CHEST critical care最新文献

{"title":"The Silent Threat","authors":"Wai-Tsan Ng MBChB, FHKCA, FHKCA (Intensive Care), FHKAM, FCICM, FANZCA , Song Wan MD, PhD, FRCS, FACC , Yuk-Hoi Lam MBChB, FRCS , Yu-Yeung Yip MBChB, FHKCA, FHKCA (Intensive Care), FHKAM, FCICM, FANZCA","doi":"10.1016/j.chstcc.2025.100166","DOIUrl":"10.1016/j.chstcc.2025.100166","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100166"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830356","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 Relationship Between Neighborhood Deprivation and Mortality in a Sepsis Cohort in England","authors":"Ritesh Maharaj MD, PhD ,&nbsp;Ishan Rola ,&nbsp;Irene Papanicolas PhD","doi":"10.1016/j.chstcc.2025.100165","DOIUrl":"10.1016/j.chstcc.2025.100165","url":null,"abstract":"<div><h3>Background</h3><div>Worse health outcomes have been described for patients with sepsis from more deprived neighborhoods, but it is unclear if this disparity gap has narrowed. Moreover, the mechanisms by which neighborhood disadvantage influences sepsis outcomes are not understood fully.</div></div><div><h3>Research Question</h3><div>What is the trajectory of mortality among patients with sepsis in England across varying levels of neighborhood deprivation, and to what extent do patterns of ICU admission and treatment explain observed differences?</div></div><div><h3>Study Design and Methods</h3><div>This retrospective observational study using multivariable logistic regression included 519,789 patients older than 16 years admitted to the ICU with sepsis between April 1, 2009, and December 31, 2023, from 304 ICUs of 207 acute hospitals in England. The primary outcome was hospital mortality. The secondary outcomes were direct ICU admission from the emergency department; use of mechanical ventilation, renal replacement therapy, and vasopressor therapy; and decisions to limit life-sustaining therapy.</div></div><div><h3>Results</h3><div>Mortality improved across all groups of neighborhood deprivation from the baseline period from 2009 through 2011, and was 4.5% lower from 2022 through 2023 in the most deprived and 4.4% lower in the least deprived quartile, with no significant narrowing of the disparity gap over time (<em>P</em> = .833). Direct ICU admission from the emergency department was similar for patients across groups of neighborhood deprivation at baseline and increased similarly over time with no significant between-group difference. The gap in mechanical ventilation, renal placement therapy, and vasopressor use narrowed over time. Mortality trends were driven primarily by within-hospital improvements in care, and only a minor component was attributable to shift of patients from lower-quality to higher-quality hospitals.</div></div><div><h3>Interpretation</h3><div>Although sepsis mortality has improved across England, a persistent disparity associated with neighborhood deprivation exists. Further investigation is required to evaluate other potential contributory factors to help understand better how living in deprived areas contributes to the mortality gap.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144860400","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 Concurrent, Mixed-Methods Evaluation of the Four Supports Intervention in ICUs","authors":"Taylor E. Lincoln MD ,&nbsp;Rachel A. Butler MHA, MPH ,&nbsp;Anne-Marie Shields MSN, RN ,&nbsp;Kate Petty MD ,&nbsp;Tracy Campbell MD ,&nbsp;Johanna Bellon PhD, CFA ,&nbsp;Praewpannarai Buddadhumaruk MS, RN ,&nbsp;Jennifer B. Seaman PhD, RN ,&nbsp;Kimberly J. Rak PhD ,&nbsp;Caroline Pidro BS ,&nbsp;Rachel M. Gustafson DNP, RN ,&nbsp;Kristyn Felman MPH, CPH, MSW ,&nbsp;Wendy Stonehouse MSN, RN ,&nbsp;Mary Beth Happ PhD, RN ,&nbsp;Mi-Kyung Song PhD, RN ,&nbsp;Charles F. Reynolds III MD ,&nbsp;Jennifer Q. Morse PhD ,&nbsp;Seth Landefeld MD ,&nbsp;Derek Angus MD, MPH, FRCP ,&nbsp;Robert M. Arnold MD ,&nbsp;Douglas B. White MD, MAS","doi":"10.1016/j.chstcc.2025.100164","DOIUrl":"10.1016/j.chstcc.2025.100164","url":null,"abstract":"<div><h3>Background</h3><div>Surrogate decision-makers in ICUs frequently struggle in this role and experience lasting psychological distress. A recent multicenter trial of the Four Supports Intervention, a multicomponent family support intervention delivered by an external interventionist, revealed that the intervention did not improve patient- or family-centered outcomes, but the main trial results do not provide insights into why the intervention was ineffective.