2015 Jun - Distinct Molecular Phenotypes of Direct vs Indirect ARDS in Single-Center and Multicenter Studies

Carolyn S. Calfee, MD, MAS; David R. Janz, MD; Gordon R. Bernard, MD, FCCP; Addison K. May, MD; Kirsten N. Kangelaris, MD, MAS; Michael A. Matthay, MD, FCCP; Lorraine B. Ware, MD, FCCP; the NIH NHLBI ARDS Network  CHEST Jun 2015; 147(6): 1539-1548

BACKGROUND: ARDS is a heterogeneous syndrome that encompasses lung injury from both direct and indirect sources. Direct ARDS (pneumonia, aspiration) has been hypothesized to cause more severe lung epithelial injury than indirect ARDS (eg, nonpulmonary sepsis); however, this hypothesis has not been well studied in humans.

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2015 Jun - Impact of COPD in the Outcome of ICU-Acquired Pneumonia With and Without Previous Intubation

Mariano Rinaudo, MD; Miquel Ferrer, MD, PhD; Silvia Terraneo, MD; Francesca De Rosa, MD; Rogelio Peralta, MD; Laia Fernández-Barat, PhD; Gianluigi Li Bassi, MD, PhD; Antoni Torres, MD, PhD  CHEST Jun 2015; 147(6): 1530-1538

BACKGROUND: COPD seems related to poor outcome in patients with ventilator-associated pneumonia (VAP). However, many patients in the ICU with COPD do not require intubation but can also develop pneumonia in the ICU. We, therefore, compared the characteristics and outcomes of patients with ICU-acquired pneumonia (ICUAP) with and without underlying COPD.

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2015 Jun - Comparison of a Self-Inflating Bulb Syringe and a Colorimetric CO2 Indicator With Capnography and Radiography to Detect the Misdirection of Naso/Orogastric Tubes Into the Airway of Critically Ill Adult Patients

Nicholas A. Smyrnios, MD, FCCP; Richard Lenard, RRT-NPS, RPFT; Sunil Rajan, MD, FCCP; Michael S. Newman, DO; Stephen P. Baker, MScPH; Nehal Thakkar, MD, FCCP; Wahid Wassef, MD; Niraj K. Ajmere, MD; Richard S. Irwin, MD, Master FCCP  CHEST Jun 2015; 147(6): 1523-1529

OBJECTIVE: The objective of this study was to develop a mechanism of discovering misdirection into the airway of naso/orogastric (NG) tubes before they reach their full depth of placement in adults.

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2015 Jun - The Use of Inhaled Prostaglandins in Patients With ARDS: A Systematic Review and Meta-analysis

Brian M. Fuller, MD, MSCI; Nicholas M. Mohr, MD; Lee Skrupky, PharmD, BCPS; Susan Fowler, MLIS; Marin H. Kollef, MD, FCCP; Christopher R. Carpenter, MD  CHEST Jun 2015; 147(6): 1510-1522

OBJECTIVE: This study aimed to determine whether inhaled prostaglandins are associated with improvement in pulmonary physiology or mortality in patients with ARDS and assess adverse effects.

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2015 Jun - A Randomized Controlled Trial Comparing the Ventilation Duration Between Adaptive Support Ventilation and Pressure Assist/Control Ventilation in Medical Patients in the ICU

Cenk Kirakli, MD; Ilknur Naz, PT, MS; Ozlem Ediboglu, MD; Dursun Tatar, MD; Ahmet Budak, MD; Emel Tellioglu, MD  CHEST Jun 2015; 147(6): 1503-1509

BACKGROUND: Adaptive support ventilation (ASV) is a closed loop mode of mechanical ventilation (MV) that provides a target minute ventilation by automatically adapting inspiratory pressure and respiratory rate with the minimum work of breathing on the part of the patient. The aim of this study was to determine the effect of ASV on total MV duration when compared with pressure assist/control ventilation.

