CHEST critical care最新文献

{"title":"Caring Through the Continuum","authors":"HyunBin You PhD, MSN, RN , Ji Won Shin PhD, RN","doi":"10.1016/j.chstcc.2026.100235","DOIUrl":"10.1016/j.chstcc.2026.100235","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"4 1","pages":"Article 100235"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187321","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":"Comparison of Use of Fentanyl, Hydromorphone, and Morphine Infusions in Critically Ill Patients With Acute Respiratory Failure","authors":"Hannah Wunsch MD ,&nbsp;Andrea D. Hill PhD ,&nbsp;Elizabeth M. Viglianti MD, MPH ,&nbsp;Lisa Burry PharmD, PhD ,&nbsp;David N. Juurlink MD, PhD ,&nbsp;Nicholas A. Bosch MD ,&nbsp;Bijan Teja MD, PhD ,&nbsp;H. Thomas Stelfox MD, PhD ,&nbsp;Ruxandra Pinto PhD ,&nbsp;Theodore J. Iwashyna MD, PhD ,&nbsp;Allan Walkey MD","doi":"10.1016/j.chstcc.2025.100222","DOIUrl":"10.1016/j.chstcc.2025.100222","url":null,"abstract":"<div><h3>Background</h3><div>Limited evidence suggests that the choice of opioid may influence the intensity of opioid exposure for patients receiving invasive mechanical ventilation (IMV).</div></div><div><h3>Research Question</h3><div>Is the choice of opioid associated with overall opioid exposure or short-term outcomes?</div></div><div><h3>Study Design and Methods</h3><div>This was a retrospective cohort study of patients receiving IMV in 21 ICUs who received an initial opioid infusion (&gt; 6 hours) of fentanyl, hydromorphone, or morphine. The primary outcome was mean hourly opioid dose (morphine milligram equivalents [MMEs]) of all opioids, including boluses, after the initiation of an opioid infusion until death, transition to comfort measures, or discharge from the ICU. Secondary outcomes included ICU and hospital mortality. All comparisons were with fentanyl using generalized estimating equation models to account for clustering of patients within ICUs.</div></div><div><h3>Results</h3><div>Among 8,262 patients receiving IMV, the mean (SD) age was 53.9 (17.0) years and 38.0% were female. Overall, 6,913 patients (83.7%) received fentanyl, 1,148 patients (13.9%) received hydromorphone, and 201 patients (2.4%) received morphine. Patients treated initially with hydromorphone were started on a higher dose (median, 10.0 MME [interquartile range (IQR), 5.0-10.0 MME] vs 3.3 MME [IQR, 1.7-6.7 MME] for fentanyl and 5.0 MME [IQR, 3.0-5.0 MME] for morphine). The median hourly MMEs of opioids during the ICU stay was highest for patients who received hydromorphone (median, 3.3 MME [IQR, 1.6-6.3 MME] vs 1.7 MME [IQR, 0.8-3.4 MME] for fentanyl and 3.0 MME [IQR, 1.4-4.8 MME] for morphine). These differences remained for hydromorphone vs fentanyl after adjustment for patient characteristics, but not after accounting for clustering within ICUs (adjusted rate ratio for hydromorphone vs fentanyl: 1.14 MME [IQR, 0.93-1.41 MME]; and for morphine vs fentanyl: 0.98 MME [IQR, 0.75-1.27 MME]). All other measures of opioid exposure were similarly highest for hydromorphone, but were not different after adjustment. No differences in short-term outcomes were noted.</div></div><div><h3>Interpretation</h3><div>Among patients receiving IMV, use of hydromorphone infusions was associated with a greater overall opioid exposure, which was not accounted for by patient characteristics; accounting for clustering of patients within ICUs attenuated the differences.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"4 1","pages":"Article 100222"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147421381","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":"Does Vilobelimab in Combination With Tocilizumab, Levilimab, or Baricitinib Improve Mortality in Patients With COVID-19 ARDS?","authors":"Andrew F. Shorr MD ,&nbsp;Alexander P.J. Vlaar MD, PhD ,&nbsp;Endry H.T. Lim MD, PhD ,&nbsp;Roy F. Chemaly MD ,&nbsp;Bruce P. Burnett PhD ,&nbsp;Simon Rückinger PhD ,&nbsp;Robert Zerbib MSc ,&nbsp;Renfeng Guo MD ,&nbsp;Niels Riedemann MD, PhD ,&nbsp;Diederik van de Beek MD, PhD ,&nbsp;Christian Sandrock MD","doi":"10.1016/j.chstcc.2025.100217","DOIUrl":"10.1016/j.chstcc.2025.100217","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Vilobelimab, unlike upstream complement inhibitors, blocks C5a without altering the membrane attack complex. Vilobelimab demonstrated significant mortality benefit in intubated patients with COVID-19 ARDS in a placebo-controlled study. Standard of care included corticosteroids in 97%, antithrombotic prophylaxis in 98%, and other immunomodulators in approximately 20% of the study population. The survival benefit of combined immunomodulator administration with vilobelimab is unknown.