Abstract:
PURPOSES:Patients receiving prolonged acute mechanical ventilation (PAMV), although comprising a third of all mechanical ventilation (MV) patients, consume two-thirds of all the resources allocated to MV, and their numbers are projected to double by 2020. By virtue of their prolonged hospital length of stay (median LOS, 17 days), they are subject to such nosocomial infections as Clostridium difficile-associated disease (CDAD), the incidence and age-adjusted case fatality rate of which doubled between 2000 and 2005. We examined the rates and outcomes of CDAD among adult PAMV patients. METHODS:We analyzed 2005 data from the Health Care Utilization Project/Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality. PAMV and CDAD were identified using the International Classification of Diseases, ninth revision, clinical modification codes 96.72 and 008.45, respectively. RESULTS:Among 64,910 adult PAMV patients who were discharged in 2005, 3,468 patients (5.34%) had a concurrent diagnosis of CDAD (PAMV patients who were discharged with concomitant diagnosis of CDAD [CDAD+]). CDAD+ patients who were discharged were older (mean [+/- SD] age, 66.7 +/- 15.9 vs 63.7 +/- 16.9 years, respectively; p < 0.001) and were more likely to have been admitted to the hospital from a long-term care facility (5.7% vs 2.9%, respectively; p < 0.001) than PAMV patients who were discharged without CDAD (CDAD-). Although crude hospital mortality rates did not differ among PAMV patients who were discharged from the hospital by CDAD status (CDAD+, 32.6%; CDAD-, 33.0%; p = 0.598), both unadjusted calculations and propensity-score adjustment showed a substantial increase in LOS (6.1 days; 95% confidence interval [CI], 4.9 to 7.4) and total costs ($10,355; 95% CI, $7,540 to $13,170) among CDAD+ patients. CONCLUSIONS:PAMV patients have an order of magnitude higher risk of having CDAD than other hospitalized patients. Concurrent CDAD infection is associated with increased hospital LOS and costs. The PAMV population is an attractive target for aggressive measures aimed at CDAD prevention.
journal_name
Chestjournal_title
Chestauthors
Zilberberg MD,Nathanson BH,Sadigov S,Higgins TL,Kollef MH,Shorr AFdoi
10.1378/chest.09-0596subject
Has Abstractpub_date
2009-09-01 00:00:00pages
752-758issue
3eissn
0012-3692issn
1931-3543pii
S0012-3692(09)60543-2journal_volume
136pub_type
杂志文章相关文献
CHEST文献大全abstract::We report a patient with situs inversus and ischemic heart disease who had myocardial revascularization with anastomosis of the right mammary artery to the anterior descending coronary artery. ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.94.4.886
更新日期:1988-10-01 00:00:00
abstract:BACKGROUND:Malignant pleural effusion is associated with short life expectancy and significant morbidity. A randomized controlled trial comparing indwelling pleural catheters (IPCs) with talc pleurodesis found that IPCs reduced in-hospital time and the need for additional procedures but were associated with excess adve...
journal_title:Chest
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1378/chest.13-2481
更新日期:2014-10-01 00:00:00
abstract::Our current understanding of the pathogenesis of sepsis suggests that bacteria as well as bacterial-derived products activate an uncontrolled network of host-derived mediators such as proinflammatory cytokines (ie, tumor necrosis factor [TNF] and interleukin [IL]-1beta), which can ultimately lead to cardiovascular col...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.121.4.1329
更新日期:2002-04-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the interaction between craniofacial structure and obesity in male patients with obstructive sleep apnea (OSA). DESIGN:Retrospective analysis of a cohort of OSA patients. The relationships between neck circumference (NC), body mass index, apnea severity, and craniofacial and upper airway so...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.108.2.375
更新日期:1995-08-01 00:00:00
abstract:STUDY OBJECTIVES:To investigate whether oxidative stress occurs following lobectomy and pneumonectomy and to evaluate whether markers of oxidative stress might be of value in the assessment of the diagnosis, course, and prognosis of postoperative complications. DESIGN:A prospective study. SETTING:A specialized thorac...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.117.4.999
更新日期:2000-04-01 00:00:00
abstract::Human genetic variation has enormous implications for individual susceptibility to lung disease, as well as for differences in prognosis and response to therapeutic interventions. Single-nucleotide polymorphisms (SNPs) are the most common type of DNA sequence variation. An SNP is the substitution of a single base in t...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.06-2252
更新日期:2007-04-01 00:00:00
