Chest

2010 Sep - The Association Between BMI and Plasma Cytokine Levels in Patients With Acute Lung Injury

Renee D. Stapleton, MD, FCCP, Anne E. Dixon, MD, FCCP, Polly E. Parsons, MD, FCCP, Lorraine B. Ware, MD, FCCP, Benjamin T. Suratt, MD, FCCP and the NHLBI Acute Respiratory Distress Syndrome Network. Published online before print April 30, 2010, doi: 10.1378/chest.10-0014. CHEST September 2010 vol. 138 no. 3 568-577
Background: Obesity is associated with poor outcomes in many diseases, although recent data suggest that acute lung injury (ALI) is an exception. This is particularly interesting because obesity is marked by increased levels of proinflammatory mediators associated with increased morbidity and mortality in ALI. We hypothesized that cytokine response might be attenuated in patients who are obese and critically ill or that obesity might modify the relationship between plasma cytokines and clinical outcomes in ALI.

2010 Sep - Clinical Characteristics and Outcomes of Sepsis-Related vs Non-Sepsis-Related ARDS

Chau-Chyun Sheu, MD, Michelle N. Gong, MD, Rihong Zhai, MD, PhD, Feng Chen, PhD, Ednan K. Bajwa, MD, Peter F. Clardy, MD, Diana C. Gallagher, MD, B. Taylor Thompson, MD and David C. Christiani, MD, FCCP. Published online before print May 27, 2010, doi: 10.1378/chest.09-2933. CHEST September 2010 vol. 138 no. 3 559-567
Background: ARDS may occur after either septic or nonseptic injuries. Sepsis is the major cause of ARDS, but little is known about the differences between sepsis-related and non-sepsis-related ARDS.

2010 Sep - Factors Associated With Nonadherence to Early Goal-Directed Therapy in the ED

Mark E. Mikkelsen, MD, David F. Gaieski, MD, Munish Goyal, MD, Andrea N. Miltiades, BA, Jeffrey C. Munson, MD, Jesse M. Pines, MD, Barry D. Fuchs, MD, FCCP, Chirag V. Shah, MD, Scarlett L. Bellamy, ScD and Jason D. Christie, MD, FCCP. Published online before print February 19, 2010, doi: 10.1378/chest.09-2210. CHEST September 2010 vol. 138 no. 3 551-558
Background: Protocol-driven early goal-directed therapy (EGDT) has been shown to reduce mortality in patients with severe sepsis and septic shock in the ED. EGDT appears to be underused, even in centers with formalized protocols. The aim of our study was to identify factors associated with not initiating EGDT in the ED.

2010 Aug - Epidemiologic Trend of Severe Sepsis in Taiwan From 1997 Through 2006

Hsiu-Nien Shen, MD, Chin-Li Lu, MS and Hsi-Hsing Yang, MD. Published online before print April 2, 2010, doi: 10.1378/chest.09-2205. CHEST August 2010 vol. 138 no. 2 298-304
Background: The epidemiologic data of severe sepsis are limited in developing countries. Among patients, the contribution of subsequent severe sepsis episodes to the disease burden is unclear.

2010 Aug - Predictors of Time to Death After Terminal Withdrawal of Mechanical Ventilation in the ICU

Colin R. Cooke, MD, David L. Hotchkin, MD, Ruth A. Engelberg, PhD, Lewis Rubinson, MD, PhD, FCCP and J. Randall Curtis, MD, FCCP. Published online before print April 2, 2010, doi: 10.1378/chest.10-0289. CHEST August 2010 vol. 138 no. 2 289-297
Background: Little information exists about the expected time to death after terminal withdrawal of mechanical ventilation. We sought to determine the independent predictors of time to death after withdrawal of mechanical ventilation.

2010 Jul - Acute Left Ventricular Dysfunction in the Critically Ill

Anand Chockalingam, MD, Ankit Mehra, MD, Smrita Dorairajan, MD and Kevin C. Dellsperger, MD, PhD. CHEST July 2010 vol. 138 no. 1 198-207
Acute left ventricular (LV) dysfunction is common in the critical care setting and more frequently affects the elderly and patients with comorbidities. Because of increased mortality and the potential for significant improvement with early revascularization, the practitioner must first consider acute coronary syndrome. However, variants of stress (takotsubo) cardiomyopathy may be more prevalent in ICU settings than previously recognized.

