Chest最新文献

{"title":"Characteristic Pulmonary Impedance With Exercise Detects Abnormal Pulmonary Vascular Response and Uncoupling in Pulmonary Hypertension Resulting From Heart Failure With Preserved Ejection Fraction.","authors":"Christopher G Lechuga, Farhan Raza, Mitchel J Colebank, Claudia E Korcarz, Aimee T Broman, Jens C Eickhoff, Naomi C Chesler","doi":"10.1016/j.chest.2025.02.019","DOIUrl":"10.1016/j.chest.2025.02.019","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hypertension (PH) resulting from heart failure with preserved ejection fraction (PH-HFpEF) can lead to right ventricular-pulmonary arterial (RV-PA) uncoupling despite normal steady hemodynamics (eg, pulmonary vascular resistance). Unsteady hemodynamics, quantified by characteristic pulmonary impedance (Z_C), may be useful in differentiating those patients with PH-HFpEF who have sufficient coupling from those who have insufficient coupling. We hypothesized that abnormal pulsatile hemodynamics with exercise, quantified by Z_C, precisely detect abnormal cardiopulmonary function in PH-HFpEF.</p><p><strong>Research question: </strong>Can Z_C with exercise detect abnormal pulmonary vascular response and RV-PA uncoupling in PH-HFpEF?</p><p><strong>Study design and methods: </strong>Our approach was pilot tested in a small cohort of patients with PH-HFpEF (n = 8), precapillary PH (n = 5), and no PH (n = 2) who underwent rest-exercise (every 25 W)-recovery testing with repeated measurements of characteristic impedance (Z_C, from invasive cardiopulmonary exercise and echocardiography for pulmonary vascular pressure flow) and coupling (end systolic elastance [E_es] to effective arterial elastance [E_a] ratio, from right ventricle [RV] pressure-volume loops). Analysis included disease-specific autoregressive correlation structure of order 1 (for repeated measures in time-series analysis).</p><p><strong>Results: </strong>Metrics of steady pulmonary hemodynamics with exercise changed in a similar fashion in the two disease groups. In contrast, at rest in PH-HFpEF (vs precapillary PH), Z_C was low (0.22 [0.14] mm Hg/L/min vs 0.70 [0.20] mm Hg/L/min; P < .0001) and E_es to E_a ratio was high (1.10 [0.36] vs 0.58 [0.22]; P = .0007). During exercise in PH-HFpEF, Z_C increased and E_es to E_a ratio decreased, but both remained unchanged in precapillary PH. In PH-HFpEF, a significant negative correlation was found between Z_C and E_es to E_a ratio (slope, -0.96; r² = 0.18; P < .0001) that was absent in precapillary PH (slope, -0.20; r² = 0.11; P = .53).</p><p><strong>Interpretation: </strong>Despite the small sample size, RV-PA uncoupling with exercise was significantly negatively correlated with Z_C in PH-HFpEF, which was not evident in precapillary PH, suggesting that abnormal exercise pulsatile hemodynamics are key to RV failure in left heart disease.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deciphering the Role of FDG-PET/CT Imaging in the Management of Sarcoidosis.","authors":"Ryan Donnelly, Alessandro N Franciosi, Sarah H Forde, Michael McDermott, Michael P Keane, David J Murphy, Emmet E McGrath, Cormac McCarthy","doi":"10.1016/j.chest.2025.02.017","DOIUrl":"10.1016/j.chest.2025.02.017","url":null,"abstract":"<p><strong>Background: </strong>2-Deoxy-2-[¹⁸F]fluoro-d-glucose (FDG)-PET/CT imaging has utility in identifying sites of active sarcoidosis. However, the role of FDG-PET/CT imaging in predicting treatment response and guiding therapy outside of cardiac disease is yet to be completely understood.</p><p><strong>Research question: </strong>Do physicians agree on the utility of FDG-PET/CT imaging in sarcoid cases, and do they agree on the appropriate treatment response, based on the associated reports?</p><p><strong>Study design and methods: </strong>Physician respondents were presented with a series of anonymized sarcoidosis case vignettes. The perceived utility of FDG-PET/CT imaging in each case, as well as the ultimate treatment decision following provision of FDG-PET/CT results, was assessed. Interrater agreement was assessed overall and per-case vignette specialty, using the Gwet agreement coefficient (AC1).</p><p><strong>Results: </strong>Respondents (n = 215) were predominantly respiratory physicians (86.78%) experienced in sarcoidosis management (94.39%), and one-third of whom had > 20 years of experience (32.66%). Pulmonary sarcoidosis case vignettes had the lowest rates of FDG-PET/CT endorsement among surveyed subspecialties (38%-64%). Overall interrater agreement was assessed among physicians who positively endorsed FDG-PET/CT imaging. Treatment rationalization based on FDG-PET/CT report approached near-chance agreement for pulmonary cases (AC1 = 0.178) (n = 217; 95% CI, 0.125-0.234; P = .07) and multisystem cases (AC1 = 0.296) (n = 168; 95% CI, 0.066-0.477; P = .41), whereas agreement was highest for cases of cardiac sarcoidosis (AC1 = 0.797) (n = 374; 95% CI, 0.759-0.838; P < .05).