2014 Sep - Variation in Decisions to Forgo Life-Sustaining Therapies in US ICUs

Caroline M. Quill, MD; Sarah J. Ratcliffe, PhD; Michael O. Harhay, MPH; Scott D. Halpern, MD, PhD  CHEST Sep 2014; 146(3): 573-582

BACKGROUND: The magnitude and implication of variation in end-of-life decision-making among ICUs in the United States is unknown.

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2014 Aug - Inappropriate Care in European ICUs: Confronting Views From Nurses and Junior and Senior Physicians

Ruth D. Piers, MD, PhD; Elie Azoulay, MD, PhD; Bara Ricou, MD; Freda DeKeyser Ganz, RN, PhD; Adeline Max, MD; Andrej Michalsen, MD, MPH; Paulo Azevedo Maia, MD; Radoslaw Owczuk, MD, PhD; Francesca Rubulotta, MD, PhD; Anne-Pascale Meert, MD; Anna K. Reyners, MD, PhD; Johan Decruyenaere, MD, PhD; Dominique D. Benoit, MD, PhD; for the Appropricus Study Group of the Ethics Section of the European Society of Intensive Care Medicine  CHEST Aug 2014; 146(2): 267-275

BACKGROUND: ICU care providers often feel that the care given to a patient may be inconsistent with their professional knowledge or beliefs. This study aimed to assess differences in, and reasons for, perceived inappropriate care (PIC) across ICU care providers with varying levels of decision-making power.

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2014 Aug - Outcomes for Patients With Cancer Admitted to the ICU Requiring Ventilatory Support: Results From a Prospective Multicenter Study

Luciano C. P. Azevedo, MD, PhD; Pedro Caruso, MD, PhD; Ulysses V. A. Silva, MD; André P. Torelly, MD; Eliézer Silva, MD, PhD; Ederlon Rezende, MD; José J. Netto, MD; Claudio Piras, MD, PhD; Suzana M. A. Lobo, MD, PhD; Marcos F. Knibel, MD; José M. Teles, MD; Ricardo. A. Lima, MD, PhD; Bruno S. Ferreira, MD; Gilberto Friedman, MD, PhD; Alvaro Rea-Neto, MD, PhD, FCCP; Felipe Dal-Pizzol, MD, PhD; Fernando A. Bozza, MD, PhD; Jorge I. F. Salluh, MD, PhD; Márcio Soares, MD, PhD on behalf of the Brazilian Research in Intensive Care Network (BRICNet)  CHEST Aug 2014; 146(2): 257-266

BACKGROUND: This study was undertaken to evaluate the clinical characteristics and outcomes of patients with cancer requiring nonpalliative ventilatory support.

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2014 Jul - Ventilator-Associated Pneumonia During Weaning From Mechanical Ventilation: Role of Fluid Management

Armand Mekontso Dessap, MD, PhD; Sandrine Katsahian, MD; Ferran Roche-Campo, MD, PhD; Hugo Varet, PhD; Achille Kouatchet, MD; Vinko Tomicic, MD; Gaetan Beduneau, MD; Romain Sonneville, MD, PhD; Samir Jaber, MD, PhD; Michael Darmon, MD, PhD; Diego Castanares-Zapatero, MD; Laurent Brochard, MD; Christian Brun-Buisson, MD  CHEST Jul 2014; 146(1): 58-65

BACKGROUND: Pulmonary edema may alter alveolar bacterial clearance and infectivity. Manipulation of fluid balance aimed at reducing fluid overload may, therefore, influence ventilator-associated pneumonia (VAP) occurrence in intubated patients. The objective of the present study was to assess the impact of a depletive fluid-management strategy on ventilator-associated complication (VAC) and VAP occurrence during weaning from mechanical ventilation.

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2014 Jul - Thrombosis Prophylaxis and Mortality Risk Among Critically Ill AdultsVTE Prophylaxis

Craig M. Lilly, MD, FCCP; Xinggang Liu, MD, PhD; Omar Badawi, PharmD, MPH; Christine S. Franey, MPH; Ilene H. Zuckerman, PharmD, PhD  CHEST Jul 2014; 146(1): 51-57

BACKGROUND: The optimal approach for managing increased risk of VTE among critically ill adults is unknown.

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2014 Jun - Efficacy and Safety of Early Dexmedetomidine During Noninvasive Ventilation for Patients With Acute Respiratory Failure: A Randomized, Double-Blind, Placebo-Controlled Pilot Study

John W. Devlin, PharmD; Nada S. Al-Qadheeb, PharmD, FCCP; Amy Chi, MD; Russel J. Roberts, PharmD; Imrana Qawi, MD; Erik Garpestad, MD, FCCP; Nicholas S. Hill, MD, FCCP  CHEST Jun 2014; 145(6): 1204-1212

Background: Successful application of noninvasive ventilation (NIV) for acute respiratory failure (ARF) requires patient cooperation and comfort. The efficacy and safety of early IV dexmedetomidine when added to protocolized, as-needed IV midazolam and fentanyl remain unclear.

