CHEST critical care最新文献

{"title":"Best Practices for Hospital-Based Donor Care Unit Operations","authors":"Emily A. Vail MD ,&nbsp;Varun K. Goyal MD ,&nbsp;Ashley C. McGinity MD ,&nbsp;Todd Sarge MD ,&nbsp;Julie K. Heimbach MD ,&nbsp;Arthur R. Mielke MD, MPH ,&nbsp;Allison J. Tompeck MD ,&nbsp;Carolina B. Maciel MD ,&nbsp;Katharina M. Busl MD ,&nbsp;Thomas M. Leventhal MD ,&nbsp;Devang K. Sanghavi MBBS, MD ,&nbsp;Rishi Kumar MD ,&nbsp;Philip M. Sommer MD ,&nbsp;Kim M. Olthoff MD ,&nbsp;Niels D. Martin MD ,&nbsp;Samuel T. Windham MD ,&nbsp;Rita N. Bakhru MD","doi":"10.1016/j.chstcc.2025.100144","DOIUrl":"10.1016/j.chstcc.2025.100144","url":null,"abstract":"<div><div>United States organ procurement organizations increasingly are centralizing the management and recovery of organs from deceased donors into dedicated donor care units (DCUs) with growing evidence of effectiveness. This paradigm shift offers logistical advantages, but introduces new considerations for intensivists responsible for the safe, effective, and efficient management of deceased potential organ donors. In this How I Do It article, intensivist leaders of 12 US DCUs collaborating in the Donor Care Unit Network for Optimizing Recovery group describe best practices for delivering care and organ recovery from deceased donors after brain death and circulatory death in hospital-based donor care units. Specific considerations include donor transfers, clinical donor management, performance assessment, and quality improvement.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100144"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124084","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":"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":"Advancing Prognostic Enrichment in Pediatric Sepsis-Associated Acute Respiratory Dysfunction","authors":"Richard W. Pierce MD ,&nbsp;Colin J. Sallee MD","doi":"10.1016/j.chstcc.2025.100140","DOIUrl":"10.1016/j.chstcc.2025.100140","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100140"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859179","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":"A Systematic Review of the Development and Implementability of Complex Interventions After Hospitalization for Survivors of Intensive Care","authors":"Evelyn Sloan DPT ,&nbsp;Selina M. Parry PhD ,&nbsp;Alisha A. da Silva BPhysio, AdvRes (Hons) ,&nbsp;Catherine L. Granger PhD ,&nbsp;Zoe Fehlberg MPH ,&nbsp;Owen Gustafson PhD ,&nbsp;Catherine Voutier MInfoMgmt ,&nbsp;Camille E. Short PhD ,&nbsp;Marlena Klaic PhD","doi":"10.1016/j.chstcc.2025.100142","DOIUrl":"10.1016/j.chstcc.2025.100142","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Survivors of the ICU can experience physical, mental, and cognitive impairments, limiting activities and societal participation. Limited evidence supports the effectiveness of complex interventions after hospitalization, raising questions regarding how these interventions are developed and evaluated. Recommendations from implementation science and complex intervention research may provide further insight.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Research Question&lt;/h3&gt;&lt;div&gt;What methods have informed the development and evaluation of complex interventions after hospitalization for survivors of the ICU. How have implementability (acceptability, fidelity, and feasibility) and efficacy been considered in the development and evaluation of these interventions?&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design and Methods&lt;/h3&gt;&lt;div&gt;Studies were included if they developed or evaluated, or both, a complex, structured intervention after hospitalization aimed at improving recovery outcomes for survivors of the ICU. MEDLINE, Embase, PsycINFO, CINAHL, and PEDro were searched through June 4, 2024. Extracted data included intervention development processes; intervention description; and if and how acceptability or satisfaction, fidelity, feasibility, and efficacy were evaluated. Synthesis methods included deductive analysis and scoring using the Template for Intervention Description and Reporting (TIDieR) and the National Institutes of Health’s Treatment Fidelity Framework. Quality appraisal was completed using the applicable Johanna Briggs Institute (JBI) guidelines.