CHEST critical care最新文献_第8页

Sepsis in Previously Healthy Adults 先前健康成人的败血症

CHEST critical care

Pub Date : 2025-05-17 DOI: 10.1016/j.chstcc.2025.100172

Fizza Manzoor MD, Michael Klompas MD, MPH, Chanu Rhee MD, MPH

引用次数: 0

Response 响应

CHEST critical care

Pub Date : 2025-05-17 DOI: 10.1016/j.chstcc.2025.100173

Tessa A. Mulder MD , Linda Becude MD , Jorge E. Lopez Matta MD , Wilbert B. van den Hout PhD , David J. van Westerloo MD, PhD , Martijn P. Bauer MD, PhD

引用次数: 0

Parsing Prone Positioning Practices 解析倾向定位实践

CHEST critical care

Pub Date : 2025-05-17 DOI: 10.1016/j.chstcc.2025.100171

Chad H. Hochberg MD, MHS, David N. Hager MD, PhD

引用次数: 0

The Silent Threat 无声的威胁

CHEST critical care

Pub Date : 2025-05-08 DOI: 10.1016/j.chstcc.2025.100166

Wai-Tsan Ng MBChB, FHKCA, FHKCA (Intensive Care), FHKAM, FCICM, FANZCA , Song Wan MD, PhD, FRCS, FACC , Yuk-Hoi Lam MBChB, FRCS , Yu-Yeung Yip MBChB, FHKCA, FHKCA (Intensive Care), FHKAM, FCICM, FANZCA

引用次数: 0

The Relationship Between Neighborhood Deprivation and Mortality in a Sepsis Cohort in England 英格兰脓毒症队列中邻里剥夺与死亡率的关系

CHEST critical care

Pub Date : 2025-05-02 DOI: 10.1016/j.chstcc.2025.100165

Ritesh Maharaj MD, PhD , Ishan Rola , Irene Papanicolas PhD

Background

Worse health outcomes have been described for patients with sepsis from more deprived neighborhoods, but it is unclear if this disparity gap has narrowed. Moreover, the mechanisms by which neighborhood disadvantage influences sepsis outcomes are not understood fully.

Research Question

What is the trajectory of mortality among patients with sepsis in England across varying levels of neighborhood deprivation, and to what extent do patterns of ICU admission and treatment explain observed differences?

Study Design and Methods

This retrospective observational study using multivariable logistic regression included 519,789 patients older than 16 years admitted to the ICU with sepsis between April 1, 2009, and December 31, 2023, from 304 ICUs of 207 acute hospitals in England. The primary outcome was hospital mortality. The secondary outcomes were direct ICU admission from the emergency department; use of mechanical ventilation, renal replacement therapy, and vasopressor therapy; and decisions to limit life-sustaining therapy.

Results

Mortality improved across all groups of neighborhood deprivation from the baseline period from 2009 through 2011, and was 4.5% lower from 2022 through 2023 in the most deprived and 4.4% lower in the least deprived quartile, with no significant narrowing of the disparity gap over time (P = .833). Direct ICU admission from the emergency department was similar for patients across groups of neighborhood deprivation at baseline and increased similarly over time with no significant between-group difference. The gap in mechanical ventilation, renal placement therapy, and vasopressor use narrowed over time. Mortality trends were driven primarily by within-hospital improvements in care, and only a minor component was attributable to shift of patients from lower-quality to higher-quality hospitals.

Interpretation

Although sepsis mortality has improved across England, a persistent disparity associated with neighborhood deprivation exists. Further investigation is required to evaluate other potential contributory factors to help understand better how living in deprived areas contributes to the mortality gap.

