CHEST critical care最新文献

{"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}

{"title":"Lactation Practices in Critically Ill Patients","authors":"Kayla J. Kolbe MD ,&nbsp;Virginia Sheffield MD ,&nbsp;Katerina Castillo MD ,&nbsp;Kriya S. Patel MD ,&nbsp;Jessica A. Blank MD ,&nbsp;Melissa H. Ross MD ,&nbsp;Thomas S. Valley MD ,&nbsp;Rommel Sagana MD","doi":"10.1016/j.chstcc.2024.100123","DOIUrl":"10.1016/j.chstcc.2024.100123","url":null,"abstract":"<div><h3>Background</h3><div>Most birthing people in the United States initiate lactation, but little is known about lactation practices in patients who are critically ill.</div></div><div><h3>Research Question</h3><div>What are the lactation rates and practices in adult patients in the ICU and what are potential barriers to lactation and resource use?</div></div><div><h3>Study Design and Methods</h3><div>We performed a retrospective chart review of immediately postpartum patients in the ICU at an academic medical center between January 2018 and January 2024. Information regarding initiation, cessation, communication, and lactation consultant (LC) services were extracted and bivariate tests of association were conducted.</div></div><div><h3>Results</h3><div>Most immediately postpartum patients in the ICU initiated lactation (85% [87 of 102]), but only 70% (72 of 102) continued until hospital discharge. Documented lactation plans were present before delivery for 60% of patients, and a documented plan to initiate lactation before delivery was associated with increased odds of initiating lactation after delivery (OR, 9.21; 95% CI, 1.96-43.3; <em>P</em> = .005). Although most patients (75%) saw LCs, less than 30% of patients saw LCs within 24 hours of delivery. An association between seeing an LC and continuing lactation until hospital discharge was found (OR, 4.74; 95% CI, 1.77-12.7; <em>P</em> = .002). More than one-half of lactating patients received mechanical ventilation (55%), but nearly 20% of these intubated patients did not undergo milk expression while ventilated.</div></div><div><h3>Interpretation</h3><div>Most postpartum patients who are critically ill initiate lactation, but not all continue until hospital discharge. Having documented plans to lactate before delivery and seeing LCs were protective of lactation in the ICU, but many patients did not see LCs promptly. Additional gaps in care included lack of documentation and delays in lactation initiation in intubated patients. We hypothesize that these gaps may hinder patients who are critically ill from achieving their personal lactation goals, and steps should be taken to address and mitigate these challenges.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100123"},"PeriodicalIF":0.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487206","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":"Feasibility of Measuring Driving Pressure and Patient Effort in Assisted Modes of Ventilation","authors":"Malik Farooqi MD ,&nbsp;Michael Mikhaeil MD ,&nbsp;Jason Z.X. Chen MD ,&nbsp;Mohamed Althobity MD ,&nbsp;Alisha Greer MD ,&nbsp;Arjun Sharma MD ,&nbsp;Kimberley Lewis MD ,&nbsp;Tom Piraino MD ,&nbsp;Deborah Cook MD ,&nbsp;Bram Rochwerg MD","doi":"10.1016/j.chstcc.2024.100125","DOIUrl":"10.1016/j.chstcc.2024.100125","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100125"},"PeriodicalIF":0.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444658","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":"Venovenous Extracorporeal Membrane Oxygenation in Patients With Shock","authors":"Jonah Rubin MD","doi":"10.1016/j.chstcc.2024.100127","DOIUrl":"10.1016/j.chstcc.2024.100127","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100127"},"PeriodicalIF":0.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444744","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":"Continuous Glucose Monitor in Adult Diabetic Ketoacidosis","authors":"Rafael Barberena Moraes MD, PhD ,&nbsp;Amanda Vilaverde Perez MD","doi":"10.1016/j.chstcc.2024.100122","DOIUrl":"10.1016/j.chstcc.2024.100122","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100122"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487295","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}