</p><p><strong>Interpretation: </strong>Our results indicate low agreement between physicians regarding their management of pulmonary sarcoidosis following FDG-PET/CT imaging. This highlights a need for further research and clarity concerning the role of FDG-PET/CT imaging in the therapeutic management of pulmonary sarcoidosis.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the Causal Effect of Double-Blind Peer Review for a Pulmonary, Critical Care, and Sleep Medicine Journal.","authors":"Hayley B Gershengorn, Kelly C Vranas, Colin R Cooke, Christopher G Slatore, Stephanie M Levine","doi":"10.1016/j.chest.2025.02.016","DOIUrl":"10.1016/j.chest.2025.02.016","url":null,"abstract":"<p><strong>Background: </strong>Double-blind peer review (DBPR; reviewers blinded to author identities and vice versa) aims to reduce biases. The effectiveness of DBPR has not been studied in pulmonary, critical care, and sleep journals.</p><p><strong>Research question: </strong>What was the causal effect on bias of DBPR at CHEST?</p><p><strong>Study design and methods: </strong>From January 2020 to June 2022, CHEST and Annals of the American Thoracic Society (AATS) used single-blind peer review (reviewers concealed from authors only); in July 2022, CHEST switched to DBPR. We estimated the causal effect of DBPR on manuscript acceptance at CHEST using AATS as a control. The co-primary exposures were first and last author gender; author residence in English-fluent countries was considered as a secondary exposure. To estimate DBPR's differential impact according to exposure, multivariable regression models were constructed with triple interaction terms (eg, author gender × CHEST vs AATS × pre- vs post-DBPR), all component factors (eg, author gender), paired interactions (eg, author gender × CHEST vs AATS), and covariables (year, topic).</p><p><strong>Results: </strong>The study included 4,651 manuscripts (CHEST, 3,494; AATS, 1,157) sent for peer review; 4,645 (99.9%) had identifiable author gender. From 2020 to 2024, CHEST submissions (compared with AATS) were less frequently authored by women (first, 38.7% vs 45.5% [standardized mean difference (SMD), 0.14]; last, 23.9% vs 31.2% [SMD, 0.16]) or people from English-fluent countries (first, 56.0% vs 77.7% [SMD, 0.47]; last, 57.9% vs 79.0% [SMD, 0.47]), and acceptance rates were lower (30.7% vs 48.4%; SMD, 0.37). Following adjustment, no difference was appreciated in the impact of DBPR on acceptance for women vs men authors (first, -7.4 [95% CI, -20.9 to 6.0] percentage points [P = .28]; last, -10.1 [95% CI, -25.1 to 5.0] percentage points [P = .19]). DBPR negatively affected first (but not last) authors from English-fluent countries (vs non-fluent, -16.8 [95% CI, -32.1 to -1.6] percentage points; P = .030).</p><p><strong>Interpretation: </strong>DBPR did not differentially affect authors by gender but did by presumed English fluency.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Yield and Synergistic Impact of Needle Aspiration and Forceps Biopsy With Electromagnetic Navigation Bronchoscopy for Peripheral Pulmonary Lesions (CONFIDENT-ENB): A Randomized Controlled Trial.","authors":"Yeon Wook Kim, Hyung-Jun Kim, Byoung Soo Kwon, Ye Jin Lee, Myung Jin Song, Sung Hyun Yoon, Sung Yoon Lim, Yeon Joo Lee, Jong Sun Park, Young-Jae Cho, Kyung Hee Lee, Jin-Haeng Chung, Yeon Bi Han, Fabien Maldonado, So Yeon Ahn, Youngmi Park, Dong-Hyun Joo, Jae Ho Lee, Choon-Taek Lee","doi":"10.1016/j.chest.2025.02.015","DOIUrl":"10.1016/j.chest.2025.02.015","url":null,"abstract":"<p><strong>Background: </strong>Electromagnetic navigation bronchoscopy (ENB) is an advanced imaging-guided technique used to diagnose peripheral pulmonary lesions. However, the optimal strategy for selecting biopsy devices remains unclear.</p><p><strong>Research question: </strong>Does the combination of needle aspiration and forceps biopsy improve diagnostic yield compared with that using a single device alone?