CHEST critical care最新文献

{"title":"Advancing Prognostic Enrichment in Pediatric Sepsis-Associated Acute Respiratory Dysfunction","authors":"Richard W. Pierce MD , Colin J. Sallee MD","doi":"10.1016/j.chstcc.2025.100140","DOIUrl":"10.1016/j.chstcc.2025.100140","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100140"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859179","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 Systematic Review of the Development and Implementability of Complex Interventions After Hospitalization for Survivors of Intensive Care","authors":"Evelyn Sloan DPT , Selina M. Parry PhD , Alisha A. da Silva BPhysio, AdvRes (Hons) , Catherine L. Granger PhD , Zoe Fehlberg MPH , Owen Gustafson PhD , Catherine Voutier MInfoMgmt , Camille E. Short PhD , Marlena Klaic PhD","doi":"10.1016/j.chstcc.2025.100142","DOIUrl":"10.1016/j.chstcc.2025.100142","url":null,"abstract":"<div><h3>Background</h3><div>Survivors of the ICU can experience physical, mental, and cognitive impairments, limiting activities and societal participation. Limited evidence supports the effectiveness of complex interventions after hospitalization, raising questions regarding how these interventions are developed and evaluated. Recommendations from implementation science and complex intervention research may provide further insight.</div></div><div><h3>Research Question</h3><div>What methods have informed the development and evaluation of complex interventions after hospitalization for survivors of the ICU. How have implementability (acceptability, fidelity, and feasibility) and efficacy been considered in the development and evaluation of these interventions?</div></div><div><h3>Study Design and Methods</h3><div>Studies were included if they developed or evaluated, or both, a complex, structured intervention after hospitalization aimed at improving recovery outcomes for survivors of the ICU. MEDLINE, Embase, PsycINFO, CINAHL, and PEDro were searched through June 4, 2024. Extracted data included intervention development processes; intervention description; and if and how acceptability or satisfaction, fidelity, feasibility, and efficacy were evaluated. Synthesis methods included deductive analysis and scoring using the Template for Intervention Description and Reporting (TIDieR) and the National Institutes of Health’s Treatment Fidelity Framework. Quality appraisal was completed using the applicable Johanna Briggs Institute (JBI) guidelines.</div></div><div><h3>Results</h3><div>Seventy-one publications were included involving 62 unique patient cohorts. Twelve studies (19%) used intervention development frameworks, whereas 24 studies (39%) engaged stakeholders in development processes. The median TIDieR score was 16 (interquartile range [IQR], 14-20) of 24. Twenty-two studies (35%) evaluated patient acceptability, of which 2 studies also evaluated clinician acceptability. Median treatment fidelity score was 6 (IQR, 6-9) of 21 with training, delivery, receipt, and enactment domains described poorly. The median consent rate was 48% (IQR, 34%-68%). Thirteen of the 22 studies (59%) designed to test efficacy achieved their sample size. Eight studies (13%) evaluated cost and 20 studies (34% of studies delivering interventions) reported safety. The median JBI score was 61% (IQR, 50%-70%).</div></div><div><h3>Interpretation</h3><div>Few studies reported applying theory-informed methods or engaging stakeholders in intervention development. Treatment fidelity focused on delivery with little description of receipt or enactment. Future efforts may consider applying implementation science theory and complex intervention approaches.</div></div><div><h3>Clinical Trial Registration</h3><div>International Prospective Register of Systematic Reviews; No.: CRD42023444648; URL: <span><span>https://www.crd.york.ac.uk/prospero/</span><svg><path></path></svg></span></di","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100142"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166513","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":"Lactation as Liberation","authors":"R. Nicholas Burns MD","doi":"10.1016/j.chstcc.2025.100141","DOIUrl":"10.1016/j.chstcc.2025.100141","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100141"},"PeriodicalIF":0.