CHEST critical care最新文献

{"title":"Innovation and Adaptation in COVID-19 Pandemic Posthospital Discharge Contact and Monitoring in the United States","authors":"Katrina E. Hauschildt PhD ,&nbsp;Jacquelyn Miller MA ,&nbsp;Nathan Wright MA ,&nbsp;Amanda Schutz PhD ,&nbsp;Lexi Wilhelmsen MPH ,&nbsp;Katharine Seagly PhD ,&nbsp;Sara E. Golden PhD ,&nbsp;Aluko A. Hope MD ,&nbsp;Kelly C. Vranas MD ,&nbsp;Catherine L. Hough MD ,&nbsp;Thomas S. Valley MD","doi":"10.1016/j.chstcc.2024.100101","DOIUrl":"10.1016/j.chstcc.2024.100101","url":null,"abstract":"<div><h3>Background</h3><div>To address unknown risk for readmission among patients with COVID-19 and persistent capacity strain, hospital systems used postdischarge contact and monitoring to facilitate safe discharge and recovery. However, little work has systematically documented how hospitals implemented changes to hospitalization postdischarge contact practices during COVID-19.</div></div><div><h3>Research Question</h3><div>How did hospitals’ innovate and adapt postdischarge telephone follow-up and remote monitoring strategies to assess discharged patients with COVID-19 for risk of readmission and recovery progress?</div></div><div><h3>Study Design and Methods</h3><div>Semistructured interviews were conducted (January 2022 to March 2023) with 70 inpatient and outpatient providers and administrators (5-12 per site) in nine health systems that varied by size, region, rurality, proportion of Medicaid patients, and estimated scale of post-COVID-19 care organization. Participants described innovation in and implementation of discharge and postdischarge care processes used to assess patients with COVID-19 for readmission risk and recovery progress. The primary analysis was site-level case comparative analysis.</div></div><div><h3>Results</h3><div>Respondents described hospital systems’ motivations for adapting preexisting resources and innovating new postdischarge programs, including postdischarge telephone follow-up and remote monitoring programs, to facilitate safe hospital discharge and transitions to ambulatory care for patients with COVID-19. Respondents also explained various factors that influenced the implementation and use of postdischarge contact practices. Participants perceived that these practices mitigated postdischarge risks and alleviated capacity strain. Respondents described retiring or adapting remote monitoring programs for other conditions as COVID-19 demands declined.</div></div><div><h3>Interpretation</h3><div>Our results show that hospitals implemented and adapted postdischarge practices to help facilitate recovery and address unknown risk for readmission during the pandemic. Some efforts may present opportunities to manage readmission concerns and capacity strain more generally.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100101"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748377","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}

{"title":"Silent Burdens","authors":"Cassiano Teixeira MD, PhD","doi":"10.1016/j.chstcc.2024.100106","DOIUrl":"10.1016/j.chstcc.2024.100106","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100106"},"PeriodicalIF":0.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700607","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}

{"title":"Prevalence of Inpatient Pulse Oximetry in Operative and Nonoperative Settings","authors":"Nicholas A. Bosch MD ,&nbsp;Anica C. Law MD ,&nbsp;Ashraf Fawzy MD, MPH ,&nbsp;Theodore J. Iwashyna MD, PhD","doi":"10.1016/j.chstcc.2024.100104","DOIUrl":"10.1016/j.chstcc.2024.100104","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100104"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700608","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}

