Abstract:
BACKGROUND:Adjunctive strategies are an important part of the management of ARDS. However, their application in clinical practice remains inconsistent. RESEARCH QUESTION:We wished to determine the frequency and patterns of use of adjunctive strategies in patients with moderate to severe ARDS (Pao2/Fio2 [P/F ratio] < 150) enrolled into the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. STUDY DESIGN AND METHODS:The LUNG SAFE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in 2014 in 459 ICUs from 50 countries. The primary objective of this substudy was to determine the frequency of use of widely available (neuromuscular blockade, prone position) adjuncts vs adjuncts requiring specialized equipment (extracorporeal membrane oxygenation, inhaled vasodilators, high-frequency ventilation) in patients in the first 48 h of moderate to severe ARDS (P/F ratio < 150). RESULTS:Of 1,146 patients on invasive ventilation with moderate to severe ARDS, 811 patients (71%) received no adjunct within 48 h of ARDS onset. Of 335 (29%) that received adjunctive strategies, 252 (75%) received a single strategy, and 83 (25%) receiving more than one adjunct. Of ARDS nonsurvivors, 67% did not receive any adjunctive strategy in the first 48 h. Most patients (67%) receiving specialized adjuncts did not receive prone positioning or neuromuscular blockade. Patients that received adjuncts were more likely to have their ARDS recognized, be younger and sicker, have pneumonia, be more difficult to ventilate, and be in a European high-income country than those that did not receive adjuncts. INTERPRETATION:Three in 10 patients with moderate to severe ARDS, and only one-third of nonsurvivors, received adjunctive strategies over the first 48 h of ARDS. A more consistent and evidence-driven approach to adjunct use may reduce costs and improve outcomes in patients with moderate to severe ARDS. TRIAL REGISTRY:ClinicalTrials.gov; No.: NCT02010073; URL: www.clinicaltrials.gov.
journal_name
Chestjournal_title
Chestauthors
Duggal A,Rezoagli E,Pham T,McNicholas BA,Fan E,Bellani G,Rubenfeld G,Pesenti AM,Laffey JG,LUNG SAFE Investigators and the ESICM Trials Group.doi
10.1016/j.chest.2020.01.041subject
Has Abstractpub_date
2020-06-01 00:00:00pages
1497-1505issue
6eissn
0012-3692issn
1931-3543pii
S0012-3692(20)30322-6journal_volume
157pub_type
杂志文章相关文献
CHEST文献大全abstract::The relationship between coffee consumption and the prevalence of bronchial asthma has been evaluated using data from the 1983 Italian National Health Survey, based on 72,284 individuals aged over 15 years randomly selected within strata of geographic area, size of the place of residence and of the household in order ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.94.2.386
更新日期:1988-08-01 00:00:00
abstract::Coronary bypass patients less than 40 years of age were identified and compared with a control group previously studied at our hospital. In patients less than 40 years, the average age was 35 years. Men comprised 90.1 percent of group 1, and 83.4 percent of group 2. Operative mortality was 2.89 percent for group 1 and...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.94.6.1138
更新日期:1988-12-01 00:00:00
abstract:BACKGROUND:COPD is accepted to be a multicomponent disease with various comorbidities. To our knowledge, the contribution of the GI tract to the systemic manifestation of COPD has never been investigated. This metabolically active organ may experience recurring local oxygen deficits during daily life, leading to distur...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.13-0584
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:Tuberculosis (TB) remains a public health threat with significant annual impacts on morbidity and mortality. However, few studies have examined the impact of active and latent TB infection (LTBI) on health-related quality of life (HRQL). METHODS:Patients with recently diagnosed active TB or LTBI patients we...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.07-1494
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND:An obesity paradox, wherein patients who are obese have lower mortality, has been described in cardiopulmonary diseases, including pulmonary arterial hypertension (PAH). Our objective was to determine whether obesity and BMI are associated with mortality in patients with PAH. METHODS:We assessed incident pa...
