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Evaluation for Osteoporosis Using Low-Dose Chest CT (LDCT) Obtained for Lung Cancer Screening: A Retrospective Study of 1336 Patients. 肺癌筛查低剂量胸部CT （LDCT）对骨质疏松症的评价：1336例患者的回顾性研究

IF 9.6 1区医学 Q1 CRITICAL CARE MEDICINE

Chest

Pub Date : 2026-01-08 DOI: 10.1016/j.chest.2025.12.031

Muhammad O Awiwi,Xu Zhang,Vedat Burak Kandemirli,Cihan Duran,Mina F Hanna,Mohamed Aburadi,Humaira Chaudhry,Ervin Gjoni,Nahid J Rianon

BACKGROUNDOsteoporosis is an important cause for morbidity, but it remains underdiagnosed and current screening programs for osteoporosis are underutilized.RESEARCH QUESTIONCan low-dose chest CT (LDCT) obtained for lung cancer screening identify patients with osteoporosis?STUDY DESIGN AND METHODSPatients who received LDCT and Dual energy x-ray (DXA) within 4 months of each other were identified. CT was used to manually measure vertebral trabecular bone attenuation (TBA) at the T7-L1 vertebrae. Vertebral fractures seen on CT were noted. DXA was used to obtain T-scores and FRAX scores. Mean CT-TBA values were correlated with DXA T-scores. Threshold CT-TBA values below which osteoporosis was present were reported.RESULTS1336 patients were included. The median age was 68 years (64-72). Osteoporosis was diagnosed in 33.0% of the cohort based on DXA T-scores and FRAX scores. At least one vertebral fracture occurred in 11.9% of patients. Mean CT-TBAT7-L1 had a moderate correlation with DXA T-score with an r-coefficient of 0.573 (95% CI: 0.531-0.614). The AUC of mean CT TBAT7-L1 in diagnosing osteoporosis was 0.771 (95% CI; 0.744-0.798, p<0.001). A CT-TBAT7-L1 threshold value of ≤130 HU yielded a sensitivity of 90.5% and a specificity of 39.7%. A TBAT7-L1 threshold value of ≤80 HU yielded a specificity of 93.1%. The prevalence of vertebral fractures at T-score ≤-2.5 was 21%; a similar fracture prevalence occurred at a CT-TBA threshold of ≤110 HU. T-score values of ≤-2.5 failed to identify 50.9% of vertebral fractures.INTERPRETATIONCT-TBA is a promising tool for diagnosing osteoporosis using LDCT obtained for lung cancer screening. This technique can be performed after minimal training without additional software, hardware, cost, or radiation exposure.

背景：骨质疏松症是一种重要的发病原因，但它仍未得到充分诊断，目前的骨质疏松症筛查计划也未得到充分利用。研究问题：用于肺癌筛查的低剂量胸部CT （LDCT）能否识别骨质疏松症患者？研究设计与方法选取4个月内分别接受LDCT和DXA检查的患者。采用CT人工测量T7-L1椎体椎小梁骨衰减（TBA）。CT显示椎体骨折。采用DXA法获得t评分和FRAX评分。CT-TBA平均值与DXA t评分相关。CT-TBA阈值低于骨质疏松存在的报告。结果共纳入1336例患者。中位年龄为68岁（64-72岁）。根据DXA t评分和FRAX评分，33.0%的队列诊断为骨质疏松症。11.9%的患者至少发生一次椎体骨折。平均CT-TBAT7-L1与DXA t评分有中等相关性，r系数为0.573 （95% CI: 0.531-0.614）。CT TBAT7-L1诊断骨质疏松的平均AUC为0.771 （95% CI; 0.744 ~ 0.798, p<0.001）。CT-TBAT7-L1阈值≤130 HU时，敏感性为90.5%，特异性为39.7%。TBAT7-L1阈值≤80 HU的特异性为93.1%。t评分≤-2.5的椎体骨折发生率为21%；CT-TBA阈值≤110 HU时也出现类似的骨折发生率。t评分值≤-2.5不能识别50.9%的椎体骨折。ct - tba是一种很有前途的工具，可以通过肺癌筛查获得的LDCT来诊断骨质疏松症。这项技术可以在最少的训练后执行，不需要额外的软件、硬件、成本或辐射暴露。

