CHEST critical care最新文献

{"title":"Association of Hyperinflammatory Subphenotype With Code Status De-Escalation in Patients With Acute Respiratory Failure","authors":"Amanda C. Moale MD , S. Mehdi Nouraie MD, PhD , Haris Zia MD , Caitlin Schaefer MPH , Ian J. Barbash MD, MS , Douglas B. White MD, MAS , Bryan J. McVerry MD , 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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}

{"title":"Resource Use in the Randomized Master Protocol for Immune Modulators for Treating COVID-19 (ACTIV-1 IM)","authors":"Anne M. Lachiewicz MD, MPH ,&nbsp;Miloni Shah MPH ,&nbsp;Tatyana Der MD ,&nbsp;Derek Cyr PhD ,&nbsp;Hussein R. Al-Khalidi PhD ,&nbsp;Christopher Lindsell PhD ,&nbsp;Vivek Iyer MD ,&nbsp;Akram Khan MD ,&nbsp;Reynold Panettieri MD ,&nbsp;Adriana M. Rauseo MD ,&nbsp;Martin Maillo MD ,&nbsp;Andreas Schmid MD ,&nbsp;Sugeet Jagpal MD ,&nbsp;William G. Powderly MD ,&nbsp;Samuel A. Bozzette MD, PhD ,&nbsp;Randomized Master Protocol for Immune Modulators for Treating COVID-19 (ACTIV-1 IM) Study Group","doi":"10.1016/j.chstcc.2024.100095","DOIUrl":"10.1016/j.chstcc.2024.100095","url":null,"abstract":"<div><h3>Background</h3><div>COVID-19 pneumonia requires considerable health care resources.</div></div><div><h3>Research Question</h3><div>Does a single dose of infliximab or abatacept, in addition to remdesivir and steroids, decreased resource use among patients hospitalized with COVID-19 pneumonia?</div></div><div><h3>Study Design and Methods</h3><div>The Randomized Master Protocol for Immune Modulators for Treating COVID-19 (ACTIV-1 IM) was a randomized, placebo-controlled trial examining the potential benefit in time to recovery and mortality of the immunomodulators infliximab, abatacept, and cenicriviroc. This observational study performed a secondary analysis of the participants receiving infliximab, abatacept, and common placebo to examine resource use. Hospital days, ICU days, days with supplemental oxygen, days with high-flow nasal cannula or noninvasive ventilation, ventilator days, and days of extracorporeal membrane oxygenation each were examined. Proportional odds models were used to compare days alive and free of resource use over 28 days between infliximab and placebo groups and between abatacept and placebo groups.</div></div><div><h3>Results</h3><div>In this study, infliximab infusion, compared with placebo, was associated with greater odds of being alive and free of all interventions tested. Abatacept use was associated only with greater odds of days alive and free of hospitalization and supplemental oxygen.</div></div><div><h3>Interpretation</h3><div>Infliximab and abatacept use were associated with decreased use of health care resources over 28 days compared with placebo, but the absolute differences were small.</div></div><div><h3>Clinical Trial Registry</h3><div>ClinicalTrials.gov; No.: NCT04593940; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578325","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":"Circulatory Extracorporeal Membrane Oxygenation Support for High-Risk Acute Pulmonary Embolism","authors":"Salman Abdulaziz MBBS, FRCP ,&nbsp;Vivek Kakar MD, FRCA ,&nbsp;Huda Alfoudri MBChB, FCARCSI ,&nbsp;Mohammed Shalaby MD ,&nbsp;Mikaela V. Allen NMD ,&nbsp;Shameena Beegom RN, MSc ,&nbsp;John F. Fraser MBChB, PhD, FRCP, FRCA, FFARCSI, FCICM, FELSO ,&nbsp;Saleh Fares Al Ali MD, MPH","doi":"10.1016/j.chstcc.2024.100096","DOIUrl":"10.1016/j.chstcc.2024.100096","url":null,"abstract":"<div><div>High-risk pulmonary embolism (PE), defined as obstruction of the pulmonary arterial tree that leads to hemodynamic instability, is a common cause of cardiac arrest, with a mortality rate of up to 50%. The obstruction of the pulmonary circulation interferes with gas exchange and causes hemodynamic disturbances in both the right and left sides of the heart. Some international guidelines have suggested the use of extracorporeal membrane oxygenation (ECMO), in combination with definitive therapy, in patients with PE with refractory circulatory collapse or cardiac arrest. Furthermore, several observational studies have shown that ECMO may be beneficial in stabilizing patients with high-risk PE, especially as a form of bridging therapy in patients for whom common reperfusion methods may be insufficient or have delayed efficacy. We present the case of a patient with acute high-risk PE and the role of ECMO in addressing the physiologic derangements caused by PE and improving patient outcomes. We reviewed the literature reporting the experience on ECMO use in conjunction with various forms of definitive treatment for PE. We describe the various ECMO cannulation strategies applicable for patients with high-risk PE, the role of adjunct mechanical circulatory support, practical guidance on ECMO weaning, and the interaction between the PE response team and the ECMO team in the setting of high-risk PE.