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Seventy-one publications were included involving 62 unique patient cohorts. Twelve studies (19%) used intervention development frameworks, whereas 24 studies (39%) engaged stakeholders in development processes. The median TIDieR score was 16 (interquartile range [IQR], 14-20) of 24. Twenty-two studies (35%) evaluated patient acceptability, of which 2 studies also evaluated clinician acceptability. Median treatment fidelity score was 6 (IQR, 6-9) of 21 with training, delivery, receipt, and enactment domains described poorly. The median consent rate was 48% (IQR, 34%-68%). Thirteen of the 22 studies (59%) designed to test efficacy achieved their sample size. Eight studies (13%) evaluated cost and 20 studies (34% of studies delivering interventions) reported safety. The median JBI score was 61% (IQR, 50%-70%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Few studies reported applying theory-informed methods or engaging stakeholders in intervention development. Treatment fidelity focused on delivery with little description of receipt or enactment. Future efforts may consider applying implementation science theory and complex intervention approaches.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Clinical Trial Registration&lt;/h3&gt;&lt;div&gt;International Prospective Register of Systematic Reviews; No.: CRD42023444648; URL: &lt;span&gt;&lt;span&gt;https://www.crd.york.ac.uk/prospero/&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;&lt;/di","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100142"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166513","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":"Lactation as Liberation","authors":"R. Nicholas Burns MD","doi":"10.1016/j.chstcc.2025.100141","DOIUrl":"10.1016/j.chstcc.2025.100141","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100141"},"PeriodicalIF":0.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839076","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":"Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass Grafting","authors":"Jon-Emile S. Kenny MD ,&nbsp;Geoffrey Clarke MEng ,&nbsp;Sarah Atwi PhD ,&nbsp;Isabel Kerrebijn MSc ,&nbsp;Tracy Savery MASc ,&nbsp;Meredith Knott BSN ,&nbsp;Chelsea E. Munding PhD ,&nbsp;Mai Elfarnawany PhD ,&nbsp;Andrew M. Eibl BComm ,&nbsp;Joseph K. Eibl PhD ,&nbsp;Bhanu Nalla MD ,&nbsp;Rony Atoui MD","doi":"10.1016/j.chstcc.2025.100138","DOIUrl":"10.1016/j.chstcc.2025.100138","url":null,"abstract":"<div><h3>Background</h3><div>As a measure of preload responsiveness (PR), change in carotid artery corrected flow time (ccFT_Δ) is a surrogate for change in stroke volume (SV_Δ). However, the optimal threshold and accuracy of ccFT_Δ to detect SV_Δ are inconsistent in previous reports.</div></div><div><h3>Research Question</h3><div>Does ccFT_Δ from a wireless, wearable Doppler ultrasound accurately detect a 10% SV_Δ measured by transesophageal echocardiography?</div></div><div><h3>Study Design and Methods</h3><div>This was a prospective, single-center study of adult patients after elective coronary artery bypass grafting. PR was defined as ≥ 10% augmentation in transesophageal echocardiography left ventricular outflow tract velocity time integral (as a surrogate for SV_Δ) during Trendelenburg positioning. Synchronous carotid Doppler imaging was captured by a wireless, wearable Doppler ultrasound. The optimal ccFT_Δ threshold to detect PR, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. Linear correlation between ccFT_Δ and SV_Δ was assessed by Pearson correlation coefficient. We also evaluated the effect of the number of consecutively averaged cardiac cycles on ccFT_Δ accuracy.</div></div><div><h3>Results</h3><div>This analysis included 30 patients; 7 patients showed a ≥ 10% SV_Δ during Trendelenburg positioning. The optimal ccFT_Δ thresholds were +6.6 ms or 2.2% with sensitivities of 100%, specificities of 70%, and AUCs of 0.89 and 0.88, respectively. A strong, linear correlation between ccFT_Δ and SV_Δ was found (<em>r</em> = 0.70; <em>P</em> &lt; .001). The mean AUC increased from 0.68 to 0.87 when using 1 vs 20 consecutively averaged cardiac cycles.</div></div><div><h3>Interpretation</h3><div>After cardiopulmonary bypass, ccFT_Δ measured by wireless, wearable ultrasound detected SV_Δ during Trendelenburg positioning with high accuracy. The AUC improved as a function of consecutively averaged cardiac cycles. As a surrogate for preload-induced SV_Δ, ccFT_Δ can direct fluid therapy in the postoperative period.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100138"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887741","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":"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":"The Lingering Impact of COVID-19 on Respiratory Health","authors":"Fernando Luis Scolari MD, PhD","doi":"10.1016/j.chstcc.2025.100137","DOIUrl":"10.1016/j.chstcc.2025.100137","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100137"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859180","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}