</p><p><strong>Study design and methods: </strong>We conducted a randomized crossover study during ENB performed under moderate sedation. This trial recruited participants with peripheral pulmonary lesions requiring biopsy who were eligible for elective ENB. ENB-guided needle aspiration and forceps biopsy were sequentially performed in a randomized order. The primary outcome was diagnostic yield, defined as the percentage of patients for whom the biopsy provided a specific diagnosis able to inform patient management. The diagnostic yield achieved by each biopsy modality individually and in combination was evaluated.</p><p><strong>Results: </strong>Between December 1, 2021, and November 13, 2023, 142 participants were enrolled and underwent the study procedures. Complete follow-up data were obtained for 140 participants. Diagnostic yield was 44.4% (63 of 142) for forceps biopsy, 51.4% (73 of 142) for needle aspiration (P = .221 vs forceps), and 66.9% (95 of 142) for the combination (P < .001 vs forceps alone, P < .001 vs needle alone). Sensitivities for malignancy were 58.3% (70 of 120) for needle aspiration and 47.5% (57 of 120) for forceps biopsy (P = .074). The combination of the 2 modalities resulted in a significantly improved sensitivity of 71.7% (86 of 120) compared with either individual modality (P < .001 vs forceps alone and needle alone). Pneumothorax occurred in 3.5% (5 of 142) of patients, and 1.4% (2 of 142) developed pneumothorax requiring tube drainage.</p><p><strong>Interpretation: </strong>When performing ENB under moderate sedation, the combination of needle aspiration and forceps biopsy significantly improves the diagnostic yield and sensitivity for malignancy compared with each modality alone, with a favorable safety profile. These results indicate that a multimodal approach using needles and forceps is a valid diagnostic strategy for ENB.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT05110131; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growing Up With Developmental Lung Diseases: A Review for the Adult Pulmonologist.","authors":"Yadira Rivera-Sanchez, Zachary W Blair, Tyler J Wall, Kara N Goss","doi":"10.1016/j.chest.2025.02.014","DOIUrl":"10.1016/j.chest.2025.02.014","url":null,"abstract":"<p><strong>Topic importance: </strong>Improved childhood management strategies have decreased the early life morbidity and mortality of severe developmental lung disorders, such that an increasing number of individuals ultimately transition care to adult pulmonologists for management. Alternatively, individuals with milder malformations may present in adulthood or may have an increased risk for the development of more common adult pulmonary comorbidities (eg, COPD, pulmonary hypertension). As such, there is a critical need for adult pulmonologists to understand how developmental lung disorders may impact respiratory morbidity over the lifespan.</p><p><strong>Review findings: </strong>There is growing recognition that abnormal lung development contributes to lung disease across the lifespan. This article reviews commonly encountered complex developmental lung diseases, including bronchopulmonary dysplasia, congenital diaphragmatic hernia, Down syndrome, and representative isolated airway and vascular anomalies. Their childhood and adult clinical presentations and comorbidities will be discussed.</p><p><strong>Summary: </strong>This review aims to provide the adult pulmonologist with a framework for evaluating and managing individuals with developmental lung diseases.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Main Pulmonary Artery Diameter in Pulmonary Arterial Hypertension.","authors":"Jacob Y Cao, Rita-Maria Abdo, Nelson Wang, Nicholas Olsen, Kate Kearney, Kirby Wong, Edmund Lau, David Celermajer, Eugene Kotlyar, Rachael Cordina","doi":"10.1016/j.chest.2025.02.012","DOIUrl":"10.1016/j.chest.2025.02.012","url":null,"abstract":"<p><strong>Background: </strong>Accurate risk stratification is critical aspect of pulmonary arterial hypertension (PAH) management. It is unclear whether main pulmonary artery (MPA) enlargement offers additional prognostic value to validated risk scores.</p><p><strong>Research question: </strong>Is MPA diameter prognostic in PAH, independent of the existing risk scores?</p><p><strong>Study design and methods: </strong>A retrospective review of patients with PAH from 2 large referral centers was conducted. Baseline Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) 2.0, REVEAL Lite 2, and European Society of Cardiology and European Respiratory Society scores were calculated. The primary end points were composite death, lung transplantation, and right heart failure hospitalization. Cox proportional hazards models were used for time-to-event analyses. Receiver operator characteristic and net reclassification improvement analyses additionally assessed the prognostic value of MPA diameter.