journal_title:Chest
pub_type: 杂志文章
doi:10.1016/j.chest.2018.05.006
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:Asthma morbidity and mortality are higher in the United States for African-American (AA) children when compared to European-American (EA) children. STUDY OBJECTIVES:To explore racial differences in physiologic factors associated with pediatric asthma severity. DESIGN:Cross-sectional. METHODS:We analyzed d...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.117.5.1336
更新日期:2000-05-01 00:00:00
abstract::Each of four examiners performed standardized physical examinations on a group of patients who had just undergone tests of ventilatory function. The intensity of breath sounds heard with deep inspiration was graded on a rating scale of 0 to 4; the grades in six areas of the chest were added to give a total score, with...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.70.3.341
更新日期:1976-09-01 00:00:00
abstract::In the case reported, a patient with severe right ventricular failure following coronary revascularization was successfully weaned from cardiopulmonary bypass following creation of an atrial septal defect. This technique facilitated rapid decompression of the failing right ventricle by shunting blood to the more compl...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.92.5.950
更新日期:1987-11-01 00:00:00
abstract:BACKGROUND:Amphiregulin, a member of the epidermal growth factor family, has been shown to promote the growth of fibroblasts, to be associated with the T-helper type 2 cell adaptive immune response, and to up-regulate mucin gene expression. We aimed to determine whether sputum amphiregulin is expressed at elevated leve...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.08-2972
更新日期:2009-09-01 00:00:00
abstract::Theophylline is commonly prescribed for patients with nonasthmatic chronic airflow obstruction (CAO) even though clinical efficacy is not well established. We studied objective and subjective responses to theophylline in 14 men with CAO. Subjects randomly received week-long treatments of placebo or theophylline at two...
journal_title:Chest
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1378/chest.82.5.538
更新日期:1982-11-01 00:00:00
abstract::On the occasion of this Fourth World Conference on Lung Cancer, I am privileged to present the opening keynote address. This presentation has been sponsored by the Ontario Cancer Treatment and Research Foundation. In 1952, the Foundation established an annual lectureship in memory of one of their prominent physicians....
journal_title:Chest
pub_type: 临床试验,历史文章,杂志文章,评审
doi:10.1378/chest.89.4.200s
更新日期:1986-04-01 00:00:00
abstract::A review of the largest observational studies on post-ICU weaning from prolonged mechanical ventilation yields evidence that more than half of such patients can be successfully liberated from mechanical ventilation. Success is likely to fall within a 3-month window, with late successes and partial ventilator independe...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.120.6_suppl.482s
更新日期:2001-12-01 00:00:00
abstract::The inhibitory effect of lidocaine and lidocaine plus methylparaben as a preservative was studied with 25 strains of bacteria. The tested strains were mixed with each topical anesthetic preparation, and quantitative cultures were performed on aspirates at 0, 30, 60, and 120 minutes. Results were compared to counts obt...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.76.1.37
更新日期:1979-07-01 00:00:00
abstract:BACKGROUND:COPD is associated with significant morbidity primarily driven by acute exacerbations. Relative pulmonary artery (PA) enlargement, defined as a PA to ascending aorta (A) diameter ratio greater than one (PA:A>1) identifies patients at increased risk for exacerbations. However, little is known about the correl...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.13-1422
更新日期:2014-04-01 00:00:00
abstract::The most examined tumor markers in lung cancer patients are CEA, hormonal peptides, and some neurogenic enzymes in small cell carcinoma. Calcitonin, ACTH, ADH, CEA, neurophysin, oxytocin, beta-endorphin, neuron-specific enolase, and CK BB are elevated in serum specimens in 25-75% of cases of small cell carcinoma. The ...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.89.4_supplement.219s
更新日期:1986-04-01 00:00:00
abstract:BACKGROUND:Self-reported tobacco pack-year history plays a large role in decisions about low-dose CT screening for lung cancer, yet is challenging to measure accurately. RESEARCH QUESTION:To what extent does random measurement error in pack-year information impact screening decisions and screening effectiveness? STUD...
journal_title:Chest
pub_type: 杂志文章
doi:10.1016/j.chest.2020.08.2112
更新日期:2020-09-14 00:00:00
abstract::The "elimination" of the left atrial appendage (LAA) seems to be an attractive alternative to oral anticoagulation in the treatment of atrial fibrillation, especially in patients with contraindications to oral anticoagulation therapy. The LAA, however, plays an important role in the maintenance and regulation of the c...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.124.6.2356
更新日期:2003-12-01 00:00:00
abstract::A critically-ill 73-year-old man was admitted with simultaneous mitral valve endocarditis and aortic stenosis. Balloon aortic valvuloplasty was performed successfully and without complications and was followed by prompt clinical improvement. Balloon aortic valvuloplasty should be considered in patients with aortic ste...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.99.6.1534
更新日期:1991-06-01 00:00:00
abstract::Echocardiographic studies were performed in 86 patients with right ventricular volume overload. In 45 of these 86 patients, 58 echocardiograms were performed at different intervals in the postoperative period. For control purposes, 60 normal subjects and 18 patients with right ventricular pressure overload were also e...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.69.3.388
更新日期:1976-03-01 00:00:00
abstract::Morbid obesity is often associated with severe respiratory insufficiency, commonly known as the pickwickian syndrome. This can be divided into the following two primary breathing disorders which can affect patients alone or in combination: the obstructive sleep apnea syndrome (SAS); and the obesity-hypoventilation syn...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.90.1.81
更新日期:1986-07-01 00:00:00
abstract::Flecainide and propafenone are effective in suppressing both ventricular and supraventricular tachyarrhythmias, but their efficacy is often limited by dose-related side effects. This study was performed to evaluate noninvasively the effects of intravenous flecainide and propafenone on left ventricular systolic functio...