</div></div><div><h3>Research Question</h3><div>How was the Four Supports Intervention experienced by families and clinicians and how can the intervention be improved?</div></div><div><h3>Study Design and Methods</h3><div>We conducted a concurrent mixed-methods evaluation of the Four Supports Intervention among 45 participants in the intervention arm of the trial (30 surrogates and 15 clinicians). The research team and participants were masked to trial results during data collection and analysis. Participants completed a quantitative survey and a semistructured interview focusing on their perceptions of whether the intervention provided emotional support to surrogates, facilitated effective clinician-family communication, and fostered patient-centered decision-making. Coders used a thematic analysis approach to identify key themes from the interviews.</div></div><div><h3>Results</h3><div>Ninety percent of surrogates perceived that the intervention improved the degree to which their needs and concerns were addressed, 93% of surrogates and 100% of clinicians perceived that the intervention improved clinician-family communication, and 87% of surrogates and 87% of clinicians reported that the intervention improved the patient-centeredness of care. Key themes from the interviews with surrogates included that the interventionist provided comfort, was present and listened during a difficult time, and ensured that needed clinician-family conversations happened. Interviews with clinicians revealed that the intervention prepared family members for the role of surrogate decision-maker, helped in recognizing and addressing nascent misunderstandings, and aided creation of positive clinician-family relationships. Surrogates and clinicians suggested potential improvements, including extending the intervention into the period after discharge, better integrating the interventionists’ role with the ICU team, and prioritizing families most in need.</div></div><div><h3>Interpretation</h3><div>Surrogate decision-makers and clinicians reported that the Four Supports Intervention improved emotional support for surrogates and communication about goals of care. In light of the negative trial results, these findings have important implications for the field.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100164"},"PeriodicalIF":0.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144887021","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":"Identification of Acute Respiratory Failure Phenotypes With Electronic Health Record Data","authors":"Charles R. Terry MD, MSCR ,&nbsp;Daniel L. Brinton PhD ,&nbsp;Katie G. Kirchoff MS ,&nbsp;Andrew J. Goodwin MD, MSCR ,&nbsp;Dee W. Ford MD, MSCR","doi":"10.1016/j.chstcc.2025.100163","DOIUrl":"10.1016/j.chstcc.2025.100163","url":null,"abstract":"<div><h3>Background</h3><div>Secondary analysis of clinical trial data and highly selected observational cohorts have identified 2 subphenotypes in acute respiratory failure, but have not been reported previously using only real-world electronic health record (EHR) data.</div></div><div><h3>Research Question</h3><div>Are subphenotypes of acute ventilator-dependent respiratory failure identifiable using readily available EHR data?</div></div><div><h3>Study Design and Methods</h3><div>This multicenter retrospective cohort study used patient encounters from the Medical University of South Carolina (n = 4,233 between 2016 and 2023) and the Medical Information Mart for Intensive Care III (n = 8,313 between 2001 and 2012) to train and validate K-means models with multiply imputed cluster analysis at 24 and 48 hours after intubation.