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引用次数: 0

"Lateral Decubitus Strategy (LADS) is Superior to Ventilatory Strategy (VESPA) in Preventing Atelectasis from Obscuring Targets during Robotic Bronchoscopy, Leading to Improved Procedural Outcomes" (LADS vs VESPA Trial). “侧躺策略（LADS）优于通气策略（VESPA），在机器人支气管镜检查中防止肺不张导致目标模糊，从而改善手术结果”（LADS与VESPA试验）。

IF 9.6 1区医学 Q1 CRITICAL CARE MEDICINE

Chest

Pub Date : 2026-01-07 DOI: 10.1016/j.chest.2025.11.044

Joshua M Boster,Mike Goertzen,Mona Sarkiss,Aristides J Armas Villalba,Bharat S Bandari,Juhee Song,Carlos A Jimenez,Bruce F Sabath,Julie Lin,Horiana B Grosu,David E Ost,George A Eapen,Gouthami Chintalapani,Roberto F Casal

BACKGROUNDAtelectasis during peripheral bronchoscopy can cause CT-to body divergence, false positive radial-probe endobronchial ultrasound images, and can obscure a target. As shown in prior studies, ventilatory strategies to prevent atelectasis, though useful, cannot completely avoid this phenomenon.RESEARCH QUESTIONIs a lateral decubitus superior to a ventilatory strategy in preventing atelectasis from obscuring targets in patients with lung nodules in dependent zones?STUDY DESIGN AND METHODSRandomized controlled study (1:1) in which patients undergoing robotic bronchoscopy for nodules ≤ 3 cm in dependent lung zones were randomized to lateral decubitus strategy (LADS) vs. a ventilatory strategy to prevent atelectasis (VESPA). Patients who developed atelectasis obscuring the target crossed over to the opposite arm. Primary outcome was the development of atelectasis obscuring the target detected with m-CBCT. Secondary endpoints included tool in lesion (TIL), diagnostic yield (DY), and safety.RESULTS62 patients were analyzed, 29 in LADS and 33 in VESPA. No patients developed atelectasis obscuring target in LADS, and 9 patients did in VESPA (27.3%, 95% CI, 13.3%-45.5%) (p=0.002). TIL was achieved in 29 patients (100%, 95%CI 88.1%-100%) in LADS and in 24 patients (72.7%, 95% CI 54.5%-86.7%) in VESPA (p=0.005). DY on index biopsy was made in 25 patients (86.2%, 95% CI 68.3%-96.1%) in LADS and 19 patients (57.6%, 95% CI 39.2%-74.5%) in VESPA (p=0.026). In all 9 patients who crossed over from VESPA to LADS, atelectasis was eliminated leading to TIL, and diagnosis was obtained in 7 (78%). There were no major complications and no differences in the rate of minor complications.INTERPRETATIONLADS is superior to VESPA in preventing atelectasis from obscuring targets in patients with nodules located in dependent areas, it can help eliminate atelectasis, it is safe, and it is also associated with better procedural outcomes such as TIL and diagnostic yield.

背景：外周支气管镜检查时的肺扩张可引起ct -体发散，假阳性的支气管内超声图像，并可掩盖目标。先前的研究表明，预防肺不张的通气策略虽然有用，但不能完全避免这种现象。研究问题：对于依赖区有肺结节的患者，侧卧是否优于通气策略，可以防止肺不张模糊目标？研究设计和方法随机对照研究（1:1），在该研究中，对依赖肺区≤3cm的结节进行机器人支气管镜检查的患者随机分为侧卧策略（LADS）和通气策略（VESPA），以防止肺不张。发生肺不张的患者会转移到对侧手臂。主要结果是肺不张的发展，模糊了m-CBCT检测到的目标。次要终点包括病灶内工具（TIL）、诊断率（DY）和安全性。结果共分析62例患者，其中lad 29例，VESPA 33例。lad组无患者发生肺不张，VESPA组有9例（27.3%,95% CI, 13.3%-45.5%）（p=0.002）。29例LADS患者（100%,95%CI 88.1%-100%）和24例VESPA患者（72.7%,95%CI 54.5%-86.7%）（p=0.005）达到TIL。25例LADS患者（86.2%,95% CI 68.3%-96.1%）和19例VESPA患者（57.6%,95% CI 39.2%-74.5%）进行了指数活检（p=0.026）。在所有从VESPA过渡到LADS的9例患者中，肺不张被消除导致TIL， 7例（78%）获得诊断。两组无重大并发症，轻微并发症发生率无差异。对于依赖区域结节患者，lads在防止肺不张模糊靶标方面优于VESPA，它可以帮助消除肺不张，它是安全的，并且还与更好的手术结果（如TIL和诊断率）相关。

