CHEST critical care最新文献

{"title":"“Mitolocalization”","authors":"Bryan D. Kraft MD","doi":"10.1016/j.chstcc.2024.100073","DOIUrl":"10.1016/j.chstcc.2024.100073","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100073"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000273/pdfft?md5=cfe56cd4d8464818840a4903a8c1d1be&pid=1-s2.0-S2949788424000273-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140759025","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":"Prone Positioning for ARDS","authors":"Elizabeth Levy MD , Meeta Prasad Kerlin MD, MSCE","doi":"10.1016/j.chstcc.2024.100069","DOIUrl":"10.1016/j.chstcc.2024.100069","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100069"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000236/pdfft?md5=307a36a208d4740352088098f3c1b00b&pid=1-s2.0-S2949788424000236-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140765342","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":"Extracorporeal Support in Adults With Status Asthmaticus","authors":"Samuel H. Belok MD ,&nbsp;Alexandros Karavas MD ,&nbsp;Jamel Ortoleva MD","doi":"10.1016/j.chstcc.2024.100066","DOIUrl":"10.1016/j.chstcc.2024.100066","url":null,"abstract":"<div><p>Status asthmaticus is refractory bronchospasm that can result in hypercarbia, altered mental status, respiratory failure, hypoxemia, and death. The care of patients with status asthmaticus often requires care in the ICU and, in rare circumstances, consideration of extracorporeal membrane oxygenation (ECMO) or extracorporeal CO₂ removal support. Compared with ARDS, status asthmaticus is a relatively rare indication for venovenous ECMO and, to our knowledge, its use has not been examined in prospective multicenter studies. As ECMO becomes more widely available, it may be valuable for providers to understand better its role in the management of status asthmaticus. In this edition of “How I Do It,” we provide a case example of life-threatening status asthmaticus to discuss unique considerations in the care of these patients with this complex disease.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100066"},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000200/pdfft?md5=7e287928f37d13b569263d65331017c1&pid=1-s2.0-S2949788424000200-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140398815","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":"Sedation-Ventilation Interaction in Acute Hypoxemic Respiratory Failure","authors":"Jose Dianti MD ,&nbsp;Idunn S. Morris MD ,&nbsp;Thiago G. Bassi MD, PhD ,&nbsp;Eddy Fan MD, PhD ,&nbsp;Arthur S. Slutsky MD ,&nbsp;Laurent J. Brochard MD ,&nbsp;Niall D. Ferguson MD ,&nbsp;Ewan C. Goligher MD, PhD","doi":"10.1016/j.chstcc.2024.100067","DOIUrl":"10.1016/j.chstcc.2024.100067","url":null,"abstract":"<div><h3>Background</h3><p>Ventilation and sedation are used for the management of acute hypoxemic respiratory failure (AHRF), but their optimal combination to minimize the risks of ventilation is not well understood.</p></div><div><h3>Research Question</h3><p>What are the individual effects and interactions of inspiratory and positive end-expiratory pressure (PEEP), sedation, and venovenous extracorporeal membrane oxygenation (VV-ECMO) on respiratory drive, effort, and lung-distending pressure in patients with AHRF triggering the ventilator?</p></div><div><h3>Study Design and Methods</h3><p>In this secondary exploratory analysis of a trial of lung and diaphragm protection in AHRF, inspiratory pressure, sedation, PEEP, and VV-ECMO were titrated while respiratory drive (airway pressure in the first 100 ms [P_0.1]), effort (esophageal pressure swing [|ΔPes|]), and lung-distending pressure (dynamic transpulmonary driving pressure [ΔP_L,dyn]) were recorded. Associations were evaluated using linear mixed-effects regression models including prespecified terms for potential interactions.</p></div><div><h3>Results</h3><p>The study included 223 individual measurements of P_0.1 and 235 individual measurements of |ΔPes| and ΔP_L,dyn from 30 patients. Propofol-attenuated P_0.1 (–0.4 cm H₂O; 95% CI, –0.3 to –0.1 cm H₂O per 10-μm/kg/min increase), |ΔPes| (–2.5 cm H₂O; 95% CI, –3.4 to –1.7 cm H₂O per 10-μm/kg/min increase), and ΔP_L,dyn (–1.6 cm H₂O; 95% CI, –2.3 to –0.8 cm H₂O per 10-μm/kg/min increase). The effect of inspiratory pressure on |ΔPes| varied depending on propofol dose: with higher propofol dose, inspiratory pressure resulted in higher ΔP_L,dyn. With VV-ECMO, patients (n = 16) showed significantly lower |ΔPes| (–10 cm H₂O; 95% CI, –17.5 to –2.5 cm H₂O) and required less sedation to reduce |ΔPes| than without VV-ECMO (n = 14).