CHEST critical care最新文献

{"title":"Current Use, Training, and Barriers to Point-of-Care Ultrasound Use in ICUs in the Department of Veterans Affairs","authors":"Christopher K. Schott MD ,&nbsp;Erin Wetherbee MD ,&nbsp;Rahul Khosla MD ,&nbsp;Robert Nathanson MD ,&nbsp;Jason P. Williams MD ,&nbsp;Michael J. Mader MS ,&nbsp;Elizabeth K. Haro MPH ,&nbsp;Dean Kellogg III MD ,&nbsp;Abraham Rodriguez DO ,&nbsp;Kevin C. Proud MD ,&nbsp;Jeremy S. Boyd MD ,&nbsp;Brian Bales MD ,&nbsp;Harald Sauthoff MD ,&nbsp;Zahir Basrai MD ,&nbsp;Dana Resop MD ,&nbsp;Brian P. Lucas MD ,&nbsp;Marcos I. Restrepo MD, PhD ,&nbsp;Nilam J. Soni MD","doi":"10.1016/j.chstcc.2023.100012","DOIUrl":"https://doi.org/10.1016/j.chstcc.2023.100012","url":null,"abstract":"<div><h3>Background</h3><p>Point-of-care ultrasound (POCUS) has become an integral part of critical care medicine for procedural guidance, bedside diagnostics, and assessing response to treatment. Multiple critical care societies recommend POCUS use, and POCUS training has been a requirement for critical care fellowship since 2012. Yet, current practice patterns of POCUS use in ICUs are not well known.</p></div><div><h3>Research Question</h3><p>This study aimed to characterize current POCUS use, training needs, and barriers to use among intensivists.</p></div><div><h3>Study Design and Methods</h3><p>A prospective observational study of all Veterans Affairs (VA) medical centers was conducted between June 2019 and March 2020 using a web-based survey of all chiefs of staff and ICU chiefs. These data were compared with those from a similar survey conducted in 2015.</p></div><div><h3>Results</h3><p>Chiefs of staff and ICU chiefs from 130 VA medical centers were surveyed with 100% and 94% response rates, respectively. At least one physician currently uses POCUS in 93% of ICUs, and 62% of individual physicians were estimated to be using POCUS. The most common POCUS applications were procedural guidance (59%), cardiac ultrasound (55%), and thoracic ultrasound (56%) . Most chiefs (80%) reported teaching POCUS to trainees in their ICU. The most frequently reported barriers to POCUS use were lack of trained providers (48%), lack of funding for training (45%), lack of training opportunities (37%), and lack of image archiving (34%). From 2015 through 2020, POCUS use increased across most applications and an increase in desire for training was seen.</p></div><div><h3>Interpretation</h3><p>POCUS use increased across VA ICUs between 2015 and 2020, but significant gaps remain. Without a deliberate investment in POCUS training and infrastructure for physicians in practice, institutions are unlikely to benefit fully from standardized POCUS use in ICUs.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49778165","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}

{"title":"Patient-Reported Symptoms After Hematopoietic Stem Cell Transplantation Complicated by Critical Illness","authors":"R. Scott Stephens MD","doi":"10.1016/j.chstcc.2023.100013","DOIUrl":"https://doi.org/10.1016/j.chstcc.2023.100013","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49778162","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}