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引用次数: 0

The Influence of Heart Failure and Ventilatory Support mode on hospital morbidity and mortality in patients with or at risk for Obesity Hypoventilation syndrome: findings from the National Inpatient Sample. 心力衰竭和呼吸支持方式对肥胖低通气综合征或有风险患者住院发病率和死亡率的影响：来自全国住院患者样本的调查结果

IF 9.6 1区医学 Q1 CRITICAL CARE MEDICINE

Chest

Pub Date : 2026-01-07 DOI: 10.1016/j.chest.2025.11.039

Roop Kaw,Shashank Shekhar,Reena Mehra,Loutfi Aboussouan,Babak Mokhlesi

BACKGROUNDHeart failure (HF) is common in obesity hypoventilation syndrome (OHS). We explored the impact of HF on in-hospital outcomes of patients with or at risk for OHS treated with mechanical ventilation (MV), non-invasive ventilation (NIV) or both.RESEARCH QUESTIONWhat is the outcome of OHS patients with HF?STUDY DESIGN AND METHODSThe National Inpatient Sample (2016-2020) was queried to extract data on patients with or at risk for OHS. Association of adverse outcomes with HF in OHS patients was explored by analysis adjusted for clinically relevant confounders.RESULTSAmong 72,385 OHS hospitalizations, 58.8% had an underlying diagnosis of HF and 26.3% were discharged with a primary diagnosis of HF. OHS patients with HF were older (mean age 60 vs. 54 years), frequently white (56.9 vs 43.1%), had longer length of stay (median 6 vs. 5 days) and independently associated with need for NIV [OR: 1.35], MV [1.34], and NIV+MV [1.67]. HF patients had lower likelihood of discharge to home [OR: 0.83; P<0.001], more in-hospital deaths [1.27], and more frequent adverse cardiovascular outcomes [1.20]. Utilization of NIV, MV or both was higher in patients with HF (36% vs 30%; P<0.001) but did not result in improvement in any of the above outcomes. When NIV was used in conjunction with MV, higher inpatient mortality [OR 14.8 vs 13.1 vs 1.5], more acute kidney injury (AKI) [3.9 vs 3.0 vs 1.3], and more major adverse cardiac events (MACE) [2.9 vs 2.4 vs 1.1] were reported when compared to use of either MV or NIV alone.INTERPRETATIONCo-morbid HF exists in 59% of hospitalized patients with or at risk of OHS. Utilization of NIV, MV or both was higher in patients with HF but did not result in improvement in any outcomes. All outcomes were worse in patients where both NIV and MV were utilized.

背景：心力衰竭（HF）在肥胖低通气综合征（OHS）中很常见。我们探讨了HF对机械通气（MV）、无创通气（NIV）或两者同时治疗的OHS患者或有OHS风险患者住院结局的影响。研究问题：OHS合并心衰患者的预后如何？研究设计和方法对2016-2020年全国住院患者样本进行查询，提取有OHS风险或存在OHS风险的患者数据。通过调整临床相关混杂因素的分析，探讨OHS患者不良结局与HF的关系。结果在72,385例OHS住院患者中，58.8%的患者诊断为心衰，26.3%的患者出院时诊断为心衰。OHS合并HF的患者年龄较大（平均年龄60岁对54岁），经常是白人（56.9%对43.1%），住院时间较长（中位数6天对5天），并且与需要使用NIV [OR: 1.35], MV[1.34]和NIV+MV[1.67]独立相关。心衰患者出院回家的可能性较低[OR: 0.83；P<0.001]，更多的院内死亡[1.27]和更频繁的不良心血管结局[1.20]。心衰患者使用NIV、MV或两者均较高（36% vs 30%， P<0.001），但上述任何结果均未得到改善。当NIV与MV联合使用时，与单独使用MV或NIV相比，报告了更高的住院死亡率[OR 14.8 vs 13.1 vs 1.5]，更多的急性肾损伤（AKI） [3.9 vs 3.0 vs 1.3]和更多的主要不良心脏事件（MACE） [2.9 vs 2.4 vs 1.1]。解释：59%的OHS患者或有OHS风险的住院患者存在合并性HF。心衰患者使用NIV、MV或两者都较高，但没有导致任何结果的改善。同时使用NIV和MV的患者的所有结果都更差。

