Chest

2011 Jun - Impact of Nonexacerbated COPD on Mortality in Critically Ill Patients

Alejandro Rodríguez, MD, PhD, Thiago Lisboa, MD, Jorge Solé-Violán, MD, PhD, Federico Gómez, MD, Oriol Roca, MD, PhD, Sandra Trefler, BSc, Joaquim Gea, MD, PhD, Joan R. Masclans, MD, PhD and Jordi Rello, MD, PhD. Published online before print March 10, 2011, doi: 10.1378/chest.10-2439. CHEST June 2011 vol. 139 no. 6 1354-1360
Background: The real contribution of nonexacerbated COPD to mortality has not been studied. The aim of our study was to evaluate the impact of nonexacerbated COPD on mortality in patients requiring mechanical ventilation (MV).

2011 Jun - Impact of Nonphysician Staffing on Outcomes in a Medical ICU

Hayley B. Gershengorn, MD, Hannah Wunsch, MD, Romina Wahab, MD, David Leaf, MD, Daniel Brodie, MD, FCCP, Guohua Li, MD, DrPH and Phillip Factor, DO, FCCP
Background: As the number of ICU beds and demand for intensivists increase, alternative solutions are needed to provide coverage for critically ill patients. The impact of different staffing models on the outcomes of patients in the medical ICU (MICU) remains unknown. In our study, we compare outcomes of nonphysician provider-based teams to those of medical house staff-based teams in the MICU.

2011 Jun - Quality of Life, Pulmonary Function, and Tomographic Scan Abnormalities After ARDS

Joan R. Masclans, MD, PhD, Oriol Roca, MD, PhD, Xavier Muñoz, MD, PhD, Esther Pallisa, MD, Ferran Torres, MD, PhD, Jordi Rello, MD, PhD and Ferran Morell, MD, PhD. Published online before print February 17, 2011, doi: 10.1378/chest.10-2438
CHEST June 2011 vol. 139 no. 6 1340-1346
Background: ARDS can produce a loss of lung function with persistent sequelae. This study aimed to evaluate health-related quality of life (HRQL) in survivors of ARDS compared with a healthy reference population and to determine the middle/long-term radiographic abnormalities and functional status, as well as their relation to observed HRQL, in these patients.

2011 May 1 - Leucyl/Cystinyl Aminopeptidase Gene Variants in Septic Shock

Taka-aki Nakada, MD, PhD, James A. Russell, MD, Hugh Wellman, MSc, John H. Boyd, MD, Emiri Nakada, MD, Katherine R. Thain, BSc, Simone A. Thair, BSc, Hiroyuki Hirasawa, MD, PhD, Shigeto Oda, MD, PhD and Keith R. Walley, MD. Published online before print February 17, 2011, doi: 10.1378/chest.10-2517 CHEST May 2011 vol. 139 no. 5 1042-1049
Background: Vasopressin is an essential peptide hormone regulating cardiovascular homeostasis and an adjunctive vasopressor therapy for septic shock.

2011 May 1 - Evaluation of the Total Face Mask for Noninvasive Ventilation to Treat Acute Respiratory Failure

Aylin Ozsancak, MD, Samy S. Sidhom, MD, MPH, Timothy N. Liesching, MD, FCCP, William Howard, RRT and Nicholas S. Hill, MD, FCCP. Published online before print February 17, 2011, doi: 10.1378/chest.10-1905 CHEST May 2011 vol. 139 no. 5 1034-1041
Background: We hypothesized that the total face mask (TFM) would be perceived as more comfortable than a standard oronasal mask (ONM) by patients receiving noninvasive mechanical ventilation (NIV) therapy for acute respiratory failure (ARF) and would be quicker to apply by respiratory therapists.

