2013 Nov - Cumulative Total Effective Whole-Body Radiation Dose in Critically Ill Patients

Deborah J. Rohner, MD; Suzanne Bennett, MD; Chandrasiri Samaratunga, PhD; Elizabeth S. Jewell, MS; Jeffrey P. Smith, MS; Mary Gaskill-Shipley, MD; Steven J. Lisco, MD, FCCP  CHEST Nov, 2013; 144(5): 1481-1486

Background: Uncertainty exists about a safe dose limit to minimize radiation-induced cancer. Maximum occupational exposure is 20 mSv/y averaged over 5 years with no more than 50 mSv in any single year. Radiation exposure to the general population is less, but the average dose in the United States has doubled in the past 30 years, largely from medical radiation exposure. We hypothesized that patients in a mixed-use surgical ICU (SICU) approach or exceed this limit and that trauma patients were more likely to exceed 50 mSv because of frequent diagnostic imaging.

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2013 Nov - Interventions to Improve the Physical Function of ICU Survivors: A Systematic Review

Enrique Calvo-Ayala, MD; Babar A. Khan, MD; Mark O. Farber, MD, FCCP; E. Wesley Ely, MD, MPH, FCCP; Malaz A. Boustani, MD, MPH  CHEST Nov, 2013; 144(5): 1469-1480

Background: ICU admissions are ever increasing across the United States. Following critical illness, physical functioning (PF) may be impaired for up to 5 years. We performed a systematic review of randomized controlled trials evaluating the efficacy of interventions targeting PF among ICU survivors. The objective of this study was to identify effective interventions that improve long-term PF in ICU survivors.

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2013 Nov - Temporal Trends of Ventilator-Associated Pneumonia Incidence and the Effect of Implementing Health-care Bundles in a Suburban Community

Shifang Ding, MD, PhD; Oguz Kilickaya, MD; Serkan Senkal, MD; Ognjen Gajic, MD, FCCP; Rolf D. Hubmayr, MD, FCCP; Guangxi Li, MD  CHEST Nov, 2013; 144(5):1461-1468

Background: Recent changes in critical care delivery, including the widespread implementation of health-care bundles, were aimed at reducing complications of critical illness, in particular ventilator-associated pneumonia (VAP), but no population-based study evaluated its effectiveness.

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2013 Nov - The Clinical Impact and Preventability of Ventilator-Associated Conditions in Critically Ill Patients Who Are Mechanically Ventilated

John Muscedere, MD; Tasnim Sinuff, MD, PhD; Daren K. Heyland, MD; Peter M. Dodek, MD, MHSc; Sean P. Keenan, MD; Gordon Wood, MD; Xuran Jiang, MSc; Andrew G. Day, MSc; Denny Laporta, MD; Michael Klompas, MD, MPH; on behalf of for the Canadian Critical Care Trials Group  CHEST Nov, 2013; 144(5):1453-1460

Background: Ventilator-associated conditions (VACs) and infection-related ventilator-associated complications (iVACs) are the Centers for Disease Control and Prevention’s new surveillance paradigms for patients who are mechanically ventilated. Little is known regarding the clinical impact and preventability of VACs and iVACs and their relationship to ventilator-associated pneumonia (VAP). We evaluated these using data from a large, multicenter, quality-improvement initiative.

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2013 Nov - Developing a New, National Approach to Surveillance for Ventilator-Associated Events: Executive Summary

Shelley S. Magill, MD, PhD; Michael Klompas, MD, MPH; Robert Balk, MD; Suzanne M. Burns, RN, ACNP, MSN, RRT; Clifford S. Deutschman, MS, MD; Daniel Diekema, MD; Scott Fridkin, MD; Linda Greene, RN, MPS; Alice Guh, MD, MPH; David Gutterman, MD; Beth Hammer, RN, MSN, ANP-BC; David Henderson, MD; Dean R. Hess, PhD, RRT; Nicholas S. Hill, MD; Teresa Horan, MPH; Marin Kollef, MD; Mitchell Levy, MD; Edward Septimus, MD; Carole VanAntwerpen, RN, BSN; Don Wright, MD, MPH; Pamela Lipsett, MD, MHPE  CHEST Nov, 2013;144(5):1448-1452