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引用次数: 0

Young chronic e-cigarette users display cardiopulmonary abnormalities during exercise and blunted recruitment of pulmonary diffusing capacity 年轻的慢性电子烟使用者在运动期间表现出心肺异常和肺弥散能力的钝化

IF 9.6 1区医学 Q1 CRITICAL CARE MEDICINE

Chest

Pub Date : 2026-01-02 DOI: 10.1016/j.chest.2025.12.024

Thomas G. Williams, Sophie É. Collins, Andrew R. Brotto, Andrew W. D’Souza, Cameron M. Ehnes, Bronwen Hicks, Jason Weatherald, Janice M. Leung, Michael K. Stickland

引用次数: 0

CHEST How I Do It: Management of chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy 我是怎么做的：肺血栓动脉内膜切除术前后慢性血栓栓塞性肺动脉高压的处理

IF 9.6 1区医学 Q1 CRITICAL CARE MEDICINE

Chest

Pub Date : 2026-01-02 DOI: 10.1016/j.chest.2025.12.028

Jenny Z. Yang, Michael M. Madani, Demosthenes G. Papamatheakis, Timothy M. Fernandes, David S. Poch, Mona Alotaibi, Kim M. Kerr, Nick H. Kim

引用次数: 0

Clinical Trial Eligibility in Pulmonary Arterial Hypertension: Why Its So Challenging? 肺动脉高压的临床试验资格：为什么如此具有挑战性？

IF 9.6 1区医学 Q1 CRITICAL CARE MEDICINE

Chest

Pub Date : 2026-01-02 DOI: 10.1016/j.chest.2025.12.027

Chidinma Ejikeme, Nelson Villasmil Hernandez, Maria Jose Maestre, Meagan Chavarria, Sandeep Sahay

引用次数: 0

An Inventory of Clinical Sarcoidosis Status in the United States. 美国临床结节病状况的调查。

IF 8.6 1区医学 Q1 CRITICAL CARE MEDICINE

Chest

Pub Date : 2026-01-01 Epub Date: 2025-08-28 DOI: 10.1016/j.chest.2025.07.4091

Kerry M Hena, Briana Barkes, Fabian Heinrich, Rebecca Kogan, Rachel K Strykowski, Ogugua Ndili Obi, Marc A Judson, Lisa A Maier, Karen C Patterson

Background: The landscape of sarcoidosis in the United States is unclear, which makes it difficult to optimize the allocation of health care resources, clinical care programs, and research activities for sites that specialize in sarcoidosis.

Research question: Can the features of sarcoidosis be defined in patients requiring specialty care in the United States to inform the design of clinical management and research programs?

Study design and methods: Adult patients with sarcoidosis were enrolled in this multicenter, longitudinal cohort study. Demographic and clinical characteristics, including lung function and imaging features, were recorded at baseline. Patients were followed up for a median of 21 months (interquartile range, 9-27 months).

Results: The cohort comprised 2,034 patients from 39 states. Even when excluding lymph node involvement, 51.8% of patients had multi-organ disease, and sarcoidosis was chronic (≥ 3 years) for 66.5% of patients. Pulmonary fibrosis was present in 35.9% of those with lung involvement and was associated with worse lung function, an effect most pronounced when bronchiectasis was present. Slightly more than one-half (53.4%) of the cohort required treatment at the time of study entry; of those, 24.8% were on a steroidal regimen alone, 39.7% were on a nonsteroidal regimen alone, and 35.5% were on a combination regimen. During follow-up, there were 120 new organ events, resulting in a new organ rate of 5.5 per 100 patient-years (95% CI, 4.6-6.6). Cardiac sarcoidosis was present in 16.2% of patients at baseline, and emergent cardiac involvement was the most common new organ phenotype during follow-up.

Interpretation: Sarcoidosis is frequently chronic and dynamic. These data support the need for programs aimed at preventing and treating pulmonary fibrosis and cardiac sarcoidosis, as well as the development of long-term, multidisciplinary management strategies.

