CHEST critical care最新文献

{"title":"Elevated Hemoglobin A1c and the Risk of Developing ARDS in Two Cohort Studies","authors":"","doi":"10.1016/j.chstcc.2024.100082","DOIUrl":"10.1016/j.chstcc.2024.100082","url":null,"abstract":"<div><h3>Background</h3><p>Only a subset of patients at risk for ARDS go on to develop it, and the contribution of preexisting comorbidities (eg, diabetes) to ARDS risk is not well understood. Prior studies of the association between diabetes and ARDS have yielded conflicting results.</p></div><div><h3>Research Question</h3><p>Does assessing ARDS risk based on hemoglobin A1c (HbA1c) as a marker of long-term blood glucose levels, rather than a charted diagnosis of diabetes, clarify the relationship between diabetes and ARDS?</p></div><div><h3>Study Design and Methods</h3><p>Using data from two prospective observational cohorts of critically ill adults (Validating Acute Lung Injury Biomarkers for Diagnosis [VALID] and Early Assessment of Renal and Lung Injury [EARLI]), we analyzed the association between clinical HbA1c category and development of ARDS in patients with a risk factor for ARDS and at least one clinical HbA1c measurement within the 180 days prior through 14 days after enrollment.</p></div><div><h3>Results</h3><p>A total of 599 patients in VALID and 276 in EARLI met inclusion criteria, of whom 164 and 58 developed ARDS, respectively. Patients with a charted diagnosis of diabetes were not shown to be more likely to develop ARDS (VALID: 24.6% ARDS in those categorized as nondiabetic vs 30.0% in those categorized as diabetic, <em>P</em> = .14; EARLI: 19.6% vs 22.8%, respectively; <em>P</em> = .55). However, in VALID, patients categorized as diabetic with inadequate glycemic control based on their HbA1c had an increased risk of developing ARDS compared with those with nondiabetic HbA1c (20.9% vs 34.0%, respectively; <em>P</em> = .0073), a finding that persisted in multivariable analysis (OR for those categorized as diabetic with inadequate glycemic control vs those categorized as nondiabetic range HbA1c, 1.25; 95% CI, 1.01-1.57). These findings were not reproduced in the smaller EARLI cohort, but were appreciated when the cohorts were combined for analysis.</p></div><div><h3>Interpretation</h3><p>Elevated HbA1c may be associated with risk of developing ARDS, independent of clinical diagnosis of diabetes, but prospective validation is needed. If confirmed, these findings suggest that inadequate glycemic control could be an unrecognized risk factor for ARDS.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 3","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000364/pdfft?md5=5bbe0c5796bf31738e810f7557810907&pid=1-s2.0-S2949788424000364-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141057536","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":"Potential Value of the Radiographic Assessment of Lung Edema Score to Assess Resolution of Pulmonary Edema in a Clinical Trial in ARDS","authors":"Matthieu Jabaudon MD, PhD ,&nbsp;Melissa A. Warren MD ,&nbsp;Tatsuki Koyama PhD ,&nbsp;Philip Lavin PhD, FASA, FRAPS ,&nbsp;Jonathan C. Javitt MD, MPH ,&nbsp;Melvin L. Morganroth MD ,&nbsp;Marc Korczykowski MSc ,&nbsp;John W. Hollingsworth MD ,&nbsp;Richard A. Lee MD ,&nbsp;Jihad G. Youssef MD ,&nbsp;Lorraine B. Ware MD","doi":"10.1016/j.chstcc.2024.100081","DOIUrl":"10.1016/j.chstcc.2024.100081","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 3","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000352/pdfft?md5=e84ccb995b76e97e34d56cda15ee1e4a&pid=1-s2.0-S2949788424000352-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141038967","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":"Cancellation and Resumption of Elective Surgeries Over Time Across a National Sample of US Hospitals During the COVID-19 Pandemic","authors":"Kelly C. Vranas MD, MCR ,&nbsp;Deena Kelly Costa PhD, RN ,&nbsp;Billie S. Davis PhD ,&nbsp;Andrew J. Admon MD, MPH ,&nbsp;Bo Zhao PhD ,&nbsp;Jeremy M. Kahn MD ,&nbsp;Meeta Prasad Kerlin MD, MSCE","doi":"10.1016/j.chstcc.2024.100080","DOIUrl":"10.1016/j.chstcc.2024.100080","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 3","pages":"Article 100080"},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000340/pdfft?md5=e47b1ef03c869bddea88c72279f99b38&pid=1-s2.0-S2949788424000340-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141033775","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":"Ideal Postdischarge Follow-Up After Severe Pneumonia or Acute Respiratory Failure","authors":"Katrina E. Hauschildt PhD, BCPA ,&nbsp;Stephanie Parks Taylor MD ,&nbsp;Catherine L. Hough MD, MSc ,&nbsp;Melissa deCardi Hladek PhD, CRNP, FNP-BC ,&nbsp;Eliana M. Perrin MD, MPH ,&nbsp;Theodore J. Iwashyna MD, PhD","doi":"10.1016/j.chstcc.2024.100079","DOIUrl":"10.1016/j.chstcc.2024.100079","url":null,"abstract":"<div><h3>Background</h3><p>Most patients discharged after hospitalization for severe pneumonia or acute respiratory failure receive follow-up care from primary care clinicians, yet guidelines are sparse.</p></div><div><h3>Research Question</h3><p>What do primary care clinicians consider to be ideal follow-up care after hospitalization for severe pneumonia or acute respiratory failure and what do they perceive to be barriers and facilitators to providing ideal follow-up?