CHEST critical care最新文献

{"title":"Initial Opioid Exposure in the ICU and 1-Year Opioid-Related Outcomes in Patients Who Are Mechanically Ventilated","authors":"Theodore J. Iwashyna MD, PhD ,&nbsp;Elizabeth M. Viglianti MD, MPH ,&nbsp;Jennifer Cano MPH ,&nbsp;Sarah Seelye PhD ,&nbsp;Nicholas A. Bosch MD ,&nbsp;Lisa D. Burry PhD ,&nbsp;Bijan Teja MD ,&nbsp;David N. Juurlink MD, PhD ,&nbsp;Henry T. Stelfox MD, PhD ,&nbsp;Downing Lu MD, MPH ,&nbsp;Andrea D. Hill PhD ,&nbsp;Allan J. Walkey MD ,&nbsp;Hannah Wunsch MD","doi":"10.1016/j.chstcc.2024.100124","DOIUrl":"10.1016/j.chstcc.2024.100124","url":null,"abstract":"<div><h3>Background</h3><div>Little is known about whether the choice of opioid influences long-term outcomes for critically ill patients.</div></div><div><h3>Research Question</h3><div>To determine whether initiation of IV morphine or hydromorphone during mechanical ventilation (MV) is associated with reduced opioid use after discharge relative to fentanyl.</div></div><div><h3>Study Design and Methods</h3><div>This was a retrospective cohort study of 14,197 veterans who underwent MV in 116 Veterans Administration hospitals (2014-2020) and who received fentanyl, morphine, or hydromorphone as the initial and only IV opioid during their first 2 days in the ICU. The primary outcome was persistent opioid use in the year after hospital discharge.</div></div><div><h3>Results</h3><div>Overall, 11,903 patients (83.8%) received fentanyl, 1,156 patients (8.1%) received morphine, and 1,138 patients (8.0%) received hydromorphone as the initial and only IV opioid during the first 2 days in the ICU. The median patient age was 67 years (interquartile range, 61-72 years). Persistent opioid use in the year after discharge was more common with hydromorphone (16.5%) vs fentanyl (12.0%; adjusted OR [aOR], 1.25; 95% CI, 1.00-1.56), but not with morphine (15.7%) vs fentanyl (aOR, 1.12; 95% CI, 0.91-1.39). Stratified by prior persistent opioid use, the association between opioid initially received in the ICU and an increased risk of persistent use in the following year was present only among individuals without this history for both morphine and hydromorphine compared with fentanyl (morphine: aOR, 1.44 [95% CI, 1.07-1.94]; hydromorphone: aOR, 1.51 [95% CI, 1.12-2.04]).</div></div><div><h3>Interpretation</h3><div>Among patients in the ICU who received MV, persistent opioid use in the year after hospital discharge was more frequent among patients initially exposed to IV morphine or hydromorphone compared with fentanyl, but only among those without a prior history of persistent opioid use. The choice of initial opioid may have long-term consequences for patients. Further research is needed to confirm these exploratory findings.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100124"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510988","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":"Developing Core Outcome (Measurement) Sets for Critical Care Research Using the Modified Delphi Method","authors":"Sarah L. Gorst PhD ,&nbsp;Diana C. Bouhassira MD ,&nbsp;Alison E. Turnbull DVM, MPH, PhD","doi":"10.1016/j.chstcc.2025.100128","DOIUrl":"10.1016/j.chstcc.2025.100128","url":null,"abstract":"<div><h3>Topic Importance</h3><div>High-quality core outcome sets (COSs) and core outcome measurement sets (COMSs) can help to optimize research by allowing the results of clinical trials to be compared and combined in systematic reviews. The number of registered COSs and COMSs for critical care research is increasing, and most are developed using the Delphi method. However, the quality of these tools varies substantially.</div></div><div><h3>Review Findings</h3><div>At least 39 COSs and 10 associated COMSs have been designed for clinical research in critical care and at least 21 ongoing development projects. The Delphi method is the most common method used to foster agreement on the content of a COS or COMS. It is flexible and permits the development process to be tailored to the medical condition and population of interest. However, designing an effective Delphi study requires time and careful deliberation. Clearly defining scope, piloting survey materials, and crafting a consensus process that uses the strengths of each stakeholder group and minimizes loss to follow-up are encouraged. Reporting on COS and COMS development should be sufficiently detailed for readers to understand and critique both the process and the resulting research tool. Established checklists and guidelines are available to assist with both protocol development and peer review of manuscripts reporting on newly generated COSs and COMSs.