Chest最新文献

{"title":"Biological phenotypes of alveolar injury and immune failure predict mortality in non-HIV Pneumocystis jirovecii pneumonia: a Spanish multicentre cohort study.","authors":"Javier Martínez de Victoria Carazo, Emilio Guirao Arrabal, Lucía Guillén Zafra, Adolfo de Salazar, Naya Faro Míguez, Francisco Anguita Santos, David Vinuesa García, Leopoldo Muñoz Medina, Miguel Ángel Montero Alonso, Javier Rodríguez Granger, Carmen Hidalgo Tenorio, Teresa López Plana, Federico García García, Andrés Ruíz Sancho","doi":"10.1016/j.chest.2026.09.011","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.011","url":null,"abstract":"<p><strong>Background: </strong>Non-HIV Pneumocystis jirovecii pneumonia (PJP) carries high in-hospital mortality, yet bedside risk stratification remains limited. Admission lactate dehydrogenase (LDH) and lymphocyte count are universally available and may capture two distinct pathophysiological axes (cytolytic tissue injury and failure of adaptive immune control).</p><p><strong>Research question: </strong>Do admission phenotypes defined by LDH and lymphocyte count identify distinct in-hospital mortality risk in non-HIV PJP?</p><p><strong>Study design and methods: </strong>Retrospective multicentre cohort of adults with EORTC/MSGERC probable or proven non-HIV PJP admitted to three hospitals (2019-2024). Admission LDH (≥400 U/L) and lymphocyte count (<700 cells/μL) defined four phenotypes (F1-F4). The primary outcome was in-hospital, all-cause mortality analysed within a competing-risks framework (live discharge as the competing event); the primary analysis was a Fine-Gray subdistribution hazards model adjusted for CURB-65 and solid-organ malignancy, with 30-day Kaplan-Meier/Cox analyses as secondary. Discrimination and calibration were internally validated by bootstrap.</p><p><strong>Results: </strong>Seventy-eight patients were included; in-hospital mortality was 39/78 (50.0%). The 30-day cumulative incidence of death rose monotonically across phenotypes (F1 12.5%, F2 28.6%, F3 47.1%, F4 64.0%; Gray's test p=0.008). The convergent cytolytic-immunodepressed phenotype (F4) was independently associated with mortality (subdistribution hazard ratio 6.15; 95% CI 1.27-29.84), as were CURB-65 and solid-organ malignancy; intermediate phenotypes were directional but imprecise. The multivariable prediction model retained good discrimination (optimism-corrected AUC 0.88) and calibration.</p><p><strong>Interpretation: </strong>Two universally available admission markers define an ordered mortality gradient and a high-risk convergent phenotype in non-HIV PJP, supporting early bedside risk stratification and phenotype-stratified investigation of adjunctive therapies.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073648","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":"Cough function during mechanical ventilation.","authors":"Vincent Bonny, Martin Dres, Fabiana Madotto, Tomas Urbina, Louai Missri, Jérémie Joffre, Éric Maury, Lise Piquilloud, Antenor Rodrigues, Laurent Brochard, Hafid Ait-Oufella","doi":"10.1016/j.chest.2026.09.023","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.023","url":null,"abstract":"<p><strong>Topic importance: </strong>Cough is a vital physiological function that clears the tracheobronchial tree and facilitates effective gas exchange through secretion clearance. In ICU patients, ineffective cough is frequent, primarily due to respiratory muscle dysfunction and the presence of the endotracheal tube, which prevents glottic closure. Ineffective cough has been identified as an independent risk factor for extubation failure and prolonged mechanical ventilation.</p><p><strong>Review findings: </strong>Current guidelines recognize ineffective cough as a key criterion for successful weaning from mechanical ventilation. Nevertheless, its clinical assessment remains challenging and lacks standardization. Accurate and objective evaluation of cough may improve the identification of patients at high risk of extubation failure. Beyond extubation failure, ineffective cough has also been associated with increased incidence of post-extubation pneumonia, longer ICU stay, and impaired long-term respiratory function. Poor outcome highlights the broader clinical impact of ineffective cough and reinforce the need for standardized assessment during ventilator weaning.</p><p><strong>Summary: </strong>This narrative review aims to decipher the mechanisms underlying the cough reflex, outline the pathophysiological alterations observed in critically ill patients, particularly during the weaning process, and examine the available methods for cough quantification.