2017 Jun - A Randomized Trial of the Amikacin Fosfomycin Inhalation System for the Adjunctive Therapy of Gram-Negative Ventilator-Associated Pneumonia: IASIS Trial
Marin H. Kollef, MD; Jean-Damien Ricard, MD; Damien Roux, MD; Bruno Francois, MD; Eleni Ischaki, MD; Zsolt Rozgonyi, MD; Thierry Boulain, MD; Zsolt Ivanyi, MD; Gál János, MD; Denis Garot, MD; Firas Koura, MD; Epaminondas Zakynthinos, MD; George Dimopoulos, MD; Antonio Torres, MD; Wayne Danker, MD; A. Bruce Montgomery, MD CHEST Jun 2017; 151(6): 1239-1246
Background: Clinical failures in ventilator-associated pneumonia (VAP) caused by gram-negative bacteria are common and associated with substantial morbidity, mortality, and resource utilization.
2017 Jun - Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study
Paul E. Marik, MD, FCCP; Vikramjit Khangoora, MD; Racquel Rivera, PharmD; Michael H. Hooper, MD; John Catravas, PhD, FCCP CHEST Jun 2017; 151(6): 1229-1238
Background: The global burden of sepsis is estimated as 15 to 19 million cases annually, with a mortality rate approaching 60% in low-income countries.
2017 May - A 10-Year Review of Total Hospital-Onset ICU Bloodstream Infections at an Academic Medical Center
Anna M. Civitarese, BS; Eric Ruggieri, PhD; J. Matthias Walz, MD; Deborah Ann Mack, RN, CIC; Stephen O. Heard, MD; Michael Mitchell, MD; Craig M. Lilly, MD; Karen E. Landry, BS; Richard T. Ellison, III, MD CHEST May 2017; 151(5): 1011-1017
Background: The rates of central line-associated bloodstream infections (CLABSIs) in U.S. ICUs have decreased significantly, and a parallel reduction in the rates of total hospital-onset bacteremias in these units should also be expected. We report 10-year trends for total hospital-onset ICU-associated bacteremias at a tertiary-care academic medical center.
2017 May - Prophylactic Corticosteroids for Prevention of Postextubation Stridor and Reintubation in Adults: A Systematic Review and Meta-analysis
Akira Kuriyama, MD, MPH; Noriyuki Umakoshi, MD; Rao Sun, MD, PhD CHEST May 2017; 151(5): 1002-1010
Background: Corticosteroid administration before elective extubation has been used to prevent postextubation stridor and reintubation. We updated a systematic review to identify which patients would benefit from prophylactic corticosteroid administration before elective extubation.
2017 Apr - Can High-flow Nasal Cannula Reduce the Rate of Endotracheal Intubation in Adult Patients With Acute Respiratory Failure Compared With Conventional Oxygen Therapy and Noninvasive Positive Pressure Ventilation?: A Systematic Review and Meta-anal
Yue-Nan Ni, MM; Jian Luo, MD; He Yu, MD; Dan Liu, MD; Zhong Ni, MD; Jiangli Cheng, MD; Bin-Miao Liang, MD; Zong-An Liang, MD CHEST Apr 2017; 151(4): 764-775
Background: The effects of high-flow nasal cannula (HFNC) on adult patients with acute respiratory failure (ARF) are controversial. We aimed to further determine the effectiveness of HFNC in reducing the rate of endotracheal intubation in adult patients with ARF by comparison to noninvasive positive pressure ventilation (NIPPV) and conventional oxygen therapy (COT).
Liang Luo, MD; Ciara M. Shaver, MD, PhD; Zhiguo Zhao, PhD; Tatsuki Koyama, PhD; Carolyn S. Calfee, MD; Julie A. Bastarache, MD; Lorraine B. Ware, MD CHEST Apr 2017; 151(4): 755-763
Background: Direct (pulmonary) and indirect (extrapulmonary) ARDS are distinct syndromes with important pathophysiologic differences. The goal of this study was to determine whether clinical characteristics and predictors of mortality differ between direct or indirect ARDS.
Julian deBacker, MSc; Nicholas Hart, PhD; Eddy Fan, MD, PhD Chest Feb 2017; 151(3): 697-706
Neuromuscular blockings agents (NMBAs) have a controversial role in the ventilatory and medical management of critical illness. The clinical concern surrounding NMBA-induced complications stems from evidence presented in the 2002 clinical practice guidelines, but new evidence from subsequent randomized trials and studies provides a more optimistic outlook about the application of NMBAs in the ICU.
