CHEST critical care最新文献

CHEST critical care Pub Date : 2025-07-07 DOI: 10.1016/j.chstcc.2025.100191

Audrey De Jong MD, PhD, Samir Jaber MD, PhD

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Rheological Theory of Ergotrauma 角外伤的流变理论

CHEST critical care Pub Date : 2025-07-05 DOI: 10.1016/j.chstcc.2025.100190

Vicent Modesto i Alapont MD, PhD

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The Role of Calibration Practices in Optimizing Continuous Glucose Monitor Accuracy in Critically Ill Patients 校准实践在优化危重患者连续血糖监测准确性中的作用

CHEST critical care Pub Date : 2025-07-05 DOI: 10.1016/j.chstcc.2025.100193

Melanie Natasha Rayan MD, MPH , Eileen R. Faulds PhD, RN , Brooke Lee , Molly McNett PhD, RN , Matthew Exline MD, MPH , Chyongchiou J. Lin PhD , Laureen Jones RN , Amanie Rasul , Kathleen M. Dungan MD, MPH

{"title":"The Role of Calibration Practices in Optimizing Continuous Glucose Monitor Accuracy in Critically Ill Patients","authors":"Melanie Natasha Rayan MD, MPH , Eileen R. Faulds PhD, RN , Brooke Lee , Molly McNett PhD, RN , Matthew Exline MD, MPH , Chyongchiou J. Lin PhD , Laureen Jones RN , Amanie Rasul , Kathleen M. Dungan MD, MPH","doi":"10.1016/j.chstcc.2025.100193","DOIUrl":"10.1016/j.chstcc.2025.100193","url":null,"abstract":"<div><h3>Background</h3><div>In the ICU, continuous glucose monitors (CGMs) may improve glycemia and reduce the need for point-of-care blood glucose (POC BG) monitoring, but face challenges because of clinical conditions that affect accuracy.</div></div><div><h3>Research Question</h3><div>What is the feasibility of using POC BG calibration to improve CGM accuracy?</div></div><div><h3>Study Design and Methods</h3><div>This feasibility study pooled data from a retrospective study of patients with COVID-19 in the ICU and a prospective single-arm clinical trial of patients in the ICU. Our sample included 110 patients receiving IV insulin monitored using a hybrid CGM plus POC BG protocol with a factory-calibrated Dexcom G6 CGM (Dexcom, Inc.). Validation was required for initial and ongoing nonadjunctive use or for standalone use and was defined as CGM ± 20% of POC BG measurement for values of ≥ 100 mg/dL or ± 20 mg/dL for values of < 100 mg/dL. In the cohort with COVID-19, calibration was performed at the nurse’s discretion. In the prospective study, calibration was performed after persistent failure to achieve validation.</div></div><div><h3>Results</h3><div>A total of 55 patients (50%) underwent 167 calibrations. Those with a calibration had a mean age of 57.9 ± 13.6 years, 49% were male, 83% were White, and 60% had type 2 diabetes. After calibration, validation was achieved in 72.6%, 66.7%, and 77.8% of patients at 6, 12, and 24 hours after calibration, respectively. The mean absolute relative difference (MARD) was 25% at calibration, decreasing to 9.6%, 12.7%, and 13.2% at 6, 12, and 24 hours. Similar percentages were observed after eliminating pairs with multiple calibrations. Calibration was timely, within 5 minutes of the POC BG measurement in 70% and < 10 minutes in 83%. No statistical difference in MARD was found between timely and late calibrations or based on sensor rate of change at the time of calibration.</div></div><div><h3>Interpretation</h3><div>Our feasibility study demonstrated an improvement in CGM accuracy with POC BG calibrations in ICU patients. Further research is needed to understand optimal implementation strategies and impact on outcomes.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145160044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Revisiting an Old Drug and a New Challenge 重温旧药，迎接新挑战

CHEST critical care Pub Date : 2025-06-19 DOI: 10.1016/j.chstcc.2025.100188

Arsh Chowdhary MD, T.S. Dharmarajan MD

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Response 响应

CHEST critical care Pub Date : 2025-06-19 DOI: 10.1016/j.chstcc.2025.100189

Sarah N. Obeidalla MEd , Gordon R. Bernard MD , Lorraine B. Ware MD , V. Eric Kerchberger MD