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Research Question&lt;/h3&gt;&lt;div&gt;Does adding vilobelimab in patients with COVID-19 ARDS treated with tocilizumab, levilimab, or baricitinib with corticosteroids lead to improved survival?&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design and Methods&lt;/h3&gt;&lt;div&gt;This post hoc analysis evaluated vilobelimab’s effect on survival and safety in a subgroup of intubated patients with COVID-19 ARDS treated previously, concomitantly, or both with tocilizumab, levilimab, or baricitinib. Censored time-to-event variable by Kaplan-Meier type method and Cox regression analysis adjusted for age, baseline comorbidities, and ARDS severity was used to assess all-cause mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Seventy-two patients administered vilobelimab (n = 35) or placebo (n = 37) were treated before, concomitantly, or both with tocilizumab, levilimab, or baricitinib. Twenty-eight-day mortality was 9.0% for the vilobelimab plus immunomodulator subgroup vs 40.9% for the placebo plus immunomodulator group (hazard ratio [HR], 0.19; 95% CI, 0.06-0.67; &lt;em&gt;P&lt;/em&gt; = .010). Day 60 mortality was 18.9% vs 49.3% (HR, 0.30; 95% CI, 0.12-0.77; &lt;em&gt;P&lt;/em&gt; = .012). When patients were treated with vilobelimab and only tocilizumab (n = 30) vs placebo and tocilizumab (n = 31), 28-day mortality was 7.1% vs 42.3% (HR, 0.14; 95% CI, 0.03-0.62; &lt;em&gt;P&lt;/em&gt; = .010), respectively. All 4 patients treated with vilobelimab and only with baricitinib survived compared with 3 of 6 patients who received placebo with baricitinib. Treatment-emergent adverse events (TEAEs) were equal in all subgroups. Serious TEAEs were reported in fewer patients in the vilobelimab plus immunomodulator group vs other subgroups. Unspecified infections occurred less frequently in the vilobelimab plus immunomodulator subgroup vs the placebo plus immunomodulator subgroup, whereas viral and fungal infections were comparable.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;This small post hoc analysis suggests that vilobelimab treatment combined with tocilizumab or baricitinib potentially could improve survival in patients with COVID-19 ARDS. Combination immunomodulator therapy may have further application in broad populations of virus-induced ARDS, and these results warrant additional investigations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Clinical Trial Registration&lt;/h3&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;ClinicalTrials.gov&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;; No.: NCT04333420; URL: &lt;span&gt;&lt;span&gt;www.clinicaltrials.gov&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/s","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"4 1","pages":"Article 100217"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187322","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 Thematic Analysis of Family Perspectives on Traumatic Stress and Critical Illness of a Loved One","authors":"Deepshikha Charan Ashana MD ,&nbsp;Greer Tiver MPH ,&nbsp;Christopher E. Cox MD, MPH ,&nbsp;Nicholas Madamidola ,&nbsp;Joseph H. Neiman MD, MPH ,&nbsp;Christian Noval ,&nbsp;Bassam Syed ,&nbsp;Heta Patel ,&nbsp;Shewit Jaynes MSPH, BSN, RN ,&nbsp;Jennie Jaggers ,&nbsp;Ernestine C. Briggs PhD ,&nbsp;Karen Steinhauser PhD ,&nbsp;Joanna L. Hart MD, MSHP","doi":"10.1016/j.chstcc.2025.100208","DOIUrl":"10.1016/j.chstcc.2025.100208","url":null,"abstract":"<div><h3>Background</h3><div>Trauma-informed care is a promising framework for understanding and ultimately mitigating traumatic stress associated with critical care. Specific components of trauma-informed adult critical care have not been defined.</div></div><div><h3>Research Question</h3><div>How do family members with traumatic stress experience ICU care of a loved one?