journal_title:Chest
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1378/chest.103.4.1068
更新日期:1993-04-01 00:00:00
abstract::This report describes the cross-sectional echocardiographic features of a left ventricular diverticulum. The echocardiographic findings are illustrated and discussed in relation to the diagnostic capabilities of this noninvasive imaging technique. ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.69.4.544
更新日期:1976-04-01 00:00:00
abstract::The risk and benefits of three treatment strategies were examined in 64 consecutive patients with acute myocardial infarction and cardiogenic shock. Thirteen patients received thrombolytic therapy (group 1), 29 patients received intra-aortic balloon pump counterpulsation support (group 2), and 22 patients were treated...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.105.4.997
更新日期:1994-04-01 00:00:00
abstract:BACKGROUND:Pulmonary arterial hypertension (PAH) is a rare disease with a predilection for young women that is associated with right ventricular failure and premature death. PAH can complicate pregnancy with hemodynamic instability or sudden death during parturition and postpartum. Our aim was to examine the impact of ...
journal_title:Chest
pub_type: 杂志文章,多中心研究
doi:10.1378/chest.12-0528
更新日期:2013-05-01 00:00:00
abstract:STUDY OBJECTIVES:The effect of therapy using a cervicomandibular support collar (CMSC) to manage obstructive sleep apnea (OSA) was compared with standard therapy, nasal continuous positive airway pressure (nCPAP). DESIGN:Subjects received treatment with CMSC or nCPAP each for 1 month in random order. The study was ana...
journal_title:Chest
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1378/chest.125.1.118
更新日期:2004-01-01 00:00:00
abstract::To elucidate the criterion for amplitude of circadian FEV1 variation suitable for phase analysis, six FEV1 measurements within a day were made on 346 days in 125 stable asthmatic children aged 8 to 12 years. Since coefficient of variation (CV) of FEV1 within a day in nonasthmatic children in our laboratory is less tha...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.102.3.771
更新日期:1992-09-01 00:00:00
abstract::The assessment of the structure and function of the subvalvular apparatus (SVA) in patients with rheumatic mitral stenosis (MS) is complex, yet is of major importance prior to therapeutic decision making. Currently available methods of assessment are neither sufficiently accurate nor feasible. We review anatomic and f...
journal_title:Chest
pub_type: 杂志文章,评审
doi:10.1378/chest.124.5.1929
更新日期:2003-11-01 00:00:00
abstract:BACKGROUND:Lung cancer screening, despite its proven mortality benefit, remains vastly underutilized. Previous studies examined knowledge, attitudes, and beliefs to better understand the reasons underlying the low screening rates. These investigations may have limited generalizability because of traditional participant...
journal_title:Chest
pub_type: 杂志文章
doi:10.1016/j.chest.2019.12.048
更新日期:2020-07-01 00:00:00
abstract::This report describes the definitive diagnosis of venous air-embolism by documentation of spontaneous echo contrast in the right cardiac chambers following removal of a jugular venous catheter in a patient with hepatic failure. This complication was potentiated by the presence of concurrent hepatic coagulopathy which ...
journal_title:Chest
pub_type: 杂志文章
doi:10.1378/chest.99.3.784
更新日期:1991-03-01 00:00:00
abstract:STUDY OBJECTIVES:To evaluate the cost-effectiveness of inhaled fluticasone propionate (FP) in children aged 12 to 47 months with asthma symptoms. DESIGN:A retrospective economic analysis conducted from the perspective of the Danish health-care system, based on clinical data from a 12-week study. SETTING:Thirty-three ...
journal_title:Chest
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1378/chest.120.6.1835
更新日期:2001-12-01 00:00:00