Niven, A S

Abstract Background Single breath diffusing capacity of the lung for carbon monoxide (DLCO) remains the most widely used test to assess pulmonary gas exchange. GLI DLCO reference equations are based on a larger, more diverse dataset and offer age-specific and internally consistent reference values. However, their impact on interpretation in a real-world population remains uncertain. Research Question Describe the direction and magnitude of DLCO interpretation changes resulting from our multicenter PFT laboratory transition from Miller to GLI reference equations. Study Design and Methods In this multicenter cross-sectional study, we reanalyzed 88,060 DLCO measurements in a large pulmonary function laboratory database performed between 2016 and 2022 using GLI and Miller reference equations, stratified by self-reported race and ethnicity. Baseline patient characteristics and lung function measurements were summarized with continuous characteristics as median (IQR) and categorical variables as n (%). Kruskal-Wallis test was used to evaluate the difference between GLI and Miller DLCO % predicted difference between races, and two-by-two and four-by-four tables were generated to summarize the proportion of concordance and discordance of GLI to Miller severity levels. A repeated measures multivariable logistic regression was used to evaluate discordance between GLI and Miller severity and patient characteristics (age, sex, race, and BMI). Results We included 63,357 individuals with 88,060 PFT visits; 91.6% (58,076) identified as Caucasian, 5.2% (3,262) as Black, 1.4 % (895) as Asian, and 1.8% (1,113) as mixed/other race. Fifty-one percent were female with an median age of 64 years (range: 5- 85). 7.4% (6509) of DLCO results were discordant, with 0.5% (n = 439) abnormal by GLI only, and 6.9% (n = 6070) abnormal by Miller only. Compared to the Miller, GLI interpretations were associated with a greater shift toward normal interpretations. Younger age, lower BMI, female sex, and being of NE Asian, SE Asian, or Other/mixed race compared to Caucasian were associated with higher odds of discordance in DLCO severity/normal classification. Interpretation The use of GLI reference equations substantially alters the interpretation of DLCO results, shifting a meaningful subset of patients from abnormal to normal classification. While GLI reference equations offer more comprehensive, population-based approach, it is crucial to place these interpretations within the context of the patient presentation until further investigations more clearly define the clinical implications of these transitions. This abstract is funded by: none

Abstract Rationale Oscillometry measures the mechanical properties of the respiratory system using the response to pressure signals superimposed on tidal breathing. The JaegerTM IOS device generates “pulse packets” of harmonic frequencies between 5 and 35 Hz in 5 Hz intervals, while the Resmon ProTM V3 FOT and Thorasys TremofloTM C-100 employ prime pseudorandom sine waveforms between 5-19 Hz and 5-37 Hz, respectively. Prior studies have raised concerns about harmonic distortion with the IOS technique, but a direct comparison of reproducibility using current devices has not been performed. Methods Healthy volunteers with normal spirometry performed weekly oscillometry following ERS technical standards using JaegerTM and ResmonTM or ThorasysTM oscillometers in random order for 10 consecutive weeks. Z scores were calculated using Berger and Oostveen normative equations. Means, pooled within-subject distributions and interquartile range, standard error (SEM), coefficient of variation (CVw%), absolute and relative minimal detectable change (MDC, MDC%), and between device and subject intraclass correlation coefficients (ICC) were calculated for R5, R10/R11, R20/R19, R5-R20/R5-R19, X5, AX, and Fres and compared. Results Fifteen participants completed 10 weekly measurement sessions with JaegerTM and ResmonTM and twelve with JaegerTM and ThorasysTM. One subject did not complete the ResmonTM analysis due to intolerance; another subject only completed three weeks of ThorasysTM prior to work assignment change. The majority (65%) were female with mean (SD) age of 37.7 (10.2) years and BMI 27 (5) kg/m2. Rrs reproducibility was excellent across devices (ICC > 0.89), with more variability for X5, AX, and Fres (ICC 0.66 - 0.93) and little difference between devices (Figure 1). Small, systematic increases in mean Rrs were seen with JaegerTM compared to ResmonTM (5-10%, p < 0.008) and TremofloTM (5-12%, p < 0.02), with higher mean AX vs ResmonTM (44%, p = 0.002) and lower Fres vs TremofloTM (19%, p = 0.02). There was high ICC (0.97-0.99) across ResmonTM and TremofloTM Rrs comparisons with minimal bias. Intra-subject reproducibility was similar between devices. MDC% was 22.7-39.4% for Rrs values, 52.7-70.8% for X5, and 131-142% for AX. Conclusions JaegerTM, ResmonTM, and ThorasysTM oscillometers performed similarly in healthy adults over 10 weeks, with small but systematic measurement differences seen with the JaegerTM device. Rrs and Fres values demonstrated the greatest reproducibility both within and between subjects. Reactance measurements had less between-device agreement and higher MDC. Rrs, X5, and AX changes of up to 40%, 70%, and 140% over time may be due to normal subject and measurement variation. This abstract is funded by: 2024 Pulmonary, Critical Care, and Sleep Medicine Schuen Family Innovation Award

