CHEST critical care最新文献

{"title":"Evidence Synthesis of Outcomes of Extracorporeal Membrane Oxygenation for Life-Threatening Asthma Exacerbations","authors":"Burton H. Shen MD, Anica C. Law MD, Kevin C. Wilson MD","doi":"10.1016/j.chstcc.2023.100044","DOIUrl":"10.1016/j.chstcc.2023.100044","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 1","pages":"Article 100044"},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788423000448/pdfft?md5=086df12a330ec2092a35f3414c6c936e&pid=1-s2.0-S2949788423000448-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139193990","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":"Critical Care ATLAS","authors":"Kelsey D. Sack MD, PhD ,&nbsp;Chandrashish Chakravarty MD ,&nbsp;Juliana Carvalho Ferreira MD, PhD ,&nbsp;Daniela Helena Machado Freitas MD ,&nbsp;Chris McGrath MBBCh ,&nbsp;Mark E. Mikkelsen MD ,&nbsp;Matteo Di Nardo MD ,&nbsp;Elisabeth Riviello MD, MPH ,&nbsp;Michael Root MD ,&nbsp;Jon A. Silversides MBBCh (Hons), PhD ,&nbsp;Theogene Twagirumugabe MD, PhD ,&nbsp;Doris Uwamahoro MD","doi":"10.1016/j.chstcc.2023.100043","DOIUrl":"10.1016/j.chstcc.2023.100043","url":null,"abstract":"<div><p>The practice of critical care depends not only on the particular patient population served, but also on the context in which critical care is provided, including culture and regional norms and resources. How clinicians interpret and implement new evidence or guideline recommendations is affected by their unique context. In 2023, the Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension (CLOVERS) trial was published. The CLOVERS trial included 1,563 patients and studied early vasopressor initiation vs liberal fluid initiation after an initial fluid bolus for patients with septic shock seeking treatment in the United States. No mortality difference was found between the two treatment arms. In this article, adult and pediatric critical care clinicians from the United States, the United Kingdom, Italy, Rwanda, India, and Brazil describe how CLOVERS has impacted or will impact their practice.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 1","pages":"Article 100043"},"PeriodicalIF":0.0,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788423000436/pdfft?md5=3abd142c7c745714eea6d32274d2320b&pid=1-s2.0-S2949788423000436-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139188795","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":"Actual vs Expected Survival With the Use of the Molecular Adsorbent Recirculating System for Acute Liver Failure","authors":"Elizabeth K. Powell MD ,&nbsp;Guinevere A. Johnson MS-2 ,&nbsp;William Teeter MD ,&nbsp;Donna Mursch RN, BSN ,&nbsp;Jeff Broski RN ,&nbsp;Christopher Kolokythas RN, MS, CRNP, DNP ,&nbsp;Katie B. Andersen RN, MS, CRNP ,&nbsp;Shannon Gaasch RN, MS, CRNP ,&nbsp;Deborah M. Stein MD ,&nbsp;Thomas M. Scalea MD, MCCM ,&nbsp;Samuel M. Galvagno Jr. DO, PhD","doi":"10.1016/j.chstcc.2023.100041","DOIUrl":"10.1016/j.chstcc.2023.100041","url":null,"abstract":"<div><h3>Background</h3><p>Acute liver failure (ALF) has a mortality rate of approximately 50%. Thus, it is evident that improvements in treatment of ALF are necessary. The Molecular Adsorbent Recirculating System (MARS; Baxter), an extracorporeal liver support system that detoxifies water-soluble and protein-bound toxins, has been available at select centers worldwide for &gt; 2 decades. Although some studies have shown the efficacy of MARS in the management of ALF, the literature remains limited. The objective of this study was to assess the outcomes of patients with ALF who underwent MARS therapy at a single institution using institutionally developed indications based on current best evidence.</p></div><div><h3>Research Question</h3><p>Is MARS used for selected causes of ALF associated with better survivability than predicted by standardized mortality rates (SMRs)?