</p><p><strong>Results: </strong>Three hundred fifty-one patients were included. Baseline mean (SD) MPA diameter was 35.3 (7.1) mm. MPA grew by a mean (SD) of 0.4 (1.1) mm/y (1.1% baseline diameter). Over a mean (SD) of 4.0 (3.4) years of follow-up, 190 primary events occurred, and MPA diameter was a predictor (hazard ratio [HR], 1.06/mm; 95% CI, 1.04-1.07/mm; P < .001). MPA diameter remained an independent predictor after multivariable adjustments for the 3 risk scores and their individual components. MPA growth rate also predicted the outcome (HR, 1.79/mm/y; 95% CI, 1.52-2.11/mm/y; P < .001), independent of baseline MPA diameter. Area under the receiver operating characteristic curve for the risk of the primary end point at 1 year was similar for MPA alone (0.72) compared with the 3 risk scores (0.72-0.75). Furthermore, using MPA in addition to REVEAL 2.0 score resulted in risk reclassification in 23% of patients, mostly because of appropriate risk downgrading.</p><p><strong>Interpretation: </strong>MPA diameter is a significant independent predictor of adverse clinical events in patients with PAH without congenital heart disease. It may be a novel prognostic marker in addition to the existing risk scores.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Noninvasive Ventilation Before and After Cardiac Surgery for Preventing Cardiac and Pulmonary Complications: A Clinical Randomized Trial.","authors":"Marion Goret, Kevin Pluchon, Raphaël Le Mao, Ali Badra, Jean-Ferréol Oilleau, Yohann Morvan, Marc Beaumont, Gwenaëlle Desanglois, Marie Guegan, Aude Barnier, Christophe Gut-Gobert, Cécile Tromeur, Christophe Leroyer, Jean-Noël Choplain, Ahmed Khalifa, Eric Bezon, Francis Couturaud","doi":"10.1016/j.chest.2025.02.010","DOIUrl":"10.1016/j.chest.2025.02.010","url":null,"abstract":"<p><strong>Background: </strong>The immediate postoperative period after heart surgery poses a substantial risk of life-threatening complications, notably acute pulmonary and cardiac failure. Use of noninvasive ventilation (NIV) may reduce the incidence of pulmonary or heart failure, or both.</p><p><strong>Research question: </strong>Is the use of NIV before and after cardiac surgery associated with a lower rate of acute pulmonary and heart failure in patients at risk of postoperative complications?</p><p><strong>Study design and methods: </strong>We designed a prospective, randomized, monocentric trial comparing preoperative and postoperative NIV in cardiac surgery with standard care. Adult patients classified as being at risk of postoperative cardiac or pulmonary failure were allocated to receive NIV for 5 days before and 5 days after surgery in addition to usual care vs usual care alone. The primary outcome was the composite of predefined and adjudicated cardiorespiratory failure at 1 month after cardiac surgery.</p><p><strong>Results: </strong>Two hundred sixteen patients were included. During the 1-month follow-up period after surgery, the composite outcome occurred in 59 of 107 patients (55.1%) in the NIV group and in 87 of 109 patients (79.8%) in the no NIV group (relative risk, 0.69; 95% CI, 0.57-0.84; P < .001). The benefit persisted at 3 months. No difference between the two groups was found in terms of intubation need and length of hospital stay in cardiac and pulmonary surgery ICUs and in cardiac and pulmonary surgery units.</p><p><strong>Interpretation: </strong>The use of NIV before and after cardiac surgery reduces the rate of cardiopulmonary failure after high-risk cardiac surgery.</p><p><strong>Clinical trial registry: </strong>ClinicalTrials.gov; No.: NCT02302300; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glossopharyngeal Nerve Stimulation Stabilizes the Lateral Pharyngeal Wall and Ventilation in OSA A Pilot Study.","authors":"David T Kent, John J Ceremsak, Yike Li, Pratyusha Yalamanchi, Kyle Mannion, David Zealear, Matthew S Shotwell, Megan E Hall, Christopher J Lindsell, Holly A Budnick, Silvana Bellotto, Katherine E Estes, Carol LeeAnn Wells, Alan R Schwartz","doi":"10.1016/j.chest.2025.02.009","DOIUrl":"10.1016/j.chest.2025.02.009","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normosol-R vs Lactated Ringers in the Critically Ill: A Randomized Trial.","authors":"Edward T Qian, Ryan M Brown, Karen E Jackson, Li Wang, Joanna L Stollings, Robert E Freundlich, Jonathan P Wanderer, Edward D Siew, Gordon R Bernard, Wesley H Self, Jonathan D Casey, Todd W Rice, Matthew W Semler","doi":"10.1016/j.chest.2025.02.008","DOIUrl":"10.1016/j.chest.2025.02.008","url":null,"abstract":"<p><strong>Background: </strong>Balanced crystalloid solutions may improve clinical outcomes compared with saline for some critically ill adults, but it is unclear whether differences in composition between balanced crystalloid solutions affect outcomes.