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2014 Jun - Modified Criteria for the Systemic Inflammatory Response Syndrome Improves Their Utility Following Cardiac Surgery

Niall S. MacCallum, PhD; Simon J. Finney, PhD; Sarah E. Gordon, MD; Gregory J. Quinlan, PhD; Timothy W. Evans, MD, PhD  CHEST Jun 2014; 145(6): 1197-1203

Background: Debate remains regarding whether the systemic inflammatory response syndrome (SIRS) identifies patients with clinically important inflammation. Defining criteria may be disproportionately sensitive and lack specificity. We investigated the incidence and evolution of SIRS in a homogenous population (following cardiac surgery) over 7 days to establish the relationship between SIRS and outcome, modeling alternative permutations of the criteria to increase their discriminatory power for mortality, length of stay, and organ dysfunction.

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2014 May - Use and Outcomes of Noninvasive Positive Pressure Ventilation in Acute Care Hospitals in Massachusetts

Aylin Ozsancak Ugurlu, MD; Samy S. Sidhom, MD, MPH; Ali Khodabandeh, MD; Michael Ieong, MD; Chester Mohr, MD; Denis Y. Lin, MD; Irwin Buchwald, MD, FCCP; Imad Bahhady, MD; John Wengryn, MD, FCCP; Vinay Maheshwari, MD, FCCP; Nicholas S. Hill, MD, FCCP  CHEST May, 2014; 145(5): 964-971

Background: This study determined actual utilization rates and outcomes of noninvasive positive pressure ventilation (NIV) at selected hospitals that had participated in a prior survey on NIV use.

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2014 May - The Emotional and Cognitive Impact of Unexpected Simulated Patient Death: A Randomized Controlled Trial

Kristin Fraser, MD; James Huffman, MD; Irene Ma, MD; Matthew Sobczak, BSc; Joanne McIlwrick, MD; Bruce Wright, MD; Kevin McLaughlin, PhD  CHEST May, 2014; 145(5): 958-963

Background: Observational studies suggest that emotions experienced during simulation training may affect cognitive load and learning outcomes. The objective of this study was to manipulate emotions during simulation training and assess the impact on cognitive load and learning.

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2014 Apr - ABO Blood Type A Is Associated With Increased Risk of ARDS in Whites Following Both Major Trauma and Severe Sepsis

John P. Reilly, MD; Nuala J. Meyer, MD, FCCP; Michael G. S. Shashaty, MD; Rui Feng, PhD; Paul N. Lanken, MD, FCCP; Robert Gallop, PhD; Sandra Kaplan, BSN; Maximilian Herlim; Nathaniel L. Oz, BS; Isabel Hiciano, BA; Ana Campbell, MD; Daniel N. Holena, MD; Muredach P. Reilly, MBBCh; Jason D. Christie, MD  CHEST Apr 2014; 145(4): 753-761

Background: ABO glycosyltransferases catalyze antigen modifications on various glycans and glycoproteins and determine the ABO blood types. Blood type A has been associated with increased risk of vascular diseases and differential circulating levels of proteins related to inflammation and endothelial function. The objective of this study was to determine the association of ABO blood types with ARDS risk in patients with major trauma and severe sepsis.

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2014 Apr - Leveraging a Critical Care Database: Selective Serotonin Reuptake Inhibitor Use Prior to ICU Admission Is Associated With Increased Hospital Mortality

Marzyeh Ghassemi, MS; John Marshall, PharmD; Nakul Singh, MS; David J. Stone, MD; Leo Anthony Celi, MD, MPH  CHEST Apr 2014; 145(4): 745-752

Background: Observational studies have found an increased risk of adverse effects such as hemorrhage, stroke, and increased mortality in patients taking selective serotonin reuptake inhibitors (SSRIs). The impact of prior use of these medications on outcomes in critically ill patients has not been previously examined. We performed a retrospective study to determine if preadmission use of SSRIs or serotonin norepinephrine reuptake inhibitors (SNRIs) is associated with mortality differences in patients admitted to the ICU.

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2014 Mar - Temporal Trends in the Use of Parenteral Nutrition in Critically Ill Patients

Hayley B. Gershengorn, MD; Jeremy M. Kahn, MD; Hannah Wunsch, MD  CHEST March 2014; 145(3): 508-517

Background: Clinical practice guidelines recommend enteral over parenteral nutrition in critical illness and do not recommend early initiation. Few data are available on parenteral nutrition use or timing of initiation in the ICU or how this use may have changed over time.

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2014 Mar - A Multicenter Study of ICU Telemedicine Reengineering of Adult Critical Care

Craig M. Lilly, MD, FCCP; John M. McLaughlin, PhD, MSPH; Huifang Zhao, PhD; Stephen P. Baker, MScPH; Shawn Cody, RN, MSN, MBA; Richard S. Irwin, MD, Master FCCP; for the UMass Memorial Critical Care Operations Group  CHEST March 2014; 145(3): 500-507

Background: Few studies have evaluated both the overall effect of ICU telemedicine programs and the effect of individual components of the intervention on clinical outcomes.

