CHEST critical care最新文献

{"title":"Withdrawal of Mechanical Ventilation in the ICU","authors":"Corey R. Fehnel MD, MPH ,&nbsp;Zara Cooper MD, MPH ,&nbsp;Margaret Campbell RN, PhD ,&nbsp;Daniel Habtemariam MSc, MPH ,&nbsp;Thomas G. Travison PhD ,&nbsp;Daniel Forsman MD ,&nbsp;Richard M. Schwartzstein MD ,&nbsp;Douglas B. White MD, MAS ,&nbsp;Susan L. Mitchell MD, MPH","doi":"10.1016/j.chstcc.2025.100204","DOIUrl":"10.1016/j.chstcc.2025.100204","url":null,"abstract":"<div><h3>Background</h3><div>More than 1 in 5 Americans die in ICUs, 50% of whom undergo palliative withdrawal of mechanical ventilation (WMV). Little is known about their experiences or best practices to minimize any suffering they may experience.</div></div><div><h3>Research Question</h3><div>How frequent is distress among patients undergoing withdrawal of mechanical ventilation, and what are the risk factors for distress?</div></div><div><h3>Study Design and Methods</h3><div>The Observational Study of Withdrawal of Mechanical Ventilation is a prospective cohort study conducted from January 2021 through July 2022 in 12 ICUs at 2 academic medical centers among mechanically ventilated, intubated patients transitioning to comfort-focused care via WMV. The cumulative incidence of experiencing distressful episodes resulting from either observed respiratory distress (respiratory distress observation score of &gt; 3 or self-reported dyspnea rated ≥ 5), pain (visual analog scale or clinical pain observation tool score of ≥ 3), or agitation (Richmond Agitation-Sedation Scale score of ≥ +2) from the time of WMV initiation until death (or up to 3 hours after WMV) were calculated. Multivariable Poisson regression identified factors associated with the number of distressful episodes, adjusting for time at risk, generating adjusted incidence risk ratios (aIRRs) with 95% CIs.</div></div><div><h3>Results</h3><div>Among 153 participants, the cumulative incidence of at least 1 distressful episode after WMV was 91% (individual symptoms were: respiratory distress, 90%; pain, 56%; and agitation, 5%), with 41% of patients having &gt; 3 episodes. In multivariable analysis, receiving opiates within 1 hour before WMV (anticipatory dosing) was associated with a lower risk of distressful episodes (aIRR, 0.74; 95% CI, 0.55-0.99). Factors associated with higher risk of distressful episodes included: ICU stays of &gt; 10 days (aIRR, 1.85; 95% CI, 1.20-2.88), lower levels of consciousness (lower Glasgow coma scale score; aIRR, 1.72; 95% CI, 1.06-2.78), and distressful episodes before WMV (aIRR, 1.63; 95% CI, 1.21-2.18).</div></div><div><h3>Interpretation</h3><div>Our results show that nearly all ICU patients undergoing palliative WMV at the end of life demonstrated distressful symptoms or signs. Anticipatory dosing with opiates before WMV may help to mitigate their distress.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100204"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145474419","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 of Peripheral Norepinephrine Protocol Implementation on Central Venous Catheter Placement in a Medical ICU","authors":"Lara M. Groetzinger PharmD, BCCCP ,&nbsp;Julia Williams MSN, RN, CCRN ,&nbsp;Susan Svec MSN, RN, CCRN ,&nbsp;Michael P. Donahoe MD ,&nbsp;Phillip E. Lamberty MD ,&nbsp;Ian J. Barbash MD","doi":"10.1016/j.chstcc.2025.100195","DOIUrl":"10.1016/j.chstcc.2025.100195","url":null,"abstract":"<div><h3>Background</h3><div>Central venous catheters (CVCs) are associated with significant morbidity, mortality, and costs in the ICU. One strategy to reduce CVC complications is to avoid placing them altogether. Although norepinephrine (NE) is typically administered via a CVC, data increasingly suggest it may be safely administered via peripheral IV lines.</div></div><div><h3>Research Question</h3><div>Can protocolized administration of peripheral NE decrease CVC utilization?