CHEST critical care最新文献

{"title":"Derivation and Validation of a Clinical and Endothelial Biomarker Risk Model to Predict Persistent Pediatric Sepsis-Associated Acute Respiratory Dysfunction","authors":"James G. Williams MD ,&nbsp;Jane E. Whitney MD ,&nbsp;Scott L. Weiss MD ,&nbsp;Brian M. Varisco MD ,&nbsp;Nadir Yehya MD ,&nbsp;Mihir R. Atreya MD, MPH ,&nbsp;Sepsis Genomics Collaborative and the Children’s Hospital of Philadelphia Sepsis Investigators","doi":"10.1016/j.chstcc.2024.100120","DOIUrl":"10.1016/j.chstcc.2024.100120","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis-associated ARDS results in high morbidity and mortality in children. However, heterogeneity among patients makes identifying those at risk of persistent acute respiratory dysfunction challenging. Endothelial dysfunction is a key feature of ARDS pathophysiologic characteristics, contributing to lung injury in sepsis. Incorporating endothelial biomarkers into risk models may enhance prediction of those with persistent acute respiratory dysfunction.</div></div><div><h3>Research Question</h3><div>Can clinical variables and endothelial biomarkers measured early in the course of sepsis predict risk of persistent acute respiratory dysfunction among critically ill children?</div></div><div><h3>Study Design And Methods</h3><div>This was a multicenter derivation and single center test cohort study of prospectively enrolled children with sepsis. The derivation cohort was split into training and holdout validation sets. We trained TreeNet (Minitab, LLC) and classification and regression tree (CART) models using clinical and endothelial biomarkers measured on day 1 of septic shock to predict risk of sepsis-associated acute respiratory dysfunction (SA ARD) on day 3. The performance of the CART model was tested in the holdout validation data set and in the independent test cohort.</div></div><div><h3>Results</h3><div>In the derivation (n = 625) and test (n = 162) cohorts, children with day 3 SA ARD showed increased mortality, length of mechanical ventilation, and PICU length of stay compared with those without. The TreeNet and CART models yielded comparable results. The variables included in the final CART model were presence of SA ARD on day 1, Pa<span>o</span>₂ to F<span>io</span>₂ ratio of &lt; 250, soluble thrombomodulin, and vascular cell adhesion molecule 1 concentrations. This model showed an area under the receiver operating characteristic curve (AUC) of 0.88 in the training data set, sensitivity of 0.91 (95% CI, 0.86-0.94), specificity of 0.76 (95% CI, 0.68-0.82), and demonstrated reproducibility in validation data set and test cohort (AUC range, 0.78-0.83).</div></div><div><h3>Interpretation</h3><div>We derived and validated predictive models incorporating clinical and endothelial biomarkers to identify pediatric patients with septic shock at high risk of persistent acute respiratory dysfunction. Pending prospective validation, such models may facilitate enrichment and targeted intervention in future clinical trials.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100120"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487208","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":"Acetaminophen and Clinical Outcomes in Sepsis","authors":"Sarah N. Obeidalla MEd ,&nbsp;Gordon R. Bernard MD ,&nbsp;Lorraine B. Ware MD ,&nbsp;V. Eric Kerchberger MD","doi":"10.1016/j.chstcc.2024.100118","DOIUrl":"10.1016/j.chstcc.2024.100118","url":null,"abstract":"<div><h3>Background</h3><div>The Ibuprofen in Sepsis Study (ISS) randomized trial found no difference in duration of shock, ARDS, or mortality with ibuprofen treatment for sepsis. However, higher use of acetaminophen, a known hemoprotein reductant with potentially beneficial effects in sepsis, as an antipyretic in the control arm may have masked the clinical benefits from either drug.</div></div><div><h3>Research Question</h3><div>Does an association exist between administration of acetaminophen and clinical outcomes in adults with sepsis?</div></div><div><h3>Study Design and Methods</h3><div>We performed a retrospective propensity-matched analysis of the previously reported ISS trial. We created a propensity score for receiving acetaminophen during the first 2 study days using sex, age, presence of shock at enrollment, trial study drug assignment (ibuprofen or placebo), febrile status at enrollment, need for mechanical ventilation, and Acute Physiology and Chronic Health Evaluation II score at enrollment, and then matched trial participants 1:1 into acetaminophen-exposed and acetaminophen-unexposed groups based on their propensity scores. We tested the association between receipt of acetaminophen with 30-day mortality as the primary outcome. Secondary outcomes included development of renal failure and ventilator-free days (VFDs).