CHEST Guidelines-Response_chest

Response_chest_23

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The document primarily comprises two correspondence sections regarding published research in the CHEST journal. <br /><br />The first section is a correspondence from Guanyu Yang, discussing a study by Al-Dorzi et al. on venous thromboembolism (VTE) risk assessment models in critically ill patients receiving pharmacologic thromboprophylaxis. Yang highlights that while the study identified independent predictive factors for VTE, it omitted two significant predictors identified in a meta-analysis: a history of recent surgery and prior VTE. Yang suggests that including these factors could offer new insights and emphasizes the necessity of testing for multicollinearity in multivariate logistic regression models to ensure reliable outcomes. The response from researchers Al-Dorzi and colleagues acknowledges Yang's points, detailing how the updated analysis considered these variables and validated the model's reliability through multicollinearity testing methods.<br /><br />The second section involves a response to a study by Huespe et al. comparing bispectral index (BIS) monitoring and clinical assessment (CA) in deep sedation for critically ill patients. Authors Alcántara Carmona, Romera Ortega, and Chamorro-Jambrina critique the study’s methodology, noting that the presence of electromyography (EMG) activity could skew BIS values, suggesting BIS interpretations are unreliable unless EMG is accounted for. The critique further questions the pharmacologic strategy employed, highlighting that BIS values are validated with GABAergic sedatives, and the opioid-based sedation used in the study might produce inaccurate BIS readings. The authors acknowledge BIS-guidance benefits in reducing sedative doses but argue for a more comprehensive EEG-based approach rather than relying solely on numerical BIS values.<br /><br />Overall, these correspondences reflect critical engagement among researchers, emphasizing methodological robustness in studies on thromboembolism risk and sedation monitoring.

Keywords

venous thromboembolism

VTE risk assessment

critically ill patients

pharmacologic thromboprophylaxis

multicollinearity

bispectral index monitoring

deep sedation

electromyography

EEG-based approach

methodological robustness