{"title":"Operationalizing the New Global Definition of ARDS","authors":"George L. Anesi MD, MSCE, MBE ,&nbsp;Arisha Ramkillawan MBChB ,&nbsp;Jonathan Invernizzi MBBCh, MMed ,&nbsp;Stella M. Savarimuthu MD ,&nbsp;Robert D. Wise MBChB, MMed ,&nbsp;Zane Farina MBChB ,&nbsp;Michelle T.D. Smith MBChB, PhD","doi":"10.1016/j.chstcc.2024.100103","DOIUrl":"10.1016/j.chstcc.2024.100103","url":null,"abstract":"<div><h3>Background</h3><div>A proposed new global definition of ARDS seeks to update the Berlin definition and account for nonintubated ARDS and ARDS diagnoses in resource-variable settings.</div></div><div><h3>Research Question</h3><div>How do ARDS epidemiologic characteristics change with operationalizing the new global definition of ARDS in a resource-limited setting?</div></div><div><h3>Study Design and Methods</h3><div>We performed a real-use retrospective cohort study among adult patients meeting criteria for the Berlin definition of ARDS or the global definition of ARDS at ICU admission in two public hospitals in the KwaZulu-Natal Department of Health, South Africa, from January 2017 through June 2022.</div></div><div><h3>Results</h3><div>Among 5,760 adults (aged ≥ 18 years) admitted to the ICU, 2,027 patients (35.2%) met at least one ARDS definition, including 1,218 patients meeting the Berlin definition of ARDS (60.1% of all ARDS diagnoses) and 809 new diagnoses of the global definition of ARDS that were not captured by the Berlin definition alone (39.9% of all ARDS diagnoses and 14.0% of all ICU admissions). After adjustment for hospital-level factors, patients who met only the global definition of ARDS criteria (ie, who would not have been captured by the Berlin definition) showed no statistically significant ICU mortality difference vs patients with ARDS according to the Berlin definition (21.7% [95% CI, 18.9%-24.4%] vs 23.8% [95% CI, 21.5%-26.2%]; OR, 0.88 [95% CI, 0.70-1.10]; <em>P</em> = .25). In prespecified exploratory subgroup analyses, patients without COVID-19 who met only the criteria for the global definition of ARDS showed reduced ICU mortality (14.2% [95% CI, 11.6%-16.9%] vs 22.2% [95% CI, 19.8%-24.6%]; OR, 0.58 [95% CI, 0.45-0.75]; <em>P</em> &lt; .0005) compared with patients without COVID-19 who met the Berlin definition for ARDS.</div></div><div><h3>Interpretation</h3><div>The new global definition of ARDS captures a significant proportion of patients who would not have been included by the Berlin definition alone. These additional patients with ARDS may have heterogenous patterns of outcomes among diagnostic subgroups, including by COVID-19 status, compared with patients with ARDS according to the Berlin definition.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100103"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721472","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}

{"title":"Corrigendum to: Psomiadis JS, Khawaja A, Zimmerman J. CHEST Critical Care. 2023;1(3):100022","authors":"","doi":"10.1016/j.chstcc.2024.100105","DOIUrl":"10.1016/j.chstcc.2024.100105","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100105"},"PeriodicalIF":0.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700610","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}

{"title":"Transitions of Care Between Community to Hospital and Back Again","authors":"Kimberley J. Haines PhD ,&nbsp;Yasmine Ali Abdelhamid PhD","doi":"10.1016/j.chstcc.2024.100102","DOIUrl":"10.1016/j.chstcc.2024.100102","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100102"},"PeriodicalIF":0.0,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700606","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}

{"title":"Association Between Sex and Race and Ethnicity and IV Sedation Use in Patients Receiving Invasive Ventilation","authors":"Sarah L. Walker ,&nbsp;Federico Angriman MD, PhD ,&nbsp;Lisa Burry PharmD, PhD ,&nbsp;Leo Anthony Celi MD, MPH ,&nbsp;Kirsten M. Fiest PhD ,&nbsp;Judy Gichoya MD ,&nbsp;Alistair Johnson PhD ,&nbsp;Kuan Liu PhD ,&nbsp;Sangeeta Mehta MD ,&nbsp;Georgiana Roman-Sarita RRT ,&nbsp;Laleh Seyyed-Kalantari PhD ,&nbsp;Thanh-Giang T. Vu MD ,&nbsp;Elizabeth L. Whitlock MD ,&nbsp;George Tomlinson PhD ,&nbsp;Christopher J. Yarnell MD, PhD","doi":"10.1016/j.chstcc.2024.100100","DOIUrl":"10.1016/j.chstcc.2024.100100","url":null,"abstract":"<div><h3>Background</h3><div>IV sedation is an important tool for managing patients receiving invasive ventilation, yet excess sedation is harmful, and dosing could be influenced by implicit bias.</div></div><div><h3>Research Question</h3><div>What are the associations between sex or race and ethnicity and sedation practices?</div></div><div><h3>Study Design and Methods</h3><div>We performed a retrospective single-center cohort study of adults receiving invasive ventilation for ≥ 24 hours using the Medical Information Mart for Intensive Care Version IV (2008-2019) database from Boston, Massachusetts. We used a repeated-measures design (4-hour intervals) to study the association between sex (female or male) or race and ethnicity (Asian, Black, Hispanic, White) and sedation outcomes. Sedation outcomes included sedative use (propofol, benzodiazepine, dexmedetomidine) and minimum sedation score. We categorized sedative use as follows: no sedative and then lowest, second, third, and highest quartiles of sedative dose. We adjusted for covariates with multilevel Bayesian proportional odds modeling and reported ORs with 95% credible intervals (CrIs).</div></div><div><h3>Results</h3><div>We studied 6,764 patients: 43% female; 3.5% Asian, 12% Black, 4.5% Hispanic, and 80% White. Benzodiazepines were administered to 2,334 patients (36%). Black patients received benzodiazepines less often and at lower doses than White patients (more benzodiazepine: OR, 0.66; 95% CrI, 0.49-0.92). Propofol was administered to 3,865 patients (57%). Female patients received propofol less often and at lower doses than male patients (more propofol: OR, 0.72; 95% CrI, 0.61-0.86). Dexmedetomidine was administered to 1,439 patients (21%), and use was similar across sex or race and ethnicity. Female patients were less sedated than male patients (deeper sedation: OR, 0.71; 95% CrI, 0.62-0.81), and Black patients were more sedated than White patients (more sedated: OR, 1.28; 95% CrI, 1.05-1.55).</div></div><div><h3>Interpretation</h3><div>Among patients receiving invasive ventilation for at least 24 hours, IV sedation and attained sedation levels varied by sex and by race and ethnicity. Adherence to sedation guidelines may improve equity in sedation management for critically ill patients.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100100"},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700609","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}