背景：美国结节病的情况尚不清楚，这使得难以优化医疗资源的分配，临床护理计划，以及专门研究结节病的研究活动。研究问题：明确美国需要专科治疗的结节病患者的特征，为临床管理和研究计划的设计提供信息。研究设计和方法：成年患者被纳入这项多中心、纵向队列研究。在基线时记录人口统计学和临床特征，包括肺功能和影像学特征。患者的中位随访时间为21个月（IQR 9-27）。结果：该队列由来自39个州的2034名患者组成。即使排除淋巴结累及，51.8%的患者有多器官疾病，66.5%的结节病为慢性（≥3年）。35.9%的肺部受累患者存在肺纤维化，并伴有肺功能恶化，当存在支气管扩张时，这种影响最为明显。超过一半（53.4%）的队列在研究开始时需要治疗；其中，24.8%的患者单独服用类固醇药物，39.7%的患者单独服用非类固醇药物，35.5%的患者联合服用类固醇药物。随访期间，发生120例新器官事件，新器官发生率为5.5/100患者-年（95%CI 4.60-6.64）。在基线时，16.2%的患者存在心脏结节病，在随访期间，紧急心脏受累是最常见的新器官表型。结节病通常是慢性和动态的。我们的数据支持围绕肺纤维化和心脏结节病的预防和治疗方案的需求，以及长期、多学科管理策略的发展。

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引用次数: 0

A 74-Year-Old Woman With Dyspnea, Muscle Weakness, and Rapidly Progressive Bilateral Diffuse Pulmonary Infiltrates. 74岁女性，呼吸困难，肌肉无力，双侧弥漫性肺浸润迅速进展。

IF 9.6 1区医学 Q1 CRITICAL CARE MEDICINE

Chest

Pub Date : 2026-01-01 DOI: 10.1016/j.chest.2025.07.4069

Chunli Wu,Xiaoxiao Zhu,Qi Dai,Zhenyue Ye,Lin Yang,Yong Zhou,Zhaoxing Dong

A 74-year-old woman sought treatment with a 4-day history of high fever and rapidly progressive dyspnea. A 2-day course of ceftriaxone and betamethasone administered in an outpatient setting did not result in any clinical improvement, leading to her admission to our hospital. She demonstrated a slight cough but did not report heartburn, night sweats, hemoptysis, myalgia, arthralgia, or weight loss. Her family history was unremarkable.

一名74岁女性因4天高烧和快速进行性呼吸困难就诊。在门诊进行了2天的头孢曲松和倍他米松治疗，但没有任何临床改善，导致她入院。她表现为轻微咳嗽，但未报告烧心、盗汗、咯血、肌痛、关节痛或体重减轻。她的家族史平平无奇。

引用次数: 0

A Case of Mediastinal Adenopathy and Clinically Suspected Myocarditis. 纵隔腺病伴临床疑似心肌炎1例。

IF 9.6 1区医学 Q1 CRITICAL CARE MEDICINE

Chest

Pub Date : 2026-01-01 DOI: 10.1016/j.chest.2025.07.4094

Alexandre Terré,Catherine Julié,Nathalie Dournon,Pierre Cappy,Stephen Binsse,Thomas Hanslik,Jean-Emmanuel Kahn,Camille Montardi

A 29-year-old man originally from an Eastern European country with a high TB incidence had resided in Western Europe for 6 years. He worked in air conditioning repair and currently smoked. He presented to the emergency department with a 10-day history of chest pain, dry cough, and fever. He had no significant medical history, recent travel, animal contact, or insect bites. He denied IV drug use and risk factors for sexually transmitted infections. On admission, his vital signs were stable except for a low-grade fever of 38.5 °C, with no respiratory distress or audible wheezing noted. He was discharged with a diagnosis of a common cold.

一名来自结核病高发病率的东欧国家的29岁男子曾在西欧居住6年。他从事空调维修工作，目前吸烟。他以胸痛、干咳和发烧10天的病史就诊于急诊科。患者无明显病史、近期旅行史、动物接触史或蚊虫叮咬史。他否认静脉注射药物和性传播感染的风险因素。入院时，除38.5°C低烧外，生命体征稳定，未见呼吸窘迫或听得见喘息。他被诊断为普通感冒而出院了。

引用次数: 0

Ceftriaxone to Prevent Early-Onset Pneumonia in Comatose Patients Following Out-of-Hospital Cardiac Arrest: A Pilot Randomized Controlled Trial and Resistome Assessment (PROTECT). 头孢曲松预防院外心脏骤停后昏迷患者早发性肺炎：一项试点随机对照试验和抵抗组评估（PROTECT）

IF 8.6 1区医学 Q1 CRITICAL CARE MEDICINE

Chest

Pub Date : 2026-01-01 Epub Date: 2025-08-28 DOI: 10.1016/j.chest.2025.08.007

David J Gagnon, Kristin M Burkholder, Alexandra J Weissman, Richard R Riker, Sergey Ryzhov, Teresa L May, John DiPalazzo, Joanne T deKay, Lacey Knudsen, Meagan W Moore, Nicholas A Pozzessere, Mary Weatherbee, Muriel Kelly, Adane S Nigatu, Joseph L Sevigny, Stephen Simpson, W Kelley Thomas, Clifton W Callaway, Bram J Geller, Douglas B Sawyer, David B Seder

Background: Antibiotic prophylaxis following out-of-hospital cardiac arrest (OHCA) reduces early-onset pneumonia. However, it has an uncertain impact on mortality and noninfectious outcomes, with ongoing concerns about the subsequent development of antibiotic resistance.

