CHEST critical care最新文献

{"title":"Lactation Practices in Critically Ill Patients","authors":"Kayla J. Kolbe MD ,&nbsp;Virginia Sheffield MD ,&nbsp;Katerina Castillo MD ,&nbsp;Kriya S. Patel MD ,&nbsp;Jessica A. Blank MD ,&nbsp;Melissa H. Ross MD ,&nbsp;Thomas S. Valley MD ,&nbsp;Rommel Sagana MD","doi":"10.1016/j.chstcc.2024.100123","DOIUrl":"10.1016/j.chstcc.2024.100123","url":null,"abstract":"<div><h3>Background</h3><div>Most birthing people in the United States initiate lactation, but little is known about lactation practices in patients who are critically ill.</div></div><div><h3>Research Question</h3><div>What are the lactation rates and practices in adult patients in the ICU and what are potential barriers to lactation and resource use?</div></div><div><h3>Study Design and Methods</h3><div>We performed a retrospective chart review of immediately postpartum patients in the ICU at an academic medical center between January 2018 and January 2024. Information regarding initiation, cessation, communication, and lactation consultant (LC) services were extracted and bivariate tests of association were conducted.</div></div><div><h3>Results</h3><div>Most immediately postpartum patients in the ICU initiated lactation (85% [87 of 102]), but only 70% (72 of 102) continued until hospital discharge. Documented lactation plans were present before delivery for 60% of patients, and a documented plan to initiate lactation before delivery was associated with increased odds of initiating lactation after delivery (OR, 9.21; 95% CI, 1.96-43.3; <em>P</em> = .005). Although most patients (75%) saw LCs, less than 30% of patients saw LCs within 24 hours of delivery. An association between seeing an LC and continuing lactation until hospital discharge was found (OR, 4.74; 95% CI, 1.77-12.7; <em>P</em> = .002). More than one-half of lactating patients received mechanical ventilation (55%), but nearly 20% of these intubated patients did not undergo milk expression while ventilated.</div></div><div><h3>Interpretation</h3><div>Most postpartum patients who are critically ill initiate lactation, but not all continue until hospital discharge. Having documented plans to lactate before delivery and seeing LCs were protective of lactation in the ICU, but many patients did not see LCs promptly. Additional gaps in care included lack of documentation and delays in lactation initiation in intubated patients. We hypothesize that these gaps may hinder patients who are critically ill from achieving their personal lactation goals, and steps should be taken to address and mitigate these challenges.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100123"},"PeriodicalIF":0.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487206","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":"Feasibility of Measuring Driving Pressure and Patient Effort in Assisted Modes of Ventilation","authors":"Malik Farooqi MD ,&nbsp;Michael Mikhaeil MD ,&nbsp;Jason Z.X. Chen MD ,&nbsp;Mohamed Althobity MD ,&nbsp;Alisha Greer MD ,&nbsp;Arjun Sharma MD ,&nbsp;Kimberley Lewis MD ,&nbsp;Tom Piraino MD ,&nbsp;Deborah Cook MD ,&nbsp;Bram Rochwerg MD","doi":"10.1016/j.chstcc.2024.100125","DOIUrl":"10.1016/j.chstcc.2024.100125","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100125"},"PeriodicalIF":0.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444658","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":"Venovenous Extracorporeal Membrane Oxygenation in Patients With Shock","authors":"Jonah Rubin MD","doi":"10.1016/j.chstcc.2024.100127","DOIUrl":"10.1016/j.chstcc.2024.100127","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100127"},"PeriodicalIF":0.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444744","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":"Continuous Glucose Monitor in Adult Diabetic Ketoacidosis","authors":"Rafael Barberena Moraes MD, PhD ,&nbsp;Amanda Vilaverde Perez MD","doi":"10.1016/j.chstcc.2024.100122","DOIUrl":"10.1016/j.chstcc.2024.100122","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100122"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487295","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":"Derivation and Validation of a Clinical and Endothelial Biomarker Risk Model to Predict Persistent Pediatric Sepsis-Associated Acute Respiratory