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058568","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":"Safety of Age-Adjusted and Clinical Probability-Adjusted D-dimer Cut-offs in Suspected Pulmonary Embolism: A Systematic Review and Meta-Analysis.","authors":"Mara Graziani, Bram Akerboom, Yonathan Freund, Héloïse Bannelier, Marc Righini, Thijs E van Mens, Maria Cristina Vedovati, Geert-Jan Geersing, Frederikus A Klok, Cecilia Becattini","doi":"10.1016/j.chest.2026.09.030","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.030","url":null,"abstract":"<p><strong>Background: </strong>Adaptive D-dimer strategies for rule out of pulmonary embolism (PE) have been proposed to improve the efficiency of conventional fixed '500' D-dimer thresholds. Validations of adaptive D-dimer strategies post-hoc in cohorts managed according to the fixed D-dimer threshold seems to questions their safety. Research Question What is the proportion of diagnostic failures in patients with suspected PE managed according to an adaptive strategy who have a D-dimer level >500 ng/mL but below the adaptive threshold, defined as the \"adaptive window\"?</p><p><strong>Study design and methods: </strong>We conducted a systematic review and meta-analysis of prospective diagnostic management studies that recruited at least 50 patients with suspected PE and in which an adaptive D-dimer threshold was used to guide chest imaging. Diagnostic failure was defined as venous thromboembolism or PE-related or unexplained death occurring within 3 months. Exclusion criteria were: i) data required to calculate the primary outcome were unavailable; or ii) the study included only children or pregnant women. Study-specific proportions were pooled using a random-effects meta-analysis.</p><p><strong>Results: </strong>Six studies (12,194 patients) were included, with a PE prevalence ranging from 7.0% to 19.2%. Among all patients in whom PE was ruled out without CTPA using adaptive D-dimer strategies, failure rates ranged from 0.00% to 0.27%, with a pooled overall failure rate of 0.12% (95%CI 0.06-0.26%; I² 0%). The pooled failure rate in the adaptive D-dimer window was 0.50% (95%CI 0.20-1.11%; I² 0%). Pooled algorithm-based efficiency was 60.8% (95%CI 49.2-71.2; I² 99.3%).</p><p><strong>Interpretation: </strong>The diagnostic failure rate of adaptive strategies for the diagnosis of acute PE is acceptably low, also in patients with a D-dimer in the adaptive window.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058679","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":"Continuing ECMO without Potential Recovery, Transplant, or Device.","authors":"Alexander Supady, William L Allen, Thaddeus M Pope","doi":"10.1016/j.chest.2026.09.022","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.022","url":null,"abstract":"<p><strong>Topic importance: </strong>The use of extracorporeal membrane oxygenation (ECMO) as a temporary bridge to recovery, transplant or durable device implant is widely accepted. Major unease remains for patients already on ECMO progressing in ways that preclude recovery, transplantation, or device. A substantial number of clinicians argue that when a patient no longer qualifies for recovery, transplantation, or device; ECMO should be withdrawn, even over patient or authorized decision-maker objection.</p><p><strong>Overview: </strong>In this manuscript, we assess ethical arguments for this unilateral withdrawal position, make counterarguments in opposition to unilateral withdrawal, and offer practical suggestions for resolving conflicts. We critique four ethical rationales for unilaterally discontinuing ECMO - (1) the original design and purpose of ECMO; (2) medically inappropriate treatment; (3) the equivalency thesis: because withholding is permissible, so is withdrawing; and (4) resources, expense, and distributive justice. In addition, we review legal issues and outline practical steps for conflict resolution.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036763","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":"Pulmonary Artery Dilation on Chest CT Across the Spectrum of Chronic Lung Disease.","authors":"Tyler J Couch, Gerald J Beck, Erika Berman Rosenzweig, J Jeffrey Carr, Joao A de Andrade, Serpil C Erzurum, Robert P Frantz, Paul M Hassoun, Nicholas S Hill, Evelyn M Horn, Jay S Leb, Jason K Lempel, Jane A Leopold, Cheng T Lin, Stephen C Mathai, Monica Mukherjee, Hui Nian, Geralyn M Palmer, Farbod N Rahagi, David N Ray, Franz P Rischard, Kevin T Schwalbach, James G Terry, George R Washko, Anna R Hemnes","doi":"10.1016/j.chest.2026.08.053","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.053","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary artery (PA) dilation on CT has been associated with pulmonary hypertension (PH) in subjects without lung disease using outdated PH criteria. The relationship between PA size and PH in chronic lung disease is unclear.