</div></div><div><h3>Results</h3><div>Of 455 patients in the original trial, 276 patients (61%) were matched into acetaminophen-exposed and acetaminophen-unexposed groups. In the propensity-matched analysis, we found a lower mortality among acetaminophen-exposed patients compared with acetaminophen-unexposed patients (hazard ratio, 0.58; 95% CI, 0.40-0.84; <em>P</em> = .004). Additionally, acetaminophen-exposed patients experienced more days alive and free of mechanical ventilation compared with the acetaminophen-unexposed patients (OR, 2.09 for having 19-28 VFDs vs 0 or 1-18 VFDs; 95% CI, 1.12-3.95; <em>P</em> = .02). We observed no significant association between renal failure and receipt of acetaminophen.</div></div><div><h3>Interpretation</h3><div>In this propensity-matched retrospective analysis, adults with sepsis who received acetaminophen showed decreased mortality and more days alive and free of mechanical ventilation. This study highlights the potential of acetaminophen as a modulator of outcomes in sepsis and warrants further investigation.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100118"},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465575","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":"ARDS Subphenotypes Exhibit Different Right Ventricular-Pulmonary Arterial Coupling Profiles","authors":"Matthew T. Siuba DO ,&nbsp;Maxwell A. Hockstein MD ,&nbsp;Diego Ariel Rey PhD ,&nbsp;Abhijit Duggal MD, MPH ,&nbsp;Rodrigo Octavio Deliberato MD, PhD","doi":"10.1016/j.chstcc.2024.100119","DOIUrl":"10.1016/j.chstcc.2024.100119","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100119"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444745","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":"Causes of Death Among Patients Supported by Extracorporeal Membrane Oxygenation","authors":"Renata P. Lerner MD, PhD ,&nbsp;Amira Mohamed MD ,&nbsp;Annette Ilg MD ,&nbsp;Raghu R. Seethala MD ,&nbsp;Alison Witkin MD ,&nbsp;Jerome Crowley MD ,&nbsp;Anthony Carlese MD ,&nbsp;Michelle Ng Gong MD, MPH ,&nbsp;Iris Aimlin MD ,&nbsp;Jen-Ting Chen MD, MS ,&nbsp;David Furfaro MD, MPH ,&nbsp;Brian O’Gara MD ,&nbsp;Ryan Gardner MD ,&nbsp;Malorie Butera RN ,&nbsp;Shahzad Shaefi MD, MPH ,&nbsp;Daniel Knox MD ,&nbsp;Daniel Gutteridge MD, MBA ,&nbsp;Christie Horner BSN, CCRN ,&nbsp;Anthony Manasia MD, MPH ,&nbsp;Nidhi Kavi MD ,&nbsp;Ari Moskowitz MD, MPH","doi":"10.1016/j.chstcc.2024.100114","DOIUrl":"10.1016/j.chstcc.2024.100114","url":null,"abstract":"<div><h3>Background</h3><div>Mortality for patients who are critically ill receiving extracorporeal membrane oxygenation (ECMO) support (venovenous or venoarterial) is high, but the proximal causes of death have not been characterized fully.</div></div><div><h3>Research Question</h3><div>We aimed to characterize the reasons for death in patients who underwent cannulation while receiving venoarterial or venovenous ECMO.</div></div><div><h3>Study Design and Methods</h3><div>This was a retrospective multicenter observational cohort study of adult patients who underwent cannulation for ECMO and who died while receiving ECMO at 6 medical centers in the United States.</div></div><div><h3>Results</h3><div>We categorized the causes of death for 751 patients who underwent cannulation for ECMO. We summarized and compared baseline patient characteristics among the 6 sites. Reasons for death were comorbid withdrawal of life-sustaining therapy (n = 248 [33%]), progressive hemodynamic shock (n = 200 [27%]), neurologic withdrawal of life-sustaining therapy (n = 135 [18%]), cardiogenic shock (n = 126 [17%]), respiratory failure (n = 31 [4.1%]), and equipment failure (n = 11 [1.5%]). Comorbid withdrawal of life-sustaining therapy was the most common cause of death in patients who underwent cannulation for both venoarterial (n = 141 [29%]) and venovenous (n = 107 [41%]) ECMO. The rate of palliative care consultation differed among sites.</div></div><div><h3>Interpretation</h3><div>This study showed that most deaths result from comorbid withdrawal of life-sustaining therapy and that death or withdrawal because of refractory respiratory failure and cardiogenic shock account for a lower proportion of deaths in patients receiving ECMO. Our efforts to reduce mortality in patients receiving ECMO should account for the proportion of deaths attributable to comorbid withdrawal of life-sustaining therapy.