CHEST critical care最新文献

{"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}

{"title":"“Mitolocalization”","authors":"Bryan D. Kraft MD","doi":"10.1016/j.chstcc.2024.100073","DOIUrl":"10.1016/j.chstcc.2024.100073","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100073"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000273/pdfft?md5=cfe56cd4d8464818840a4903a8c1d1be&pid=1-s2.0-S2949788424000273-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140759025","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":"Prone Positioning for ARDS","authors":"Elizabeth Levy MD ,&nbsp;Meeta Prasad Kerlin MD, MSCE","doi":"10.1016/j.chstcc.2024.100069","DOIUrl":"10.1016/j.chstcc.2024.100069","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100069"},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000236/pdfft?md5=307a36a208d4740352088098f3c1b00b&pid=1-s2.0-S2949788424000236-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140765342","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":"Extracorporeal Support in Adults With Status Asthmaticus","authors":"Samuel H. Belok MD ,&nbsp;Alexandros Karavas MD ,&nbsp;Jamel Ortoleva MD","doi":"10.1016/j.chstcc.2024.100066","DOIUrl":"10.1016/j.chstcc.2024.100066","url":null,"abstract":"<div><p>Status asthmaticus is refractory bronchospasm that can result in hypercarbia, altered mental status, respiratory failure, hypoxemia, and death. The care of patients with status asthmaticus often requires care in the ICU and, in rare circumstances, consideration of extracorporeal membrane oxygenation (ECMO) or extracorporeal CO₂ removal support. Compared with ARDS, status asthmaticus is a relatively rare indication for venovenous ECMO and, to our knowledge, its use has not been examined in prospective multicenter studies. As ECMO becomes more widely available, it may be valuable for providers to understand better its role in the management of status asthmaticus. In this edition of “How I Do It,” we provide a case example of life-threatening status asthmaticus to discuss unique considerations in the care of these patients with this complex disease.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100066"},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000200/pdfft?md5=7e287928f37d13b569263d65331017c1&pid=1-s2.0-S2949788424000200-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140398815","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":"Sedation-Ventilation Interaction in Acute Hypoxemic Respiratory Failure","authors":"Jose Dianti MD ,&nbsp;Idunn S. Morris MD ,&nbsp;Thiago G. Bassi MD, PhD ,&nbsp;Eddy Fan MD, PhD ,&nbsp;Arthur S. Slutsky MD ,&nbsp;Laurent J. Brochard MD ,&nbsp;Niall D. Ferguson MD ,&nbsp;Ewan C. Goligher MD, PhD","doi":"10.1016/j.chstcc.2024.100067","DOIUrl":"10.1016/j.chstcc.2024.100067","url":null,"abstract":"<div><h3>Background</h3><p>Ventilation and sedation are used for the management of acute hypoxemic respiratory failure (AHRF), but their optimal combination to minimize the risks of ventilation is not well understood.</p></div><div><h3>Research Question</h3><p>What are the individual effects and interactions of inspiratory and positive end-expiratory pressure (PEEP), sedation, and venovenous extracorporeal membrane oxygenation (VV-ECMO) on respiratory drive, effort, and lung-distending pressure in patients with AHRF triggering the ventilator?</p></div><div><h3>Study Design and Methods</h3><p>In this secondary exploratory analysis of a trial of lung and diaphragm protection in AHRF, inspiratory pressure, sedation, PEEP, and VV-ECMO were titrated while respiratory drive (airway pressure in the first 100 ms [P_0.1]), effort (esophageal pressure swing [|ΔPes|]), and lung-distending pressure (dynamic transpulmonary driving pressure [ΔP_L,dyn]) were recorded. Associations were evaluated using linear mixed-effects regression models including prespecified terms for potential interactions.</p></div><div><h3>Results</h3><p>The study included 223 individual measurements of P_0.1 and 235 individual measurements of |ΔPes| and ΔP_L,dyn from 30 patients. Propofol-attenuated P_0.1 (–0.4 cm H₂O; 95% CI, –0.3 to –0.1 cm H₂O per 10-μm/kg/min increase), |ΔPes| (–2.5 cm H₂O; 95% CI, –3.4 to –1.7 cm H₂O per 10-μm/kg/min increase), and ΔP_L,dyn (–1.6 cm H₂O; 95% CI, –2.3 to –0.8 cm H₂O per 10-μm/kg/min increase). The effect of inspiratory pressure on |ΔPes| varied depending on propofol dose: with higher propofol dose, inspiratory pressure resulted in higher ΔP_L,dyn. With VV-ECMO, patients (n = 16) showed significantly lower |ΔPes| (–10 cm H₂O; 95% CI, –17.5 to –2.5 cm H₂O) and required less sedation to reduce |ΔPes| than without VV-ECMO (n = 14).</p></div><div><h3>Interpretation</h3><p>Mechanical ventilation, sedation, and VV-ECMO exert interdependent effects on respiratory drive, effort, and lung-distending pressure in AHRF. Patients receiving VV-ECMO require less sedation to control respiratory effort.