CHEST critical care最新文献

{"title":"Integrating Social Determinants of Health in Critical Care","authors":"Deepa Ramadurai MD ,&nbsp;Heta Patel BS ,&nbsp;Summer Peace BA ,&nbsp;Justin T. Clapp PhD, MPH ,&nbsp;Joanna L. Hart MD, MSHP","doi":"10.1016/j.chstcc.2024.100057","DOIUrl":"10.1016/j.chstcc.2024.100057","url":null,"abstract":"<div><h3>Background</h3><p>Social determinants of health (SDOHs) mediate outcomes of critical illness. Increasingly, professional organizations recommend screening for social risks. Yet, how clinicians should identify and then incorporate SDOHs into acute care practice is poorly defined.</p></div><div><h3>Research Question</h3><p>How do medical ICU clinicians currently operationalize SDOHs within patient care, given that SDOHs are known to mediate outcomes of critical illness?</p></div><div><h3>Study Design and Methods</h3><p>Using ethnographic methods, we observed clinical work rounds in three urban ICUs within a single academic health system to capture use of SDOHs during clinical care. Adults admitted to the medical ICU with respiratory failure were enrolled prospectively sequentially. Observers wrote field notes and narrative excerpts from rounding observations. We also reviewed electronic medical record documentation for up to 90 days after ICU admission. We then qualitatively coded and triangulated data using a constructivist grounded theory approach and the Centers for Disease Control and Prevention Healthy People SDOHs framework.</p></div><div><h3>Results</h3><p>Sixty-six patients were enrolled and &gt; 200 h of observation of clinical work rounds were included in the analysis. ICU clinicians infrequently integrated social structures of patients’ lives into their discussions. Social structures were invoked most frequently when related to: (1) causes of acute respiratory failure, (2) decisions regarding life-sustaining therapies, and (3) transitions of care. Data about common SDOHs were not collected in any systematic way (eg, food and housing insecurity), and some SDOHs were discussed rarely or never (eg, access to education, discrimination, and incarceration).</p></div><div><h3>Interpretation</h3><p>We found that clinicians do not incorporate many areas of known SDOHs into ICU rounds. Improvements in integration of SDOHs should leverage the multidisciplinary team, identifying who is best suited to collect information on SDOHs during different time points in critical illness. Next steps include clinician-focused, patient-focused, and caregiver-focused assessments of feasibility and acceptability of an ICU-based SDOHs assessment.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100057"},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294978842400011X/pdfft?md5=43c7735b0fc3930b46dd348f980f579f&pid=1-s2.0-S294978842400011X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140466691","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":"Exposure Ascertainment of Alcohol Use in Critical Illness","authors":"Rachel M. Bennett MD ,&nbsp;John P. Reilly MD, MSCE","doi":"10.1016/j.chstcc.2024.100055","DOIUrl":"10.1016/j.chstcc.2024.100055","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100055"},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000091/pdfft?md5=38836744b234a6396e049e8d98e2722d&pid=1-s2.0-S2949788424000091-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139813528","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":"Circulating Biomarkers of Endothelial Dysfunction Associated With Ventilatory Ratio and Mortality in ARDS Resulting From SARS-CoV-2 Infection Treated With Antiinflammatory Therapies","authors":"Jehan W. Alladina MD ,&nbsp;Francesca L. Giacona BA ,&nbsp;Alexis M. Haring BA ,&nbsp;Kathryn A. Hibbert MD ,&nbsp;Benjamin D. Medoff MD ,&nbsp;Eric P. Schmidt MD ,&nbsp;Taylor Thompson MD ,&nbsp;Bradley A. Maron MD ,&nbsp;George A. Alba MD","doi":"10.1016/j.chstcc.2024.100054","DOIUrl":"10.1016/j.chstcc.2024.100054","url":null,"abstract":"<div><h3>Background</h3><p>The association of plasma biomarkers and clinical outcomes in ARDS resulting from SARS-CoV-2 infection predate the evidence-based use of immunomodulators.</p></div><div><h3>Research Question</h3><p>Which plasma biomarkers are associated with clinical outcomes in patients with ARDS resulting from SARS-CoV-2 infection treated routinely with immunomodulators?