This article is an executive summary of a report from the Centers for Disease Control and Prevention Ventilator-Associated Pneumonia Surveillance Definition Working Group, entitled “Developing a new, national approach to surveillance for ventilator-associated events” and published in Critical Care Medicine (Magill SS, Klompas M, Balk R, et al. Developing a new, national approach to surveillance for ventilator-associated events. Crit Care Med. 2013;41(11):2467-2475.). The full report provides a comprehensive description of the Working Group process and outcome.

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2013 Oct - Prehospital Management of Evolving Critical Illness by the Primary Care Provider

Kerri A. Ellis, DNP; Alireza Hosseinnezhad, MD; Ashfaq Ullah, MD; Yuka-Marie Vinagre, MD, PhD; Stephen P. Baker, MScPH; Craig M. Lilly, MD, FCCP  CHEST Oct 2013; 144(4): 1216-1221

Background: The factors that limit primary care providers (PCPs) from intervening for adults with evolving, acute, severe illness are less understood than the increasing frequency of management by acute care providers.

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2013 Oct - Thrombocytopenia in Critically Ill Patients Receiving Thromboprophylaxis: Frequency, Risk Factors, and Outcomes

David R. Williamson, BPharm, MSc; Martin Albert, MD; Diane Heels-Ansdell, MSc; Donald M. Arnold, MD; François Lauzier, MD; Ryan Zarychanski, MD; Mark Crowther, MD; Theodore E. Warkentin, MD; Peter Dodek, MD; John Cade, MD, FCCP; Olivier Lesur, MD, PhD; Wendy Lim, MD; Robert Fowler, MD; Francois Lamontagne, MD; Stephan Langevin, MD; Andreas Freitag, MD, FCCP; John Muscedere, MD; Jan O. Friedrich, MD, DPhil; William Geerts, MD; Lisa Burry, PharmD; Jamal Alhashemi, MD, FCCP; Deborah Cook, MD; on behalf of and the PROTECT collaborators, the Canadian Critical Care Trials Group, and the Australian and New Zealand Intensive Care Society Clinical Trials Group  CHEST Oct 2013, 144(4):1207-1215

Background: Thrombocytopenia is the most common hemostatic disorder in critically ill patients. The objective of this study was to describe the incidence, risk factors, and outcomes of thrombocytopenia in patients admitted to medical-surgical ICUs.

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2013 Sep - Repair of Lipopolysaccharide-Induced Acute Lung Injury in Mice by Endothelial Progenitor Cells, Alone and in Combination With Simvastatin

Hao Li, MD; Yong Qiang, MMed; Lian Wang, MD; Gaoming Wang, MMed; Jun Yi, MD; Hua Jing, MMed; Haiwei Wu, MD  CHEST Sep 2013, 144(3): 876-886


Background: Endothelial progenitor cells (EPCs) are involved in endothelium repair of acute lung injury (ALI). Numerous studies have demonstrated that statins can promote EPC function in vitro and in vivo; therefore, the purpose of this study was to determine whether simvastatin enhances the function of EPCs participating in the repair of ALI.

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2013 Sep - Severity of Acute Kidney Injury and Two-Year Outcomes in Critically Ill Patients

Lior Fuchs, MD; Joon Lee, PhD; Victor Novack, MD, PhD; Yael Baumfeld, MD; Daniel Scott, PhD; Leo Celi, MD, MPH; Tal Mandelbaum, MD; Michael Howell, MD, MPH; Daniel Talmor, MD, MPH  CHEST Sep 2013, 144(3): 866-875


Background: The association between levels of acute kidney injury (AKI) during ICU admission and long-term mortality are not well defined.