来自贫困社区的败血症患者的健康状况更差，但尚不清楚这种差距是否已经缩小。此外，邻里不利影响败血症结果的机制尚不完全清楚。研究问题：在不同程度的邻里剥夺中，英国败血症患者的死亡率轨迹是什么？ ICU入院和治疗模式在多大程度上解释了观察到的差异？研究设计与方法采用多变量logistic回归的回顾性观察研究纳入了2009年4月1日至2023年12月31日期间英国207家急症医院304个ICU收治的519,789例16岁以上脓毒症患者。主要终点是住院死亡率。次要结局为急诊科直接入ICU；使用机械通气、肾脏替代治疗和血管加压治疗；以及决定限制维持生命的治疗。结果从2009年到2011年的基线期，所有社区贫困群体的死亡率都有所改善，从2022年到2023年，最贫困人群的死亡率降低了4.5%，最贫困人群的死亡率降低了4.4%，但随着时间的推移，差距没有显著缩小（P = 0.833）。从急诊科直接入住ICU的患者在基线时邻里剥夺组相似，随着时间的推移也相似地增加，组间无显著差异。随着时间的推移，机械通气、肾脏放置治疗和血管加压药物的使用差距逐渐缩小。死亡率趋势主要是由医院内护理的改善推动的，只有一小部分可归因于患者从低质量医院转到高质量医院。尽管脓毒症的死亡率在整个英格兰都有所改善，但与邻里剥夺相关的持续差异仍然存在。需要进一步调查来评估其他潜在的促成因素，以帮助更好地了解生活在贫困地区是如何导致死亡率差距的。

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引用次数: 0

A Concurrent, Mixed-Methods Evaluation of the Four Supports Intervention in ICUs icu四种支持干预的并发、混合方法评价

CHEST critical care

Pub Date : 2025-04-26 DOI: 10.1016/j.chstcc.2025.100164

Taylor E. Lincoln MD , Rachel A. Butler MHA, MPH , Anne-Marie Shields MSN, RN , Kate Petty MD , Tracy Campbell MD , Johanna Bellon PhD, CFA , Praewpannarai Buddadhumaruk MS, RN , Jennifer B. Seaman PhD, RN , Kimberly J. Rak PhD , Caroline Pidro BS , Rachel M. Gustafson DNP, RN , Kristyn Felman MPH, CPH, MSW , Wendy Stonehouse MSN, RN , Mary Beth Happ PhD, RN , Mi-Kyung Song PhD, RN , Charles F. Reynolds III MD , Jennifer Q. Morse PhD , Seth Landefeld MD , Derek Angus MD, MPH, FRCP , Robert M. Arnold MD , Douglas B. White MD, MAS

Background

Surrogate decision-makers in ICUs frequently struggle in this role and experience lasting psychological distress. A recent multicenter trial of the Four Supports Intervention, a multicomponent family support intervention delivered by an external interventionist, revealed that the intervention did not improve patient- or family-centered outcomes, but the main trial results do not provide insights into why the intervention was ineffective.

Research Question

How was the Four Supports Intervention experienced by families and clinicians and how can the intervention be improved?

Study Design and Methods

We conducted a concurrent mixed-methods evaluation of the Four Supports Intervention among 45 participants in the intervention arm of the trial (30 surrogates and 15 clinicians). The research team and participants were masked to trial results during data collection and analysis. Participants completed a quantitative survey and a semistructured interview focusing on their perceptions of whether the intervention provided emotional support to surrogates, facilitated effective clinician-family communication, and fostered patient-centered decision-making. Coders used a thematic analysis approach to identify key themes from the interviews.

Results

Ninety percent of surrogates perceived that the intervention improved the degree to which their needs and concerns were addressed, 93% of surrogates and 100% of clinicians perceived that the intervention improved clinician-family communication, and 87% of surrogates and 87% of clinicians reported that the intervention improved the patient-centeredness of care. Key themes from the interviews with surrogates included that the interventionist provided comfort, was present and listened during a difficult time, and ensured that needed clinician-family conversations happened. Interviews with clinicians revealed that the intervention prepared family members for the role of surrogate decision-maker, helped in recognizing and addressing nascent misunderstandings, and aided creation of positive clinician-family relationships. Surrogates and clinicians suggested potential improvements, including extending the intervention into the period after discharge, better integrating the interventionists’ role with the ICU team, and prioritizing families most in need.

