CHEST critical care最新文献

{"title":"A Computable Electronic Health Record ARDS Classifier and the Association Between the MUC5B Promoter Polymorphism and ARDS in Critically Ill Adults","authors":"V. Eric Kerchberger MD ,&nbsp;J. Brennan McNeil BS ,&nbsp;Neil Zheng MD ,&nbsp;Diana Chang PhD ,&nbsp;Carrie M. Rosenberger PhD ,&nbsp;Angela J. Rogers MD ,&nbsp;Julie A. Bastarache MD ,&nbsp;QiPing Feng PhD ,&nbsp;Wei-Qi Wei MD, PhD ,&nbsp;Lorraine B. Ware MD","doi":"10.1016/j.chstcc.2025.100150","DOIUrl":"10.1016/j.chstcc.2025.100150","url":null,"abstract":"<div><h3>Background</h3><div>Large population-based DNA biobanks linked to electronic health records (EHRs) may provide novel opportunities to identify genetic drivers of ARDS.</div></div><div><h3>Research Question</h3><div>Can a computerized algorithm identify ARDS in a large EHR biobank database, and can this be used to identify ARDS genetic risk factors?</div></div><div><h3>Study Design and Methods</h3><div>We developed a classifier algorithm to identify a diagnosis of ARDS as identified from the electronic health record (EHR-ARDS) using diagnostic billing codes, laboratory test results, and chest radiography report text. The classifier model performance was evaluated against investigator-adjudicated ARDS using standard classification metrics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the Cohen κ value. After confirming acceptable classifier performance, we evaluated the association between EHR-ARDS and the <em>MUC5B</em> promoter polymorphism rs35705950 in 2 parallel genotyped cohorts: a prospective biomarker cohort of critically ill adults (Validating Acute Lung Injury Biomarkers for Diagnosis [VALID]) and a retrospective cohort from our institution’s de-identified EHR biobank, BioVU.</div></div><div><h3>Results</h3><div>We included 2,795 patients from VALID and 9,025 hospitalized participants from BioVU. EHR-ARDS showed moderate agreement with investigator-adjudicated ARDS (VALID: sensitivity, 0.86; specificity, 0.70; PPV, 0.49; NPV, 0.93; and κ, 0.45; BioVU: sensitivity, 0.94; specificity, 0.81; PPV, 0.66; NPV, 0.97; and κ, 0.67). We observed a significant age-gene interaction effect for EHR-ARDS in VALID: among older patients, rs35705950 was associated with increased EHR-ARDS risk (OR, 1.37; 95% CI, 1.05-1.78; <em>P</em> = .019), whereas among younger patients, this association was absent (OR, 0.92; 95% CI, 0.70-1.21; <em>P</em> = .55). In BioVU, rs35705950 was associated with EHR-ARDS among all participants (OR, 1.20; 95% CI, 1.01-1.43; <em>P</em> = .043); however, this effect did not vary by age.</div></div><div><h3>Interpretation</h3><div>The <em>MUC5B</em> promoter polymorphism was associated with EHR-ARDS in 2 parallel cohorts of at-risk adults. An age-gene effect modification was observed in VALID, whereas BioVU identified a consistent association between <em>MUC5B</em> and EHR-ARDS regardless of age. Our study highlights the potential for EHR biobanks to enable precision medicine ARDS studies.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100150"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654097","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":"The SONIC CENTRAL Study Does Not See the Forest for the Trees","authors":"Yonatan Y. Greenstein MD, FCCP,&nbsp;Keith Guevarra DO, FCCP","doi":"10.1016/j.chstcc.2025.100151","DOIUrl":"10.1016/j.chstcc.2025.100151","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100151"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143943113","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":"High Respiratory Effort During Invasive Pressure Support Ventilation","authors":"Anis Chaba MD ,&nbsp;Joanna W.Y. Chow MBBS ,&nbsp;Atthaphong Phongphithakchai MD ,&nbsp;Wisam Al-Bassam MD ,&nbsp;Fumitaka Yanase PhD ,&nbsp;Zachary O’Brien MBBS ,&nbsp;Glenn Eastwood PhD ,&nbsp;Ahmad Bassam MD ,&nbsp;Stefanos Hadzakis MD ,&nbsp;Sofia Spano MD ,&nbsp;Akinori Maeda MD ,&nbsp;Lucinda Roberts MD ,&nbsp;Rinaldo Bellomo PhD ,&nbsp;Ary Serpa Neto PhD","doi":"10.1016/j.chstcc.2025.100147","DOIUrl":"10.1016/j.chstcc.2025.100147","url":null,"abstract":"<div><h3>Background</h3><div>High respiratory effort may be common in invasively ventilated patients receiving pressure support ventilation, but its epidemiologic characteristics are unclear.</div></div><div><h3>Research Question</h3><div>What are the epidemiologic characteristics of high respiratory efforts in critically ill patients, does agreement exist between high respiratory drive and high respiratory effort, what are clinician responses during such events, and what is the relationship between those with clinical parameters and outcomes?