2011 May 1 - The Influence of Race/Ethnicity and Socioeconomic Status on End-of-Life Care in the ICU

Sarah Muni, MD, Ruth A. Engelberg, PhD, Patsy D. Treece, RN, MN, Danae Dotolo, MSW and J. Randall Curtis, MD, MPH, FCCP. Published online before print February 3, 2011, doi: 10.1378/chest.10-3011 CHEST May 2011 vol. 139 no. 5 1025-1033
Background: There is conflicting evidence about the influence of race/ethnicity on the use of intensive care at the end of life, and little is known about the influence of socioeconomic status.

2011 May 1 - The Effect of Supplemental Oxygen on Hypercapnia in Subjects With Obesity-Associated Hypoventilation: A Randomized, Crossover, Clinical Study

Meme Wijesinghe, MBBS, Mathew Williams, DipExSci, Kyle Perrin, PhD, Mark Weatherall, MBChB and Richard Beasley, DSc. Published online before print October 14, 2010, doi: 10.1378/chest.10-1280 CHEST May 2011 vol. 139 no. 5 1018-1024
Background: It is unknown whether oxygen therapy causes worsening hypercapnia in patients with obesity-associated hypoventilation (OAH), similar to the response observed in COPD. The objectives of this study were to investigate whether breathing 100% oxygen results in an increase in hypercapnia in patients with OAH and the mechanisms of any effect.

2010 Oct - Counterpoint: Efficacy of Extracorporeal Membrane Oxygenation in 2009 Influenza A(H1N1) - Sufficient Evidence?

Alan H. Morris, MD, FCCPMurray, UT, Eliotte Hirshberg, MDSalt Lake City, UT, Russell R. Miller III, MDMurray, UT, Kimberly D. Statler, MDSalt Lake City, UT and R. Duncan Hite, MD, FCCPWinston-Salem, NC. doi: 10.1378/chest.10-1792 CHEST October 2010 vol. 138 no. 4 778-781
Extracorporeal life support (ECLS) (including extracorporeal membrane oxygenation [ECMO] and extracorporeal CO2 removal) can be used in patients with inadequate oxygen delivery, including ineffective oxygenation due to severe lung disease. The current 2009 influenza A(H1N1) [A(H1N1)] epidemic has promoted ECMO use2 due to the severe hypoxemia witnessed in several populations.2-7

2011 Apr - Do Elderly Patients Fare Well in the ICU?

Brian H. Nathanson, PhD, Thomas L. Higgins, MD, MBA, Maura J. Brennan, MD, Andrew A. Kramer, PhD, Maureen Stark, MS and Daniel Teres, MD. Published online before print November 11, 2010, doi: 10.1378/chest.10-1233 CHEST April 2011 vol. 139 no. 4 825-831
Background: A recent update of the Mortality Probability Model (MPM)-III found 14% of intensive care patients had age as their only MPM risk factor for hospital mortality. This subgroup had a low mortality rate (2% vs 14% overall), and pronounced differences were noted among elderly patients. This article is an expanded analysis of age-related mortality rates in patients in the ICU.

2011 Apr - Mechanical Ventilation-Induced Oxidative Stress in the Diaphragm: Role of Heme Oxygenase-1

Darin J. Falk, PhD, Andreas N. Kavazis, PhD, Melissa A. Whidden, PhD, Ashley J. Smuder, MS, Joseph M. McClung, PhD, Matthew B. Hudson, MS and Scott K. Powers, PhD, EdD. Published online before print November 24, 2010, doi: 10.1378/chest.09-2787 CHEST April 2011 vol. 139 no. 4 816-824
Background: Prolonged mechanical ventilation (MV) results in a rapid onset of diaphragmatic atrophy that is primarily due to increased proteolysis. Although MV-induced protease activation can involve several factors, it is clear that oxidative stress is a required signal for protease activation in the diaphragm during prolonged MV. However, the oxidant-producing pathways in the diaphragm that contribute to MV-induced oxidative stress remain unknown. We have demonstrated that prolonged MV results in increased diaphragmatic expression of a key stress-sensitive enzyme, heme oxygenase (HO)-1. Paradoxically, HO-1 can function as either a pro-oxidant or an antioxidant, and the role that HO-1 plays in MV-induced diaphragmatic oxidative stress is unknown. We tested the hypothesis that HO-1 acts as a pro-oxidant in the diaphragm during prolonged MV.

