2016 Oct - ICU–Acquired Weakness: A Rehabilitation Perspective of Diagnosis, Treatment, and Functional Management

Richard D. Zorowitz, MD  CHEST Oct 2016; 150(4): 966-971

ICU-acquired weakness (ICUAW) occurs with reported incidence rates from 25% to 100%. Risk factors include immobility, sepsis, persistent systemic inflammation, multiorgan system failure, hyperglycemia, glucocorticoids, and neuromuscular blocking agents. 

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2016 Oct - Negative-Pressure Pulmonary Edema

Mallar Bhattacharya, MD; Richard H. Kallet, MS, RRT; Lorraine B. Ware, MD; Michael A. Matthay, MD CHEST Oct 2016; 150 (4): 927-933

Negative-pressure pulmonary edema (NPPE) or postobstructive pulmonary edema is a well-described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. 

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2016 Oct - Where You Live Matters: The Impact of Place of Residence on Severe Sepsis Incidence and Mortality

Andrew J. Goodwin, MD, MSCR; Nandita R. Nadig, MD, MSCR; James T. McElligott, MD, MSCR; Kit N. Simpson, DrPh; Dee W. Ford, MD, MSCR  CHEST Oct 2016; 150(4): 829-836

Background: Medically underserved areas are composed of vulnerable populations with reduced access to ambulatory care services. Our goal was to determine the association between residence in a medically underserved area and severe sepsis incidence and mortality.

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2016 Oct - Procalcitonin as an Early Marker of the Need for Invasive Respiratory or Vasopressor Support in Adults With Community-Acquired Pneumonia

Wesley H. Self, MD, MPH; Carlos G. Grijalva, MD, MPH; Derek J. Williams, MD, MPH; Alison Woodworth, PhD; Robert A. Balk, MD; Sherene Fakhran, MD; Yuwei Zhu, MD; D. Mark Courtney, MD; James Chappell, MD, PhD; Evan J. Anderson, MD; Chao Qi, PhD; Grant W. Waterer, MD, PhD; Christopher Trabue, MD; Anna M. Bramley, MPH; Seema Jain, MD; Kathryn M. Edwards, MD; Richard G. Wunderink, MD  CHEST Oct 2016; 150(4): 819-828

Background: Predicting the need for intensive care among adults with community-acquired pneumonia (CAP) remains challenging.

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2016 Sep - ICU Use and Quality of Care for Patients With Myocardial Infarction and Heart Failure

Thomas S. Valley, MD; Michael W. Sjoding, MD; Zachary D. Goldberger, MD; Colin R. Cooke, MD  CHEST Sep  2016; 150(3): 524-532

Background: Quality of care for acute myocardial infarction (AMI) and heart failure (HF) varies across hospitals, but the factors driving variation are incompletely understood. We evaluated the relationship between a hospital’s ICU or coronary care unit (CCU) admission rate and quality of care provided to patients with AMI or HF.

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2016 Sep - Platelet Transfusion Practices in the ICU: Data From a Large Transfusion Registry

Shuoyan Ning, MD; Rebecca Barty, MSc; Yang Liu, MMath; Nancy M. Heddle, MSc; Bram Rochwerg, MD; Donald M. Arnold, MD CHEST Sep 2016; 150(3): 516-523

Background: Platelet transfusions are commonly used in critically ill patients, but transfusion thresholds, count increments, and predictors of ineffectual transfusions remain unclear.

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2016 Sep - A Novel PF4-Dependent Platelet Activation Assay Identifies Patients Likely to Have Heparin-Induced Thrombocytopenia/Thrombosis

Anand Padmanabhan, MD, PhD; Curtis G. Jones, BS; Brian R. Curtis, PhD; Daniel W. Bougie, PhD; Mia J. Sullivan, BS; Namrata Peswani, MD; Janice G. McFarland, MD; Daniel Eastwood, MS; Demin Wang, PhD; Richard H. Aster, MD  CHEST Sep 2016; 150(3): 506-515

Background: Almost without exception, patients with heparin-induced thrombocytopenia/thrombosis (HIT) have antibodies that recognize platelet factor 4 (PF4) in a complex with heparin; however, many heparin-treated patients without HIT are also antibody-positive. A platelet activation test, the serotonin release assay (SRA), is useful for identifying a subset of antibodies that are platelet-activating and most likely to cause HIT. However, this “gold standard” assay for HIT diagnosis is technically demanding and is routinely available only through referral laboratories, limiting its availability for timely diagnosis and management.

