Chest radiography versus lung ultrasound for identification of acute respiratory distress syndrome: a retrospective observational study

Abstract Background Lung ultrasound may be a reasonable alternative to chest radiography for the identification of acute respiratory distress syndrome (ARDS), but the diagnostic performance of lung ultrasound for ARDS is uncertain. We therefore analyzed the clinical outcomes of ARDS diagnosed according to the Berlin Definition, using either chest radiography (Berlin-CXR) or lung ultrasound (Berlin-LUS) as an alternative imaging method. Methods This was a retrospective observational study in a 20-bed medical intensive care unit (ICU). Patients who required noninvasive ventilation or invasive ventilation for hypoxemic respiratory failure on ICU admission from August 2014 to March 2017 were included. Both chest radiography and lung ultrasound were performed routinely upon ICU admission. Comparisons were made using either the Berlin-CXR or Berlin-LUS definitions to diagnose ARDS with respect to the patient characteristics and clinical outcomes for each definition. ICU and hospital mortality were the main outcome measures for both definitions. Results The first admissions of 456 distinct patients were analyzed. Compared with the 216 patients who met the Berlin-CXR definition (ICU mortality 19.4%, hospital mortality 36.1%), 229 patients who met the Berlin-LUS definition (ICU mortality 22.7%, hospital mortality 34.5%) and 79 patients who met the Berlin-LUS but not the Berlin-CXR definition (ICU mortality 21.5%, hospital mortality 29.1%) had similar outcomes. In contrast, the 295 patients who met either definition had higher mortality than the 161 patients who did not meet either definition (ICU mortality 20.0% versus 12.4%, P = 0.041; hospital mortality 34.2% versus 24.2%, P = 0.027). Compared with Berlin-CXR, Berlin-LUS had a positive predictive value of 0.66 (95% confidence interval 0.59–0.72) and a negative predictive value of 0.71 (0.65–0.77). Among the 216 Berlin-CXR ARDS patients, 150 patients (69.4%) also fulfilled Berlin-LUS definition. Conclusions For the identification of ARDS using the Berlin definition, both chest radiography and lung ultrasound were equally related to mortality. The Berlin definition using lung ultrasound helped identify patients at higher risk of death, even if these patients did not fulfill the conventional Berlin definition using chest radiography. However, the moderate overlap of patients when chest imaging modalities differed suggests that chest radiography and lung ultrasound should be complementary rather than used interchangeably

Frequency and prognostic impact of basic critical care echocardiography abnormalities in patients with acute respiratory distress syndrome

Abstract Background Among intensive care unit (ICU) patients with acute respiratory distress syndrome (ARDS), apart from acute cor pulmonale (ACP), the frequency and prognostic impact of basic critical care echocardiography (BCCE) abnormalities are not well defined. Methods Observational study of patients with ARDS, admitted from September 2012 to May 2014, who underwent BCCE within 48 h of admission to a 20-bed medical ICU. We examined the association of two major BCCE-detected abnormalities (left ventricular ejection fraction < 40% and severe ACP) with ICU/hospital mortality and ICU/hospital length of stay. Multivariable models adjusted for age and illness severity. Results Of 234 patients with ARDS (age 62.3 ± 14.3 years; 88/37.6% female; APACHE II 26.8 ± 8.3; 26.5% ICU mortality; 32.1% hospital mortality), 94 (40.2%) had at least one major BCCE-detected abnormality. The more common major BCCE abnormality found was severe ACP (28.2%), followed by left ventricular ejection fraction < 40% (16.2%). On multivariate analysis, only severe ACP remained significantly associated with ICU/hospital mortality. Hospital mortality for mild, moderate and severe ARDS was 17.0, 27.9 and 50.0%, respectively (without severe ACP), and was 29.2, 48.3 and 53.8%, respectively (with severe ACP). Conclusions BCCE abnormalities were common, but only severe ACP had prognostic significance in ARDS, identifying patients who are at increased risk of ICU and hospital mortality. The presence of severe ACP appears to upstage ARDS severity by one level

Extended Mortality and Chronic Kidney Disease After Septic Acute Kidney Injury

10.1177/0885066618764617JOURNAL OF INTENSIVE CARE MEDICINE356527-53

Prognostication in Patients With Chronic Obstructive Pulmonary Disease Using the BOS Index

10.1378/chest.2225059Chest1484683

Filter life and safety of heparin-grafted membrane for continuous renal replacement therapy - A randomized controlled trial

