CHEST Guidelines-Response_chest

Response_chest_30

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The document provides two separate pieces of correspondence discussing recent studies published in the journal "Chest." <br /><br />The first is a response from Federico C. Carini, MD, and colleagues regarding their study on bispectral index (BIS) monitoring versus clinical assessments for sedation in ICUs. They address comments made by Carmona et al., acknowledging electromyographic interference as a known issue in BIS measurements. In their pragmatic trial, only 20% of patients used neuromuscular blockade, reflecting common ICU practices. They note that 32% of monitored hours showed BIS values below 40 due to nurses' engagement with daily tasks, indicating a difference with other studies comparing automated versus manual BIS-guided sedation. The authors advocate for the development of automated systems to improve sedation management and recommend incorporating advanced EEG metrics in future research.<br /><br />The second correspondence, from Victoria Gilrane, DO, and colleagues, critiques a study by De Jong et al. on the risk factors for extubation failure among critically ill patients, including those with obesity. They highlight the study's strengths, such as its large cohort and diverse patient population. However, they express concerns about methodological issues, such as variability in ICU practices across different centers, lack of standardized extubation protocols, and inadequate adjustment for potential confounders like comorbidities. These factors may have affected conclusions about obesity as a risk factor for extubation failure. The authors suggest future research should focus on standardizing protocols or evaluating different management strategies to assure best practices are determined for obese patients.<br /><br />Both correspondences underscore the importance of methodological considerations in research and recommend enhancements in future studies to better understand clinical outcomes in ICU settings.

Keywords

BIS monitoring

ICU sedation

electromyographic interference

neuromuscular blockade

extubation failure

obesity risk factor

standardized protocols

EEG metrics

clinical outcomes

methodological considerations