</div></div><div><h3>Study Design and Methods</h3><div>This clinician-masked, prospective, observational study in 2 centers measured the drop in airway pressure during the first 100 ms of an inspiratory effort with an occluded airway (P_0.1), a validated noninvasive measure of respiratory drive, in patients receiving pressure support ventilation for &gt; 24 hours. We also measured estimated respiratory muscle pressure (_eP_musc), a validated surrogate of inspiratory effort. We measured _eP_musc and P_0.1 twice daily.</div></div><div><h3>Results</h3><div>Of 528 ventilated patients, 80 patients received pressure support ventilation for &gt; 24 hours. Among them, 33 patients (41%) exhibited high respiratory effort, which was more common in COVID-19 ARDS, with 19 of such patients (58%) reached the predefined threshold vs 14 patients (27%) in the non-COVID-19 cohort (OR, 5.0; 95% CI, 1.9-14.9; <em>P</em> = .001). Moreover, 36% of P_0.1 values were ≥ 4 cm H₂O, indicating high respiratory drive. Moderate agreement was found between _eP_musc and P_0.1 measurements (intraclass correlation coefficient, 0.65), suggesting significant discrepancies between those 2 parameters. Clinician-directed management based on usual clinical observations (but masked to P_0.1 and _eP_musc) rarely changed in the presence of high respiratory effort. Higher _eP_musc and its concomitant elevation with P_0.1 were associated with worse blood gas parameters and respiratory mechanics. A concomitant elevation of both _eP_musc and P_0.1 was associated independently with a decreased likelihood of being alive and ventilator-free up to day 28 (OR, 0.26; 95% CI, 0.06-0.87; <em>P</em> = .037).</div></div><div><h3>Interpretation</h3><div>In this study, many critical care patients receiving invasive pressure support ventilation exhibited high respiratory efforts. In these patients, adjustments to ventilator settings were uncommon, despite association with worse clinical parameters and outcomes.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100147"},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146831","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":"The Semiawake Exit","authors":"Abigail Chua MD, MPH ,&nbsp;James Richard Mattson MD ,&nbsp;Ewa Rakowski MD ,&nbsp;Hailey Capuano RN ,&nbsp;Sahar Ahmad MD","doi":"10.1016/j.chstcc.2025.100149","DOIUrl":"10.1016/j.chstcc.2025.100149","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100149"},"PeriodicalIF":0.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070638","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":"Longitudinal Respiratory Subphenotypes and Differences in Response to Positive End-Expiratory Pressure and Fio2 Ventilation Strategy in COVID-19 ARDS","authors":"Robin L. Goossen MD ,&nbsp;Daan F.L. Filippini MD ,&nbsp;Relin van Vliet MD ,&nbsp;Laura A. Buiteman-Kruizinga RN, PhD ,&nbsp;Markus W. Hollmann MD, PhD ,&nbsp;Sheila N. Myatra MD ,&nbsp;Ary Serpa Neto MD, PhD ,&nbsp;Peter E. Spronk MD, PhD ,&nbsp;Meta C.E. van der Woude MD, PhD ,&nbsp;Marcus J. Schultz MD, PhD ,&nbsp;David M.P. van Meenen MD, PhD ,&nbsp;Frederique Paulus PhD ,&nbsp;Lieuwe D.J. Bos MD, PhD ,&nbsp;Practice of Ventilation and Adjunctive Therapies in ICU Patients With COVID-19 Investigators","doi":"10.1016/j.chstcc.2025.100145","DOIUrl":"10.1016/j.chstcc.2025.100145","url":null,"abstract":"<div><h3>Background</h3><div>In patients with ARDS, positive end-expiratory pressure (PEEP) titration remains a challenge and recommendations are not in agreement. In mechanically ventilated patients with COVID-19, subphenotypes based on different respiratory trajectories have been identified, but their heterogeneity in response to PEEP/F<span>io</span>₂ strategy remains understudied.</div></div><div><h3>Research Question</h3><div>Can these previously determined subphenotypes be detected early in the course of mechanical ventilation, and do these subphenotypes moderate the association between PEEP and F<span>io</span>₂ ventilation strategy and mortality?</div></div><div><h3>Study Design and Methods</h3><div>Retrospective analysis of invasively ventilated patients with COVID-19. Patients were categorized into 2 treatment groups: high PEEP/low F<span>io</span>₂ strategy and low PEEP/high F<span>io</span>₂ strategy. To replicate previously described longitudinal respiratory subphenotypes, hereafter named the <em>low-power</em> or <em>high-power</em> subphenotype, a prediction model was created. The primary outcome was the interaction between PEEP/F<span>io</span>₂ strategy and subphenotype, with mortality as the dependent variable.