2011 Apr - Health-care-Associated Bloodstream Infections at Admission to the ICU

Jordi Vallés, MD, PhD, Francisco Alvarez-Lerma, MD, Mercedes Palomar, MD, Armando Blanco, MD, Ana Escoresca, MD, Fernando Armestar, MD, José María Sirvent, MD, Carina Balasini, MD, Rafael Zaragoza, MD, María Marín, MD and the Study Group of Infectious Diseases of the Spanish Society of Critical Care Medicine*. Published online before print November 24, 2010, doi: 10.1378/chest.10-1715 CHEST April 2011 vol. 139 no. 4 810-815
Background: Infections occurring among outpatients having recent contact with the health-care system have been recently classified as health-care-associated infections to distinguish them from hospital- and community-acquired infections. Patients with bloodstream infections (BSIs) were studied to assess health-care-associated infections at admission in the ICU.

2011 Apr - Code Status Orders and Goals of Care in the Medical ICU

Thomas G. Gehlbach, MD, Laura A. Shinkunas, BA, Valerie L. Forman-Hoffman, PhD, MPH, Karl W. Thomas, MD, Gregory A. Schmidt, MD, FCCP and Lauris C. Kaldjian, MD, PhD. Published online before print February 3, 2011, doi: 10.1378/chest.10-1798 CHEST April 2011 vol. 139 no. 4 802-809
Background: Decisions about CPR in the medical ICU (MICU) are important. However, discussions about CPR (code status discussions) can be challenging and may be incomplete if they do not address goals of care.

2011 Apr - ICU Care Associated With Symptoms of Depression and Posttraumatic Stress Disorder Among Family Members of Patients Who Die in the ICU

Erin K. Kross, MD, Ruth A. Engelberg, PhD, Cynthia J. Gries, MD, Elizabeth L. Nielsen, MPH, Douglas Zatzick, MD and J. Randall Curtis, MD, MPH, FCCP. Published online before print September 9, 2010, doi: 10.1378/chest.10-0652 CHEST April 2011 vol. 139 no. 4 795-801
Background: Psychologic symptoms of posttraumatic stress disorder (PTSD) and depression are relatively common among family members of patients who die in the ICU. The patient-level risk factors for these family symptoms are not well understood but may help to target future interventions.

2011 Mar - Community-Acquired Respiratory Coinfection in Critically Ill Patients With Pandemic 2009 Influenza A(H1N1) Virus

Ignacio Martín-Loeches, MD, PhD, Ana Sanchez-Corral, MD, Emili Diaz, MD, PhD, Rosa María Granada, MD, Rafael Zaragoza, MD, Christian Villavicencio, MD, Antonio Albaya, MD, Enrique Cerdá, MD, Rosa María Catalán, MD, Pilar Luque, MD, Amparo Paredes, MD, Inés Navarrete, MD, Jordi Rello, MD, PhD, Alejandro Rodríguez, MD, PhD and H1N1 SEMICYUC Working Group. Published online before print October 7, 2010, doi: 10.1378/chest.10-1396. CHEST March 2011 vol. 139 no. 3 555-562
Background: Little is known about the impact of community-acquired respiratory coinfection in patients with pandemic 2009 influenza A(H1N1) virus infection.

2011 Mar - Randomized, Controlled Trials of Interventions to Improve Communication in Intensive Care: A Systematic Review

Leslie P. Scheunemann, MD, Michelle McDevitt, RN, BSN, Shannon S. Carson, MD and Laura C. Hanson, MD, MPH. CHEST March 2011 vol. 139 no. 3 543-554
Background: Communication between families and providers in the ICU affects patient and family outcomes and use of health-care resources. Recent research studies have tested interventions designed to improve communication quality and outcomes between providers and families of patients in the ICU. We conducted a systematic review of these studies.