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100114"},"PeriodicalIF":0.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487207","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":"Innovation and Adaptation in COVID-19 Pandemic Posthospital Discharge Contact and Monitoring in the United States","authors":"Katrina E. Hauschildt PhD ,&nbsp;Jacquelyn Miller MA ,&nbsp;Nathan Wright MA ,&nbsp;Amanda Schutz PhD ,&nbsp;Lexi Wilhelmsen MPH ,&nbsp;Katharine Seagly PhD ,&nbsp;Sara E. Golden PhD ,&nbsp;Aluko A. Hope MD ,&nbsp;Kelly C. Vranas MD ,&nbsp;Catherine L. Hough MD ,&nbsp;Thomas S. Valley MD","doi":"10.1016/j.chstcc.2024.100101","DOIUrl":"10.1016/j.chstcc.2024.100101","url":null,"abstract":"<div><h3>Background</h3><div>To address unknown risk for readmission among patients with COVID-19 and persistent capacity strain, hospital systems used postdischarge contact and monitoring to facilitate safe discharge and recovery. However, little work has systematically documented how hospitals implemented changes to hospitalization postdischarge contact practices during COVID-19.</div></div><div><h3>Research Question</h3><div>How did hospitals’ innovate and adapt postdischarge telephone follow-up and remote monitoring strategies to assess discharged patients with COVID-19 for risk of readmission and recovery progress?</div></div><div><h3>Study Design and Methods</h3><div>Semistructured interviews were conducted (January 2022 to March 2023) with 70 inpatient and outpatient providers and administrators (5-12 per site) in nine health systems that varied by size, region, rurality, proportion of Medicaid patients, and estimated scale of post-COVID-19 care organization. Participants described innovation in and implementation of discharge and postdischarge care processes used to assess patients with COVID-19 for readmission risk and recovery progress. The primary analysis was site-level case comparative analysis.</div></div><div><h3>Results</h3><div>Respondents described hospital systems’ motivations for adapting preexisting resources and innovating new postdischarge programs, including postdischarge telephone follow-up and remote monitoring programs, to facilitate safe hospital discharge and transitions to ambulatory care for patients with COVID-19. Respondents also explained various factors that influenced the implementation and use of postdischarge contact practices. Participants perceived that these practices mitigated postdischarge risks and alleviated capacity strain. Respondents described retiring or adapting remote monitoring programs for other conditions as COVID-19 demands declined.</div></div><div><h3>Interpretation</h3><div>Our results show that hospitals implemented and adapted postdischarge practices to help facilitate recovery and address unknown risk for readmission during the pandemic. Some efforts may present opportunities to manage readmission concerns and capacity strain more generally.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100101"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748377","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":"Long-Term Outcomes of Critically Ill Survivors of COVID-19","authors":"María Zuil MD ,&nbsp;Anna Vila-Fornells MSc ,&nbsp;Sally Santisteve MSc ,&nbsp;Rafaela Vaca MSc ,&nbsp;Maria Aguilà MSc ,&nbsp;Aida Monge MSc ,&nbsp;Anna Sánchez-Cucó MSc ,&nbsp;Iván D. Benítez PhD ,&nbsp;Nuria Forns MSc ,&nbsp;Olga Minguez MSc ,&nbsp;Anna Moncusí-Moix MSc ,&nbsp;Jesús Caballero MD ,&nbsp;Carme Barberà MD ,&nbsp;David de Gonzalo-Calvo PhD ,&nbsp;Antonio Torres MD ,&nbsp;Ferran Barbé MD ,&nbsp;Jessica González MD","doi":"10.1016/j.chstcc.2024.100116","DOIUrl":"10.1016/j.chstcc.2024.100116","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100116"},"PeriodicalIF":0.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444695","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":"Associations Among Skeletal Muscle Health, Disability, and Self-Reported Physical Function in Survivors of Critical Illness","authors":"Kimberly F. Rengel MD, MSCI ,&nbsp;Jo Ellen Wilson MD, MPH, PhD ,&nbsp;Heidi J. Silver RD, PhD ,&nbsp;Emma Hollingsworth MPH ,&nbsp;Onur M. Orun MS ,&nbsp;James C. Jackson PsyD ,&nbsp;Matthew F. Mart MD ,&nbsp;Christopher G. Hughes MD ,&nbsp;E. Wesley Ely MD, MPH ,&nbsp;Nathan E. Brummel MD, MSCI, ATSF","doi":"10.1016/j.chstcc.2024.100115","DOIUrl":"10.1016/j.chstcc.2024.100115","url":null,"abstract":"<div><h3>Background</h3><div>Factors associated with disability after critical illness are incompletely understood. Lower pre-existing muscle mass and muscle density on CT imaging are associated with greater mortality resulting from critical illness. Their relationship with disability and physical function in survivors of critical illness is unclear.