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839076","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":"Carotid Artery Corrected Flow Time Measured by Wearable Doppler Ultrasound Detects Stroke Volume Change Measured by Transesophageal Echocardiography After Coronary Artery Bypass Grafting","authors":"Jon-Emile S. Kenny MD ,&nbsp;Geoffrey Clarke MEng ,&nbsp;Sarah Atwi PhD ,&nbsp;Isabel Kerrebijn MSc ,&nbsp;Tracy Savery MASc ,&nbsp;Meredith Knott BSN ,&nbsp;Chelsea E. Munding PhD ,&nbsp;Mai Elfarnawany PhD ,&nbsp;Andrew M. Eibl BComm ,&nbsp;Joseph K. Eibl PhD ,&nbsp;Bhanu Nalla MD ,&nbsp;Rony Atoui MD","doi":"10.1016/j.chstcc.2025.100138","DOIUrl":"10.1016/j.chstcc.2025.100138","url":null,"abstract":"<div><h3>Background</h3><div>As a measure of preload responsiveness (PR), change in carotid artery corrected flow time (ccFT_Δ) is a surrogate for change in stroke volume (SV_Δ). However, the optimal threshold and accuracy of ccFT_Δ to detect SV_Δ are inconsistent in previous reports.</div></div><div><h3>Research Question</h3><div>Does ccFT_Δ from a wireless, wearable Doppler ultrasound accurately detect a 10% SV_Δ measured by transesophageal echocardiography?</div></div><div><h3>Study Design and Methods</h3><div>This was a prospective, single-center study of adult patients after elective coronary artery bypass grafting. PR was defined as ≥ 10% augmentation in transesophageal echocardiography left ventricular outflow tract velocity time integral (as a surrogate for SV_Δ) during Trendelenburg positioning. Synchronous carotid Doppler imaging was captured by a wireless, wearable Doppler ultrasound. The optimal ccFT_Δ threshold to detect PR, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated. Linear correlation between ccFT_Δ and SV_Δ was assessed by Pearson correlation coefficient. We also evaluated the effect of the number of consecutively averaged cardiac cycles on ccFT_Δ accuracy.</div></div><div><h3>Results</h3><div>This analysis included 30 patients; 7 patients showed a ≥ 10% SV_Δ during Trendelenburg positioning. The optimal ccFT_Δ thresholds were +6.6 ms or 2.2% with sensitivities of 100%, specificities of 70%, and AUCs of 0.89 and 0.88, respectively. A strong, linear correlation between ccFT_Δ and SV_Δ was found (<em>r</em> = 0.70; <em>P</em> &lt; .001). The mean AUC increased from 0.68 to 0.87 when using 1 vs 20 consecutively averaged cardiac cycles.</div></div><div><h3>Interpretation</h3><div>After cardiopulmonary bypass, ccFT_Δ measured by wireless, wearable ultrasound detected SV_Δ during Trendelenburg positioning with high accuracy. The AUC improved as a function of consecutively averaged cardiac cycles. As a surrogate for preload-induced SV_Δ, ccFT_Δ can direct fluid therapy in the postoperative period.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100138"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887741","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":"Understanding Cause of Death for Patients Receiving Extracorporeal Membrane Oxygenation Is Essential for Patient-Centered Care","authors":"Sarah Godfrey MD, MPH","doi":"10.1016/j.chstcc.2025.100139","DOIUrl":"10.1016/j.chstcc.2025.100139","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100139"},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143748637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Lingering Impact of COVID-19 on Respiratory Health","authors":"Fernando Luis Scolari MD, PhD","doi":"10.1016/j.chstcc.2025.100137","DOIUrl":"10.1016/j.chstcc.2025.100137","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100137"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859180","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":"Immunomodulation for ARDS","authors":"Emma Rademaker MD ,&nbsp;Jelle L.G. Haitsma Mulier MD ,&nbsp;Julia