</p></div><div><h3>Study Design and Methods</h3><p>This was a single-center, retrospective cohort study of the outcomes of patients with ALF who underwent MARS at the R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center. All patients aged 18 years or older who were admitted to our institution and underwent MARS treatment between July 1, 2013, and February 9, 2021, were included in this study. Data relevant to the study were collected from electronic medical records and were stored in Research Electronic Data Capture tools. From these data, estimated mortality from Model for End-Stage Liver Disease scores were used to calculate SMR. The SMRs then were compared for different institutional indications for MARS. Additional descriptive statistics were applied.</p></div><div><h3>Results</h3><p>Sixty-one patients underwent MARS treatment during the study period. Overall survival in the cohort was 56%. The SMR was lower than expected for patients who underwent MARS who were transplant candidates (SMR, 0.78; 95% CI, 0.63-0.93). Although no significant differences were found before and after MARS treatment in median ammonia levels (58 Umol/L [interquartile range (IQR), 32-104 Umol/L] vs 39 Umol/L [IQR, 18-57 Umol/L]; <em>P</em> = .44) or norepinephrine doses (0.21 μg/kg/min [IQR, 0.08-0.4 μg/kg/min] vs 0.06 μg/kg/min [IQR, 0.04-0.14 μg/kg/min]; <em>P</em> = .46), significant decreases in median aspartate transferase (3,334 U/L [IQR, 1,174-11,151 U/L] vs 344 U/L [IQR, 196-978 U/L]; <em>P</em> &lt; .001), alanine transaminase (1,410 U/L [IQR, 600-5,505 U/L] vs 347 U/L [IQR, 153-952 U/L]; <em>P</em> &lt; .001), international normalized ratio (3.2 [IQR, 2-4.5] vs 1.5 [IQR, 1.3-1.9]; <em>P</em> &lt; .001), and median lactic acid levels (7.7 mM [IQR, 4.8-13.2 mM] vs 2.4 mM [IQR, 1.7-3.1 mM]; <em>P</em> &lt; .001) were seen.</p></div><div><h3>Interpretation</h3><p>We report our experience using MARS for institutionally developed indications in a level 1 trauma center and transplant center. These data add to a growing body of literature that support the use of MARS as an extraco","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 1","pages":"Article 100041"},"PeriodicalIF":0.0,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788423000412/pdfft?md5=67f4354cd80d5847617803051bd6fb88&pid=1-s2.0-S2949788423000412-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139194366","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":"Introducing CHEST Critical Care’s ATLAS (Around the Land and Across Specialties)","authors":"Margaret M. Hayes MD ,&nbsp;Regis Goulart Rosa MD ,&nbsp;Singatiya Stella Chikumbanje MD","doi":"10.1016/j.chstcc.2023.100042","DOIUrl":"10.1016/j.chstcc.2023.100042","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 1","pages":"Article 100042"},"PeriodicalIF":0.0,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788423000424/pdfft?md5=e5fe77652cbd74724dd8681b132f9e38&pid=1-s2.0-S2949788423000424-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139194473","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":"Transesophageal Lung Ultrasound in Hypoxemic Patients With COVID-19","authors":"Osman Adi BSc ,MD, MMed ,&nbsp;Chan Pei Fong MBBS, MMed ,&nbsp;Azma Haryaty Ahmad MBBch, MMed ,&nbsp;Nova Panebianco MD, MPH ,&nbsp;Carlos L. Alviar MD , FACC ,&nbsp;Guido Tavazzi MD , EDIC , EDEC , PhD","doi":"10.1016/j.chstcc.2023.100039","DOIUrl":"10.1016/j.chstcc.2023.100039","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 1","pages":"Article 100039"},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788423000394/pdfft?md5=6f6a5c939637ba593217e636665144c7&pid=1-s2.0-S2949788423000394-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139014276","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":"Reducing the Climate Impact of Critical Care","authors":"Alexander S. Rabin MD ,&nbsp;Peggy S. Lai MD, MPH ,&nbsp;Stephanie I. Maximous MD ,&nbsp;Hari M. Shankar MD","doi":"10.1016/j.chstcc.2023.100037","DOIUrl":"https://doi.org/10.1016/j.chstcc.2023.100037","url":null,"abstract":"<div><p>As the health effects of climate change intensify, critical care providers have an urgent