</p></div><div><h3>Interpretation</h3><p>Mechanical ventilation, sedation, and VV-ECMO exert interdependent effects on respiratory drive, effort, and lung-distending pressure in AHRF. Patients receiving VV-ECMO require less sedation to control respiratory effort.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100067"},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000212/pdfft?md5=f25e6e71a95a38d7f7f3ab9c096599d1&pid=1-s2.0-S2949788424000212-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406475","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":"Protein Interaction Assessing Mitochondrial Biogenesis as a Next Generation Biomarker in Sepsis","authors":"Patrick Thon PhD ,&nbsp;Ellen Trübner MD ,&nbsp;Frieda Zimmer MD ,&nbsp;Lars Palmowski MD ,&nbsp;Stefan F. Ehrentraut MD ,&nbsp;Christian Putensen MD ,&nbsp;Dietrich Henzler MD ,&nbsp;Elke Schwier PhD ,&nbsp;Andrea Witowski MD ,&nbsp;Britta Marko MD ,&nbsp;Dominik Ziehe PhD ,&nbsp;Hartmuth Nowak MD ,&nbsp;Katharina Rump PhD ,&nbsp;Lars Bergmann MD ,&nbsp;Alexander Wolf MD ,&nbsp;Matthias Unterberg MD ,&nbsp;Michael Adamzik MD ,&nbsp;Björn Koos PhD ,&nbsp;Tim Rahmel MD ,&nbsp;SepsisDataNet.NRW Study Group","doi":"10.1016/j.chstcc.2024.100065","DOIUrl":"10.1016/j.chstcc.2024.100065","url":null,"abstract":"<div><h3>Background</h3><p>Metabolic derangements in sepsis stem from mitochondrial injury and contribute to organ dysfunction and mortality. Thus, repair of mitochondrial damage seems pivotal for recovery and determining clinical outcome in sepsis. However, reliable biomarkers assessing mitochondrial repair noninvasively in peripheral blood are currently lacking.</p></div><div><h3>Research Question</h3><p>Are different gene transcripts related to mitochondrial repair (ie, biogenesis, fusion, fission, mitophagy) and the protein interaction assessing mitochondrial biogenesis, both measured in peripheral blood, associated with disease severity and clinical outcome?</p></div><div><h3>Study Design and Methods</h3><p>Healthy control patients (n = 22), uninfected critically ill control patients (n = 13), and patients with sepsis (n = 75) were included in this prospective multicentric observational study. Gene products of mitochondrial quality control and mitochondrial DNA were measured on day 1 and 4 in peripheral blood mononuclear cells. In addition, we assessed in the same samples the mitochondrial protein interaction of mitochondrial transcription factor A (TFAM)-mitochondrial transcription factor B2 (TFB2M) using a proximity ligation assay. Patients with sepsis were stratified in the outcome-related subgroups ICU-free within 1 week (n = 16), not ICU-free within 1 week (n = 36), and 30-day nonsurvivors (n = 23).</p></div><div><h3>Results</h3><p>Transcript levels of the assessed messenger RNA markers of patients with sepsis were not associated with disease severity nor did they predict clinical outcome. Strikingly, the mitochondrial protein interaction of TFAM-TFB2M on day 4 (<em>P</em> &lt; .05) and the difference between day 1 and 4 (<em>P</em> &lt; .001) allowed stratification in the three clinical outcome subgroups. In addition, a decline in TFAM-TFB2M protein interactions between day 1 and 4 was an independent predicator for 30-day mortality (adjusted hazard ratio, 8.34; 95% CI, 2.73-25.45; <em>P</em> &lt; .001).</p></div><div><h3>Interpretation</h3><p>Patients with sepsis with an early activation of mitochondrial biogenesis were more likely to be ICU-free within 1 week. A mitochondrial and clinical recovery can be assessed via the protein interaction of TFAM-TFB2M in peripheral blood. Thus, mitochondrial protein interactions targeting mitochondrial biogenesis provide a promising dimension of novel biomarkers assessing mitochondrial dysfunction in sepsis.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100065"},"PeriodicalIF":0.