</div></div><div><h3>Study Design and Methods</h3><div>We implemented a protocol using peripheral IVs to administer NE infusion in our medical ICU (MICU) in March 2019. To determine the impact of our protocol on CVC placement, we compared the proportion of MICU patients who received a CVC before (July 1, 2017, to February 28th, 2019) and after (March 1, 2019 to December 31, 2023) protocol implementation. We then compared the change in CVC utilization in the MICU with that in all other ICUs in the same hospital from 2017 to 2023. We also evaluated the percentage of patients receiving the peripheral infusion who ultimately did not require a CVC during their index MICU stay.</div></div><div><h3>Results</h3><div>The average proportion of MICU patients who received a CVC decreased significantly after protocol initiation: pre, 59.5% vs post, 53.5%, <em>P</em> &lt; .01. Central line utilization in the control ICUs remained consistent over the same period, with 60.5% in the pre-intervention period and 61.5% in the postintervention period (<em>P</em> = .34). In the MICU postintervention period, there were 819 peripheral NE infusions, with 391 (47.4%) never receiving a CVC during their index MICU stay. Nine patients (1.1%) received extravasation treatment.</div></div><div><h3>Interpretation</h3><div>Implementation of a protocol using peripherally infused NE was found to be safe, feasible, and associated with a decrease CVC utilization over time. Our study provides further evidence that many patients prescribed NE do not require a central line, and protocolized administration can decrease the use of CVCs on a broader scale.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145333693","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":"Outcomes of Venovenous Extracorporeal Membrane Oxygenation Consultation in Patients With COVID-19 ARDS","authors":"Kha Dinh MD ,&nbsp;Bindu Akkanti MD ,&nbsp;Maulin Patel MD ,&nbsp;Rahat Hussain MD ,&nbsp;Farah Kazzaz MD ,&nbsp;Ismael A. Salas de Armas MD ,&nbsp;Sachin Kumar MD ,&nbsp;Manish Patel MD ,&nbsp;Marwan Jumean MD ,&nbsp;Jayeshkumar Patel MD ,&nbsp;Sukhdeep Basra MD ,&nbsp;Sriram Nathan MD ,&nbsp;Igor Banjac CCP ,&nbsp;Lisa Janowiak CCP ,&nbsp;Lilit Sargsyan MD ,&nbsp;Bela Patel MD ,&nbsp;Igor D. Gregoric MD ,&nbsp;Biswajit Kar MD","doi":"10.1016/j.chstcc.2025.100205","DOIUrl":"10.1016/j.chstcc.2025.100205","url":null,"abstract":"<div><h3>Background</h3><div>Although outcomes of patients supported with venovenous extracorporeal membrane oxygenation (ECMO) are well documented, outcomes of those who are referred but do not undergo cannulation remain limited.</div></div><div><h3>Research Question</h3><div>Among patients with COVID-19-related ARDS referred for venovenous ECMO, how do outcomes compare between those who undergo cannulation and those who do not?</div></div><div><h3>Study Design and Methods</h3><div>This single-center retrospective study of a prospective registry evaluated all adult patients with COVID-19-related ARDS who underwent venovenous ECMO consultation through a multidisciplinary approach between March 2020 and October 2022. The primary outcome was 90-day survival after ECMO consultation, comparing cannulated patients with a propensity-matched noncannulated cohort. Secondary outcomes included unadjusted 90-day survival and survival to hospital discharge with and without Respiratory ECMO Survival Prediction (RESP) score stratification. For propensity score matching, covariates were age, pH, Pa<span>co</span>₂, Pa<span>o</span>₂ to F<span>io</span>₂ ratio, acute kidney injury, vasopressor or inotropic requirement, and RESP score.</div></div><div><h3>Results</h3><div>Of 247 patients referred for venovenous ECMO, 90-day survival after ECMO consultation—the primary outcome—was higher in the cannulated group (n = 86) than the propensity-matched noncannulated group (n = 86; 48.8% vs 23.3%; hazard ratio, 0.40 [95% CI, 0.28-0.59]; <em>P</em> &lt; .001). Secondary analyses demonstrated similar findings: unadjusted 90-day survival was 48.8% vs 15.5% (hazard ratio, 0.31 [95% CI, 0.22-0.43]; <em>P</em> &lt; .001), and survival to hospital discharge in matched cohorts was 43.0% vs 24.4% (<em>P</em> &lt; .001). When stratified by RESP scores, survival to discharge for the so-called sick patients remained higher among cannulated patients (RESP score of 3 to 5: 63.6% vs 19.3% [<em>P</em> &lt; .001]; RESP score of –1 to 2, 28.6% vs 7.8% [<em>P</em> = .016]).