CHEST critical care最新文献

{"title":"Operationalizing the New Global Definition of ARDS","authors":"George L. Anesi MD, MSCE, MBE ,&nbsp;Arisha Ramkillawan MBChB ,&nbsp;Jonathan Invernizzi MBBCh, MMed ,&nbsp;Stella M. Savarimuthu MD ,&nbsp;Robert D. Wise MBChB, MMed ,&nbsp;Zane Farina MBChB ,&nbsp;Michelle T.D. Smith MBChB, PhD","doi":"10.1016/j.chstcc.2024.100103","DOIUrl":"10.1016/j.chstcc.2024.100103","url":null,"abstract":"<div><h3>Background</h3><div>A proposed new global definition of ARDS seeks to update the Berlin definition and account for nonintubated ARDS and ARDS diagnoses in resource-variable settings.</div></div><div><h3>Research Question</h3><div>How do ARDS epidemiologic characteristics change with operationalizing the new global definition of ARDS in a resource-limited setting?</div></div><div><h3>Study Design and Methods</h3><div>We performed a real-use retrospective cohort study among adult patients meeting criteria for the Berlin definition of ARDS or the global definition of ARDS at ICU admission in two public hospitals in the KwaZulu-Natal Department of Health, South Africa, from January 2017 through June 2022.</div></div><div><h3>Results</h3><div>Among 5,760 adults (aged ≥ 18 years) admitted to the ICU, 2,027 patients (35.2%) met at least one ARDS definition, including 1,218 patients meeting the Berlin definition of ARDS (60.1% of all ARDS diagnoses) and 809 new diagnoses of the global definition of ARDS that were not captured by the Berlin definition alone (39.9% of all ARDS diagnoses and 14.0% of all ICU admissions). After adjustment for hospital-level factors, patients who met only the global definition of ARDS criteria (ie, who would not have been captured by the Berlin definition) showed no statistically significant ICU mortality difference vs patients with ARDS according to the Berlin definition (21.7% [95% CI, 18.9%-24.4%] vs 23.8% [95% CI, 21.5%-26.2%]; OR, 0.88 [95% CI, 0.70-1.10]; <em>P</em> = .25). In prespecified exploratory subgroup analyses, patients without COVID-19 who met only the criteria for the global definition of ARDS showed reduced ICU mortality (14.2% [95% CI, 11.6%-16.9%] vs 22.2% [95% CI, 19.8%-24.6%]; OR, 0.58 [95% CI, 0.45-0.75]; <em>P</em> &lt; .0005) compared with patients without COVID-19 who met the Berlin definition for ARDS.</div></div><div><h3>Interpretation</h3><div>The new global definition of ARDS captures a significant proportion of patients who would not have been included by the Berlin definition alone. These additional patients with ARDS may have heterogenous patterns of outcomes among diagnostic subgroups, including by COVID-19 status, compared with patients with ARDS according to the Berlin definition.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100103"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721472","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":"Corrigendum to: Psomiadis JS, Khawaja A, Zimmerman J. CHEST Critical Care. 2023;1(3):100022","authors":"","doi":"10.1016/j.chstcc.2024.100105","DOIUrl":"10.1016/j.chstcc.2024.100105","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100105"},"PeriodicalIF":0.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700610","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":"Transitions of Care Between Community to Hospital and Back Again","authors":"Kimberley J. Haines PhD ,&nbsp;Yasmine Ali Abdelhamid PhD","doi":"10.1016/j.chstcc.2024.100102","DOIUrl":"10.1016/j.chstcc.2024.100102","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100102"},"PeriodicalIF":0.0,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700606","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":"Association Between Sex and Race and Ethnicity and IV Sedation Use in Patients Receiving Invasive Ventilation","authors":"Sarah L. Walker ,&nbsp;Federico Angriman MD, PhD ,&nbsp;Lisa Burry PharmD, PhD ,&nbsp;Leo Anthony Celi MD, MPH ,&nbsp;Kirsten M. Fiest PhD ,&nbsp;Judy Gichoya MD ,&nbsp;Alistair Johnson PhD ,&nbsp;Kuan Liu PhD ,&nbsp;Sangeeta Mehta MD ,&nbsp;Georgiana Roman-Sarita RRT ,&nbsp;Laleh Seyyed-Kalantari PhD ,&nbsp;Thanh-Giang T. Vu MD ,&nbsp;Elizabeth L. Whitlock MD ,&nbsp;George Tomlinson PhD ,&nbsp;Christopher J. Yarnell MD, PhD","doi":"10.1016/j.chstcc.2024.100100","DOIUrl":"10.1016/j.chstcc.2024.100100","url":null,"abstract":"<div><h3>Background</h3><div>IV sedation is an important tool for managing patients receiving invasive ventilation, yet excess sedation is harmful, and dosing could be influenced by implicit bias.