2010 Jul - Femoral-Based Central Venous Oxygen Saturation Is Not a Reliable Substitute for Subclavian/Internal Jugular-Based Central Venous Oxygen Saturation in Patients Who Are Critically Ill

Danielle L. Davison, MD, Lakhmir S. Chawla, MD, Leelie Selassie, MD, Elizabeth M. Jones, PA-C, Kayc C. McHone, PA-C, Amy R. Vota, PA-C, Christopher Junker, MD, Sara Sateri, MD and Michael G. Seneff, MD, FCCP. Published online before print April 23, 2010. CHEST July 2010 vol. 138 no. 1 76-83
Background: Central venous oxygen saturation (Scvo2) has been used as a surrogate marker for mixed venous oxygen saturation (Svo2). Femoral venous oxygen saturation (Sfvo2) is sometimes used as a substitute for Scvo2. The purpose of this study is to test the hypothesis that these values can be used interchangeably in a population of patients who are critically ill.

2010 Jul - Association Between Time of Admission to the ICU and Mortality: A Systematic Review and Metaanalysis

Rodrigo Cavallazzi, MD, Paul E. Marik, MD, FCCP, Amyn Hirani, MD, Monvasi Pachinburavan, MD, Tajender S. Vasu, MD and Benjamin E. Leiby, PhD. Published online before print April 23, 2010, doi: 10.1378/chest.09-3018. CHEST July 2010 vol. 138 no. 1 68-75
Background: The organizational and staffing structure of an ICU influences the outcome of critically ill and injured patients. A change in the ICU staffing structure frequently occurs at nighttime and on weekends (off-hours). We postulated that patients who are admitted to an ICU during off hours may be at an increased risk of death.

2010 Jul - Factors Associated With Illness Perception Among Critically Ill Patients and Surrogates

Dee Ford, MD, MSc, FCCP, Jane Zapka, ScD, Mulugeta Gebregziabher, PhD, Chengwu Yang, MD and Katherine Sterba, PhD. Published online before print January 15, 2010, doi: 10.1378/chest.09-2124. CHEST July 2010 vol. 138 no. 1 59-67
Background: We investigated illness perceptions among critically ill patients or their surrogates in a university medical ICU using a prospective survey. We hypothesized that these would vary by demographic, personal, and clinical measures.

2010 May - Severe Hypoxemic Respiratory Failure: Part 1—Ventilatory Strategies

Adebayo Esan, MD, Dean R. Hess, PhD, RRT, FCCP, Suhail Raoof, MD, FCCP, Liziamma George, MD, FCCP and Curtis N. Sessler, MD, FCCP. CHEST May 2010 vol. 137 no. 5 1203-1216
Approximately 16% of deaths in patients with ARDS results from refractory hypoxemia, which is the inability to achieve adequate arterial oxygenation despite high levels of inspired oxygen or the development of barotrauma. A number of ventilator-focused rescue therapies that can be used when conventional mechanical ventilation does not achieve a specific target level of oxygenation are discussed.

2010 Jun - Severe Hypoxemic Respiratory Failure: Part 2—Nonventilatory Strategies

Suhail Raoof, MD, FCCP, Keith Goulet, MD, Adebayo Esan, MD, Dean R. Hess, PhD, RRT, FCCP and Curtis N. Sessler, MD, FCCP. CHEST June 2010 vol. 137 no. 6 1437-1448
ARDS is characterized by hypoxemic respiratory failure, which can be refractory and life-threatening. Modifications to traditional mechanical ventilation and nontraditional modes of ventilation are discussed in Part 1 of this two-part series. In this second article, we examine nonventilatory strategies that can influence oxygenation, with particular emphasis on their role in rescue from severe hypoxemia.

2010 Jun - Marital Status and the Epidemiology and Outcomes of Sepsis

Christopher W. Seymour, MD, Theodore J. Iwashyna, MD, PhD, Colin R. Cooke, MD, MSc, Catherine L. Hough, MD, MSc and Greg S. Martin, MD, MSc, FCCP. Published online before print February 19, 2010, doi: 10.1378/chest.09-2661. CHEST June 2010 vol. 137 no. 6 1289-1296
Background: Sepsis is a major public health problem. Social factors may affect health behaviors, economic resources, and immune response, leading to hospitalization for infection. This study examines the association between marital status and sepsis incidence and outcomes in a population-based cohort.

2010 Jun - Resistant Pathogens in Nonnosocomial Pneumonia and Respiratory Failure: Is It Time To Refine the Definition of Health-care-Associated Pneumonia?

Matthew P. Schreiber, MD, Chee M. Chan, MD and Andrew F. Shorr, MD, MPH, FCCP. Published online before print February 12, 2010, doi: 10.1378/chest.09-2434, CHEST June 2010 vol. 137 no. 6 1283-1288
Background: The concept of health-care-associated pneumonia (HCAP) exists to identify patients infected with highly resistant pathogens. It is unclear how precise this concept is and how well it performs as a screening tool for resistance.

