CHEST critical care最新文献

Anti-CD14 Treatment in Patients With Severe COVID-19 Clinical and Biological Effects in a Phase 2 Randomized Open-Label Adaptive Platform Clinical Trial 在一项 2 期随机开放标签自适应平台临床试验中，对重度 COVID-19 患者进行抗 CD14 治疗的临床和生物效应研究

CHEST critical care Pub Date : 2025-03-01 DOI: 10.1016/j.chstcc.2024.100117

F. Linzee Mabrey MD, MSc , Thomas R. Martin MD , Carolyn S. Calfee MD , Kathleen D. Liu MD , Benjamin LaCombe BS , Lamorna Brown-Swigart PhD , Andrea Discacciati PhD , Martin Eklund PhD , Susan R. Heckbert MD , Michael A. Matthay MD , Laura Esserman MD , Mark M. Wurfel MD, PhD

{"title":"Anti-CD14 Treatment in Patients With Severe COVID-19 Clinical and Biological Effects in a Phase 2 Randomized Open-Label Adaptive Platform Clinical Trial","authors":"F. Linzee Mabrey MD, MSc , Thomas R. Martin MD , Carolyn S. Calfee MD , Kathleen D. Liu MD , Benjamin LaCombe BS , Lamorna Brown-Swigart PhD , Andrea Discacciati PhD , Martin Eklund PhD , Susan R. Heckbert MD , Michael A. Matthay MD , Laura Esserman MD , Mark M. Wurfel MD, PhD","doi":"10.1016/j.chstcc.2024.100117","DOIUrl":"10.1016/j.chstcc.2024.100117","url":null,"abstract":"<div><h3>Background</h3><div>Cluster of differentiation 14 (CD14)-dependent innate immunity contributes to poor outcomes in COVID-19 pneumonia.</div></div><div><h3>Research Question</h3><div>What are the clinical and biological effects of a blocking anti-CD14 monoclonal antibody (IC14) for treatment of severe COVID-19 pneumonia and what is the usefulness of a biomarker of CD14 pathway activation in predicting outcome?</div></div><div><h3>Study Design And Methods</h3><div>We report a preplanned secondary analysis of the Investigation of Serial Studies to Predict Your Therapeutic Response With Imaging and Molecular Analysis to Coronavirus Disease of 2019 (I-SPY COVID) trial, which enrolled hospitalized patients with severe COVID-19 pneumonia who required high-level respiratory support at 19 medical centers in the United States. Participants were randomized to receive either IV IC14 (4 mg/kg on day 1, then 2 mg/kg on days 2-4; n = 67) or standard care (n = 76). Primary end points included time to recovery, defined as the first 2-day period with ≤ 6 L/min of oxygen, and mortality. In predefined secondary analyses, we tested the association between IC14 treatment and mortality in patients with high or low baseline plasma presepsin, a biomarker of CD14 pathway activity, and the effects of IC14 on plasma biomarkers of pharmacodynamics, injury, and inflammation.</div></div><div><h3>Results</h3><div>IC14 treatment did not improve time to recovery or 28-day mortality in the overall population, and the trial was stopped because of meeting futility criteria for the time-to-recovery end point. However, a predefined subgroup analysis showed that IC14 treatment was associated with a numerical reduction in 28-day mortality in participants with high (above median) baseline presepsin levels (n = 47; hazard ratio for mortality [HRm], 0.52; 95% credible interval, 0.22-1.22; posterior probability [Pr] HRm < 1 (Pr(HRm < 1 | data)) = 0.93). IC14 treatment increased plasma sCD14, a pharmacodynamic marker, and decreased plasma inflammatory biomarkers, including IL-8, receptor for advanced glycation end products, vascular endothelial growth factor, and presepsin.</div></div><div><h3>Interpretation</h3><div>Although IC14 treatment did not improve overall clinical outcomes, this new secondary analysis showed that IC14 produced the expected pharmacodynamic and biological effects and that baseline plasma presepsin concentrations may identify patients likely to respond to IC14 treatment. Further trials are needed to determine the efficacy of IC14 treatment in acute lung injury and the value of presepsin to identify patients most likely to respond.</div></div><div><h3>Clinical Trial Registry</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: NCT04488081; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100117"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The New Global Definition of ARDS ARDS的新全球定义

