American Journal of Respiratory and Critical Care Medicine

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RATIONALE: It is unclear whether opioid use increases the risk of ICU delirium. Prior studies have not accounted for confounding including daily severity of illness, pain and competing events that may preclude delirium detection. OBJECTIVES: To evaluate the association between ICU opioid exposure, opioid dose, and delirium occurrence. METHODS: In consecutive adults admitted >24 hours to the ICU, daily mental status was classified as awake without delirium, delirium, or unarousable...

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RATIONALE: Delirium is common in the intensive care unit (ICU) and portends worse ICU and hospital outcomes. The effect of delirium in the ICU on post-hospital discharge mortality and health resource utilization is less well known. OBJECTIVES: To estimate mortality and health resource utilization 2.5-years post-hospital discharge in critically ill patients admitted to ICU. METHODS: Population-based, propensity-score matched, retrospective cohort study of adult patients admitted to one of fourteen medical-surgical ICUs from January 1, 2014 to June 30, 2016...

RATIONALE: The role and needs of extracorporeal membrane oxygenation (ECMO) at a population-level during the COVID-19 pandemic have not been completely established. OBJECTIVES: To identify the cumulative incidence for ECMO use in the first pandemic wave and to describe the Nationwide Chilean cohort of ECMO-supported COVID-19 patients. METHODS: We conducted a population-based study from March 3 to August 31, 2020, using linked data from National agencies...

RATIONALE: Most lung cancers are diagnosed at an advanced stage. Pre-symptomatic identification of high-risk individuals can prompt earlier intervention and improve long-term outcomes. OBJECTIVE: To develop a model to predict a future diagnosis of lung cancer based on routine clinical and laboratory data, using machine-learning. METHODS: We assembled 6,505 non-small cell lung cancer (NSCLC) cases and 189,597 contemporaneous controls and compared the accuracy of a novel machine-learning model to a modified version of the well-validated PLCOm2012 risk model, using the area under the receiver operating characteristic curve (AUC), sensitivity and diagnostic odds ratio (OR) as measures of model performance...

RATIONALE: Patients with pulmonary hypertension admitted to pediatric cardiac intensive care units are at high risk of mortality. OBJECTIVES: We identified factors associated with mortality in cardiac critical care admissions with pulmonary hypertension. METHODS: We evaluated pulmonary hypertension medical admissions to Pediatric Cardiac Critical Care Consortium (PC4) institutions over five years. Pulmonary hypertension was standardly defined in the clinical registry by diagnosis and/or receipt of intensive care-level pulmonary vasodilator therapy...

RATIONALE: Evidence linking outdoor air pollution with COVID-19 incidence and mortality is largely based on ecological comparisons between regions that may differ in factors such as access to testing and control measures that may not be independent of air pollution concentrations. Moreover, studies have yet to focus on key mechanisms of air pollution toxicity such as oxidative stress. OBJECTIVES: To conduct a within-city analysis of spatial variations in COVID-19 incidence and the estimated generation of reactive oxygen species (ROS) in lung lining fluid attributable to fine particulate matter (PM2...

RATIONALE: Respiratory support (non-invasive ventilation or high flow nasal cannula) applied at the time of extubation has been reported to reduce reintubation rates, but concerns regarding effectiveness have limited uptake into practice. OBJECTIVES: To determine if providing post-extubation respiratory support to all patients undergoing extubation in a medical ICU would decrease the incidence of reintubation. METHODS: We conducted a pragmatic, two-armed, cluster-crossover trial of adults undergoing extubation from invasive mechanical ventilation between October 1, 2017 and March 31, 2019 in the medical intensive care unit of an academic medical center...

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