</div></div><div><h3>Study Design and Methods</h3><div>Family members of mechanically ventilated patients who endorsed substantial historical trauma or current traumatic stress during their loved one’s ICU stay were recruited from 9 ICUs in 1 urban and 1 suburban-rural health system. Family members participated in semistructured interviews eliciting their perceptions of traumatic stress during ICU care and aspects of critical care that modified stress. Interviews were transcribed and emergent themes were captured through iterative coding, case narrative memos, and abductive thematic analyses. Interviews continued until, through concurrent analyses, both thematic saturation and information power were reached.</div></div><div><h3>Results</h3><div>Among 26 family members, the median age was 53.2 years (interquartile range [IQR] 48.3-61.1 years) and most were female (n = 20 [76.9%]) and Black (n = 14 [53.8%]). Family members endorsed a median of 9 (IQR, 5-13) potentially traumatic events in their lifetimes. Emergent themes included: (1) behaviors suggestive of possible trauma responses (eg, vigilance) during ICU stays, (2) reluctance to disclose prior trauma to ICU clinicians because of concerns about bias or lack of support, (3) perception that surrogate decision-making and caregiving responsibilities exacerbated stress, and (4) structural and procedural aspects of ICU care reduced or amplified stress, including presence (visitation) policies, physical hospital and ICU environment, and family support resources.</div></div><div><h3>Interpretation</h3><div>Family members of critically ill patients described potential traumatic stress responses during ICU experiences and identified components of critical care that may complement and expand existing models of family-centered ICU care to incorporate trauma-informed approaches.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"4 1","pages":"Article 100208"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580158","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":"Comparison of Corticosteroid Regimens for COVID-19 and Non-COVID-19 ARDS","authors":"Ryosuke Imai MD ,&nbsp;Takayuki Niitsu MD ,&nbsp;Monica Yun Liu MD, PhD ,&nbsp;Hilary Faust MD ,&nbsp;Lynn M. Schnapp MD ,&nbsp;Shota Yamamoto MD, PhD","doi":"10.1016/j.chstcc.2025.100207","DOIUrl":"10.1016/j.chstcc.2025.100207","url":null,"abstract":"<div><h3>Background</h3><div>Although previous trials suggest that systemic corticosteroids improve survival in ARDS, the optimal dose remains uncertain.</div></div><div><h3>Research Question</h3><div>Which corticosteroid dose offers the greatest efficacy, safety, or both in ARDS?</div></div><div><h3>Study Design and Methods</h3><div>We conducted a model-based dose-response network meta-analysis (NMA) that pooled randomized controlled trials (RCTs) of dexamethasone, hydrocortisone, and methylprednisolone, converting regimens to cumulative methylprednisolone-equivalent doses. For short-term mortality, we fitted agent-specific dose-response curves and estimated the 95% effective dose (ED₉₅) as a near-maximal dose. A Bayesian equal-dose NMA compared treatment effects at ED₉₅ and at a nonspecific dose of NMA. Certainty of evidence was assessed using Confidence in Network Meta-Analysis.</div></div><div><h3>Results</h3><div>Six thousand five hundred two participants from 28 RCTs were analyzed. ED₉₅ (cumulative methylprednisolone-equivalent doses) was 840 mg for dexamethasone and 1,400 mg for methylprednisolone. At ED₉₅, dexamethasone reduced short-term mortality by 87 deaths per 1,000 patients vs placebo (95% credible interval [CrI], 148 fewer-7 fewer; low certainty) and methylprednisolone reduced mortality by 98 deaths per 1,000 patients vs placebo (95% CrI, 172 fewer-26 fewer; low certainty). Hydrocortisone, primarily evaluated at lower cumulative doses, showed an ED₉₅ of 270 mg methylprednisolone-equivalent doses, based on a log-linear model, with a mortality reduction of 73 deaths per 1,000 patients vs placebo (95% CrI, 152 fewer-22 more; low certainty). Escalating to pulse-dose regimens provided no additional benefit. In the equal-dose NMA, dexamethasone and methylprednisolone improved ventilator-free days vs placebo, whereas hydrocortisone did not. No meaningful differences were observed in safety outcomes across agents.</div></div><div><h3>Interpretation</h3><div>Our results suggest that dexamethasone and methylprednisolone, when administered at ED₉₅, are associated with lower mortality and more ventilator-free days in patients with ARDS. Hydrocortisone’s lower mortality benefit likely reflects suboptimal doses in RCTs; its log-linear dose response suggests potential for greater benefit at higher doses.