</div></div><div><h3>Results</h3><div>Clustering models identified 2 clusters for 24-hour and 48-hour models in both training and test cohorts with clusters separating on variables related to pulmonary physiology, perfusion, organ dysfunction, and metabolic dysregulation. Cluster 2 showed higher 90-day mortality after discharge and more ventilator days compared with cluster 1 that persisted despite multivariable adjustment for age, illness severity, and comorbidities. Cluster models and clusters were stable in 0- to 24-hour and 25- to 48-hour models with crossover (29.2% and 25.9% of the test and training cohorts) from the higher-acuity cluster 2 to the lower-acuity cluster 1 subphenotype occurring by 48 hours after intubation.</div></div><div><h3>Interpretation</h3><div>Our results suggest that acute ventilator-dependent respiratory failure has 2 subphenotypes that are discernible using readily available data from EHRs with identifiable differences in pulmonary physiologic features, perfusion, organ dysfunction, and metabolic dysregulation at 24 and 48 hours after intubation. This may enable future EHR tools to identify particularly vulnerable patients.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904074","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 Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDS","authors":"Herng Lee Tan MSc ,&nbsp;Rehena Sultana MSc(stat) ,&nbsp;Phuc Huu Phan MD ,&nbsp;Muralidharan Jayashree MD ,&nbsp;Hongxing Dang MD ,&nbsp;Soo Lin Chuah MBBS ,&nbsp;Chin Seng Gan MBBS ,&nbsp;Siew Wah Lee MD ,&nbsp;Karen Ka Yan Leung MBBS, MSc ,&nbsp;Ellis Kam Lun Hon MBBS, MD ,&nbsp;Xuemei Zhu MD ,&nbsp;Pei Chuen Lee MMed(Paeds) ,&nbsp;Chian Wern Tai MD ,&nbsp;Jacqueline Soo May Ong MB BChir ,&nbsp;Lijia Fan MD ,&nbsp;Kah Min Pon MD ,&nbsp;Li Huang MD ,&nbsp;Kazunori Aoki MD ,&nbsp;Hiroshi Kurosawa MD, PhD ,&nbsp;Rujipat Samransamruajkit MD ,&nbsp;Judith Ju Ming Wong MB BCh BAO","doi":"10.1016/j.chstcc.2025.100162","DOIUrl":"10.1016/j.chstcc.2025.100162","url":null,"abstract":"<div><h3>Background</h3><div>The topic of mechanical power (MP) in pediatric ARDS (PARDS) is not well explored in the current literature, limiting our understanding of its potentially detrimental effect.</div></div><div><h3>Research Question</h3><div>What is the association between MP and clinical outcomes, and does impairment in oxygenation mediate the association between MP and clinical outcomes?</div></div><div><h3>Study Design and Methods</h3><div>This post hoc causal mediation analysis of data from a before-and-after study recruited children with PARDS from 21 PICUs. We used a simplified MP calculation for pressure-controlled and volume-controlled ventilation normalized to predicted body weight. We identified low, moderate, and high MP cutoffs and used multivariable regression to determine the association between MP categories on ICU mortality, 28-day ventilator-free days (VFDs) and ICU-free days (IFDs), adjusting for the Pediatric Index of Mortality 3 score, Pediatric Logistic Organ Dysfunction 2 score, oxygenation index (OI), and age. Causal mediation analysis was performed to estimate the causal effect of MP on outcomes treating oxygenation impairment (represented by OI) as mediator and age as a confounder.</div></div><div><h3>Results</h3><div>A total of 466 patients were included for this analysis. Cutoffs for low, moderate, and high MP were &lt; 0.2262 J/min/kg, 0.2262 to 0.4487 J/min/kg, and &gt; 0.4487 J/min/kg, respectively. High vs low MP was associated with reduced VFDs (adjusted incidence rate ratio, –0.22 [95% CI, –0.35 to –0.10]; <em>P</em> &lt; .001) and IFDs (adjusted incidence rate ratio, –0.14 [95% CI, –0.27 to –0.01]; <em>P</em> = .034), but not ICU mortality. In the causal analysis, OI showed a significant indirect effect on the causal pathway of MP on VFDs (indirect effect, –4.30 [<em>P</em> &lt; .001]; direct effect, –1.17 [<em>P</em> = .635]; total effect, –5.47 [<em>P</em> = .024]) and IFDs [indirect effect, –3.13 [<em>P</em> &lt; .001]; direct effect, –0.72 [<em>P</em> = .635]; total effect, –3.84 [<em>P</em> = .024]), but not ICU mortality.