CHEST critical care Pub Date : 2025-03-01 DOI: 10.1016/j.chstcc.2024.100121

Theogene Twagirumugabe MD, PhD

引用次数: 0

Initial Opioid Exposure in the ICU and 1-Year Opioid-Related Outcomes in Patients Who Are Mechanically Ventilated ICU初始阿片类药物暴露和机械通气患者1年阿片类药物相关结局

CHEST critical care Pub Date : 2025-03-01 DOI: 10.1016/j.chstcc.2024.100124

Theodore J. Iwashyna MD, PhD , Elizabeth M. Viglianti MD, MPH , Jennifer Cano MPH , Sarah Seelye PhD , Nicholas A. Bosch MD , Lisa D. Burry PhD , Bijan Teja MD , David N. Juurlink MD, PhD , Henry T. Stelfox MD, PhD , Downing Lu MD, MPH , Andrea D. Hill PhD , Allan J. Walkey MD , Hannah Wunsch MD

{"title":"Initial Opioid Exposure in the ICU and 1-Year Opioid-Related Outcomes in Patients Who Are Mechanically Ventilated","authors":"Theodore J. Iwashyna MD, PhD , Elizabeth M. Viglianti MD, MPH , Jennifer Cano MPH , Sarah Seelye PhD , Nicholas A. Bosch MD , Lisa D. Burry PhD , Bijan Teja MD , David N. Juurlink MD, PhD , Henry T. Stelfox MD, PhD , Downing Lu MD, MPH , Andrea D. Hill PhD , Allan J. Walkey MD , Hannah Wunsch MD","doi":"10.1016/j.chstcc.2024.100124","DOIUrl":"10.1016/j.chstcc.2024.100124","url":null,"abstract":"<div><h3>Background</h3><div>Little is known about whether the choice of opioid influences long-term outcomes for critically ill patients.</div></div><div><h3>Research Question</h3><div>To determine whether initiation of IV morphine or hydromorphone during mechanical ventilation (MV) is associated with reduced opioid use after discharge relative to fentanyl.</div></div><div><h3>Study Design and Methods</h3><div>This was a retrospective cohort study of 14,197 veterans who underwent MV in 116 Veterans Administration hospitals (2014-2020) and who received fentanyl, morphine, or hydromorphone as the initial and only IV opioid during their first 2 days in the ICU. The primary outcome was persistent opioid use in the year after hospital discharge.</div></div><div><h3>Results</h3><div>Overall, 11,903 patients (83.8%) received fentanyl, 1,156 patients (8.1%) received morphine, and 1,138 patients (8.0%) received hydromorphone as the initial and only IV opioid during the first 2 days in the ICU. The median patient age was 67 years (interquartile range, 61-72 years). Persistent opioid use in the year after discharge was more common with hydromorphone (16.5%) vs fentanyl (12.0%; adjusted OR [aOR], 1.25; 95% CI, 1.00-1.56), but not with morphine (15.7%) vs fentanyl (aOR, 1.12; 95% CI, 0.91-1.39). Stratified by prior persistent opioid use, the association between opioid initially received in the ICU and an increased risk of persistent use in the following year was present only among individuals without this history for both morphine and hydromorphine compared with fentanyl (morphine: aOR, 1.44 [95% CI, 1.07-1.94]; hydromorphone: aOR, 1.51 [95% CI, 1.12-2.04]).</div></div><div><h3>Interpretation</h3><div>Among patients in the ICU who received MV, persistent opioid use in the year after hospital discharge was more frequent among patients initially exposed to IV morphine or hydromorphone compared with fentanyl, but only among those without a prior history of persistent opioid use. The choice of initial opioid may have long-term consequences for patients. Further research is needed to confirm these exploratory findings.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100124"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Advancing Prognostic Enrichment in Pediatric Sepsis-Associated Acute Respiratory Dysfunction 推进小儿败血症相关急性呼吸功能障碍的预后富集

