Abstract:
:The median age of presentation with lung cancer is 71, making the elderly the dominant subgroup. Although some elderly patients are frail, others have great physiological reserve. Geriatric assessment can clarify the specific strengths and weaknesses of older patients, improving management. This assessment should, at the minimum, encompass performance status, comorbidity, medications, level of independence in activities of daily living and instrumental activities of daily living, cognitive assessment, nutrition assessment, and assessment of social support. The fit elderly with localized disease should be offered curative resection; video-assisted thoracic surgery may be preferred over thoracotomy. Fit septuagenarians with node positive or > 4 cm primary tumors should then be considered for adjuvant chemotherapy. For less fit patients, the data on stereotactic radiosurgery indicate that it presents a viable treatment option. Data on stage III disease are limited but suggest that chemoradiotherapy, particularly when the chemotherapy is administered on a weekly schedule, is feasible in fit older patients. For the older patients with metastatic cancer, abundant tissue should be obtained at diagnosis to allow for comprehensive molecular characterization with the hopes of rendering the patient eligible for targeted therapy. When such a targeted therapy is not available, there is duration of life and quality of life benefit to the administration of cytotoxic chemotherapy. The standard of care for older patients with Eastern Cooperative Oncology Group (ECOG) performance status 0 to 2 is a platinum-based doublet. Prospective data on second-line therapy after failure of first-line therapy are limited but suggest a benefit to treatment.
journal_name
Semin Respir Crit Care Medjournal_title
Seminars in respiratory and critical care medicineauthors
Weiss J,Langer Cdoi
10.1055/s-0033-1358560subject
Has Abstractpub_date
2013-12-01 00:00:00pages
802-9issue
6eissn
1069-3424issn
1098-9048journal_volume
34pub_type
杂志文章abstract::The nontuberculous mycobacteria (NTM) are typically environmental organisms residing in soil and water. Although generally of low pathogenicity to humans, NTM can cause a wide array of clinical diseases; pulmonary disease is most frequent, followed by lymphadenitis in children, skin disease by M. marinum (particularly...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-0033-1333569
更新日期:2013-02-01 00:00:00
abstract::The sleep of intensive care unit (ICU) patients is remarkably disrupted. Several studies, employing both subjective and objective measures of sleep quality, have demonstrated that critically ill patients exhibit severe sleep fragmentation and reduced restorative sleep, particularly a suppression of rapid eye movement ...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章
doi:10.1055/s-2001-13829
更新日期:2001-01-01 00:00:00
abstract::Assisted mechanical ventilation (MV) may be a favorable alternative to controlled MV at the early phase of acute respiratory distress syndrome (ARDS), since it requires less sedation, no paralysis and is associated with less hemodynamic deterioration, better distal organ perfusion, and lung protection, thus reducing t...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-0034-1382153
更新日期:2014-08-01 00:00:00
abstract::Pandemics of influenza have been reported since the early sixteenth century. Recent pandemics include the Spanish flu (H1N1) from 1918 to 1920 (resulting in approximately 50 million deaths worldwide); the Asian flu (H2N2) from 1957 to 1958 (resulting in more than 1 million deaths); the Hong Kong flu (H3N2) from 1968 t...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-2007-976488
更新日期:2007-04-01 00:00:00
abstract::The diaphragm is the most important muscle of ventilation. Its contraction is key to the development of intrathoracic pressures. Diseases that affect diaphragmatic function result in decreased pressure-generating capacity by the respiratory muscles. If the involvement is severe or if there is underlying respiratory pa...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章
doi:10.1055/s-2002-33036
更新日期:2002-06-01 00:00:00
abstract::The overarching goals of early sepsis management include early recognition, appropriate antibiotic therapy and source control, maintenance of hemodynamic stability, and supportive care of organ dysfunction. Despite increasing awareness of the global burden of sepsis, and general agreement on the goals of management, t...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-0039-1696981
更新日期:2019-10-01 00:00:00
abstract::Pulmonary immunity to fungal pathogens requires both innate and adaptive immune responses. Alveolar macrophages, dendritic cells, and neutrophils are the phagocytic cells of the lung innate system. These cells produce early inflammatory mediators (i.e., reactive oxygen species, cytokines, and chemokines) in response t...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章