</div></div><div><h3>Results</h3><div>Of the 1,464 patients included in this analysis, 361 patients (25%) were allocated into the high PEEP/low F<span>io</span>₂ strategy and 1,103 patients (75%) were allocated into the low PEEP/high F<span>io</span>₂ strategy. A prediction model consisting of respiratory data of the first 2 days of invasive ventilation (area under the receiver operating characteristics curve, 0.88) assigned 908 patients (62%) to the low-power subphenotype and 556 patients (38%) to the high-power subphenotype. The high-power subphenotype was characterized by higher minute volume, mechanical power, ventilatory ratio, and driving pressure. The association between PEEP/F<span>io</span>₂ ventilation strategy and ICU mortality was moderated by the subphenotype (<em>P = .</em>03), with high PEEP/low F<span>io</span>₂ ventilation being associated with lower mortality in the low-power subphenotype (OR, 0.46; 95% CI, 0.31-0.67; <em>P &lt; .</em>001) and not in the high-power subphenotype (OR, 0.85; 95% CI, 0.57-1.28; <em>P = .</em>44).</div></div><div><h3>Interpretation</h3><div>In this study, high PEEP/low F<span>io</span>₂ ventilation was associated with improved mortality only in one of the subphenotypes, suggesting that such subphenotypes influence heterogeneity of PEEP and F<span>io</span>₂ effect and should be considered in personalized ventilation strategies.</div></div><div><h3>Clinical Trial Registry</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: NCT05954351; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100145"},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166487","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":"Association of Central Nervous System-Related Biomarkers With Hospital Delirium in Patients With Respiratory Failure in the ICU","authors":"Andrew T. Pham MD ,&nbsp;Ryan A. Peterson PhD ,&nbsp;Suzanne Slaughter MS ,&nbsp;Morgan Martin BS ,&nbsp;Joseph A. Hippensteel MD ,&nbsp;Ellen L. Burnham MD","doi":"10.1016/j.chstcc.2025.100143","DOIUrl":"10.1016/j.chstcc.2025.100143","url":null,"abstract":"<div><h3>Background</h3><div>Delirium commonly occurs in critical illness and is associated with significant morbidity and mortality. Although risk reduction measures can mitigate the risk of delirium, identifying patients in whom delirium will develop remains clinically challenging.</div></div><div><h3>Research Question</h3><div>In critically ill patients with respiratory failure, are central nervous system (CNS)-related biomarkers measured at admission associated with delirium diagnosis?</div></div><div><h3>Study Design and Methods</h3><div>We performed a secondary analysis of a cohort of patients with respiratory failure in the medical ICU enrolled at a single medical center. Using serum collected at ICU admission, we measured CNS-related biomarkers including brain-derived neurotrophic factor (BDNF), chitinase-3-like protein 1, glial fibrillary acidic protein, neurofilament light chain (NF-L), neurogranin, S100 calcium-binding protein B, and triggering receptor expressed on myeloid cells 2 via a multiplex immunoassay. The primary outcome was diagnosis of in-hospital delirium, defined using validated methods. Associations between individual biomarkers and delirium diagnosis were examined using multivariable logistic regressions, adjusting for factors known to predispose and precipitate delirium. Secondary outcomes included in-hospital mortality, ventilator-free days, ICU-free days, and hospital-free days.</div></div><div><h3>Results</h3><div>Serum biomarkers were measured in 100 patients. Delirium occurred in 73% of the cohort. Patients with vs without delirium did not differ significantly in terms of age, sex, comorbidities, severity of illness, or unhealthy alcohol use. After adjustment, NF-L was associated positively with delirium diagnosis (adjusted OR, 1.86; 95% CI, 1.09-3.43), whereas BDNF was associated negatively with delirium (adjusted OR, 0.43; 95% CI, 0.15-0.82). No associations were found between other measured biomarkers and delirium diagnosis. NF-L levels were associated negatively with ICU-free and hospital-free days.</div></div><div><h3>Interpretation</h3><div>Our results indicate that CNS-related biomarkers measured at ICU admission are associated with delirium diagnosis in critically ill patients. Prospective investigations are necessary to validate the role of these biomarkers in predicting delirium.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100143"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144070637","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":"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}