CHEST critical care最新文献

{"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}

{"title":"Understanding Provider-Level Variation in Clinical Practice","authors":"Kanupriya Soni MD ,&nbsp;Leigh A. Bukowski MPH ,&nbsp;Billie S. Davis PhD ,&nbsp;Joel M. Levin BA ,&nbsp;Jeremy M. Kahn MD","doi":"10.1016/j.chstcc.2025.100134","DOIUrl":"10.1016/j.chstcc.2025.100134","url":null,"abstract":"<div><h3>Background</h3><div>Clinician practice patterns vary widely in the ICU, particularly in the context of therapies with moderate-quality evidence. A better understanding of the psychological factors underlying provider-level practice variation may reveal targets to standardize practice and speed adoption of new evidence.</div></div><div><h3>Research Question</h3><div>Are provider-level psychological traits associated with practice patterns in the ICU?</div></div><div><h3>Study Design and Methods</h3><div>We administered a longitudinal questionnaire to intensivist clinicians in a single integrated health system from 2018 through 2021. We selected corticosteroids in septic shock as an example of a guideline-recommended practice supported by moderate-quality evidence. In response to a clinical vignette of septic shock, intensivists rated their willingness to administer corticosteroids, their perceptions of the strength of evidence, and their perception of how well the mechanism of action is understood. Via the same questionnaire, we measured psychological traits hypothesized to affect decision-making under uncertainty. We used multivariate regression to examine the relationship between these factors and respondents’ willingness to treat with corticosteroids.</div></div><div><h3>Results</h3><div>The overall survey completion rate was 50.5%. Among 201 participants, 101 participants (50%) were attending physicians, 77 participants (38%) were fellow physicians, and 23 participants (11%) were advanced practice providers. Willingness to treat with corticosteroids increased over time, from 15.3% to 24.4% in 2021. In multivariate regression analyses using generalized estimating equations for repeated measures, risk tolerance (OR, 1.34, 95% CI, 1.07-1.67; <em>P</em> = .01) and perceived strength of evidence (OR, 1.45; 95% CI, 1.18-1.77; <em>P</em> &lt; .001) were associated with increased willingness to treat with corticosteroids, controlling for other factors. Willingness to treat was not associated with perceived understanding of the mechanism of action or other psychological factors.</div></div><div><h3>Interpretation</h3><div>Our findings indicate that ICU providers’ individual level of risk tolerance is associated with their willingness to prescribe corticosteroids for septic shock.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100134"},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807291","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":"Accuracy and Interobserver Reliability of Bedside Assessments of Endotracheal Secretions Among Critically Ill Patients","authors":"Sam Schuiteman MD ,&nbsp;Nathaniel Soper MD ,&nbsp;Keith S. Kaye MD, MPH ,&nbsp;Kelly Fiorino MS, RRT, RRT-ACCS ,&nbsp;Andrew J. Weirauch MS, RRT, RRT-ACCS ,&nbsp;Owen R. Albin MD","doi":"10.1016/j.chstcc.2025.100133","DOIUrl":"10.1016/j.chstcc.2025.100133","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100133"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759463","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 Role of Oxygen Saturation to Fio2 Ratio in Recognition of Hypoxemia in Patients With Hypoxemic Respiratory Failure and ARDS","authors":"Elizabeth Levy MD, MSHP ,&nbsp;Barry D. Fuchs MD ,&nbsp;Michael Harhay PhD, MPH ,&nbsp;Rachel Kohn MD, MSCE ,&nbsp;Stefania Scott MS ,&nbsp;Gary E. Weissman MD, MSHP ,&nbsp;Meeta Prasad Kerlin MD, MSCE","doi":"10.1016/j.chstcc.2025.100130","DOIUrl":"10.1016/j.chstcc.2025.100130","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100130"},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146826","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":"Why Biomarker-Guided Strategies Shape the Future of Randomized Controlled Trials for Immunomodulating Therapies","authors":"Erik H.A. Michels MD ,&nbsp;Rombout B.E. van Amstel MD","doi":"10.1016/j.chstcc.2025.100131","DOIUrl":"10.1016/j.chstcc.2025.100131","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100131"},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759462","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":"Developing Core Outcome (Measurement) Sets for Critical Care Research Using the Modified Delphi Method","authors":"Sarah L. Gorst PhD ,&nbsp;Diana C. Bouhassira MD ,&nbsp;Alison E. Turnbull DVM, MPH, PhD","doi":"10.1016/j.chstcc.2025.100128","DOIUrl":"10.1016/j.chstcc.2025.100128","url":null,"abstract":"<div><h3>Topic Importance</h3><div>High-quality core outcome sets (COSs) and core outcome measurement sets (COMSs) can help to optimize research by allowing the results of clinical trials to be compared and combined in systematic reviews. The number of registered COSs and COMSs for critical care research is increasing, and most are developed using the Delphi method. However, the quality of these tools varies substantially.</div></div><div><h3>Review Findings</h3><div>At least 39 COSs and 10 associated COMSs have been designed for clinical research in critical care and at least 21 ongoing development projects. The Delphi method is the most common method used to foster agreement on the content of a COS or COMS. It is flexible and permits the development process to be tailored to the medical condition and population of interest. However, designing an effective Delphi study requires time and careful deliberation. Clearly defining scope, piloting survey materials, and crafting a consensus process that uses the strengths of each stakeholder group and minimizes loss to follow-up are encouraged. Reporting on COS and COMS development should be sufficiently detailed for readers to understand and critique both the process and the resulting research tool. Established checklists and guidelines are available to assist with both protocol development and peer review of manuscripts reporting on newly generated COSs and COMSs.</div></div><div><h3>Summary</h3><div>Thorough preliminary work, planning, and reporting increase the likelihood that COSs or COMSs related to critical care will reflect the opinions of knowledgeable stakeholders and will improve the usefulness of clinical trial data.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100128"},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474472","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":"Managing Immune Checkpoint Inhibitor Pneumonitis in the ICU","authors":"Kristina Montemayor MD, MHS ,&nbsp;Mohammad I. Ghanbar MD ,&nbsp;Abigail L. Koch MD, MHS ,&nbsp;Karthik Suresh MD ,&nbsp;Robert Scott Stephens MD","doi":"10.1016/j.chstcc.2024.100126","DOIUrl":"10.1016/j.chstcc.2024.100126","url":null,"abstract":"<div><div>Recent advancements in the management of non-small cell lung cancer, especially with immunotherapeutic agents like immune checkpoint inhibitors (ICIs), have improved patient outcomes significantly. However, despite their effectiveness, ICIs can cause immune-related adverse events, including checkpoint inhibitor pneumonitis. Diagnosing and managing pneumonitis can be particularly challenging and patients with moderate or severe symptoms typically require ICU level of care. The management of patients with ICI pneumonitis requires a multidisciplinary approach and numerous treatment decisions, including the use of systemic corticosteroids and adjunctive therapies in certain cases. In this How I Do It article, we offer a case-based discussion covering evaluation, common radiographic changes, diagnosis, grading, and management of ICI pneumonitis in patients in the ICU. We also address common clinical decisions related to corticosteroid dosing, guidance on initiation of adjunctive therapies, and future use of ICI therapy.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100126"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487635","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}