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2014 Feb - Innovative Designs for the Smart ICU: Part 1: From Initial Thoughts to Occupancy

Neil A. Halpern, MD, FCCP CHEST Feb 2014; 145(2): 399-403


Designing a smart ICU is a time-consuming, complex, multiphased, political, and costly exercise. This process begins with two notions: First, all hospital parties agree that a new or renovated ICU is required, and second, the hospital has agreed to allocate space, personnel, and fiscal resources for the project. In this first of a three-part series on innovative designs for the smart ICU, we will explore the roles of the ICU design team in managing the design process. 

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2014 Feb - Differences in End-of-Life Care in the ICU Across Patients Cared for by Medicine, Surgery, Neurology, and Neurosurgery Physicians

Erin K. Kross, MD; Ruth A. Engelberg, PhD; Lois Downey, MA; Joseph Cuschieri, MD; Matthew R. Hallman, MD; W. T. Longstreth, Jr, MD, MPH; David L. Tirschwell, MD; J. Randall Curtis, MD, MPH, FCCP  CHEST Feb 2014; 145(2): 313-321


Background: Some of the challenges in the delivery of high-quality end-of-life care in the ICU include the variability in the characteristics of patients with certain illnesses and the practice of critical care by different specialties.

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2014 Jan - Persistent Fever in the ICU

Tayyab Rehman, MD; Bennett P. deBoisblanc, MD  CHEST Jan, 2014; 145(1): 158-165


Disorders of elevated body temperature may be classified as either fever or hyperthermia. Fever is caused by a pyrogen-mediated upward adjustment of the hypothalamic thermostat; hyperthermia results from a loss of physiologic control of temperature regulation. Fever in the ICU can be due to infectious or noninfectious causes. 

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2014 Jan - Albuterol Administration Is Commonly Associated With Increases in Serum Lactate in Patients With Asthma Treated for Acute Exacerbation of Asthma

Lawrence M. Lewis, MD; Ian Ferguson, BA; Stacey L. House, MD, PhD; Kristen Aubuchon; John Schneider, BA; Kirk Johnson, PhD; Kazuko Matsuda, MD, PhD  CHEST Jan, 2014; 145(1): 53-59


Background: Controversy exists around the incidence and cause of hyperlactatemia during asthma exacerbations. We evaluated the incidence, potential causes, and adverse events of hyperlactatemia in patients with acute asthma exacerbation.

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2013 Dec - Effect of Aerosolized Colistin as Adjunctive Treatment on the Outcomes of Microbiologically Documented Ventilator-Associated Pneumonia Caused by Colistin-Only Susceptible Gram-Negative Bacteria

Mario Tumbarello, MD; Gennaro De Pascale, MD; Enrico Maria Trecarichi, MD, PhD; Salvatore De Martino, MD; Giuseppe Bello, MD; Riccardo Maviglia, MD; Teresa Spanu, MD; Massimo Antonelli, MD  CHEST Dec, 2013; 144(6): 1768-1775

Background: The increasing frequency of ventilator-associated pneumonia (VAP) caused by colistin-only susceptible (COS) gram-negative bacteria (GNB) is of great concern. Adjunctive aerosolized (AS) colistin can reportedly increase alveolar levels of the drug without increasing systemic toxicity. Good clinical results have been obtained in patients with cystic fibrosis, but conflicting data have been reported in patients with VAP.

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2013 Dec - Short- vs Long-Duration Antibiotic Regimens for Ventilator-Associated Pneumonia: A Systematic Review and Meta-analysis

George Dimopoulos, MD, PhD; Garyphallia Poulakou, MD, PhD; Ioannis A. Pneumatikos, MD, PhD; Apostolos Armaganidis, MD, PhD; Marin H. Kollef, MD, FCCP; Dimitrios K. Matthaiou, MD CHEST Dec, 2013; 144(6): 1759-1767

Background: We performed a systematic review and meta-analysis of short- vs long-duration antibiotic regimens for ventilator-associated pneumonia (VAP).

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2013 Nov - Pharmacist Contributions as Members of the Multidisciplinary ICU Team

Candice R. Preslaski, PharmD; Ishaq Lat, PharmD, FCCP; Robert MacLaren, PharmD; Jason Poston, MD  CHEST Nov, 2013; 144(5): 1687-1695

Critical care pharmacy services in the ICU have expanded from traditional dispensing responsibilities to being recognized as an essential component of multidisciplinary care for critically ill patients. Augmented by technology and resource utilization, this shift in roles has allowed pharmacists to provide valuable services in the form of assisting physicians and clinicians with pharmacotherapy decision-making, reducing medication errors, and improving medication safety systems to optimize patient outcomes. 

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