</div></div><div><h3>Research Question</h3><div>We sought to understand the relationship between muscle mass and muscle density before critical illness and disability and self-reported physical function after surviving a critical illness.</div></div><div><h3>Study Design and Methods</h3><div>We conducted a nested cohort study of 125 survivors of critical illness with abdominal imaging between 6 months before and 4 days after ICU admission. We measured skeletal muscle cross-sectional area at the L3 vertebra, indexed by height, to obtain the skeletal muscle mass index and measured skeletal muscle density by calculating the mean Hounsfield units of the muscles. We recorded discharge location and, at 3 and 12 months after hospital discharge, assessed for disability with basic activities of daily living, instrumental activities of daily living, and self-reported physical function. We used multivariable regression to assess the relationship between baseline skeletal muscle mass index or density and outcomes.</div></div><div><h3>Results</h3><div>We found no association between skeletal muscle mass index and discharge to a facility or disability. However, lower skeletal muscle density was associated with greater odds of discharge to a facility, but not with disability at either time point.</div></div><div><h3>Interpretation</h3><div>A substantial percentage of participants (40%) demonstrated low muscle mass on abdominal imaging before seeking treatment for a critical illness. We did not find muscle mass or density to be associated with long-term disability or physical function after critical illness, although lower density was associated with increased risk of discharge to a facility. Further work is needed to understand the relationship between muscle health and physical recovery after critical illness.</div></div><div><h3>Trial Registry</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: NCT00392795; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 2","pages":"Article 100115"},"PeriodicalIF":0.0,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143815889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Descriptive Qualitative Study of Religion and Spirituality’s Role in Critical Illness Decision-Making Among Black and White Family Caregivers","authors":"Oluwatumilara F. Akeke MPH ,&nbsp;Dingyue Wang BSN ,&nbsp;Deborah Ejem PhD ,&nbsp;Kimberly S. Johnson MD ,&nbsp;Sharron L. Docherty PhD, RN ,&nbsp;Christopher E. Cox MD, MPH ,&nbsp;Katelyn Dempsey MPH ,&nbsp;Laura Fish MPH, PhD ,&nbsp;Sirajbir Sodhi BS ,&nbsp;Devika Shenoy BS ,&nbsp;Nidhi Charan BS ,&nbsp;Muhammed S. Bah BA ,&nbsp;Deepshikha C. Ashana MD","doi":"10.1016/j.chstcc.2024.100113","DOIUrl":"10.1016/j.chstcc.2024.100113","url":null,"abstract":"<div><h3>Background</h3><div>Spiritual beliefs and spiritual support from clinicians can affect medical decision-making and coping during times of serious illness.</div></div><div><h3>Research Question</h3><div>How do religion and spirituality affect the critical illness experience of Black and White family caregivers of patients who are critically ill?</div></div><div><h3>Study Design and Methods</h3><div>Twenty-one semistructured interviews were conducted with Black and White family caregivers of patients admitted to ICUs in a southeastern United States health system between January 3, 2023, and May 11, 2023. Eligible family caregivers either reported unmet spiritual needs or a high degree of importance of spirituality in their lives. Participants were asked how spirituality affected medical decision-making and coping while their loved ones were seriously ill. Coders were masked to participant race during thematic analysis.</div></div><div><h3>Results</h3><div>Of 21 family caregivers, 9 caregivers (42.9%) were Black and 12 caregivers (57.1%) were White. Black and White family caregivers generally were middle-aged (mean [SD]: 50.6 [13.6] years and 61.7 [10.7] years, respectively) and female (n = 7 [77.8%] and n = 9 [75.0%], respectively). We observed that clinicians showed less engagement about spirituality with Black compared with White family caregivers in this sample. Black family caregivers felt more comfortable discussing their spirituality with members of their community, such as pastors or friends. A common belief among all family caregivers in this sample was that God, rather than the medical team, was in control of their loved one’s outcome. This was accompanied by a shared desire for accessible spiritual spaces in the ICU and proactive clinician engagement in their spirituality.