2016 Mar - Hospitals’ Patterns of Use of Noninvasive Ventilation in Patients With Asthma Exacerbation

Mihaela S. Stefan, MD, PhD; Brian H. Nathanson, PhD, DSHS; Aruna Priya, MA, MSc; Penelope S. Pekow, PhD; Tara Lagu, MD, MPH; Jay S. Steingrub, MD; Nicholas S. Hill, MD; Robert J. Goldberg, PhD; David M. Kent, MD; Peter K. Lindenauer, MD  CHEST Mar 2016; 149(3): 729-736

Background Limited data are available on the use of noninvasive ventilation in patients with asthma exacerbations. The objective of this study was to characterize hospital patterns of noninvasive ventilation use in patients with asthma and to evaluate the association with the use of invasive mechanical ventilation and case fatality rate.

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2016 Feb - Capnography During Critical Illness

Boulos S. Nassar, MD; Gregory A. Schmidt, MD, FCCP  CHEST Feb 2016, 149(2): 576-585

Capnography has made steady inroads in the ICU and is increasingly used for all patients who are mechanically ventilated. There is growing recognition that capnography is rich in information about lung and circulatory physiology and provides insight into many diseases and treatments.

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2016 Jan - Practice Patterns and Outcomes of Treatments for Atrial Fibrillation During Sepsis: A Propensity-Matched Cohort Study

Allan J. Walkey, MD, MSc; Stephen R. Evans, MPH; Michael R. Winter, MPH; Emelia J. Benjamin, MD, ScM  CHEST Jan 2016; 149(1): 74-83

Background: Atrial fibrillation (AF) during sepsis is associated with increased morbidity and mortality, but practice patterns and outcomes associated with rate- and rhythm-targeted treatments for AF during sepsis are unclear.

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2015 Dec - Clinical Characteristics and Outcomes Are Similar in ARDS Diagnosed by Oxygen Saturation/Fio2 Ratio Compared With Pao2/Fio2 Ratio

Wei Chen, MD; David R. Janz, MD, MSCI; Ciara M. Shaver, MD, PhD; Gordon R. Bernard, MD; Julie A. Bastarache, MD; Lorraine B. Ware, MD  CHEST Dec 2015; 148(6): 1477-1483

BACKGROUND: Oxygen saturation as measured by pulse oximetry/Fio2 (SF) ratio is highly correlated with the Pao2/Fio2 (PF) ratio in patients with ARDS. However, it remains uncertain whether SF ratio can be substituted for PF ratio for diagnosis of ARDS and whether SF ratio might identify patients who are systemically different from patients diagnosed by PF ratio.

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2015 Dec - The Association Between Indwelling Arterial Catheters and Mortality in Hemodynamically Stable Patients With Respiratory Failure: A Propensity Score Analysis

Douglas J. Hsu, MD; Mengling Feng, PhD; Rishi Kothari, MD; Hufeng Zhou, PhD; Kenneth P. Chen, MD; Leo A. Celi, MD, MPH  CHEST Dec 2015; 148(6): 1470-1476

BACKGROUND: Indwelling arterial catheters (IACs) are used extensively in the ICU for hemodynamic monitoring and for blood gas analysis. IAC use also poses potentially serious risks, including bloodstream infections and vascular complications. The purpose of this study was to assess whether IAC use was associated with mortality in patients who are mechanically ventilated and do not require vasopressor support.

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2015 Dec - Targeted Fluid Minimization Following Initial Resuscitation in Septic Shock: A Pilot Study

Catherine Chen, MD; Marin H. Kollef, MD  CHEST Dec 2015; 148(6): 1462-1469

BACKGROUND: IV fluid represents a basic therapeutic intervention for septic shock. Unfortunately, the optimal administration of IV fluid to maximize patient outcomes and prevent complications is largely unknown.

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2015 Nov - Who Gets Early Tracheostomy?: Evidence of Unequal Treatment at 185 Academic Medical Centers

Joshua J. Shaw, MD; Heena P. Santry, MD  CHEST Nov 2015; 148(5): 1242-1250

BACKGROUND: Although the benefits of early tracheostomy in patients dependent on ventilators are well established, the reasons for variation in time from intubation to tracheostomy remain unclear. We identified clinical and demographic disparities in time to tracheostomy.

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2015 Nov - Delirium and Circadian Rhythm of Melatonin During Weaning From Mechanical Ventilation: An Ancillary Study of a Weaning Trial

Armand Mekontso Dessap, MD, PhD; Ferran Roche-Campo, MD; Jean-Marie Launay, PharmD, PhD; Anais Charles-Nelson, MSc; Sandrine Katsahian, MD, PhD; Christian Brun-Buisson, MD; Laurent Brochard, MD  CHEST Nov 2015; 148(5): 1231-1241

BACKGROUND: Delirium is frequent in patients in the ICU, but its association with the outcome of weaning from mechanical ventilation has not been assessed. Circadian rhythm alteration may favor delirium. In the current study, we assessed the impact of delirium during weaning and associated alterations in the circadian rhythm of melatonin excretion.

