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Hariri LP, Sharma A, Nandy S, Berigei SR, Yamamoto S, Raphaely RA, Flashner BM, Muniappan A, Auchincloss HG, Lanuti M, Hallowell RW, Shea BS, Keyes CM. Endobronchial Optical Coherence Tomography as a Novel Method for In Vivo Microscopic Assessment of Interstitial Lung Abnormalities. Am J Respir Crit Care Med 2024. [PMID: 38207094 DOI: 10.1164/rccm.202310-1871le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/10/2024] [Indexed: 01/13/2024] Open
Affiliation(s)
- Lida P Hariri
- Massachusetts General Hospital, Pathology, Boston, Massachusetts, United States;
| | - Amita Sharma
- Massachusetts General Hospital, Radiology, Boston, Massachusetts, United States
| | - Sreyankar Nandy
- Massachusetts General Hospital, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Sarita R Berigei
- Massachusetts General Hospital, 2348, Boston, Massachusetts, United States
| | - Satomi Yamamoto
- Massachusetts General Hospital, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Rebecca A Raphaely
- University of Washington, 7284, Division of Pulmonary and Critical Care Medicine, Seattle, Washington, United States
| | - Bess M Flashner
- Beth Israel Deaconess Medical Center, 1859, Internal Medicine, Boston, Massachusetts, United States
| | - Ashok Muniappan
- Massachusetts General Hospital, Thoracic Surgery, Boston, Massachusetts, United States
| | - Hugh G Auchincloss
- Massachusetts General Hospital, Thoracic Surgery, Boston, Massachusetts, United States
| | - Michael Lanuti
- Massachusetts General Hospital, Thoracic Surgery, Boston, Massachusetts, United States
| | - Robert W Hallowell
- Massachusetts General Hospital, 2348, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Barry S Shea
- Massachusetts General Hospital, 2348, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Colleen M Keyes
- Massachusetts General Hospital, Interventional Pulmonology, Boston, Massachusetts, United States
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2
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Nandy S, Raphaely RA, Muniappan A, Shih A, Roop BW, Sharma A, Keyes CM, Colby TV, Auchincloss HG, Gaissert HA, Lanuti M, Morse CR, Ott HC, Wain JC, Wright CD, Garcia-Moliner ML, Smith ML, VanderLaan PA, Berigei SR, Mino-Kenudson M, Horick NK, Liang LL, Davies DL, Szabari MV, Caravan P, Medoff BD, Tager AM, Suter MJ, Hariri LP. Reply to Kalverda et al.: Endobronchial Optical Coherence Tomography: Shining New Light on Diagnosing Usual Interstitial Pneumonitis? Am J Respir Crit Care Med 2022; 205:968-971. [PMID: 35148493 PMCID: PMC9838623 DOI: 10.1164/rccm.202112-2737le] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Sreyankar Nandy
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Rebecca A. Raphaely
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Ashok Muniappan
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Angela Shih
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | - Amita Sharma
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Colleen M. Keyes
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | - Hugh G. Auchincloss
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Henning A. Gaissert
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Michael Lanuti
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Christopher R. Morse
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Harald C. Ott
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - John C. Wain
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts,St. Elizabeth’s Medical CenterBoston, Massachusetts
| | - Cameron D. Wright
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | | | - Paul A. VanderLaan
- Harvard Medical SchoolBoston, Massachusetts,Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | | | - Mari Mino-Kenudson
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Nora K. Horick
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | | | | | - Margit V. Szabari
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Peter Caravan
- Harvard Medical SchoolBoston, Massachusetts,Athinoula A. Martinos Center for Biomedical ImagingCharlestown, Massachusetts,Massachusetts General HospitalCharlestown, Massachusetts
| | - Benjamin D. Medoff
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Andrew M. Tager
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Melissa J. Suter
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
| | - Lida P. Hariri
- Massachusetts General HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts,Corresponding author (e-mail: )
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3
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Nandy S, Raphaely RA, Muniappan A, Shih A, Roop BW, Sharma A, Keyes CM, Colby TV, Auchincloss HG, Gaissert HA, Lanuti M, Morse CR, Ott HC, Wain JC, Wright CD, Garcia-Moliner ML, Smith ML, VanderLaan PA, Berigei SR, Mino-Kenudson M, Horick NK, Liang LL, Davies DL, Szabari MV, Caravan P, Medoff BD, Tager AM, Suter MJ, Hariri LP. Diagnostic Accuracy of Endobronchial Optical Coherence Tomography for the Microscopic Diagnosis of Usual Interstitial Pneumonia. Am J Respir Crit Care Med 2021; 204:1164-1179. [PMID: 34375171 PMCID: PMC8759308 DOI: 10.1164/rccm.202104-0847oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