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Skeletal Muscle Is a Vital Organ During Critical Illness 骨骼肌是危重疾病时的重要器官

CHEST critical care Pub Date : 2025-06-19 DOI: 10.1016/j.chstcc.2025.100187

Ariel Jaitovich MD, ATSF

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Semiawake Extubation Semiawake拔管

CHEST critical care Pub Date : 2025-06-09 DOI: 10.1016/j.chstcc.2025.100182

Flavia Gabe Beltrami MD, PhD , Felippe Leopoldo Dexheimer Neto MD, PhD

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Surrogate Decision-Making Support Trials in the ICU ICU的替代决策支持试验

CHEST critical care Pub Date : 2025-06-09 DOI: 10.1016/j.chstcc.2025.100183

Natalie A. Pattison DNSc, RN

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Epidemiologic Characteristics and Management of Sepsis Among Previously Healthy Patients 先前健康患者败血症的流行病学特征和处理

CHEST critical care Pub Date : 2025-06-01 DOI: 10.1016/j.chstcc.2025.100148

Rachel K. Hechtman MD , Megan E. Heath PhD , Jennifer K. Horowitz MA , Elizabeth McLaughlin MS, RN , Patricia J. Posa RN, BSN, MSA, CCRN , John Blamoun MD , Paul Bozyk MD , Megan Cahill DO, MBA, FACOEP , Rania Esteitie MD, FCCP, ATSF , Kevin Furlong DO , Namita Jayaprakash MB, BcH BAO, MRCEM , Jessica Jones PharmD , Maximiliano Tamae-Kakazu MD , Joan Nagelkirk MD , Thomas Pfotenhauer DO , Derek C. Angus MD, MPH, FRCP , Scott A. Flanders MD , Elizabeth S. Munroe MD , Hallie C. Prescott MD

{"title":"Epidemiologic Characteristics and Management of Sepsis Among Previously Healthy Patients","authors":"Rachel K. Hechtman MD , Megan E. Heath PhD , Jennifer K. Horowitz MA , Elizabeth McLaughlin MS, RN , Patricia J. Posa RN, BSN, MSA, CCRN , John Blamoun MD , Paul Bozyk MD , Megan Cahill DO, MBA, FACOEP , Rania Esteitie MD, FCCP, ATSF , Kevin Furlong DO , Namita Jayaprakash MB, BcH BAO, MRCEM , Jessica Jones PharmD , Maximiliano Tamae-Kakazu MD , Joan Nagelkirk MD , Thomas Pfotenhauer DO , Derek C. Angus MD, MPH, FRCP , Scott A. Flanders MD , Elizabeth S. Munroe MD , Hallie C. Prescott MD","doi":"10.1016/j.chstcc.2025.100148","DOIUrl":"10.1016/j.chstcc.2025.100148","url":null,"abstract":"<div><h3>Background</h3><div>Most deaths resulting from sepsis occur among patients with advanced age, multiple morbidities, or frailty. It is unclear how many sepsis-related deaths truly are preventable. Previously healthy patients may provide insight into preventable sepsis mortality.</div></div><div><h3>Research Question</h3><div>What are the baseline characteristics, management, and outcomes associated with previously healthy patients with sepsis?</div></div><div><h3>Study Design and Methods</h3><div>This was a retrospective cohort of patients hospitalized for community-onset sepsis at 66 Michigan hospitals (November 2020-January 2024). We developed major and minor criteria to classify patients as previously healthy vs having significant comorbidities. We compared baseline characteristics, management, and outcomes of previously healthy patients vs patients with comorbid sepsis. Physicians reviewed charts of previously healthy patients with in-hospital death to evaluate baseline health status and rate preventability of death.</div></div><div><h3>Results</h3><div>Of 29,688 patients hospitalized for sepsis, 2,963 patients (10.0%) were classified as previously healthy. Previously healthy patients had median age of 53 years, a median of 2 minor comorbidities, and lower in-hospital mortality (5.8% vs 12.7%; <em>P</em> < .01) vs comorbid patients. Delivery of guideline-recommended early sepsis management ranged from 56.8% to 80.9% across individual care practices. Several care practices were less common among previously healthy patients, including lactate measurement (67.5% vs 73.8%; <em>P</em> < .01) and timely antibiotic administration (58.0% vs 66.3%; <em>P</em> < .01), whereas some were more common, including ≥ 30 mL/kg fluid resuscitation (72.4% vs 55.3%; <em>P</em> < .01). Among 48 charts of previously healthy decedents reviewed, 77.1% of patients were deemed to have life expectancy > 5 years without sepsis. Most deaths were judged to be unpreventable because of severity of illness on presentation.</div></div><div><h3>Interpretation</h3><div>We found that 1 in 10 patients with community-onset sepsis was healthy previously. Although gaps in in-hospital management were identified, deaths among previously healthy patients generally were deemed unpreventable with better in-hospital management because of patients seeking treatment too late in the course of sepsis. This study highlights system-level opportunities for better recognition and triage of sepsis before hospitalization.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100148"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Accuracy of Ultrasonography in Confirming Correct Positioning of Nasogastric Tube in the Intensive Care Setting 超声在重症监护中确定鼻胃管正确位置的准确性