{"title":"Protocol and Statistical Analysis Plan for the Pragmatic Trial Examining Oxygenation Prior to Intubation of Preoxygenation With Noninvasive Ventilation vs Oxygen Mask in Critically Ill Adults","authors":"Kevin W. Gibbs MD ,&nbsp;Adit A. Ginde MD, MPH ,&nbsp;Matthew E. Prekker MD, MPH ,&nbsp;Kevin P. Seitz MD, MSc ,&nbsp;Susan B. Stempek PA, MBA ,&nbsp;Caleb Taylor MD, MPH ,&nbsp;Sheetal Gandotra MD ,&nbsp;Heath White DO, MS ,&nbsp;Daniel Resnick-Ault MD ,&nbsp;Akram Khan MD ,&nbsp;Amira Mohmed MD ,&nbsp;Jason C. Brainard MD ,&nbsp;Daniel G. Fein MD ,&nbsp;Neil R. Aggarwal MD ,&nbsp;Micah R. Whitson MD ,&nbsp;Stephen J. Halliday MD, MSc ,&nbsp;John P. Gaillard MD ,&nbsp;Veronika Blinder DO ,&nbsp;Brian E. Driver MD ,&nbsp;Jessica A. Palakshappa MD, MS ,&nbsp;Jonathan D. Casey MD, MSc","doi":"10.1016/j.chstcc.2023.100014","DOIUrl":"https://doi.org/10.1016/j.chstcc.2023.100014","url":null,"abstract":"<div><h3>Background</h3><p>Hypoxemia is a common and life-threatening complication during emergency tracheal intubation of critically ill adults. The administration of supplemental oxygen before the procedure (ie, preoxygenation) decreases the risk of hypoxemia during intubation.</p></div><div><h3>Research Question</h3><p>Does preoxygenation with noninvasive ventilation prevent hypoxemia during tracheal intubation of critically ill adults compared with preoxygenation with an oxygen mask?</p></div><div><h3>Study Design and Methods</h3><p>The Pragmatic Trial Examining Oxygenation Prior to Intubation (PREOXI) is a prospective, multicenter, nonmasked randomized comparative effectiveness trial being conducted in seven EDs and 17 ICUs across the United States. The trial compares preoxygenation with noninvasive ventilation vs oxygen mask among 1,300 critically ill adults undergoing emergency tracheal intubation. Eligible patients are randomized in a 1:1 ratio to receive either noninvasive ventilation or an oxygen mask before induction. The primary outcome is the incidence of hypoxemia, defined as a peripheral oxygen saturation of &lt; 85% between induction and 2 min after intubation. The secondary outcome is the lowest oxygen saturation between induction and 2 min after intubation. Enrollment began on March 10, 2022, and is expected to conclude in 2023.</p></div><div><h3>Interpretation</h3><p>The PREOXI investigation will provide important data on the comparative effectiveness of preoxygenation with noninvasive ventilation vs oxygen mask for the prevention of hypoxemia during emergency tracheal intubation. Specifying the protocol and statistical analysis plan before the conclusion of enrollment increases the rigor, reproducibility, and interpretability of the trial.</p></div><div><h3>Trial Registry</h3><p>ClinicalTrials.gov; No.: NCT05267652; URL: <span>www.clinicaltrials.gov</span><svg><path></path></svg></p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49778166","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}

{"title":"Introducing CHEST Critical Care","authors":"Hayley B. Gershengorn MD","doi":"10.1016/j.chstcc.2023.100001","DOIUrl":"https://doi.org/10.1016/j.chstcc.2023.100001","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49734748","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}

{"title":"Survival ≠ Recovery","authors":"Emily Schwitzer MD ,&nbsp;Kristin Schwab Jensen MD ,&nbsp;Lorie Brinkman OTD, OTR/L ,&nbsp;Lynette DeFrancia MA, OTR/L ,&nbsp;Joe VanVleet BSRC, RRT ,&nbsp;Esau Baqi PT, DPT ,&nbsp;Ravi Aysola MD ,&nbsp;Nida Qadir MD","doi":"10.1016/j.chstcc.2023.100003","DOIUrl":"https://doi.org/10.1016/j.chstcc.2023.100003","url":null,"abstract":"<div><p>Surviving critical illness does not always equate to recovery, with its aftermath frequently complicated by post-intensive care syndrome (PICS). This syndrome consists of a collection of new or worsening impairments in the physical, psychological, or cognitive domains that develop after critical illness. In this review, we describe the clinical manifestations, evaluation, and management of PICS. We also examine the interplay between PICS and social determinants of health. Finally, we discuss how multidisciplinary PICS clinics can be used to care for patients who survive the ICU and potentially improve care within the ICU.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49716524","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}