Dysfunction","authors":"James G. Williams MD ,&nbsp;Jane E. Whitney MD ,&nbsp;Scott L. Weiss MD ,&nbsp;Brian M. Varisco MD ,&nbsp;Nadir Yehya MD ,&nbsp;Mihir R. Atreya MD, MPH ,&nbsp;Sepsis Genomics Collaborative and the Children’s Hospital of Philadelphia Sepsis Investigators","doi":"10.1016/j.chstcc.2024.100120","DOIUrl":"10.1016/j.chstcc.2024.100120","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis-associated ARDS results in high morbidity and mortality in children. However, heterogeneity among patients makes identifying those at risk of persistent acute respiratory dysfunction challenging. Endothelial dysfunction is a key feature of ARDS pathophysiologic characteristics, contributing to lung injury in sepsis. Incorporating endothelial biomarkers into risk models may enhance prediction of those with persistent acute respiratory dysfunction.</div></div><div><h3>Research Question</h3><div>Can clinical variables and endothelial biomarkers measured early in the course of sepsis predict risk of persistent acute respiratory dysfunction among critically ill children?</div></div><div><h3>Study Design And Methods</h3><div>This was a multicenter derivation and single center test cohort study of prospectively enrolled children with sepsis. The derivation cohort was split into training and holdout validation sets. We trained TreeNet (Minitab, LLC) and classification and regression tree (CART) models using clinical and endothelial biomarkers measured on day 1 of septic shock to predict risk of sepsis-associated acute respiratory dysfunction (SA ARD) on day 3. The performance of the CART model was tested in the holdout validation data set and in the independent test cohort.</div></div><div><h3>Results</h3><div>In the derivation (n = 625) and test (n = 162) cohorts, children with day 3 SA ARD showed increased mortality, length of mechanical ventilation, and PICU length of stay compared with those without. The TreeNet and CART models yielded comparable results. The variables included in the final CART model were presence of SA ARD on day 1, Pa<span>o</span>₂ to F<span>io</span>₂ ratio of &lt; 250, soluble thrombomodulin, and vascular cell adhesion molecule 1 concentrations. This model showed an area under the receiver operating characteristic curve (AUC) of 0.88 in the training data set, sensitivity of 0.91 (95% CI, 0.86-0.94), specificity of 0.76 (95% CI, 0.68-0.82), and demonstrated reproducibility in validation data set and test cohort (AUC range, 0.78-0.83).</div></div><div><h3>Interpretation</h3><div>We derived and validated predictive models incorporating clinical and endothelial biomarkers to identify pediatric patients with septic shock at high risk of persistent acute respiratory dysfunction. Pending prospective validation, such models may facilitate enrichment and targeted intervention in future clinical trials.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100120"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487208","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":"Acetaminophen and Clinical Outcomes in Sepsis","authors":"Sarah N. Obeidalla MEd ,&nbsp;Gordon R. Bernard MD ,&nbsp;Lorraine B. Ware MD ,&nbsp;V. Eric Kerchberger MD","doi":"10.1016/j.chstcc.2024.100118","DOIUrl":"10.1016/j.chstcc.2024.100118","url":null,"abstract":"<div><h3>Background</h3><div>The Ibuprofen in Sepsis Study (ISS) randomized trial found no difference in duration of shock, ARDS, or mortality with ibuprofen treatment for sepsis. However, higher use of acetaminophen, a known hemoprotein reductant with potentially beneficial effects in sepsis, as an antipyretic in the control arm may have masked the clinical benefits from either drug.</div></div><div><h3>Research Question</h3><div>Does an association exist between administration of acetaminophen and clinical outcomes in adults with sepsis?</div></div><div><h3>Study Design and Methods</h3><div>We performed a retrospective propensity-matched analysis of the previously reported ISS trial. We created a propensity score for receiving acetaminophen during the first 2 study days using sex, age, presence of shock at enrollment, trial study drug assignment (ibuprofen or placebo), febrile status at enrollment, need for mechanical ventilation, and Acute Physiology and Chronic Health Evaluation II score at enrollment, and then matched trial participants 1:1 into acetaminophen-exposed and acetaminophen-unexposed groups based on their propensity scores. We tested the association between receipt of acetaminophen with 30-day mortality as the primary outcome. Secondary outcomes included development of renal failure and ventilator-free days (VFDs).