</div></div><div><h3>Interpretation</h3><div>In this study, higher MP was associated with fewer VFDs and IFDs. The causal effect of MP on VFDs and IFDs was mediated fully by the impairment in oxygenation.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653989","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":"Long-Term Morbidity Associated With Non-COVID-19 Pneumonia in Patients Receiving Mechanical Ventilation","authors":"Alexander T. Clark MD ,&nbsp;Clark I. Strunk MD ,&nbsp;Matthew W. Semler MD, MSCI ,&nbsp;Jonathan D. Casey MD, MSCI ,&nbsp;Cathy A. Jenkins MS ,&nbsp;Guanchao Wang MS ,&nbsp;James C. Jackson PsyD ,&nbsp;E. Wesley Ely MD, MPH ,&nbsp;Amy L. Kiehl MA ,&nbsp;Patsy T. Bryant MS ,&nbsp;Alana Lauck MS ,&nbsp;Stephanie C. DeMasi MD ,&nbsp;Robert E. Freundlich MD, MSCI ,&nbsp;Wesley H. Self MD, MPH ,&nbsp;Rameela Raman PhD ,&nbsp;Jin H. Han MD","doi":"10.1016/j.chstcc.2025.100161","DOIUrl":"10.1016/j.chstcc.2025.100161","url":null,"abstract":"<div><h3>Background</h3><div>The COVID-19 pandemic highlighted the impact of acute respiratory illnesses on long-term morbidity. However, the long-term morbidity associated with non-COVID-19 pneumonia is unclear, particularly in patients who are receiving mechanical ventilation.</div></div><div><h3>Research Question</h3><div>What is the burden of 12-month long-term cognitive impairment (LTCI), functional impairment, psychological distress, and quality of life in critically ill patients receiving mechanical ventilation for non-COVID-19 pneumonia?</div></div><div><h3>Study Design and Methods</h3><div>This single-site prospective cohort study enrolled patients with non-COVID-19 pneumonia receiving mechanical ventilation in the emergency department and ICUs from June 18, 2018, through August 30, 2021. Global cognition at 12 months was measured by the Montreal Cognitive Assessment for the Blind, with higher scores representing better cognition. Secondary outcomes were basic and instrumental activities of daily living (ADLs), psychological distress (posttraumatic stress disorder [PTSD], depression, and anxiety), and quality of life.</div></div><div><h3>Results</h3><div>Of 408 patients with non-COVID-19 pneumonia (63.4%), 96 patients survived and completed the 12-month follow-up. Among survivors of non-COVID-19 pneumonia, 57.3% met the criteria for LTCI, 13.5% showed executive dysfunction, 17.7% showed impairments in at least 1 basic ADL, 51.0% showed impairments in at least 1 instrumental ADL, 44.0% demonstrated physical disability, 17.8% met the criteria for PTSD, 37.8% met the criteria for depression, 46.7% met the criteria for anxiety, and 19.4% rated their quality of life as poor at 12 months.</div></div><div><h3>Interpretation</h3><div>A substantial proportion of patients with non-COVID-19 pneumonia receiving mechanical ventilation met criteria for LTCI. Additionally, many demonstrated difficulty performing ADLs, showed physical disability, and experienced psychological sequelae, leading to poor quality of life at 12 months. Interventions designed to reduce these adverse outcomes are needed.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779452","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 Delphi Consensus on Recommendations for Improving Research Processes and Infrastructure to Address Health Disparities","authors":"Amira Mohamed MD ,&nbsp;A. Adegunsoye MD, FACP, FCCP ,&nbsp;M. Armstrong-Hough MPH, PhD ,&nbsp;N. Ferguson-Myrthil PharmD, BCCCP ,&nbsp;I. Hassan MD ,&nbsp;F.B. Mayr MD, MPH ,&nbsp;T.S. Valley MD ,&nbsp;D.R. Winkfield PhD, RN, FNP-BC ,&nbsp;C.B. Walsh MD ,&nbsp;J.T. Chen MD","doi":"10.1016/j.chstcc.2025.100160","DOIUrl":"10.1016/j.chstcc.2025.100160","url":null,"abstract":"<div><h3>Background</h3><div>Racial and ethnic disparities in critical care medicine remain poorly understood, making them difficult to address. This initiative developed a thought leader consensus with recommendations for critical care research to document, assess, and understand potential disparities.