Chest

2010 Apr - Involuntary Cough Strength and Extubation Outcomes for Patients in an ICU

Wen-Lin Su, MD, MPH, Yeong-Hwang Chen, MD, MPH, Chien-Wen Chen, MD, Shih-Hsing Yang, MS, Chien-Ling Su, MS, Wann-Cherng Perng, MD, Chin-Pyng Wu, MD, PhD and Jenn-Han Chen, PhD. Published online before print January 22, 2010, doi: 10.1378/chest.07-2808
CHEST April 2010 vol. 137 no. 4 777-782
Background: Removing the artificial airway is the last step in the mechanical ventilation withdrawal process. In order to assess cough effectiveness, a critical component of this process, we evaluated the involuntary cough peak flow (CPFi) to predict the extubation outcome for patients weaned from mechanical ventilation in ICUs.

2010 Mar - Late Admission to the ICU in Patients With Community-Acquired Pneumonia Is Associated With Higher Mortality

Marcos I. Restrepo, MD, MSc, FCCP, Eric M. Mortensen, MD, MSc, Jordi Rello, MD, PhD, Jennifer Brody, MD and Antonio Anzueto, MD. Published online before print October 31, 2009, doi: 10.1378/chest.09-1547. CHEST March 2010 vol. 137 no. 3 552-557
Background: Limited data are available on the impact of time to ICU admission and outcomes for patients with severe community acquired pneumonia (CAP). Our objective was to examine the association of time to ICU admission and 30-day mortality in patients with severe CAP.

2010 Mar - Toward Understanding Tight Glycemic Control in the ICU: A Systematic Review and Metaanalysis

Paul E. Marik, MD, FCCP and Jean-Charles Preiser, MD. Published online before print December 16, 2009, doi: 10.1378/chest.09-1737
CHEST March 2010 vol. 137 no. 3 544-551
Background: Following publication of the Leuven Intensive Insulin Therapy Trial in 2001, tight glycemic control became the standard of care in ICUs around the world. Recent studies suggest that this approach may be flawed. The goal of this systematic review was to determine the benefits and risks of tight glycemic control in ICU patients and to explain the differences in outcomes among reported trials.

2010 Feb - N-Methyl-D-Aspartate Glutamate Receptor Blockade Attenuates Lung Injury Associated With Experimental Sepsis

Aline A. da Cunha, PharmD, Vânia Pauli, BSc, Vasyl C. Saciura, BSc, Melissa G. S. Pires, PhD, Leandra C. Constantino, BSc, Bruna de Souza, PharmD, Fabricia Petronilho, MSc, Jarbas Rodrigues de Oliveira, PharmD, PhD, Cristiane Ritter, MD, PhD, Pedro R. T. Romão, PhD, Carina Rodrigues Boeck, PhD, Rafael Roesler, PhD, João Quevedo, MD, PhD and Felipe Dal-Pizzol, MD, PhD. Published online before print October 16, 2009, doi: 10.1378/chest.09-1570. CHEST February 2010 vol. 137 no. 2 297-302
Background: The aim of this study was to examine the effects of the N-methyl-D-aspartate receptor (NMDAR) channel blocker dizocilpine (MK-801) on lung injury in rats submitted to experimental sepsis induced by cecal ligation and perforation (CLP).

2010 Feb - Prognostic and Pathogenetic Value of Combining Clinical and Biochemical Indices in Patients With Acute Lung Injury

Lorraine B. Ware, MD, FCCP, Tatsuki Koyama, PhD, D. Dean Billheimer, PhD, William Wu, PhD, Gordon R. Bernard, MD, FCCP, B. Taylor Thompson, MD, Roy G. Brower, MD, Theodore J. Standiford, MD, Thomas R. Martin, MD, Michael A. Matthay, MD, FCCP and the NHLBI ARDS Clinical Trials Network*. Published online before print October 26, 2009, doi: 10.1378/chest.09-1484. CHEST February 2010 vol. 137 no. 2 288-296
Background: No single clinical or biologic marker reliably predicts clinical outcomes in acute lung injury (ALI)/ARDS. We hypothesized that a combination of biologic and clinical markers would be superior to either biomarkers or clinical factors alone in predicting ALI/ARDS mortality and would provide insight into the pathogenesis of clinical ALI/ARDS.

2010 Feb - Predictors of Symptoms of Posttraumatic Stress and Depression in Family Members After Patient Death in the ICU

Cynthia J. Gries, MD, MSc, Ruth A. Engelberg, PhD, Erin K. Kross, MD, Doug Zatzick, MD, Elizabeth L. Nielsen, MPH, Lois Downey, MA and J. Randall Curtis, MD, MPH, FCCP. Published online before print September 17, 2009, doi: 10.1378/chest.09-1291
CHEST February 2010 vol. 137 no. 2 280-287
Background: Patients’ deaths in the ICU have been associated with a high burden of psychologic symptoms in families. This study identifies characteristics associated with psychologic symptoms in family members.