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553387","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":"Reshaping Postpandemic Critical Care Collaboration in the Asia-Pacific Region","authors":"Eamon P. Raith MBBS, PhD, FCICM ,&nbsp;See Kay Choong ,&nbsp;Mark Nicholls ,&nbsp;Wong Wai Tat ,&nbsp;Sheila Nainan Myatra ,&nbsp;Erwin Pradian MD, PhD ,&nbsp;Moritoki Egi MD, PhD ,&nbsp;Gee-Young Suh MD, PhD ,&nbsp;Shanti Rudra Deva ,&nbsp;Naranpurev Mendsaikhan ,&nbsp;Shital Adhikari ,&nbsp;Jose Melanio Grayda ,&nbsp;Ming-Cheng Chan ,&nbsp;Suthat Rungruanghiranya ,&nbsp;Sean Loh FCCP, FRCP ,&nbsp;David Ku FCICM","doi":"10.1016/j.chstcc.2024.100094","DOIUrl":"10.1016/j.chstcc.2024.100094","url":null,"abstract":"<div><div>The COVID-19 pandemic presented the greatest challenge to modern intensive care medicine since its founding as a specialty in 1952, with its effects felt across health care services in all regions, including low-resourced settings. A paucity of data remains regarding the provision of intensive care medicine across the globe, particularly after the COVID-19 pandemic. To determine the broad state of critical care medicine after the pandemic in the Asia-Pacific region, the inaugural Asia-Pacific Critical Care Societies Summit was held in Singapore as a satellite meeting of the Asia-Pacific Intensive Care Symposium on August 18, 2023. This article summarizes this summit and provides key health and economic data for representative countries before detailing the resolutions and planned actions arising from this initiative. Fourteen critical care societies participated in the inaugural summit and consented to publication of societal reports. Common challenges and priorities for participating societies included issues around education and training, specialty and workforce advocacy, and collaboration and research. As a result of this summit, societies resolved to establish an Asia-Pacific education forum, to encourage the development of Asia-Pacific critical care trials, and to support engagement in multinational studies. A second Asia-Pacific Critical Care Societies Summit will be convened in 2024, with a focus on safety and quality challenges within ICUs represented by the societies present and discussion of the listed priority areas.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142659378","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":"Predictors of Medical Mistrust Among Surrogate Decision-Makers of Patients in the ICU at High Risk of Death","authors":"Scott T. Vasher MD, MSCR ,&nbsp;Jeff Laux PhD ,&nbsp;Shannon S. Carson MD ,&nbsp;Blair Wendlandt MD, MSCR","doi":"10.1016/j.chstcc.2024.100092","DOIUrl":"10.1016/j.chstcc.2024.100092","url":null,"abstract":"<div><h3>Background</h3><div>Medical mistrust may worsen communication between ICU surrogate decision-makers and intensivists. The prevalence of and risk factors for medical mistrust among surrogate decision-makers are not known.</div></div><div><h3>Research Question</h3><div>What are the potential sociodemographic risk factors for high medical mistrust among surrogate decision-makers of critically ill patients at high risk of death?</div></div><div><h3>Study Design and Methods</h3><div>In this pilot cross-sectional study conducted at a single academic medical center between August 2022 and August 2023, adult patients admitted to the medical ICU and their surrogate decision-makers were enrolled. All patients were incapacitated at enrollment with Sequential Organ Failure Assessment scores of ≥ 7 or required mechanical ventilation with vasopressor infusion. Surrogate decision-maker sociodemographic characteristics were age, race, sex, education, relationship to the patient, employment, prior exposure to a loved one transitioning to hospice or comfort-focused care, and religiousness. The primary outcome was surrogate decision-maker medical mistrust, measured using the Medical Mistrust Multiformat Scale. Multiple linear regression was used to determine sociodemographic characteristics associated with higher medical mistrust.</div></div><div><h3>Results</h3><div>Thirty-one patients and their surrogate decision-makers were enrolled during the study period, surpassing our goal of 30 pairs and indicating recruitment feasibility. Mean ± SD surrogate age was 53.8 ± 14.5 years, 24 surrogates were female, and mean medical mistrust score was 17.1 ± 5.4. Race was associated with medical mistrust, with Black participants showing higher medical mistrust compared with White participants (β =10.21; 95% CI, 3.40-17.02; <em>P</em> = .010). Religiousness was associated with lower medical mistrust (β = –2.94; 95% CI, –4.43 to –1.41; <em>P = .</em>003). Prior exposure to hospice or comfort-focused care was associated with higher medical mistrust (β = 7.06; 95% CI, 1.21-12.91; <em>P = .</em>025).</div></div><div><h3>Interpretation</h3><div>We found that recruiting ICU surrogates and measuring medical mistrust within 48 h of ICU admission was feasible. Several surrogate sociodemographic characteristics were associated with changes in medical mistrust. These preliminary findings will inform the design of future studies.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142538303","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":"The SONIC CENTRAL Study","authors":"Tessa A. Mulder MD ,&nbsp;Linda Becude MD ,&nbsp;Jorge E. Lopez Matta MD ,&nbsp;Wilbert B. van den Hout PhD ,&nbsp;David J. van Westerloo MD, PhD ,&nbsp;Martijn P. Bauer MD, PhD","doi":"10.1016/j.chstcc.2024.100091","DOIUrl":"10.1016/j.chstcc.2024.100091","url":null,"abstract":"<div><h3>Background</h3><div>Estimating central venous pressure (CVP) is essential in the diagnostic evaluation and treatment guidance of most hospitalized patients. It is unknown how different noninvasive bedside methods to estimate CVP correlate with each other and which method has the best accuracy.