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100207"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528276","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":"Investigation of Skin Pigmentation Effect on Performance of Pulse Oximetry","authors":"Alison B. Travers MD ,&nbsp;Charles R. Terry MD, MSCR ,&nbsp;Will P. Merrell ,&nbsp;Marc E. Heincelman MD, MPH ,&nbsp;Ashley D. Warden ,&nbsp;Andrew J. Goodwin MD, MSCR","doi":"10.1016/j.chstcc.2025.100209","DOIUrl":"10.1016/j.chstcc.2025.100209","url":null,"abstract":"<div><h3>Background</h3><div>The accuracy of blood oxygen saturation measured by pulse oximetry (Sp<span>o</span>₂) in critically ill patients with darkly pigmented skin remains controversial, with accuracy studies that are either retrospective or laboratory based among healthy volunteers.</div></div><div><h3>Research Question</h3><div>Can a pragmatically-designed prospective study feasibly enroll critically ill patients across the full skin pigmentation spectrum within a real-world ICU setting while applying the technical rigor of a laboratory-based study?</div></div><div><h3>Study Design and Methods</h3><div>A feasibility analysis was performed after 50 patients across 2 ICUs contributed samples. Feasibility was defined as (1) coverage of skin pigmentation, with a range of &gt; 100° using an objective measure (individual topology angle [ITA]) and (2) ≥ 80% of collected blood samples generate a valid Sp<span>o</span>₂ and Sa<span>o</span>₂ pair fulfilling predefined technical criteria. Exploratory analysis was performed through Bland-Altman analysis, with standard-of-care blood draws used for Sa<span>o</span>₂ measurements. Rates of occult hypoxemia (Sa<span>o</span>₂ &lt; 88% when Sp<span>o</span>₂ was 92%-96%) were compared among skin pigmentation groups.</div></div><div><h3>Results</h3><div>Eighty-four blood samples collected from 50 patients (52% male; median age, 55 years [interquartile range, 46-61.8 years]) yielded 80 valid pairs (95%) from 49 patients. Feasibility thresholds were met for skin pigmentation (ITA range, –66° to 59°), with 52% of patients classified as dark-skinned overall. In the exploratory analysis, overall pulse oximeter root-mean-square accuracy was 1.47%, with a median bias of –0.6% (mean, –0.7%). Dark-skinned and light-skinned patients did not differ significantly, with a median bias of –0.2% vs –0.9% (mean, –0.1% vs –1.1%), respectively. Nearly one-half the data pairs were collected when patients were at risk of occult hypoxemia (Sp<span>o</span>₂, 92%-96%), yet no occult hypoxemic events occurred.</div></div><div><h3>Interpretation</h3><div>This feasibility study demonstrated high fidelity and efficient data collection from pulse oximeter sensors and reference blood gas analyzers in critically ill patients across varying skin pigments while applying requisite technical criteria within an ICU setting.</div></div><div><h3>Clinical Trial Registration</h3><div>ClinicalTrials.gov; No.: NCT06432881; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100209"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528707","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 Prospective Cohort Study Investigating the Prognostic Performance and Utility of 3 Severity of Illness Scores","authors":"Tiara F Calhoun MD ,&nbsp;Nelly Kebeney MSc ,&nbsp;Letizia Trevisi PhD ,&nbsp;Mary Adam MD, PhD ,&nbsp;Ndaziona P.K. Banda Cert Pulm ,&nbsp;Abi Beane PhD ,&nbsp;B. Jason Brotherton MD ,&nbsp;Jeanine Condo MD, PhD ,&nbsp;Dingase Dula MSc ,&nbsp;Layoni Dullawe BA ,&nbsp;E. Wes Ely MD, MPH ,&nbsp;Nedson Fosiko MBBS, MPH ,&nbsp;Blaise Gahungu MD, MPH ,&nbsp;Dona Fabiola Gashame MD, MMed ,&nbsp;Swati Goel MD, MSPH ,&nbsp;Stephen B. Gordon MD, FCRP ,&nbsp;Jean Damascène Hagenimana MD ,&nbsp;Rashan Haniffa PhD ,&nbsp;Bethany Hedt-Gauthier PhD ,&nbsp;Wanja Kageche RN, HND, KRCCN ,&nbsp;Elisabeth Riviello MD, MPH","doi":"10.1016/j.chstcc.2025.100196","DOIUrl":"10.1016/j.chstcc.2025.100196","url":null,"abstract":"<div><h3>Background</h3><div>Mortality prediction is difficult in resource-constrained settings. Severity of illness scores have not been tested in hypoxemic adults in Africa.