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100067"},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000212/pdfft?md5=f25e6e71a95a38d7f7f3ab9c096599d1&pid=1-s2.0-S2949788424000212-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406475","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":"Protein Interaction Assessing Mitochondrial Biogenesis as a Next Generation Biomarker in Sepsis","authors":"Patrick Thon PhD ,&nbsp;Ellen Trübner MD ,&nbsp;Frieda Zimmer MD ,&nbsp;Lars Palmowski MD ,&nbsp;Stefan F. Ehrentraut MD ,&nbsp;Christian Putensen MD ,&nbsp;Dietrich Henzler MD ,&nbsp;Elke Schwier PhD ,&nbsp;Andrea Witowski MD ,&nbsp;Britta Marko MD ,&nbsp;Dominik Ziehe PhD ,&nbsp;Hartmuth Nowak MD ,&nbsp;Katharina Rump PhD ,&nbsp;Lars Bergmann MD ,&nbsp;Alexander Wolf MD ,&nbsp;Matthias Unterberg MD ,&nbsp;Michael Adamzik MD ,&nbsp;Björn Koos PhD ,&nbsp;Tim Rahmel MD ,&nbsp;SepsisDataNet.NRW Study Group","doi":"10.1016/j.chstcc.2024.100065","DOIUrl":"10.1016/j.chstcc.2024.100065","url":null,"abstract":"<div><h3>Background</h3><p>Metabolic derangements in sepsis stem from mitochondrial injury and contribute to organ dysfunction and mortality. Thus, repair of mitochondrial damage seems pivotal for recovery and determining clinical outcome in sepsis. However, reliable biomarkers assessing mitochondrial repair noninvasively in peripheral blood are currently lacking.</p></div><div><h3>Research Question</h3><p>Are different gene transcripts related to mitochondrial repair (ie, biogenesis, fusion, fission, mitophagy) and the protein interaction assessing mitochondrial biogenesis, both measured in peripheral blood, associated with disease severity and clinical outcome?</p></div><div><h3>Study Design and Methods</h3><p>Healthy control patients (n = 22), uninfected critically ill control patients (n = 13), and patients with sepsis (n = 75) were included in this prospective multicentric observational study. Gene products of mitochondrial quality control and mitochondrial DNA were measured on day 1 and 4 in peripheral blood mononuclear cells. In addition, we assessed in the same samples the mitochondrial protein interaction of mitochondrial transcription factor A (TFAM)-mitochondrial transcription factor B2 (TFB2M) using a proximity ligation assay. Patients with sepsis were stratified in the outcome-related subgroups ICU-free within 1 week (n = 16), not ICU-free within 1 week (n = 36), and 30-day nonsurvivors (n = 23).</p></div><div><h3>Results</h3><p>Transcript levels of the assessed messenger RNA markers of patients with sepsis were not associated with disease severity nor did they predict clinical outcome. Strikingly, the mitochondrial protein interaction of TFAM-TFB2M on day 4 (<em>P</em> &lt; .05) and the difference between day 1 and 4 (<em>P</em> &lt; .001) allowed stratification in the three clinical outcome subgroups. In addition, a decline in TFAM-TFB2M protein interactions between day 1 and 4 was an independent predicator for 30-day mortality (adjusted hazard ratio, 8.34; 95% CI, 2.73-25.45; <em>P</em> &lt; .001).</p></div><div><h3>Interpretation</h3><p>Patients with sepsis with an early activation of mitochondrial biogenesis were more likely to be ICU-free within 1 week. A mitochondrial and clinical recovery can be assessed via the protein interaction of TFAM-TFB2M in peripheral blood. Thus, mitochondrial protein interactions targeting mitochondrial biogenesis provide a promising dimension of novel biomarkers assessing mitochondrial dysfunction in sepsis.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100065"},"PeriodicalIF":0.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000194/pdfft?md5=d001c5ce7e33801b5e4829bf22002e7d&pid=1-s2.0-S2949788424000194-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140283400","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":"Progressive Encephalopathy With New Pulmonary Opacities in an Immunocompromised Host","authors":"Marika Orlov MD, PhD ,&nbsp;Andrew T. Pham MD ,&nbsp;Dan Merrick MD ,&nbsp;Markus Wu MD ,&nbsp;Sias Scherger MD ,&nbsp;Tanya Marvi MD ,&nbsp;Arun Kannappan MD","doi":"10.1016/j.chstcc.2024.100064","DOIUrl":"10.1016/j.chstcc.2024.100064","url":null,"abstract":"<div><h3>Case Presentation</h3><p>A 48-year-old man with history of recent travel to central Mexico and immunosuppression sought treatment with a 1-month-long history of progressive headache, fatigue, word-finding difficulties, and night sweats. The patient had a history of end-stage renal disease; he had undergone a kidney transplantation 7 years prior with good graft function with immunosuppression with tacrolimus, everolimus, and low-dose prednisone. At an outside hospital, he recently had been treated with empiric antibiotics for meningitis, but these were discontinued given the low suspicion for a bacterial cause. After discharge, he continued to have headaches, limited oral intake, persistent nausea, urinary frequency, and falls, prompting him to seek treatment at the ED. Physical examination findings were benign aside from disorientation. Laboratory workup was significant for hyponatremia of 122 mM, creatinine of 1.4 mg/dL (baseline, 1.4-1.5 mg/dL), WBC count of 7.2 10⁹/L, hemoglobin of 13 g/dL, and platelet count of 349 10⁹/L. Neither tacrolimus nor everolimus levels were supratherapeutic.</p></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"2 2","pages":"Article 100064"},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949788424000182/pdfft?md5=617f09c10c4baecdf6ac902705093b61&pid=1-s2.0-S2949788424000182-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273092","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}