</p></div><div><h3>Study Design and Methods</h3><p>We conducted, via videoconferencing, semistructured interviews of 20 primary care clinicians working in diverse settings from five US states and Washington, DC. Participants described postdischarge visits, ongoing follow-up, and referrals for patients recovering from hospitalizations for pneumonia or respiratory failure bad enough to be hospitalized and to require significant oxygen support or seeking treatment at the ICU. Barriers and facilitators were probed using the capability, opportunity, motivation, behavior framework. Interview summaries and rigorous and accelerated data reduction analysis techniques were used.</p></div><div><h3>Results</h3><p>Core elements of primary care follow-up after severe pneumonia or acute respiratory failure included safety assessment, medication management, medical specialty follow-up, integrating the hospitalization into the primary care relationship, assessing mental and physical well-being, rehabilitation follow-up, and social context of recovery. Clinicians described specific practices as well as barriers and facilitators at multiple levels to optimal care.</p></div><div><h3>Interpretation</h3><p>Our findings suggest that at least seven core elements are common in follow-up care after severe pneumonia or acute respiratory failure, and conventional systems include barriers and facilitators to delivering what primary care clinicians consider to be optimal follow-up care. Future research could leverage identified barriers and facilitators to develop implementation tools that enhance the delivery of robust follow-up care for severe pneumonia or acute respiratory failure.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 3","pages":"Article 100079"},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000339/pdfft?md5=9b4a5bbc67e074d68b2b0ab779d32583&pid=1-s2.0-S2949788424000339-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141050268","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":"Vulnerabilities During and After Critical Illness","authors":"Valerie Danesh PhD ,&nbsp;Jason A. Ettlinger MA","doi":"10.1016/j.chstcc.2024.100078","DOIUrl":"10.1016/j.chstcc.2024.100078","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 3","pages":"Article 100078"},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000327/pdfft?md5=a7810b0cad00ac52ebbab342e116f3f7&pid=1-s2.0-S2949788424000327-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141054164","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":"Neuroprognostication After Cardiac Arrest","authors":"Julie Kromm MD ,&nbsp;Andrea Davenport MD ,&nbsp;M. Elizabeth Wilcox MD, PhD","doi":"10.1016/j.chstcc.2024.100074","DOIUrl":"https://doi.org/10.1016/j.chstcc.2024.100074","url":null,"abstract":"<div><p>Cardiac arrest is a significant cause of mortality and morbidity. Despite advances in technologies and resuscitative care, patients who remain comatose after cardiac arrest present the bedside clinician with both diagnostic and therapeutic uncertainty because of variable comfort with how best to neuroprognosticate. Recent guidelines attempt to address existing knowledge gaps; however, significant variability remains in clinical practice, including the application of guideline recommendations at the bedside. We present a case-based discussion to illustrate key principles for early care and a subsequent approach to neuroprognostication. We explore many of the clinical nuances in neuroprognostication, including the utility of the clinical examination combined with either neuroimaging or neurophysiologic studies, in helping to care for these patients and support their families in decision-making processes. We discuss how a multimodal approach to neuroprognostication may be subject to site-specific availability of testing. Furthermore, how to incorporate the multidisciplinary team in patient care, including subspecialty services such as neurology and palliative care, is discussed when faced with complex clinical situations.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 3","pages":"Article 100074"},"PeriodicalIF":0.0,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000285/pdfft?md5=d6b7c02d66b922ee66f65a1255205ac5&pid=1-s2.0-S2949788424000285-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141303588","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: Schott CK, Wetherbee E, Khosla R, et al. CHEST Critical Care. 2023;1(2):100012","authors":"","doi":"10.1016/j.chstcc.2024.100077","DOIUrl":"https://doi.org/10.1016/j.chstcc.2024.100077","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100077"},"PeriodicalIF":0.0,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000315/pdfft?md5=642bf9fca9518e08e47fb83ade5bfaf3&pid=1-s2.0-S2949788424000315-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141084227","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":"Platelet Bioenergetics and Associations With Delirium and Coma in Patients With Sepsis","authors":"Chukwudi A. Onyemekwu DO ,&nbsp;Niall T. Prendergast MD ,&nbsp;Kelly M. Potter PhD ,&nbsp;Nicole A. Toney MPH ,&nbsp;Mehdi S. Nouraie MD, PhD ,&nbsp;Sruti Shiva PhD ,&nbsp;Timothy D. Girard MD, MSCI","doi":"10.1016/j.chstcc.2024.100076","DOIUrl":"https://doi.org/10.1016/j.chstcc.2024.100076","url":null,"abstract":"<div><h3>Background</h3><p>Acute brain dysfunction during sepsis, which manifests as delirium or coma, is common and is associated with multiple adverse outcomes, including longer periods of mechanical ventilation, prolonged hospital stays, and increased mortality. Delirium and coma during sepsis may be manifestations of alteration in systemic metabolism. Because access to brain mitochondria is a limiting factor, measurement of peripheral platelet bioenergetics offers a potential opportunity to understand metabolic changes associated with acute brain dysfunction during sepsis.