Interpretation

Surrogate decision-makers and clinicians reported that the Four Supports Intervention improved emotional support for surrogates and communication about goals of care. In light of the negative trial results, these findings have important implications for the field.

icu的替代决策者经常在这一角色中挣扎，并经历持久的心理困扰。最近的一项多中心试验的四支持干预，多组件的家庭支持干预提供了一个外部干预，显示干预并没有改善患者或家庭为中心的结果，但主要的试验结果并没有提供见解为什么干预是无效的。研究问题：家庭和临床医生对四种支持干预的体验如何？如何改进干预？研究设计和方法我们在试验干预组的45名参与者（30名代理人和15名临床医生）中同时进行了四种支持干预的混合方法评估。在数据收集和分析过程中，研究小组和参与者对试验结果不知情。参与者完成了一项定量调查和半结构化访谈，重点是他们对干预是否为代孕母亲提供了情感支持、促进了有效的临床-家庭沟通、促进了以患者为中心的决策的看法。编码员使用主题分析方法从访谈中确定关键主题。结果90%的代理人认为干预改善了他们的需求和关注得到解决的程度，93%的代理人和100%的临床医生认为干预改善了医生与家庭的沟通，87%的代理人和87%的临床医生报告说干预改善了以病人为中心的护理。与代理人访谈的关键主题包括干预者提供安慰，在困难时期在场并倾听，并确保必要的临床医生-家庭对话发生。与临床医生的访谈显示，干预使家庭成员为替代决策者的角色做好准备，有助于认识和解决新生的误解，并有助于建立积极的临床医生-家庭关系。代理人和临床医生提出了可能的改进措施，包括将干预延长至出院后，更好地整合干预师与ICU团队的角色，并优先考虑最需要的家庭。代理人决策者和临床医生报告说，四种支持干预改善了代理人的情感支持和关于护理目标的沟通。鉴于否定的试验结果，这些发现对该领域具有重要意义。

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引用次数: 0

Identification of Acute Respiratory Failure Phenotypes With Electronic Health Record Data 用电子健康记录数据识别急性呼吸衰竭表型

CHEST critical care

Pub Date : 2025-04-22 DOI: 10.1016/j.chstcc.2025.100163

Charles R. Terry MD, MSCR , Daniel L. Brinton PhD , Katie G. Kirchoff MS , Andrew J. Goodwin MD, MSCR , Dee W. Ford MD, MSCR

Background

Secondary analysis of clinical trial data and highly selected observational cohorts have identified 2 subphenotypes in acute respiratory failure, but have not been reported previously using only real-world electronic health record (EHR) data.

Research Question

Are subphenotypes of acute ventilator-dependent respiratory failure identifiable using readily available EHR data?

Study Design and Methods

This multicenter retrospective cohort study used patient encounters from the Medical University of South Carolina (n = 4,233 between 2016 and 2023) and the Medical Information Mart for Intensive Care III (n = 8,313 between 2001 and 2012) to train and validate K-means models with multiply imputed cluster analysis at 24 and 48 hours after intubation.

Results

Clustering models identified 2 clusters for 24-hour and 48-hour models in both training and test cohorts with clusters separating on variables related to pulmonary physiology, perfusion, organ dysfunction, and metabolic dysregulation. Cluster 2 showed higher 90-day mortality after discharge and more ventilator days compared with cluster 1 that persisted despite multivariable adjustment for age, illness severity, and comorbidities. Cluster models and clusters were stable in 0- to 24-hour and 25- to 48-hour models with crossover (29.2% and 25.9% of the test and training cohorts) from the higher-acuity cluster 2 to the lower-acuity cluster 1 subphenotype occurring by 48 hours after intubation.

Interpretation

Our results suggest that acute ventilator-dependent respiratory failure has 2 subphenotypes that are discernible using readily available data from EHRs with identifiable differences in pulmonary physiologic features, perfusion, organ dysfunction, and metabolic dysregulation at 24 and 48 hours after intubation. This may enable future EHR tools to identify particularly vulnerable patients.

临床试验数据的二次分析和高度选择的观察性队列已经确定了急性呼吸衰竭的2个亚表型，但以前仅使用真实世界的电子健康记录（EHR）数据尚未报道。研究问题：急性呼吸机依赖性呼吸衰竭的亚表型是否可以通过现有的电子病历数据来识别？研究设计和方法本多中心回顾性队列研究使用来自南卡罗来纳医科大学（2016年至2023年期间n = 4233）和重症监护医学信息市场III（2001年至2012年期间n = 8313）的患者就诊资料，在插管后24和48小时使用多重输入聚类分析训练和验证K-means模型。结果聚类模型在训练和测试队列中分别为24小时和48小时模型确定了2个聚类，并根据肺生理、灌注、器官功能障碍和代谢失调等相关变量进行聚类分离。尽管对年龄、疾病严重程度和合并症进行了多变量调整，但与第1类患者相比，第2类患者出院后90天死亡率更高，使用呼吸机天数更长。在0- 24小时和25- 48小时模型中，聚类模型和聚类是稳定的，在插管后48小时发生从高锐度聚类2到低锐度聚类1亚表型的交叉（29.2%和25.9%的测试和训练队列）。我们的研究结果表明，急性呼吸机依赖型呼吸衰竭有两种亚表型，可通过电子病历中可获得的数据识别，在插管后24和48小时在肺生理特征、灌注、器官功能障碍和代谢失调方面存在可识别的差异。这可能使未来的电子病历工具能够识别特别脆弱的患者。