</div></div><div><h3>Research Question</h3><div>What are the associations between sex or race and ethnicity and sedation practices?</div></div><div><h3>Study Design and Methods</h3><div>We performed a retrospective single-center cohort study of adults receiving invasive ventilation for ≥ 24 hours using the Medical Information Mart for Intensive Care Version IV (2008-2019) database from Boston, Massachusetts. We used a repeated-measures design (4-hour intervals) to study the association between sex (female or male) or race and ethnicity (Asian, Black, Hispanic, White) and sedation outcomes. Sedation outcomes included sedative use (propofol, benzodiazepine, dexmedetomidine) and minimum sedation score. We categorized sedative use as follows: no sedative and then lowest, second, third, and highest quartiles of sedative dose. We adjusted for covariates with multilevel Bayesian proportional odds modeling and reported ORs with 95% credible intervals (CrIs).</div></div><div><h3>Results</h3><div>We studied 6,764 patients: 43% female; 3.5% Asian, 12% Black, 4.5% Hispanic, and 80% White. Benzodiazepines were administered to 2,334 patients (36%). Black patients received benzodiazepines less often and at lower doses than White patients (more benzodiazepine: OR, 0.66; 95% CrI, 0.49-0.92). Propofol was administered to 3,865 patients (57%). Female patients received propofol less often and at lower doses than male patients (more propofol: OR, 0.72; 95% CrI, 0.61-0.86). Dexmedetomidine was administered to 1,439 patients (21%), and use was similar across sex or race and ethnicity. Female patients were less sedated than male patients (deeper sedation: OR, 0.71; 95% CrI, 0.62-0.81), and Black patients were more sedated than White patients (more sedated: OR, 1.28; 95% CrI, 1.05-1.55).</div></div><div><h3>Interpretation</h3><div>Among patients receiving invasive ventilation for at least 24 hours, IV sedation and attained sedation levels varied by sex and by race and ethnicity. Adherence to sedation guidelines may improve equity in sedation management for critically ill patients.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100100"},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700609","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":"Association of Hyperinflammatory Subphenotype With Code Status De-Escalation in Patients With Acute Respiratory Failure","authors":"Amanda C. Moale MD ,&nbsp;S. Mehdi Nouraie MD, PhD ,&nbsp;Haris Zia MD ,&nbsp;Caitlin Schaefer MPH ,&nbsp;Ian J. Barbash MD, MS ,&nbsp;Douglas B. White MD, MAS ,&nbsp;Bryan J. McVerry MD ,&nbsp;Georgios D. Kitsios MD, PhD","doi":"10.1016/j.chstcc.2024.100098","DOIUrl":"10.1016/j.chstcc.2024.100098","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100098"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573267","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":"Interpreting Clinical Trial Results","authors":"Christopher Kearney MD ,&nbsp;Brooke Barlow PharmD ,&nbsp;Brandon Pang MD ,&nbsp;Nicholas A. Bosch MD","doi":"10.1016/j.chstcc.2024.100097","DOIUrl":"10.1016/j.chstcc.2024.100097","url":null,"abstract":"<div><div>Randomized clinical trials (RCTs) are the gold standard to evaluate intervention efficacy and effectiveness. To apply current, evidence-based interventions to daily practice, it is imperative that practicing intensivists be able to interpret the results of individual RCTs in the context of their patients. In this article, we outline an approach to interpreting critical care RCTs from the perspective of the clinician that focuses on answering four questions: (1) Would my patient have been enrolled and represented in the RCT? (2) Is the intervention feasible? (3) Are there threats to the internal validity of the RCT results? (4) Are the RCT results meaningful? Answers to these four questions can be used to assist intensivists in deciding whether to apply RCT evidence to their patients at the bedside and to avoid common pitfalls of RCT interpretation.