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2016 Aug - ICU Telemedicine Comanagement Methods and Length of Stay

Helen A. Hawkins, PhD; Craig M. Lilly, MD, FCCP; David A. Kaster, BS; Robert H. Groves, Jr., MD, FCCP; Hargobind Khurana, MD CHEST Aug 2016; 150(2): 314-319

Background: Studies have identified processes that are associated with more favorable length of stay (LOS) outcomes when an ICU telemedicine program is implemented. Despite these studies, the relation of the acceptance of ICU telemedicine management services by individual ICUs to LOS outcomes is unknown.

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2016 Aug - Nonlinear Imputation of Pao2/Fio2 From Spo2/Fio2 Among Patients With Acute Respiratory Distress Syndrome

Samuel M. Brown, MD; Colin K. Grissom, MD; Marc Moss, MD; Todd W. Rice, MD; David Schoenfeld, PhD; Peter C. Hou, MD; B. Taylor Thompson, MD; Roy G. Brower, MD  CHEST Aug 2016; 150(2): 307-313

Background: ARDS is an important clinical problem. The definition of ARDS requires testing of arterial blood gas to define the ratio of Pao2 to Fio2 (Pao2/Fio2 ratio). However, many patients with ARDS do not undergo blood gas measurement, which may result in underdiagnosis of the condition. As a consequence, a method for estimating Pao2 on the basis of noninvasive measurements is desirable.

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2016 Jul - Risk of Procedural Hemorrhage

Krysta S. Wolfe, MD; John P. Kress, MD, FCCP  CHEST Jul 2016; 150(1): 237-246

Patients who are critically ill and hospitalized often require invasive procedures as a part of their medical care. Each procedure carries a unique set of risks and associated complications, but common to all of them is the risk of hemorrhage.

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2016 Jul - B-Type Natriuretic Peptide, Aldosterone, and Fluid Management in ARDS

Matthew W. Semler, MD; Annis M. Marney, MD; Todd W. Rice, MD; Hui Nian, MS; Chang Yu, PhD; Arthur P. Wheeler, MD; Nancy J. Brown, MD  CHEST Jul 2016; 150(1): 102-111

Background: Conservative fluid management increases ventilator-free days without influencing overall mortality in acute respiratory distress syndrome. Plasma concentrations of B-type natriuretic peptide (a marker of ventricular filling) or aldosterone (a marker of effective circulating volume) may identify patients for whom fluid management impacts survival.

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2016 Jun - The Critically Ill Kidney Transplant Recipient: A Narrative Review

Emmanuel Canet, MD; Lara Zafrani, MD, PhD; Élie Azoulay, MD, PhD  CHEST Jun 2016; 149(6): 1546-1555

Kidney transplantation is the most common solid organ transplantation performed worldwide. Up to 6% of kidney transplant recipients experience a life-threatening complication that requires ICU admission, chiefly in the late posttransplantation period (≥ 6 months). Acute respiratory failure and septic shock are the main reasons for ICU admission. 

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2016 Jun - Feasibility, Utility, and Safety of Midodrine During Recovery Phase From Septic Shock

Micah R. Whitson, MD; Edwin Mo, MD; Tasnima Nabi, MS; Lauren Healy, PharmD; Seth Koenig, MD; Mangala Narasimhan, DO; Paul H. Mayo, MD  CHEST Jun 2016; 149(6): 1380-1383

Background:  We describe the feasibility, utility, and safety of oral midodrine to replace IV vasopressors during recovery from septic shock.