2017 Mar - Systemic Inflammatory Response Syndrome, Quick Sequential Organ Function Assessment, and Organ Dysfunction: Insights From a Prospective Database of ED Patients With Infection
Julian M. Williams, MBBS; Jaimi H. Greenslade, PhD; Juliet V. McKenzie, MBBS; Kevin Chu, MBBS, MS; Anthony F.T. Brown, MBChB; Jeffrey Lipman, MD Chest Feb 2017; 151(3): 586-596
Background: A proposed revision of sepsis definitions has abandoned the systemic inflammatory response syndrome (SIRS), defined organ dysfunction as an increase in total Sequential Organ Function Assessment (SOFA) score of ≥ 2, and conceived “qSOFA” (quick SOFA) as a bedside indicator of organ dysfunction. We aimed to (1) determine the prognostic impact of SIRS, (2) compare the diagnostic accuracy of SIRS and qSOFA for organ dysfunction, and (3) compare standard (Sepsis-2) and revised (Sepsis-3) definitions for organ dysfunction in ED patients with infection.
2017 Mar - An Educational Intervention Optimizes the Use of Arterial Blood Gas Determinations Across ICUs From Different Specialties: A Quality-Improvement Study
Carlos D. Martínez-Balzano, MD; Paulo Oliveira, MD; Michelle O’Rourke, DAP ACBP-BC; Luanne Hills, BS, RRT; Andrés F. Sosa, MD, FCCP Chest Feb 2017; 151(3): 579-585
Background: Overuse of arterial blood gas (ABG) determinations leads to increased costs, inefficient use of staff work hours, and patient discomfort and blood loss. We developed guidelines to optimize ABG use in the ICU.
Lee E. Morrow, MD; Paul Wischmeyer, MD Chest Feb 2017; 151(2): 492-499
Clinicians have traditionally dichotomized bacteria as friendly commensals or harmful pathogens. However, the line separating the two has become blurred with the recognition that the intestinal microbiome is a complex entity in which species can shift sides—from friend to foe and back again—based on crucial factors in their local environment.
2017 Feb - Comparing Quality of Dying and Death Perceived by Family Members and Nurses for Patients Dying in US and Dutch ICUs
Rik T. Gerritsen, MD; Matty Koopmans, RN, MSc; José G.M. Hofhuis, RN, PhD; J. Randall Curtis, MD, MPH; Hanne Irene Jensen, RN, PhD; Jan G. Zijlstra, MD, PhD; Ruth A. Engelberg, PhD; Peter E. Spronk, MD, PhD Chest Feb 2017; 151(2): 298-307
Background: The Quality of Dying and Death (QODD) questionnaire is used as a self-reported measure to allow families and clinicians to assess patients’ quality of dying and death. We evaluated end-of-life (EOL) experiences as measured by the QODD completed by families and nurses in the United States and the Netherlands to explore similarities and differences in these experiences and identify opportunities for improving EOL care.
Craig M. Lilly, MD, FCCP; Christine Motzkus, MPH; Teresa Rincon, RN, BSN; Shawn E. Cody, PhD, MSN/MBA, RN; Karen Landry, BS; Richard S. Irwin, MD, Master FCCP Chest Feb 2017; 151(2): 286-297
Background: ICU telemedicine improves access to high-quality critical care, has substantial costs, and can change financial outcomes. Detailed information about financial outcomes and their trends over time following ICU telemedicine implementation and after the addition of logistic center function has not been published to our knowledge.
2017 Feb - Estimating Ten-Year Trends in Septic Shock Incidence and Mortality in United States Academic Medical Centers Using Clinical Data
Sameer S. Kadri, MD; Chanu Rhee, MD, MPH; Jeffrey R. Strich, MD; Megan K. Morales, MD; Samuel Hohmann, PhD; Jonathan Menchaca, BA; Anthony F. Suffredini, MD; Robert L. Danner, MD; Michael Klompas, MD, MPH CHEST Feb 2017; 151(2): 278-285
Background: Reports that septic shock incidence is rising and mortality rates declining may be confounded by improving recognition of sepsis and changing coding practices. We compared trends in septic shock incidence and mortality in academic hospitals using clinical vs claims data.
Eric L. Scholten, MD; Jeremy R. Beitler, MD, MPH; G. Kim Prisk, PhD, DSc; Atul Malhotra, MD CHEST Jan, 2017; 151(1): 215-224
Prone positioning was first proposed in the 1970s as a method to improve gas exchange in ARDS. Subsequent observations of dramatic improvement in oxygenation with simple patient rotation motivated the next several decades of research.