responsibility to minimize the environmental impact of health care delivery. Although the response of critical care clinicians in managing climate-exacerbated diseases such as asthma and heat stroke is well recognized, the impact of critical care delivery on climate change itself may be less familiar. This case-based review explores the drivers of the ICU climate footprint, including high energy and electricity use, supply chain contributions, pharmaceutical greenhouse gas emissions, plastic waste, and low-value care. Potential solutions then are presented for each of these elements, with an emphasis on multidisciplinary team engagement to enact lasting change. The role of the ICU clinician as environmental policy advocate also is explored. Despite the grave clinical implications of the climate crisis, critical care providers are well positioned to mitigate their own climate impacts and to help lead health care decarbonization.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 1","pages":"Article 100037"},"PeriodicalIF":0.0,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788423000370/pdfft?md5=fb29980d4d7409aa212c08e2aa7b3372&pid=1-s2.0-S2949788423000370-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139937032","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":"Post-ICU Clinic","authors":"Lori Flores DNP, AGPCNP-BC ,&nbsp;Alexandra Barber PharmD ,&nbsp;Rebecca Bookstaver Korona BSN, PharmD ,&nbsp;Rita N. Bakhru MD","doi":"10.1016/j.chstcc.2023.100036","DOIUrl":"10.1016/j.chstcc.2023.100036","url":null,"abstract":"<div><p>Increasing numbers of patients survive critical illness. Survivors of critical illness are at risk of post-intensive care syndrome (PICS). Post-ICU clinics are one way to help patients with PICS and to assist patients in their recovery progress. We report herein how we have structured our ICU recovery clinic and highlight important elements to consider when evaluating patients in a post-ICU clinic, including a new mnemonic, IMPORTANCE: ICU debriefing, medications and immunizations, PICS evaluation, organ failure assessment, referrals, testing, addressing future goals of care, needs assessment, caregiver support, and education about expectations. We present a case study from our ICU recovery clinic. Finally, we discuss future directions of post-ICU clinics.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 1","pages":"Article 100036"},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788423000369/pdfft?md5=78707de88e81c315280a9738355b3096&pid=1-s2.0-S2949788423000369-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139020185","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":"Procalcitonin Levels and Bacterial Coinfection in Hospitalized Patients With COVID-19","authors":"Shahin Isha MD, MBBS ,&nbsp;Parthkumar Satashia MD, MBBS ,&nbsp;Lekhya Raavi MBBS ,&nbsp;Sadhana Jonna MBBS ,&nbsp;Anna Jenkins BS ,&nbsp;Abby J. Hanson BS ,&nbsp;Emily C. Craver ,&nbsp;Arvind Balavenkataraman MD, MBBS ,&nbsp;Aysun Tekin MD ,&nbsp;Vikas Bansal MBBS, MPH ,&nbsp;Sean M. Caples DO ,&nbsp;Syed Anjum Khan MD ,&nbsp;Nitesh K. Jain MBBS ,&nbsp;Abigail T. LaNou MD ,&nbsp;Rahul Kashyap MBBS, MBA ,&nbsp;Rodrigo Cartin-Ceba MD ,&nbsp;Bhavesh M. Patel MD ,&nbsp;Ricardo Diaz Milian MD ,&nbsp;Carla P. Venegas MD ,&nbsp;Anna B. Shapiro MD ,&nbsp;Archana Roy MD","doi":"10.1016/j.chstcc.2023.100035","DOIUrl":"10.1016/j.chstcc.2023.100035","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 1","pages":"Article 100035"},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788423000357/pdfft?md5=7a140bcf7eab9d5a0be2e1a6053e5b07&pid=1-s2.0-S2949788423000357-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138621418","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":"Reimagining Patient-Centered Outcome Measurement","authors":"Cassiano Teixeira MD, PhD","doi":"10.1016/j.chstcc.2023.100032","DOIUrl":"10.1016/j.chstcc.2023.100032","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 1","pages":"Article 