Rationale: Early, accurate diagnosis of interstitial lung disease (ILD) informs prognosis and therapy, especially in idiopathic pulmonary fibrosis (IPF). Current diagnostic methods are imperfect. High-resolution computed tomography has limited resolution, and surgical lung biopsy (SLB) carries risks of morbidity and mortality. Endobronchial optical coherence tomography (EB-OCT) is a low-risk, bronchoscope-compatible modality that images large lung volumes in vivo with microscopic resolution, including subpleural lung, and has the potential to improve the diagnostic accuracy of bronchoscopy for ILD diagnosis. Objectives: We performed a prospective diagnostic accuracy study of EB-OCT in patients with ILD with a low-confidence diagnosis undergoing SLB. The primary endpoints were EB-OCT sensitivity/specificity for diagnosis of the histopathologic pattern of usual interstitial pneumonia (UIP) and clinical IPF. The secondary endpoint was agreement between EB-OCT and SLB for diagnosis of the ILD fibrosis pattern. Methods: EB-OCT was performed immediately before SLB. The resulting EB-OCT images and histopathology were interpreted by blinded, independent pathologists. Clinical diagnosis was obtained from the treating pulmonologists after SLB, blinded to EB-OCT. Measurements and Main Results: We enrolled 31 patients, and 4 were excluded because of inconclusive histopathology or lack of EB-OCT data. Twenty-seven patients were included in the analysis (16 men, average age: 65.0 yr): 12 were diagnosed with UIP and 15 with non-UIP ILD. Average FVC and DlCO were 75.3% (SD, 18.5) and 53.5% (SD, 16.4), respectively. Sensitivity and specificity of EB-OCT was 100% (95% confidence interval, 75.8-100.0%) and 100% (79.6-100%), respectively, for both histopathologic UIP and clinical diagnosis of IPF. There was high agreement between EB-OCT and histopathology for diagnosis of ILD fibrosis pattern (weighted κ: 0.87 [0.72-1.0]). Conclusions: EB-OCT is a safe, accurate method for microscopic ILD diagnosis, as a complement to high-resolution computed tomography and an alternative to SLB.
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Affiliation(s)
- Sreyankar Nandy
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Rebecca A. Raphaely
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Ashok Muniappan
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Angela Shih
- Department of Pathology
- Harvard Medical School, Boston, Massachusetts
| | - Benjamin W. Roop
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
| | - Amita Sharma
- Department of Radiology, and
- Harvard Medical School, Boston, Massachusetts
| | - Colleen M. Keyes
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Thomas V. Colby
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | | | - Michael Lanuti
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | | | - Harald C. Ott
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - John C. Wain
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
- St. Elizabeth’s Medical Center, Boston, Massachusetts
| | - Cameron D. Wright
- Division of Thoracic Surgery
- Harvard Medical School, Boston, Massachusetts
| | - Maria L. Garcia-Moliner
- Department of Pathology, Rhode Island Hospital and Alpert Medical School, Providence, Rhode Island
| | - Maxwell L. Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Paul A. VanderLaan
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sarita R. Berigei
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
| | | | - Nora K. Horick
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | - Margit V. Szabari
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Peter Caravan
- Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts; and
- Institute for Innovation in Imaging (i), Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Benjamin D. Medoff
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Andrew M. Tager
- Division of Pulmonary and Critical Care Medicine
- Harvard Medical School, Boston, Massachusetts
| | - Melissa J. Suter
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Harvard Medical School, Boston, Massachusetts
| | - Lida P. Hariri
- Division of Pulmonary and Critical Care Medicine
- Wellman Center for Photomedicine
- Department of Pathology
- Harvard Medical School, Boston, Massachusetts
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Nandy S, Helland TL, Roop BW, Raphaely RA, Ly A, Lew M, Berigei SR, Villiger M, Sorokina A, Szabari MV, Fintelmann FJ, Suter MJ, Hariri LP. Rapid non-destructive volumetric tumor yield assessment in fresh lung core needle biopsies using polarization sensitive optical coherence tomography. Biomed Opt Express 2021; 12:5597-5613. [PMID: 34692203 PMCID: PMC8515979 DOI: 10.1364/boe.433346] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 05/28/2023]
Abstract
Adequate tumor yield in core-needle biopsy (CNB) specimens is essential in lung cancer for accurate histological diagnosis, molecular testing for therapeutic decision-making, and tumor biobanking for research. Insufficient tumor sampling in CNB is common, primarily due to inadvertent sampling of tumor-associated fibrosis or atelectatic lung, leading to repeat procedures and delayed diagnosis. Currently, there is no method for rapid, non-destructive intraprocedural assessment of CNBs. Polarization-sensitive optical coherence tomography (PS-OCT) is a high-resolution, volumetric imaging technique that has the potential to meet this clinical need. PS-OCT detects endogenous tissue properties, including birefringence from collagen, and degree of polarization uniformity (DOPU) indicative of tissue depolarization. Here, PS-OCT birefringence and DOPU measurements were used to quantify the amount of tumor, fibrosis, and normal lung parenchyma in 42 fresh, intact lung CNB specimens. PS-OCT results were compared to and validated against matched histology in a blinded assessment. Linear regression analysis showed strong correlations between PS-OCT and matched histology for quantification of tumors, fibrosis, and normal lung parenchyma in CNBs. PS-OCT distinguished CNBs with low tumor content from those with higher tumor content with high sensitivity and specificity. This study demonstrates the potential of PS-OCT as a method for rapid, non-destructive, label-free intra-procedural tumor yield assessment.
