CHEST critical care最新文献

{"title":"Atrial Septal Aneurysm as a Harbinger of Right-to-Left Intracardiac Shunting and Hypoxemia","authors":"Heather Andrade MD , Joseph Vroegop DO , Sarah Seyffert MD , Alyson Bundy DO , Daniel S. Brenner MD, PhD , Mitchell Holland BS , Brooke Jackson NP , Francesca Duncan MD , John Grotberg MD , Daniel Rozenbaum MD , Edwin J. Jackson DO, MBA, RDCS, FCCP","doi":"10.1016/j.chstcc.2025.100233","DOIUrl":"10.1016/j.chstcc.2025.100233","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"4 1","pages":"Article 100233"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187326","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 Glory of Light in Darkness","authors":"Rachel Hadler MD , Rebecca A. Aslakson MD, PhD, FAAHPM, FCCM","doi":"10.1016/j.chstcc.2025.100227","DOIUrl":"10.1016/j.chstcc.2025.100227","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"4 1","pages":"Article 100227"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187324","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":"Surrogate Perspectives on the Communication and Support Processes That Enable Them as Active Decision-Makers Across Chronic Critical Illness","authors":"Amanda C. Moale MD ,&nbsp;Douglas B. White MD, MAS ,&nbsp;Bryan J. McVerry MD ,&nbsp;Robert Grier ,&nbsp;Chareeni E. Kurukulasuriya MD ,&nbsp;Mikhaila N. Layshock MD ,&nbsp;Svea Cheng BA ,&nbsp;Robert M. Arnold MD ,&nbsp;Maya I. Ragavan MD, MPH ,&nbsp;Renee D. Boss MD, MHS ,&nbsp;Judy C. Chang MD, MPH","doi":"10.1016/j.chstcc.2025.100220","DOIUrl":"10.1016/j.chstcc.2025.100220","url":null,"abstract":"<div><h3>Background</h3><div>Chronic critical illness (CCI) is marked by persistent respiratory failure, with patients commonly receiving tracheostomies for ongoing ventilation across ICU and post-ICU settings. Well-documented communication and support breakdowns across CCI worsen family distress and may perpetuate care misaligned with patient values and goals. Yet, effective interventions supporting surrogate decision-makers throughout CCI are lacking.</div></div><div><h3>Research Question</h3><div>What are the communication and support processes that families view as essential to enabling them as active surrogate decision-makers across the patient’s trajectory to better inform future intervention development?</div></div><div><h3>Study Design and Methods</h3><div>We conducted semistructured interviews with surrogate decision-makers of patients who received a tracheostomy for persistent respiratory failure after an acute illness at 2 time points (first, 2 weeks to 6 months after tracheostomy; second, weeks to months later). We used deductive and inductive coding, followed by thematic analysis of interview transcripts.</div></div><div><h3>Results</h3><div>We interviewed 23 surrogate decision-makers of 19 medical and surgical patients with moderate-high illness severity (mean Acute Physiology and Chronic Health Evaluation II score, 21.5 <span><math><mrow><mo>±</mo></mrow></math></span> 5.3). Five themes were generated from family perspectives, representing the essential communication and support processes to enable families as active decision-makers across time and settings in CCI. They included being (1) engaged proactively during transitions; (2) connected to tailored practical resources that enable their presence, engagement, and space for self-care across the CCI trajectory; (3) actively engaged in ongoing and iterative anticipatory guidance and reassessment; (4) recognized as the expert and advocate for the patient; and (5) treated with compassion and respect.</div></div><div><h3>Interpretation</h3><div>Our findings suggest that future interventions should deliver decisional support in CCI through longitudinal, relationship-centered strategies integrating iterative care planning, compassionate and inclusive family engagement, and tailored practical resources as core intervention components.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"4 1","pages":"Article 100220"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187798","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":"Superimposed Pressure for Predicting Mortality in Acute Respiratory Failure During Spontaneous Breathing","authors":"Emanuele Rezoagli MD, PhD ,&nbsp;Davide Signori MD ,&nbsp;Yi Xin PhD ,&nbsp;Sarah Gerard PhD ,&nbsp;Aurora Magliocca MD, PhD ,&nbsp;Francesca Graziano PhD ,&nbsp;Giovanni Vitale MD ,&nbsp;Linda Mussoni MD ,&nbsp;Jonathan Montomoli MD, PhD ,&nbsp;Matteo Subert MD ,&nbsp;Alessandra Ponti MD ,&nbsp;Savino Spadaro MD ,&nbsp;Giancarla Poli MD ,&nbsp;Francesco Casola PhD ,&nbsp;Roberta Garberi MD ,&nbsp;Davide Raimondi Cominesi MD ,&nbsp;Alice Nova MD ,&nbsp;Marco Giani MD ,&nbsp;Giuseppe Foti MD ,&nbsp;John G. Laffey MD, MA, DSc, MRIA ,&nbsp;Matteo Giacomini","doi":"10.1016/j.chstcc.2025.100231","DOIUrl":"10.1016/j.chstcc.2025.100231","url":null,"abstract":"<div><h3>Background</h3><div>Early lung imaging may improve patient management and prognostication in acute respiratory failure (ARF).