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2015 Jun - A Pilot Study of the Noninvasive Assessment of the Lung Microbiota as a Potential Tool for the Early Diagnosis of Ventilator-Associated Pneumonia

Addison K. May, MD; Jacob S. Brady, BA; Joann Romano-Keeler, MD; Wonder P. Drake, MD; Patrick R. Norris, PhD; Judith M. Jenkins, MSN; Richard J. Isaacs, PhD; Erik M. Boczko, PhD  CHEST Jun 2015; 147(6): 1494-1502

BACKGROUND: Ventilator-associated pneumonia (VAP) remains a common complication in critically ill surgical patients, and its diagnosis remains problematic. Exhaled breath contains aerosolized droplets that reflect the lung microbiota. We hypothesized that exhaled breath condensate fluid (EBCF) in hygroscopic condenser humidifier/heat and moisture exchanger (HCH/HME) filters would contain bacterial DNA that qualitatively and quantitatively correlate with pathogens isolated from quantitative BAL samples obtained for clinical suspicion of pneumonia.

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2015 May - Exhaled Air Dispersion During Noninvasive Ventilation via Helmets and a Total Facemask

David S. Hui, MD, FCCP; Benny K. Chow, PhD; Thomas Lo, MSc; Susanna S. Ng, MBChB; Fanny W. Ko, MD, FCCP; Tony Gin, MD; Matthew T. V. Chan, MD  CHEST May 2015; 147(5): 1336-1343

BACKGROUND: Noninvasive ventilation (NIV) via helmet or total facemask is an option for managing patients with respiratory infections in respiratory failure. However, the risk of nosocomial infection is unknown.

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2015 May - Endotracheal Tubes for Critically Ill Patients: An In Vivo Analysis of Associated Tracheal Injury, Mucociliary Clearance, and Sealing Efficacy

Gianluigi Li Bassi, MD, PhD; Nestor Luque, MD; Joan Daniel Martí, PhD, RPT; Eli Aguilera Xiol, MSc; Marta Di Pasquale, MD; Valeria Giunta, MD; Talitha Comaru, PhD, RPT; Montserrat Rigol, DVM, PhD; Silvia Terraneo, MD; Francesca De Rosa, MD; Mariano Rinaudo, MD; Ernesto Crisafulli, MD, PhD, FCCP; Rogelio Cesar Peralta Lepe, MD; Carles Agusti, MD, PhD; Carmen Lucena, MD; Miguel Ferrer, MD, PhD; Laia Fernández, PhD; Antoni Torres, MD, PhD, FCCP  CHEST May 2015; 147(5): 1327-1335

BACKGROUND: Improvements in the design of the endotracheal tube (ETT) have been achieved in recent years. We evaluated tracheal injury associated with ETTs with novel high-volume low-pressure (HVLP) cuffs and subglottic secretions aspiration (SSA) and the effects on mucociliary clearance (MCC).

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2015 May - Construct Validity and Minimal Important Difference of 6-Minute Walk Distance in Survivors of Acute Respiratory Failure

Kitty S. Chan, PhD; Elizabeth R. Pfoh, PhD; Linda Denehy, PhD; Doug Elliott, PhD; Anne E. Holland, PhD; Victor D. Dinglas, MPH; Dale M. Needham, MD, PhD  CHEST May 2015; 147(5): 1316-1326

OBJECTIVE: The 6-min walk distance (6MWD), a widely used test of functional capacity, has limited evidence of construct validity among patients surviving acute respiratory failure (ARF) and ARDS. The objective of this study was to examine construct validity and responsiveness and estimate minimal important difference (MID) for the 6MWD in patients surviving ARF/ARDS.