CHEST critical care Pub Date : 2025-02-21 DOI: 10.1016/j.chstcc.2025.100140

Richard W. Pierce MD , Colin J. Sallee MD

引用次数: 0

Lactation as Liberation 哺乳作为解放

CHEST critical care Pub Date : 2025-02-15 DOI: 10.1016/j.chstcc.2025.100141

R. Nicholas Burns MD

引用次数: 0

Understanding Cause of Death for Patients Receiving Extracorporeal Membrane Oxygenation Is Essential for Patient-Centered Care 了解接受体外膜氧合的患者的死亡原因对以患者为中心的护理至关重要

CHEST critical care Pub Date : 2025-02-04 DOI: 10.1016/j.chstcc.2025.100139

Sarah Godfrey MD, MPH

引用次数: 0

The Lingering Impact of COVID-19 on Respiratory Health COVID-19对呼吸系统健康的持续影响

CHEST critical care Pub Date : 2025-01-31 DOI: 10.1016/j.chstcc.2025.100137

Fernando Luis Scolari MD, PhD

引用次数: 0

Immunomodulation for ARDS ARDS的免疫调节

CHEST critical care Pub Date : 2025-01-23 DOI: 10.1016/j.chstcc.2025.100129

Emma Rademaker MD , Jelle L.G. Haitsma Mulier MD , Julia Drylewicz PhD , Eveline M. Delemarre MD, PhD , Marleen A. Slim MD, PhD , Nicole P. Juffermans MD, PhD , Peter Pickkers MD, PhD , Marc J.M. Bonten MD, PhD , Olaf L. Cremer MD, PhD , Lennie P.G. Derde MD, PhD

{"title":"Immunomodulation for ARDS","authors":"Emma Rademaker MD , Jelle L.G. Haitsma Mulier MD , Julia Drylewicz PhD , Eveline M. Delemarre MD, PhD , Marleen A. Slim MD, PhD , Nicole P. Juffermans MD, PhD , Peter Pickkers MD, PhD , Marc J.M. Bonten MD, PhD , Olaf L. Cremer MD, PhD , Lennie P.G. Derde MD, PhD","doi":"10.1016/j.chstcc.2025.100129","DOIUrl":"10.1016/j.chstcc.2025.100129","url":null,"abstract":"<div><h3>Background</h3><div>The success of targeted immunomodulation in COVID-19 underscores its potential for ARDS resulting from other causes. However, it is important to understand both its targeted and broader impacts on the inflammatory host response. To guide future ARDS studies, we explored this in patients with COVID-19 using targeted proteomics.</div></div><div><h3>Research Question</h3><div>How do different immune modulators affect the immune profiles of patients who are critically ill with COVID-19-related ARDS?</div></div><div><h3>Study Design and Methods</h3><div>In this multicenter cohort study, we used 2 Dutch biorepositories to compare patients with COVID-19 with acute respiratory failure treated with: no immunotherapy (n = 18), corticosteroids (n = 21), anakinra plus corticosteroids (n = 9), or tocilizumab plus corticosteroids (n = 22). Plasma proteins related to inflammation and cardiovascular injury were measured using proximity extension assays on ICU days 0 through 1, ICU days 2 through 4 (T3), and ICU days 6 through 8 (T7) after treatment initiation.</div></div><div><h3>Results</h3><div>We observed lower expression of inflammatory biomarkers immediately after tocilizumab administration and from T3 onward after anakinra administration. After treatment with corticosteroids alone, fewer inflammatory biomarkers were suppressed, and only at T3. Multivariate analyses at T3 identified tumor necrosis factor-related apoptosis-inducing ligand, IL-1 receptor-like 2, and tumor necrosis factor β as markedly increased and proto-oncogene tyrosine-protein kinase (SRC) and serine/threonine kinase 4 (STK4) as decreased, solely after tocilizumab. At T7, lower concentrations of 2,4-dienoyl-CoA reductase 1, signaling lymphocytic activation molecule family member 7, SRC, and STK4 were observed in patients treated with tocilizumab or anakinra, whereas interferon γ, chemokine (C-X-C motif) ligand 9, and chemokine (C-C motif) ligand 19 were decreased only after anakinra treatment.</div></div><div><h3>Interpretation</h3><div>In this exploratory study, adding tocilizumab or anakinra to corticosteroids triggered a much broader immunoregulatory response than can be explained by their receptor-specific actions. The response after tocilizumab occurred more rapidly than that after anakinra, offering a potential advantage in the time-sensitive ICU setting. Additionally, tocilizumab preserved the interferon pathway, crucial for antiviral defense, whereas anakinra suppressed it.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100129"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859181","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}

