2013 Jul - Is a Strategy Based on Routine Endotracheal Cultures the Best Way to Prescribe Antibiotics in Ventilator-Associated Pneumonia?

Carlos M. Luna, MD, PhD, FCCP; Sergio Sarquis; Michael S. Niederman; Fernando A. Sosa; Maria Otaola; Nicolas Bailleau; Carlos A. Vay; Angela Famiglietti; Célica Irrazabal; Abelardo A. Capdevila  CHEST July, 2013; 144(1): 63-71

Abstract

Objectives: The objectives of this study were to evaluate if a strategy based on routine endotracheal aspirate (ETA) cultures is better than using the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines to prescribe antimicrobials in ventilator-associated pneumonia (VAP).

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2013 Jul - Iloprost Improves Gas Exchange in Patients With Pulmonary Hypertension and ARDS

Eva Sawheny, MD; Ashley L. Ellis, RN; Gary T. Kinasewitz, MD, FCCP  CHEST July, 2013; 144(1): 55-62

Abstract

Objective: We hypothesized that nebulized iloprost would improve ventilation-perfusion matching in patients with pulmonary hypertension and ARDS as reflected by an improved Pao2/Fio2 ratio and Pao2 without adversely affecting lung mechanics or systemic hemodynamics.

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2013 Jul - Outcomes of Morbidly Obese Patients Receiving Invasive Mechanical Ventilation: A Nationwide Analysis

Gagan Kumar, MD; Tilottama Majumdar, MD, FCCP; Elizabeth R. Jacobs; Valerie Danesh, MS; Gaurav Dagar; Abhishek Deshmukh; Amit Taneja; Rahul Nanchal  CHEST July, 2013; 144(1): 48-54

Abstract

Background: Critically ill, morbidly obese patients (BMI ≥ 40 kg/m2) are at high risk of respiratory failure requiring invasive mechanical ventilation (IMV). It is not clear if outcomes of critically ill, obese patients are affected by obesity. Due to limited cardiopulmonary reserve, they may have poor outcomes. However, literature to this effect is limited and conflicted.

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2013 Jul - The Occurrence and Impact of Bacterial Organisms Complicating Critical Care Illness Associated With 2009 Influenza A(H1N1) Infection

John Muscedere, MD; Marianna Ofner, PhD; Anand Kumar; Jennifer Long, MSc; Francois Lamontagne; Deborah Cook; Allison McGeer; Clarence Chant, PharmD; John Marshall; Philippe Jouvet, MD, PhD; Robert Fowler  CHEST July, 2013; 144(1): 39-47

Abstract

Background: Although secondary infections are recognized as a cause of morbidity and mortality in seasonal influenza, their frequency, characteristics, and associated clinical outcomes in 2009 influenza A(H1N1) (A[H1N1])-related critical illness are unknown.

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2013 Jul - Ventilator-Associated Tracheobronchitis in a Mixed Medical/Surgical Pediatric ICU

Vickie S. Simpson, MSN, RN; Ann Bailey, MBA, RN; Renee A. Higgerson, MD; LeeAnn M. Christie  CHEST July, 2013; 144(1): 32-38

Abstract

Background: Adult studies have demonstrated that ventilator-associated tracheobronchitis (VAT) may be a precursor to ventilator-associated pneumonia (VAP). No published data on VAT in pediatric ICUs (PICUs) were found. The purposes of this retrospective, descriptive study are to describe the incidence, characteristics, and outcomes of patients at risk for VAT and formalize a process of VAT surveillance in the PICU population.

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2013 Jul - Posttraumatic Stress Disorder in Survivors of Acute Lung Injury: Evaluating the Impact of Event Scale-Revised

O. Joseph Bienvenu, MD, PhD; Jason B. Williams; Andrew Yang, BS; Ramona O. Hopkins; Dale M. Needham  CHEST July, 2013; 144(1): 24-31

Abstract

Background: Survivors of acute lung injury (ALI) and other critical illnesses often experience substantial posttraumatic stress disorder (PTSD) symptoms. However, most questionnaires have not been validated against a PTSD diagnostic reference standard in this patient population. Hence, in the current study of survivors of ALI, we evaluated the Impact of Events Scale-Revised (IES-R), a questionnaire measure of PTSD symptoms, against the Clinician-Administered PTSD Scale (CAPS), the current state-of-the-art PTSD diagnostic reference standard, which also provides a quantitative assessment of PTSD symptoms.

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2013 Jun - Monitoring Tissue Perfusion, Oxygenation, and Metabolism in Critically Ill Patients

Nasirul J. Ekbal, MBBS; Alex Dyson, PhD; Claire Black, MSc; Mervyn Singer, MD  CHEST June, 2013; 143(6):1799-1808

Abstract

Alterations in oxygen transport and use are integral to the development of multiple organ failure; therefore, the ultimate goal of resuscitation is to restore effective tissue oxygenation and cellular metabolism. Hemodynamic monitoring is the cornerstone of management to promptly identify and appropriately manage (impending) organ dysfunction.