doi:10.1055/s-2004-822306
更新日期:2004-02-01 00:00:00
abstract::Hyperoxia, or excess oxygen supplementation, prevails in the intensive care unit (ICU) without a beneficial effect and, in some instances, may cause harm. Recent interest and surge in clinical studies in mechanically ventilated critically ill patients has brought this to the attention of clinicians and researchers. Hy...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-0035-1570359
更新日期:2016-02-01 00:00:00
abstract::Legionella pneumophila has been found to be a common cause of community-acquired pneumonia in patients who required intensive care unit (ICU) admission. In many studies, the clinical manifestations for Legionnaires' disease were more severe and the mortality was higher when compared with pneumonias of other etiology. ...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章
doi:10.1055/s-2000-9862
更新日期:2000-01-01 00:00:00
abstract::This article discusses the pleural effusions that occur with the post-cardiac injury (Dressler's) syndrome (PCIS) and those that occur after coronary artery bypass graft (CABG) surgery. The PCIS can occur after any type of cardiac injury and is thought to be due to anti-myocardial antibodies. The primary symptoms are ...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章
doi:10.1055/s-2001-18802
更新日期:2001-12-01 00:00:00
abstract::Oral corticosteroids are powerful relatively nonspecific antiinflammatory agents with a range of well-characterized side effects. There is good evidence to show that they accelerate the rate of resolution of exacerbations of COPD and relapse is less likely if patients receive these drugs. Maintenance therapy with oral...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-2005-869542
更新日期:2005-04-01 00:00:00
abstract::Cardiopulmonary resuscitation (CPR) is performed frequently by paramedics, emergency department personnel, and inpatient physicians. Unfortunately, after more than 40 years of practice and study, there are still many controversies and unresolved treatment issues. This article focuses on four current controversies in C...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章
doi:10.1055/s-2001-13839
更新日期:2001-01-01 00:00:00
abstract::Achieving hemostasis, preventing and treating thrombosis, and laboratory measurement of the hemostatic pathways constitute the core elements of managing the critically ill patient with liver failure. Uncontrolled bleeding in acutely decompensated cirrhosis and acute-on-chronic liver failure is probably the most famili...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-0038-1673658
更新日期:2018-10-01 00:00:00
abstract::Cystic fibrosis (CF) is now more common in adults than children in countries with well-developed health care systems. The number of adults continues to increase and will further increase if the new cystic fibrosis transmembrane conductance regulator (CFTR) modulators are disease modifying. Most of the complex morbidit...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-0039-3400289
更新日期:2019-12-01 00:00:00
abstract::Hepatic sarcoidosis is a relatively common manifestation of extrapulmonary sarcoidosis. It occurs in 20 to 30% of cases and is rarely severe. However, a cluster of patients may develop severe complications such as cirrhosis and portal hypertension. In this review, we describe the current knowledge of clinical, biologi...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章
doi:10.1055/s-0040-1713799
更新日期:2020-10-01 00:00:00
abstract::Respiratory samples obtained by bronchoalveolar lavage (BAL) in infectious processes provide important microbiological and cytological information to manage this type of patient. Most of the clinical and experimental BAL investigations have been done in ventilator-associated pneumonia (VAP) and in immunosuppressed con...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-2007-991524
更新日期:2007-10-01 00:00:00
abstract::Patients with severe infections are often treated with multiple courses of antibiotics in the intensive care unit (ICU), making the ICU a true antibiotic hotspot. The increasing incidence of multidrug resistance worldwide emphasizes the need for continued efforts in developing and implementing antibiotic stewardship p...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-0039-1693995
更新日期:2019-08-01 00:00:00
abstract::The evolution of scientific investigation in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is replete with examples of effective bench-to-bedside transitions, pioneering research methodology, and international collaboration. This article highlights for clinicians a selection of challenges and ...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章
doi:10.1055/s-0033-1351120
更新日期:2013-08-01 00:00:00