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100097"},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553381","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":"Time Is Brain","authors":"Giulia M. Benedetti MD ,&nbsp;Lindsey A. Morgan MD ,&nbsp;Dana B. Harrar MD, PhD","doi":"10.1016/j.chstcc.2024.100099","DOIUrl":"10.1016/j.chstcc.2024.100099","url":null,"abstract":"<div><div>Status epilepticus (SE) is a life-threatening emergency that requires prompt recognition and treatment and is common in the ICU. The definition of SE has evolved, with a shift toward highlighting the potential for permanent neurologic injury and prioritizing early termination. Although EEG serves a confirmatory role in the diagnosis of convulsive SE, SE in the ICU often is nonconvulsive, making EEG essential for diagnosis and management. In this review, we characterize the neurobiology of SE and provide clinically applicable strategies for timely recognition and effective treatment of SE, highlighting ICU-level therapies and integration of continuous EEG. We also discuss the simultaneous etiologic evaluation that must take place to identify the cause of SE.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100099"},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578324","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":"Resource Use in the Randomized Master Protocol for Immune Modulators for Treating COVID-19 (ACTIV-1 IM)","authors":"Anne M. Lachiewicz MD, MPH ,&nbsp;Miloni Shah MPH ,&nbsp;Tatyana Der MD ,&nbsp;Derek Cyr PhD ,&nbsp;Hussein R. Al-Khalidi PhD ,&nbsp;Christopher Lindsell PhD ,&nbsp;Vivek Iyer MD ,&nbsp;Akram Khan MD ,&nbsp;Reynold Panettieri MD ,&nbsp;Adriana M. Rauseo MD ,&nbsp;Martin Maillo MD ,&nbsp;Andreas Schmid MD ,&nbsp;Sugeet Jagpal MD ,&nbsp;William G. Powderly MD ,&nbsp;Samuel A. Bozzette MD, PhD ,&nbsp;Randomized Master Protocol for Immune Modulators for Treating COVID-19 (ACTIV-1 IM) Study Group","doi":"10.1016/j.chstcc.2024.100095","DOIUrl":"10.1016/j.chstcc.2024.100095","url":null,"abstract":"<div><h3>Background</h3><div>COVID-19 pneumonia requires considerable health care resources.</div></div><div><h3>Research Question</h3><div>Does a single dose of infliximab or abatacept, in addition to remdesivir and steroids, decreased resource use among patients hospitalized with COVID-19 pneumonia?</div></div><div><h3>Study Design and Methods</h3><div>The Randomized Master Protocol for Immune Modulators for Treating COVID-19 (ACTIV-1 IM) was a randomized, placebo-controlled trial examining the potential benefit in time to recovery and mortality of the immunomodulators infliximab, abatacept, and cenicriviroc. This observational study performed a secondary analysis of the participants receiving infliximab, abatacept, and common placebo to examine resource use. Hospital days, ICU days, days with supplemental oxygen, days with high-flow nasal cannula or noninvasive ventilation, ventilator days, and days of extracorporeal membrane oxygenation each were examined. Proportional odds models were used to compare days alive and free of resource use over 28 days between infliximab and placebo groups and between abatacept and placebo groups.</div></div><div><h3>Results</h3><div>In this study, infliximab infusion, compared with placebo, was associated with greater odds of being alive and free of all interventions tested. Abatacept use was associated only with greater odds of days alive and free of hospitalization and supplemental oxygen.</div></div><div><h3>Interpretation</h3><div>Infliximab and abatacept use were associated with decreased use of health care resources over 28 days compared with placebo, but the absolute differences were small.