2015 Feb - A Scoping Review of Patient Discharge From Intensive Care: Opportunities and Tools to Improve Care
Henry T. Stelfox, MD, PhD; Dan Lane, MSc; Jamie M. Boyd, BA; Simon Taylor, BSc; Laure Perrier, MEd, MLIS; Sharon Straus, MD; David Zygun, MD; Danny J. Zuege, MD, FCCP CHEST 2015; 147(2): 317-327
BACKGROUND: We conducted a scoping review to systematically review the literature reporting patient discharge from ICUs, identify facilitators and barriers to high-quality care, and describe tools developed to improve care.
2015 Jan - Would Triage Predictors Perform Better Than First-Come, First-Served in Pandemic Ventilator Allocation?
Robert K. Kanter, MD CHEST Jan 2015; 147(1): 102-108
BACKGROUND: In a pandemic, needs for ventilators might overwhelm the limited supply. Outcome predictors have been proposed to guide ventilator triage allocation decisions. However, pandemic triage predictors have not been validated. This quantitative simulation study evaluated outcomes resulting from allocation strategies varying in their performance for selecting short-stay survivors as favorable candidates for ventilators.
Arendina W. van der Kooi, PhD; Irene J. Zaal, MD; Francina A. Klijn, MD; Huiberdina L. Koek, MD, PhD; Ronald C. Meijer, MD; Frans S. Leijten, MD, PhD; Arjen J. Slooter, MD, PhD CHEST Jan 2015; 147(1): 94-101
BACKGROUND: Despite its frequency and impact, delirium is poorly recognized in postoperative and critically ill patients. EEG is highly sensitive to delirium but, as currently used, it is not diagnostic. To develop an EEG-based tool for delirium detection with a limited number of electrodes, we determined the optimal electrode derivation and EEG characteristic to discriminate delirium from nondelirium.
2015 Jan - Factors Associated With Family Satisfaction With End-of-Life Care in the ICU: A Systematic Review
Laura J. Hinkle, MD; Gabriel T. Bosslet, MD, FCCP; Alexia M. Torke, MD CHEST Jan 2015; 147(1): 82-93
BACKGROUND: Family satisfaction with end-of-life care in the ICU has not previously been systematically reviewed. Our objective was to perform a review, synthesizing published data identifying factors associated with family satisfaction with end-of-life care in critically ill adult populations.
2015 Jan - A Prospective Evaluation of Ventilator-Associated Conditions and Infection-Related Ventilator-Associated Conditions
Anthony F. Boyer, MD; Noah Schoenberg, MD; Hilary Babcock, MD, MPH; Kathleen M. McMullen, MPH; Scott T. Micek, PharmD; Marin H. Kollef, MD, FCCP CHEST Jan 2015; 147(1): 68-81
BACKGROUND: The Centers for Disease Control and Prevention has shifted policy away from using ventilator-associated pneumonia (VAP) and toward using ventilator-associated conditions (VACs) as a marker of ICU quality. To date, limited prospective data regarding the incidence of VAC among medical and surgical ICU patients, the ability of VAC criteria to capture patients with VAP, and the potential clinical preventability of VACs are available.
Nita Khandelwal, MD; Ruth A. Engelberg, PhD; David C. Benkeser, MPH; Norma B. Coe, PhD; J. Randall Curtis, MD, MPH CHEST Dec 2014; 146(6): 1594-1603
OBJECTIVE: Although end-of-life care in the ICU accounts for a large proportion of health-care costs, few studies have examined the association between costs and satisfaction with care. The objective of this study was to investigate the association of ICU costs with family- and nurse-assessed quality of dying and family satisfaction.
2014 Dec - Integrated Use of Bedside Lung Ultrasound and Echocardiography in Acute Respiratory Failure: A Prospective Observational Study in ICU
Benoit Bataille, MD; Beatrice Riu, MD; Fabrice Ferre, MD; Pierre Etienne Moussot, MD; Arnaud Mari, MD; Elodie Brunel, MD; Jean Ruiz, MD; Michel Mora, MD; Olivier Fourcade, MD, PhD; Michele Genestal, MD; Stein Silva, MD, PhD CHEST Dec 2014; 146(6): 1586-1593
BACKGROUND: It has been suggested that the complementary use of echocardiography could improve the diagnostic accuracy of lung ultrasonography (LUS) in patients with acute respiratory failure (ARF). Nevertheless, the additional diagnostic value of echocardiographic data when coupled with LUS is still debated in this setting. The aim of the current study was to compare the diagnostic accuracy of LUS and an integrative cardiopulmonary ultrasound approach (thoracic ultrasonography [TUS]) in patients with ARF.