</p><p><strong>Research question: </strong>Is PA size associated with PH in subjects with chronic lung disease, and does association differ by disease etiology?</p><p><strong>Methods: </strong>PA diameter and PA/aorta ratio (PA/A) were measured on CT for all group 3 PH subjects and comparators in the PVDOMICS Cohort. Subjects were categorized into obstructive, interstitial, or non-parenchymal subgroups. Mean PA pressure (mPAP) was measured on right heart catheterization. Associations and diagnostic performance were assessed using multivariable linear and logistic regression and receiver operating curve analysis.</p><p><strong>Results: </strong>Among 252 subjects (81 obstructive, 125 interstitial, 46 non-parenchymal), PA size associated with PH (Q3 vs Q1 OR 4.30 [2.32-8.00] for diameter, 5.66 [2.86-11.18] for PA/A) and mPAP (ρ = 0.516 for diameter, 0.494 for PA/A; p < 0.001) and possessed moderate ability to detect PH (AUC 0.794 for diameter, 0.765 for PA/A). Association between PA/A and mPAP was strongest in non-parenchymal subjects (ρ = 0.750) and weakest in interstitial subjects (ρ = 0.373). PA/A diagnostic performance was lower in interstitial subjects (AUC 0.704) than in obstructive (AUC 0.865) and non-parenchymal (AUC 0.822) subjects. PA dilation between Q1 and Q3 mPAP was lower in interstitial (3.9 [95% CI 2.3-5.4] mm) compared to obstructive (4.9 [2.4-7.4] mm) and non-parenchymal (4.8 [1.8-7.8] mm) subjects.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036760","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":"Epithelial injury and inflammatory phenotypes for personalized ventilation in ARDS: Secondary analysis of the LIVE trial.","authors":"Joris Pensier, Laurent Renard-Triché, Camille Theilliere, Fanny Henrioux, Vincent Sapin, Damien Bouvier, Thomas Godet, Marc Garnier, Samir Jaber, Jean-Michel Constantin, Emmanuel Futier, Matthieu Jabaudon","doi":"10.1016/j.chest.2026.08.054","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.054","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend against systematic lung recruitment strategies in acute respiratory distress syndrome (ARDS). sRAGE, an alveolar epithelial injury plasmatic biomarker, and inflammatory phenotypes may guide personalized approaches.</p><p><strong>Research question: </strong>Does baseline sRAGE or inflammatory phenotype identify heterogeneity in the treatment effect of lung recruitment on mortality in ARDS?</p><p><strong>Study design and methods: </strong>This analysis included 259 patients with plasma sRAGE measurements from the original LIVE trial that compared lung recruitment with low-PEEP strategies in patients with focal or non-focal ARDS. Baseline sRAGE was dichotomized at 2,440 pg/mL into high and low groups. Inflammatory phenotypes were identified using a validated parsimonious model (IL-8, sTNFr-1, bicarbonate). The primary and secondary outcomes were 90-day mortality and sRAGE trajectory until day 6. Inverse probability weighting and weighted Cox models were used; sRAGE trajectories were assessed using joint models.</p><p><strong>Results: </strong>High plasma sRAGE (r=0.26, p<0.001), but not the inflammatory phenotype, was moderately correlated with non-focal ARDS. Treatment effect varied by baseline sRAGE (p-for-interaction=0.006), but not by inflammatory phenotype (p-for-interaction=0.56); however, the hyperinflammatory phenotype was associated with 90-day mortality (57% vs 26%, p<0.001). Among high-sRAGE patients, lung recruitment was associated with lower 90-day mortality (HR 0.41, 95%CI 0.18-0.93; p=0.033); among low-sRAGE patients it was associated with higher mortality (HR 3.27, 95%CI, 1.06-10.1; p=0.039). Lung recruitment was associated with different sRAGE slopes compared with low PEEP, with effect modification by baseline sRAGE. Lung recruitment was associated with a steeper decline in sRAGE among patients with high baseline sRAGE (p-for-interaction<0.001), and with a slower decline among patients with low baseline sRAGE (p-for-interaction=0.038). Inflammatory phenotypes did not identify heterogeneity of treatment effect. Sensitivity analyses without inverse probability weighting were directionally consistent.</p><p><strong>Interpretation: </strong>In ARDS, epithelial injury assessed by plasma sRAGE may identify heterogeneity of treatment effect with lung recruitment, whereas inflammatory phenotypes remained prognostic for mortality.