CHEST Guidelines-Not-So-Fast-With-the-Foley Catheter

Not-So-Fast-With-the-Foley Catheter_chest

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The document includes two main sections, each focused on different studies from the "Chest" journal.<br /><br />The first study explores the association between pepsin presence and asthma severity, utilizing pepsin as a biomarker for aspiration. Conducted by researchers including Desmond M. Murphy and Chris Ward, the study found pepsin present in the airways of 46 out of 78 asthmatic patients. However, no correlation was identified between the levels of airway pepsin and the severity of asthma. The study used bronchoalveolar lavage (BAL) to measure pepsin levels, which were reportedly diluted during collection. This dilution complicates direct comparisons to serum levels, suggesting that potential serum contribution to airway pepsin values is minimal. The authors highlight the need for further research into the role of aspiration in other airway conditions.<br /><br />The second section involves a response to an article by Jin et al. regarding urine output monitoring in critically ill patients and its association with mortality risk. Nikita Desai and Imran Iftikhar express concerns about inconsistencies in the study's presented data and hazard ratios (HR). In their letter, they clarify interpretations around the hazard ratios related to monitoring urine output and the presence of acute kidney injury (AKI). The debate centers on whether intensive urine monitoring improves survival rates beyond 30 days.<br /><br />John A. Kellum and colleagues respond to these concerns, explaining their results and confirming that intensive monitoring correlates with better outcomes only when patients do not experience AKI. They address the statistical interpretation issues raised by Desai and Iftikhar, clarifying that adjusted data shows AKI absence is intrinsically linked to improved survival outcomes, regardless of monitoring intensity. When extended to one-year data, these conclusions remained unchanged. Both studies emphasize further investigation and clarity in medical research methodologies.

Keywords

pepsin

asthma

bronchoalveolar lavage

aspiration

urine output monitoring

acute kidney injury

mortality risk

intensive monitoring

medical research

hazard ratios