Improving Management of ARDS Acute respiratory distress syndrome (ARDS) poses a significant global health challenge, with high in-hospital mortality rates of approximately 40% despite advancements in supportive care. There's notable variability in patient management across different regions, with proven life-saving treatments like low tidal volume ventilation not uniformly implemented. ARDS is a diverse condition, suggesting that therapeutic responses can vary amon...

Chest Infections: Original Research Using Trajectories of Bedside Vital Signs to Identify COVID-19 Subphenotypes Sivasubramanium V. Bhavani, Chad Robichaux, Philip A. Verhoef, et al Chest 2024; 165: 529-539 https://doi.org/10.1016/j.chest.2023.09.020 Background Trajectories of bedside vital signs have been used to identify sepsis subphenotypes with distinct outcomes and treatment responses. The objective of this study was to validate the vitals trajector...

Critical Care: Original Research Changes in Respiratory Mechanics With Trunk Inclination Differs Between Patients With ARDS With and Without Obesity Shailesh Bihari, Ubbo F. Wiersema Chest 2024; 165: 583-589 https://doi.org/10.1016/j.chest.2023.09.032 Background Studies investigating the effect of trunk inclination on respiratory mechanics in mechanically ventilated patients with ARDS have reported postural differences in partition respiratory ...

Monotherapy or Combination Therapy for Septic Shock International guidelines recommend using corticosteroids for adults with septic shock who require vasopressor therapy, supported by moderate-quality evidence. While corticosteroids may shorten the duration of shock, their impact on mortality remains uncertain. A recent meta-analysis found no significant reduction in mortality among septic shock patients treated with hydrocortisone compared to those given a placebo...

Invited Commentary  Nephrology March 8, 2024 Dialysis-Dependent Acute Kidney Injury—A Risk Factor for Adverse Outcomes Marlies Ostermann, Nuttha Lumlertgul, Matthew T. James JAMA Netw Open. 2024;7(3):e240346. doi:10.1001/jamanetworkopen.2024.0346 Acute kidney injury (AKI), acute kidney disease (AKD), and chronic kidney disease (CKD) have been defined as discrete entities but in practice can form a continuum whereby an initial kidney insult...

ORIGINAL ARTICLE Recombinant ADAMTS13 in Congenital Thrombotic Thrombocytopenic Purpura Authors: Marie Scully, Ana Antun, Spero R. Cataland, et al N Engl J Med 2024;390:1584-1596 DOI: 10.1056/NEJMoa2314793 Abstract BACKGROUND Congenital thrombotic thrombocytopenic purpura (TTP) results from severe hereditary deficiency of ADAMTS13. The efficacy and safety of recombinant ADAMTS13 and standard therapy (plasma-derived products) administered as routine pr...

Informative Subtyping, Targeted Immunomodulatory Therapies for Sepsis Sepsis is characterised by dysregulated immune responses. Traditional approaches to treating sepsis by targeting proinflammatory and immunosuppressive responses have been largely unsuccessful. Recent efforts have shifted towards identifying subtypes of sepsis to enable personalised treatment. However, many important immunological concepts, such as resistance, disease tolerance, resilience, resolu...

Critical Care: Original Research Prospective Evaluation of Venous Excess Ultrasound for Estimation of Venous Congestion August Longino, Katie Martin, Katarina Leyba, et al Chest 2024; 165: 590-600 https://doi.org/10.1016/j.chest.2023.09.029 Background Venous excess ultrasound (VExUS) is a novel ultrasound technique previously reported as a noninvasive measure of venous congestion and predictor of cardiorenal acute kidney injury. ...

Chest Infections: Original Research Prevalence, Risk Factors, Clinical Features, and Outcome of Influenza-Associated Pulmonary Aspergillosis in Critically Ill Patients: A Systematic Review and Meta-Analysis Lawrence Y. Lu, Hui Min Lee, Andrew Burke, et al Chest 2024; 165: 540-558 https://doi.org/10.1016/j.chest.2023.09.019 Background Influenza-associated pulmonary aspergillosis (IAPA) increasingly is being reported in critically ill patients. We conducte...

Chest Infections: Original Research Legionnaires Disease in Solid Organ Transplant Recipients: A Decade-Long Nationwide Study in France Guillaume Thizy, Adrien Flahault, Anne Scemla, et al Chest 2024; 165: 507-520 https://doi.org/10.1016/j.chest.2023.09.033 Background Legionnaires disease (LD) is a rare, life-threatening opportunistic bacterial infection that poses a significant risk to patients with impaired cell-mediated immunity such as solid organ tr...