10.1111/sdi.12951SEMINARS IN DIALYSIS344300-30

Supplemental Material, R1_Septic_AKI_supplementary_tables_and_figure_HR_2-2-18 - Extended Mortality and Chronic Kidney Disease After Septic Acute Kidney Injury

<p>Supplemental Material, R1_Septic_AKI_supplementary_tables_and_figure_HR_2-2-18 for Extended Mortality and Chronic Kidney Disease After Septic Acute Kidney Injury by Horng-Ruey Chua, Weng-Kin Wong, Venetia Huiling Ong, Dipika Agrawal, Anantharaman Vathsala, Hui-Ming Tay, and Amartya Mukhopadhyay in Journal of Intensive Care Medicine</p

SP478HEPARIN-GRAFTED MEMBRANE FOR CONTINUOUS RENAL REPLACEMENT THERAPY IN CRITICALLY ILL PATIENTS WITH BLEEDING RISK - A RANDOMIZED CROSSOVER STUDY

10.1093/ndt/gfy104.sp478Nephrology Dialysis Transplantation33suppl_1i508-i508complete

Satisfaction Domains Differ between the Patient and Their Family in Adult Intensive Care Units

Background. Patients’ and family’s satisfaction data from the Asian intensive care units (ICUs) is lacking. Objective. Domains between patient and family satisfaction and contribution of each domain to the general satisfaction were studied. Method. Over 3 months, adult patients across 4 ICUs staying for more than 48 hours with abbreviated mental test score of 7 or above and able to understand English and immediate family members were surveyed by separate validated satisfaction questionnaires. Results. Two hundred patients and 194 families were included in the final analysis. Significant difference in the satisfaction scores was observed between the ICUs. Patients were most and least satisfied in the communication (4.2 out of 5) and decision-making (2.9 out of 5) domains, respectively. Families were most and least satisfied in the relationship with doctors (3.9 out of 5) and family’s involvement domains (3.3 out of 5), respectively. Domains contributing most to the general satisfaction were the illness management domain for patients (β coefficient = 0.44) and characteristics of doctors and nurses domain for family (β coefficient = 0.45). Discussion. In an Asian ICU community, patients and families differ in their expectations and valuations of health care processes. Health care providers have difficult tasks in attending to these different domains

Single amino acid charge switch defines clinically distinct proline-serine-threonine phosphatase-interacting protein 1 (PSTPIP1)-associated inflammatory diseases

Background: Hyperzincemia and hypercalprotectinemia (Hz/Hc) is a distinct autoinflammatory entity involving extremely high serum concentrations of the proinflammatory alarmin myeloid-related protein (MRP) 8/14 (S100A8/S100A9 and calprotectin). Objective: We sought to characterize the genetic cause and clinical spectrum of Hz/Hc. Methods: Proline-serine-threonine phosphatase-interacting protein 1 (PSTPIP1) gene sequencing was performed in 14 patients with Hz/Hc, and their clinical phenotype was compared with that of 11 patients with pyogenic arthritis, pyoderma gangrenosum, and acne (PAPA) syndrome. PSTPIP1-pyrin interactions were analyzed by means of immunoprecipitation and Western blotting. A structural model of the PSTPIP1 dimer was generated. Cytokine profiles were analyzed by using the multiplex immunoassay, and MRP8/14 serum concentrations were analyzed by using an ELISA. Results: Thirteen patients were heterozygous for a missense mutation in the PSTPIP1 gene, resulting in a p.E250K mutation, and 1 carried a mutation resulting in p. E257K. Both mutations substantially alter the electrostatic potential of the PSTPIP1 dimer model in a region critical for protein-protein interaction. Patients with Hz/Hc have extremely high MRP8/14 concentrations (2045 +/- 1300 mu g/mL) compared with those with PAPA syndrome (116 +/- 74 mu g/mL) and have a distinct clinical phenotype. A specific cytokine profile is associated with Hz/Hc. Hz/Hc mutations altered protein binding of PSTPIP1, increasing interaction with pyrin through phosphorylation of PSTPIP1. Conclusion: Mutations resulting in charge reversal in the y-domain of PSTPIP1 (E -&gt; K) and increased interaction with pyrin cause a distinct autoinflammatory disorder defined by clinical and biochemical features not found in patients with PAPA syndrome, indicating a unique genotype-phenotype correlation for mutations in the PSTPIP1 gene. This is the first inborn autoinflammatory syndrome in which inflammation is driven by uncontrolled release of members of the alarmin family