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000194/pdfft?md5=d001c5ce7e33801b5e4829bf22002e7d&pid=1-s2.0-S2949788424000194-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140283400","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":"Progressive Encephalopathy With New Pulmonary Opacities in an Immunocompromised Host","authors":"Marika Orlov MD, PhD ,&nbsp;Andrew T. Pham MD ,&nbsp;Dan Merrick MD ,&nbsp;Markus Wu MD ,&nbsp;Sias Scherger MD ,&nbsp;Tanya Marvi MD ,&nbsp;Arun Kannappan MD","doi":"10.1016/j.chstcc.2024.100064","DOIUrl":"10.1016/j.chstcc.2024.100064","url":null,"abstract":"<div><h3>Case Presentation</h3><p>A 48-year-old man with history of recent travel to central Mexico and immunosuppression sought treatment with a 1-month-long history of progressive headache, fatigue, word-finding difficulties, and night sweats. The patient had a history of end-stage renal disease; he had undergone a kidney transplantation 7 years prior with good graft function with immunosuppression with tacrolimus, everolimus, and low-dose prednisone. At an outside hospital, he recently had been treated with empiric antibiotics for meningitis, but these were discontinued given the low suspicion for a bacterial cause. After discharge, he continued to have headaches, limited oral intake, persistent nausea, urinary frequency, and falls, prompting him to seek treatment at the ED. Physical examination findings were benign aside from disorientation. Laboratory workup was significant for hyponatremia of 122 mM, creatinine of 1.4 mg/dL (baseline, 1.4-1.5 mg/dL), WBC count of 7.2 10⁹/L, hemoglobin of 13 g/dL, and platelet count of 349 10⁹/L. Neither tacrolimus nor everolimus levels were supratherapeutic.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100064"},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000182/pdfft?md5=617f09c10c4baecdf6ac902705093b61&pid=1-s2.0-S2949788424000182-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273092","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":"Biomarker Analysis Provides Evidence for Host Response Homogeneity in Patients With COVID-19","authors":"Rombout B.E. van Amstel MD ,&nbsp;Erik H.A. Michels MD ,&nbsp;Brent Appelman MD ,&nbsp;Justin de Brabander MD ,&nbsp;Patrick J. Smeele MD ,&nbsp;Tom van der Poll MD, PhD ,&nbsp;Alexander P.J. Vlaar MD, PhD ,&nbsp;Lonneke A. van Vught MD, PhD ,&nbsp;Lieuwe D.J. Bos MD, PhD ,&nbsp;the Amsterdam UMC COVID-19 Biobank Study Group","doi":"10.1016/j.chstcc.2024.100062","DOIUrl":"10.1016/j.chstcc.2024.100062","url":null,"abstract":"<div><h3>Background</h3><p>The exploration of subphenotypes in hospitalized patients with COVID-19 has garnered substantial attention. Most existing studies operate under the assumption of heterogeneity in COVID-19 patient populations, and this assumption can lead to erroneous conclusions.</p></div><div><h3>Research Question</h3><p>Do plasma biomarker profiles reflective of various pathophysiologic pathways provide evidence for heterogeneity in hospitalized patients with COVID-19?</p></div><div><h3>Study Design and Methods</h3><p>This is a secondary analysis of two prospective observational studies of adult patients hospitalized with COVID-19-related respiratory failure in the general ward and ICU of two medical centers and with 44 host response biomarkers available. Parsimonious models were used to allocate and validate ARDS inflammatory subphenotypes. Novel biological subphenotypes were identified using latent profile analysis (LPA) and hierarchical clustering. Heterogeneity of treatment effect for corticosteroids was assessed using an interaction term in a logistic regression model.</p></div><div><h3>Results</h3><p>The cohort consisted of 162 patients admitted to the ICU and 464 patients admitted to the ward. Using the parsimonious models in ICU patients, only 3.1% to 13% of patients were classified as hyperinflammatory subphenotype. Using de novo subphenotyping techniques, neither clustering nor LPA revealed significant evidence for heterogeneity in the ward (<em>P</em> = .11-.13), ICU (<em>P</em> = .23-.88), or combined cohort (<em>P</em> = .05-.88). Adding clinical variables did not alter results in the ICU or combined cohort. Using the combined approach in the ward cohort, indices provided borderline significance for two subphenotypes, and there was good agreement between clustering and LPA (87.9%), but no heterogeneity of treatment effect for corticosteroids was observed between these two classes (<em>P</em> = .198).