Use of Noninvasive vs Invasive Ventilation for Patients Hospitalized With Acute Exacerbation of COPD, 2010 to 2019.

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) contribute to morbidity and mortality. Noninvasive ventilation (NIV), a resource-intensive intervention, decreases mortality and the need for invasive mechanical ventilation.

Objective: To study NIV and mechanical ventilation use, NIV failure, and hospital NIV case volumes for inpatients with AECOPD from 2010 to 2019.

Development and Pilot Testing for a Novel Shared Decision-Making Tool for Tracheostomy Decision-Making.

Background: Tracheostomy and prolonged mechanical ventilation decision-making is one of the most emotionally difficult decisions facing surrogate decision-makers in health care. Often, surrogates face decisions between the potential for prolonged life support verses transitions to comfort measures and possible death. Despite more than two decades of research, major gaps exist in improving the decision-making process.

Identifying Decisional Needs for Adult Tracheostomy and Prolonged Mechanical Ventilation Decision Making to Inform Shared Decision-Making Interventions.

Background: Decision making for adult tracheostomy and prolonged mechanical ventilation is emotionally complex. Expectations of surrogate decision makers and physicians rarely align. Little is known about what surrogates need to make goal-concordant decisions.

Uncertainty and Communication Preferences Among Patients Undergoing Lung Transplant Evaluation: A Mixed-Methods Study.

Objective: Higher uncertainty is associated with poorer quality of life and may be impacted by clinician communication about the future. We determined how patients undergoing lung transplant evaluation experience uncertainty and communication about the future from clinicians.

Methods: We performed a convergent parallel mixed-methods study using a cross-sectional survey and semistructured interviews.

Drivers of Decision-Making for Adult Tracheostomy for Prolonged Mechanical Ventilation: A Qualitative Study.

Background: Decision-making about tracheostomy and prolonged mechanical ventilation (PMV) is emotionally complex. Expectations of surrogate decision-makers and physicians rarely align. Little is known about what surrogates need to make goal-concordant decisions.

Perspectives on Sedation Among Interdisciplinary Team Members in ICU: A Survey Study.

Objective: To explore the interdisciplinary team members' beliefs and attitudes about sedation when caring for mechanically ventilated patients in the ICU.

Design: Cross-sectional survey.

Setting: A 17-bed cardiothoracic ICU at a tertiary care academic hospital in Colorado.

Healthcare Trajectories and Outcomes in the First Year After Tracheostomy Based on Patient Characteristics.

Objectives: To define healthcare trajectories after tracheostomy to inform shared decision-making efforts for critically ill patients.

Design: Retrospective epidemiologic cohort study.

Setting: California Patient Discharge Database 2018-2019.

Utilization of Hospital Do-Not-Resuscitate Orders in Older Adults During COVID-19 Surges in 2020.

Reports of poor outcomes among older adults with COVID-19 may have changed patient perceptions of Do-Not-Resuscitate (DNR) orders or caused providers to pressure older adults into accepting DNR orders to conserve resources. We determined early-DNR utilization during COVID-19 surges compared with nonsurge periods among nonsurgical adults ≥75 and its connection to hospital mortality. We conducted a retrospective cohort study among adults ≥75 years using the California Patient Discharge Database 2020.

Association of Hospital Mortality With Initiation of Mechanical Ventilation on a Weekend: A Retrospective Cohort Study.

Rationale: Increased mortality in patients admitted to hospitals on weekends is a well-described phenomenon labeled the "weekend effect." Studies evaluating the weekend effect in intensive care units (ICUs) have arrived at conflicting results. Identifying a weekend effect for critically-ill patients may inform clinical care pathways and resource allocation.

Disparities in Adult Patient Selection for Extracorporeal Membrane Oxygenation in the United States: A Population-Level Study.

Disparities in patient selection for advanced therapeutics in health care have been identified in multiple studies, but it is unclear if disparities exist in patient selection for extracorporeal membrane oxygenation (ECMO), a rapidly expanding critical care resource. To determine if disparities exist in patient selection for ECMO based on sex, primary insurance, and median income of the patient's neighborhood. In a retrospective cohort study using the Nationwide Readmissions Database 2016-2019, we identified patients treated with mechanical ventilation (MV) and/or ECMO with billing codes.