{"title":"Early Serial Echocardiographic and Ultrasonographic Findings in Critically Ill Patients With COVID-19","authors":"Michael J. Lanspa MD ,&nbsp;Siddharth P. Dugar MD ,&nbsp;Heather L. Prigmore MPH ,&nbsp;Jeremy S. Boyd MD ,&nbsp;Jordan D. Rupp MD ,&nbsp;Chris J. Lindsell PhD ,&nbsp;Todd W. Rice MD ,&nbsp;Nida Qadir MD ,&nbsp;George W. Lim MD ,&nbsp;Ariel L. Shiloh MD ,&nbsp;Vladyslav Dieiev MD ,&nbsp;Michelle N. Gong MD ,&nbsp;Steven W. Fox MD ,&nbsp;Eliotte L. Hirshberg MD ,&nbsp;Akram Khan MD ,&nbsp;James Kornfield MD ,&nbsp;Jacob H. Schoeneck MD ,&nbsp;Nicholas Macklin MD ,&nbsp;D.Clark Files MD ,&nbsp;Kevin W. Gibbs MD ,&nbsp;Olivia G. Arter","doi":"10.1016/j.chstcc.2023.100002","DOIUrl":"https://doi.org/10.1016/j.chstcc.2023.100002","url":null,"abstract":"<div><h3>Background</h3><p>Cardiac function of critically ill patients with COVID-19 generally has been reported from clinically obtained data. Echocardiographic deformation imaging can identify ventricular dysfunction missed by traditional echocardiographic assessment.</p></div><div><h3>Research Question</h3><p>What is the prevalence of ventricular dysfunction and what are its implications for the natural history of critical COVID-19?</p></div><div><h3>Study Design and Methods</h3><p>This is a multicenter prospective cohort of critically ill patients with COVID-19. We performed serial echocardiography and lower extremity vascular ultrasound on hospitalization days 1, 3, and 8. We defined left ventricular (LV) dysfunction as the absolute value of longitudinal strain of &lt; 17% or left ventricle ejection fraction (LVEF) of &lt; 50%. Primary clinical outcome was inpatient survival.</p></div><div><h3>Results</h3><p>We enrolled 110 patients. Thirty-nine (35.5%) died before hospital discharge. LV dysfunction was present at admission in 38 patients (34.5%) and in 21 patients (36.2%) on day 8 (<em>P</em> = .59). Median baseline LVEF was 62% (interquartile range [IQR], 52%-69%), whereas median absolute value of baseline LV strain was 16% (IQR, 14%-19%). Survivors and nonsurvivors did not differ statistically significantly with respect to day 1 LV strain (17.9% vs 14.4%; <em>P</em> = .12) or day 1 LVEF (60.5% vs 65%; <em>P</em> = .06). Nonsurvivors showed worse day 1 right ventricle (RV) strain than survivors (16.3% vs 21.2%; <em>P</em> = .04).</p></div><div><h3>Interpretation</h3><p>Among patients with critical COVID-19, LV and RV dysfunction is common, frequently identified only through deformation imaging, and early (day 1) RV dysfunction may be associated with clinical outcome.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49716525","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}

{"title":"Symptom Trajectory in Hematopoietic Stem Cell Transplantation Recipients Who Survive Critical Illness","authors":"Bruno L. Ferreyro MD, PhD ,&nbsp;Laveena Munshi MD ,&nbsp;Refik Saskin MSc ,&nbsp;Matthew C. Cheung MD ,&nbsp;Vikas Gupta MD ,&nbsp;Santhosh Thyagu MD ,&nbsp;Hannah Wunsch MD ,&nbsp;Damon C. Scales MD, PhD","doi":"10.1016/j.chstcc.2023.100004","DOIUrl":"https://doi.org/10.1016/j.chstcc.2023.100004","url":null,"abstract":"<div><h3>Background</h3><p>Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk of ICU admission. Data are sparse about long-term patient-reported outcomes in patients who survive the ICU. The Edmonton Symptom Assessment System (ESAS) score is a validated method for measuring symptoms across nine domains (pain, tiredness, lack of appetite, shortness of breath, nausea, drowsiness, depression, anxiety, and poor well-being) and has been collected systematically for patients with cancer in Ontario, Canada.</p></div><div><h3>Research Question</h3><p>What is the association between ICU admission and subsequent symptom trajectory among HSCT recipients?</p></div><div><h3>Study Design and Methods</h3><p>This was a population-based cohort study of HSCT recipients in the province of Ontario between 2006 and 2017. The main exposure was being discharged alive from the ICU; these patients were matched on baseline characteristics to patients who survived hospitalization (without the ICU). The primary outcome was the rate of moderate to severe symptoms within 1 year of hospital discharge, measured by ESAS total distress score. Secondary outcomes included each individual domain of ESAS. We performed Poisson regression analysis and reported incidence rate ratios (IRRs) with 95% CIs.</p></div><div><h3>Results</h3><p>During the study period, 5,844 adult patients received HSCT in Ontario, of whom 1,580 (27.0%) were admitted to the ICU and 552 (34.9%) died in the hospital. Compared with patients who survived hospitalization, patients who survived the ICU showed a higher rate of moderate to severe symptoms within 1 year as measured by the total distress score (IRR, 1.29; 95% CI, 1.05-1.59) and for domains of pain (IRR, 1.22; 95% CI, 1.00-1.50), shortness of breath (IRR, 1.58; 95% CI, 1.25-1.99), drowsiness (IRR, 1.26; 95% CI, 1.03-1.54), depression (1.41; 95% CI, 1.09-1.82), anxiety (IRR, 1.40; 95% CI, 1.10-1.78), and poor well-being (IRR, 1.27; 95% CI, 1.08-1.50).</p></div><div><h3>Interpretation</h3><p>HSCT recipients who survive critical illness show an increased rate of moderate to severe symptoms during follow-up when compared with patients who survive hospitalization.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49716523","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}