</p></div><div><h3>Interpretation</h3><p>Systemic inflammatory subphenotypes derived from patients with ARDS did not reflect the variation in severity of COVID-19 in this study. Empirical evidence, derived from cluster analysis or LPA, offers limited support for biological heterogeneity in COVID-19.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100062"},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000169/pdfft?md5=23f368aa8ea0fa264b1390baa2d98c1c&pid=1-s2.0-S2949788424000169-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273436","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-COVID-19 Clinic Utilization Among Survivors of Critical Illness in Two Waves of SARS-CoV-2 Infection","authors":"Cher X. Huang MD ,&nbsp;Daniel Okin MD, PhD ,&nbsp;Emily E. Moin MD ,&nbsp;Sirus J. Jesudasen MD ,&nbsp;Nupur A. Dandawate MD ,&nbsp;Alexander Gavralidis MD ,&nbsp;Leslie L. Chang MD ,&nbsp;Alison S. Witkin MD ,&nbsp;Lucy B. Schulson MD, MPH ,&nbsp;Kathryn A. Hibbert MD ,&nbsp;Aran Kadar MD ,&nbsp;Patrick L. Gordan MD ,&nbsp;Lisa M. Bebell MD ,&nbsp;Peggy S. Lai MD, MPH ,&nbsp;George A. Alba MD","doi":"10.1016/j.chstcc.2024.100061","DOIUrl":"10.1016/j.chstcc.2024.100061","url":null,"abstract":"<div><h3>Background</h3><p>Post-COVID-19 clinics were implemented to improve postacute care for patients with COVID-19, including survivors of critical illness, many of whom experience post-intensive care syndrome (PICS). Whether postacute care changed over the course of the pandemic and if inequities in utilization exist remain unclear.</p></div><div><h3>Research Question</h3><p>Among survivors of COVID-19 critical illness, what were the patterns of postdischarge care during different pandemic waves, and are there inequities in outpatient utilization?</p></div><div><h3>Study Design and Methods</h3><p>In this retrospective cohort study, we describe sociodemographics, illness severity, outpatient utilization, and PICS burden up to 18 months after discharge for patients with COVID-19 admitted to an ICU at three Boston, Massachusetts, area hospitals during two waves (wave 1 and wave 2) of hospitalizations during the pandemic. Multivariable logistic regression models identified variables associated with follow-up in post-COVID-19 clinics and adverse postdischarge health care outcomes, including readmissions, ED visits, and all-cause postdischarge mortality.</p></div><div><h3>Results</h3><p>A total of 319 of 478 wave 1 patients (66.7%) and 80 of 187 wave 2 patients (42.8%) survived to hospital discharge. During wave 1, there was a higher proportion of patients with limited English proficiency (LEP) admitted to the ICU (45.5% vs 30.0%, <em>P</em> = .012) and a lower severity of illness on admission (Sequential Organ Failure Assessment score 4; interquartile range, 2-8 vs 6; interquartile range, 4-8; <em>P</em> = .013). PICS symptoms were common across both waves (80.6% vs 78.8%, <em>P</em> = .72). In multivariable analyses, LEP was associated with decreased odds of post-COVID-19 clinic follow-up (adjusted OR, 0.80; 95% CI, 0.70-0.92; <em>P</em> &lt; .01) and increased odds of adverse postdischarge health care outcomes (adjusted OR, 1.49; 95% CI, 1.11-2.0; <em>P</em> &lt; .01).</p></div><div><h3>Interpretation</h3><p>The overall burden of PICS was high across waves. LEP was associated with inequities in post-COVID-19 clinic follow-up and worse postdischarge outcomes, suggesting that language is an important target for further interventions to support equitable recovery after critical illness.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100061"},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000157/pdfft?md5=390990559efd14e872acb2e5fd0df755&pid=1-s2.0-S2949788424000157-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140272638","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":"Mobile App-Based Mindfulness Intervention for Addressing Psychological Distress Among Survivors of Hospitalization for COVID-19 Infection","authors":"Christopher E. Cox MD, MPH ,&nbsp;John A. Gallis ScM ,&nbsp;Maren K. Olsen PhD ,&nbsp;Laura S. Porter PhD ,&nbsp;Tina M. Gremore PhD ,&nbsp;Theodore J. Iwashyna MD, PhD ,&nbsp;Ellen S. Caldwell MS ,&nbsp;Jeffrey M. Greeson PhD ,&nbsp;Marc Moss MD ,&nbsp;Catherine L. Hough MD","doi":"10.1016/j.chstcc.2024.100063","DOIUrl":"https://doi.org/10.1016/j.chstcc.2024.100063","url":null,"abstract":"<div><h3>Background</h3><p>Psychological distress symptoms are present and persistent among many patients who survive a critical illness like COVID-19.