2014 Dec - Diagnosis of Ventilator-Associated Pneumonia: A Pilot, Exploratory Analysis of a New Score Based on Procalcitonin and Chest Echography
Giovanni Zagli, MD, PhD; Morena Cozzolino, MD; Alessandro Terreni, BSc; Tiziana Biagioli, PhD; Anna Lucia Caldini, BSc; Adriano Peris, MD CHEST Dec 2014; 146(6): 1578-1585
BACKGROUND: To facilitate the clinical diagnosis of ventilator-associated pneumonia (VAP) in the ICU, the Clinical Pulmonary Infection Score (CPIS) has been proposed but has shown a low diagnostic performance in subsequent studies. We propose a new score based on procalcitonin level and chest echography with the aim of improving VAP diagnosis: the Chest Echography and Procalcitonin Pulmonary Infection Score (CEPPIS).
2014 Dec - The Effect of Point-of-Care Ultrasonography on Imaging Studies in the Medical ICU: A Comparative Study
Margarita Oks, MD; Krystal L. Cleven, MD; Jose Cardenas-Garcia, MD; Jennifer Ann Schaub, MD; Seth Koenig, MD, FCCP; Rubin I. Cohen, MD, FCCP; Paul H. Mayo, MD, FCCP; Mangala Narasimhan, DO, FCCP CHEST Dec 2014; 146(6): 1574-1577
BACKGROUND: Point-of-care ultrasonography performed by frontline intensivists offers the possibility of reducing the use of traditional imaging in the medical ICU (MICU). We compared the use of traditional radiographic studies between two MICUs: one where point-of-care ultrasonography is used as a primary imaging modality, the other where it is used only for procedure guidance.
Deena Kelly Costa, PhD, RN; David J. Wallace, MD, MPH; Amber E. Barnato, MD, MPH; Jeremy M. Kahn, MD CHEST Dec 2014; 146(6): 1566-1573
BACKGROUND: ICUs are increasingly staffed with nurse practitioners/physician assistants (NPs/PAs), but it is unclear how NPs/PAs influence quality of care. We examined the association between NP/PA staffing and in-hospital mortality for patients in the ICU.
2014 Dec - Hospital-Level Variation in ICU Admission and Critical Care Procedures for Patients Hospitalized for Pulmonary Embolism
Andrew J. Admon, MD, MPH; Christopher W. Seymour, MD; Hayley B. Gershengorn, MD; Hannah Wunsch, MD; Colin R. Cooke, MD CHEST Dec 2014; 146(6): 1452-1461
BACKGROUND: Variation in the use of ICUs for low-risk conditions contributes to health system inefficiency. We sought to examine the relationship between ICU use for patients with pulmonary embolism (PE) and cost, mortality, readmission, and procedure use.
Renee D. Stapleton, MD, PhD, FCCP; William J. Ehlenbach, MD; Richard A. Deyo, MD, MPH; J. Randall Curtis, MD, MPH CHEST Nov 2014; 146(5): 1214-1225
BACKGROUND: Outcomes after in-hospital CPR in older adults with chronic illness are unclear.
2014 Nov - Sepsis Severe or Septic Shock: Outcome According to Immune Status and Immunodeficiency Profile
Violaine Tolsma, MD; Carole Schwebel, MD, PhD; Elie Azoulay, MD, PhD; Michael Darmon, MD, PhD; Bertrand Souweine, MD, PhD; Aurélien Vesin, MSc; Dany Goldgran-Toledano, MD; Maxime Lugosi, MD; Samir Jamali, MD; Christine Cheval, MD; Christophe Adrie, MD, PhD; Hatem Kallel, MD; Adrien Descorps-Declere, MD; Maïté Garrouste-Orgeas, MD, PhD; Lila Bouadma, MD, PhD; Jean-François Timsit, MD, PhD CHEST Nov 2014; 146(5): 1205-1213
OBJECTIVES: This study evaluated the influence of the immune profile on the outcome at day 28 (D28) of patients admitted to the ICU for septic shock or severe sepsis.