</div></div><div><h3>Interpretation</h3><div>Our results show that among select patients with severe COVID-19-related ARDS referred for venovenous ECMO, cannulation was associated with higher observed survival. However, despite matching, residual confounding—particularly from clinical judgement factors affecting cannulation decisions—limits causal inference. These findings underscore the need for cautious interpretation and further prospective studies to better define ECMO candidacy and outcomes.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100205"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578637","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":"Protocol and Statistical Analysis Plan for the Vasopressin for Septic Shock Pragmatic (VASSPR) Cluster-Crossover Randomized Trial","authors":"Ithan D. Peltan MD ,&nbsp;Danielle Groat PhD ,&nbsp;Jason R. Jacobs PhD ,&nbsp;Elisabeth H. Tillman BS ,&nbsp;Ben J. Brintz PhD ,&nbsp;Stephanie Chauv PharmD, BCCCP ,&nbsp;Sarah J. Beesley MD ,&nbsp;Jennifer H. Edwards MD ,&nbsp;Natalia Arizmendez MD ,&nbsp;Eliotte L. Hirshberg MD ,&nbsp;Jason R. Carr MD ,&nbsp;Michael J. Lanspa MD ,&nbsp;Joseph R. Bledsoe MD ,&nbsp;Austin T. Smith MD ,&nbsp;Harmony Schneider PharmD ,&nbsp;Ping Hu MCS ,&nbsp;Tamara D. Moores Todd MD ,&nbsp;Carolyn Klippel BS ,&nbsp;Matthew W. Semler MD ,&nbsp;Jonathan W. Casey MD ,&nbsp;Lindsay M. Leither DO","doi":"10.1016/j.chstcc.2025.100178","DOIUrl":"10.1016/j.chstcc.2025.100178","url":null,"abstract":"<div><h3>Background</h3><div>Guidelines recommend vasopressin as the preferred second-line vasopressor for treatment of septic shock. However, the optimal threshold for vasopressin initiation is unclear.</div></div><div><h3>Research Question</h3><div>Does a treatment strategy using a lower or a higher threshold for initiation of vasopressin as a secondary vasopressor decrease the incidence of 28-day mortality for patients with septic shock?</div></div><div><h3>Study Design and Methods</h3><div>The Vasopressin for Septic Shock Pragmatic (VASSPR) trial is a multicenter, open-label, cluster-randomized, multiple cluster-crossover pragmatic clinical trial being conducted in 13 hospitals in Utah and Idaho. The trial compares a strategy for septic shock management recommending initiation of fixed-dose vasopressin as a secondary vasopressor at a lower threshold (when the total dose of other vasopressors reaches 0.1 μg/kg/min norepinephrine equivalents [NEEs]) to a strategy initiating vasopressin at a higher threshold (when other vasopressors reach 0.4 μg/kg/min NEEs). All adult patients with septic shock at study hospitals are enrolled in the trial and assigned to the treatment strategy in place at the study hospital when and where they start vasopressor treatment for suspected or confirmed septic shock. Individual patient care, including adherence to the assigned vasopressin initiation strategy, occurs at the discretion of each patient’s treating clinicians. The primary outcome is 28-day all-cause mortality. The key secondary outcome is renal replacement therapy-free days to day 28.</div></div><div><h3>Results</h3><div>This article describes the protocol and statistical analysis plan for the conduct and analysis of the VASSPR trial.</div></div><div><h3>Interpretation</h3><div>The VASSPR trial will provide important data to guide vasopressor management for patients with septic shock. Prespecification of the trial protocol and statistical analysis plan before completion of enrollment is important for rigorous trial conduct and reporting.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: NCT06217562; 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 100178"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528706","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":"Comparing Outcomes Amongst Mechanically Ventilated Patients Who Are Transferred vs Retained in a Large Health System","authors":"Amy Ludwig ,&nbsp;Reiping Huang ,&nbsp;Jennifer Slota ,&nbsp;Jacqueline M. Kruser ,&nbsp;Jane L. Holl ,&nbsp;Adin-Christian Andrei ,&nbsp;Meeta P. Kerlin ,&nbsp;Brian J. Anderson ,&nbsp;Anna Pawlowski ,&nbsp;Nandita R. Nadig","doi":"10.1016/j.chstcc.2025.100199","DOIUrl":"10.1016/j.chstcc.2025.100199","url":null,"abstract":"<div><h3>Background</h3><div>Mechanically ventilated (MV) patients undergoing a transfer to a higher-resourced hospital have variable outcomes. We aimed to evaluate patient outcomes by transfer status and timing.