</div></div><div><h3>Summary</h3><div>Thorough preliminary work, planning, and reporting increase the likelihood that COSs or COMSs related to critical care will reflect the opinions of knowledgeable stakeholders and will improve the usefulness of clinical trial data.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100128"},"PeriodicalIF":0.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474472","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":"Managing Immune Checkpoint Inhibitor Pneumonitis in the ICU","authors":"Kristina Montemayor MD, MHS ,&nbsp;Mohammad I. Ghanbar MD ,&nbsp;Abigail L. Koch MD, MHS ,&nbsp;Karthik Suresh MD ,&nbsp;Robert Scott Stephens MD","doi":"10.1016/j.chstcc.2024.100126","DOIUrl":"10.1016/j.chstcc.2024.100126","url":null,"abstract":"<div><div>Recent advancements in the management of non-small cell lung cancer, especially with immunotherapeutic agents like immune checkpoint inhibitors (ICIs), have improved patient outcomes significantly. However, despite their effectiveness, ICIs can cause immune-related adverse events, including checkpoint inhibitor pneumonitis. Diagnosing and managing pneumonitis can be particularly challenging and patients with moderate or severe symptoms typically require ICU level of care. The management of patients with ICI pneumonitis requires a multidisciplinary approach and numerous treatment decisions, including the use of systemic corticosteroids and adjunctive therapies in certain cases. In this How I Do It article, we offer a case-based discussion covering evaluation, common radiographic changes, diagnosis, grading, and management of ICI pneumonitis in patients in the ICU. We also address common clinical decisions related to corticosteroid dosing, guidance on initiation of adjunctive therapies, and future use of ICI therapy.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100126"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487635","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":"Lactation Practices in Critically Ill Patients","authors":"Kayla J. Kolbe MD ,&nbsp;Virginia Sheffield MD ,&nbsp;Katerina Castillo MD ,&nbsp;Kriya S. Patel MD ,&nbsp;Jessica A. Blank MD ,&nbsp;Melissa H. Ross MD ,&nbsp;Thomas S. Valley MD ,&nbsp;Rommel Sagana MD","doi":"10.1016/j.chstcc.2024.100123","DOIUrl":"10.1016/j.chstcc.2024.100123","url":null,"abstract":"<div><h3>Background</h3><div>Most birthing people in the United States initiate lactation, but little is known about lactation practices in patients who are critically ill.</div></div><div><h3>Research Question</h3><div>What are the lactation rates and practices in adult patients in the ICU and what are potential barriers to lactation and resource use?</div></div><div><h3>Study Design and Methods</h3><div>We performed a retrospective chart review of immediately postpartum patients in the ICU at an academic medical center between January 2018 and January 2024. Information regarding initiation, cessation, communication, and lactation consultant (LC) services were extracted and bivariate tests of association were conducted.</div></div><div><h3>Results</h3><div>Most immediately postpartum patients in the ICU initiated lactation (85% [87 of 102]), but only 70% (72 of 102) continued until hospital discharge. Documented lactation plans were present before delivery for 60% of patients, and a documented plan to initiate lactation before delivery was associated with increased odds of initiating lactation after delivery (OR, 9.21; 95% CI, 1.96-43.3; <em>P</em> = .005). Although most patients (75%) saw LCs, less than 30% of patients saw LCs within 24 hours of delivery. An association between seeing an LC and continuing lactation until hospital discharge was found (OR, 4.74; 95% CI, 1.77-12.7; <em>P</em> = .002). More than one-half of lactating patients received mechanical ventilation (55%), but nearly 20% of these intubated patients did not undergo milk expression while ventilated.