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2013 Sep - Usefulness of Cardiothoracic Chest Ultrasound in the Management of Acute Respiratory Failure in Critical Care Practice

Stein Silva, MD, PhD; Caroline Biendel, MD; Jean Ruiz, MD; Michel Olivier, MD; Benoit Bataille, MD; Thomas Geeraerts, MD, PhD; Arnaud Mari, MD; Beatrice Riu, MD; Olivier Fourcade, MD, PhD; Michele Genestal, MD  CHEST Sep 2013,144(3): 859-865

Background: This study investigated the clinical relevance of early general chest ultrasonography (ie, heart and lung recordings) in patients in the ICU with acute respiratory failure (ARF).

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2013 Sep - Heparin-Induced Thrombocytopenia in Medical Surgical Critical Illness

Theodore E. Warkentin, MD; Jo-Ann I. Sheppard, BSc; Diane Heels-Ansdell, MSc; John C. Marshall, MD; Lauralyn McIntyre, MD; Marcelo G. Rocha, MD; Sangeeta Mehta, MD; Andrew R. Davies, MD; Andrew D. Bersten, MD; Tim M. Crozier, MD; David Ernest, MD; Nicholas E. Vlahakis, MD, FCCP; Richard I. Hall, MD, FCCP; Gordon G. Wood, MD; Germain Poirier, MD; Mark A. Crowther, MD; Deborah J. Cook, MD; for the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group  CHEST Sep 2013, 144(3): 848-858

Background: In a recent multicenter randomized trial comparing unfractionated heparin (UFH) with low-molecular-weight heparin (dalteparin) for thromboprophylaxis in 3,746 critically ill patients, 17 patients (0.5%) developed heparin-induced thrombocytopenia (HIT) based on serotonin-release assay-positive (SRA+) status. A trend to a lower frequency of HIT with dalteparin vs UFH was observed in the intention-to-treat analysis (five vs 12 patients, P = .14), which was statistically significant (three vs 12 patients, P = .046) in a prespecified per-protocol analysis that excluded patients with DVT at study entry. We sought to characterize HIT outcomes and to determine how dalteparin thromboprophylaxis may reduce HIT frequency in patients in the ICU.

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2013 Sep - Physiotherapy in Intensive Care: An Updated Systematic Review

Kathy Stiller, PhD  CHEST Sep 2013; 144(3): 825-847

Background: Although physiotherapy is frequently provided to patients in the ICU, its role has been questioned. The purpose of this systematic literature review, an update of one published in 2000, was to examine the evidence concerning the effectiveness of physiotherapy for adult, intubated patients who are mechanically ventilated in the ICU.

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2013 Aug - Management of Hyponatremia in the ICU

Richard H. Sterns, MD; John K. Hix, MD; Stephen M. Silver, MD  CHEST Aug, 2013; 144(2): 672-679

Hyponatremia is common in critical care units. Avoidance of neurologic injury requires a clear understanding of why the serum sodium (Na) concentration falls and why it rises, how the brain responds to a changing serum Na concentration, and what the goals of therapy should be. 

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2013 Aug - Echocardiographic and Hemodynamic Predictors of Mortality in Idiopathic Pulmonary Fibrosis

Belinda N. Rivera-Lebron, MD; Paul R. Forfia, MD, FCCP; Maryl Kreider, MD; James C. Lee, MD; John H. Holmes, PhD; Steven M. Kawut, MD, FCCP  CHEST Aug, 2013; 144(2): 564-570

Background: Idiopathic pulmonary fibrosis (IPF) can lead to the development of pulmonary hypertension, which is associated with an increased risk of death. In pulmonary arterial hypertension, survival is directly related to the capacity of the right ventricle to adapt to elevated pulmonary vascular load. The relative importance of right ventricular function in IPF is not well understood. Our objective was to evaluate right ventricular echocardiographic and hemodynamic predictors of mortality in a cohort of patients with IPF referred for lung transplant evaluation.

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2013 Aug - Altered Circadian Rhythmicity in Patients in the ICU

Joost A. C. Gazendam, MD, PhD; Hans P. A. Van Dongen, PhD; Devon A. Grant, MS; Neil S. Freedman, MD; Jan H. Zwaveling, MD, PhD; Richard J. Schwab, MD  CHEST Aug, 2013; 144(2): 483-489

Background: Patients in the ICU are thought to have abnormal circadian rhythms, but quantitative data are lacking.