</div></div><div><h3>Research Question</h3><div>What are the characteristics and outcomes of mechanically ventilated patients who are transferred from 1 ICU to another? Does timing of transfer affect these outcomes?</div></div><div><h3>Study Design and Methods</h3><div>In a retrospective observational study, we identified patients admitted on a ventilator to a Midwestern health system (7 local hospitals, 1 tertiary hospital) from March 2018 to December 2021. Exposures were transfer status (being transferred to a tertiary hospital or retained at a local hospital) and transfer timing (early transfers if transferred ≤ 2 days after admission or late transfers). Propensity score weighting was used to balance patient characteristics (age, sex, race/ethnicity, insurance, comorbidity, and primary diagnosis) and baseline clinical factors (admission Sequential Organ Failure Assessment score, COVID-19 test, days on mechanical ventilation, major surgery, and ICU use of dialysis, tracheostomy, and vasopressors). Associations with exposures were estimated through multinomial logistic regression for discharge destination or negative binomial regression for total length of stay (LOS).</div></div><div><h3>Results</h3><div>Of a total of 5,883 adult MV patients, 5,719 were retained and 164 were transfers (80 early transfers and 84 later transfers). Transfers were associated with longer LOS (33.4 days vs 10.2 days; incident rate ratio [IRR] = 3.11; 95% CI, 2.53-3.82; <em>P</em> &lt; .001) and had an increased likelihood of discharge to other facilities (rehabilitation and nursing facilities) (OR = 2.62; 95% CI, 1.51-4.56; <em>P</em> &lt; .01) than retained patients at the local hospitals. Additionally, early transfer was found to be associated with a shorter LOS than late transfers (19.6 days vs 47.7 days; IRR = 0.41; 95% CI, 0.33-0.51; <em>P</em> &lt; .01).</div></div><div><h3>Interpretation</h3><div>Our results show that MV patient transfers within our health system have lower likelihood of discharge to home and longer LOS when compared with MV patients retained at local hospitals. However, the time to transfer may be an important contributor to better outcomes.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100199"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363107","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":"Rheological Theory of Ergotrauma","authors":"Vicent Modesto i Alapont MD, PhD","doi":"10.1016/j.chstcc.2025.100190","DOIUrl":"10.1016/j.chstcc.2025.100190","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100190"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145160045","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 Effects of Cyproheptadine on Severe COVID-19 From the I-SPY COVID Adaptive Platform Trial","authors":"Sara C. Auld MD ,&nbsp;Fady A. Youssef MD ,&nbsp;Timothy E. Albertson MD ,&nbsp;Jeremy R. Beitler MD ,&nbsp;Paul A. Berger MD ,&nbsp;Ellen L. Burnham MD ,&nbsp;Nathan Cobb MD ,&nbsp;Eliot Friedman MD ,&nbsp;Sheetal Gandotra MD ,&nbsp;Kevin W. Gibbs MD ,&nbsp;Jeremiah Hayanga MD ,&nbsp;Robert Hyzy MD ,&nbsp;Malik M.H.S. Khan MD ,&nbsp;Jonathan L. Koff MD ,&nbsp;Richard A. Lee MD ,&nbsp;Nuala J. Meyer MD ,&nbsp;Timothy Obermiller MD ,&nbsp;Caroline Quill MD ,&nbsp;Philip Robinson MD ,&nbsp;Sandhya Samavedam MD ,&nbsp;Neil Aggarwal MD","doi":"10.1016/j.chstcc.2025.100201","DOIUrl":"10.1016/j.chstcc.2025.100201","url":null,"abstract":"<div><h3>Background</h3><div>Severe COVID-19 has been associated with hypercoagulability and platelet activation, which is known to result in excessive accumulation of serotonin. However, few studies have evaluated whether serotonergic blockade may improve clinical outcomes among those with COVID-19.</div></div><div><h3>Research Question</h3><div>Does cyproheptadine, an antiserotonergic drug most commonly used to treat serotonin syndrome, improve time to clinical recovery in patients with severe COVID-19?