Chest

2011 Dec - Epidemiology of Critical Care Syndromes, Organ Failures, and Life-Support Interventions in a Suburban US Community

Rodrigo Cartin-Ceba, MD, Marija Kojicic, MD, Guangxi Li, MD, Daryl J. Kor, MD, Jaise Poulose, MD, Vitaly Herasevich, MD, Rahul Kashyap, MBBS, MD, Cesar Trillo-Alvarez, MD, Javier Cabello-Garza, MD, Rolf Hubmayr, MD, FCCP, Edward G. Seferian, MD and Ognjen Gajic, MD. Published online before print October 13, 2011, doi: 10.1378/chest.11-1197 CHEST December 2011 vol. 140 no. 6 1447-1455
Background: ICU services represent a significant and increasing proportion of medical care. Population-based epidemiologic studies are essential to inform physicians and policymakers about current and future ICU demands. We aimed to determine the incidence of critical care syndromes, organ failures, and life-support interventions in a defined US suburban community with unrestricted access to critical care services.

2011 Dec - Omission of Early Thromboprophylaxis and Mortality in Critically Ill Patients: A Multicenter Registry Study

Kwok M. Ho, PhD, Shaila Chavan, MSPH and David Pilcher, MBBS. Published online before print September 22, 2011, doi: 10.1378/chest.11-1444 CHEST December 2011 vol. 140 no. 6 1436-1446
Background: VTE is a preventable cause of death within hospitals. This study aimed to assess the association between omission of early thromboprophylaxis for > 24 h after ICU admission and mortality in critically ill patients.

2011 Dec - Percutaneous Catheter Decompression in the Treatment of Elevated Intraabdominal Pressure

Michael L. Cheatham, MD and Karen Safcsak, RN. Published online before print September 8, 2011, doi: 10.1378/chest.10-2789 CHEST December 2011 vol. 140 no. 6 1428-1435
Background: Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) traditionally have been treated surgically through emergent laparotomy. Intensivist-performed bedside drainage of free intraperitoneal fluid or blood (percutaneous catheter decompression [PCD]) has been advocated as a less-invasive alternative to open abdominal decompression (OAD).

2011 Nov - Early ICU Energy Deficit Is a Risk Factor for Staphylococcus aureus Ventilator-Associated Pneumonia

Christophe Faisy, MD, PhD, Maria Candela Llerena, MD, Magali Savalle, MD, Jean-Luc Mainardi, MD, PhD and Jean-Yves Fagon, MD, PhD. Published online before print September 8, 2011, doi: 10.1378/chest.11-1499 CHEST November 2011 vol. 140 no. 5 1254-1260
Background: Caloric insufficiency during the first week of ICU stay has been associated with increased infection rates. The connection between specific pathogens and host nutritional status in the ICU is not well known. This study was undertaken to determine the impact of patients’ early in-ICU energy balance on the pathogens responsible for ventilator-associated pneumonia (VAP).

2011 Nov - IV Delivery of Induced Pluripotent Stem Cells Attenuates Endotoxin-Induced Acute Lung Injury in Mice

Kuang-Yao Yang, MD, PhD, Hsin-Chin Shih, MD, PhD, Chorng-Kuang How, MD, Cheng-Yu Chen, MD, PhD, Han-Shui Hsu, MD, PhD, Ching-Wen Yang, BS, Yu-Chin Lee, MD, FCCP, Reury-Perng Perng, MD, PhD, FCCP, Chi-Hsien Peng, MD, Hsin-Yang Li, MD, PhD, Chia-Ming Chang, MD, Chung-Yuan Mou, PhD and Shih-Hwa Chiou, MD, PhD. Published online before print August 11, 2011, doi: 10.1378/chest.11-0539 CHEST November 2011 vol. 140 no. 5 1243-1253
Background: Induced pluripotent stem (iPS) cells are novel stem cell populations, but the role of iPS cells in acute lung injury (ALI) is not currently known. We investigated the effect of iPS cells in modifying the pathophysiology of endotoxin-induced ALI.

2011 Nov - Benchmark Data From More Than 240,000 Adults That Reflect the Current Practice of Critical Care in the United States

Craig M. Lilly, MD, FCCP, Ilene H. Zuckerman, PharmD, PhD, Omar Badawi, PharmD and Richard R. Riker, MD, FCCP. Published online before print August 25, 2011, doi: 10.1378/chest.11-0718 CHEST November 2011 vol. 140 no. 5 1232-1242
Background: Nationwide benchmarks representing current critical care practice for the range of ICUs are lacking. This information may highlight opportunities for care improvement and allows comparison of ICU practice data.