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引用次数: 0

The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDS 机械功率归一化预测体重对儿童ARDS预后的影响

CHEST critical care

Pub Date : 2025-04-22 DOI: 10.1016/j.chstcc.2025.100162

Herng Lee Tan MSc , Rehena Sultana MSc(stat) , Phuc Huu Phan MD , Muralidharan Jayashree MD , Hongxing Dang MD , Soo Lin Chuah MBBS , Chin Seng Gan MBBS , Siew Wah Lee MD , Karen Ka Yan Leung MBBS, MSc , Ellis Kam Lun Hon MBBS, MD , Xuemei Zhu MD , Pei Chuen Lee MMed(Paeds) , Chian Wern Tai MD , Jacqueline Soo May Ong MB BChir , Lijia Fan MD , Kah Min Pon MD , Li Huang MD , Kazunori Aoki MD , Hiroshi Kurosawa MD, PhD , Rujipat Samransamruajkit MD , Judith Ju Ming Wong MB BCh BAO

Background

The topic of mechanical power (MP) in pediatric ARDS (PARDS) is not well explored in the current literature, limiting our understanding of its potentially detrimental effect.

Research Question

What is the association between MP and clinical outcomes, and does impairment in oxygenation mediate the association between MP and clinical outcomes?

Study Design and Methods

This post hoc causal mediation analysis of data from a before-and-after study recruited children with PARDS from 21 PICUs. We used a simplified MP calculation for pressure-controlled and volume-controlled ventilation normalized to predicted body weight. We identified low, moderate, and high MP cutoffs and used multivariable regression to determine the association between MP categories on ICU mortality, 28-day ventilator-free days (VFDs) and ICU-free days (IFDs), adjusting for the Pediatric Index of Mortality 3 score, Pediatric Logistic Organ Dysfunction 2 score, oxygenation index (OI), and age. Causal mediation analysis was performed to estimate the causal effect of MP on outcomes treating oxygenation impairment (represented by OI) as mediator and age as a confounder.

Results

A total of 466 patients were included for this analysis. Cutoffs for low, moderate, and high MP were < 0.2262 J/min/kg, 0.2262 to 0.4487 J/min/kg, and > 0.4487 J/min/kg, respectively. High vs low MP was associated with reduced VFDs (adjusted incidence rate ratio, –0.22 [95% CI, –0.35 to –0.10]; P < .001) and IFDs (adjusted incidence rate ratio, –0.14 [95% CI, –0.27 to –0.01]; P = .034), but not ICU mortality. In the causal analysis, OI showed a significant indirect effect on the causal pathway of MP on VFDs (indirect effect, –4.30 [P < .001]; direct effect, –1.17 [P = .635]; total effect, –5.47 [P = .024]) and IFDs [indirect effect, –3.13 [P < .001]; direct effect, –0.72 [P = .635]; total effect, –3.84 [P = .024]), but not ICU mortality.

Interpretation

In this study, higher MP was associated with fewer VFDs and IFDs. The causal effect of MP on VFDs and IFDs was mediated fully by the impairment in oxygenation.