</div></div><div><h3>Research Question</h3><div>What key areas should future critical care research focus on to better identify and address disparities related to race, ethnicity, and language?</div></div><div><h3>Study Design and Methods</h3><div>A modified Delphi-based method was used to form a consensus about addressing racial disparities through future critical care research. Nine thought leaders discussed aspects related to 4 topics: collection of race, ethnicity, and language variables; establishing recruitment plans for researchers from racial and ethnic minority groups; designating minority serving institutions; and health disparity education and community engagement. Consensus was reached when ≥ 80% of members agreed (answered with yes or with 4 to 5 points on a Likert scale).</div></div><div><h3>Results</h3><div>Thought leaders arrived at a consensus agreement (100%) that improved data quality, achieved by more robust recruitment of research participants from racial and ethnic minority groups and standardization of race and ethnicity data, is crucial as the initial step of uncovering health disparities. They agreed that collection of language preferences should be part of all research studies to expose potential biases and disparities in non-English speakers (100% agreement). Engagement of racial and ethnic minority communities was agreed to be essential to obtain involvement of research participants from such minoritized groups (100%).</div></div><div><h3>Interpretation</h3><div>This consensus revealed the notable data deficiency impacting health disparities within critical care research especially when compared with other settings, highlighting the crucial need for comprehensive focus on this domain. Standardization of race, ethnicity, and language data collection, with the goal of increasing the number of research participants from racial and ethnic minority groups, is vital for understanding health disparities in critical care research and its potential causes.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632999","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 Lightning Strikes the Heart","authors":"Abiodun Idowu MD ,&nbsp;Indiresha R. Iyer MD","doi":"10.1016/j.chstcc.2025.100157","DOIUrl":"10.1016/j.chstcc.2025.100157","url":null,"abstract":"<div><div>Cloud-to-ground lightning strikes are the second leading cause of weather-related deaths in the United States. Lightning strike injuries are more common in summer months, especially in the southeastern and southern parts of the United States. Deaths resulting from lightning strikes are 4 times more common in male patients. The average age of death is 37 years. Two-thirds of lightning-associated deaths occur in the first hour of injury and generally are the result of cardiorespiratory arrest. Lightning injuries occur through direct strike, indirect strike, side flash, ground current, upward streamers, and blast effects. Postulated mechanisms for cardiovascular damage include electroporation, myocardial hemorrhage and necrosis, contusion, induced electric currents, catecholaminergic surge, coronary vasospasm, blast injury, and corticomedullary brain dysfunction. Clinical cardiac manifestations include asystole; ventricular and atrial arrhythmias; hypotension; ventricular dysfunction; cardiomyopathy; cardiogenic shock; dynamic ST-segment and T-wave ECG changes, including ST-segment elevation myocardial infarction pattern; pericardial effusion; tamponade; and aortic injury. Immediate, sustained, and aggressive resuscitation efforts, so-called reverse triage, and rapid transportation to hospitals, even with prolonged asystole, often lead to complete recovery. Among hospitalized patients, cardiac arrest, ventricular arrhythmias, and an ECG pattern of ST-segment elevation myocardial infarction are associated with increased odds of mortality. Standard trauma, burn, and advanced cardiac life support protocols are recommended for management. Technological advances in weather forecasting, public awareness, and policies related to extreme weather are important in preventing lightning strike injuries.