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Affiliation(s)
- Sreyankar Nandy
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Harvard Medical School, Boston, MA 02110, USA
| | - Timothy L. Helland
- Harvard Medical School, Boston, MA 02110, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02110, USA
| | - Benjamin W. Roop
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02110, USA
| | - Rebecca A. Raphaely
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Harvard Medical School, Boston, MA 02110, USA
| | - Amy Ly
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Harvard Medical School, Boston, MA 02110, USA
| | - Madelyn Lew
- Department of Pathology, University of Michigan, Ann Arbor, MI 48104, USA
| | - Sarita R. Berigei
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02110, USA
| | - Martin Villiger
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Harvard Medical School, Boston, MA 02110, USA
| | - Anastasia Sorokina
- Department of Pathology, University of Illinois at Chicago, Chicago, IL 60131, USA
- Department of Pathology, Research Institute of Human Morphology, Moscow 103132, Russia
| | - Margit V. Szabari
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Harvard Medical School, Boston, MA 02110, USA
| | - Florian J. Fintelmann
- Harvard Medical School, Boston, MA 02110, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02110, USA
| | - Melissa J. Suter
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Harvard Medical School, Boston, MA 02110, USA
| | - Lida P. Hariri
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02110, USA
- Harvard Medical School, Boston, MA 02110, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02110, USA
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5
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Raphaely RA, Mongiardo MA, Goldstein RL, Robinson SA, Wan ES, Moy ML. Pain in Veterans with COPD: relationship with physical activity and exercise capacity. BMC Pulm Med 2021; 21:238. [PMID: 34266401 PMCID: PMC8280683 DOI: 10.1186/s12890-021-01601-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain is a common but underappreciated symptom experienced by people with Chronic Obstructive Pulmonary Disease (COPD). The relationships between pain and physical activity (PA) and exercise capacity are poorly understood. METHODS This retrospective secondary analysis includes three cohorts of Veterans with COPD who participated in longitudinal studies evaluating PA and exercise capacity with objective measures of daily step counts and 6-min walk test (6MWT) distance, respectively. Pain was assessed using the bodily pain domain of the Veterans RAND-36. In two cohorts, participants were randomly assigned to a web-based, pedometer-mediated PA intervention which has previously been demonstrated to improve PA. RESULTS Three-hundred and seventy-three (373) unique study participants were included in this analysis. Eighty-three percent (n = 311) of the population reported at least mild pain and/or at least a little bit of interference due to pain at baseline. Cross-sectionally, greater bodily pain was associated with lower 6MWT distance (β = 0.51; 95% CI 0.20, 0.82; p = 0.0013). Longitudinally, worsening bodily pain was associated with a decline in 6MWT distance (β = 0.30; 95% CI 0.03, 0.58; p = 0.0312). There was no association between baseline bodily pain and baseline daily step counts, baseline bodily pain and change in PA, or change in bodily pain and change in PA. Compared to usual care, our PA intervention improved bodily pain scores (β = 6.17; 95% CI 1.84, 10.45; p = 0.0054). Bodily pain scores did not affect the impact of the intervention on daily step counts. CONCLUSION Pain is highly prevalent and significantly associated with lower exercise capacity among Veterans with COPD. Worsening pain co-occurred with decline in exercise capacity but not PA. Our intervention reduced pain, although pain did not affect the impact of the intervention on PA.
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Affiliation(s)
- Rebecca A Raphaely
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
- Department of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
- Department of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Maria A Mongiardo
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
| | - Rebekah L Goldstein
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
| | - Stephanie A Robinson
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
- VA Bedford Healthcare Systems, Bldg 70, 200 Springs Rd, Bedford, MA, 01732, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Emily S Wan
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA
- Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Marilyn L Moy
- Pulmonary and Critical Care Medicine Section, VA Boston Healthcare System, 1400 VFW Parkway, Mail Code 111P, Boston, MA, 02132, USA.
- Harvard Medical School, Boston, MA, USA.
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Shoults B, Barber M, Millham L, Mulla M, Nanji N, Steele G, Peck T, Smithedajkul P, Worsham C, Currier P, Raphaely RA. Feasibility and Limitations of Proning Protocol for Nonintubated Patients With COVID-19. J Patient Exp 2021; 8:2374373520981486. [PMID: 34179358 PMCID: PMC8205337 DOI: 10.1177/2374373520981486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Proning awake patients with COVID-19 is associated with lower mortality and intubation rates. However, these studies also demonstrate low participation rates and tolerance of awake proning. In this study, we attempt to understand barriers to proning. Medical and dental students surveyed nonintubated patients to understand factors affecting adherence to a proning protocol. Only patients who discussed proning with their medical team attempted the practice. Eight of nine patients who were informed about benefits of proning attempted the maneuver. Discomfort was the primary reason patients stopped proning. Addressing discomfort and implementing systematic patient education may increase adherence to proning.
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Affiliation(s)
- Benjamin Shoults
- Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | | - Tyler Peck
- Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | | | - Christopher Worsham
- Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Paul Currier
- Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Rebecca A Raphaely
- Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
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