</div></div><div><h3>Research Question</h3><div>How well do 3 severity of illness scores (Modified Early Warning Score [MEWS], quick Sequential Organ Failure Assessment [qSOFA], and Universal Vital Assessment [UVA]) and the ability to walk predict mortality in hypoxemic hospitalized adults in Africa?</div></div><div><h3>Study Design and Methods</h3><div>All adults with hypoxemia on admission in 5 hospitals in Kenya, Malawi, and Rwanda between November 2022 and April 2023 were prospectively enrolled in the study. The capability of MEWS, qSOFA, UVA, and the ability to walk was evaluated to predict hospital mortality. In exploratory analyses, differences in disease severity and mortality were compared between sites.</div></div><div><h3>Results</h3><div>A total of 24,724 admissions were screened; 1,732 of these were hypoxemic and had complete outcomes data. Median age was 52 years (interquartile range, 36-70 years), and hospital mortality was 35% (n = 615). Sites varied in the completeness of score variables (44%-99%). Increased odds of mortality were found using predefined thresholds for each score; UVA predicted best, with an OR of 3.40 (95% CI, 2.54-4.56). The area under the receiver-operating curves for MEWS, qSOFA, and UVA were 0.66 (95% CI, 0.62-0.69), 0.66 (95% CI, 0.63-0.69), and 0.69 (95% CI, 0.65-0.72), respectively, using complete case analysis; they were 0.61 (95% CI, 0.58-0.64), 0.65 (95% CI, 0.62-0.67), and 0.66 (95% CI, 0.64-0.69) with missing data imputed as normal. Inability to walk independently was also predictive of mortality (OR, 2.26; 95% CI, 1.62-3.15). UVA pairwise comparisons showed different mortality between 4 of 6 sites; these differences remained significant in 2 comparisons when adjusting for illness severity.</div></div><div><h3>Interpretation</h3><div>In the largest prospective cohort of hypoxemic adults in Africa to date, MEWS, qSOFA, UVA, and ability to walk on admission had modest capability to predict hospital death. Missing data were common. Imputation of missing variables only slightly altered performance, and thus it is possible that scores could be simplified. UVA had the best predictive performance and may be cautiously used to aid clinical decision-making, quality improvement, research comparisons, and risk adjustment.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100196"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363106","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":"Revisiting an Old Drug and a New Challenge","authors":"Arsh Chowdhary MD,&nbsp;T.S. Dharmarajan MD","doi":"10.1016/j.chstcc.2025.100188","DOIUrl":"10.1016/j.chstcc.2025.100188","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100188"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108980","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":"ARDS After Spinal Cord Injury","authors":"Christopher S. Lozano MD ,&nbsp;Vishwathsen Karthikeyan MD ,&nbsp;Michael C. Sklar MD ,&nbsp;Ahmad Essa MD, MPH ,&nbsp;Francois Mathieu MD ,&nbsp;Husain Shakil MD ,&nbsp;Armaan K. Malhotra MD ,&nbsp;Vincent Ye MD ,&nbsp;Alexandra De Sequeira BSc ,&nbsp;Andrew S. Jack MD ,&nbsp;Ying Shi He MSc ,&nbsp;Eva Y. Yuan MSc ,&nbsp;Jetan H. Badhiwala MD, PhD ,&nbsp;Michael G. Fehlings MD, PhD ,&nbsp;Jefferson R. Wilson MD, PhD ,&nbsp;Christopher D. Witiw MD","doi":"10.1016/j.chstcc.2025.100211","DOIUrl":"10.1016/j.chstcc.2025.100211","url":null,"abstract":"<div><h3>Background</h3><div>ARDS is a life-threatening respiratory complication after traumatic spinal cord injury (SCI), yet contemporary, large-scale estimates of its frequency, determinants, and impact on inpatient outcomes are scarce.</div></div><div><h3>Research Question</h3><div>Among adults with acute traumatic SCI, what is the incidence of ARDS; which patient, injury, and hospital factors are associated with it; and how does ARDS influence inpatient mortality and adverse events?</div></div><div><h3>Study Design and Methods</h3><div>We retrospectively analyzed data from 2010 through 2020 from the Trauma Quality Improvement Program. Adults ≥ 16 years of age with SCI were identified by Abbreviated Injury Scale (AIS) codes. Multivariable logistic regression identified covariates associated with the development of ARDS and quantified the associations of ARDS with mortality and adverse events. Sensitivity analyses excluded patients with AIS code ≥ 3 extraspinal injuries and examined the Berlin criteria era after 2012.