CHEST critical care最新文献

{"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 ,&nbsp;Thomas R. Martin MD ,&nbsp;Carolyn S. Calfee MD ,&nbsp;Kathleen D. Liu MD ,&nbsp;Benjamin LaCombe BS ,&nbsp;Lamorna Brown-Swigart PhD ,&nbsp;Andrea Discacciati PhD ,&nbsp;Martin Eklund PhD ,&nbsp;Susan R. Heckbert MD ,&nbsp;Michael A. Matthay MD ,&nbsp;Laura Esserman MD ,&nbsp;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 &lt; 1 (Pr(HRm &lt; 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}

{"title":"The New Global Definition of ARDS","authors":"Theogene Twagirumugabe MD, PhD","doi":"10.1016/j.chstcc.2024.100121","DOIUrl":"10.1016/j.chstcc.2024.100121","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100121"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610862","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":"Initial Opioid Exposure in the ICU and 1-Year Opioid-Related Outcomes in Patients Who Are Mechanically Ventilated","authors":"Theodore J. Iwashyna MD, PhD ,&nbsp;Elizabeth M. Viglianti MD, MPH ,&nbsp;Jennifer Cano MPH ,&nbsp;Sarah Seelye PhD ,&nbsp;Nicholas A. Bosch MD ,&nbsp;Lisa D. Burry PhD ,&nbsp;Bijan Teja MD ,&nbsp;David N. Juurlink MD, PhD ,&nbsp;Henry T. Stelfox MD, PhD ,&nbsp;Downing Lu MD, MPH ,&nbsp;Andrea D. Hill PhD ,&nbsp;Allan J. Walkey MD ,&nbsp;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}