</p></div><div><h3>Study Design and Methods</h3><p>We collected plasma from patients with ARDS resulting from SARS-CoV-2 infection within 24 h of admission to the ICU between December 2020 and March 2021 (N = 69). We associated 16 total biomarkers of inflammation (eg, IL-6), coagulation (eg, D-dimer), epithelial injury (eg, surfactant protein D), and endothelial injury (eg, angiopoietin-2) with the primary outcome of in-hospital mortality and secondary outcome of ventilatory ratio (at baseline and day 3).</p></div><div><h3>Results</h3><p>Thirty patients (43.5%) died within 60 days. All patients received corticosteroids and 6% also received tocilizumab. Compared with survivors, nonsurvivors demonstrated a higher baseline modified Sequential Organ Failure Assessment score (median, 8.5 [interquartile range (IQR), 7-9] vs 7 [IQR, 5-8]); <em>P</em> = .004), lower Pa<span>o</span>₂ to F<span>io</span>₂ ratio (median, 153 [IQR, 118-182] vs 184 [IQR, 142-247]; <em>P</em> = .04), and higher ventilatory ratio (median, 2.0 [IQR, 1.9-2.3] vs 1.5 [IQR, 1.4-1.9]; <em>P</em> &lt; .001). No difference was found in inflammatory, coagulation, or epithelial biomarkers between groups. Nonsurvivors showed higher median neural precursor cell expressed, developmentally down-regulated 9 (NEDD9) levels (median, 8.4 ng/mL [IQR, 7.0-11.2 ng/mL] vs 6.9 ng/mL [IQR, 5.5-8.0 ng/mL]; <em>P</em> = .0025), von Willebrand factor domain A2 levels (8.7 ng/mL [IQR, 7.9-9.7 ng/mL] vs 6.5 ng/mL [IQR, 5.7-8.7 ng/mL]; <em>P</em> = .007), angiopoietin-2 levels (9.0 ng/mL [IQR, 7.9-14.1 ng/mL] vs 7.0 ng/mL [IQR, 5.6-10.6 ng/mL]; <em>P</em> = .01), and syndecan-1 levels (15.9 ng/mL [IQR, 14.5-17.5 ng/mL] vs 12.6 ng/mL [IQR, 10.5-16.1 ng/mL]; <em>P</em> = .01). Only NEDD9 level met the adjusted threshold for significance (<em>P</em> &lt; .003). Plasma NEDD9 level was associated with 60-day mortality (adjusted OR, 9.7; 95% CI, 1.6-60.4; <em>P</em> = .015). Syndecan-1 level correlated with both baseline (ρ = 0.4; <em>P</em> = .001) and day 3 ventilatory ratio (ρ = 0.5; <em>P</em> &lt; .001).</p></div><div><h3>Interpretation</h3><p>Biomarkers of inflammation, coagulation, and epithelial injury were not associated with clinical outcomes in a small cohort of patients with ARDS uniformly treated with immunomodulators. However, endothelial biomarkers, including plasma NEDD9, were associated with 60-day mortality.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100054"},"PeriodicalIF":0.0,"publicationDate":"2024-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294978842400008X/pdfft?md5=35b37476cd22672e512be05ff829f5de&pid=1-s2.0-S294978842400008X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139816672","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":"Benzodiazepines and Hospital-Level Sedation Practices Continue to Impact Outcomes","authors":"Christina S. Boncyk MD, MPH,&nbsp;Christopher G. Hughes MD","doi":"10.1016/j.chstcc.2024.100052","DOIUrl":"10.1016/j.chstcc.2024.100052","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100052"},"PeriodicalIF":0.0,"publicationDate":"2024-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000066/pdfft?md5=e5d8ca1f7136d5593539fd57334b4d21&pid=1-s2.0-S2949788424000066-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139888056","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":"Benzodiazepines and Hospital-Level Sedation Practices Continue to Impact Outcomes","authors":"C. Boncyk, Christopher G. Hughes","doi":"10.1016/j.chstcc.2024.100052","DOIUrl":"https://doi.org/10.1016/j.chstcc.2024.100052","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"59 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139828233","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":"Exposure ascertainment of alcohol use in critical illness: the path to PEth","authors":"Rachel M. Bennett, John P. Reilly","doi":"10.1016/j.chstcc.2024.100055","DOIUrl":"https://doi.org/10.1016/j.chstcc.2024.100055","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"31 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139873355","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":"Physician Perspectives on Challenges in Understanding Patient Preferences for Emergency Intubation: A Qualitative Assessment of Hospital Code Status Orders","authors":"Emily J. Shearer, Jacob A. Blythe, S. Wieten, Elizabeth W. Dzeng, Miriam P. Cotler, Karin B. Porter-Williamson, Joshua B. Kayser, Stephanie M. Harman, David C. Magnus, J. Batten","doi":"10.1016/j.chstcc.2024.100053","DOIUrl":"https://doi.org/10.1016/j.chstcc.2024.100053","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"17 