Drylewicz PhD ,&nbsp;Eveline M. Delemarre MD, PhD ,&nbsp;Marleen A. Slim MD, PhD ,&nbsp;Nicole P. Juffermans MD, PhD ,&nbsp;Peter Pickkers MD, PhD ,&nbsp;Marc J.M. Bonten MD, PhD ,&nbsp;Olaf L. Cremer MD, PhD ,&nbsp;Lennie P.G. Derde MD, PhD","doi":"10.1016/j.chstcc.2025.100129","DOIUrl":"10.1016/j.chstcc.2025.100129","url":null,"abstract":"<div><h3>Background</h3><div>The success of targeted immunomodulation in COVID-19 underscores its potential for ARDS resulting from other causes. However, it is important to understand both its targeted and broader impacts on the inflammatory host response. To guide future ARDS studies, we explored this in patients with COVID-19 using targeted proteomics.</div></div><div><h3>Research Question</h3><div>How do different immune modulators affect the immune profiles of patients who are critically ill with COVID-19-related ARDS?</div></div><div><h3>Study Design and Methods</h3><div>In this multicenter cohort study, we used 2 Dutch biorepositories to compare patients with COVID-19 with acute respiratory failure treated with: no immunotherapy (n = 18), corticosteroids (n = 21), anakinra plus corticosteroids (n = 9), or tocilizumab plus corticosteroids (n = 22). Plasma proteins related to inflammation and cardiovascular injury were measured using proximity extension assays on ICU days 0 through 1, ICU days 2 through 4 (T3), and ICU days 6 through 8 (T7) after treatment initiation.</div></div><div><h3>Results</h3><div>We observed lower expression of inflammatory biomarkers immediately after tocilizumab administration and from T3 onward after anakinra administration. After treatment with corticosteroids alone, fewer inflammatory biomarkers were suppressed, and only at T3. Multivariate analyses at T3 identified tumor necrosis factor-related apoptosis-inducing ligand, IL-1 receptor-like 2, and tumor necrosis factor β as markedly increased and proto-oncogene tyrosine-protein kinase (SRC) and serine/threonine kinase 4 (STK4) as decreased, solely after tocilizumab. At T7, lower concentrations of 2,4-dienoyl-CoA reductase 1, signaling lymphocytic activation molecule family member 7, SRC, and STK4 were observed in patients treated with tocilizumab or anakinra, whereas interferon γ, chemokine (C-X-C motif) ligand 9, and chemokine (C-C motif) ligand 19 were decreased only after anakinra treatment.</div></div><div><h3>Interpretation</h3><div>In this exploratory study, adding tocilizumab or anakinra to corticosteroids triggered a much broader immunoregulatory response than can be explained by their receptor-specific actions. The response after tocilizumab occurred more rapidly than that after anakinra, offering a potential advantage in the time-sensitive ICU setting. Additionally, tocilizumab preserved the interferon pathway, crucial for antiviral defense, whereas anakinra suppressed it.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100129"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859181","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":"Prediction Models for Mortality in Patients With Moderate to Severe ARDS Treated in the ICU","authors":"Katrijn Daenen MD ,&nbsp;Sara C.M. Stoof MD, PhD ,&nbsp;Hugo van Willigen MD ,&nbsp;Anders Boyd PhD ,&nbsp;Virgil A.S.H. Dalm MD, PhD ,&nbsp;Diederik A.M.P.J. Gommers MD, PhD ,&nbsp;Eric C.M. van Gorp MD, PhD ,&nbsp;Abraham J. Valkenburg MD, PhD ,&nbsp;Henrik Endeman MD, PhD ,&nbsp;Jilske A. Huijben MD, PhD","doi":"10.1016/j.chstcc.2025.100132","DOIUrl":"10.1016/j.chstcc.2025.100132","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Mortality prediction models have been developed for patients in the ICU, but infrequently are targeted for specific conditions. Because ARDS is characterized by high morbidity and mortality, ARDS-specific models for outcome prediction could be valuable for informing patients and relatives, for clinical decision-making, for targeted interventions, and for research.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Research Question&lt;/h3&gt;&lt;div&gt;What are the available prediction models for moderate to severe ARDS and what is their capacity to predict mortality?