</p></div><div><h3>Research Question</h3><p>Could a self-directed mobile app-delivered mindfulness intervention be feasibly and rapidly implemented within a clinical trials network to reduce distress symptoms?</p></div><div><h3>Study Design and Methods</h3><p>A randomized clinical trial was conducted between January 2021 and May 2022 at 29 US sites and included survivors of hospitalization due to COVID-19-related illness with elevated symptoms of depression at discharge. Participants were randomized to intervention or usual care control. The intervention consisted of four themed weeks of daily audio, video, and text content. All study procedures were virtual. The primary outcome was depression symptoms assessed with the Patient Health Questionnaire 9 at 3 months. Secondary outcomes included anxiety (Generalized Anxiety Disorder 7-item scale), quality of life (EQ-5D), and adherence. We used general linear models to estimate treatment arm differences in outcomes over time.</p></div><div><h3>Results</h3><p>Among 56 randomized participants (mean age ± SD, 51.0 ± 13.2 years; 38 female [67.9%]; 14 Black participants [25%]), 45 (intervention: n = 23 [79%]; control: n = 22 [81%]) were retained at 6 months. There was no difference in mean improvement between intervention and control participants at 3 months in Patient Health Questionnaire 9 (−0.5 vs 0.1), Generalized Anxiety Disorder 7-item scale (−0.3 vs 0.1), or EQ-5D (−0.03 vs 0.02) scores, respectively; 6-month results were similar. Only 15 participants (51.7%) initiated the intervention, whereas the mean number ± SD of the 56 prescribed intervention activities completed was 12.0 ± 15.2. Regulatory approvals delayed trial initiation by nearly a year.</p></div><div><h3>Interpretation</h3><p>Among survivors of COVID-19 hospitalization with elevated psychological distress symptoms, a self-directed mobile app-based mindfulness intervention had poor adherence. Future psychological distress interventions mobilized at broad scale should focus efforts on patient engagement and regulatory simplification to enhance success.</p></div><div><h3>Trial Registration</h3><p><span>ClinicalTrials.gov</span><svg><path></path></svg>; No.: <span>NCT04581200</span><svg><path></path></svg>; URL: <span>www.clinicaltrials.gov</span><svg><path></path></svg></p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100063"},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000170/pdfft?md5=cf8d3aef90fa8920d9face6f4cab4bbd&pid=1-s2.0-S2949788424000170-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141095961","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":"Early Mobilization in the ICU","authors":"Himanshu Rawal MD ,&nbsp;Rita N. Bakhru MD, MS","doi":"10.1016/j.chstcc.2023.100038","DOIUrl":"10.1016/j.chstcc.2023.100038","url":null,"abstract":"<div><p>ICU-acquired weakness (ICU-AW) impacts up to 40% of patients admitted to the ICU and can have long-lasting effects on those who survive an ICU stay. In the last decade, early mobilization (EM) has emerged as an intervention to help prevent or to mitigate ICU-AW, or both, and to improve functional outcomes for patients. Despite its feasibility, safety, and potential benefits, a large gap in implementation of EM in ICUs globally remains. The purpose of this article is to review ICU-AW, to discuss the evidence base and current guidelines about EM, and to offer a practical approach for EM implementation with an emphasis on patient safety and common barriers.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 1","pages":"Article 100038"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788423000382/pdfft?md5=a5cfb27df93fda155d93a6080da928c6&pid=1-s2.0-S2949788423000382-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139020547","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}