CHEST critical care Pub Date : 2025-05-29 DOI: 10.1016/j.chstcc.2025.100181

Alessandro F. Chiesa MD , Giulia Nenna MD , Christian Nicole , Francesco Caronni MD , Michael Llamas MD , Elisa Racina MD , Marco Previsdomini MD , Andrea Garbagnati MD , Alberto Pagnamenta MD

{"title":"Accuracy of Ultrasonography in Confirming Correct Positioning of Nasogastric Tube in the Intensive Care Setting","authors":"Alessandro F. Chiesa MD , Giulia Nenna MD , Christian Nicole , Francesco Caronni MD , Michael Llamas MD , Elisa Racina MD , Marco Previsdomini MD , Andrea Garbagnati MD , Alberto Pagnamenta MD","doi":"10.1016/j.chstcc.2025.100181","DOIUrl":"10.1016/j.chstcc.2025.100181","url":null,"abstract":"<div><h3>Background</h3><div>Nasogastric tubes (NGTs) are used frequently in ICUs. Radiographic confirmation of correct placement represents the best available standard. According to a recently published Cochrane systematic review, ultrasonography has insufficient accuracy as a single test to confirm the correct placement.</div></div><div><h3>Research Question</h3><div>In a 2-step approach, is ultrasonography with a dynamic fogging test at the epigastric level reliable to confirm correct NGT placement?</div></div><div><h3>Study Design and Methods</h3><div>The study was conducted at 4 ICUs in Switzerland. The ultrasonography consisted of 2 parts: neck scan and epigastric scan with injection test. For safety concerns, only patients with a visible NGT in the esophagus underwent epigastric imaging with an injection test. We considered 3 results for the injection test: correct placement, incorrect placement, or uncertain placement in the stomach. Comparisons between the diagnostic test and the reference standard permitted to assess sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.</div></div><div><h3>Results</h3><div>One hundred eighty-two patients were eligible for the study. The mean age was 68 years, 122 patients were male, 42 patients had obesity, and 120 patients were mechanically ventilated. Ten patients had to be excluded from the final analysis because of protocol violation or failed visualization of NGT in the esophagus. Dynamic fogging detection results were positive, negative, and inconclusive in 125 patients (73%), 39 patients (22%), and 8 patients (5%), respectively. Excluding inconclusive results, the test showed sensitivity of 79% (95% CI, 71.4%-84.7%), specificity of 100% (95% CI, 47.8%-100%), positive predictive value of 100% (95% CI, 97.1%-100%), negative predictive value of 13% (95% CI, 4.3%-27.4%), and an accuracy of 79.3% (95% CI, 72.3%-85.2%). Considering inconclusive results as both positive and negative, we obtained similar diagnostic test performances.</div></div><div><h3>Interpretation</h3><div>Our results indicate that in the ICU setting, the dynamic fogging test is a reliable method to confirm NGT placement in the stomach. It could reduce the need for radiography in a considerable number of patients.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: NCT06693219; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100181"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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