</div></div><div><h3>Research Question</h3><div>Does quantitative assessment of lung injury by CT imaging predict outcome in spontaneously breathing patients with COVID-19 ARF?</div></div><div><h3>Study Design and Methods</h3><div>This was a large retrospective, multicenter cohort study including patients seeking treatment at the emergency department with a clinical diagnosis of COVID-19 respiratory failure and undergoing early lung CT imaging at hospital admission. Lung injury was characterized by the severity of lung involvement as follows: (1) absence, unilateral, or bilateral infiltrates; (2) number of lung quadrants affected by infiltrates (0-4); and level of global and regional (3) superimposed pressure (SP) and (4) gas to tissue (GT) ratio. Baseline, laboratory, and clinical characteristics were described by the presence or absence of laterality of lung infiltrates. Association of 90-day mortality and lung CT scan characterization was explored using Cox multivariable models and areas under receiving operating characteristic curves. Subphenotypes including CT scan assessment were explored by latent class analyses.</div></div><div><h3>Results</h3><div>Eight hundred eight patients were included. Bilateral infiltrates were associated with higher global and regional SP and GT ratio and a higher 90-day mortality (38%) compared with unilateral infiltrates (18%) or no lung infiltrates (11%). Involvement by laterality, quadrants, degree of global SP, and GT ratio all were associated with the degree of hypoxemia on admission and 90-day mortality. Among other CT scan-derived variables of lung injury, SP characterized a subphenotype with a robust relationship with 90-day mortality.</div></div><div><h3>Interpretation</h3><div>Characterization of lung injury severity by early lung CT imaging findings was shown to describe the severity of hypoxemia. The adjunct of CT scan global SP to clinical and laboratory parameters identified a subphenotype with high 90-day mortality prediction. Early lung CT imaging may enhance population enrichment and may improve prognostication in nonintubated patients with ARF.</div></div><div><h3>Clinical Trial Registration</h3><div>ClinicalTrials.gov; No.: NCT04395482; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"4 1","pages":"Article 100231"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147419589","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":"When Doing Nothing Is a Decision","authors":"Jayshil J. Patel MD ,&nbsp;Katherine R. Gavinski MD","doi":"10.1016/j.chstcc.2026.100248","DOIUrl":"10.1016/j.chstcc.2026.100248","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"4 1","pages":"Article 100248"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147419582","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":"Clinician Preferences in Provision of Respiratory Support to Patients With Respiratory Failure Receiving Intensive Care","authors":"Peter C. Nauka MD ,&nbsp;Eric J. Yablonsky BS ,&nbsp;S. Mehdi Nouraie MD ,&nbsp;Timothy D. Girard MD, MSCI ,&nbsp;Jeremy M. Kahn MD ,&nbsp;Bryan J. McVerry MD ,&nbsp;Christopher W. Seymour MD","doi":"10.1016/j.chstcc.2025.100224","DOIUrl":"10.1016/j.chstcc.2025.100224","url":null,"abstract":"<div><h3>Background</h3><div>Acute respiratory failure is a common and deadly diagnosis among patients receiving intensive care. Physicians have a variety of oxygenation support devices available to support patients, ranging from low-flow oxygen to high-flow nasal cannula, noninvasive ventilation, and invasive mechanical ventilation. Clinical equipoise exists regarding selection of a specific device, spurred by varying physician practice patterns and preferences.</div></div><div><h3>Research Questions</h3><div>Do physician preferences for oxygenation support vary within a single institution?</div></div><div><h3>Study Design and Methods</h3><div>A survey distributed to 100 critical care physicians across 5 academic and community hospitals within an integrated health care system in Western Pennsylvania. The survey contained 5 real-world clinical scenarios across 5 domains: (1) a patient experiencing an acute COPD exacerbation with refractory hypercapnia, (2) a patient with worsening hypoxemia secondary to streptococcal pneumonia, (3) an immunosuppressed host with severe COVID-19 pneumonia, (4) an older patient with multiple cardiopulmonary comorbidities demonstrating hypoxemia and septic shock, and (5) a patient with flash pulmonary edema in the setting of multiple cardiac comorbidities. Physicians were asked to provide an oxygenation support recommendation from the following: (1) low-flow or facemask oxygen, (2) heated high-flow nasal cannula, (3) bilevel pressure ventilation, or (4) endotracheal intubation to initiate mechanical ventilation. We assessed interrater agreement within each scenario by percent agreement and performed a sensitivity analysis dichotomizing clinician recommendation around endotracheal intubation.