2011 Nov - Nationwide Trends of Severe Sepsis in the 21st Century (2000-2007)

Gagan Kumar, MD, Nilay Kumar, MD, MPH, Amit Taneja, MD, Thomas Kaleekal, MD, Sergey Tarima, PhD, Emily McGinley, MPH, Edgar Jimenez, MD, Anand Mohan, MD, Rumi Ahmed Khan, MD, Jeff Whittle, MD, Elizabeth Jacobs, MD, FCCP, Rahul Nanchal, MD, FCCP and from the Milwaukee Initiative in Critical Care Outcomes Research (MICCOR) Group of Investigators. Published online before print August 18, 2011, doi: 10.1378/chest.11-0352 CHEST November 2011 vol. 140 no. 5 1223-1231
Background: Severe sepsis is common and often fatal. The expanding armamentarium of evidence-based therapies has improved the outcomes of persons with this disease. However, the existing national estimates of the frequency and outcomes of severe sepsis were made before many of the recent therapeutic advances. Therefore, it is important to study the outcomes of this disease in an aging US population with rising comorbidities.

2011 Nov - Salivary Cortisol Can Replace Free Serum Cortisol Measurements in Patients With Septic Shock

Published online before print August 4, 2011, doi: 10.1378/chest.11-0448 CHEST November 2011 vol. 140 no. 5 1216-1222. Rosa M. Estrada-Y-Martin, MD, FCCP and Philip R. Orlander, MD
Background: There is a renewed interest in adrenal function during severe sepsis. Most studies have used total serum cortisol levels; however, only free serum cortisol is biologically active. The aim of this study was to determine the validity of salivary cortisol levels as a surrogate for free serum cortisol levels during septic shock.

2011 Nov - Development and Validation of a Risk Calculator Predicting Postoperative Respiratory Failure

Published online before print July 14, 2011, doi: 10.1378/chest.11-0466 CHEST November 2011 vol. 140 no. 5 1207-1215. Himani Gupta, MD, Prateek K. Gupta, MD, Xiang Fang, PhD, Weldon J. Miller, MS, Samuel Cemaj, MD, R. Armour Forse, MD, PhD and Lee E. Morrow, MD, FCCP
Background: Postoperative respiratory failure (PRF) (requiring mechanical ventilation > 48 h after surgery or unplanned intubation within 30 days of surgery) is associated with significant morbidity and mortality. The objective of this study was to identify preoperative factors associated with an increased risk of PRF and subsequently develop and validate a risk calculator.

2011 Nov - Extreme Obesity and Outcomes in Critically Ill Patients

Published online before print August 4, 2011, doi: 10.1378/chest.10-3023 CHEST November 2011 vol. 140 no. 5 1198-1206. Jenny L. Martino, MD, MSPH, Renee D. Stapleton, MD, PhD, FCCP, Miao Wang, MSc, Andrew G. Day, MSc, Naomi E. Cahill, RD, MSc, Anne E. Dixon, MD, FCCP, Benjamin T. Suratt, MD, FCCP and Daren K. Heyland, MD
Background: Recent literature suggests that obese critically ill patients do not have worse outcomes than patients who are normal weight. However, outcomes in extreme obesity (BMI ≥ 40 kg/m2) are unclear. We sought to determine the association between extreme obesity and ICU outcomes.

2011 Oct - Noninvasive Ventilation in COPD: Impact of Inspiratory Pressure Levels on Sleep Quality

Michael Dreher, MD, Emelie Ekkernkamp, MD, Stephan Walterspacher, MD, David Walker, MD, Claudia Schmoor, PhD, Jan H. Storre, MD and Wolfram Windisch, MD. Published online before print May 12, 2011, doi: 10.1378/chest.11-0253 CHEST October 2011 vol. 140 no. 4 939-945
Background: Although high-intensity noninvasive positive pressure ventilation (HI-NPPV) is superior to low-intensity noninvasive positive pressure ventilation (LI-NPPV) in controlling nocturnal hypoventilation in stable hypercapnic patients with COPD, it produces higher amounts of air leakage, which, in turn, could impair sleep quality. Therefore, the present study assessed the difference in sleep quality during HI-NPPV and LI-NPPV.

2011 Oct - Hemophagocytic Lymphohistiocytosis: A Potentially Underrecognized Association With Systemic Inflammatory Response Syndrome, Severe Sepsis, and Septic Shock in Adults

Robert A. Raschke, MD and Roxanne Garcia-Orr, MD. Published online before print July 7, 2011, doi: 10.1378/chest.11-0619 CHEST October 2011 vol. 140 no. 4 933-938
Background: Hemophagocytic lymphohistiocytosis (HLH) was originally described as a genetic disorder of immune regulation, presenting in neonates with protracted fever, hepatosplenomegaly, and cytopenia. A secondary form of HLH, triggered by serious infections, was subsequently described in adults.

2011 Oct - Pancreatic Stone Protein: A Marker of Organ Failure and Outcome in Ventilator-Associated Pneumonia

Lucas Boeck, MD, Rolf Graf, MD, Philippe Eggimann, MD, Hans Pargger, MD, Dimitri A. Raptis, MD, Nicholas Smyrnios, MD, Nehal Thakkar, MD, Martin Siegemund, MD, Janko Rakic, MD, Michael Tamm, MD, FCCP and Daiana Stolz, MD, MPH. Published online before print August 11, 2011, doi: 10.1378/chest.11-0018 CHEST October 2011 vol. 140 no. 4 925-932
Background: Ventilator-associated pneumonia (VAP) is the most common hospital-acquired, life-threatening infection. Poor outcome and health-care costs of nosocomial pneumonia remain a global burden. Currently, physicians rely on their experience to discriminate patients with good and poor outcome. However, standardized prognostic measures might guide medical decisions in the future. Pancreatic stone protein (PSP)/regenerating protein (reg) is associated with inflammation, infection, and other disease-related stimuli. The prognostic value of PSP/reg among critically ill patients is unknown. The aim of this pilot study was to evaluate PSP/reg in VAP.