{"title":"ICU Mortality Across Prepandemic and Pandemic Cohorts in a Resource-Limited Setting","authors":"George L. Anesi MD, MSCE, MBE ,&nbsp;Stella M. Savarimuthu MD ,&nbsp;Jonathan Invernizzi MBBCh, MMed ,&nbsp;Robyn Hyman MBChB(Pret) ,&nbsp;Arisha Ramkillawan MBChB ,&nbsp;Creaghan Eddey MBBCh(Wits) ,&nbsp;Robert D. Wise MBChB, MMed ,&nbsp;Michelle T.D. Smith MBChB, MMed, PhD","doi":"10.1016/j.chstcc.2023.100005","DOIUrl":"https://doi.org/10.1016/j.chstcc.2023.100005","url":null,"abstract":"<div><h3>Background</h3><p>Hospital adaptation and resiliency, required during public health emergencies to optimize outcomes, are understudied especially in resource-limited settings.</p></div><div><h3>Research Question</h3><p>What are the prepandemic and pandemic critical illness outcomes in a resource-limited setting and in the context of capacity strain?</p></div><div><h3>Study Design and Methods</h3><p>We performed a retrospective cohort study among patients admitted to ICUs at two public hospitals in the KwaZulu-Natal Department of Health in South Africa preceding and during the COVID-19 pandemic (2017-2022). We used multivariate logistic regression to analyze the association between three patient cohorts (prepandemic non-COVID-19, pandemic non-COVID-19, and pandemic COVID-19) and ICU capacity strain and the primary outcome of ICU mortality.</p></div><div><h3>Results</h3><p>Three thousand two hundred twenty-one patients were admitted to the ICU during the prepandemic period and 2,539 patients were admitted to the ICU during the pandemic period (n = 375 [14.8%] with COVID-19 and n = 2,164 [85.2%] without COVID-19). The prepandemic and pandemic non-COVID-19 cohorts were similar. Compared with the non-COVID-19 cohorts, the pandemic COVID-19 cohort showed older age, higher rates of chronic cardiovascular disease and diabetes, less extrapulmonary organ dysfunction, and longer ICU length of stay. Compared with the prepandemic non-COVID-19 cohort, the pandemic non-COVID-19 cohort showed similar odds of ICU mortality (OR, 1.06; 95% CI, 0.90-1.25; <em>P</em> = .50) whereas the pandemic COVID-19 cohort showed significantly increased odds of ICU mortality (OR, 3.91; 95% CI, 3.03-5.05 P &lt; .0005). ICU occupancy was not associated with ICU mortality in either the COVID-19 cohort (OR, 1.05 per 10% change in ICU occupancy; 95% CI, 0.96-1.14; P = .27) or the pooled non-COVID-19 cohort (OR, 1.01 per 10% change in ICU occupancy; 95% CI, 0.98-1.03; <em>P</em> = .52).</p></div><div><h3>Interpretation</h3><p>Patients admitted to the ICU before and during the pandemic without COVID-19 were broadly similar in clinical characteristics and outcomes, suggesting critical care resiliency, whereas patients admitted to the ICU with COVID-19 showed important clinical differences and significantly higher mortality.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49716586","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}