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100157"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633000","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 Snapshot of the Central Nervous System","authors":"Christina Boncyk MD, MPH ,&nbsp;Christopher G. Hughes MD","doi":"10.1016/j.chstcc.2025.100159","DOIUrl":"10.1016/j.chstcc.2025.100159","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100159"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522752","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":"Mapping the Epidemiologic Features of Endotracheal Tube Obstruction","authors":"Vimal Bhardwaj MD, FNB(Critical Care), EDIC ,&nbsp;Abhishek Samprathi MD, DrNB, EDIC ,&nbsp;Manu M.K. Varma MD, DM ,&nbsp;Kingshuk Saha MSc ,&nbsp;Ross Prager MD ,&nbsp;John Basmaji MD ,&nbsp;Nicolas Orozco MD ,&nbsp;Srirang Ramamoorthy MSc ,&nbsp;Jose Chacko MD, EDIC ,&nbsp;Arjun Alva MD","doi":"10.1016/j.chstcc.2025.100156","DOIUrl":"10.1016/j.chstcc.2025.100156","url":null,"abstract":"<div><h3>Background</h3><div>Endotracheal tube blockages (ETBs) are a common yet often overlooked cause of weaning failure, ventilator dyssynchrony, and hypoxia in the ICU, with limited studies on their prevalence, clinical factors, and outcomes.</div></div><div><h3>Research Question</h3><div>What are the incidence, risk factors, and associated clinical and ventilator factors of ETBs in ventilated patients in the ICU?</div></div><div><h3>Study Design and Methods</h3><div>We assessed 369 endotracheal tubes (ETTs) of mechanically ventilated patients after extubation. This prospective observational study was conducted at the tertiary cardiothoracic ICUs (CICUs) and medical ICUs (MICUs) of Narayana Health City, Bengaluru, India. Tubes were inspected visually and were cut at the point of maximum blockage, and cross-sectional images captured with a 12-megapixel camera were analyzed for ETB percentage using the SketchAndCalc algorithm.</div></div><div><h3>Results</h3><div>Of the 369 ETTs assessed, ETBs were categorized as showing low (0%-9%), moderate (10%-49%), and severe (&gt; 50%) occlusion. In the CICU, severe ETBs was observed in &lt; 2% of patients, compared with 4% of patients in the MICU, whereas moderate ETBs were present in 27.9% of patients in the CICU and 16.5% of patients in the MICU. On univariable analysis, suction type (β = 9.62 [95% CI, 5.27-13.98]; <em>P</em> &lt; .01), peak pressure (P_peak; β = 1.73 [95% CI, 1.38-2.08]; <em>P</em> &lt; .01), coagulopathy (β = 9.42 [95% CI, 4.22-14.62]; <em>P</em> &lt; .01), and ICU type (β = 9.62 [95% CI, 5.28-13.96]; <em>P</em> &lt; .01) were statistically significant. Multivariable regression analysis showed only P_peak (β = 1.65 [95% CI, 1.28-2.02]; <em>P</em> &lt; .01), coagulopathy (β = 8.02 [95% CI, 3.26-12.79]; <em>P</em> &lt; .01) and larger number of days receiving invasive mechanical ventilation (β = 0.02 [95% CI, 0.01-0.03]; <em>P</em> &lt; .01) to be significant factors associated with ETB percentage.</div></div><div><h3>Interpretation</h3><div>Moderate ETB was more prevalent in patients in the ICU, with significant factors including coagulopathy, closed suction practice, and mechanical ventilation duration. P_peak alarms lacked clinical impact, despite statistical significance.</div></div><div><h3>Clinical Trial Registry</h3><div>Clinical Trial Registry-India; No.: CTRI/2023/10/058184; URL: <span><span>www.ctri.nic.in</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100156"},"PeriodicalIF":0.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166512","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}