2011 Sep 1 - A Prerotational, Simulation-Based Workshop Improves the Safety of Central Venous Catheter Insertion - Results of a Successful Internal Medicine House Staff Training Program

Hiroshi Sekiguchi, MD, Joji Erik Tokita, MD, Taro Minami, MD, Lewis Ari Eisen, MD, FCCP, Paul Henry Mayo, MD, FCCP and Mangala Narasimhan, DO, FCCP. Published online before print June 9, 2011, doi: 10.1378/chest.10-3319 CHEST September 2011 vol. 140 no. 3 652-658
Background: The purpose of this study was to evaluate the effectiveness of a simulation-based workshop with ultrasonography instruction in reducing mechanical complications associated with central venous catheter (CVC) insertion.

2011 Sep 1 - Effect of Antibiotic Diversity on Ventilator-Associated Pneumonia Caused by ESKAPE Organisms

Alberto Sandiumenge, MD, PhD, Thiago Lisboa, MD, Frederic Gomez, MD, Pilar Hernandez, Laura Canadell, PharmD and Jordi Rello, MD, PhD. Published online before print June 9, 2011, doi: 10.1378/chest.11-0462
CHEST September 2011 vol. 140 no. 3 643-651
Background: The aim of this study was to test in the clinic whether antimicrobial diversity affects resistance of Enterococcus faecium, Staphylococcus aureus, Klebsiella species, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species (ESKAPE) pathogens in ventilator-associated pneumonia (VAP).

2011 Aug - Preventive and Therapeutic Effects of Phosphoinositide 3-Kinase Inhibitors on Acute Lung Injury

Chengshui Chen, MD, PhD, Xiaocong Fang, MD, Yaoli Wang, MD, PhD, Yuping Li, MD, Diane Wang, Xia Zhao, MD, PhD, Chunxue Bai, MD, PhD, FCCP and Xiangdong Wang, MD, PhD
Abstract
Background: Phosphoinositide 3-kinases (PI3Ks) are involved in a number of biologic responses. Recent preclinical studies demonstrated that the PI3K-dominant signal pathway could play an important role in the development of acute lung injury, although the mechanism remains unclear.

2011 Aug - Pre-B-Cell Colony-Enhancing Factor and Its Clinical Correlates With Acute Lung Injury and Sepsis

Kathleen A. Lee, MD and Michelle N. Gong, MD
Abstract
Background: Pre-B-cell colony-enhancing factor (PBEF) is a potential biomarker for acute lung injury (ALI) in sepsis. We aimed to determine the clinical correlates for elevated plasma PBEF upon ICU admission for severe sepsis and the usefulness of PBEF to predict ALI development and sepsis mortality.

2011 July - The Effect of Catheter to Vein Ratio on Blood Flow Rates in a Simulated Model of Peripherally Inserted Central Venous Catheters

Thomas P. Nifong, MD and Timothy J. McDevitt, PhD. CHEST July 2011 vol. 140 no. 1 48-53
Abstract
Background: Catheter-related thrombosis is a common complication in all anatomic sites, especially when smaller veins of the upper extremity are considered. It is presumed that the presence of a catheter within the lumen of a vein will decrease flow and potentially create stasis, and clinical data suggest that the size of the catheter impacts thrombosis rates. We sought to determine, both mathematically and experimentally, the impact of catheters on fluid flow rates.

2011 Jun - Neighborhood Poverty Rate and Mortality in Patients Receiving Critical Care in the Academic Medical Center Setting

Sam Zager, MPhil, Mallika L. Mendu, MD, Domingo Chang, MD, Heidi S. Bazick, MD, Andrea B. Braun, MD, Fiona K. Gibbons, MD and Kenneth B. Christopher, MD. Published online before print March 31, 2011, doi: 10.1378/chest.10-2594. CHEST June 2011 vol. 139 no. 6 1368-1379
Background: Poverty is associated with increased risk of chronic illness but its contribution to critical care outcome is not well defined.

2011 Jun - Rapid Response Team in an Academic Institution: Does It Make a Difference?

Shiwan K. Shah, DO, Victor J. Cardenas Jr, MD, Yong-Fang Kuo, PhD and Gulshan Sharma, MD, MPH. Published online before print September 23, 2010, doi: 10.1378/chest.10-0556. CHEST June 2011 vol. 139 no. 6 1361-1367
Background: Although data remain contradictory, rapid response systems are implemented across US hospitals. We aimed to determine whether implementation of a rapid response team (RRT) in a tertiary academic hospital improved outcomes.

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