Abstract Rationale Clear and accurate communication is essential in critical care, yet patients with non-English language preferences (NELP) often face limited access to professional interpreters. Although machine translation has been explored in healthcare, most studies have focused on written translation. Their use in real-time, two-way interpretation specifically for high-stakes ICU conversations remains largely unexamined. To bridge this gap, we developed AI-TransLATE (AI-enhanced Transition to Language-Agnostic Transcultural Engagement), a voice-to-voice multilingual interpretation tool designed to support real-time interactions in critical care. Following successful initial validation, we evaluated clinicians’ perceptions of its usability in simulated ICU encounters and compared its performance with commercially available AI tools, including Gemini and ChatGPT. Methods We developed three standardized ICU role-play scenarios focused on shared decision-making regarding ECMO, tracheostomy, and comfort care, designed to encourage natural, unscripted dialogue. Clinicians were asked to use the AI translation tools during these encounters in Spanish, Chinese, or Arabic, while a bilingual research team member acted as the patient’s family member. After each simulation, participants completed a post-session survey evaluating communication quality, satisfaction (using a 5-point Likert scale), and usability through the System Usability Scale (SUS). Results Eighteen clinicians participated, including residents, fellows, and attending physicians with an average of 3.6 ± 1.2 years of postgraduate experience. Fifty-four post-simulation surveys were completed across Arabic, Chinese, and Spanish languages comparing AI-TransLATE, ChatGPT, and Google Gemini. Participants rated the simulation as realistic across all cases (ECMO = 3.94 ± 0.66; Tracheostomy = 4.22 ± 0.43; Comfort Care = 4.06 ± 0.42; p = 0.32). Satisfaction was highest for AI-TransLATE (4.11 ± 0.68) and ChatGPT (4.00 ± 0.69) but lowest for Gemini (2.06 ± 1.00; p < 0.001). Willingness to use in real life followed the same trend. (AI-TransLATE = 4.00 ± 0.69, ChatGPT = 3.89 ± 0.96, Gemini = 2.00 ± 1.03 (p < 0.001)). SUS scores supported these findings (AI-TransLATE = 71.25 ± 13.35; ChatGPT = 72.22 ± 15.57; Gemini = 40.28 ± 21.30; p < 0.001), corresponding to good usability for AI-TransLATE and ChatGPT and poor usability for Gemini. Clinicians mentioned interruptions, uneven translation flow, and difficulty judging accuracy, but appreciated it when the AI-TransLATE conveyed tone and intonation, enabling smoother, more natural communication. Conclusion Overall, AI-TransLATE and ChatGPT demonstrated strong usability and satisfaction, showing promise as clinical communication tools; however, further validation in real-world ICU settings is warranted, and data privacy and confidentiality remain important considerations. This abstract is funded by: Critical care research committee mayo clinic

Abstract Rationale Critical care education has been identified as a global priority to improve the early identification and management of common syndromes, including sepsis and respiratory failure. International practice varies widely, and frontline clinical team perspectives remain poorly defined. The CERTAIN (Checklist for Early Recognition and Treatment of Acute Illness and iNjury) program provides a structured, checklist-based approach shown to improve the delivery of best practices and patient-centered outcomes worldwide. Over the past decade we have performed a needs assessment at the start of each international CERTAIN program. We performed a retrospective analysis of these data to examine the critical care domains prioritized by frontline interprofessional teams to inform global training priorities. MethodsWe developed an anonymous online survey consisting of 20 previously defined activities essential to the practice of critical care. Participants ranked these activities using Q-sort methodology on a forced distribution scale from -4 (lowest priority) to + 4 (highest priority). Individual rankings were summed across all participants to generate aggregate scores for each activity, with higher values reflecting greater collective prioritization. Aggregate scores were calculated for the entire cohort and each site and summarized with bar plots to illustrate prioritization patterns across critical care domains. ResultsA total of 213 intensivists, emergency medicine physicians, nurses, and pharmacists from hospitals in China (75), Cambodia (70), Croatia (31), Japan (24) and India (13) completed the survey. The distribution of priorities across content domains is illustrated in Figure. Management of shock, sepsis, mechanical ventilation, and respiratory failure received the highest aggregate scores. Interprofessional critical care coordination was the only process of care activity identified as high priority, and transitions of care, patient centered communication, and shared decision making were consistently ranked lowest. While minor variation existed across individual sites, resuscitation and the acute management of high-risk clinical conditions were consistently prioritized over processes of care and patient-centered care domains. ConclusionThis multicenter analysis demonstrates consistent interprofessional clinician prioritization of acute clinical management topics for training. These insights inform both areas of emphasis and highlight challenges that CERTAIN and other programs face to improve global patient care delivery. Variation in care processes has been consistently identified as the largest modifiable factor to improve patient outcomes, and cultural differences may present barriers to engagement on the best approaches to patient centered care. Figure. Distribution of aggregate Q-sort scores across 20 critical care activities. Scores represent summed participant rankings (n=213) from -4 (lowest priority) to +4 (highest priority). This abstract is funded by: None