CHEST critical care最新文献

{"title":"Interhospital Transfers in Critical Illness","authors":"Rachel A. Hadler MD , Rachel Kohn MD, MSCE, ATS","doi":"10.1016/j.chstcc.2025.100202","DOIUrl":"10.1016/j.chstcc.2025.100202","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100202"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528279","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 Between Effects of Frailty and Delirium on Hospital Mortality in Critically Ill Patients in the ICU Requiring Noninvasive Ventilation","authors":"Ashwin Subramaniam PhD, FCICM ,&nbsp;Ryan Ruiyang Ling MBBS ,&nbsp;Wisam Al-Bassam FCICM ,&nbsp;Neil Glassford PhD, FCICM ,&nbsp;Kimberley Lewis MSc, FRCPC ,&nbsp;Yahya Shehabi PhD, FCICM, FANZCA ,&nbsp;David Pilcher FCICM","doi":"10.1016/j.chstcc.2025.100194","DOIUrl":"10.1016/j.chstcc.2025.100194","url":null,"abstract":"<div><h3>Background</h3><div>An increasing number of patients with acute respiratory failure are supported with noninvasive ventilation (NIV). Although one-third of the patients receiving NIV experience delirium, its cause largely is unknown. It is hypothesized that frailty may be a contributing factor.</div></div><div><h3>Research Question</h3><div>Does delirium have an association with hospital mortality in patients with and without frailty receiving only NIV?</div></div><div><h3>Study Design and Methods</h3><div>This was a retrospective, multicenter registry-based observational study using the Australian and New Zealand Intensive Care Society Adult Patient Database. All adults (aged ≥ 16 years) with critical illness across 178 ICUs between January 1, 2018, and December 31, 2022, with a documented clinical frailty scale score requiring NIV were included. The primary outcome was hospital mortality. We assessed the association between delirium and hospital mortality in patients with and without frailty, adjusting for acute illness severity at ICU admission, sex, hospital type, unplanned ICU admission, and if ICU admission happened after rapid response team review.</div></div><div><h3>Results</h3><div>We included 30,534 patients, of whom 12,872 patients (42.2%) were frail. Delirium was more prevalent in patients with frailty (10.0% vs 5.6%; <em>P</em> &lt; .001). The in-hospital mortality was higher in patients with frailty (22.5% vs 9.0%; <em>P</em> &lt; .001) when compared with those without frailty. Delirium was associated independently with higher mortality across all patients, regardless of the frailty status (33.2% vs 21.0%; adjusted OR [aOR], 1.59; 95% CI, 1.40-1.80). Furthermore, delirium was associated with smaller increases in hospital mortality in patients with frailty (aOR, 1.42; 95% CI, 1.22-1.66) compared with those without frailty (aOR, 1.90; 95% CI, 1.53-2.35).</div></div><div><h3>Interpretation</h3><div>Although delirium was associated with higher hospital mortality, the relative impact of this association was greatest in patients without frailty. These findings challenge the 1-size-fits-all approach to delirium management in the ICU, advocating for nuanced strategies that consider the broader clinical context, including frailty.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100194"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145333692","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":"Oxygenation Trajectories After Inhaled Nitric Oxide in Nonintubated and Mechanically Ventilated Patients With COVID-19","authors":"Tara S. Ramaswamy MD ,&nbsp;Andrew R. Moore MD ,&nbsp;Alexandria M. Jensen PhD ,&nbsp;Ana Pacheco-Navarro MD ,&nbsp;Jonasel Roque BS ,&nbsp;Shaun M. Pienkos MD ,&nbsp;Jennifer G. Wilson MD ,&nbsp;Joseph E. Levitt MD ,&nbsp;William J. Collins MD ,&nbsp;Angela J. Rogers MD","doi":"10.1016/j.chstcc.2025.100200","DOIUrl":"10.1016/j.chstcc.2025.100200","url":null,"abstract":"<div><h3>Background</h3><div>Inhaled nitric oxide (iNO) is an inhaled vasodilator used in hypoxemic respiratory failure; however, the evidence supporting its benefits is lacking. This study evaluated the physiologic impact of iNO on oxygenation trajectories using slope-based analysis in a predominantly nonintubated population with COVID-19, a group underrepresented in existing iNO research.</div></div><div><h3>Research Questions</h3><div>Is iNO associated with improvement in hypoxemia in patients with respiratory failure resulting from COVID-19? Does this improvement vary by respiratory support method (intubated vs nonintubated) and are changes in hypoxemia associated with outcomes such as mortality and progression to intubation?