</p><p><strong>Research question: </strong>Does the choice of balanced crystalloid solutions (Normosol-R vs lactated Ringers) impact acid-base status, organ function, or outcomes for critically ill adults?</p><p><strong>Study design and methods: </strong>This pragmatic, cluster-randomized, multiple-crossover trial at an academic medical center in the United States compared the use of Normosol-R vs lactated Ringers among critically ill adults. The primary outcome was the plasma bicarbonate (HCO₃^-) concentration between enrollment and 7 days. Secondary outcomes included receipt of kidney replacement therapy and death by day 30.</p><p><strong>Results: </strong>Between June 1, 2018, and January 31, 2019, 2,084 patients were enrolled. The median age was 59 years, 1,006 patients (48.3%) were female, and the median Sequential Organ Failure Assessment score was 5 (interquartile range, 3-8). HCO₃^- concentration between enrollment and 7 days did not differ between the Normosol-R and lactated Ringers groups (mean difference, -0.12 mmol/dL; 95% CI, -0.61 to 0.36; P = .61). A total of 58 patients (6.0%) in the Normosol-R group and 47 patients (5.0%) in the lactated Ringers group received new kidney replacement therapy (absolute risk difference, 1.0%; 95% CI, -1.2% to 3.1%). Death by day 30 occurred in 172 patients (16.3%) in the Normosol-R group and 164 patients (16.0%) in the lactated Ringers group (absolute risk difference, 0.3%; 95% CI, -2.9% to 3.6%).</p><p><strong>Interpretation: </strong>Among critically ill adults, the use of Normosol-R for IV fluid therapy did not affect plasma HCO₃^- concentrations or clinical outcomes compared with lactated Ringers.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT03537898; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Glucose Monitoring for Hyperglycemia in Critically Ill Patients: A Randomized Controlled Trial.","authors":"Andrew J Franck, Andrew L Hendrickson, Evan D Telford, BreAnna L Davids, Irina Murray Casanova, Abbie N Rosen, Susheela Hadigal, Robert C Ross","doi":"10.1016/j.chest.2025.02.006","DOIUrl":"10.1016/j.chest.2025.02.006","url":null,"abstract":"<p><strong>Background: </strong>Continuous glucose monitors (CGMs) could potentially improve management of hyperglycemia compared with standard point-of-care glucose monitoring for critically ill patients. However, there is limited evidence to support routine use of CGMs in the ICU.</p><p><strong>Research question: </strong>In critically ill patients with hyperglycemia, do CGMs improve time within target glucose range compared with standard of care?</p><p><strong>Study design and methods: </strong>This was an investigator-initiated, single-center, parallel-group, open-label, randomized controlled trial. Adult patients admitted to a medical or surgical ICU, who had diabetes mellitus or hyperglycemia, and were treated with insulin were eligible for enrollment. Participants were randomly assigned to have glucose monitoring performed with a CGM (intervention group) or standard of care (control group). Groups were compared for glycemic control and other relevant outcomes. The primary outcome for the study was percentage of time within the normoglycemic range, defined as 70 to 180 mg/dL (3.9-10 mmol/L).</p><p><strong>Results: </strong>Eighty-five participants were enrolled and randomized to study groups, with 43 participants in the intervention (CGM) group and 42 patients in the control (standard of care) group. For the primary outcome, there was no statistically significant difference between the intervention group (mean ± SD, 60.5% ± 30.5%) and the control group (mean ± SD, 61.4% ± 28.3%) in time within the goal glucose range (mean difference, -0.9%; 95% CI, -13.6 to 11.8; P = .9). Except for patient satisfaction, there were no statistically significant differences between groups for secondary and exploratory outcomes.</p><p><strong>Interpretation: </strong>The results of this study do not support CGMs as a superior method for routine glucose monitoring in the ICU compared with standard of care.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov; No.: NCT05442853; URL: www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}