</div></div><div><h3>Interpretation</h3><div>Although spirituality served as an important coping mechanism for all family caregivers in this sample, racial differences in spiritual support offered to family caregivers were identified. Ensuring that multidisciplinary critical care teams are prepared to deliver culturally competent spiritual care is a priority.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100113"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444657","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 P0.1 With Duration of Ventilation and Mortality in Patients With COVID-19 ARDS","authors":"Else A.M.D. ter Haar MD ,&nbsp;Maurits H. Renes MD ,&nbsp;Hendrik W. Zijlstra MD ,&nbsp;Salvador J. Recinos MD ,&nbsp;Peter Dieperink MD ,&nbsp;Walter M. van den Bergh MD, PhD ,&nbsp;Joep M. Droogh MD, PhD ,&nbsp;Judith M. Vonk PhD ,&nbsp;Janesh Pillay MD, PhD","doi":"10.1016/j.chstcc.2024.100112","DOIUrl":"10.1016/j.chstcc.2024.100112","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100112"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453331","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":"Improvements in Vasopressor Requirements With Venovenous Extracorporeal Membrane Oxygenation","authors":"Mazen F. Odish MD ,&nbsp;Travis Pollema DO ,&nbsp;Alex Ignatyev BS ,&nbsp;Jerry Lipinski MD ,&nbsp;Cassia Yi MSN ,&nbsp;Michelle Parrett BSN ,&nbsp;Khang Tong MS ,&nbsp;Lin Liu PhD ,&nbsp;Atul Malhotra MD ,&nbsp;Robert L. Owens MD","doi":"10.1016/j.chstcc.2024.100111","DOIUrl":"10.1016/j.chstcc.2024.100111","url":null,"abstract":"<div><h3>Background</h3><div>Venovenous extracorporeal membrane oxygenation (ECMO) is used increasingly for severe respiratory failure. Some ECMO clinicians may view concurrent vasopressors as a contraindication for venovenous ECMO. However, we noted improved vasopressor requirements after venovenous ECMO cannulation.</div></div><div><h3>Research Question</h3><div>How does venovenous ECMO affect vasopressor requirements in patients with respiratory failure?</div></div><div><h3>Methods</h3><div>This was a retrospective review of all venovenous ECMO initiations from December 2016 through December 31, 2023, at a large-volume ECMO center. The changes in norepinephrine equivalent dose and number of continuous IV vasopressors were determined immediately before and 24 hours after venovenous ECMO cannulation. This change was assessed by Wilcoxon signed-rank tests, and their associations with potential predictor variables (pH, Pa<span>co</span>₂, Pa<span>o</span>₂, and positive end-expiratory pressure) were examined by linear regressions.</div></div><div><h3>Results</h3><div>Two hundred five patients received venovenous ECMO during this time, with 108 patients taking vasopressors at ECMO cannulation and included in this analysis. The mean (SD) norepinephrine equivalent dose at ECMO initiation, 0.23 (0.29) μm/kg/min, to 24 hours after ECMO, 0.14 (0.23) μm/kg/min, decreased significantly (<em>P</em> &lt; .001). The mean (SD) number of pressors at ECMO initiation, 1.69 (0.92), to 24 hours later, 1.29 (1.04), decreased significantly (<em>P</em> &lt; .001). A significant decrease in positive end-expiratory pressure, mean airway pressure, and Pa<span>co</span>₂ with a significant increase in pH and Pa<span>o</span>₂ was found (<em>P</em> ≤ .001 for all). The changes in pH (<em>P</em> &lt; .001) were associated with changes in norepinephrine equivalent dose and number of vasopressors after adjusting for baseline outcomes. Twenty-seven patients (25%) had received a norepinephrine equivalent dose of ≥ 0.3 μm/kg/min at ECMO initiation; of these, 16 patients (59.3%) survived to hospital discharge (compared with 51.9% survival among those with a lower norepinephrine equivalent dose at ECMO initiation; <em>P</em> = .66).</div></div><div><h3>Interpretation</h3><div>Our results show that patients’ vasopressor requirements significantly decreased 24 hours after venovenous ECMO initiation, with a change in pH weakly associated with vasopressor improvement. The requirement of vasopressors, even norepinephrine equivalent dose of ≥ 0.3 μm/kg/min at the time of ECMO consideration, is not a clear contraindication to ECMO candidacy.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100111"},"PeriodicalIF":0.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444659","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}