</div></div><div><h3>Results</h3><div>A total of 44 (44%) physicians completed the survey instrument. Initiating mechanical ventilation was chosen variably by physicians ranging from 5% (n = 2, scenario 2) to 61% (n = 27, scenario 3). Interrater agreement was poor across scenarios 1, 3, 4, and 5 (range, 0.32-0.56) and moderate only in scenario 2 (0.83). Dichotomizing the clinical decision to pursue endotracheal intubation or not improved agreement slightly in scenario 2 (0.92) and scenario 5 (0.73).</div></div><div><h3>Interpretation</h3><div>Our results show that critical care physicians are unlikely to agree on oxygenation support device for patients receiving intensive care, confirming clinical equipoise.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"4 1","pages":"Article 100224"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187325","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":"Temporal Nomenclature and Definitions for Prolonged Course ARDS","authors":"Floris E.J. Jolink MD ,&nbsp;Cornelis P. van Stee MD ,&nbsp;Karin I. Sijtsma ,&nbsp;Peter Dieperink MD ,&nbsp;Hendrik W. Zijlstra MD ,&nbsp;Joep M. Droogh MD, PhD ,&nbsp;Janesh Pillay MD, PhD","doi":"10.1016/j.chstcc.2025.100225","DOIUrl":"10.1016/j.chstcc.2025.100225","url":null,"abstract":"<div><h3>Background</h3><div>ARDS affects &gt; 20% of critically ill, mechanically ventilated patients and carries a high mortality rate. A prolonged course of ARDS is associated with high health care costs and extended ICU admission. It exhibits considerable heterogeneity in cause, biological characteristics, and chronology. ARDS criteria are subject to continuous revision by expert consensus. Expert consensus has not provided a clear definition of a prolonged course of ARDS (ie, persistent or nonresolving).</div></div><div><h3>Research Question</h3><div>What nomenclature and time-based definitions have been used in the ARDS literature over the past 3 decades to describe patients with a prolonged course of ARDS?</div></div><div><h3>Study Design And Methods</h3><div>We conducted a scoping review to assess the definitions used for a prolonged course of ARDS. PubMed and EMBASE databases were searched using a predefined and preregistered search string.</div></div><div><h3>Results</h3><div>We included 66 articles and found marked heterogeneity in nomenclature and definitions. Fifteen different nomenclatures were used with time frames ranging from 30 minutes to several weeks. This heterogeneity persisted across periods of the existing consensus criteria (American-European Consensus Conference vs the Berlin definition) and research topics (ie, pharmacology or biomarkers). The most common nomenclatures were persistent (n = 26 [39%]) and late (n = 26 [39%]), with the most frequent time definition being 7 days after onset of ARDS (n = 28 [42%]).</div></div><div><h3>Interpretation</h3><div>The relative paucity of studies found using a comprehensive search strategy and the use of heterogeneous definitions preclude adequate meta-analyses required to gain insight into the cause, outcomes, and possible interventions aimed at improving patient care. A focused discussion is required to create a consensus definition for a prolonged course of ARDS to standardize research efforts toward improving patient outcomes.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"4 1","pages":"Article 100225"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147419588","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":"Critical Care ATLAS","authors":"Anna M. Janas MD, PhD ,&nbsp;Kevin P. Seitz MD ,&nbsp;Matthew W. Semler MD ,&nbsp;Jonathan D. Casey MD ,&nbsp;Lauren Fortier PNP, MSN ,&nbsp;Amrita Roy MD ,&nbsp;César Augusto Ikeda Akiyama MD ,&nbsp;Daniela Carla de Souza MD, PhD ,&nbsp;Aline B. Maddux MD, MSCS","doi":"10.1016/j.chstcc.2025.100218","DOIUrl":"10.1016/j.chstcc.2025.100218","url":null,"abstract":"<div><div>The Oxygen-PICU trial, published in 2024, enrolled 2,040 children who had been admitted to PICUs in the United Kingdom with respiratory failure that required mechanical ventilation and supplemental oxygen. Participants were assigned randomly to 1 of 2 oxygenation target groups based on Sp<span>o</span>₂: a conservative group (patients maintained Sp<span>o</span>₂ at 88% to 92%) and a liberal group (patients maintained Sp<span>o</span>₂ &gt; 94%). The study found that the conservative oxygenation group had improved outcomes that measured as a reduction in the duration of organ support or death, censored at 30 days follow up, compared with the liberal group. We highlight perspectives on how the findings of the Oxygen-PICU trial have influenced or are expected to influence clinical practice across diverse settings. We collected narratives from critical care clinicians with different backgrounds (medical doctors, advance practice provider) who served different populations (adults and children) and who practiced in resource-rich or resource-limited settings.