2010 Jan - 2010 Jan - Coagulopathy in Critically III Patients: Part 2–Soluble Clotting Factors and Hemostatic Testing

Arthur P. Wheeler, MD, FCCP and Todd W. Rice, MD, MSc. CHEST January 2010 vol. 137 no. 1 185-194
This manuscript provides an overview of how to interpret in vitro clotting studies and how to select studies to evaluate patients with bleeding disorders in the ICU.

2010 Jan - Patient-Specific, Time-Varying Predictors of Post-ICU Informal Caregiver Burden: The Caregiver Outcomes After ICU Discharge Project

David C. Van Pelt, MD, MSc, Richard Schulz, PhD, Lakshmipathi Chelluri, MD, MPH and Michael R. Pinsky, MD, FCCP. Published online before print September 17, 2009, doi: 10.1378/chest.09-0795. CHEST January 2010 vol. 137 no. 1 88-94
Background: The outcomes of informal caregivers of survivors of critical illness likely depend on patient characteristics, which may change over time. To date, few studies have examined patient-specific predictors of post-ICU informal caregiver burden, and none has tested whether predictors vary after hospital discharge.

2010 Jan - ARDS of Early or Late Onset: Does It Make a Difference?

Jean-Louis Vincent, MD, PhD, FCCP, Yasser Sakr, MB, BCh, PhD, Johan Groeneveld, MD, Durk F. Zandstra, MD, Eric Hoste, MD, Yannick Malledant, MD, Katie Lei, MD and Charles L. Sprung, MD, FCCP*. Published online before print October 9, 2009, doi: 10.1378/chest.09-0714. CHEST January 2010 vol. 137 no. 1 81-87
Background: Differences in outcomes have been demonstrated for critically ill patients with late-onset compared with early-onset renal failure and late-onset compared with early-onset shock, which could cause a lead-time bias in clinical trials assessing potential therapies for these conditions. We used data from a large, multicenter observational study to assess whether late-onset ARDS was similarly associated with worse outcomes compared with early-onset ARDS.

2010 Jan - Noninvasive Ventilation Reduces Intubation in Chest Trauma-Related Hypoxemia: A Randomized Clinical Trial

Gonzalo Hernandez, MD, PhD, Rafael Fernandez, MD, PhD, Pilar Lopez-Reina, MD, Rafael Cuena, MD, Ana Pedrosa, MD, Ramon Ortiz, MD and Paloma Hiradier, MD. Published online before print September 11, 2009, doi: 10.1378/chest.09-1114. CHEST January 2010 vol. 137 no. 1 74-80
Background: Guidelines for noninvasive mechanical ventilation (NIMV) recommend continuous positive airway pressure in patients with thoracic trauma who remain hypoxic despite regional anesthesia. This recommendation is rated only by level C evidence because randomized controlled trials in this specific population are lacking. Our aim was to determine whether NIMV reduces intubation in severe trauma-related hypoxemia.

2009 Dec - Coagulopathy in critically ill patients: part 1: platelet disorders. [Review]

Rice TW, Wheeler AP.; Chest. 2009 Dec;136(6):1622-30.
Abnormalities of platelet number and function are the most common coagulation disorders seen among ICU patients. This article reviews the most frequent causes of thrombocytopenia by providing an overview of the following most common mechanisms: impaired production; sequestration; dilution; and destruction. Guidelines for treating thrombocytopenia and platelet dysfunction are also provided.

2009 Dec - Massive Transfusion: New Insights

Kristen C. Sihler, MD, MS and Lena M. Napolitano, MD, FCCP. CHEST December 2009 vol. 136 no. 6 1654-1667
Massive transfusion (MT) is used for the treatment of uncontrolled hemorrhage. Earlier definitive control of life-threatening hemorrhage has significantly improved patient outcomes, but MT is still required. A number of recent advances in the area of MT have emerged, including the use of “hypotensive” or “delayed” resuscitation for victims of penetrating trauma before hemorrhage is controlled and “hemostatic resuscitation” with increased use of plasma and platelet transfusions in an attempt to maintain coagulation.

2009 Dec - Clinical Management of Pandemic (H1N1) Infection

Hui DS, Lee N, Chan PK.; Chest. 2009 Dec 18. [Epub ahead of print]
Antiviral therapy and vaccination are important strategies for controlling pandemic (H1N1) 2009 influenza but efficacy depends on the timing of administration and is often limited by shortage of supply.

