Abstract:
OBJECTIVES:Immunosuppressive pharmacologic agents prescribed to patients with diffuse interstitial and inflammatory lung disease and lung transplant recipients are associated with potential risks for adverse reactions. Strategies for minimizing such risks include administering these drugs according to established, safe protocols; monitoring to detect manifestations of toxicity; and patient education. Hence, an evidence-based guideline for physicians can improve safety and optimize the likelihood of a successful outcome. To maximize the likelihood that these agents will be used safely, the American College of Chest Physicians established a committee to examine the clinical evidence for the administration and monitoring of immunosuppressive drugs (with the exception of corticosteroids) to identify associated toxicities associated with each drug and appropriate protocols for monitoring these agents. METHODS:Committee members developed and refined a series of questions about toxicities of immunosuppressives and current approaches to administration and monitoring. A systematic review was carried out by the American College of Chest Physicians. Committee members were supplied with this information and created this evidence-based guideline. CONCLUSIONS:It is hoped that these guidelines will improve patient safety when immunosuppressive drugs are given to lung transplant recipients and to patients with diffuse interstitial lung disease.
journal_name
Chestjournal_title
Chestauthors
Baughman RP,Meyer KC,Nathanson I,Angel L,Bhorade SM,Chan KM,Culver D,Harrod CG,Hayney MS,Highland KB,Limper AH,Patrick H,Strange C,Whelan Tdoi
10.1378/chest.12-1044subject
Has Abstractpub_date
2012-11-01 00:00:00pages
e1S-e111Sissue
5eissn
0012-3692issn
1931-3543pii
S0012-3692(12)60657-6journal_volume
142pub_type
杂志文章,实务指引相关文献
CHEST文献大全abstract::Acute elevation of the ST segment in several ECG leads was observed in seven patients with bacterial shock during the course of therapy. Six patients had bacterial pneumonia, one had acute cholecystitis, and none had a previous history of heart disease. At the onset of the ST elevation, all patients were receiving dop...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.81.4.444
更新日期:1982-04-01 00:00:00
abstract::The role of infection in exacerbations of COPD remains controversial and incompletely understood. Although some investigators believe that bacteria are not important for patients with exacerbation, we disagree and believe that patients with at least two of the three cardinal symptoms of exacerbation should receive ant...
journal_title:Chest
pub_type: 评论,杂志文章,评审
doi:10.1378/chest.118.1.204
更新日期:2000-07-01 00:00:00
abstract::Bacterial pericarditis with cardiac tamponade is a life-threatening disorder that has been associated with a variety of organisms. There is usually an associated underlying condition or a seeding of the pericardium from an infection elsewhere. We report the development of cardiac tamponade and a subsequent pericardial...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.115.6.1746
更新日期:1999-06-01 00:00:00
abstract::Although infectious mononucleosis is usually a benign illness, life-threatening complications may occur. We describe a 17-year-old pregnant girl who developed necrotizing epiglottitis and dysphagia progressing to aspiration pneumonia and respiratory failure. The factors predisposing to this life-threatening complicati...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.96.1.204
更新日期:1989-07-01 00:00:00
abstract::We report three cases of organophosphate (OP) poisoning. One patient was a 19-year-old woman who drank OP compounds in an attempt at suicide. The other two patients became intoxicated on the way to the hospital during mouth-to-mouth breathing. The first patient died in the emergency department, and the other two were ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.122.2.740
更新日期:2002-08-01 00:00:00
abstract::Clinicians who auscultate the chest of normal children note that the frequency content of their breath sounds appears to vary with age. Because these changes have not been systematically documented before, we recorded and analyzed inspiratory breath sounds in 35 children (0 to 13 years) and five adults (34 to 43 years...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.100.4.999
更新日期:1991-10-01 00:00:00