</div></div><div><h3>Interpretation</h3><div>Most postpartum patients who are critically ill initiate lactation, but not all continue until hospital discharge. Having documented plans to lactate before delivery and seeing LCs were protective of lactation in the ICU, but many patients did not see LCs promptly. Additional gaps in care included lack of documentation and delays in lactation initiation in intubated patients. We hypothesize that these gaps may hinder patients who are critically ill from achieving their personal lactation goals, and steps should be taken to address and mitigate these challenges.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100123"},"PeriodicalIF":0.0,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487206","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":"Feasibility of Measuring Driving Pressure and Patient Effort in Assisted Modes of Ventilation","authors":"Malik Farooqi MD ,&nbsp;Michael Mikhaeil MD ,&nbsp;Jason Z.X. Chen MD ,&nbsp;Mohamed Althobity MD ,&nbsp;Alisha Greer MD ,&nbsp;Arjun Sharma MD ,&nbsp;Kimberley Lewis MD ,&nbsp;Tom Piraino MD ,&nbsp;Deborah Cook MD ,&nbsp;Bram Rochwerg MD","doi":"10.1016/j.chstcc.2024.100125","DOIUrl":"10.1016/j.chstcc.2024.100125","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100125"},"PeriodicalIF":0.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444658","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":"Venovenous Extracorporeal Membrane Oxygenation in Patients With Shock","authors":"Jonah Rubin MD","doi":"10.1016/j.chstcc.2024.100127","DOIUrl":"10.1016/j.chstcc.2024.100127","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100127"},"PeriodicalIF":0.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444744","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":"Continuous Glucose Monitor in Adult Diabetic Ketoacidosis","authors":"Rafael Barberena Moraes MD, PhD ,&nbsp;Amanda Vilaverde Perez MD","doi":"10.1016/j.chstcc.2024.100122","DOIUrl":"10.1016/j.chstcc.2024.100122","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100122"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487295","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":"Derivation and Validation of a Clinical and Endothelial Biomarker Risk Model to Predict Persistent Pediatric Sepsis-Associated Acute Respiratory Dysfunction","authors":"James G. Williams MD ,&nbsp;Jane E. Whitney MD ,&nbsp;Scott L. Weiss MD ,&nbsp;Brian M. Varisco MD ,&nbsp;Nadir Yehya MD ,&nbsp;Mihir R. Atreya MD, MPH ,&nbsp;Sepsis Genomics Collaborative and the Children’s Hospital of Philadelphia Sepsis Investigators","doi":"10.1016/j.chstcc.2024.100120","DOIUrl":"10.1016/j.chstcc.2024.100120","url":null,"abstract":"<div><h3>Background</h3><div>Sepsis-associated ARDS results in high morbidity and mortality in children. However, heterogeneity among patients makes identifying those at risk of persistent acute respiratory dysfunction challenging. Endothelial dysfunction is a key feature of ARDS pathophysiologic characteristics, contributing to lung injury in sepsis. Incorporating endothelial biomarkers into risk models may enhance prediction of those with persistent acute respiratory dysfunction.</div></div><div><h3>Research Question</h3><div>Can clinical variables and endothelial biomarkers measured early in the course of sepsis predict risk of persistent acute respiratory dysfunction among critically ill children?</div></div><div><h3>Study Design And Methods</h3><div>This was a multicenter derivation and single center test cohort study of prospectively enrolled children with sepsis. The derivation cohort was split into training and holdout validation sets. We trained TreeNet (Minitab, LLC) and classification and regression tree (CART) models using clinical and endothelial biomarkers measured on day 1 of septic shock to predict risk of sepsis-associated acute respiratory dysfunction (SA ARD) on day 3. The performance of the CART model was tested in the holdout validation data set and in the independent test cohort.</div></div><div><h3>Results</h3><div>In the derivation (n = 625) and test (n = 162) cohorts, children with day 3 SA ARD showed increased mortality, length of mechanical ventilation, and PICU length of stay compared with those without. The TreeNet and CART models yielded comparable results. The variables included in the final CART model were presence of SA ARD on day 1, Pa<span>o</span>₂ to F<span>io</span>₂ ratio of &lt; 250, soluble thrombomodulin, and vascular cell adhesion molecule 1 concentrations. This model showed an area under the receiver operating characteristic curve (AUC) of 0.88 in the training data set, sensitivity of 0.91 (95% CI, 0.86-0.94), specificity of 0.76 (95% CI, 0.68-0.82), and demonstrated reproducibility in validation data set and test cohort (AUC range, 0.78-0.83).