</div></div><div><h3>Research Question</h3><div>Which noninvasive bedside method to estimate CVP has the best accuracy to detect elevated CVP?</div></div><div><h3>Study Design and Methods</h3><div>During this prospective, single-center, observational study, we included patients admitted to the ward or ICU who already had an indwelling central venous catheter and who did not undergo positive pressure ventilation. We measured height of the fluid column in the external jugular vein (EJV) according to the Lewis and Borst method (EJV height), maximum and minimum diameters and height of the fluid column of the internal jugular vein (IJV; IJV height) using ultrasound, and diameters of the inferior vena cava (IVC) throughout a respiratory cycle and sniffing. We then compared these measurements with intravenously measured CVP.</div></div><div><h3>Results</h3><div>Ninety patients were included. Twenty-seven patients (30%) showed CVP of ≥ 10 mm Hg. All measurements had a significant correlation with CVP, except for the diameter of the IJV. Areas under the receiver operating characteristic curve for IJV height, EJV height, maximum diameter, and collapsibility on inspiration of the IVC were 0.85, 0.80, 0.78, and 0.76 respectively. The interobserver agreement was good to excellent. We estimated continuous likelihood ratios for the measurements to aid clinical decision-making.</div></div><div><h3>Interpretation</h3><div>Our results indicated that EJV height, IJV height, IVC diameter, and IVC collapsibility can be used to identify an elevated CVP in hospitalized patients. Among these, ultrasonographic estimation of the height of the fluid column in the IJV is quick and easy and allows identification of an elevated CVP with the best reproducibility and accuracy.</div></div><div><h3>Clinical Trial Registration</h3><div>National Trial Register; ID: NL-OMON22937; URL: <span><span>https://onderzoekmetmensen.nl/en/trial/22937</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578326","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":"Feasibility of In-Hospital Administration of a Tool to Predict Persistent Post-ICU Functional Impairment Among Older ICU Survivors","authors":"Julia A. Stevenson BA ,&nbsp;Terrence E. Murphy PhD ,&nbsp;Baylah Tessier-Sherman MPH ,&nbsp;Margaret A. Pisani MD, MPH ,&nbsp;Thomas M. Gill MD ,&nbsp;Lauren E. Ferrante MD, MHS","doi":"10.1016/j.chstcc.2024.100093","DOIUrl":"10.1016/j.chstcc.2024.100093","url":null,"abstract":"<div><h3>Background</h3><div>A recent international consensus conference called for the development of risk prediction models to identify ICU survivors at increased risk of each of the post-ICU syndrome domains. We previously developed and validated a risk prediction tool for functional impairment after ICU admission among older adults.</div></div><div><h3>Research Question</h3><div>In this pilot study, we assessed the feasibility of administering the risk prediction tool in the hospital to older adults who had just survived critical illness. An exploratory objective was to evaluate whether augmentation of the model with additional hospital-related factors improved discrimination.</div></div><div><h3>Study Design and Methods</h3><div>Between January and October 2020, 50 adults aged 65 years and older underwent in-hospital administration of the risk prediction tool. Survivors were called monthly for 6 months after discharge. Feasibility was defined as completion of all tool components by ≥ 70% of enrolled participants. Persistent functional impairment was defined as failure to return to the functional baseline from before the ICU stay at the 6-month interview based on seven daily activities. The model was sequentially refit after adding three in-hospital factors as predictors, one at a time and then all together. Model discrimination was assessed with receiver operating characteristic curves.</div></div><div><h3>Results</h3><div>The tool met the a priori feasibility threshold, with 92.0% of enrolled participants completing all eight components. In the exploratory analysis, the addition of Acute Physiology and Chronic Health Evaluation II score, presence of delirium, and maximum in-hospital mobility resulted in a 5% gain in discrimination that did not achieve statistical significance (area under the receiver operating characteristic curve, 0.75; 95% CI, 0.68-0.82; <em>P</em> = .09).</div></div><div><h3>Interpretation</h3><div>Our results indicate that the risk prediction tool is feasible for use in the hospital setting, enabling the identification of ICU survivors at high risk of persistent functional impairment at 6 months after discharge. Augmentation with hospital-related factors improved model discrimination, but did not achieve statistical significance in this pilot study. Future studies should evaluate the augmented model in larger cohorts.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142534039","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":"Sugar Rush","authors":"Andrew J. Boyle PhD ,&nbsp;Adam M. Deane PhD","doi":"10.1016/j.chstcc.2024.100090","DOIUrl":"10.1016/j.chstcc.2024.100090","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000443/pdfft?md5=7f17d804f410309f213fddc342bdfb21&pid=1-s2.0-S2949788424000443-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696189","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}