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2016 Jun - Associations Between Different Sedatives and Ventilator-Associated Events, Length of Stay, and Mortality in Patients Who Were Mechanically Ventilated

Michael Klompas, MD, MPH; Lingling Li, PhD; Paul Szumita, PharmD; Ken Kleinman, ScD; Michael V. Murphy, BA  CHEST Jun 2016; 149(6): 1373-1379

Background:  Current sedation guidelines recommend avoiding benzodiazepines but express no preference for propofol vs dexmedetomidine. In addition, few data exist on whether randomized controlled trials of sedatives can be successfully generalized to routine practice, in which conditions tend to be more varied and complex.

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2016 May - Cardiac Dysfunction After Neurologic Injury: What Do We Know and Where Are We Going?

Vijay Krishnamoorthy, MD, MPH; G. Burkhard Mackensen, MD, PhD; Edward F. Gibbons, MD; Monica S. Vavilala, MD  CHEST May 2016; 149(5): 1325-133

Recent literature has implicated severe neurologic injuries, such as aneurysmal subarachnoid hemorrhage, as a cause of cardiac dysfunction, impaired hemodynamic function, and poor outcomes.

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2016 May - The Presence of Diffuse Alveolar Damage on Open Lung Biopsy Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Pablo Cardinal-Fernández, MD, PhD; Ednan K. Bajwa, MD; Andrea Dominguez-Calvo, MD; Justo M. Menéndez, MD, PhD; Laurent Papazian, MD; B. Taylor Thompson, MD  CHEST May 2016; 149(5): 1155-1164

Objective: Diffuse alveolar damage (DAD) is considered the histologic hallmark of ARDS although DAD is absent in approximately half of patients with ARDS. The clinical implications of having the syndrome of ARDS with DAD vs other histologic patterns is unknown. To address this question, we conducted a meta-analysis of lung biopsy series for patients with ARDS.

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2016 May - Outcomes of Nurse Practitioner-Delivered Critical Care: A Prospective Cohort Study

Janna S. Landsperger, ACNP-BC; Matthew W. Semler, MD; Li Wang, MS; Daniel W. Byrne, MS; Arthur P. Wheeler, MD  CHEST May 2016; 149(5): 1146-1154

Background: Acute care nurse practitioners (ACNPs) are increasingly being employed in ICUs to offset physician shortages, but no data exist about outcomes of critically ill patients continuously cared for by ACNPs.

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2016 Apr - Crises in Sickle Cell Disease

Enrico M. Novelli, MD; Mark T. Gladwin, MD  CHEST Apr 2016; 149(4): 1082-1093

In spite of significant strides in the treatment of sickle cell disease (SCD), SCD crises are still responsible for high morbidity and early mortality. While most patients initially seek care in the acute setting for a seemingly uncomplicated pain episode (pain crisis or vaso-occlusive crisis), this initial event is the primary risk factor for potentially life-threatening complications.

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2016 Apr - Lung Ultrasound for Early Diagnosis of Ventilator-Associated Pneumonia

Silvia Mongodi, MD, PhD; Gabriele Via, MD; Martin Girard, MD; Isabelle Rouquette, MD; Benoit Misset, MD, PhD; Antonio Braschi, MD; Francesco Mojoli, MD; Bélaïd Bouhemad, MD, PhD  CHEST Apr 2016; 149(4): 969-980

Background:  Lung ultrasound (LUS) has been successfully applied for monitoring aeration in ventilator-associated pneumonia (VAP) and to diagnose and monitor community-acquired pneumonia. However, no scientific evidence is yet available on whether LUS reliably improves the diagnosis of VAP.

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2016 Mar - Ionized Calcium in the ICU: Should It Be Measured and Corrected?

Scott K. Aberegg, MD, MPH  CHEST Mar 2016; 149(3): 846-855

Serum ionized calcium (iCa) is often measured in patients admitted to ICUs, and at least half of these patients will have values outside the reference range during their ICU stay. The vast majority of these patients do not have an underlying disease of calcium homeostasis. This Contemporary Review discusses the rationale for measurement of iCa and whether available data support its measurement and correction.

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