背景：目前文献对儿童ARDS （PARDS）中机械动力（MP）的研究还不够深入，限制了我们对其潜在有害影响的理解。研究问题：MP与临床结果之间的关系是什么？氧合损伤是否介导MP与临床结果之间的关系？研究设计和方法本研究对来自21个picu的PARDS患儿的前后研究数据进行了事后因果中介分析。我们使用简化的MP计算压力控制和容量控制通气归一化到预测体重。我们确定了低、中等和高的MP截止值，并使用多变量回归来确定MP类别与ICU死亡率、28天无呼吸机天数（vfd）和无ICU天数（IFDs）之间的关系，调整了儿科死亡率指数3评分、儿科Logistic器官功能障碍2评分、氧合指数（OI）和年龄。进行了因果中介分析，以估计MP对治疗氧合损伤（以OI为代表）的结果的因果效应为中介，年龄为混杂因素。结果共纳入466例患者。低、中、高MP的截止值为<；0.2262 J/min/kg, 0.2262 ~ 0.4487 J/min/kg, >；0.4487 J/min/kg。MP高低与vfd降低相关(调整后的发病率比，-0.22 [95% CI, -0.35至-0.10]；P & lt;.001)和ifd(校正发病率比，-0.14 [95% CI, -0.27至-0.01]；P = 0.034)，但与ICU死亡率无关。在因果分析中，OI对MP对vfd的因果通路有显著的间接影响（间接影响，-4.30）[P <；措施);直接效应，-1.17 [P = .635]；总效应，-5.47 [P = 0.024])和ifd[间接效应，-3.13 [P <；措施);直接效应，-0.72 [P = .635]；总有效率为-3.84 [P = 0.024])，但与ICU死亡率无关。在本研究中，较高的MP与较少的vfd和ifd相关。MP对vfd和IFDs的因果作用完全由氧合损伤介导。

{"title":"The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDS","authors":"Herng Lee Tan MSc , Rehena Sultana MSc(stat) , Phuc Huu Phan MD , Muralidharan Jayashree MD , Hongxing Dang MD , Soo Lin Chuah MBBS , Chin Seng Gan MBBS , Siew Wah Lee MD , Karen Ka Yan Leung MBBS, MSc , Ellis Kam Lun Hon MBBS, MD , Xuemei Zhu MD , Pei Chuen Lee MMed(Paeds) , Chian Wern Tai MD , Jacqueline Soo May Ong MB BChir , Lijia Fan MD , Kah Min Pon MD , Li Huang MD , Kazunori Aoki MD , Hiroshi Kurosawa MD, PhD , Rujipat Samransamruajkit MD , Judith Ju Ming Wong MB BCh BAO","doi":"10.1016/j.chstcc.2025.100162","DOIUrl":"10.1016/j.chstcc.2025.100162","url":null,"abstract":"<div><h3>Background</h3><div>The topic of mechanical power (MP) in pediatric ARDS (PARDS) is not well explored in the current literature, limiting our understanding of its potentially detrimental effect.</div></div><div><h3>Research Question</h3><div>What is the association between MP and clinical outcomes, and does impairment in oxygenation mediate the association between MP and clinical outcomes?</div></div><div><h3>Study Design and Methods</h3><div>This post hoc causal mediation analysis of data from a before-and-after study recruited children with PARDS from 21 PICUs. We used a simplified MP calculation for pressure-controlled and volume-controlled ventilation normalized to predicted body weight. We identified low, moderate, and high MP cutoffs and used multivariable regression to determine the association between MP categories on ICU mortality, 28-day ventilator-free days (VFDs) and ICU-free days (IFDs), adjusting for the Pediatric Index of Mortality 3 score, Pediatric Logistic Organ Dysfunction 2 score, oxygenation index (OI), and age. Causal mediation analysis was performed to estimate the causal effect of MP on outcomes treating oxygenation impairment (represented by OI) as mediator and age as a confounder.</div></div><div><h3>Results</h3><div>A total of 466 patients were included for this analysis. Cutoffs for low, moderate, and high MP were < 0.2262 J/min/kg, 0.2262 to 0.4487 J/min/kg, and > 0.4487 J/min/kg, respectively. High vs low MP was associated with reduced VFDs (adjusted incidence rate ratio, –0.22 [95% CI, –0.35 to –0.10]; <em>P</em> < .001) and IFDs (adjusted incidence rate ratio, –0.14 [95% CI, –0.27 to –0.01]; <em>P</em> = .034), but not ICU mortality. In the causal analysis, OI showed a significant indirect effect on the causal pathway of MP on VFDs (indirect effect, –4.30 [<em>P</em> < .001]; direct effect, –1.17 [<em>P</em> = .635]; total effect, –5.47 [<em>P</em> = .024]) and IFDs [indirect effect, –3.13 [<em>P</em> < .001]; direct effect, –0.72 [<em>P</em> = .635]; total effect, –3.84 [<em>P</em> = .024]), but not ICU mortality.</div></div><div><h3>Interpretation</h3><div>In this study, higher MP was associated with fewer VFDs and IFDs. The causal effect of MP on VFDs and IFDs was mediated fully by the impairment in oxygenation.</div></div>","PeriodicalId":93934,"journal":{"name":"CHEST critical care","volume":"3 3","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long-Term Morbidity Associated With Non-COVID-19 Pneumonia in Patients Receiving Mechanical Ventilation 机械通气患者与非covid -19肺炎相关的长期发病率