abstract::Venous thromboembolism (VTE) is a frequent complication in surgical patients, with the potential for long-term disability or fatal outcome. The rationale behind routine use of thromboprophylaxis can be summarized in three points: (1) VTE is frequent in certain surgical populations, (2) VTE may be fatal, (3) thrombopro...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-2008-1047566
更新日期:2008-02-01 00:00:00
abstract::Sarcoidosis is by definition a disease of "unknown causes," but recent epidemiologic advances suggest that the long-standing definition of sarcoidosis may soon need to be amended. The recently completed ACCESS (A Case-Control Etiologic Study of Sarcoidosis) study was not able to definitively identify the "cause" of sa...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-2007-970331
更新日期:2007-02-01 00:00:00
abstract::Chronic pulmonary sepsis is the predominant cause of morbidity for patients with cystic fibrosis (CF) and non-CF bronchiectasis. Previously it was thought that respiratory infection in these patients was mostly limited to a very small number of typical pathogens; however, in recent years there have been increasing rep...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-0035-1546752
更新日期:2015-04-01 00:00:00
abstract::The genus Scedosporium comprises a group of filamentous fungi found ubiquitously in the environment. The two major human pathogens within this genus are S. apiospermum-the asexual state of Pseudallescheria boydii-and S. prolificans. Both histologically resemble Aspergillus species, with hyphae that are septated and br...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章
doi:10.1055/s-2004-824901
更新日期:2004-04-01 00:00:00
abstract::Catheters are the leading source of bloodstream infections in critically ill patients. Because the clinical signs of infection are nonspecific, such infections are overly suspected, which results in unnecessary removal of catheters. A conservative approach might be attempted in mild infections, whereas catheters shoul...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-0031-1275526
更新日期:2011-04-01 00:00:00
abstract::Paracoccidioidomycosis (formerly known as South American blastomycosis) is produced by the thermally dimorphic fungus Paracoccidioides brasiliensis. Most often this mycosis runs a chronic progressive course affecting preferentially the lungs followed by the skin, mucous membranes, adrenals, and reticuloendothelial org...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-2008-1063857
更新日期:2008-04-01 00:00:00
abstract::Pulmonary rehabilitation is a standard of care for patients with chronic lung disease. Through appropriate patient selection and assessment, exercise training, educational and psychosocial intervention, nutritional counseling, and breathing retraining, many benefits (e.g., reduction in level of dyspnea, improvement in...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 历史文章,杂志文章,评审
doi:10.1055/s-0029-1242632
更新日期:2009-12-01 00:00:00
abstract::Pulmonary fibrosis is a devastating disease that occurs in association with environmental exposures, several inherited diseases, collagen vascular disease, as well as in an idiopathic form. Epithelial cell damage, excessive fibroblast proliferation, upregulation of extracellular matrix production, and attenuated matri...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章
doi:10.1055/s-2002-25306
更新日期:2002-04-01 00:00:00
abstract::Sinonasal sarcoidosis is a fairly uncommon, yet clinically challenging, manifestation of this systemic disease. The diagnosis is often difficult to establish, treatment options are often unclear, and ultimate clinical responses can be quite variable. This article discusses the varied clinical presentations of this unu...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章
doi:10.1055/s-2002-36519
更新日期:2002-12-01 00:00:00
abstract::Asthma is a heterogeneous disorder with a complex etiology. Prevalence rates for asthma have been increasing in many countries over the past few decades. While it is unclear why this increase is occurring, the variation reported in asthma prevalence and severity associated with ethnicity offers some insight into the d...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-0037-1618568
更新日期:2018-02-01 00:00:00
abstract::Computed tomography (CT) is the core imaging modality for the evaluation of thoracic disorders. With the recently developed dual-energy CT (DECT) technique, the clinical utility of CT in the management of pulmonary diseases can be expanded. The most actively investigated principle of dual energy is material decomposit...
journal_title:Seminars in respiratory and critical care medicine
pub_type: 杂志文章,评审
doi:10.1055/s-0033-1363452
更新日期:2014-02-01 00:00:00
abstract:: ...
journal_title:Seminars in respiratory and critical care medicine
pub_type:
doi:10.1055/s-0038-1676969
更新日期:2018-12-01 00:00:00