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2015 Nov - VTE Incidence and Risk Factors in Patients With Severe Sepsis and Septic Shock

David Kaplan, MD; T. Charles Casper, PhD; C. Gregory Elliott, MD; Shaohua Men, MS; Robert C. Pendleton, MD; Larry W. Kraiss, MD; Andrew S. Weyrich, PhD; Colin K. Grissom, MD; Guy A. Zimmerman, MD; Matthew T. Rondina, MD  CHEST Nov 2015; 148(5): 1224-1230

BACKGROUND: Prospective studies on the incidence of VTE during severe sepsis and septic shock remain absent, hindering efficacy assessments regarding VTE prevention strategies in sepsis.

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2015 Oct - Outcomes in Critically Ill Patients With Systemic Rheumatic Disease: A Multicenter Study

Guillaume Dumas, MD; Guillaume Géri, MD; Claire Montlahuc, MD; Sarah Chemam, MD; Laurence Dangers, MD; Claire Pichereau, MD; Nicolas Brechot, MD; Matthieu Duprey, MD; Julien Mayaux, MD; Maleka Schenck, MD; Julie Boisramé-Helms, MD, PhD; Guillemette Thomas, MD; Loredana Baboi, PhD; Luc Mouthon, MD, PhD; Zair Amoura, MD, PhD; Thomas Papo, MD, PhD; Alfred Mahr, MD, PhD; Sylvie Chevret, MD, PhD; Jean-Daniel Chiche, MD, PhD; Elie Azoulay, MD, PhD  CHEST Oct 2015; 148(4): 927-935

BACKGROUND: Patients with systemic rheumatic diseases (SRDs) may require ICU management for SRD exacerbation or treatment-related infections or toxicities.

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2015 Oct - Response to Fluid Boluses in the Fluid and Catheter Treatment Trial

Matthew R. Lammi, MD; Brianne Aiello, MD; Gregory T. Burg, MD; Tayyab Rehman, MD; Ivor S. Douglas, MD; Arthur P. Wheeler, MD; Bennett P. deBoisblanc, MD; for the National Institutes of Health, National Heart, Lung, and Blood Institute ARDS Network Investigators  CHEST Oct 2015; 148(4): 919-926

BACKGROUND: Recent emphasis has been placed on methods to predict fluid responsiveness, but the usefulness of using fluid boluses to increase cardiac index in critically ill patients with ineffective circulation or oliguria remains unclear.

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2015 Oct - Critical Care Ultrasonography Differentiates ARDS, Pulmonary Edema, and Other Causes in the Early Course of Acute Hypoxemic Respiratory Failure

Hiroshi Sekiguchi, MD; Louis A. Schenck, MS; Ryohei Horie, MD; Jun Suzuki, MD; Edwin H. Lee, MD; Brendan P. McMenomy, MD; Tien-En Chen, MD; Alexander Lekah, MD; Sunil V. Mankad, MD, FCCP; Ognjen Gajic, MD, FCCP  CHEST Oct 2015; 148(4): 912-918

BACKGROUND: Pathogenic causes of acute hypoxemic respiratory failure (AHRF) can be difficult to identify at early clinical presentation. We evaluated the diagnostic utility of combined cardiac and thoracic critical care ultrasonography (CCUS).

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2015 Sep - Prognostication of Mortality in Critically Ill Patients With Severe Infections

Yok-Ai Que, MD, PhD; Idris Guessous, MD, PhD; Elise Dupuis-Lozeron, MSc; Clara Rodrigues Alves de Oliveira, MD, PhD; Carolina Ferreira Oliveir, MD, PhD; Rolf Graf, PhD; Gérald Seematter, MD; Jean-Pierre Revelly, MD; Jean-Luc Pagani, MD; Lucas Liaudet, MD; Vandack Nobre, MD, PhD; Philippe Eggimann, MD  CHEST Sep 2015; 148(3): 674-682

BACKGROUND: The purpose of this study was to confirm the prognostic value of pancreatic stone protein (PSP) in patients with severe infections requiring ICU management and to develop and validate a model to enhance mortality prediction by combining severity scores with biomarkers.

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2015 Aug - Mechanical Ventilation and ARDS in the ED: A Multicenter, Observational, Prospective, Cross-sectional Study

Brian M. Fuller, MD; Nicholas M. Mohr, MD; Christopher N. Miller, MD; Andrew R. Deitchman, MD; Brian J. Levine, MD; Nicole Castagno, MS; Elizabeth C. Hassebroek, MD; Adam Dhedhi, BA; Nicholas Scott-Wittenborn, BA; Edward Grace; Courtney Lehew, MD; Marin H. Kollef, MD, FCCP  CHEST Aug 2015; 148(2): 365-374

BACKGROUND: There are few data regarding mechanical ventilation and ARDS in the ED. This could be a vital arena for prevention and treatment.