{"title":"Understanding Cause of Death for Patients Receiving Extracorporeal Membrane Oxygenation Is Essential for Patient-Centered Care","authors":"Sarah Godfrey MD, MPH","doi":"10.1016/j.chstcc.2025.100139","DOIUrl":"10.1016/j.chstcc.2025.100139","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100139"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143748637","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":"Accuracy and Interobserver Reliability of Bedside Assessments of Endotracheal Secretions Among Critically Ill Patients","authors":"Sam Schuiteman MD ,&nbsp;Nathaniel Soper MD ,&nbsp;Keith S. Kaye MD, MPH ,&nbsp;Kelly Fiorino MS, RRT, RRT-ACCS ,&nbsp;Andrew J. Weirauch MS, RRT, RRT-ACCS ,&nbsp;Owen R. Albin MD","doi":"10.1016/j.chstcc.2025.100133","DOIUrl":"10.1016/j.chstcc.2025.100133","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100133"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759463","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":"Why Biomarker-Guided Strategies Shape the Future of Randomized Controlled Trials for Immunomodulating Therapies","authors":"Erik H.A. Michels MD ,&nbsp;Rombout B.E. van Amstel MD","doi":"10.1016/j.chstcc.2025.100131","DOIUrl":"10.1016/j.chstcc.2025.100131","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100131"},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759462","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":"Developing Core Outcome (Measurement) Sets for Critical Care Research Using the Modified Delphi Method","authors":"Sarah L. Gorst PhD ,&nbsp;Diana C. Bouhassira MD ,&nbsp;Alison E. Turnbull DVM, MPH, PhD","doi":"10.1016/j.chstcc.2025.100128","DOIUrl":"10.1016/j.chstcc.2025.100128","url":null,"abstract":"<div><h3>Topic Importance</h3><div>High-quality core outcome sets (COSs) and core outcome measurement sets (COMSs) can help to optimize research by allowing the results of clinical trials to be compared and combined in systematic reviews. The number of registered COSs and COMSs for critical care research is increasing, and most are developed using the Delphi method. However, the quality of these tools varies substantially.</div></div><div><h3>Review Findings</h3><div>At least 39 COSs and 10 associated COMSs have been designed for clinical research in critical care and at least 21 ongoing development projects. The Delphi method is the most common method used to foster agreement on the content of a COS or COMS. It is flexible and permits the development process to be tailored to the medical condition and population of interest. However, designing an effective Delphi study requires time and careful deliberation. Clearly defining scope, piloting survey materials, and crafting a consensus process that uses the strengths of each stakeholder group and minimizes loss to follow-up are encouraged. Reporting on COS and COMS development should be sufficiently detailed for readers to understand and critique both the process and the resulting research tool. Established checklists and guidelines are available to assist with both protocol development and peer review of manuscripts reporting on newly generated COSs and COMSs.</div></div><div><h3>Summary</h3><div>Thorough preliminary work, planning, and reporting increase the likelihood that COSs or COMSs related to critical care will reflect the opinions of knowledgeable stakeholders and will improve the usefulness of clinical trial data.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100128"},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474472","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":"Managing Immune Checkpoint Inhibitor Pneumonitis in the ICU","authors":"Kristina Montemayor MD, MHS ,&nbsp;Mohammad I. Ghanbar MD ,&nbsp;Abigail L. Koch MD, MHS ,&nbsp;Karthik Suresh MD ,&nbsp;Robert Scott Stephens MD","doi":"10.1016/j.chstcc.2024.100126","DOIUrl":"10.1016/j.chstcc.2024.100126","url":null,"abstract":"<div><div>Recent advancements in the management of non-small cell lung cancer, especially with immunotherapeutic agents like immune checkpoint inhibitors (ICIs), have improved patient outcomes significantly. However, despite their effectiveness, ICIs can cause immune-related adverse events, including checkpoint inhibitor pneumonitis. Diagnosing and managing pneumonitis can be particularly challenging and patients with moderate or severe symptoms typically require ICU level of care. The management of patients with ICI pneumonitis requires a multidisciplinary approach and numerous treatment decisions, including the use of systemic corticosteroids and adjunctive therapies in certain cases. In this How I Do It article, we offer a case-based discussion covering evaluation, common radiographic changes, diagnosis, grading, and management of ICI pneumonitis in patients in the ICU. We also address common clinical decisions related to corticosteroid dosing, guidance on initiation of adjunctive therapies, and future use of ICI therapy.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100126"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487635","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":"Lactation Practices in Critically Ill Patients","authors":"Kayla J. Kolbe MD ,&nbsp;Virginia Sheffield MD ,&nbsp;Katerina Castillo MD ,&nbsp;Kriya S. Patel MD ,&nbsp;Jessica A. Blank MD ,&nbsp;Melissa H. Ross MD ,&nbsp;Thomas S. Valley MD ,&nbsp;Rommel Sagana MD","doi":"10.1016/j.chstcc.2024.100123","DOIUrl":"10.1016/j.chstcc.2024.100123","url":null,"abstract":"<div><h3>Background</h3><div>Most birthing people in the United States initiate lactation, but little is known about lactation practices in patients who are critically ill.</div></div><div><h3>Research Question</h3><div>What are the lactation rates and practices in adult patients in the ICU and what are potential barriers to lactation and resource use?</div></div><div><h3>Study Design and Methods</h3><div>We performed a retrospective chart review of immediately postpartum patients in the ICU at an academic medical center between January 2018 and January 2024. Information regarding initiation, cessation, communication, and lactation consultant (LC) services were extracted and bivariate tests of association were conducted.</div></div><div><h3>Results</h3><div>Most immediately postpartum patients in the ICU initiated lactation (85% [87 of 102]), but only 70% (72 of 102) continued until hospital discharge. Documented lactation plans were present before delivery for 60% of patients, and a documented plan to initiate lactation before delivery was associated with increased odds of initiating lactation after delivery (OR, 9.21; 95% CI, 1.96-43.3; <em>P</em> = .005). Although most patients (75%) saw LCs, less than 30% of patients saw LCs within 24 hours of delivery. An association between seeing an LC and continuing lactation until hospital discharge was found (OR, 4.74; 95% CI, 1.77-12.7; <em>P</em> = .002). More than one-half of lactating patients received mechanical ventilation (55%), but nearly 20% of these intubated patients did not undergo milk expression while ventilated.</div></div><div><h3>Interpretation</h3><div>Most postpartum patients who are critically ill initiate lactation, but not all continue until hospital discharge. Having documented plans to lactate before delivery and seeing LCs were protective of lactation in the ICU, but many patients did not see LCs promptly. Additional gaps in care included lack of documentation and delays in lactation initiation in intubated patients. We hypothesize that these gaps may hinder patients who are critically ill from achieving their personal lactation goals, and steps should be taken to address and mitigate these challenges.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100123"},"PeriodicalIF":0.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487206","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 Measuring Driving Pressure and Patient Effort in Assisted Modes of Ventilation","authors":"Malik Farooqi MD ,&nbsp;Michael Mikhaeil MD ,&nbsp;Jason Z.X. Chen MD ,&nbsp;Mohamed Althobity MD ,&nbsp;Alisha Greer MD ,&nbsp;Arjun Sharma MD ,&nbsp;Kimberley Lewis MD ,&nbsp;Tom Piraino MD ,&nbsp;Deborah Cook MD ,&nbsp;Bram Rochwerg MD","doi":"10.1016/j.chstcc.2024.100125","DOIUrl":"10.1016/j.chstcc.2024.100125","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100125"},"PeriodicalIF":0.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444658","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}