Ellen L. Burnham, MD; Robert C. Hyzy, MD, FCCP; Robert Paine, III, MD; Aine M. Kelly, MD; Leslie E. Quint, MD; David Lynch, MB; Douglas Curran-Everett, PhD; Marc Moss, MD; Theodore J. Standiford, MD CHEST Nov 2014; 146(5): 1196-1204
BACKGROUND: In ARDS, the extent of fibroproliferative activity on chest high-resolution CT (HRCT) scan has been reported to correlate with poorer short-term outcomes and pulmonary-associated quality of life. However, clinical factors associated with HRCT scan fibroproliferation are incompletely characterized. We questioned if lung compliance assessed at the bedside would be associated with fibroproliferation on HRCT scans obtained during the resolution phase of ARDS.
Allan J. Walkey, MD; Bradley G. Hammill, MS; Lesley H. Curtis, PhD; Emelia J. Benjamin, MD CHEST Nov 2014; 146(5): 1187-1195
BACKGROUND: New-onset atrial fibrillation (AF) is associated with adverse outcomes during a sepsis hospitalization; however, long-term outcomes following hospitalization with sepsis-associated new-onset AF are unclear.
2014 Oct - Aggressiveness of Intensive Care Use Among Patients With Lung Cancer in the Surveillance, Epidemiology, and End Results-Medicare Registry
Colin R. Cooke, MD; Laura C. Feemster, MD; Renda Soylemez Wiener, MD; Maya E. O’Neil, PhD; Christopher G. Slatore, MD CHEST Oct 2014; 146(4): 916-923
BACKGROUND: Approximately 65% of elderly patients with lung cancer who are admitted to the ICU will die within 6 months. Efforts to improve end-of-life care for this population must first understand the patient factors that underlie admission to the ICU.
2014 Oct - Increased Fluid Administration in the First Three Hours of Sepsis Resuscitation Is Associated With Reduced Mortality: A Retrospective Cohort Study
Sarah J. Lee, MD, MPH; Kannan Ramar, MBBS, MD; John G. Park, MD, FCCP; Ognjen Gajic, MD, FCCP; Guangxi Li, MD; Rahul Kashyap, MBBS CHEST Oct 2014; 146(4): 908-915
BACKGROUND: The surviving sepsis guidelines recommend early aggressive fluid resuscitation within 6 h of sepsis onset. Although rapid fluid administration may offer benefit, studies on the timing of resuscitation are lacking. We hypothesized that there is an association between quicker, adequate fluid resuscitation and patient outcome from sepsis onset time.
Augustine Lee, MD, FCCP; Emir Festic, MD; Pauline K. Park, MD; Krishnan Raghavendran, MD; Ousama Dabbagh, MD, FCCP; Adebola Adesanya, MD, FCCP; Ognjen Gajic, MD, FCCP; Raquel R. Bartz, MD, FCCP; the United States Critical Illness and Injury Trials Group CHEST Oct 2014; 146(4): 899-907
BACKGROUND: Pulmonary aspiration is an important recognized cause of ARDS. Better characterization of patients who aspirate may allow identification of potential risks for aspiration that could be used in future studies to mitigate the occurrence of aspiration and its devastating complications.
2014 Sep - Characteristics and Outcomes of Patients With Lung Transplantation Requiring Admission to the Medical ICU
Amit Banga, MD, FCCP; Debasis Sahoo, MD; Charles R. Lane, MD; Atul C. Mehta, MD, FCCP; Olufemi Akindipe, MD; Marie M. Budev, DO, MPH, FCCP; Xiao-Feng Wang, PhD; Madhu Sasidhar, MD, FCCP CHEST Sep 2014; 146(3): 590-599
BACKGROUND: There are few data on characteristics and outcomes among patients with lung transplantation (LT) requiring admission to the medical ICU (MICU) beyond the perioperative period.
2014 Sep - Impact of Early Mobilization on Glycemic Control and ICU-Acquired Weakness in Critically Ill Patients Who Are Mechanically Ventilated
Bhakti K. Patel, MD; Anne S. Pohlman, MSN; Jesse B. Hall, MD, FCCP; John P. Kress, MD, FCCP CHEST Sep 2014; 146(3): 583-589
BACKGROUND: ICU-acquired weakness (ICU-AW) has immediate and long-term consequences for critically ill patients. Strategies for the prevention of weakness include modification of known risk factors, such as hyperglycemia and immobility. Intensive insulin therapy (IIT) has been proposed to prevent critical illness polyneuropathy. However, the effect of insulin and early mobilization on clinically apparent weakness is not well known.