abstract::The study objective was to assess the widespread applicability of ST/HR slope for the modified Bruce exercise test using a computerized electrocardiogram (ECG); compare the usefulness of the ST/HR slope with standard ECG criteria in detection of coronary artery disease (CAD) and identification of three-vessel or left ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.94.4.737
更新日期:1988-10-01 00:00:00
abstract:BACKGROUND:The "Dutch hypothesis" suggests that asthma and COPD have common genetic determinants. The serpin peptidase inhibitor, clade E (nexin, plasminogen activator inhibitor type 1), member 2 (SERPINE2) gene previously has been associated with COPD. We sought to determine whether SERPINE2 is associated with asthma ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.10-2973
更新日期:2011-09-01 00:00:00
abstract::We evaluated the feasibility of utilizing physician assistants as providers of primary care in a medical ICU. After a three-month period of rigorous training, two PAs were assigned to the ICU. Their performance as well as the operation of the ICU over a two-year period was evaluated and compared to two preceding years...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.99.1.89
更新日期:1991-01-01 00:00:00
abstract::Pulmonary infections, which frequently occur during the early and late period following bone marrow transplantation for hematologic malignancies, are associated with significant morbidity and mortality. In this study the incidence, the infectious causes of pneumonia and the mortality related to pneumonia in 130 alloge...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.104.2.371
更新日期:1993-08-01 00:00:00
abstract::The role of thoracic radiation therapy in the management of limited-stage small cell lung cancer (SCLC) is reviewed. Although chest irradiation has been used to treat SCLC for over four decades, its standard role in the management of limited-stage disease was established only during the last decade. Multiple prospecti...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.112.4_supplement.259s
更新日期:1997-10-01 00:00:00
abstract::An unusual case of Staphylococcus aureus endocarditis confined to the mural left atrium is presented. Echocardiographic studies revealed a 1.5 x 2.0-cm vegetation mimicking a myxoma situated in the path of a mitral regurgitant jet on a color Doppler test. Emboli to upper and lower extremities and brain complicated the...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.99.3.757
更新日期:1991-03-01 00:00:00
abstract::In order to assess the long-term clinical benefits of palliative Nd:YAG laser photoresection, we studied 69 patients with obstructing exophytic tracheobronchial lesions treated with this modality between Oct 25, 1984 and May 8, 1989. In 55 patients, there was greater than 75 percent restoration of the luminal caliber ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.98.3.581
更新日期:1990-09-01 00:00:00
abstract::The concentrations of gentamicin, netilmicin, and amikacin were determined after one single intravenous injection in uninfected pleural fluid after thoracotomy and in purulent pleural empyemas. The mean peak concentrations in the pleural fluid after the injection of gentamicin (1.5 mg/kg), netilmicin (2.0 mg/kg), and ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.93.3.530
更新日期:1988-03-01 00:00:00
abstract::The ability of mixed venous oxygen saturation (SvO2) monitoring to reflect changes in cardiac index (CI) with therapy in critically ill patients is unclear. To this end, SvO2 and CI were measured before and during an infusion of enoximone and/or dobutamine in 30 patients with advanced heart failure. A nonlinear relati...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.99.6.1403
更新日期:1991-06-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Many clinicians believe that low-dose dopamine (LDD) [2 micro g/kg/min] increases renal blood flow (RBF) and medium-dose norepinephrine (MD-NE) [0.4 micro g/kg/min] decreases RBF. They also believe that MD-NE might induce mesenteric and/or coronary ischemia. In fact, the effects of these drugs...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.125.6.2260
更新日期:2004-06-01 00:00:00
abstract:OBJECTIVE:To assess the effect of baseline variables, including treatment, on outcome in patients with nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA). DESIGN:Retrospective analysis of data from two prospective, randomized, double-blind studies. SETTING:Multinational study with 134 site...