</div></div><div><h3>Study Design and Methods</h3><div>Retrospective chart review of 142 patients with COVID-19 admitted to the ICUs of Stanford Hospital and its affiliated community hospital, Stanford Health Care—Tri-Valley, who received iNO between March 2020 and July 2022. The primary end point was the change in slope of the oxygen saturation as measured by pulse oximetry (Sp<span>o</span>₂) to F<span>io</span>₂ ratio after iNO administration. Mixed-effects modeling was applied to evaluate the change in Sp<span>o</span>₂ to F<span>io</span>₂ slope before and after iNO administration. Hyperresponsiveness and hyporesponsiveness were defined based on highest and lowest quartile change in slope. Baseline clinical factors and secondary outcome were compared.</div></div><div><h3>Results</h3><div>Mixed-effects modeling showed that iNO was associated with a statistically significant improvement in Sp<span>o</span>₂ to F<span>io</span>₂ ratio across all patients, including the 122 patients (90%) receiving a high-flow nasal cannula when iNO was initiated. Before iNO administration, Sp<span>o</span>₂ to F<span>io</span>₂ ratio was declining with an Sp<span>o</span>₂ to F<span>io</span>₂ slope of –4.3/h (95% CI, –5.6 to –3.0/h). After iNO administration, slope increased to 6.4/h (95% CI, 4.7-8.0/h). The hyperresponsive and hyporesponsive groups did not differ significantly in baseline characteristics, including respiratory method preceding iNO administration, or outcomes, including 30-day mortality (13.3% vs 23.3%; <em>P</em> = .50) and progression to intubation by day 30 (32.4% vs 20.0%; <em>P = .</em>18).</div></div><div><h3>Interpretation</h3><div>iNO was associated with improvement in Sp<span>o</span>₂ to F<span>io</span>₂ ratio in patients admitted with hypoxemic respiratory failure resulting from COVID-19, particularly among nonintubated patients. Magnitude of improvement was not associated with 30-day mortality or need for intubation.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100200"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145333764","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":"Exploring Racial Differences in Family Expressions of Emotion and Clinician Empathy in ICU Family Meetings","authors":"Matthew E. Modes MD, MPP ,&nbsp;Deborah B. Ejem PhD ,&nbsp;Whitney Welsh PhD ,&nbsp;Doreet Preiss PhD ,&nbsp;Jessica Sperling PhD ,&nbsp;Kathryn I. Pollak PhD ,&nbsp;Christopher E. Cox MD, MPH ,&nbsp;Erin K. Kross MD ,&nbsp;Teryl K. Nuckols MD, MSHS ,&nbsp;Kimberly S. Johnson MD ,&nbsp;Sungjin Kim MS ,&nbsp;Shannon S. Carson MD ,&nbsp;Catherine L. Hough MD ,&nbsp;Douglas B. White MD, MAS ,&nbsp;Deepshikha C. Ashana MD","doi":"10.1016/j.chstcc.2025.100186","DOIUrl":"10.1016/j.chstcc.2025.100186","url":null,"abstract":"<div><h3>Background</h3><div>Critical care guidelines recommend that clinicians provide emotional support to families of critically ill patients during family meetings. Little is known about how family member race impacts how emotions are expressed and supported in meetings.</div></div><div><h3>Research Question</h3><div>Are there differences in family members' expression of emotion and clinicians' provision of empathy in ICU family meetings involving Black and White family members?</div></div><div><h3>Study Design and Methods</h3><div>We conducted a directed content analysis of 40 audio-recorded meetings, matching 20 meetings with Black families and 20 meetings with White families on key characteristics including meeting length. Meetings included Black or White family members of patients receiving prolonged mechanical ventilation and critical care clinicians. We used an established coding scheme to code family expressions of negative emotion and clinician empathic statements. Two analysts, unaware of patient and family race, independently coded all meetings. After coding completion, we unmasked the data, compared code frequencies by family race, and calculated the percent of expressions of negative emotions followed by an empathic response.</div></div><div><h3>Results</h3><div>Family members were mostly middle-aged (mean [SD], 50 [10] years) and women (n = 29 [73%]). Physicians leading meetings were mostly young (mean [SD], 38 [7] years), men (n = 27 [68%]), and White (n = 36 [90%]); none were Black. Black families expressed fewer negative emotions than White families (median, 1 [interquartile range, 0-3] vs 4 [interquartile range, 2.5-7.5] expressions of emotions per meeting; <em>P</em> &lt; .001). When families expressed negative emotions, clinicians infrequently responded with empathy to all families and did so less frequently with Black families compared with White families (15% vs 30% of family expressions; <em>P</em> = .099).