abstract:STUDY OBJECTIVE:Childhood exposure to environmental tobacco smoke (ETS) adversely affects dynamic spirometric indexes as a result of combined early life (including in utero) and current exposure to parental smoking. The aim of our study was to investigate the effect of ETS on lung function and to identify the most sens...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.125.4.1387
更新日期:2004-04-01 00:00:00
abstract::Pulmonary infections, which frequently occur during the early and late period following bone marrow transplantation for hematologic malignancies, are associated with significant morbidity and mortality. In this study the incidence, the infectious causes of pneumonia and the mortality related to pneumonia in 130 alloge...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.104.2.371
更新日期:1993-08-01 00:00:00
abstract::Atrial fibrillation remains a common and challenging problem following cardiac surgery. The American College of Chest Physicians, through the Health and Science Policy Committee, established a panel to develop a set of clinical practice guidelines for the management or prophylaxis of atrial fibrillation or flutter in ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.128.2_suppl.17s
更新日期:2005-08-01 00:00:00
abstract::A protocol was originally designed to study breathing control during and following cardiac arrest in humans, taking advantage of the period of pulseless ventricular fibrillation (PVF) produced while testing a newly implanted cardioverter-defibrillator device. A patient aged in his 60s with New York Heart Association c...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.12-2950
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:There is a growing use of procalcitonin (PCT) to facilitate the diagnosis and management of severe sepsis. We investigated the impact of one to two PCT determinations on ICU day 1 on health-care utilization and cost in a large research database. METHODS:A retrospective, propensity score-matched multivariabl...
journal_title:Chest
pub_type: 杂志文章
doi:10.1016/j.chest.2016.06.046
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Clinicians lack a validated tool for risk stratification in acute exacerbations of COPD (AECOPD). We sought to validate the BAP-65 (elevated BUN, altered mental status, pulse > 109 beats/min, age > 65 years) score for this purpose. METHODS:We analyzed 34,699 admissions to 177 US hospitals (2007) with either...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.10-3035
更新日期:2011-11-01 00:00:00
abstract::At the cardiac sympathetic nerve terminal the alpha 2-adrenoceptor is presynaptic and appears to be located at an extrasynaptic site. This is suggested by (1) absence of evidence of autoinhibitory feedback at physiologic stimulus levels up to about 50 percent of the maximum chronotropic response in the isolated guinea...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.83.2_supplement.345
更新日期:1983-02-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the efficacy of small-bore (12 French vanSonnenberg) catheters compared with standard large-bore chest tubes in the drainage and sclerotherapy of malignant pleural effusions. DESIGN:Retrospective review. SETTING:An academic tertiary care hospital. PATIENTS:Adult patients with documented n...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.120.1.19
更新日期:2001-07-01 00:00:00
abstract:OBJECTIVE:Postoperative pulmonary hypertension (POPH) substantially increases mortality after repair of congenital heart diseases. Inhaled nitric oxide (NO) has been reported as an effective and specific means of controlling POPH crisis. No randomized, placebo-controlled study has addressed the ability of NO administra...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.128.5.3537
更新日期:2005-11-01 00:00:00
abstract::Pulmonary function test results of individuals with the acquired immunodeficiency syndrome (AIDS) were analyzed to determine the prevalence of abnormally low forced expiratory flow rates and bronchial hyperreactivity. Of 99 individuals with AIDS, a total of 44 (44 percent) had either low forced expiratory flow rates o...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.94.5.945
更新日期:1988-11-01 00:00:00
abstract::This report describes a patient who developed pulmonary hypertension 6 years after lung transplantation for primary pulmonary hypertension (PPH). Evaluation with right heart catheterization followed by pulmonary angiography, however, demonstrated that the pulmonary hypertension was secondary to an anastomotic narrowin...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.116.2.564
更新日期:1999-08-01 00:00:00
abstract:BACKGROUND:The occurrence of catamenial pneumothorax (CP) is rare, and the awareness of this diagnosis among physicians is insufficient. CP is highly correlated with pelvic endometriosis and remains the most common form of thoracic endometriosis syndrome. Circulating endometrial cells (CECs) have been previously detect...