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2013 Jun - Feasibility and Effectiveness of Prone Position in Morbidly Obese Patients With ARDS: A Case-Control Clinical Study

Audrey De Jong, MD; Nicolas Molinari, PhD; Mustapha Sebbane, MD; Albert Prades; Nursing Fellow; Emmanuel Futier, MD; Boris Jung, MD; Gérald Chanques, MD; Samir Jaber, MD  CHEST June 2013; 143(6):1554-1561

Abstract

Background: Obese patients are at risk for developing atelectasis and ARDS. Prone position (PP) may reduce atelectasis, and it improves oxygenation and outcome in severe hypoxemic patients with ARDS, but little is known about its effect in obese patients with ARDS.

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2013 Jun - Whole Blood Lactate Kinetics in Patients Undergoing Quantitative Resuscitation for Severe Sepsis and Septic Shock

Michael A. Puskarich, MD; Stephen Trzeciak, MD; Nathan I. Shapiro, MD; Andrew B. Albers, MD; Alan C. Heffner, MD; Jeffrey A. Kline, MD; Alan E. Jones, MD  CHEST June 2013; 143(6): 1548-1553

Abstract

Background: We sought to compare the association of whole-blood lactate kinetics with survival in patients with septic shock undergoing early quantitative resuscitation.

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2013 Mar - A novel extracorporeal CO(2) removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD

Burki NK, Mani RK, Herth FJ, Schmidt W, Teschler H, Bonin F, Becker H, Randerath WJ, Stieglitz S, Hagmeyer L, Priegnitz C, Pfeifer M, Blaas SH, Putensen C, Theuerkauf N, Quintel M, Moerer O.; Chest. 2013 Mar;143(3):678-86.

BACKGROUND: Hypercapnic respiratory failure in patients with COPD frequently requires mechanical ventilatory support. Extracorporeal CO2 removal (ECCO2R) techniques have not been systematically evaluated in these patients.

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2013 May - Hemodynamic Monitoring

Steven M. Hollenberg, MD, FCCP  CHEST May, 2013; 143(5): 1480-1488

Abstract

Hemodynamic assessment is a key component of the evaluation of the critically ill patients and has both diagnostic and prognostic utility. This review outlines a general approach to assessment of hemodynamics and perfusion, and then discusses various hemodynamic parameters: heart rate, BP, intravascular (central venous and pulmonary artery) pressures, cardiac output, and myocardial performance, within the context not only of how they are best measured but also how they should be used in a clinical context.

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2013 May - Patient-Controlled Positive End-Expiratory Pressure With Neuromuscular Disease: Effect on Speech in Patients With Tracheostomy and Mechanical Ventilation Support

Marine Garguilo, SP; Karl Leroux; Michèle Lejaille, MS; Sophie Pascal, SP; David Orlikowski, MD, PhD; Frédéric Lofaso, MD, PhD; Hélène Prigent, MD, PhD  CHEST May, 2013; 143(5): 1243-1251

Abstract

Objective: Communication is a major issue for patients with tracheostomy who are supported by mechanical ventilation. The use of positive end-expiratory pressure (PEEP) may restore speech during expiration; however, the optimal PEEP level for speech may vary individually. We aimed to improve speech quality with an individually adjusted PEEP level delivered under the patient’s control to ensure optimal respiratory comfort.

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2013 May - Trends in the Incidence and Outcomes of Disseminated Intravascular Coagulation in Critically Ill Patients (2004-2010): A Population-Based Study

Balwinder Singh, MBBS; Andrew C. Hanson, BS; Rabe Alhurani, MBBS; Shihan Wang, MD, PhD; Vitaly Herasevich, MD, PhD; Rodrigo Cartin-Ceba, MD; Daryl J. Kor, MD; Naseema Gangat, MBBS; Guangxi Li, MD  CHEST May, 2013; 143(5): 1235-1242

Abstract

Background: The incidence and outcomes of disseminated intravascular coagulation (DIC) are incompletely defined. Therefore, we aimed to evaluate the trends in incidence and outcomes of critically ill patients with DIC.

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2013 May - Moderate Glucose Control Is Associated With Increased Mortality Compared With Tight Glucose Control in Critically Ill Patients Without Diabetes

Michael J. Lanspa, MD; Eliotte L. Hirshberg, MD; Gregory D. Phillips, BA; John Holmen, PhD; Gregory Stoddard, MS; James Orme, MD, FCCP  CHEST May, 2013; 143(5): 1226-1234

Abstract

Background: Optimal glucose management in the ICU remains unclear. In 2009, many clinicians at Intermountain Healthcare selected a moderate glucose control (90-140 mg/dL) instead of tight glucose control (80-110 mg/dL). We hypothesized that moderate glucose control would affect patients with and without preexisting diabetes differently.