</div></div><div><h3>Study Design and Methods</h3><div>The Investigation of Serial Studies to Predict Your Therapeutic Response With Imaging and Molecular Analysis in COVID (I-SPY COVID) study is a phase 2, multicenter, adaptive, open-label randomized controlled trial designed to screen potential therapeutic agents rapidly to identify those with a high probability of improving outcomes for hospitalized critically ill patients with COVID-19. For this report, participants randomized to receive cyproheptadine 8 mg enterally every 8 hours for 10 days or until hospital discharge were compared with concurrently enrolled control patients who were treated with the standard of care regimen of dexamethasone and remdesivir and did not receive an investigational agent. Bayesian survival regression models were used to model the hazard functions for the 2 events of interest: (1) recovery (treating death as a competing event) and (2) overall death as a function of randomization arm and baseline COVID-19 level.</div></div><div><h3>Results</h3><div>From September through December 2021, 35 participants were randomized and consented to receive cyproheptadine and 61 concurrent control patients were eligible for analysis. At that point, futility criteria were met and the data monitoring committee halted further enrollment into the cyproheptadine arm. The posterior probability that cyproheptadine would increase the rate of recovery was 0.1% and the posterior probability that cyproheptadine would improve survival was 16.3%.</div></div><div><h3>Interpretation</h3><div>In an open-label phase 2 trial of adults critically ill with severe COVID-19, cyproheptadine did not improve recovery or survival compared with the standard of care.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: NCT04488081; 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 100201"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145333763","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":"Time-Sensitive Recovery","authors":"Kelly M. Toth PhD, RN ,&nbsp;Leanne M. Boehm PhD, RN, ACNS-BC","doi":"10.1016/j.chstcc.2025.100206","DOIUrl":"10.1016/j.chstcc.2025.100206","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100206"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528708","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 Role of Calibration Practices in Optimizing Continuous Glucose Monitor Accuracy in Critically Ill Patients","authors":"Melanie Natasha Rayan MD, MPH ,&nbsp;Eileen R. Faulds PhD, RN ,&nbsp;Brooke Lee ,&nbsp;Molly McNett PhD, RN ,&nbsp;Matthew Exline MD, MPH ,&nbsp;Chyongchiou J. Lin PhD ,&nbsp;Laureen Jones RN ,&nbsp;Amanie Rasul ,&nbsp;Kathleen M. Dungan MD, MPH","doi":"10.1016/j.chstcc.2025.100193","DOIUrl":"10.1016/j.chstcc.2025.100193","url":null,"abstract":"<div><h3>Background</h3><div>In the ICU, continuous glucose monitors (CGMs) may improve glycemia and reduce the need for point-of-care blood glucose (POC BG) monitoring, but face challenges because of clinical conditions that affect accuracy.</div></div><div><h3>Research Question</h3><div>What is the feasibility of using POC BG calibration to improve CGM accuracy?</div></div><div><h3>Study Design and Methods</h3><div>This feasibility study pooled data from a retrospective study of patients with COVID-19 in the ICU and a prospective single-arm clinical trial of patients in the ICU. Our sample included 110 patients receiving IV insulin monitored using a hybrid CGM plus POC BG protocol with a factory-calibrated Dexcom G6 CGM (Dexcom, Inc.). Validation was required for initial and ongoing nonadjunctive use or for standalone use and was defined as CGM ± 20% of POC BG measurement for values of ≥ 100 mg/dL or ± 20 mg/dL for values of &lt; 100 mg/dL. In the cohort with COVID-19, calibration was performed at the nurse’s discretion. In the prospective study, calibration was performed after persistent failure to achieve validation.