journal_title:Chest
pub_type: 杂志文章
doi:10.1016/j.chest.2019.09.008
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:We sought to determine the efficacy and safety of perioperative treatment with methylprednisolone on the development of lung injury after pulmonary thromboendarterectomy. METHODS:This was a randomized, prospective, double-blind, placebo-controlled study of 98 adult patients with chronic thromboembolic pulmo...
journal_title:Chest
pub_type: 杂志文章,随机对照试验
doi:10.1378/chest.10-2639
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:The airways in patients with cystic fibrosis (CF) are characterized by the accumulation of tenacious, dehydrated mucus that is a precursor for chronic infection, inflammation, and tissue destruction. The clearance of mucus is an integral component of daily therapy. Inhaled mannitol is an osmotic agent that i...
journal_title:Chest
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1378/chest.07-2294
更新日期:2008-06-01 00:00:00
abstract::A 57-year-old man with a history of exposure to silica for 32 years presented with pleural thickening of the lower lobe of the left lung and a chronic right-sided pleural effusion without any radiographic evidence of parenchymal nodules in either lung. Light microscopic examination of a left visceral pleural biopsy sp...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.112.5.1436
更新日期:1997-11-05 00:00:00
abstract::COPD is a significant public health challenge, notably set to become the third leading cause of death and fifth leading cause of chronic disability worldwide by the next decade. Skeletal muscle impairment is now recognized as a disabling, extrapulmonary consequence of COPD that is associated with reduced quality of li...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1016/j.chest.2015.11.021
更新日期:2016-05-01 00:00:00
abstract::Double-lumen tubes have proved to be a useful adjunct in thoracic surgery. Their use has become quite commonplace, particularly since the introduction of the softer polyvinylchloride (PVC) tubes, which are technically easier to use and may carry less risk for serious complications. Any such tube, however, can cause li...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.83.6.928
更新日期:1983-06-01 00:00:00
abstract:BACKGROUND:Inspiratory muscle weakness and abnormalities in breathing pattern and in respiratory drive have been reported in patients with multisystem disorders. In patients with systemic lupus erythematosus (SLE), data on respiratory muscle strength and control of breathing are scarce. METHODS:We studied a subset of ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.108.3.759
更新日期:1995-09-01 00:00:00
abstract::The echocardiographic diagnosis of acute rupture of a papillary muscle is described. The pertinent findings included (1) decreased systolic motion of the posterior wall, (2) exaggerated septal motion, (3) left ventricular enlargement and pattern suggesting left ventricular diastolic overload, and (4) bizarre flutterin...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.73.2.232
更新日期:1978-02-01 00:00:00
abstract:BACKGROUND:Cardiovascular comorbidities have a negative impact on the health status and prognosis of patients with COPD. We determined whether nocturnal noninvasive (positive) mechanical ventilation (NIMV) can improve heart rate variability (HRV), decrease circulating natriuretic peptide levels, and improve functional ...
journal_title:Chest
pub_type: 杂志文章,随机对照试验
doi:10.1378/chest.06-1423
更新日期:2007-01-01 00:00:00
abstract::A ventricular inhibited unipolar pacing system in a case of so-called pacemaker syndrome was successfully converted into an atrioventricular sequential system without replacing the ventricular lead. ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.77.3.436
更新日期:1980-03-01 00:00:00
abstract:STUDY OBJECTIVE:To use an existing database from a large cohort study with follow-up as long as 5.5 years to assess the extended prognosis of patients who survived their hospitalizations for severe acute respiratory failure (ARF). DESIGN, SETTING, AND PATIENTS:Secondary analysis of an inception cohort of 1,722 patient...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.126.6.1897
更新日期:2004-12-01 00:00:00
abstract::Pure posterior mediastinal cystic lymphangiomas are very rare and have seldom been documented. This is the report of such a case, including the ultrasonographic and computed tomographic manifestations of the lesion, the first documentation of such manifestations in the literature. ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.88.6.930
更新日期:1985-12-01 00:00:00
abstract::Percutaneous cannulation of the internal jugular vein is commonly performed to obtain central venous access. We report the first case of massive hemoptysis occurring during cannulation of the internal jugular vein. ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.95.5.1143
更新日期:1989-05-01 00:00:00