CHEST Guidelines-Response_chest

Response_chest_26

Pdf Summary

This document consists of two discussions in a scholarly setting, focusing on respiratory medicine and nighttime ICU staffing. <br /><br />The first section is a response from Dr. Richard D. Turner, who discusses the examination of cough intensity in patients with chronic cough compared to control subjects. The study measured respiratory muscle activation through electromyography (EMG), both invasive and non-invasive techniques. They utilized surface EMG, particularly assessing the abdominal muscle activation (EMGabdo). The research found no significant differences in muscle activation between chronic cough patients and controls. The findings suggest that variations in cough intensity are not due to increased muscle activation. Furthermore, the study did not establish a link between physiologic measures of spontaneous cough intensity and the cough-related quality of life, emphasizing further research for better insight, possibly using ambulatory measures for comprehensive analysis.<br /><br />The second section addresses nighttime ICU staffing. Researchers debate whether 24/7 intensivist coverage offers mortality benefits in the ICU. An earlier study cited suggests that intensivist coverage did not offer a mortality advantage compared to nonphysician ICUs, which reported lower adjusted mortality rates. The possible reasons could be overly aggressive care in intensivist ICUs or improper end-of-life transition processes. Additionally, the role of patient transfers and telemedicine could also impact these findings. Nonphysician ICUs, commonly in community hospitals, may benefit from telemedicine, potentially aiding the sickest patients and affecting reported outcomes.<br /><br />Both sections highlight ongoing research debates, the complexity of medical assessments, and the potential influence of various healthcare management practices on patient outcomes.

Keywords

respiratory medicine

chronic cough

EMG

muscle activation

ICU staffing

intensivist coverage

mortality rates

telemedicine

patient outcomes

healthcare management