CHEST critical care最新文献

{"title":"Analytical Accuracy of a Continuous Glucose Monitor in Adult Diabetic Ketoacidosis","authors":"Nathan L. Haas MD ,&nbsp;Lynn Ang MD ,&nbsp;Nazanene H. Esfandiari MD ,&nbsp;Ahsan M. Khan MBBS ,&nbsp;James A. Cranford PhD ,&nbsp;Ashley Cohen MD ,&nbsp;Jordan Sell MD ,&nbsp;Mostafa Abdel-Hamid MD ,&nbsp;Kevin E. Romanchik BSN, RN ,&nbsp;Frederick K. Korley MD, PhD","doi":"10.1016/j.chstcc.2024.100109","DOIUrl":"10.1016/j.chstcc.2024.100109","url":null,"abstract":"<div><h3>Background</h3><div>Management of diabetic ketoacidosis (DKA) requires frequent point-of-care blood glucose (POCBG) measurements, often necessitating ICU admission and incurring substantial costs. Replacing hourly POCBG measurements with continuous glucose monitoring (CGM) could optimize DKA management by minimizing resource use and detecting hypoglycemic events earlier. However, the accuracy of CGM in DKA is not well established.</div></div><div><h3>Research Question</h3><div>What is the clinical and analytical accuracy of CGM in adults with DKA?</div></div><div><h3>Study Design and Methods</h3><div>This was a prospective observational study at a single academic medical center emergency department. Adults older than 18 years with DKA were included. Glucose was measured every 5 minutes via Dexcom G6 CGM and compared with hourly POCBG measurements until resolution of DKA. The primary outcome was proportion of paired CGM and POCBG values in Clarke error grid zones A and B. Additional outcomes included level of agreement via Bland-Altman plot, mean absolute relative difference, and time of first detection of glucose &lt; 150 mg/dL.</div></div><div><h3>Results</h3><div>Twenty adult patients with DKA were studied. Mean age was 42 years, 60% were female, 70% had type I diabetes, and mean presenting pH was 7.17. Three hundred thirty-four paired measurements from CGM and POCBG measurements were analyzed. Clarke error grid analysis revealed 97.0% of readings to be within zones A and B. Bland-Altman analysis showed the average difference between CGM and POCBG measurement was 26.0 mg/dL (95% limits of agreement, –70.7 to 122.6). Mean absolute relative difference was 28.6% (95% CI, 26.5%-30.6%). The first incidence of glucose &lt; 150 mg/dL (n = 14) was detected 28.9 minutes earlier by CGM than POCBG measurements.</div></div><div><h3>Interpretation</h3><div>In this study, CGM provided accurate measurements of blood glucose and identified missed opportunities for earlier intervention in adults with DKA. Future interventional trials can assess the impact of CGM-guided DKA management on patient outcomes, patient experience, and resource use.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100109"},"PeriodicalIF":0.0,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143351003","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":"Best Practices for Intensivists Planning and Opening Hospital-Based Deceased Organ Donor Care Units","authors":"Emily A. Vail MD ,&nbsp;Rita N. Bakhru MD ,&nbsp;Ashley C. McGinity MD ,&nbsp;Todd Sarge MD ,&nbsp;Julie K. Heimbach MD ,&nbsp;Allison J. Tompeck MD ,&nbsp;Thomas M. Leventhal MD ,&nbsp;Devang K. Sanghavi MBBS, MD ,&nbsp;George W. Williams III MD ,&nbsp;Rishi Kumar MD ,&nbsp;Philip Sommer MD ,&nbsp;Niels D. Martin MD ,&nbsp;Samuel T. Windham MD ,&nbsp;Varun K. Goyal MD ,&nbsp;Donor Care Unit Network for Optimizing Recovery Group","doi":"10.1016/j.chstcc.2024.100110","DOIUrl":"10.1016/j.chstcc.2024.100110","url":null,"abstract":"<div><div>Over the past 2 decades, clinical management and recovery of organs from deceased donors in the United States increasingly have been centralized into specialty donor care units. Intensivists who lead or practice in donor care units colocated with hospitals (or hospital-based donor care units) are well positioned to offer operational experience, to deliver evidence-based clinical donor management, and to leverage hospital resources to facilitate research and education efforts to improve access to transplantable organs. In this How I Do It article, intensivist leaders of 11 US donor care units collaborating in the Donor Care Unit Network for Optimizing Recovery group describe the benefits and limitations of hospital-based donor care units and collate resources and shared experiences to inform planning and opening of other hospital-based donor care units.