CHEST Guidelines-Response_chest

Response_chest_26
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This document comprises multiple correspondences and research discussions published in the "Chest" journal, primarily focusing on the relationship between obesity and ventilator-associated pneumonia (VAP) and the use of high-dose anticoagulation in critically ill COVID-19 patients.<br /><br />In the first section, Dr. Saad Nseir and colleagues respond to Dr. Watanabe’s concerns about the classification of obesity in their study examining the link between obesity and VAP. They clarify that the study used the World Health Organization’s definition of obesity (BMI ≥ 30) and employed a rigorous methodology, including the Fine and Gray model, to assess VAP incidence among obese and non-obese patients. They also mention that the study's strict VAP definition, determined by an independent committee, might explain the relatively low VAP rates observed. The study acknowledges its limitation in generalizability, especially for patients without vasopressor support, and aligns its findings with broader French surveillance data.<br /><br />The second discussion addresses the potential risks of high-dose anticoagulation in critically ill COVID-19 patients. Drs. Juan José Paez Vargas, Anxela Vidal González, César Pérez-Calvo, and Javier Flandes critique a study by Tacquard et al., which reported reduced thrombosis rates with higher heparin doses but no increase in bleeding. The critique raises concerns about the increased risk of bleeding and the methodology utilized, notably the lack of separation between high and intermediate doses of anticoagulation. Additionally, they suggest further investigation into immunothrombosis and utilizing biomarkers for personalized treatment to minimize thrombotic and hemorrhagic risks.<br /><br />These discussions underscore the complexity and necessity for rigorous methodologies in clinical studies concerning critical patient populations, emphasizing the balance between intervention benefits and associated risks.
Keywords
obesity
ventilator-associated pneumonia
VAP
anticoagulation
COVID-19
critically ill patients
thrombosis
bleeding risk
clinical studies
biomarkers