</div></div><div><h3>Interpretation</h3><div>Our results indicate that racial differences exist in family expression of emotion and potentially in clinician empathic responses in ICU family meetings. Empathic communication warrants improvement, with greater improvement needed with Black families. Future interventions may be needed to enhance clinician provision of equitable emotional support.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 4","pages":"Article 100186"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145333765","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":"Prevalence and Predictors of 3 Vital Outcomes After Venoarterial Extracorporeal Membrane Oxygenation","authors":"Whitney A. Kiker MD ,&nbsp;Si Cheng PhD ,&nbsp;Erin K. Kross MD ,&nbsp;Joseph E. Tonna MD ,&nbsp;Claire J. Creutzfeldt MD ,&nbsp;Jenelle Badulak MD ,&nbsp;Daniel Brodie MD","doi":"10.1016/j.chstcc.2025.100155","DOIUrl":"10.1016/j.chstcc.2025.100155","url":null,"abstract":"<div><h3>Background</h3><div>Predictors of death resulting from extracorporeal membrane oxygenation (ECMO) withdrawal, in-hospital death after ECMO liberation, and survival to hospital discharge have been evaluated incompletely, despite the prognostic insight they provide.</div></div><div><h3>Research Question</h3><div>What are the predictors of 3 vital outcomes after venoarterial ECMO: (1) death in the context of ECMO withdrawal, (2) ECMO liberation followed by in-hospital death, and (3) survival to hospital discharge?</div></div><div><h3>Study Design</h3><div>This retrospective observational study using Extracorporeal Life Support Organization registry data included adults supported by venoarterial ECMO from 2018 through 2022 at 325 North American sites. Three generalized linear mixed models (each comparing 2 outcomes) measured associations between predictors and outcomes, using random intercepts to address data clustering by site.</div></div><div><h3>Results</h3><div>Of 23,177 patients, 10,122 patients (43.7%) died in the context of ECMO withdrawal, 3,510 patients (15.1%) died in the hospital after ECMO liberation, and 9,545 patients (41.2%) survived to hospital discharge. Statistical analysis was performed for 16,277 patients supported for ≥ 24 hours with complete data available (32.5% female; mean age, 55.7 years; and 62.7% White, 16.4% Black, 6.1% Hispanic, and 3.2% Asian). Older age, higher BMI, cardiac arrest before ECMO initiation, and renal failure were associated with increased odds of death in the context of ECMO withdrawal and death after liberation compared with survival. Higher pH and male sex also were associated with increased odds of survival relative to withdrawal. Among decedents, death in the context of ECMO withdrawal was less common than death after ECMO liberation when patients were male and pH was higher.</div></div><div><h3>Interpretation</h3><div>Patients who were older, had higher BMI, or experienced cardiac arrest or renal failure before ECMO initiation seemed to have increased risk of in-hospital death, both in the context of ECMO withdrawal and after ECMO liberation. Male individuals were shown to be less likely to experience ECMO withdrawal. These findings offer prognostic associations that may inform how to support patients and families after ECMO initiation.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100155"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830198","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 Musculoskeletal Indexes With 1-Year Outcomes After ≥ 7 Days of Mechanical Ventilation","authors":"Hannah Wozniak MD ,&nbsp;Erminio Santangelo ,&nbsp;Micheal McInnis ,&nbsp;Laura Dragoi ,&nbsp;Priscila Robles ,&nbsp;Leslie M. Chu ,&nbsp;Andrea Matte ,&nbsp;Margaret S. Herridge","doi":"10.1016/j.chstcc.2025.100176","DOIUrl":"10.1016/j.chstcc.2025.100176","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;In critically ill patients, musculoskeletal indexes have been associated with short-term outcomes such as in-hospital mortality and discharge disposition. Their influence on long-term outcomes in chronically critically ill patients remains unclear.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Research Question&lt;/h3&gt;&lt;div&gt;Does an association exist between musculoskeletal indexes and 1-year mortality in chronically critically ill patients? Are these indexes also associated with 7-day post-ICU functional independence measure (FIM) and discharge disposition?