CHEST critical care

Pub Date : 2025-04-22 DOI: 10.1016/j.chstcc.2025.100161

Alexander T. Clark MD , Clark I. Strunk MD , Matthew W. Semler MD, MSCI , Jonathan D. Casey MD, MSCI , Cathy A. Jenkins MS , Guanchao Wang MS , James C. Jackson PsyD , E. Wesley Ely MD, MPH , Amy L. Kiehl MA , Patsy T. Bryant MS , Alana Lauck MS , Stephanie C. DeMasi MD , Robert E. Freundlich MD, MSCI , Wesley H. Self MD, MPH , Rameela Raman PhD , Jin H. Han MD

Background

The COVID-19 pandemic highlighted the impact of acute respiratory illnesses on long-term morbidity. However, the long-term morbidity associated with non-COVID-19 pneumonia is unclear, particularly in patients who are receiving mechanical ventilation.

Research Question

What is the burden of 12-month long-term cognitive impairment (LTCI), functional impairment, psychological distress, and quality of life in critically ill patients receiving mechanical ventilation for non-COVID-19 pneumonia?

Study Design and Methods

This single-site prospective cohort study enrolled patients with non-COVID-19 pneumonia receiving mechanical ventilation in the emergency department and ICUs from June 18, 2018, through August 30, 2021. Global cognition at 12 months was measured by the Montreal Cognitive Assessment for the Blind, with higher scores representing better cognition. Secondary outcomes were basic and instrumental activities of daily living (ADLs), psychological distress (posttraumatic stress disorder [PTSD], depression, and anxiety), and quality of life.

Results

Of 408 patients with non-COVID-19 pneumonia (63.4%), 96 patients survived and completed the 12-month follow-up. Among survivors of non-COVID-19 pneumonia, 57.3% met the criteria for LTCI, 13.5% showed executive dysfunction, 17.7% showed impairments in at least 1 basic ADL, 51.0% showed impairments in at least 1 instrumental ADL, 44.0% demonstrated physical disability, 17.8% met the criteria for PTSD, 37.8% met the criteria for depression, 46.7% met the criteria for anxiety, and 19.4% rated their quality of life as poor at 12 months.

Interpretation

A substantial proportion of patients with non-COVID-19 pneumonia receiving mechanical ventilation met criteria for LTCI. Additionally, many demonstrated difficulty performing ADLs, showed physical disability, and experienced psychological sequelae, leading to poor quality of life at 12 months. Interventions designed to reduce these adverse outcomes are needed.

2019冠状病毒病大流行凸显了急性呼吸道疾病对长期发病率的影响。然而，与非covid -19肺炎相关的长期发病率尚不清楚，特别是在接受机械通气的患者中。非covid -19肺炎重症患者接受机械通气治疗12个月长期认知障碍（LTCI）、功能障碍、心理困扰和生活质量的负担是什么？研究设计和方法本单点前瞻性队列研究纳入了2018年6月18日至2021年8月30日在急诊科和icu接受机械通气的非covid -19肺炎患者。12个月时的全球认知能力是通过蒙特利尔盲人认知评估来测量的，分数越高代表认知能力越好。次要结局是基本和辅助日常生活活动（adl）、心理困扰（创伤后应激障碍（PTSD）、抑郁和焦虑）和生活质量。结果408例非covid -19肺炎患者（63.4%）中，96例患者存活并完成12个月的随访。在非covid -19肺炎的幸存者中，57.3%符合LTCI标准，13.5%表现为执行功能障碍，17.7%表现为至少1项基本ADL障碍，51.0%表现为至少1项辅助ADL障碍，44.0%表现为身体残疾，17.8%符合PTSD标准，37.8%符合抑郁标准，46.7%符合焦虑标准，19.4%在12个月时认为自己的生活质量较差。相当一部分接受机械通气的非covid -19肺炎患者符合LTCI标准。此外，许多人表现出执行adl的困难，表现出身体残疾，并经历心理后遗症，导致12个月时的生活质量差。需要采取旨在减少这些不良后果的干预措施。