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2013 May - Efficacy of Single-Dose Antibiotic Against Early-Onset Pneumonia in Comatose Patients Who Are Ventilated

Jordi Vallés, MD, PhD; Raquel Peredo, MD; Maria Jose Burgueño, MD, PhD; A. Patrícia Rodrigues de Freitas, MD; Susana Millán, MD; Mateu Espasa, MD; Ignacio Martín-Loeches, MD, PhD; Ricard Ferrer, MD, PhD; David Suarez, PhD; Antonio Artigas, MD, PhD  CHEST May, 2013;143(5): 1219-1225

Abstract

Background: Comatose patients present a high risk of early-onset ventilator-associated pneumonia (EO-VAP) for which antibiotic prophylaxis has been proposed. Comatose patients were studied to evaluate the efficacy of a single-dose of antibiotic prophylaxis at intubation against EO-VAP.

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2013 Apr - Mechanical Ventilation-Induced Reverse-Triggered Breaths: A Frequently Unrecognized Form of Neuromechanical Coupling

Evangelia Akoumianaki, MD; Aissam Lyazidi, PhD; Nathalie Rey, MD; Dimitrios Matamis, MD; Nelly Perez-Martinez, MD; Raphael Giraud, MD; Jordi Mancebo, MD; Laurent Brochard, MD; Jean-Christophe Marie Richard, MD, PhD  CHEST April 2013; 143(4): 927-938

Abstract: Background: Diaphragmatic muscle contractions triggered by ventilator insufflations constitute a form of patient-ventilator interaction referred to as “entrainment,” which is usually unrecognized in critically ill patients. Our objective was to review tracings, which also included muscular activity, obtained in sedated patients who were mechanically ventilated to describe the entrainment events and their characteristics. The term “reverse triggering” was adopted to describe the ventilator-triggered muscular efforts.

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2013 Apr - Radiologic Outcomes at 5 Years After Severe ARDS

M. Elizabeth Wilcox, MD; Demetris Patsios, MD; Grainne Murphy, MD; Paul Kudlow, BSc; Narinder Paul, MD; Catherine M. Tansey, PhD; Leslie Chu, BSc; Andrea Matte, BSc; George Tomlinson, PhD; Margaret S. Herridge, MD, MPH  CHEST April 2013; 143(4): 920-926

Abstract: Objective: Few studies have systematically evaluated high-resolution CT (HRCT) imaging of the thorax 5 years after severe ARDS to determine the association between radiologic findings and functional disability. The primary aim of this study was to determine chest radiologic abnormalities at 5 years in survivors of severe ARDS from the University of Toronto ARDS cohort. The secondary aim was to determine the relationship between the observed radiologic abnormalities on HRCT scan and pulmonary symptoms, pulmonary function test abnormalities, and health-related quality of life at 5-year follow-up.

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2013 Apr - A Prognostic Model for 6-Month Mortality in Elderly Survivors of Critical Illness

Matthew R. Baldwin, MD; Wazim R. Narain, MPH; Hannah Wunsch, MD; Neil W. Schluger, MD; Joseph T. Cooke, MD, FCCP; Mathew S. Maurer, MD; John W. Rowe, MD; David J. Lederer, MD; Peter B. Bach, MD, MAPP  CHEST April 2013; 143(4): 910-919

Abstract: Background: Although 1.4 million elderly Americans survive hospitalization involving intensive care annually, many are at risk for early mortality following discharge. No models that predict the likelihood of death after discharge exist explicitly for this population. Therefore, we derived and externally validated a 6-month postdischarge mortality prediction model for elderly ICU survivors.

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2013 Apr - Sex, Race, and the Development of Acute Lung Injury

Luciano B. Lemos-Filho, MD; Mark E. Mikkelsen, MD; Greg S. Martin, MD, FCCP; Ousama Dabbagh, MD, FCCP; Adebola Adesanya, MD, FCCP; Nina Gentile, MD; Annette Esper, MD; Ognjen Gajic, MD, FCCP; Michelle N. Gong, MD; for the US Critical Illness and Injury Trials Group: Lung Injury Prevention Study Investigators (USCIITG-LIPS)  CHEST April 2013; 143(4): 901-909

Abstract: Background: Prior studies suggest that mortality differs by sex and race in patients who develop acute lung injury (ALI). Whether differences in presentation account for these disparities remains unclear. We sought to determine whether sexual and racial differences exist in the rate of ALI development and ALI-related mortality after accounting for differences in clinical presentations.

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2013 Mar - Survival After Shock Requiring High-Dose Vasopressor Therapy

Samuel M. Brown, MD; Michael J. Lanspa, MD; Jason P. Jones, PhD; Kathryn G. Kuttler, PhD; Yao Li, MStat; Rick Carlson, PharmD; Russell R. Miller, III, MD, MPH; Eliotte L. Hirshberg, MD; Colin K. Grissom, MD, FCCP; Alan H. Morris, MD, FCCP  CHEST March 2013; 143(3): 664-671
Abstract
Background: Some patients with hypotensive shock do not respond to usual doses of vasopressor therapy. Very little is known about outcomes after high-dose vasopressor therapy (HDV). We sought to characterize survival among patients with shock requiring HDV. We also evaluated the possible utility of stress-dose corticosteroid therapy in these patients.

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