</div></div><div><h3>Results</h3><div>A total of 55 patients (50%) underwent 167 calibrations. Those with a calibration had a mean age of 57.9 ± 13.6 years, 49% were male, 83% were White, and 60% had type 2 diabetes. After calibration, validation was achieved in 72.6%, 66.7%, and 77.8% of patients at 6, 12, and 24 hours after calibration, respectively. The mean absolute relative difference (MARD) was 25% at calibration, decreasing to 9.6%, 12.7%, and 13.2% at 6, 12, and 24 hours. Similar percentages were observed after eliminating pairs with multiple calibrations. Calibration was timely, within 5 minutes of the POC BG measurement in 70% and &lt; 10 minutes in 83%. No statistical difference in MARD was found between timely and late calibrations or based on sensor rate of change at the time of calibration.</div></div><div><h3>Interpretation</h3><div>Our feasibility study demonstrated an improvement in CGM accuracy with POC BG calibrations in ICU patients. Further research is needed to understand optimal implementation strategies and impact on outcomes.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145160044","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":"Impact of a Real-Time Ventilator Management Dashboard With Alerts","authors":"Pranai Tandon MD ,&nbsp;Kim-Anh-Nhi Nguyen MS ,&nbsp;Ganesh Raut MS ,&nbsp;Yuxia Ouyang PhD ,&nbsp;Satya N. Cheetirala MS ,&nbsp;Shamsuddoha Ranginwala MBA, RRT-NPS ,&nbsp;Gary Oldenburg MS, RRT-NPS ,&nbsp;Neha S. Dangayach MD ,&nbsp;Samuel O. Acquah MD ,&nbsp;Roopa Kohli-Seth MD ,&nbsp;Prem Timsina ScD ,&nbsp;Arash M. Kia MD ,&nbsp;Robert Freeman DNP ,&nbsp;Natalia Egorova PhD ,&nbsp;Matthew A. Levin MD ,&nbsp;Charles A. Powell MD, MBA","doi":"10.1016/j.chstcc.2025.100167","DOIUrl":"10.1016/j.chstcc.2025.100167","url":null,"abstract":"<div><h3>Background</h3><div>Exposure to high tidal volumes in patients undergoing invasive mechanical ventilation is associated with increased mortality and worse outcomes. However, adherence to lung-protective ventilation (LPV) is suboptimal. No generalizable tool or approach exists that has been demonstrated to optimize implementation of this parameter of mechanical ventilation.</div></div><div><h3>Research Question</h3><div>We tested whether development and deployment of a real-time ventilator management dashboard with twice-daily alerts communicating synthesized ventilator information to clinicians would improve adherence to LPV (≤ 8 mL/kg ideal body weight).</div></div><div><h3>Study Design and Methods</h3><div>The Respiratory Insights Dashboard was developed to display key real-time patient and ventilator data for all patients in the ICU of a large academic medical center, as well as to send twice daily email alerts to ICU staff identifying patients with out-of-range parameters. The 5 ICUs with lowest tidal volume adherence were preselected for analysis in a quasiexperimental study comparing the periods before and after the dashboard.</div></div><div><h3>Results</h3><div>In the period before the intervention, 1,376 patients received ventilation, and in the period after the intervention, 3,064 patients received ventilation. Hourly adherence to LPV rose from 78% to 87% (<em>P</em> &lt; .001). In patients initiated on ventilation with tidal volume (Vt) of &gt; 8 mL/kg, the time to reach adherence fell from a median of 9 hours (interquartile range, 2-26 hours) to 5 hours (interquartile range, 1-15 hours; <em>P</em> = .048). Interrupted time series regression showed that temporal trends both before and after the intervention were not significantly different from zero; however, adherence level change after the intervention was 8.3 (<em>P</em> = .004). Increased adherence to LPV also was observed in multivariable regression (OR, 1.438; <em>P</em> &lt; .001), along with an increase in adherence trend over time after implementation (OR, 1.001; <em>P</em> = .004).</div></div><div><h3>Interpretation</h3><div>In this study, a real-time ventilator management dashboard with Vt alerts was shown to significantly improve adherence to LPV hospital wide as well as more rapid correction of suboptimal ventilator settings. Implementation was associated with an increase in LPV adherence that has persisted for 15 months of follow-up.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100167"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145333760","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}