</div></div><div><h3>Results</h3><div>Of 455 patients in the original trial, 276 patients (61%) were matched into acetaminophen-exposed and acetaminophen-unexposed groups. In the propensity-matched analysis, we found a lower mortality among acetaminophen-exposed patients compared with acetaminophen-unexposed patients (hazard ratio, 0.58; 95% CI, 0.40-0.84; <em>P</em> = .004). Additionally, acetaminophen-exposed patients experienced more days alive and free of mechanical ventilation compared with the acetaminophen-unexposed patients (OR, 2.09 for having 19-28 VFDs vs 0 or 1-18 VFDs; 95% CI, 1.12-3.95; <em>P</em> = .02). We observed no significant association between renal failure and receipt of acetaminophen.</div></div><div><h3>Interpretation</h3><div>In this propensity-matched retrospective analysis, adults with sepsis who received acetaminophen showed decreased mortality and more days alive and free of mechanical ventilation. This study highlights the potential of acetaminophen as a modulator of outcomes in sepsis and warrants further investigation.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100118"},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465575","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":"ARDS Subphenotypes Exhibit Different Right Ventricular-Pulmonary Arterial Coupling Profiles","authors":"Matthew T. Siuba DO ,&nbsp;Maxwell A. Hockstein MD ,&nbsp;Diego Ariel Rey PhD ,&nbsp;Abhijit Duggal MD, MPH ,&nbsp;Rodrigo Octavio Deliberato MD, PhD","doi":"10.1016/j.chstcc.2024.100119","DOIUrl":"10.1016/j.chstcc.2024.100119","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100119"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444745","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":"Causes of Death Among Patients Supported by Extracorporeal Membrane Oxygenation","authors":"Renata P. Lerner MD, PhD ,&nbsp;Amira Mohamed MD ,&nbsp;Annette Ilg MD ,&nbsp;Raghu R. Seethala MD ,&nbsp;Alison Witkin MD ,&nbsp;Jerome Crowley MD ,&nbsp;Anthony Carlese MD ,&nbsp;Michelle Ng Gong MD, MPH ,&nbsp;Iris Aimlin MD ,&nbsp;Jen-Ting Chen MD, MS ,&nbsp;David Furfaro MD, MPH ,&nbsp;Brian O’Gara MD ,&nbsp;Ryan Gardner MD ,&nbsp;Malorie Butera RN ,&nbsp;Shahzad Shaefi MD, MPH ,&nbsp;Daniel Knox MD ,&nbsp;Daniel Gutteridge MD, MBA ,&nbsp;Christie Horner BSN, CCRN ,&nbsp;Anthony Manasia MD, MPH ,&nbsp;Nidhi Kavi MD ,&nbsp;Ari Moskowitz MD, MPH","doi":"10.1016/j.chstcc.2024.100114","DOIUrl":"10.1016/j.chstcc.2024.100114","url":null,"abstract":"<div><h3>Background</h3><div>Mortality for patients who are critically ill receiving extracorporeal membrane oxygenation (ECMO) support (venovenous or venoarterial) is high, but the proximal causes of death have not been characterized fully.</div></div><div><h3>Research Question</h3><div>We aimed to characterize the reasons for death in patients who underwent cannulation while receiving venoarterial or venovenous ECMO.</div></div><div><h3>Study Design and Methods</h3><div>This was a retrospective multicenter observational cohort study of adult patients who underwent cannulation for ECMO and who died while receiving ECMO at 6 medical centers in the United States.</div></div><div><h3>Results</h3><div>We categorized the causes of death for 751 patients who underwent cannulation for ECMO. We summarized and compared baseline patient characteristics among the 6 sites. Reasons for death were comorbid withdrawal of life-sustaining therapy (n = 248 [33%]), progressive hemodynamic shock (n = 200 [27%]), neurologic withdrawal of life-sustaining therapy (n = 135 [18%]), cardiogenic shock (n = 126 [17%]), respiratory failure (n = 31 [4.1%]), and equipment failure (n = 11 [1.5%]). Comorbid withdrawal of life-sustaining therapy was the most common cause of death in patients who underwent cannulation for both venoarterial (n = 141 [29%]) and venovenous (n = 107 [41%]) ECMO. The rate of palliative care consultation differed among sites.