</p></div><div><h3>Research Question</h3><p>Are altered platelet mitochondrial bioenergetics associated with acute brain dysfunction during sepsis?</p></div><div><h3>Study Design and Methods</h3><p>We assessed participants with critical illness in the ICU for the presence of delirium or coma via validated assessment measures. Blood samples were collected and processed to isolate and measure platelet mitochondrial oxygen consumption. We used Seahorse extracellular flux to measure directly baseline, proton leak, maximal oxygen consumption rate, and extracellular acidification rate. We calculated adenosine triphosphate-linked, spare respiratory capacity, and nonmitochondrial oxygen consumption rate from the measured values.</p></div><div><h3>Results</h3><p>Maximum oxygen consumption was highest in patients with coma, as was spare respiratory capacity and extracellular acidification rate in unadjusted analysis. After adjusting for age, sedation, modified Sequential Organ Failure Assessment score without the neurologic component, and preexisting cognitive function, increased spare respiratory capacity remained associated with coma. Delirium was not associated with any platelet mitochondrial bioenergetics.</p></div><div><h3>Interpretation</h3><p>In this single-center exploratory prospective cohort study, we found that increased platelet mitochondrial spare respiratory capacity was associated with coma in patients with sepsis. Future studies powered to determine any relationship between delirium and mitochondrial respiration bioenergetics are needed.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100076"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000303/pdfft?md5=9eccba4c611878cb0ee3ee22a907d272&pid=1-s2.0-S2949788424000303-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141095962","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":"Qualitative Insights Into Patients' and Family Members’ Experiences of In-Hospital Medication Management After a Critical Care Episode","authors":"Richard S. Bourne PhD ,&nbsp;Mark Jeffries PhD ,&nbsp;Eleanor Meakin MSc ,&nbsp;Ross Norville ,&nbsp;Darren M. Ashcroft PhD","doi":"10.1016/j.chstcc.2024.100072","DOIUrl":"10.1016/j.chstcc.2024.100072","url":null,"abstract":"<div><h3>Background</h3><p>Patient recovery after a critical illness can be protracted, requiring a care continuum that extends along a patient pathway from the critical care unit, hospital ward, and into the community care setting. High-quality care on patient transfer from critical care, including medication safety, is facilitated by education for patients and families, family engagement, support systems, and health care professional (HCP)-patient communication. Currently, uncertainty exists regarding how HCPs can and should engage with critical care patients and family members about their medication.</p></div><div><h3>Research Question</h3><p>What are the views and experiences of critical care patients and family members about their involvement in, communication about, understanding of, and decision-making related to their medication after transfer from critical care to the hospital ward?</p></div><div><h3>Study Design and Methods</h3><p>This qualitative study used semistructured interviews, conducted with critical care patients and family members after transfer from critical care to a hospital ward in a large National Health Service hospital trust. Anonymized transcripts of interviews were analyzed thematically using a coding framework developed from understandings of patient and family engagement in medication administration.</p></div><div><h3>Results</h3><p>Twenty-seven participants (15 patients and 12 family members of patients) completed the interviews. We identified five themes and 15 subthemes, providing an overview of patients’ and family members’ views on medication management during acute illness and ongoing recovery. Themes identified were: impact of acute illness and treatment burden on preexisting illness, preexisting knowledge and capability, beliefs about persons roles and expectations, care continuity and individualized information exchange, and engagement in practice.</p></div><div><h3>Interpretation</h3><p>This study demonstrated that critical care patients and family members want to engage with HCPs about medication administration. HCPs must take an individualized approach to communication and timing, acknowledging the dynamic interplay between patients and family members, using multimodal forms of communication.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100072"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000261/pdfft?md5=4408a026036715241b54733ad088c86c&pid=1-s2.0-S2949788424000261-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140790338","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":"Intent, Interpretation, and Influence of Do-Not-Resuscitate Orders","authors":"Thomas S. Valley MD","doi":"10.1016/j.chstcc.2024.100070","DOIUrl":"10.1016/j.chstcc.2024.100070","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100070"},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000248/pdfft?md5=b70992b445be96f498cb5557b504c8e2&pid=1-s2.0-S2949788424000248-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775029","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}