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2015 Apr - Surrogate Receptivity to Participation in Critical Illness Genetic Research: Aligning Research Oversight and Stakeholder Concerns

Bradley D. Freeman, MD; Kevin Butler, MS; Dragana Bolcic-Jankovic, MS; Brian R. Clarridge, PhD; Carie R. Kennedy, RN; Jessica LeBlanc, BA; Sara Chandros Hull, PhD  CHEST Apr 2015; 147(4): 979-988

BACKGROUND: Collection of genetic biospecimens as part of critical illness investigations is increasingly commonplace. Oversight bodies vary in restrictions imposed on genetic research, introducing inconsistencies in study design, potential for sampling bias, and the possibility of being overly prohibitive of this type of research altogether. We undertook this study to better understand whether restrictions on genetic data collection beyond those governing research on cognitively intact subjects reflect the concerns of surrogates for critically ill patients.

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2015 Apr - The Apelin-APJ Axis Is an Endogenous Counterinjury Mechanism in Experimental Acute Lung Injury

Xiao-Fang Fan, MD; Feng Xue, MD; Yue-Qi Zhang, MD; Xue-Ping Xing, MD; Hui Liu, MD; Sun-Zhong Mao, MD, PhD; Xiao-Xia Kong, MD; Yu-Qi Gao, MD, PhD; Shu F. Liu, MD, PhD; Yong-Sheng Gong, MD, PhD  CHEST Apr 2015; 147(4): 969-978

BACKGROUND: Although the mechanisms and pathways mediating ARDS have been studied extensively, less attention has been given to the mechanisms and pathways that counteract injury responses. This study found that the apelin-APJ pathway is an endogenous counterinjury mechanism that protects against ARDS.

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2015 Apr - Trends in Mechanical Ventilation Among Patients Hospitalized With Acute Exacerbations of COPD in the United States, 2001 to 2011

Mihaela S. Stefan, MD; Meng-Shiou Shieh, PhD; Penelope S. Pekow, PhD; Nicholas Hill, MD, FCCP; Michael B. Rothberg, MD, MPH; Peter K. Lindenauer, MD  CHEST Apr 2015; 147(4): 959-968

BACKGROUND: The use of noninvasive ventilation (NIV) in acute exacerbation of COPD has increased over time. However, little is known about patient factors influencing its use in routine clinical practice.

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2015 Apr - Nighttime Intensivist Staffing, Mortality, and Limits on Life Support: A Retrospective Cohort Study

Meeta Prasad Kerlin, MD, MSCE; Michael O. Harhay, MPH; Jeremy M. Kahn, MD; Scott D. Halpern, MD, PhD  CHEST Apr 2015; 147(4): 951-958

BACKGROUND: Evidence regarding nighttime physician staffing of ICUs is suboptimal. We aimed to determine how nighttime physician staffing models influence patient outcomes.

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2015 Mar - Assessing the Utility of ICU Readmissions as a Quality Metric: An Analysis of Changes Mediated by Residency Work-Hour Reforms

Sydney E. S. Brown, MD, PhD; Sarah J. Ratcliffe, PhD; Scott D. Halpern, MD, PhD  CHEST Mar 2015; 147(3): 626-636

BACKGROUND: ICU readmissions are associated with increased mortality and costs; however, it is unclear whether these outcomes are caused by readmissions or by residual confounding by illness severity. An assessment of temporal changes in ICU readmission in response to a specific policy change could help disentangle these possibilities. We sought to determine whether ICU readmission rates changed after 2003 Accreditation Council for Graduate Medical Education Resident Duty Hours reform (“reform”) and whether there were temporally corresponding changes in other ICU outcomes.

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2015 Mar - Comparison of Hospital Mortality and Long-term Survival in Patients With Acute Lung Injury/ARDS vs Cardiogenic Pulmonary Edema

Christopher N. Schmickl, MD, MPH; Michelle Biehl, MD; Gregory A. Wilson, RRT; Ognjen Gajic, MD, FCCP  CHEST Mar 2015; 147(3): 618-625

BACKGROUND: Early differential diagnosis of acute lung injury (ALI) vs cardiogenic pulmonary edema (CPE) is important for selecting the most appropriate therapy, but the prognostic implications of this distinction have not been studied. Accurate prognostic information is essential for providing appropriate informed consent prior to initiation of mechanical ventilation.