100032"},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788423000321/pdfft?md5=2afebdbbef28f9af4fdada7baab2baa3&pid=1-s2.0-S2949788423000321-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138622378","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":"A Least Absolute Shrinkage and Selection Operator-Derived Predictive Model for Postoperative Respiratory Failure in a Heterogeneous Adult Elective Surgery Patient Population","authors":"Jacqueline C. Stocking PhD, RN ,&nbsp;Sandra L. Taylor PhD ,&nbsp;Sili Fan MS ,&nbsp;Theodora Wingert MD ,&nbsp;Christiana Drake PhD ,&nbsp;J. Matthew Aldrich MD ,&nbsp;Michael K. Ong MD, PhD, FACP ,&nbsp;Alpesh N. Amin MD, MACP, FACC ,&nbsp;Rebecca A. Marmor MD ,&nbsp;Laura Godat MD, FACS ,&nbsp;Maxime Cannesson MD, PhD ,&nbsp;Michael A. Gropper MD, PhD ,&nbsp;Garth H. Utter MD, FACS ,&nbsp;Christian E. Sandrock MD, MPH ,&nbsp;Christian Bime MD ,&nbsp;Jarrod Mosier MD ,&nbsp;Vignesh Subbian PhD ,&nbsp;Jason Y. Adams MD ,&nbsp;Nicholas J. Kenyon MD ,&nbsp;Timothy E. Albertson MD, PhD ,&nbsp;Ivo Abraham PhD, RN","doi":"10.1016/j.chstcc.2023.100025","DOIUrl":"10.1016/j.chstcc.2023.100025","url":null,"abstract":"<div><h3>Background</h3><p>Postoperative respiratory failure (PRF) is associated with increased hospital charges and worse patient outcomes. Reliable prediction models can help to guide postoperative planning to optimize care, to guide resource allocation, and to foster shared decision-making with patients.</p></div><div><h3>Research Question</h3><p>Can a predictive model be developed to accurately identify patients at high risk of PRF?</p></div><div><h3>Study Design and Methods</h3><p>In this single-site proof-of-concept study, we used structured query language to extract, transform, and load electronic health record data from 23,999 consecutive adult patients admitted for elective surgery (2014-2021). Our primary outcome was PRF, defined as mechanical ventilation after surgery of &gt; 48 h. Predictors of interest included demographics, comorbidities, and intraoperative factors. We used logistic regression to build a predictive model and the least absolute shrinkage and selection operator procedure to select variables and to estimate model coefficients. We evaluated model performance using optimism-corrected area under the receiver operating curve and area under the precision-recall curve and calculated sensitivity, specificity, positive and negative predictive values, and Brier scores.</p></div><div><h3>Results</h3><p>Two hundred twenty-five patients (0.94%) demonstrated PRF. The 18-variable predictive model included: operations on the cardiovascular, nervous, digestive, urinary, or musculoskeletal system; surgical specialty orthopedic (nonspine); Medicare or Medicaid (as the primary payer); race unknown; American Society of Anesthesiologists class ≥ III; BMI of 30 to 34.9 kg/m²; anesthesia duration (per hour); net fluid at end of the operation (per liter); median intraoperative F<span>io</span>₂, end title CO₂, heart rate, and tidal volume; and intraoperative vasopressor medications. The optimism-corrected area under the receiver operating curve was 0.835 (95% CI, 0.808-0.862) and the area under the precision-recall curve was 0.156 (95% CI, 0.105-0.203).</p></div><div><h3>Interpretation</h3><p>This single-center proof-of-concept study demonstrated that a structured query language extract, transform, and load process, based on readily available patient and intraoperative variables, can be used to develop a prediction model for PRF. This PRF prediction model is scalable for multicenter research. Clinical applications include decision support to guide postoperative level of care admission and treatment decisions.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"1 3","pages":"Article 100025"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788423000254/pdfft?md5=fb3f513258f554f0177f2414d1ec69f5&pid=1-s2.0-S2949788423000254-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135963044","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}