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2013 Aug - Mycobacterium tuberculosis Septic Shock

Shravan Kethireddy, MD; R. Bruce Light, MD; Yazdan Mirzanejad, MD; Dennis Maki, MD; Yaseen Arabi, MD; Stephen Lapinsky, MD; David Simon, MD; Aseem Kumar, PhD; Joseph E. Parrillo, MD, FCCP; Anand Kumar, MD  CHEST Aug, 2013; 144(2): 474-482

Abstract: Background: Septic shock due to Mycobacterium tuberculosis (MTB) is an uncommon but well-recognized clinical syndrome. The objective of this study was to describe the unique clinical characteristics, epidemiologic risk factors, and covariates of survival of patients with MTB septic shock in comparison with other bacterial septic shock.

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2013 Aug - Hyperimmune IV Immunoglobulin Treatment: A Multicenter Double-Blind Randomized Controlled Trial for Patients With Severe 2009 Influenza A(H1N1) Infection

Ivan F. N. Hung, MD; Kelvin K. W. To, MD; Cheuk-Kwong Lee, MD; Kar-Lung Lee, MD; Wing-Wa Yan, MD; Kenny Chan, MD; Wai-Ming Chan, MD; Chun-Wai Ngai, MD; Kin-Ip Law, MD; Fu-Loi Chow, MD; Raymond Liu, MD; Kang-Yiu Lai, MD; Candy C. Y. Lau, PhD; Shao-Haei Liu, MD; Kwok-Hung Chan, PhD; Che-Kit Lin, MD; Kwok-Yung Yuen, MD  CHEST Aug, 2013; 144(2): 464-473

Abstract: Background: Experience from influenza pandemics suggested that convalescent plasma treatment given within 4 to 5 days of symptom onset might be beneficial. However, robust treatment data are lacking.

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2013 Jul - Trendelenburg Position Does Not Increase Cross-sectional Area of the Internal Jugular Vein Predictably

Boulos Nassar, MD; Gur Raj S. Deol; Andrew Ashby; Nicole Collett; Gregory A. Schmidt, MD, FCCP  CHEST July, 2013; 144(1): 177-182


Background: The Trendelenburg position is used to distend the central veins, improving both the success and safety of vascular cannulation. The purpose of this study was to measure the cross-sectional area (CSA) of the internal jugular vein (IJV) in three different positions using surface ultrasonography.

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2013 Jul - Use of Intermittent Pneumatic Compression and Not Graduated Compression Stockings Is Associated With Lower Incident VTE in Critically Ill Patients: A Multiple Propensity Scores Adjusted Analysis

Yaseen M. Arabi, MD, FCCP; Mohammad Khedr; Saqib I. Dara; Gousia S. Dhar, MBBS; Shaila A. Bhat; Hani M. Tamim, MPH, PhD; Lara Y. Afesh, RN, MSN  CHEST July, 2013; 144(1): 152-159


Background: A limited amount of data exist regarding the effect of intermittent pneumatic compression (IPC) and graduated compression stockings (GCS) on the incidence of VTE in the ICU setting. The objective of this study was to examine the association of mechanical thromboprophylaxis with IPC or GCS with the risk of VTE and hospital mortality among critically ill medical-surgical patients.

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2013 Jul - Medical Hypnosis as a Tool to Acclimatize Children to Noninvasive Positive Pressure Ventilation: A Pilot Study

Vincent Delord, MSN; Sonia Khirani, PhD; Adriana Ramirez, MSc; Erick Louis Joseph, AS; Clotilde Gambier; Maryse Belson; Francis Gajan, MD; Brigitte Fauroux, MD, PhD  CHEST July, 2013; 144(1): 87-91


Background: Patient cooperation is crucial for the success of noninvasive positive pressure ventilation (NPPV). This study evaluated the efficacy of medical hypnosis to reduce anticipatory anxiety and acclimatization time in children who are candidates for long-term NPPV.

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