journal_title:Chest
pub_type: 杂志文章
doi:
更新日期:2003-11-01 00:00:00
abstract::A 41-year-old woman had progressive shortness of breath. Cerebrotendinous xanthomatosis was diagnosed 4 years before. An open-lung biopsy showed the simultaneous presence of cerebrotendinous xanthomatosis and pulmonary lymphangioleiomyomatosis. This is perhaps the first time the coincidental occurrence of these two di...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.112.1.273
更新日期:1997-07-01 00:00:00
abstract::This report describes a patient with right lower lung (RLL) pneumonia of a subacute nature. Sputum and bronchial washings both grew N asteroides. Open lung biopsy showed bronchiolitis obliterans. Both the clinical and radiologic picture dramatically improved during three weeks of treatment with trimethoprim and sulfam...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.92.6.1107
更新日期:1987-12-01 00:00:00
abstract:OBJECTIVE:The purpose of the study was to evaluate the long-term effects of aerosolized pentamidine (AP) on the pulmonary function of HIV-positive individuals receiving AP for Pneumocystis carinii pneumonia (PCP) prophylaxis. DESIGN:A retrospective analysis of serial pulmonary function tests (PFTs) performed on a coho...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.114.3.742
更新日期:1998-09-01 00:00:00
abstract::We carried out a study to assess the prevalence of respiratory disease in lead miners and to investigate the roles of silica and lead. We used a questionnaire for symptoms and examinations for signs of respiratory disease, chest roentgenograms, and spirometric study in 45 lead miners. Six underwent bronchoscopy and tr...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.96.1.18
更新日期:1989-07-01 00:00:00
abstract::Each of four examiners performed standardized physical examinations on a group of patients who had just undergone tests of ventilatory function. The intensity of breath sounds heard with deep inspiration was graded on a rating scale of 0 to 4; the grades in six areas of the chest were added to give a total score, with...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.70.3.341
更新日期:1976-09-01 00:00:00
abstract::We report an unusual case of a patient with a bronchopleural-subcutaneous fistula that occurred 3 years following a lobectomy and en bloc chest wall resection for carcinoma. Following a sudden resolution of subcutaneous emphysema, an epidural air collection developed. Spontaneous pneumorrhachis is a previously unrepor...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.121.5.1712
更新日期:2002-05-01 00:00:00
abstract::Extrinsic compression of the left main coronary artery (LMCA) can occur in patients with severe pulmonary hypertension and enlarged pulmonary artery trunk. It has been usually described in the setting of congenital defects such as atrial septal defect, ventricular septal defect, and, more rarely, isolated persistent d...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.08-2922
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVES:To compare the rapid shallow breathing index (RSBI) under different ventilatory support settings prior to extubation trials. DESIGN:Prospective study. SETTING:Cardiac surgery unit at a university hospital. PATIENTS:A total of 33 coronary artery bypass grafting patients ready for extubation. INTERVENTIONS...
journal_title:Chest
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1378/chest.121.2.475
更新日期:2002-02-01 00:00:00
abstract:STUDY OBJECTIVE:To define the causes and clinical features of hemoptysis in HIV-infected patients. DESIGN:Retrospective analysis of inpatient medical records for patients with HIV infection and hemoptysis. SETTING:A large New York City teaching hospital and tertiary referral center. PATIENTS:Fifty HIV-infected adult...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.110.3.737
更新日期:1996-09-01 00:00:00
abstract:BACKGROUND:In pulmonary sarcoidosis, the optimal means of quantifying change is uncertain. The comparative usefulness of simple lung function trends and chest radiography remains unclear. We aimed to explore and contrast the disease-monitoring strategies of serial pulmonary function tests (PFTs) and chest radiography c...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.12-2479
更新日期:2014-01-01 00:00:00
abstract::The chest wall is an uncommon localization for hydatid cyst. In this article, six patients were operated on because of chest wall hydatid cysts between the years 1989 to 1991 have been reported. Four of them had previously undergone surgery for pulmonary or hepatic hydatidosis; the chest wall was the primary site in t...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.105.4.1277
更新日期:1994-04-01 00:00:00
abstract::Persistent minor hemoptysis resulted from extensive granulation tissue on the main carina and adjacent bronchi due to frequent spraying of metered-dose inhaler (MDI)-generated aerosol medications directly into a permanent tracheostomy. Salbutamol, containing oleic acid, was considered the most likely cause. After an A...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.115.1.279
更新日期:1999-01-01 00:00:00
abstract:STUDY OBJECTIVES:To investigate whether oxidative stress occurs following lobectomy and pneumonectomy and to evaluate whether markers of oxidative stress might be of value in the assessment of the diagnosis, course, and prognosis of postoperative complications. DESIGN:A prospective study. SETTING:A specialized thorac...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.117.4.999
更新日期:2000-04-01 00:00:00