on adherence to CAP guidelines specifically in Switzerland. Objectives: The aim of this study was to audit the quality of diagnosis and therapy of CAP at a Swiss general hospital. Methods: A retrospective, observational, single-center cohort study was conducted, including patients older than 18 years diagnosed with CAP and admitted to a medical ward throughout 2019 without prior antibiotic therapy prescribed by their general practitioner (GP). The baseline characteristics of the patients were analyzed, and the diagnostic workup and treatment were compared to the Swiss guidelines for CAP. Results: A total of 254 patients diagnosed with CAP were included in this study (median age 78 years, 51.6% males). Atypical pneumonia was diagnosed in 4% of patients, while an organism was identified in 33% of cases, with Streptococcus pneumoniae being the most frequently detected pathogen (57%). A chest image was taken in almost all patients. Documentation of respiratory rate was missing in 23% of cases. Procalcitonin was measured in 23.2% of cases. Pneumococcal and legionella urinary antigen testing was performed on approximately 90% of all patients and blood cultures were drawn in approximately 80% of patients. In 39% of cases, arterial blood gas analysis was performed. Guideline adherence for the administration of empiric antibiotics was documented/recorded in 75% of cases. Twelve different antibiotic regimens were administered, and they were mostly amoxicillin/clavulanate with or without macrolides, as suggested by the guidelines. In particular, the use of ceftriaxone was higher (19.7%) compared to the Swiss guidelines. The average length of antibiotic therapy was longer (8.2 days) compared to the guidelines (5–7 days). Oral steroid therapy was administered to 29.1% of patients, including to 75% of those diagnosed with COPD. Conclusion: Overall, guideline adherence was moderately low, especially with regards to the assessment of respiratory rate, performance of arterial blood gas analysis, and sputum collection. Regarding antibiotic therapy, the use of ceftriaxone and the length of antibiotic therapy should be reduced. Further research is needed to identify the reasons for guideline non-adherence, and to find effective measures for the improvement of guideline adherence. Full article
(This article belongs to the Special Issue Clinical Guidelines for Pulmonary Medicine: Quality of Diagnostic and Therapeutic Management)
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11 pages, 1736 KiB  
Article
Impact of COVID-19 Pandemic on Frontline Pembrolizumab-Based Treatment for Advanced Lung Cancer
by Tawee Tanvetyanon, Dung-Tsa Chen and Jhanelle E. Gray
J. Clin. Med. 2023, 12(4), 1611; https://doi.org/10.3390/jcm12041611 - 17 Feb 2023
Viewed by 3057
Abstract
Background: Pembrolizumab monotherapy or pembrolizumab plus chemotherapy has become an important frontline treatment for advanced non-small cell lung cancer (NSCLC). To date, it remains unclear how the coronavirus disease 2019 (COVID-19) pandemic impacted the treatment outcome. Methods: A quasi-experimental study was conducted based [...] Read more.
Background: Pembrolizumab monotherapy or pembrolizumab plus chemotherapy has become an important frontline treatment for advanced non-small cell lung cancer (NSCLC). To date, it remains unclear how the coronavirus disease 2019 (COVID-19) pandemic impacted the treatment outcome. Methods: A quasi-experimental study was conducted based on a real-world database, comparing pandemic with pre-pandemic patient cohorts. The pandemic cohort consisted of patients who initiated treatment from March to July 2020, with follow-up through March 2021. The pre-pandemic cohort consisted of those initiating treatment between March and July 2019.The outcome was overall real-world survival. Multivariable Cox-proportional hazard models were constructed. Results: Analyses included data from 2090 patients: 998 in the pandemic cohort and 1092 in the pre-pandemic cohort. Baseline characteristics were comparable, with 33% of patients having PD-L1 expression level ≥50% and 29% of patients receiving pembrolizumab monotherapy. Among those treated with pembrolizumab monotherapy (N = 613), there was a differential impact of the pandemic on survival by PD-L1 expression levels (p-interaction = 0.02). For those with PD-L1 level < 50%, survival was better in the pandemic cohort than the pre-pandemic cohort: hazard ratio (HR) 0.64 (95% CI: 0.43–0.97, p = 0.03). However, for those with PD-L1 level ≥ 50%, survival was not better in the pandemic cohort: HR 1.17 (95% CI: 0.85–1.61, p = 0.34). We found no statistically significant impact of the pandemic on survival among patients treated with pembrolizumab plus chemotherapy. Conclusions: The COVID-19 pandemic was associated with an increase in survival among patients with lower PD-L1 expression who were treated with pembrolizumab monotherapy. This finding suggests an increased efficacy of immunotherapy due to viral exposure in this population. Full article
(This article belongs to the Special Issue Clinical Guidelines for Pulmonary Medicine: Quality of Diagnostic and Therapeutic Management)
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14 pages, 704 KiB  
Article
Ventilator-Associated Pneumonia in COVID-19 Patients Admitted in Intensive Care Units: Relapse, Therapeutic Failure and Attributable Mortality—A Multicentric Observational Study from the OutcomeRea Network
by Paul-Henri Wicky, Claire Dupuis, Charles Cerf, Shidasp Siami, Yves Cohen, Virginie Laurent, Bruno Mourvillier, Jean Reignier, Dany Goldgran-Toledano, Carole Schwebel, Stéphane Ruckly, Etienne de Montmollin, Niccolò Buetti and Jean-François Timsit
J. Clin. Med. 2023, 12(4), 1298; https://doi.org/10.3390/jcm12041298 - 6 Feb 2023
Cited by 11 | Viewed by 2192
Abstract
Introduction: Ventilator-associated pneumonia (VAP) incidence is high among critically ill COVID-19 patients. Its attributable mortality remains underestimated, especially for unresolved episodes. Indeed, the impact of therapeutic failures and the determinants that potentially affect mortality are poorly evaluated. We assessed the prognosis of VAP [...] Read more.