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2015 Aug - The Adult Calfactant in Acute Respiratory Distress Syndrome Trial

Douglas F. Willson, MD; Jonathon D. Truwit, MD, MBA; Mark R. Conaway, PhD; Christine S. Traul, MD; Edmund E. Egan, MD  CHEST Aug 2015; 148(2): 356-364

BACKGROUND: Surfactant has been shown to be dysfunctional in ARDS, and exogenous surfactant has proven effective in many forms of neonatal and pediatric acute lung injury (ALI). In view of the positive results of our studies in children along with evidence that surfactant-associated protein B containing pharmaceutical surfactants might be more effective, we designed a multiinstitutional, randomized, controlled, and masked trial of calfactant, a calf lung surfactant, in adults and children with ALI/ARDS due to direct lung injury.

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2015 Aug - Pressure-Controlled vs Volume-Controlled Ventilation in Acute Respiratory Failure: A Physiology-Based Narrative and Systematic Review

Nuttapol Rittayamai, MD; Christina M. Katsios, MD; François Beloncle, MD; Jan O. Friedrich, MD, PhD; Jordi Mancebo, MD; Laurent Brochard, MD  CHEST Aug 2015; 148(2): 340-355

BACKGROUND: Mechanical ventilation is a cornerstone in the management of acute respiratory failure. Both volume-targeted and pressure-targeted ventilations are used, the latter modes being increasingly used. We provide a narrative review of the physiologic principles of these two types of breath delivery, performed a literature search, and analyzed published comparisons between modes.

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2015 Aug - Acid and Weakly Acidic Gastroesophageal Reflux and Pepsin Isoforms (A and C) in Tracheal Secretions of Critically Ill Children

Cristiane Hallal, PhD; Veridiana S. Chaves, MD; Gilberto C. Borges, MD; Isabel C. Werlang, PhD; Fernanda U. Fontella, PhD; Ursula Matte, PhD; Marcelo Z. Goldani, PhD; Paulo R. Carvalho, PhD; Eliana A. Trotta, PhD; Jefferson P. Piva, PhD; Sergio G. S. Barros, PhD; Helena A. S. Goldani, MD, PhD  CHEST Aug 2015; 148(2): 333-339

BACKGROUND: Gastroesophageal reflux (GER) and pulmonary aspiration are frequent in patients in the ICU. The presence of pepsin in airways seems to be the link between them. However, pepsin isoforms A (gastric specific) and C (pneumocyte potentially derived) need to be distinguished. This study aimed to evaluate GER patterns and to determine the presence of pepsin A and C in tracheal secretions of critically ill children receiving mechanical ventilation.

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2015 Jul - Myocardial Dysfunction in Severe Sepsis and Septic Shock: No Correlation With Inflammatory Cytokines in Real-life Clinical Setting

Giora Landesberg, MD, DSc; Phillip D. Levin, MA, BChir; Dan Gilon, MD; Sergey Goodman, MD; Milena Georgieva, MD; Charles Weissman, MD; Allan S. Jaffe, MD; Charles L. Sprung, MD, FCCP; Vivian Barak, PhD  CHEST Jul 2015; 148(1): 93-102

BACKGROUND: In vitro studies suggested that circulating inflammatory cytokines cause septic myocardial dysfunction. However, no in vivo clinical study has investigated whether serum inflammatory cytokine concentrations correlate with septic myocardial dysfunction.

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2015 Jul - The Volume-Outcome Relationship in Critical Care: A Systematic Review and Meta-analysis

Yên-Lan Nguyen, MD, MPH; David J. Wallace, MD, MPH; Youri Yordanov, MD; Ludovic Trinquart, PhD; Josefin Blomkvist, MSc; Derek C. Angus, MD, MPH, FCCP; Jeremy M. Kahn, MD; Philippe Ravaud, MD, PhD; Bertrand Guidet, MD  CHEST Jul 2015; 148(1): 79-92

OBJECTIVE: The purpose of this study was to systematically review the research on volume and outcome relationships in critical care.

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2015 Jul - Standardizing Predicted Body Weight Equations for Mechanical Ventilation Tidal Volume Settings

Olinto Linares-Perdomo, PhD; Thomas D. East, PhD; Roy Brower, MD; Alan H. Morris, MD  CHEST Jul 2015; 148(1): 73-78

BACKGROUND: Recent recommendations for lung protective mechanical ventilation include a tidal volume target of 6 mL/kg predicted body weight (PBW). Different PBW equations might introduce important differences in tidal volumes delivered to research subjects and patients.

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