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030024","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":"Personalized obesity hypoventilation syndrome risk assessment among bariatric surgery candidates through explainable machine learning: A multicenter cross-sectional study.","authors":"Min Ni, Yangyang Tang, Junzheng Zhang, Yujin Lu, Jiankun Liao, Zhiyong Dong, Cunchuan Wang, Jia Feng, Wenhui Chen","doi":"10.1016/j.chest.2026.09.013","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.013","url":null,"abstract":"<p><strong>Background: </strong>Obesity hypoventilation syndrome (OHS) is frequently underdiagnosed, which substantially increases risk of perioperative complications. Limited provider awareness and the need for cumbersome diagnostic testing may hinder timely diagnosis. Machine learning (ML) may facilitate individualized OHS risk assessment by integrating multiple clinical and laboratory variables.</p><p><strong>Research question: </strong>Can an explainable ML model using readily available clinical and laboratory variables accurately identify bariatric surgery candidates at risk for OHS.</p><p><strong>Study design and methods: </strong>This retrospective cross-sectional cohort study included 673 bariatric surgery candidates from the Chinese Obesity and Metabolic Surgery Database, randomly divided into training (70%, n = 471) and internal testing (30%, n = 202) cohorts. An independent cohort of 175 patients from another tertiary hospital was collected for external validation. Feature selection was performed using LASSO regression and Boruta, with bootstrap resampling used to assess selection stability. Ten ML models were constructed and evaluated using discrimination, calibration, and clinical utility measures. SHAP analysis was performed to enhance model interpretability, and a publicly accessible web-based calculator was deployed clinical application.</p><p><strong>Results: </strong>The final logistic regression model included 7 predictors: serum bicarbonate, type 2 diabetes, mean corpuscular hemoglobin concentration, tiredness, body mass index, observed apnea, and neck circumference. The model demonstrated good discrimination in the training, internal testing, and external validation cohorts, with AUCs of 0.884 (95%CI:0.844-0.917), 0.863 (95%:0.784-0.935) and 0.870 (95%:0.806-0.926). SHAP analysis identified serum bicarbonate as the most important predictor. The model showed favorable calibration and clinical utility as well as was implemented as an online calculator.</p><p><strong>Interpretation: </strong>Our explainable ML model integrating 7 readily available clinical variables demonstrated good predictive performance for OHS in bariatric surgery candidates. This model may facilitate earlier risk stratification and targeted diagnostic evaluation.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015747","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":"Trends of Acute Respiratory Failure and Acute Respiratory Distress Syndrome Mortality Among Obese Individuals in the United States.","authors":"Harshvir S Bal, Shrey Arora, Akhil Pampana, Amrita Nayak, Nehal Vekariya, Edward A Bittner, Garima Arora, Pankaj Arora, Lorenzo Berra","doi":"10.1016/j.chest.2026.09.007","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.007","url":null,"abstract":"","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015791","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":"Chronic Obstructive Pulmonary Disease versus Type 2 Diabetes Mellitus: A Comparative and Additive Risk Assessment of Bone Health in a Nationwide Propensity Score-Matched Cohort.","authors":"Fu-Shun Ko, James Cheng-Chung Wei, Fu-Shun Yen, Yu-Chieh Wang, Der-Yang Cho, Chih-Cheng Hsu, Chii-Min Hwu","doi":"10.1016/j.chest.2026.09.018","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.018","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2DM) are both associated with bone fragility through distinct mechanisms. COPD is characterized by accelerated bone resorption, whereas T2DM is associated with impaired bone quality despite preserved bone mineral density.</p><p><strong>Research question: </strong>Does COPD confer greater skeletal hazards than T2DM, and does concomitant COPD and T2DM further increase the risks of osteoporosis and fractures?