&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design and Methods&lt;/h3&gt;&lt;div&gt;This study used the Canadian Outcomes and Needs Assessment in Intensive Care Unit (ICU) Survivors of Prolonged Mechanical Ventilation and Their Caregivers (RECOVER) phase 1 cohort of patients requiring mechanical ventilation for ≥ 7 days. Patients who underwent abdominal CT imaging within the first 14 days of ICU admission were included. Skeletal muscle index (SMI), psoas muscle index (PMI), and trabecular bone density (BD) were measured at the L3 vertebral level. Multivariable logistic regression assessed the association between each index and 1-year mortality; multivariable linear regression assessed the association with 7-day post-ICU FIM. A Kruskal-Wallis H test compared musculoskeletal indexes across 4 discharge disposition groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;One hundred patients were included; the median age was 57 years (interquartile range [IQR], 45-65 years), and 43% were female. Those who did not survive by 1 year showed lower musculoskeletal indexes than survivors: median SMI, 28.8 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt; (IQR, 22-34 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt;) vs 33.5 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt; (IQR, 25.7-44.1 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt;; &lt;em&gt;P&lt;/em&gt; = .03); median PMI, 3.3 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt; (IQR, 2.5-4.5 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt;) vs 4 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt; (IQR, 3.2-5.6 cm&lt;sup&gt;2&lt;/sup&gt;/m&lt;sup&gt;2&lt;/sup&gt;; &lt;em&gt;P&lt;/em&gt; = .02); and median BD, 131 Hounsfield units (HU; IQR, 100-196 HU) vs 175 HU (IQR, 131-220 HU; &lt;em&gt;P&lt;/em&gt; &lt; .01). Lower SMI (OR per 10-unit decrease, 2.00; 95% CI, 1.21-3.33; &lt;em&gt;P&lt;/em&gt; &lt; .01), PMI (OR per 1-unit decrease, 1.54; 95% CI, 1.06-2.23; &lt;em&gt;P&lt;/em&gt; = .02), and BD (OR per 10-unit decrease, 1.10; 95% CI, 1.01-1.20; &lt;em&gt;P&lt;/em&gt; = .05) were associated significantly with 1-year mortality. No significant association was found between musculoskeletal indexes and FIM 7 days after ICU stay. Significant differences in SMI were found across discharge groups (χ&lt;sup&gt;2&lt;/sup&gt; (3) = 7.882; &lt;em&gt;P&lt;/em&gt; = .048).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;The results of this study suggest that decreased musculoskeletal indexes are associated with 1-year mortality in chronically critically ill patients. These findings may help to inform clinical decision-making.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Clinical Trial Registration&lt;/h3&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;ClinicalTrials.gov&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;; No.: &lt;span&gt;&lt;span&gt;NC","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100176"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852955","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":"Sepsis in Previously Healthy Adults","authors":"Fizza Manzoor MD,&nbsp;Michael Klompas MD, MPH,&nbsp;Chanu Rhee MD, MPH","doi":"10.1016/j.chstcc.2025.100172","DOIUrl":"10.1016/j.chstcc.2025.100172","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144749344","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 a Multicenter Randomized Trial of Ketamine vs Etomidate for Emergency Tracheal Intubation","authors":"Stephanie C. DeMasi MD ,&nbsp;Brant Imhoff MS ,&nbsp;Ariel A. Lewis BSN, RN, MPH ,&nbsp;Kevin P. Seitz MD ,&nbsp;Brian E. Driver MD ,&nbsp;Kevin W. Gibbs MD ,&nbsp;Adit A. Ginde MD, MPH ,&nbsp;Stacy A. Trent MD, MPH ,&nbsp;Derek W. Russell MD ,&nbsp;Amelia L. Muhs MD ,&nbsp;Matthew E. Prekker MD, MPH ,&nbsp;John P. Gaillard MD ,&nbsp;Daniel Resnick-Ault MD ,&nbsp;L. Jane Stewart MD, JD, MPH ,&nbsp;Micah R. Whitson MD ,&nbsp;Graham W.W. Van Schaik MD, MBA ,&nbsp;Aaron E. Robinson MD, MPH ,&nbsp;Jessica A. Palakshappa MD ,&nbsp;Neil R. Aggarwal MD, MHSc ,&nbsp;Jason C. Brainard MD ,&nbsp;Matthew W. Semler MD","doi":"10.1016/j.chstcc.2025.100177","DOIUrl":"10.1016/j.chstcc.2025.100177","url":null,"abstract":"<div><h3>Background</h3><div>Emergency tracheal intubation is a common and high-risk procedure. Ketamine and etomidate are medicines commonly used to induce anesthesia for emergency tracheal intubation, but whether the induction medication used affects patient outcomes is uncertain.</div></div><div><h3>Research Question</h3><div>Does the use of ketamine for induction of anesthesia decrease the incidence of death among adults undergoing emergency tracheal intubation compared with the use of etomidate?