</div></div><div><h3>Results</h3><div>Of 55,643 SCI admissions, 1,791 patients (3.2%) demonstrated ARDS; yearly incidence fell from 7% to 2% over the study period. Covariates associated with ARDS included COPD (OR, 1.34; 95% CI, 1.08-1.66), diabetes (OR, 1.36; 95% CI, 1.15-1.62), smoking (OR, 1.19; 95% CI, 1.06-1.34), severe thoracic (OR, 1.79; 95% CI, 1.57-2.04) or lower-extremity (OR, 1.23; 95% CI, 1.02-1.48) injury, motor vehicle mechanism (OR, 1.18; 95% CI, 1.03-1.36), and spine surgery (OR, 1.37; 95% CI, 1.21-1.54). Negatively associated factors were Glasgow Coma Scale score of 15 on presentation, incomplete SCI, and thoracic or lumbar levels affected. ARDS was associated with increased mortality (OR, 5.11; 95% CI, 4.37-5.97), ventilator-associated pneumonia (OR, 4.51; 95% CI, 4.00-5.09), sepsis (OR, 6.22; 95% CI, 5.21-7.44), cardiac arrest (OR, 4.02; 95% CI, 3.46-4.68), immobility-related complications (OR, 2.45; 95% CI, 2.18-2.76), and prolonged ICU stay or mechanical ventilation (lasting ≥ 14 days; OR, 5.49; 95% CI, 4.57-6.60). In the subgroup excluding AIS code ≥ 3 extraspinal injuries, ARDS incidence fell to 1.8% with persistently elevated mortality and complication rates.</div></div><div><h3>Interpretation</h3><div>Our results show that although ARDS incidence after SCI has declined, it remains linked to adverse in-hospital outcomes. Key associated factors include patient comorbidities and injury-related factors.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100211"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578622","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":"Evaluation of Tracheal Pressure During Invasive CPAP Ventilation","authors":"Patrick Spraider PhD,&nbsp;Julia Abram MD,&nbsp;Janett Kreutziger MD,&nbsp;Stefan Schmid MD,&nbsp;Christopher Rugg MD","doi":"10.1016/j.chstcc.2025.100212","DOIUrl":"10.1016/j.chstcc.2025.100212","url":null,"abstract":"<div><h3>Background</h3><div>Intubated but spontaneously breathing patients in the ICU frequently are treated with CPAP ventilation during weaning from mechanical ventilation. However, depending on the patient’s inspiratory effort, a pressure gradient along the airway may arise, potentially even leading to negative values at the tracheal space.</div></div><div><h3>Research Question</h3><div>Does a significant difference exist in tracheal and airway measured inspiratory pressure?</div></div><div><h3>Study Design and Methods</h3><div>Twenty patients in the ICU were enrolled (median age, 68 years [interquartile range (IQR), 63-73 years]; 4 female patients). During a set positive end-expiratory pressure (PEEP) of 10 cm H₂O, the tracheal pressure course was recorded. Subsequently, a comparison of tracheal and artificial airway pressures was performed during CPAP and after applying a pressure support of 4 cm H₂O (pressure support ventilation [PSV]) or automatic tube compensation (ATC).</div></div><div><h3>Results</h3><div>As a primary outcome parameter, the median inspiratory pressure measured in the trachea was significantly lower than simultaneously measured airway pressures (median, 2.7 cm H₂O [IQR, 0.2-3.7 cm H₂O] vs 9.0 cm H₂O [IQR, 8.5-9.2 cm H₂O]; <em>P</em> &lt; .001). In 5 patients, negative tracheal pressures were recorded. Secondary outcome parameters revealed comparable end-expiratory pressures, but significantly higher peak and lower mean pressures when measured in the trachea. Adding PSV or ATC slightly attenuated this inspiratory pressure drop, leading to a significant increase in inspiratory tracheal pressures.</div></div><div><h3>Interpretation</h3><div>Our results show that in intubated, spontaneously breathing patients in the ICU with a set PEEP of 10 cm H₂O, the nadir of tracheal pressures during inspiration is significantly lower than airway pressures measured by the ventilator. Consistently positive tracheal pressures cannot be guaranteed by CPAP throughout the respiratory cycle. Assisted ventilation with PSV or ATC is capable of reducing the pressure drop during inspiration.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: NCT05679635; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100212"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578623","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}