</p><p><strong>Study design and methods: </strong>We conducted a nationwide retrospective cohort study using Taiwan's National Health Insurance Research Database. Propensity score matching was applied to construct three comparison cohorts of patients with T2DM, COPD, and concomitant COPD and T2DM. Adjusted hazard ratios (aHRs) for incident osteoporosis, major osteoporotic fractures (MOF), and site-specific fractures were estimated using multivariable Cox proportional hazards models after adjustment for demographic characteristics, comorbidities, and medication use.</p><p><strong>Results: </strong>Compared with T2DM, COPD was associated with a significantly higher hazard of osteoporosis (aHR, 1.51; 95% CI, 1.35-1.69). Patients with concomitant COPD and T2DM also had higher hazards of osteoporosis (aHR, 1.39; 95% CI, 1.23-1.57), MOF (aHR, 1.19; 95% CI, 1.08-1.32), spine fractures (aHR, 1.35; 95% CI, 1.16-1.58), and radioulnar fractures (aHR, 1.21; 95% CI, 1.02-1.43) than patients with T2DM alone. In contrast, osteoporosis and fracture risks were comparable between patients with concomitant COPD and T2DM and those with COPD alone. Subgroup analyses identified significant effect modification by sex, with the association between COPD and osteoporosis being stronger in men than in women.</p><p><strong>Interpretation: </strong>COPD is significantly more toxic to the skeleton than T2DM, and their coexistence amplifies fracture susceptibility compared to T2DM alone. Importantly, male patients with COPD represent a distinctly vulnerable population, exhibiting a pronounced susceptibility to disease-induced bone loss. Clinicians must prioritize early and targeted osteoporosis screening for COPD patients, especially men.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015816","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":"Comparative Effectiveness of Lidocaine and Amiodarone for Refractory VF/pVT in Adult In-Hospital Cardiac Arrest: Insights from a Nationwide Multicenter Chinese Registry.","authors":"Xu Niu, Tangxing Jiang, Wen Zheng, Ruixue Song, Jiaqi Zheng, Chunyi Wang, Mingjie Wang, Xiangkai Zhao, Yanan Peng, Yuqi Sun, Yuguo Chen, Feng Xu","doi":"10.1016/j.chest.2026.08.052","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.052","url":null,"abstract":"<p><strong>Background: </strong>Current resuscitation guidelines recommend either amiodarone or lidocaine for refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), primarily based on out-of-hospital cardiac arrest evidence. Whether the two agents differ in effectiveness for adult in-hospital cardiac arrest (IHCA) with refractory VF/pVT remains uncertain.</p><p><strong>Research question: </strong>Among adult IHCA patients with refractory VF/pVT, does lidocaine differ from amiodarone in survival or neurological outcomes?</p><p><strong>Study design and methods: </strong>We conducted data analysis based on a nationwide, multicenter, prospective Baseline Investigation of In-Hospital Cardiac Arrest (BASIC-IHCA) registry, which collects Utstein-style IHCA data from 40 hospitals across China. We included adults with refractory VF/pVT who received lidocaine or amiodarone between July 2019 and December 2020. All eligible cases were carefully adjudicated by reviewing medical records to ensure strict adherence to the recommended indications for medication in the guidelines. The primary outcome was survival to hospital discharge or 30 days; secondary outcomes were sustained return of spontaneous circulation (ROSC) and favorable neurological outcome at discharge or 30 days (CPC 1/2). Associations were evaluated using multilevel mixed-effects logistic regression with prespecified subgroup analyses.</p><p><strong>Results: </strong>Of 32,545 adult IHCA cases, 612 met inclusion criteria (lidocaine: n=259; amiodarone: n=353). Unadjusted outcomes were similar between groups: survival (20.1% vs. 23.5%; P=0.31), sustained ROSC (47.9% vs. 51.6%; P=0.38), and favorable neurological status (17.0% vs. 21.0%; P=0.22). After multivariable adjustment, no significant differences were observed for survival (adjusted OR 1.22; 95% CI 0.63-2.37; P=0.55); sustained ROSC (adjusted OR 1.21; 95% CI 0.77-1.91; P=0.40); or neurological outcome (adjusted OR 1.44; 95% CI 0.70-2.99; P=0.32), with consistent exploratory subgroup findings.</p><p><strong>Interpretation: </strong>To our knowledge, this is the first study to compare lidocaine and amiodarone specifically in a rigorously adjudicated cohort of adult refractory VF/pVT IHCA patients from a national, multicenter prospective registry. We observed no significant differences in outcomes between the two agents, providing real-world evidence that supports guideline recommendations allowing either antiarrhythmic drug during resuscitation.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015793","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}