</div></div><div><h3>Study Design and Methods</h3><div>The Randomized Trial of Sedative Choice for Intubation (RSI) is a pragmatic, multicenter, unmasked, parallel-group randomized trial being conducted at 14 sites (6 emergency departments and 8 ICUs) in the United States. The trial compares ketamine vs etomidate for induction of anesthesia among 2,364 critically ill adults undergoing emergency tracheal intubation. The primary outcome is all-cause 28-day in-hospital mortality. The secondary outcome is the incidence of cardiovascular collapse during intubation, a composite of hypotension, receipt of vasopressors, and cardiac arrest.</div></div><div><h3>Results</h3><div>Enrollment began on April 6, 2022, and is expected to conclude in 2025.</div></div><div><h3>Interpretation</h3><div>The RSI will provide important data on the effects of ketamine vs etomidate on death and other outcomes for critically ill adults undergoing emergency tracheal intubation. Specifying the protocol and statistical analysis plan before the conclusion of enrollment increases the rigor, reproducibility, and transparency of the trial.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: NCT05277896; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100177"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830197","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":"Gastroesophageal Reflux Symptoms and Health-Related Quality of Life Among ICU Survivors","authors":"Sachin Wali MD, DNB, DM ,&nbsp;Mohan Gurjar MD ,&nbsp;Samir Mohindra MD, DM ,&nbsp;Prabhaker Mishra PhD ,&nbsp;Shreyas H. Gutte MD, DM ,&nbsp;Afzal Azim MD ,&nbsp;Jitendra S. Chahar MD ,&nbsp;Banani Poddar MD","doi":"10.1016/j.chstcc.2025.100169","DOIUrl":"10.1016/j.chstcc.2025.100169","url":null,"abstract":"<div><h3>Background</h3><div>Gastroesophageal reflux disease (GERD) is a common clinical condition in the general population. However, no prospective study is available to estimate the burden of gastroesophageal reflux symptoms (GERSs) among survivors of the ICU.</div></div><div><h3>Research Question</h3><div>What are the incidence and severity of GERSs among survivors of the ICU?</div></div><div><h3>Study Design and Methods</h3><div>This prospective observational study was conducted in a 20-bed ICU at a university hospital in India. All adult survivors of the ICU were screened for the presence of GERSs, defined as presence of heartburn, regurgitation symptoms, or both ≥ 2 times/wk. Exclusions were: Glasgow Coma Scale score of &lt; 15, presence of tracheostomy or feeding tube, open abdomen, and pregnancy. The severity of symptoms was assessed through the Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) score (range, 0-50, where 50 is worst) at 2 time points 6 weeks apart.</div></div><div><h3>Results</h3><div>During the study period, 116 patients were included, with a median age of 44 years (interquartile range [IQR], 26-59 years). Sixty-five patients (56%) were male, and the median admission Sequential Organ Failure Assessment score was 7 (IQR, 4-10). During the ICU stay, 59 patients (50.8%) required mechanical ventilation, 42 patients (36.2%) required vasopressors, and 11 patients (9.4%) received dialysis. Among them, 43 patients (37%) had history of GERSs before the illness. In the remaining 73 patients, 23 patients (31.5%) had new-onset GERSs. The use of medications known to increase the risk of GERD (eg, prednisolone, acetylsalicylic acid, and amlodipine) and the prolonged presence of a feeding tube were associated significantly with new-onset GERSs (OR, 4.49 [95% CI, 1.06-18.9; <em>P</em> = .04] and OR, 1.04 [95% CI, 1.00-1.09; <em>P</em> = .03]), respectively, even after adjusting for age and presence of preexisting known risk factors (diabetes, hypertension, and smoking and alcohol intake). The median GERD-HRQL score among patients with new-onset GERSs at follow-up decreased from 10 (IQR, 2-20) to 4 (IQR, 0-15; <em>P</em> = .01).</div></div><div><h3>Interpretation</h3><div>In this study, one-third of survivors of the ICU experienced new-onset GERSs. However, symptoms improved significantly at the 6-week follow-up.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>; No.: <span><span>NCT05193266</span><svg><path></path></svg></span>; URL: <span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span></div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890539","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 Snapshot of the Central Nervous System","authors":"Christina Boncyk MD, MPH ,&nbsp;Christopher G. Hughes MD","doi":"10.1016/j.chstcc.2025.100159","DOIUrl":"10.1016/j.chstcc.2025.100159","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100159"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144522752","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}