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100110"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394764","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 Patients With COVID-19 Who Are Critically Ill","authors":"Katelyn A. Mazzochi MD ,&nbsp;Sheraya De Silva BSc(Hon) ,&nbsp;Nicholas L.M. Chan MD ,&nbsp;Erin McGann MPhysio ,&nbsp;Tayla L. Robertson MPhysioPrac ,&nbsp;Tahnee R. Hellings MPhysioPrac ,&nbsp;Carol L. Hodgson PhD ,&nbsp;Alisa M. Higgins PhD","doi":"10.1016/j.chstcc.2024.100108","DOIUrl":"10.1016/j.chstcc.2024.100108","url":null,"abstract":"<div><h3>Background</h3><div>Survivors of critical illness are susceptible to long-term functional impairments after admission to an ICU. During the COVID-19 pandemic, the number of patients admitted to an ICU with SARS-CoV-2 infection surged. The long-term consequences of critical illness resulting from COVID-19 illness remain unclear.</div></div><div><h3>Research Question</h3><div>What are the long-term outcomes of adult patients admitted to an ICU for COVID-19?</div></div><div><h3>Study Design and Methods</h3><div>We searched Ovid MEDLINE and EMBASE using subject heading and free-text terms related to long-term outcomes of critically ill patients with COVID-19. We included all articles that reported original data on outcomes from 90 days onward for adult patients admitted to an ICU for COVID-19. Data extracted included study details, patient characteristics, outcomes reported, measurement tools used, and timing of assessment.</div></div><div><h3>Results</h3><div>A total of 14,882 studies were screened, from which 134 studies fulfilled the selection criteria. Follow-up time points ranged from 90 days to 2 years after critical illness. Mortality after hospitalization was the most reported outcome (n = 60), with the general ICU cohort having an aggregate mortality rate of 35.5% (95% CI, 34.7%-36.2%) at 90 days and 31.6% (95% CI, 30.9%-32.4%) at 6 months. A plethora of other outcomes were assessed, including psychologic function and mental health (n = 49), persistent symptoms (n = 47), quality of life (n = 47), physical function (n = 33), and cognitive function (n = 31). For each outcome, different measurement tools were used, making data synthesis across studies difficult.</div></div><div><h3>Interpretation</h3><div>Important evidence gaps remain regarding the long-term health outcomes and health care needs for survivors of critical COVID-19 illness. This review found that mortality was the most reported long-term outcome. Significant heterogeneity was evident across studies in terms of outcomes assessed, measurement instruments used, and the duration of follow-up. Future research requires increased consistency in outcomes assessed and measurement tools to inform clinical practice.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100108"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465574","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":"Management of Asthma and COPD Exacerbations in Adults in the ICU","authors":"Stephen A. Mein MD,&nbsp;Michael C. Ferrera MD","doi":"10.1016/j.chstcc.2024.100107","DOIUrl":"10.1016/j.chstcc.2024.100107","url":null,"abstract":"<div><div>Severe, life-threatening asthma and COPD exacerbations are managed commonly in the ICU and are associated with significant morbidity and mortality. It is important to understand the commonalities and differences in the diagnosis and management of these obstructive lung diseases to improve patient outcomes via evidence-based care. In this review, we first outline triggers of acute asthma and COPD exacerbations and an initial diagnostic evaluation and severity assessment. We then review the pathophysiologic features of asthma and COPD exacerbations and create a framework for the management of exacerbations in critically ill adult patients aimed at reducing airway inflammation, reversing bronchospasm, and, in severe cases, supporting patients with mechanical ventilation or advanced therapies until clinical improvement is achieved.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100107"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479911","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":"Silent Burdens","authors":"Cassiano Teixeira MD, PhD","doi":"10.1016/j.chstcc.2024.100106","DOIUrl":"10.1016/j.chstcc.2024.100106","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100106"},"PeriodicalIF":0.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700607","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":"Prevalence of Inpatient Pulse Oximetry in Operative and Nonoperative Settings","authors":"Nicholas A. Bosch MD ,&nbsp;Anica C. Law MD ,&nbsp;Ashraf Fawzy MD, MPH ,&nbsp;Theodore J. Iwashyna MD, PhD","doi":"10.1016/j.chstcc.2024.100104","DOIUrl":"10.1016/j.chstcc.2024.100104","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 4","pages":"Article 100104"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142700608","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":"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}