</div></div><div><h3>Interpretation</h3><div>This study showed that most deaths result from comorbid withdrawal of life-sustaining therapy and that death or withdrawal because of refractory respiratory failure and cardiogenic shock account for a lower proportion of deaths in patients receiving ECMO. Our efforts to reduce mortality in patients receiving ECMO should account for the proportion of deaths attributable to comorbid withdrawal of life-sustaining therapy.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100114"},"PeriodicalIF":0.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487207","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":"Innovation and Adaptation in COVID-19 Pandemic Posthospital Discharge Contact and Monitoring in the United States","authors":"Katrina E. Hauschildt PhD ,&nbsp;Jacquelyn Miller MA ,&nbsp;Nathan Wright MA ,&nbsp;Amanda Schutz PhD ,&nbsp;Lexi Wilhelmsen MPH ,&nbsp;Katharine Seagly PhD ,&nbsp;Sara E. Golden PhD ,&nbsp;Aluko A. Hope MD ,&nbsp;Kelly C. Vranas MD ,&nbsp;Catherine L. Hough MD ,&nbsp;Thomas S. Valley MD","doi":"10.1016/j.chstcc.2024.100101","DOIUrl":"10.1016/j.chstcc.2024.100101","url":null,"abstract":"<div><h3>Background</h3><div>To address unknown risk for readmission among patients with COVID-19 and persistent capacity strain, hospital systems used postdischarge contact and monitoring to facilitate safe discharge and recovery. However, little work has systematically documented how hospitals implemented changes to hospitalization postdischarge contact practices during COVID-19.</div></div><div><h3>Research Question</h3><div>How did hospitals’ innovate and adapt postdischarge telephone follow-up and remote monitoring strategies to assess discharged patients with COVID-19 for risk of readmission and recovery progress?</div></div><div><h3>Study Design and Methods</h3><div>Semistructured interviews were conducted (January 2022 to March 2023) with 70 inpatient and outpatient providers and administrators (5-12 per site) in nine health systems that varied by size, region, rurality, proportion of Medicaid patients, and estimated scale of post-COVID-19 care organization. Participants described innovation in and implementation of discharge and postdischarge care processes used to assess patients with COVID-19 for readmission risk and recovery progress. The primary analysis was site-level case comparative analysis.</div></div><div><h3>Results</h3><div>Respondents described hospital systems’ motivations for adapting preexisting resources and innovating new postdischarge programs, including postdischarge telephone follow-up and remote monitoring programs, to facilitate safe hospital discharge and transitions to ambulatory care for patients with COVID-19. Respondents also explained various factors that influenced the implementation and use of postdischarge contact practices. Participants perceived that these practices mitigated postdischarge risks and alleviated capacity strain. Respondents described retiring or adapting remote monitoring programs for other conditions as COVID-19 demands declined.</div></div><div><h3>Interpretation</h3><div>Our results show that hospitals implemented and adapted postdischarge practices to help facilitate recovery and address unknown risk for readmission during the pandemic. Some efforts may present opportunities to manage readmission concerns and capacity strain more generally.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100101"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748377","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":"Long-Term Outcomes of Critically Ill Survivors of COVID-19","authors":"María Zuil MD ,&nbsp;Anna Vila-Fornells MSc ,&nbsp;Sally Santisteve MSc ,&nbsp;Rafaela Vaca MSc ,&nbsp;Maria Aguilà MSc ,&nbsp;Aida Monge MSc ,&nbsp;Anna Sánchez-Cucó MSc ,&nbsp;Iván D. Benítez PhD ,&nbsp;Nuria Forns MSc ,&nbsp;Olga Minguez MSc ,&nbsp;Anna Moncusí-Moix MSc ,&nbsp;Jesús Caballero MD ,&nbsp;Carme Barberà MD ,&nbsp;David de Gonzalo-Calvo PhD ,&nbsp;Antonio Torres MD ,&nbsp;Ferran Barbé MD ,&nbsp;Jessica González MD","doi":"10.1016/j.chstcc.2024.100116","DOIUrl":"10.1016/j.chstcc.2024.100116","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100116"},"PeriodicalIF":0.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444695","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}