Introduction: Ventilator-associated pneumonia (VAP) incidence is high among critically ill COVID-19 patients. Its attributable mortality remains underestimated, especially for unresolved episodes. Indeed, the impact of therapeutic failures and the determinants that potentially affect mortality are poorly evaluated. We assessed the prognosis of VAP in severe COVID-19 cases and the impact of relapse, superinfection, and treatment failure on 60-day mortality. Methods: We evaluated the incidence of VAP in a multicenter prospective cohort that included adult patients with severe COVID-19, who required mechanical ventilation for ≥48 h between March 2020 and June 2021. We investigated the risk factors for 30-day and 60-day mortality, and the factors associated with relapse, superinfection, and treatment failure. Results: Among 1424 patients admitted to eleven centers, 540 were invasively ventilated for 48 h or more, and 231 had VAP episodes, which were caused by Enterobacterales (49.8%), P. aeruginosa (24.8%), and S. aureus (22%). The VAP incidence rate was 45.6/1000 ventilator days, and the cumulative incidence at Day 30 was 60%. VAP increased the duration of mechanical ventilation without modifying the crude 60-day death rate (47.6% vs. 44.7% without VAP) and resulted in a 36% increase in death hazard. Late-onset pneumonia represented 179 episodes (78.2%) and was responsible for a 56% increase in death hazard. The cumulative incidence rates of relapse and superinfection were 45% and 39.5%, respectively, but did not impact death hazard. Superinfection was more frequently related to ECMO and first episode of VAP caused by non-fermenting bacteria. The risk factors for treatment failure were an absence of highly susceptible microorganisms and vasopressor need at VAP onset. Conclusions: The incidence of VAP, mainly late-onset episodes, is high in COVID-19 patients and associated with an increased risk of death, similar to that observed in other mechanically ventilated patients. The high rate of VAP due to difficult-to-treat microorganisms, pharmacokinetic alterations induced by renal replacement therapy, shock, and ECMO likely explains the high cumulative risk of relapse, superinfection, and treatment failure. Full article
(This article belongs to the Special Issue Clinical Guidelines for Pulmonary Medicine: Quality of Diagnostic and Therapeutic Management)
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Review

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11 pages, 248 KiB  
Review
“Nitrogen Wash-Out” in Non-Hypoxaemic Patients with Spontaneous Pneumothorax: A Narrative Review
by Erwin Grasmuk-Siegl and Arschang Valipour
J. Clin. Med. 2023, 12(13), 4300; https://doi.org/10.3390/jcm12134300 - 27 Jun 2023
Cited by 2 | Viewed by 5254
Abstract
Following current guidelines, spontaneous pneumothorax should be primarily managed with minimal invasive strategies. In real-world clinical practice, oxygen supplementation regardless of the presence or absence of hypoxemia is frequently applied in patients with a pneumothorax, with the intention to enhance the resorption rate [...] Read more.
Following current guidelines, spontaneous pneumothorax should be primarily managed with minimal invasive strategies. In real-world clinical practice, oxygen supplementation regardless of the presence or absence of hypoxemia is frequently applied in patients with a pneumothorax, with the intention to enhance the resorption rate of air from the pleural cavity (“nitrogen wash-out theory”). This review provides an overview of the scientific origin of this practice in animal models, and its clinical use in adult and paediatric patients. Clinical studies from PubMed, Embase and Cochrane library were reviewed by the authors using the keywords, “oxygen AND pneumothorax”, “nitrogen washout AND pneumothorax” and “nitrogen AND pneumothorax”, and recommendations from current guidelines were also reviewed by the authors. A selected total of nine clinical studies and three guidelines were included. Though in animal models there appears to be a therapeutic effect of oxygen therapy for the treatment of pneumothorax, clinical data in patient populations mainly stem from retrospective studies, mostly with a small sample size and inadequate study design. We recommend conducting prospective clinical studies with adequate methodology to address the question of whether or not oxygen therapy should be used to treat pneumothorax, regardless of the presence or absence of hypoxemia. Full article
(This article belongs to the Special Issue Clinical Guidelines for Pulmonary Medicine: Quality of Diagnostic and Therapeutic Management)
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