&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design and Methods&lt;/h3&gt;&lt;div&gt;In this systematic review and meta-analysis, we searched for eligible studies in PubMed MEDLINE, Embase, PsycINFO, Web of Science, Scopus, CINAHL, Cochrane Library, and Google Scholar databases up to March 11, 2024. We included studies that developed or validated multivariable prediction models for mortality in moderate to severe ARDS, applied within 24 hours after ICU admission. Calibration, discrimination, and clinical usefulness were summarized across models. The pooled area under the receiving operating characteristic curve (AUC) was calculated with random effects models both overall and in subgroups of models and study type (development or validation). Heterogeneity was evaluated using the &lt;em&gt;I&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt; statistic.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 7455 screened articles, 14 were included, evaluating 20 unique models. Discrimination was reported for all models, whereas calibration was reported in 16 models. The pooled AUC was 0.782 (95% CI, 0.748-0.817) with an &lt;em&gt;I&lt;/em&gt;&lt;sup&gt;2&lt;/sup&gt; of 99.5% (&lt;em&gt;P &lt; .&lt;/em&gt;0001). In subgroup analysis, the pooled AUC for the Sequential Organ Failure Assessment (SOFA) score was 0.802 (95% CI, 0.719-0.885), the age, plateau, and Pa&lt;span&gt;o&lt;/span&gt;&lt;sub&gt;2&lt;/sub&gt; to F&lt;span&gt;io&lt;/span&gt;&lt;sub&gt;2&lt;/sub&gt; ratio score was 0.724 (95% CI, 0.643-0.805), the Acute Physiology and Chronic Health Evaluation (APACHE) II score was 0.667 (95% CI, 0.613-0.721), and all other scores were 0.813 (95% CI, 0.774-0.852; &lt;em&gt;P&lt;/em&gt; = .0001 for subgroup differences). The pooled AUC was higher for derivation vs validation studies (0.816 [95% CI, 0.760-0.872] vs 0.767 [95% CI, 0.725-0.809]; &lt;em&gt;P&lt;/em&gt; = .17 for subgroup differences).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Substantial variability in discrimination exists across the included models, with calibration frequently unreported. Although models developed specifically for this patient population demonstrate superior performance, general disease severity models like APACHE and SOFA are validated more extensively. Presently, no extensively validated prediction model exists showing good discrimination and calibration for moderate to severe ARDS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Clinical Trial Registry&lt;/h3&gt;&lt;div&gt;International Prospective Register of Systematic Reviews; No.: CRD42022342893; URL: &lt;span&gt;&lt;span&gt;https://www.crd.york.ac.uk/prospero/&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;&lt;","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100132"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887740","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":"Managing Critical Bronchiolitis","authors":"David G. Speicher MD ,&nbsp;Steven L. Shein MD, FCCM","doi":"10.1016/j.chstcc.2025.100135","DOIUrl":"10.1016/j.chstcc.2025.100135","url":null,"abstract":"<div><div>Critical bronchiolitis is a common PICU diagnosis. It is a clinical diagnosis made in children younger than 2 years with low-grade fever, respiratory distress, rhinorrhea, cough, and wheezing. Like many experts, we now consider bronchiolitis to be a syndrome in which some children have uncomplicated viral disease, some have reversible bronchospasm and inflammation, and some have secondary bacterial infection. For all children, we routinely obtain a chest radiograph and basic laboratory tests. For most children, we treat them for uncomplicated viral disease with supportive care highlighted by thoughtful respiratory support. For most children, this consists of high-flow nasal cannula oxygen with flows of 1 to 2 L/kg/min and supplemental oxygen to target oxygen saturations of 92% to 97%. We routinely start enteral nutrition while administering oxygen via high-flow