引用次数: 0

Association Between Receipt of Ketamine vs Etomidate for Emergency Tracheal Intubation and Symptoms of Posttraumatic Stress Disorder at 12 Months 急诊气管插管使用氯胺酮与依托咪酯与12个月创伤后应激障碍症状的关系

CHEST critical care Pub Date : 2025-01-22 DOI: 10.1016/j.chstcc.2025.100136

Lucas C. Wollenman MD , Austin M. Tipold MD , Matthew W. Semler MD, MSCI , Jonathan D. Casey MD, MSCI , Aaron J. Lacy MD , Wesley H. Self MD, MPH , Amy L. Kiehl MA , Patsy T. Bryant MS , Stephanie C. DeMasi MD , Ian H. Stanley PhD , Cathy A. Jenkins MS , Guanchao Wang MS , Jim C. Jackson PsyD , E. Wes Ely MD, MPH , Jin H. Han MD, MSc

{"title":"Association Between Receipt of Ketamine vs Etomidate for Emergency Tracheal Intubation and Symptoms of Posttraumatic Stress Disorder at 12 Months","authors":"Lucas C. Wollenman MD , Austin M. Tipold MD , Matthew W. Semler MD, MSCI , Jonathan D. Casey MD, MSCI , Aaron J. Lacy MD , Wesley H. Self MD, MPH , Amy L. Kiehl MA , Patsy T. Bryant MS , Stephanie C. DeMasi MD , Ian H. Stanley PhD , Cathy A. Jenkins MS , Guanchao Wang MS , Jim C. Jackson PsyD , E. Wes Ely MD, MPH , Jin H. Han MD, MSc","doi":"10.1016/j.chstcc.2025.100136","DOIUrl":"10.1016/j.chstcc.2025.100136","url":null,"abstract":"<div><h3>Background</h3><div>One of 3 patients in the ICU receiving mechanical ventilation demonstrate posttraumatic stress disorder (PTSD). A single dose of ketamine has been shown to reduce PTSD symptoms in outpatients with chronic PTSD, but its long-term effect is unknown in patients who are critically ill and mechanically ventilated.</div></div><div><h3>Research Question</h3><div>Is ketamine, when used for induction of anesthesia before emergency tracheal intubation, associated with fewer symptoms of PTSD at 12 months compared with etomidate?</div></div><div><h3>Study Design and Methods</h3><div>This was a secondary analysis of a cluster-randomized trial that examined the effect of oxygen saturation targets in patients receiving invasive mechanical ventilation in an emergency department or ICU. Symptoms of PTSD were assessed by trained neuropsychologist raters using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (PCL-5) by phone. Scores ranged from 0 to 80, with higher scores indicating more severe PTSD symptoms. A score of ≥ 31 indicated probable PTSD. Symptoms of PTSD were compared between patients who received ketamine and patients who received etomidate using a proportional odds logistic regression model adjusting for age, race, sex, education, depression or PTSD before illness, comorbidities, severity of illness, sepsis, and location of intubation.</div></div><div><h3>Results</h3><div>Among the 141 patients included in this analysis, 52 patients (37%) received ketamine and 89 patients (63%) received etomidate. The median PCL-5 score at 12 months was 7 (interquartile range [IQR], 1-18) for patients who received ketamine and 14 (IQR, 5-27) for patients who received etomidate (reference; adjusted OR, 0.39; 95% CI, 0.20-0.76). A total of 8 patients (15.4%) who received ketamine and 18 patients (20.2%) who received etomidate met criteria for probable PTSD.</div></div><div><h3>Conclusions</h3><div>Compared with etomidate, induction with ketamine during emergency tracheal intubation was associated with significantly fewer symptoms of PTSD at 12 months. A randomized trial is needed to confirm this finding.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100136"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859148","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}