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139879767","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":"Physician Perspectives on Challenges in Understanding Patient Preferences for Emergency Intubation: A Qualitative Assessment of Hospital Code Status Orders","authors":"Emily J. Shearer, Jacob A. Blythe, S. Wieten, Elizabeth W. Dzeng, Miriam P. Cotler, Karin B. Porter-Williamson, Joshua B. Kayser, Stephanie M. Harman, David C. Magnus, J. Batten","doi":"10.1016/j.chstcc.2024.100053","DOIUrl":"https://doi.org/10.1016/j.chstcc.2024.100053","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"54 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139819998","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":"Circulating biomarkers of endothelial dysfunction associate with ventilatory ratio and mortality in acute respiratory distress syndrome due to SARS-CoV-2 infection treated with anti-inflammatory therapies","authors":"J. Alladina, F. Giacona, Alexis M. Haring, K. Hibbert, B. Medoff, Eric P. Schmidt, Taylor Thompson, Bradley A. Maron, G. A. Alba","doi":"10.1016/j.chstcc.2024.100054","DOIUrl":"https://doi.org/10.1016/j.chstcc.2024.100054","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"23 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139876624","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":"Process of Withdrawal of Mechanical Ventilation at End of Life in the ICU","authors":"Ava Ferguson Bryan MD, MPH ,&nbsp;Amanda J. Reich PhD, MPH ,&nbsp;Andrea C. Norton BM ,&nbsp;Margaret L. Campbell PhD, RN ,&nbsp;Richard M. Schwartzstein MD ,&nbsp;Zara Cooper MD ,&nbsp;Douglas B. White MD ,&nbsp;Susan L. Mitchell MD, MPH ,&nbsp;Corey R. Fehnel MD, MPH","doi":"10.1016/j.chstcc.2024.100051","DOIUrl":"10.1016/j.chstcc.2024.100051","url":null,"abstract":"<div><h3>Background</h3><p>Nearly one-quarter of all Americans die in the ICU. Many of their deaths are anticipated and occur following the withdrawal of mechanical ventilation (WMV). However, there are few data on which to base best practices for interdisciplinary ICU teams to conduct WMV.</p></div><div><h3>Research Question</h3><p>What are the perceptions of current WMV practices among ICU clinicians, and what are their opinions of processes that might improve the practice of WMV at end of life in the ICU?</p></div><div><h3>Study Design and Methods</h3><p>This prospective two-center observational study conducted in Boston, Massachusetts, the Observational Study of the Withdrawal of Mechanical Ventilation (OBSERVE-WMV) was designed to better understand the perspectives of clinicians and experience of patients undergoing WMV. This report focuses on analyses of qualitative data obtained from in-person surveys administered to the ICU clinicians (nurses, respiratory therapists, and physicians) caring for these patients. Surveys assessed a broad range of clinician perspectives on planning, as well as the key processes required for WMV. This analysis used independent open, inductive coding of responses to open-ended questions. Initial codes were reconciled iteratively and then organized and interpreted using a thematic analysis approach. Opinions were assessed on how WMV could be improved for individual patients and the ICU as a whole.</p></div><div><h3>Results</h3><p>Among 456 eligible clinicians, 312 in-person surveys were completed by clinicians caring for 152 patients who underwent WMV. Qualitative analyses identified two main themes characterizing high-quality WMV processes: (1) good communication (eg, mutual understanding of family preferences) between the ICU team and family; and (2) medical management (eg, planning, availability of ICU team) that minimizes patient distress. Team member support was identified as an essential process component in both themes.</p></div><div><h3>Interpretation</h3><p>Clinician perceptions of the appropriateness or success of WMV prioritize the quality of team and family communication and patient symptom management. Both are modifiable targets of interventions aimed at optimizing overall WMV.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100051"},"PeriodicalIF":0.0,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000054/pdfft?md5=6f57aac2781996dcaadec16f7775d7cd&pid=1-s2.0-S2949788424000054-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632635","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}