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"4 1","pages":"Article 100218"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147419593","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":"Predictors of Patient-Reported Financial Hardship in Patients Hospitalized With Critical Illness and Its Association With Patient Outcomes","authors":"Alison M. Uyeda MD ,&nbsp;Peter May PhD ,&nbsp;C. Clare Pytel MPA ,&nbsp;Elizabeth L. Nielsen MPH ,&nbsp;Ruth A. Engelberg PhD ,&nbsp;Nita Khandelwal MD","doi":"10.1016/j.chstcc.2025.100213","DOIUrl":"10.1016/j.chstcc.2025.100213","url":null,"abstract":"<div><h3>Background</h3><div>A high burden of financial hardship has been demonstrated in critically ill patients. Understanding the sociodemographic and clinical risk factors for financial hardship and its association with patient outcomes can help to guide future interventions to mitigate financial hardship in this patient population.</div></div><div><h3>Research Question</h3><div>What are the sociodemographic and clinical risk factors for financial hardship in critically ill patients and its association with patient-reported outcomes?</div></div><div><h3>Study Design and Methods</h3><div>This prospective cohort study enrolled adults with chronic, life-limiting illness, acute severe illness, or both hospitalized in the ICU. Twenty-six sociodemographic and clinical variables were measured using electronic health record or patient questionnaire data collected at either 1 or 3 months after ICU admission. Risk factors for patient-reported financial hardship were evaluated using linear regression. The association between financial hardship and 4 patient-reported outcomes was tested with probit and linear regression.</div></div><div><h3>Results</h3><div>We enrolled 171 patients with a median age of 58 years (interquartile range, 45, 70 years), including 64 female (37%) patients and 44 patients (26%) from racial or ethnic minority groups. Illness-related change in work status (β = 3.5; <em>P = .</em>02) and poorer self-reported health status (β = 2.4; <em>P = .</em>003) were associated with greater patient-reported financial hardship. Higher education level (β = –2.6; <em>P = .</em>001) was associated with less financial hardship. Higher financial hardship was associated with all 4 patient-reported outcomes (<em>P &lt; .</em>001): feelings of depression (β = 0.2) and anxiety (β = 0.3), poorer quality of life (β = 0.04), and lower emotional preparedness for the future (β = 0.05).</div></div><div><h3>Interpretation</h3><div>This study demonstrated an association between patient-reported financial hardship and negative patient-reported outcomes in critically ill patients. Our findings also highlight important risk factors for financial hardship and suggest that sociodemographic factors, including education level, illness-related change in work status, and poorer self-reported health status, could contribute more than clinical factors. Our findings provide a foundation for future development of screening tools and interventions to mitigate financial hardship in critically ill patients.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"4 1","pages":"Article 100213"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693876","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":"Development of a Pilot Machine Learning Model to Predict Successful Short-Term Treatment Success in Critically Ill Patients With Community-Acquired Pneumonia","authors":"Mengou Zhu MD ,&nbsp;Wan-Ting Liao MS ,&nbsp;Alec Peltekian ,&nbsp;Nikolay S. Markov MS ,&nbsp;Mengjia Kang MS ,&nbsp;Luke V. Rasmussen MS ,&nbsp;Chiagozie I. Pickens MD ,&nbsp;Thomas Stoeger PhD ,&nbsp;Theresa L. Walunas PhD ,&nbsp;Alexander V. Misharin MD, PhD ,&nbsp;Benjamin D. Singer MD ,&nbsp;G.R.Scott Budinger MD ,&nbsp;Richard G. Wunderink MD ,&nbsp;Ankit Agrawal PhD ,&nbsp;Catherine A. Gao MD ,&nbsp;NU SCRIPT Study Investigators","doi":"10.1016/j.chstcc.2025.100228","DOIUrl":"10.1016/j.chstcc.2025.100228","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"4 1","pages":"Article 100228"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147419587","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}