引用次数: 0

Understanding Provider-Level Variation in Clinical Practice 了解临床实践中提供者层面的差异

CHEST critical care Pub Date : 2025-01-22 DOI: 10.1016/j.chstcc.2025.100134

Kanupriya Soni MD , Leigh A. Bukowski MPH , Billie S. Davis PhD , Joel M. Levin BA , Jeremy M. Kahn MD

{"title":"Understanding Provider-Level Variation in Clinical Practice","authors":"Kanupriya Soni MD , Leigh A. Bukowski MPH , Billie S. Davis PhD , Joel M. Levin BA , Jeremy M. Kahn MD","doi":"10.1016/j.chstcc.2025.100134","DOIUrl":"10.1016/j.chstcc.2025.100134","url":null,"abstract":"<div><h3>Background</h3><div>Clinician practice patterns vary widely in the ICU, particularly in the context of therapies with moderate-quality evidence. A better understanding of the psychological factors underlying provider-level practice variation may reveal targets to standardize practice and speed adoption of new evidence.</div></div><div><h3>Research Question</h3><div>Are provider-level psychological traits associated with practice patterns in the ICU?</div></div><div><h3>Study Design and Methods</h3><div>We administered a longitudinal questionnaire to intensivist clinicians in a single integrated health system from 2018 through 2021. We selected corticosteroids in septic shock as an example of a guideline-recommended practice supported by moderate-quality evidence. In response to a clinical vignette of septic shock, intensivists rated their willingness to administer corticosteroids, their perceptions of the strength of evidence, and their perception of how well the mechanism of action is understood. Via the same questionnaire, we measured psychological traits hypothesized to affect decision-making under uncertainty. We used multivariate regression to examine the relationship between these factors and respondents’ willingness to treat with corticosteroids.</div></div><div><h3>Results</h3><div>The overall survey completion rate was 50.5%. Among 201 participants, 101 participants (50%) were attending physicians, 77 participants (38%) were fellow physicians, and 23 participants (11%) were advanced practice providers. Willingness to treat with corticosteroids increased over time, from 15.3% to 24.4% in 2021. In multivariate regression analyses using generalized estimating equations for repeated measures, risk tolerance (OR, 1.34, 95% CI, 1.07-1.67; <em>P</em> = .01) and perceived strength of evidence (OR, 1.45; 95% CI, 1.18-1.77; <em>P</em> < .001) were associated with increased willingness to treat with corticosteroids, controlling for other factors. Willingness to treat was not associated with perceived understanding of the mechanism of action or other psychological factors.</div></div><div><h3>Interpretation</h3><div>Our findings indicate that ICU providers’ individual level of risk tolerance is associated with their willingness to prescribe corticosteroids for septic shock.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100134"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807291","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}

引用次数: 0