2010 Jun - Swallowing Dysfunction in Nonneurologic Critically Ill Patients Who Require Percutaneous Dilatational Tracheostomy

Carlos M. Romero, MD, Andrés Marambio, MD, Jorge Larrondo, MD, Katherine Walker, MD, María-Teresa Lira, RN, Eduardo Tobar, MD, Rodrigo Cornejo, MD and Mauricio Ruiz, MD. Published online before print March 18, 2010, doi: 10.1378/chest.09-2792. CHEST June 2010 vol. 137 no. 6 1278-1282
Background: The aim of this study was to determine the incidence of swallowing dysfunction in nonneurologic critically ill patients who require percutaneous dilatational tracheostomy (PDT) for prolonged mechanical ventilation (MV) and to compare the duration of the cannulation period and length of stay in the critical care unit (CCU) in patients with and without swallowing dysfunction.

2010 Jun - Outcomes of Patients Ventilated With Synchronized Intermittent Mandatory Ventilation With Pressure Support: A Comparative Propensity Score Study

Guillermo Ortiz, MD, Fernando Frutos-Vivar, MD, Niall D. Ferguson, MD, MSc, Andres Esteban, MD, PhD, Konstantinos Raymondos, MD, Carlos Apezteguía, MD, Javier Hurtado, MD, Marco González, MD, Vinko Tomicic, MD, José Elizalde, MD, Fekri Abroug, MD, Yaseen Arabi, MD, FCCP, Paolo Pelosi, MD, Antonio Anzueto, MD and for the Ventila Group*. Published online before print December 18, 2009, doi: 10.1378/chest.09-2131. CHEST June 2010 vol. 137 no. 6 1265-1277

Background: Few data are available regarding the benefits of one mode over another for ventilatory support. We set out to compare clinical outcomes of patients receiving synchronized intermittent mandatory ventilation with pressure support (SIMV-PS) compared with assist-control (A/C) ventilation as their primary mode of ventilatory support.

2010 May - Extubation of Patients With Neuromuscular Weakness: A New Management Paradigm

John Robert Bach, MD, Miguel R. Gonçalves, PT, Irram Hamdani, MD and Joao Carlos Winck, MD, PhD. CHEST May 2010 vol. 137 no. 5 1033-1039.
Background: Successful extubation conventionally necessitates the passing of spontaneous breathing trials (SBTs) and ventilator weaning parameters. We report successful extubation of patients with neuromuscular disease (NMD) and weakness who could not pass them.

2010 May - Endoscopic Placement of a Novel Feeding Tube

Hugh Black, MD, FCCP, Ken Yoneda, MD, FCCP, John Millar, MD, Jacqueline Allen, MD and Peter Belafsky, MD, MPH, PhD. CHEST May 2010 vol. 137 no. 5 1028-1032
Background: Complications of blind feeding tube (FT) placement include pneumothorax, pneumonia, empyema, and death. A safe and effective method of FT placement is desired. The Davis FT is a novel device that detachably couples to an ultrathin transnasal gastroscope. The objective of this study was to evaluate the safety and efficacy of Davis FT placement.

2010 May - Relationship Between ICU Design and Mortality

David E. Leaf, MD, Peter Homel, PhD and Phillip H. Factor, DO, FCCP. CHEST May 2010 vol. 137 no. 5 1022-1027
Background: Architectural design of health-care facilities can influence patient safety; however, it is unknown whether patient outcomes are significantly affected by ICU design.

2010 May - Association Between a Silver-Coated Endotracheal Tube and Reduced Mortality in Patients With Ventilator-Associated Pneumonia

Bekele Afessa, MD, FCCP, Andrew F. Shorr, MD, MPH, FCCP, Antonio R. Anzueto, MD, Donald E. Craven, MD, Regina Schinner, Dipl-Stat and Marin H. Kollef, MD, FCCP. CHEST May 2010 vol. 137 no. 5 1015-1021
Background: A silver-coated endotracheal tube (ETT) reduced the incidence of ventilator-associated pneumonia (VAP) compared with an uncoated ETT in the North American Silver-Coated Endotracheal Tube (NASCENT) study.

2010 Apr - Long-Term Survival and Quality of Life After Transfusion-Associated Pulmonary Edema in Critically III Medical Patients

Guangxi Li, MD, Marija Kojicic, MD, Martin K. Reriani, MD, Evans R. Fernández Pérez, MD, FCCP, Lokendra Thakur, MD, Rahul Kashyap, MD, Camille M. Van Buskirk, MD and Ognjen Gajic, MD, FCCP. Published online before print October 16, 2009, doi: 10.1378/chest.09-0841
CHEST April 2010 vol. 137 no. 4 783-789
Background: Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) commonly complicate transfusion in critically ill patients. Prior outcome studies of TACO and TRALI have focused on short-term morbidity and mortality, but the long-term survival and quality of life (QOL) of these patients remain unknown.

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