Yonatan Y. Greenstein, MD; Ross Littauer, MD; Mangala Narasimhan, DO, FCCP; Paul H. Mayo, MD, FCCP; Seth J. Koenig, MD, FCCP CHEST Jan, 2017; 151(1): 34-40
Background: Widespread use of critical care ultrasonography (CCUS) for the management of patients in the ICU requires an effective training program. The effectiveness of national and regional CCUS training courses is not known. This study describes a national-level, simulation-based, 3-day CCUS training program and evaluates its effectiveness.
2017 Jan - Effect of Procalcitonin Testing on Health-care Utilization and Costs in Critically Ill Patients in the United States
Robert A. Balk, MD; Sameer S. Kadri, MD; Zhun Cao, PhD; Scott B. Robinson, MA, MPH; Craig Lipkin, MS; Samuel A. Bozzette, MD, PhD CHEST Jan 2017; 151(1): 23-3
Background: There is a growing use of procalcitonin (PCT) to facilitate the diagnosis and management of severe sepsis. We investigated the impact of one to two PCT determinations on ICU day 1 on health-care utilization and cost in a large research database.
2016 Dec - Risk Factors for In-Hospital Mortality in Smoke Inhalation-Associated Acute Lung Injury: Data From 68 United States Hospitals
Sameer S. Kadri, MD; Andrew C. Miller, MD; Samuel Hohmann, PhD; Stephanie Bonne, MD; Carrie Nielsen, MA; Carmen Wells, RN; Courtney Gruver, RN; Sadeq A. Quraishi, MD; Junfeng Sun, PhD; Rongman Cai, PhD; Peter E. Morris, MD; Bradley D. Freeman, MD; James H. Holmes, MD; Bruce A. Cairns, MD; Anthony F. Suffredini, MD CHEST Dec 2016; 150(6): 1260-1268
Background: Mortality after smoke inhalation–associated acute lung injury (SI-ALI) remains substantial. Age and burn surface area are risk factors of mortality, whereas the impact of patient- and center-level variables and treatments on survival are unknown.
Shipra Gupta, MD; Ankit Sakhuja, MD; Gagan Kumar, MD; Eric McGrath, MD; Rahul S. Nanchal, MD; Kianoush B. Kashani, MD, FCCP CHEST Dec 2016; 150(6): 1251-1259
Background: Although 28% to 49% of severe sepsis hospitalizations have been described as being “culture negative,” there are very limited data on the epidemiology and outcomes of those with culture-negative severe sepsis (CNSS). The objectives of this study were to investigate the proportion and trends of CNSS and its association with mortality.
Sarah E. Jolley, MD; Aaron E. Bunnell, MD; Catherine L. Hough, MD CHEST Nov 2016; 150(5): 1129-1140
Survivorship after critical illness is an increasingly important health-care concern as ICU use continues to increase while ICU mortality is decreasing. Survivors of critical illness experience marked disability and impairments in physical and cognitive function that persist for years after their initial ICU stay.
2016 Nov - Elevated Plasma Levels of sRAGE Are Associated With Nonfocal CT-Based Lung Imaging in Patients With ARDS: A Prospective Multicenter Study
Segolene Mrozek, MD; Matthieu Jabaudon, MD; Samir Jaber, MD, PhD; Catherine Paugam-Burtz, MD, PhD; Jean-Yves Lefrant, MD, PhD; Jean-Jacques Rouby, MD, PhD; Karim Asehnoune, MD, PhD; Bernard Allaouchiche, MD, PhD; Olivier Baldesi, MD; Marc Leone, MD, PhD; Qin Lu, MD, PhD; Jean-Etienne Bazin, MD, PhD; Laurence Roszyk, PharmD; Vincent Sapin, PharmD, PhD; Emmanuel Futier, MD, PhD; Bruno Pereira, PhD; Jean-Michel Constantin, MD, PhD CHEST Nov 2016; 150(5): 998-1007
Background: During ARDS, CT can reveal two distinct lung imaging patterns, focal or nonfocal, with different responses to positive end-expiratory pressure, recruitment maneuvers, and prone position. Nevertheless, their association with plasma biomarkers and their distinct functional/pathobiological mechanisms are unknown. The objective of this study was to characterize focal and nonfocal patterns of lung CT-based imaging with plasma markers of lung injury.