2011 Mar - Does a Protective Ventilation Strategy Reduce the Risk of Pulmonary Complications After Lung Cancer Surgery? A Randomized Controlled Trial

Mikyung Yang, MD, PhD, Hyun Joo Ahn, MD, PhD, Kwhanmien Kim, MD, PhD, Jie Ae Kim, MD, PhD, Chin A Yi, MD, PhD, Myung Joo Kim, MD and Hyo Jin Kim, MD. CHEST March 2011 vol. 139 no. 3 530-537
Background: Protective ventilation strategy has been shown to reduce ventilator-induced lung injury in patients with ARDS. In this study, we questioned whether protective ventilatory settings would attenuate lung impairment during one-lung ventilation (OLV) compared with conventional ventilation in patients undergoing lung resection surgery.

2011 Mar - Ultrasound-Guided Catheterization of the Radial Artery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Ariel L. Shiloh, MD, Richard H. Savel, MD, Laura M. Paulin, MD, MHS and Lewis A. Eisen, MD, FCCP. CHEST March 2011 vol. 139 no. 3 524-529
Background: Ultrasound guidance commonly is used for the placement of central venous catheters (CVCs). The Agency for Healthcare Research and Quality recommends the use of ultrasound for CVC placement as one of its 11 practices to improve patient care. Despite increased access to portable ultrasound machines and comfort with ultrasound-guided CVC access, fewer clinicians are familiar with ultrasound-guided techniques of arterial catheterization. The goal of this systematic review and meta-analysis was to determine the utility of real-time two-dimensional ultrasound guidance for radial artery catheterization.

2011 Mar - Chest Tube Drainage of Transudative Pleural Effusions Hastens Liberation From Mechanical Ventilation

Yizhak Kupfer, MD, Chanaka Seneviratne, MD, Kabu Chawla, MD, Kavan Ramachandran, MD and Sidney Tessler, MD, FCCP. Published online before print August 5, 2010, doi: 10.1378/chest.10-1012. CHEST March 2011 vol. 139 no. 3 519-523
Background: Pleural effusions occur frequently in patients requiring mechanical ventilatory support. Treatment of the precipitating cause and resolution of the pleural effusion may take considerable time. We retrospectively studied the effect of chest tube drainage of transudative pleural effusions on the liberation of patients from mechanical ventilatory support.

2011 Mar - Ventilator-Associated Tracheobronchitis in a Mixed Surgical and Medical ICU Population

John Dallas, MD, Lee Skrupky, PharmD, Nurelign Abebe, MD, Walter A. Boyle III, MD and Marin H. Kollef, MD, FCCP.Chest March 2011 139:485-488; doi:10.1378/chest.10-2641
Background: Ventilator-associated tracheobronchitis (VAT) is considered an intermediate condition between bacterial airway colonization and ventilator-associated pneumonia (VAP). The purpose of this prospective cohort study was to further characterize VAT in terms of incidence, etiology, and impact on patient outcomes.

2011 Feb - Novel Toxin Assays Implicate Mycoplasma pneumoniae in Prolonged Ventilator Course and Hypoxemia

Mark T. Muir, MD, Stephen M. Cohn, MD, Christopher Louden, MS, Thirumalai R. Kannan, PhD and Joel B. Baseman, PhD. Published online before print September 30, 2010, doi: 10.1378/chest.10-1222. CHEST February 2011 vol. 139 no. 2 305-310
Background: Community-acquired respiratory distress syndrome (CARDS) toxin is a unique Mycoplasma pneumoniae virulence factor. Molecular assays targeting this toxin are more sensitive than existing diagnostics, but these assays have not been used to investigate the role of M pneumoniae as a nosocomial infection in critical illness. We sought to determine the incidence of M pneumoniae among mechanically ventilated subjects using these novel assays and to investigate the impact of this pathogen on pulmonary outcomes.

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