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引用次数: 0

A Delphi Consensus on Recommendations for Improving Research Processes and Infrastructure to Address Health Disparities 德尔菲共识建议改善研究过程和基础设施，以解决健康差距

CHEST critical care

Pub Date : 2025-04-15 DOI: 10.1016/j.chstcc.2025.100160

Amira Mohamed MD , A. Adegunsoye MD, FACP, FCCP , M. Armstrong-Hough MPH, PhD , N. Ferguson-Myrthil PharmD, BCCCP , I. Hassan MD , F.B. Mayr MD, MPH , T.S. Valley MD , D.R. Winkfield PhD, RN, FNP-BC , C.B. Walsh MD , J.T. Chen MD

Background

Racial and ethnic disparities in critical care medicine remain poorly understood, making them difficult to address. This initiative developed a thought leader consensus with recommendations for critical care research to document, assess, and understand potential disparities.

Research Question

What key areas should future critical care research focus on to better identify and address disparities related to race, ethnicity, and language?

Study Design and Methods

A modified Delphi-based method was used to form a consensus about addressing racial disparities through future critical care research. Nine thought leaders discussed aspects related to 4 topics: collection of race, ethnicity, and language variables; establishing recruitment plans for researchers from racial and ethnic minority groups; designating minority serving institutions; and health disparity education and community engagement. Consensus was reached when ≥ 80% of members agreed (answered with yes or with 4 to 5 points on a Likert scale).

Results

Thought leaders arrived at a consensus agreement (100%) that improved data quality, achieved by more robust recruitment of research participants from racial and ethnic minority groups and standardization of race and ethnicity data, is crucial as the initial step of uncovering health disparities. They agreed that collection of language preferences should be part of all research studies to expose potential biases and disparities in non-English speakers (100% agreement). Engagement of racial and ethnic minority communities was agreed to be essential to obtain involvement of research participants from such minoritized groups (100%).

Interpretation

This consensus revealed the notable data deficiency impacting health disparities within critical care research especially when compared with other settings, highlighting the crucial need for comprehensive focus on this domain. Standardization of race, ethnicity, and language data collection, with the goal of increasing the number of research participants from racial and ethnic minority groups, is vital for understanding health disparities in critical care research and its potential causes.

背景：在重症监护医学中，种族和种族差异仍然知之甚少，使其难以解决。这一倡议形成了一个思想领袖共识，为重症监护研究提供了建议，以记录、评估和理解潜在的差异。研究问题：未来的重症监护研究应该关注哪些关键领域，以更好地识别和解决与种族、民族和语言相关的差异？研究设计与方法采用改进的德尔菲方法，对未来危重病研究中解决种族差异问题形成共识。九位思想领袖讨论了与四个主题相关的方面：种族、民族和语言变量的收集；制定招收少数民族研究人员的计划；指定少数族裔服务机构；健康差距教育和社区参与。当≥80%的成员同意（回答为“是”或李克特量表上的4到5分）时，达成共识。结果思想领袖达成了一项共识（100%），即通过更有力地招募来自种族和少数民族群体的研究参与者以及种族和民族数据的标准化来提高数据质量，作为揭示健康差异的第一步至关重要。他们一致认为，收集语言偏好应该是所有研究的一部分，以揭示非英语使用者的潜在偏见和差异（100%同意）。与会者同意，少数种族和族裔社区的参与对于获得这些少数群体的研究参与者的参与至关重要（100%）。这一共识揭示了影响重症监护研究中健康差异的显著数据不足，特别是与其他环境相比，突出了对这一领域全面关注的迫切需要。种族、民族和语言数据收集的标准化，目标是增加来自种族和少数民族群体的研究参与者的数量，对于了解重症监护研究中的健康差异及其潜在原因至关重要。

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引用次数: 0