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2015 Mar - Platelet Count Mediates the Contribution of a Genetic Variant in LRRC16A to ARDS Risk

Yongyue Wei, PhD; Zhaoxi Wang, PhD; Li Su, BSc; Feng Chen, PhD; Paula Tejera, PhD; Ednan K. Bajwa, MD; Mark M. Wurfel, MD, PhD; Xihong Lin, PhD; David C. Christiani, MD, FCCP  CHEST Mar 2015; 147(3): 607-617

BACKGROUND: Platelets are believed to be critical in pulmonary-origin ARDS as mediators of endothelial damage through their interactions with fibrinogen and multiple signal transduction pathways. A prior meta-analysis identified five loci for platelet count (PLT): BAD, LRRC16A, CD36, JMJD1C, and SLMO2. This study aims to validate the quantitative trait loci (QTLs) of PLT within BAD, LRRC16A, CD36, JMJD1C, and SLMO2 among critically ill patients and to investigate the associations of these QTLs with ARDS risk that may be mediated through PLT.

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2015 Feb - Noninvasive Positive Pressure Ventilation Following Esophagectomy: Safety Demonstrated in a Pig Model

Vignesh Raman, BS; Caitlyn E. MacGlaflin, MS; Cherie P. Erkmen, MD  CHEST 2015; 147(2): 356-361

BACKGROUND: Respiratory complications occur in 20% to 65% of patients who have undergone esophagectomy. While noninvasive positive pressure ventilation (NPPV) is associated with fewer complications than endotracheal intubation (ET), it is relatively contraindicated after esophagectomy due to potential injury to the anastomosis. We created ex vivo and in vivo pig models to determine the pressure tolerance of an esophagectomy anastomosis and compare it to esophageal pressure during NPPV.

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2015 Feb - Impact of Diagnostic Criteria on the Incidence of Ventilator-Associated Pneumonia

Amédée Ego, MD; Jean-Charles Preiser, MD, PhD; Jean-Louis Vincent, MD, PhD, FCCP  CHEST 2015; 147(2): 347-355

BACKGROUND: Ventilator-associated pneumonia (VAP) is a frequent complication of prolonged invasive ventilation. Because VAP is largely preventable, its incidence has been used as an index of quality of care in the ICU. However, the incidence of VAP varies according to which criteria are used to identify it. We compared the incidence of VAP obtained with different sets of criteria.

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2015 Feb - Single-Dose Etomidate Does Not Increase Mortality in Patients With Sepsis: A Systematic Review and Meta-analysis of Randomized Controlled Trials and Observational Studies

Wan-Jie Gu, MSc; Fei Wang, MD; Lu Tang, MD; Jing-Chen Liu, MD  CHEST 2015; 147(2): 335-346

BACKGROUND: The effect of single-dose etomidate on mortality in patients with sepsis remains controversial. We systematically reviewed the literature to investigate whether a single dose of etomidate for rapid sequence intubation increased mortality in patients with sepsis.

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2015 Feb - Preintubation Application of Oral Chlorhexidine Does Not Provide Additional Benefit in Prevention of Early-Onset Ventilator-Associated Pneumonia

Cindy L. Munro, PhD, RN, ANP; Mary Jo Grap, PhD, RN; Curtis N. Sessler, MD, FCCP; Ronald K. Elswick, Jr, PhD; Devanand Mangar, MD; Rachel Karlnoski-Everall, PhD; Paula Cairns, BSN, RN  CHEST 2015; 147(2): 328-334

BACKGROUND: Daily application of oral chlorhexidine gluconate (CHX) following intubation to reduce the risk of ventilator-associated pneumonia (VAP) is now the standard of care in many ICUs. This randomized clinical trial evaluated the benefit of adding a preintubation CHX dose to the known benefit of postintubation CHX to reduce the risk of early-onset VAP. A secondary aim was to test the effect of a preintubation oral application of CHX on early endotracheal tube (ETT) colonization.

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