</div></div><div><h3>Interpretation</h3><div>We derived and validated predictive models incorporating clinical and endothelial biomarkers to identify pediatric patients with septic shock at high risk of persistent acute respiratory dysfunction. Pending prospective validation, such models may facilitate enrichment and targeted intervention in future clinical trials.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100120"},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487208","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":"Acetaminophen and Clinical Outcomes in Sepsis","authors":"Sarah N. Obeidalla MEd ,&nbsp;Gordon R. Bernard MD ,&nbsp;Lorraine B. Ware MD ,&nbsp;V. Eric Kerchberger MD","doi":"10.1016/j.chstcc.2024.100118","DOIUrl":"10.1016/j.chstcc.2024.100118","url":null,"abstract":"<div><h3>Background</h3><div>The Ibuprofen in Sepsis Study (ISS) randomized trial found no difference in duration of shock, ARDS, or mortality with ibuprofen treatment for sepsis. However, higher use of acetaminophen, a known hemoprotein reductant with potentially beneficial effects in sepsis, as an antipyretic in the control arm may have masked the clinical benefits from either drug.</div></div><div><h3>Research Question</h3><div>Does an association exist between administration of acetaminophen and clinical outcomes in adults with sepsis?</div></div><div><h3>Study Design and Methods</h3><div>We performed a retrospective propensity-matched analysis of the previously reported ISS trial. We created a propensity score for receiving acetaminophen during the first 2 study days using sex, age, presence of shock at enrollment, trial study drug assignment (ibuprofen or placebo), febrile status at enrollment, need for mechanical ventilation, and Acute Physiology and Chronic Health Evaluation II score at enrollment, and then matched trial participants 1:1 into acetaminophen-exposed and acetaminophen-unexposed groups based on their propensity scores. We tested the association between receipt of acetaminophen with 30-day mortality as the primary outcome. Secondary outcomes included development of renal failure and ventilator-free days (VFDs).</div></div><div><h3>Results</h3><div>Of 455 patients in the original trial, 276 patients (61%) were matched into acetaminophen-exposed and acetaminophen-unexposed groups. In the propensity-matched analysis, we found a lower mortality among acetaminophen-exposed patients compared with acetaminophen-unexposed patients (hazard ratio, 0.58; 95% CI, 0.40-0.84; <em>P</em> = .004). Additionally, acetaminophen-exposed patients experienced more days alive and free of mechanical ventilation compared with the acetaminophen-unexposed patients (OR, 2.09 for having 19-28 VFDs vs 0 or 1-18 VFDs; 95% CI, 1.12-3.95; <em>P</em> = .02). We observed no significant association between renal failure and receipt of acetaminophen.</div></div><div><h3>Interpretation</h3><div>In this propensity-matched retrospective analysis, adults with sepsis who received acetaminophen showed decreased mortality and more days alive and free of mechanical ventilation. This study highlights the potential of acetaminophen as a modulator of outcomes in sepsis and warrants further investigation.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100118"},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465575","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":"ARDS Subphenotypes Exhibit Different Right Ventricular-Pulmonary Arterial Coupling Profiles","authors":"Matthew T. Siuba DO ,&nbsp;Maxwell A. Hockstein MD ,&nbsp;Diego Ariel Rey PhD ,&nbsp;Abhijit Duggal MD, MPH ,&nbsp;Rodrigo Octavio Deliberato MD, PhD","doi":"10.1016/j.chstcc.2024.100119","DOIUrl":"10.1016/j.chstcc.2024.100119","url":null,"abstract":"","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 1","pages":"Article 100119"},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444745","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}