{"title":"Association of Hyperinflammatory Subphenotype With Code Status De-Escalation in Patients With Acute Respiratory Failure","authors":"Amanda C. Moale MD ,&nbsp;S. Mehdi Nouraie MD, PhD ,&nbsp;Haris Zia MD ,&nbsp;Caitlin Schaefer MPH ,&nbsp;Ian J. Barbash MD, MS ,&nbsp;Douglas B. White MD, MAS ,&nbsp;Bryan J. McVerry MD ,&nbsp;Georgios D. Kitsios MD, PhD","doi":"10.1016/j.chstcc.2024.100098","DOIUrl":"10.1016/j.chstcc.2024.100098","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100098"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573267","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}

{"title":"Interpreting Clinical Trial Results","authors":"Christopher Kearney MD ,&nbsp;Brooke Barlow PharmD ,&nbsp;Brandon Pang MD ,&nbsp;Nicholas A. Bosch MD","doi":"10.1016/j.chstcc.2024.100097","DOIUrl":"10.1016/j.chstcc.2024.100097","url":null,"abstract":"<div><div>Randomized clinical trials (RCTs) are the gold standard to evaluate intervention efficacy and effectiveness. To apply current, evidence-based interventions to daily practice, it is imperative that practicing intensivists be able to interpret the results of individual RCTs in the context of their patients. In this article, we outline an approach to interpreting critical care RCTs from the perspective of the clinician that focuses on answering four questions: (1) Would my patient have been enrolled and represented in the RCT? (2) Is the intervention feasible? (3) Are there threats to the internal validity of the RCT results? (4) Are the RCT results meaningful? Answers to these four questions can be used to assist intensivists in deciding whether to apply RCT evidence to their patients at the bedside and to avoid common pitfalls of RCT interpretation.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100097"},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553381","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}

{"title":"Time Is Brain","authors":"Giulia M. Benedetti MD ,&nbsp;Lindsey A. Morgan MD ,&nbsp;Dana B. Harrar MD, PhD","doi":"10.1016/j.chstcc.2024.100099","DOIUrl":"10.1016/j.chstcc.2024.100099","url":null,"abstract":"<div><div>Status epilepticus (SE) is a life-threatening emergency that requires prompt recognition and treatment and is common in the ICU. The definition of SE has evolved, with a shift toward highlighting the potential for permanent neurologic injury and prioritizing early termination. Although EEG serves a confirmatory role in the diagnosis of convulsive SE, SE in the ICU often is nonconvulsive, making EEG essential for diagnosis and management. In this review, we characterize the neurobiology of SE and provide clinically applicable strategies for timely recognition and effective treatment of SE, highlighting ICU-level therapies and integration of continuous EEG. We also discuss the simultaneous etiologic evaluation that must take place to identify the cause of SE.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100099"},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578324","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}