Research question: Does prophylactic ceftriaxone reduce the incidence of early-onset pneumonia without increasing the acquisition of antibiotic resistance genes after OHCA?

Study design and methods: Comatose survivors of OHCA treated with targeted temperature management without a clinical diagnosis of pneumonia at admission were randomized to receive ceftriaxone 2 g or matching placebo every 12 hours for 3 days. The primary outcome was early-onset pneumonia occurring ≤ 4 days following intubation confirmed by masked adjudicators. Abundance of antibiotic resistance genes recovered from rectal swabs before and after study drug administration were analyzed with metagenomic sequencing.

Results: A total of 411 participants were screened; 53 (13%) were randomized to treatment, and 1 participant withdrew, leaving 26 in each group in the final analysis. Early-onset pneumonia was diagnosed in 10 (38%) participants receiving ceftriaxone and 18 (69%) participants receiving placebo (risk ratio, 0.57; 95% CI, 0.21-1.001; P = .05). Open-label antibiotics were administered to 14 (54%) participants receiving ceftriaxone and 22 (85%) receiving placebo (risk ratio, 0.64; 95% CI, 0.43-0.94); most of the antibiotics were broad-spectrum agents (93% and 100%, respectively). After adjusting for differences in abundance of antibiotic resistance genes prior to study drug administration, participants randomized to receive ceftriaxone acquired significantly fewer antibiotic resistance genes to frequently used antibiotics in the ICU compared with those randomized to receive placebo (incidence risk ratio, 0.30; 95% CI, 0.13-0.70). Serious adverse drug effects were not reported in either treatment group.

Interpretation: This trial was inconclusive regarding the impact of ceftriaxone prophylaxis on reducing the incidence of early-onset pneumonia following OHCA. However, ceftriaxone was associated with less frequent administration of open-label antibiotics and reduced acquisition of antibiotic resistance genes to frequently used antibiotics in the ICU.

Clinical trial registration: ClinicalTrials.gov; No.: NCT04999592; URL: www.

Clinicaltrials: gov.

院外心脏骤停（OHCA）后的抗生素预防可减少早发性肺炎，但对死亡率和非感染性结局的影响尚不确定，对随后抗生素耐药性的发展仍存在担忧。研究问题：预防性头孢曲松是否能在不增加OHCA后抗生素耐药基因获得的情况下降低早发性肺炎的发生率？研究设计和方法：入院时接受靶向温度管理且无肺炎临床诊断的OHCA昏迷幸存者每12小时随机服用头孢曲松2gm或匹配的安慰剂，持续3天。主要终点为经盲法评估者确认的插管后≤4天发生的早发性肺炎。通过宏基因组测序分析研究药物给药前后直肠拭子中抗生素耐药基因的丰度。结果：共筛选411例受试者，随机抽取53例（13%），退出1例，每组最终分析26例。头孢曲松组10例（38%）诊断为早发性肺炎，安慰剂组18例（69%）诊断为早发性肺炎（RR 0.57, 95% CI 0.21-1.001; p=0.05）。头孢曲松组14例（54%）和安慰剂组22例（85%）使用开放标签抗生素（RR 0.64, 95%CI 0.43-0.94），其中大多数为广谱抗生素（分别为93%和100%）。在调整研究用药前抗生素耐药基因丰度的差异后，与随机分配到安慰剂组的受试者相比，随机分配到头孢曲松组的受试者对ICU常用抗生素的耐药基因明显减少（IRR 0.30, 95% CI 0.13-0.70）。两组均未见严重的药物不良反应。解释：关于头孢曲松预防对减少OHCA后EOP发生率的影响，该试验尚无定论，但头孢曲松与开放标签抗生素的使用频率降低有关，并且减少了ICU常用抗生素的ARGs获取。临床试验注册：国家医学图书馆www.Clinicaltrials: gov （NCT04999592）。

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