How Important is Spirometry for Identifying Patients with COPD Appropriate for Palliative Care?

Background: Providing palliative care to patients with chronic obstructive pulmonary disease (COPD) is a priority. Spirometry demonstrating airflow limitation is a diagnostic test for COPD and a common inclusion criterion for palliative care research. However, requiring spirometry with airflow limitation may exclude appropriate patients unable to complete spirometry, or patients with preserved-ratio impaired spirometry and symptoms or imaging consistent with COPD.

Drivers of Burnout Among Critical Care Providers: A Multicenter Mixed-Methods Study.

Background: Critical care practitioners have some of the highest levels of burnout in health care.

Research Question: What are key drivers of burnout across the multidisciplinary ICU team?

Study Design And Methods: We conducted a multicenter mixed-methods cohort study in ICUs at three diverse hospitals. We recruited physicians, nurses, respiratory therapists, and other staff members who worked primarily in an ICU.

Research Needs for Inpatient Management of Severe Alcohol Withdrawal Syndrome: An Official American Thoracic Society Research Statement.

Severe alcohol withdrawal syndrome (SAWS) is highly morbid, costly, and common among hospitalized patients, yet minimal evidence exists to guide inpatient management. Research needs in this field are broad, spanning the translational science spectrum. This research statement aims to describe what is known about SAWS, identify knowledge gaps, and offer recommendations for research in each domain of the Institute of Medicine T-T continuum to advance the care of hospitalized patients who experience SAWS.

Crisis Standards of Care-More Than Just a Thought Experiment?

As described in two articles in the September-October 2021 issue of the Hastings Center Report, most crisis standards of care (CSC) plans include triage algorithms to guide the allocation of critical care resources to some patients and not others under conditions of extreme scarcity. The plans also include other important CSC strategies, but it is the notion of rationing scarce resources via triage that especially captured the imaginations of ethicists. Vigorous arguments have arisen over whether triage algorithms should be designed to prioritize patients based on predictions of short-, near-, or long-term survival.

Days out of Institution after Tracheostomy and Gastrostomy Placement in Critically Ill Older Adults.

Tracheostomy and gastrostomy tubes are frequently placed during critical illness for long-term life support, with most placed in older adults. Large knowledge gaps exist regarding outcomes expressed as most important to patients. To determine the number of days alive and out of institution (DAOIs) and mortality after tracheostomy and gastrostomy placement during critical illness and to evaluate associations between health states before critical illness and outcomes.

Association of Proximity to a Long-Term Acute Care Hospital With Hospital Tracheostomy Practices.

Objectives: Availability of long-term acute care hospitals has been associated with hospital discharge practices. It is unclear if long-term acute care hospital availability can influence patient care decisions. We sought to determine the association of long-term acute care hospital availability at different hospitals with the likelihood of tracheostomy.

Informing Healthcare Decisions with Observational Research Assessing Causal Effect. An Official American Thoracic Society Research Statement.

Decisions in medicine are made on the basis of knowledge and reasoning, often in shared conversations with patients and families in consideration of clinical practice guideline recommendations, individual preferences, and individual goals. Observational studies can provide valuable knowledge to inform guidelines, decisions, and policy. The American Thoracic Society (ATS) created a multidisciplinary committee to develop a research statement to clarify the role of observational studies-alongside randomized controlled trials (RCTs)-in informing clinical decisions in pulmonary, critical care, and sleep medicine.

Stability of Do-Not-Resuscitate Orders in Hospitalized Adults: A Population-Based Cohort Study.

Objectives: Prior work has shown substantial between-hospital variation in do-not-resuscitate orders, but stability of do-not-resuscitate preferences between hospitalizations and the institutional influence on do-not-resuscitate reversals are unclear. We determined the extent of do-not-resuscitate reversals between hospitalizations and the association of the readmission hospital with do-not-resuscitate reversal.

Design: Retrospective cohort study.