2009 Dec - Potential for Response Bias in Family Surveys About End-of-Life Care in the ICU

Erin K. Kross, MD, Ruth A. Engelberg, PhD, Sarah E. Shannon, RN, PhD and J. Randall Curtis, MD, MPH, FCCP. Published online before print July 17, 2009, doi: 10.1378/chest.09-0589. CHEST December 2009 vol. 136 no. 6 1496-1502
Background: After-death surveys are an important source of information about the quality of end-of-life care, but response rates generally are low. Our goal was to understand the potential for nonresponse bias in survey studies of family members after a patient's death in the hospital ICU by identifying differences in patient demographics and delivery of palliative care between patients whose families respond to a survey about end-of-life care and those whose families do not.

2009 Dec - Association Between ICU Admission During Morning Rounds and Mortality

Bekele Afessa, MD, FCCP, Ognjen Gajic, MD, FCCP, Ian J. Morales, MD, Mark T. Keegan, MB, Steve G. Peters, MD, FCCP and Rolf D. Hubmayr, MD, FCCP. Published online before print June 8, 2009, doi: 10.1378/chest.09-0529. CHEST December 2009 vol. 136 no. 6 1489-1495
Background: No previous study has evaluated the association between admission to ICUs during round time and patient outcome. The objective of this study was to determine the association between round-time ICU admission and patient outcome.

2009 Nov - ICU Admissions After Actual or Planned Hospital Discharge: Incidence, Clinical Characteristics, and Outcomes in Patients With Cancer

Sanjay Chawla, MD, FCCP, Stephen M. Pastores, MD, FCCP, Kashif Hassan, MD, Nina D. Raoof, MD, FCCP, Louis P. Voigt, MD, FCCP, Margarita Alicea, RN and Neil A. Halpern, MD, FCCP. CHEST November 2009 vol. 136 no. 5 1257-1262
Background: Unexpected ICU admissions may result from early or premature discharge from the hospital. We sought to determine the incidence, clinical characteristics, and outcomes of patients admitted to the ICU after actual or planned hospital discharge and to analyze whether the need for ICU admission was related or unrelated to the associated hospitalization.

2009 Nov - Short-term Systemic Effect of Electrical Muscle Stimulation in Critically Ill Patients

Vasiliki Gerovasili, MD, Elli Tripodaki, MD, Eleftherios Karatzanos, MSc, Theodore Pitsolis, MD, Vasiliki Markaki, MD, Dimitrios Zervakis, MD, Christina Routsi, MD, Charis Roussos, MD, PhD, FCCP and Serafim Nanas, MD. CHEST November 2009 vol. 136 no. 5 1249-1256
Background: Our study assessed the short-term effect of electrical muscle stimulation (EMS) of the lower extremities on the thenar muscle microcirculation of patients who are critically ill.

2009 Nov - Initiation of Inappropriate Antimicrobial Therapy Results in a Fivefold Reduction of Survival in Human Septic Shock

Anand Kumar, MD, Paul Ellis, MD, Yaseen Arabi, MD, FCCP, Dan Roberts, MD, Bruce Light, MD, Joseph E. Parrillo, MD, FCCP, Peter Dodek, MD, Gordon Wood, MD, Aseem Kumar, PhD, David Simon, MD, Cheryl Peters, RN, Muhammad Ahsan, MD, Dan Chateau, PhD and the Cooperative Antimicrobial Therapy of Septic Shock Database Research Group*. CHEST November 2009 vol. 136 no. 5 1237-1248
Objective: Our goal was to determine the impact of the initiation of inappropriate antimicrobial therapy on survival to hospital discharge of patients with septic shock.

Methods: The appropriateness of initial antimicrobial therapy, the clinical infection site, and relevant pathogens were retrospectively determined for 5,715 patients with septic shock in three countries.

2009 Oct - A-Lines and B-Lines: Lung Ultrasound as a Bedside Tool for Predicting Pulmonary Artery Occlusion Pressure in the Critically Ill

Daniel A. Lichtenstein, MD, FCCP, Gilbert A. Mezière, MD, Jean-François Lagoueyte, MD, Philippe Biderman, MD, Ivan Goldstein, MD and Agnès Gepner, MD. CHEST October 2009 vol. 136 no. 4 1014-1020

Background: The risk of pulmonary edema is the main limiting factor in fluid therapy in the critically ill. Interstitial edema is a subclinical step that precedes alveolar edema. This study assesses a bedside tool for detecting interstitial edema, lung ultrasound. The A-line is a horizontal artifact indicating a normal lung surface. The B-line is a kind of comet-tail artifact indicating subpleural interstitial edema. The relationship between anterior interstitial edema detected by lung ultrasound and the pulmonary artery occlusion pressure (PAOP) value was investigated.

2009 Oct - Increases in Endotracheal Tube Resistance Are Unpredictable Relative to Duration of Intubation

Alison M. Wilson, MD, Dana M. Gray and John G. Thomas, PhD. CHEST October 2009 vol. 136 no. 4 1006-1013
Background: Accumulated secretions after intubation can affect the resistance of an endotracheal tube (ETT). Our objective was to measure extubated patient tubes and size-matched controls to evaluate differences in resistance.

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