nasal cannula. We provide close monitoring and generally are tolerant of episodes of worsening respiratory distress and instability. We trial racemic epinephrine and then escalate to positive-pressure ventilation if refractory hypoxemia, encephalopathy (indicative of hypercarbia), and sustained severe dyspnea with evidence of systemic stress (eg, moderate to severe tachycardia) develop. On occasion, we treat children with profuse evidence of an asthma phenotype with bronchodilators and corticosteroids, although recognize that no reliable way exists to identify such children at the bedside. For children requiring invasive ventilation, we obtain culture samples of the lower airways shortly after intubation, begin empiric antibiotics, and complete a course if bacterial pathogens are identified. Ventilation strategies must be personalized based on ventilator parameters and physical examination findings, because signs of both obstructive and restrictive disease may be present.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100135"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Receipt of Ketamine vs Etomidate for Emergency Tracheal Intubation and Symptoms of Posttraumatic Stress Disorder at 12 Months","authors":"Lucas C. Wollenman MD ,&nbsp;Austin M. Tipold MD ,&nbsp;Matthew W. Semler MD, MSCI ,&nbsp;Jonathan D. Casey MD, MSCI ,&nbsp;Aaron J. Lacy MD ,&nbsp;Wesley H. Self MD, MPH ,&nbsp;Amy L. Kiehl MA ,&nbsp;Patsy T. Bryant MS ,&nbsp;Stephanie C. DeMasi MD ,&nbsp;Ian H. Stanley PhD ,&nbsp;Cathy A. Jenkins MS ,&nbsp;Guanchao Wang MS ,&nbsp;Jim C. Jackson PsyD ,&nbsp;E. Wes Ely MD, MPH ,&nbsp;Jin H. Han MD, MSc","doi":"10.1016/j.chstcc.2025.100136","DOIUrl":"10.1016/j.chstcc.2025.100136","url":null,"abstract":"<div><h3>Background</h3><div>One of 3 patients in the ICU receiving mechanical ventilation demonstrate posttraumatic stress disorder (PTSD). A single dose of ketamine has been shown to reduce PTSD symptoms in outpatients with chronic PTSD, but its long-term effect is unknown in patients who are critically ill and mechanically ventilated.</div></div><div><h3>Research Question</h3><div>Is ketamine, when used for induction of anesthesia before emergency tracheal intubation, associated with fewer symptoms of PTSD at 12 months compared with etomidate?</div></div><div><h3>Study Design and Methods</h3><div>This was a secondary analysis of a cluster-randomized trial that examined the effect of oxygen saturation targets in patients receiving invasive mechanical ventilation in an emergency department or ICU. Symptoms of PTSD were assessed by trained neuropsychologist raters using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (PCL-5) by phone. Scores ranged from 0 to 80, with higher scores indicating more severe PTSD symptoms. A score of ≥ 31 indicated probable PTSD. Symptoms of PTSD were compared between patients who received ketamine and patients who received etomidate using a proportional odds logistic regression model adjusting for age, race, sex, education, depression or PTSD before illness, comorbidities, severity of illness, sepsis, and location of intubation.</div></div><div><h3>Results</h3><div>Among the 141 patients included in this analysis, 52 patients (37%) received ketamine and 89 patients (63%) received etomidate. The median PCL-5 score at 12 months was 7 (interquartile range [IQR], 1-18) for patients who received ketamine and 14 (IQR, 5-27) for patients who received etomidate (reference; adjusted OR, 0.39; 95% CI, 0.20-0.76). A total of 8 patients (15.4%) who received ketamine and 18 patients (20.2%) who received etomidate met criteria for probable PTSD.</div></div><div><h3>Conclusions</h3><div>Compared with etomidate, induction with ketamine during emergency tracheal intubation was associated with significantly fewer symptoms of PTSD at 12 months. A randomized trial is needed to confirm this finding.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100136"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859148","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}