</div></div><div><h3>Clinical Trial Registry</h3><div>ClinicalTrials.gov; No.: NCT04593940; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100095"},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578325","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":"Circulatory Extracorporeal Membrane Oxygenation Support for High-Risk Acute Pulmonary Embolism","authors":"Salman Abdulaziz MBBS, FRCP ,&nbsp;Vivek Kakar MD, FRCA ,&nbsp;Huda Alfoudri MBChB, FCARCSI ,&nbsp;Mohammed Shalaby MD ,&nbsp;Mikaela V. Allen NMD ,&nbsp;Shameena Beegom RN, MSc ,&nbsp;John F. Fraser MBChB, PhD, FRCP, FRCA, FFARCSI, FCICM, FELSO ,&nbsp;Saleh Fares Al Ali MD, MPH","doi":"10.1016/j.chstcc.2024.100096","DOIUrl":"10.1016/j.chstcc.2024.100096","url":null,"abstract":"<div><div>High-risk pulmonary embolism (PE), defined as obstruction of the pulmonary arterial tree that leads to hemodynamic instability, is a common cause of cardiac arrest, with a mortality rate of up to 50%. The obstruction of the pulmonary circulation interferes with gas exchange and causes hemodynamic disturbances in both the right and left sides of the heart. Some international guidelines have suggested the use of extracorporeal membrane oxygenation (ECMO), in combination with definitive therapy, in patients with PE with refractory circulatory collapse or cardiac arrest. Furthermore, several observational studies have shown that ECMO may be beneficial in stabilizing patients with high-risk PE, especially as a form of bridging therapy in patients for whom common reperfusion methods may be insufficient or have delayed efficacy. We present the case of a patient with acute high-risk PE and the role of ECMO in addressing the physiologic derangements caused by PE and improving patient outcomes. We reviewed the literature reporting the experience on ECMO use in conjunction with various forms of definitive treatment for PE. We describe the various ECMO cannulation strategies applicable for patients with high-risk PE, the role of adjunct mechanical circulatory support, practical guidance on ECMO weaning, and the interaction between the PE response team and the ECMO team in the setting of high-risk PE.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100096"},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553387","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":"Reshaping Postpandemic Critical Care Collaboration in the Asia-Pacific Region","authors":"Eamon P. Raith MBBS, PhD, FCICM ,&nbsp;See Kay Choong ,&nbsp;Mark Nicholls ,&nbsp;Wong Wai Tat ,&nbsp;Sheila Nainan Myatra ,&nbsp;Erwin Pradian MD, PhD ,&nbsp;Moritoki Egi MD, PhD ,&nbsp;Gee-Young Suh MD, PhD ,&nbsp;Shanti Rudra Deva ,&nbsp;Naranpurev Mendsaikhan ,&nbsp;Shital Adhikari ,&nbsp;Jose Melanio Grayda ,&nbsp;Ming-Cheng Chan ,&nbsp;Suthat Rungruanghiranya ,&nbsp;Sean Loh FCCP, FRCP ,&nbsp;David Ku FCICM","doi":"10.1016/j.chstcc.2024.100094","DOIUrl":"10.1016/j.chstcc.2024.100094","url":null,"abstract":"<div><div>The COVID-19 pandemic presented the greatest challenge to modern intensive care medicine since its founding as a specialty in 1952, with its effects felt across health care services in all regions, including low-resourced settings. A paucity of data remains regarding the provision of intensive care medicine across the globe, particularly after the COVID-19 pandemic. To determine the broad state of critical care medicine after the pandemic in the Asia-Pacific region, the inaugural Asia-Pacific Critical Care Societies Summit was held in Singapore as a satellite meeting of the Asia-Pacific Intensive Care Symposium on August 18, 2023. This article summarizes this summit and provides key health and economic data for representative countries before detailing the resolutions and planned actions arising from this initiative. Fourteen critical care societies participated in the inaugural summit and consented to publication of societal reports. Common challenges and priorities for participating societies included issues around education and training, specialty and workforce advocacy, and collaboration and research. As a result of this summit, societies resolved to establish an Asia-Pacific education forum, to encourage the development of Asia-Pacific critical care trials, and to support engagement in multinational studies. A second Asia-Pacific Critical Care Societies Summit will be convened in 2024, with a focus on safety and quality challenges within ICUs represented by the societies present and discussion of the listed priority areas.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100094"},"PeriodicalIF":0.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142659378","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}