8 results on '"Sine, Christy"'
Search Results
2. Acute Respiratory Failure.
- Author
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Cannon J, Pamplin J, Zonies D, Mason P, Sine C, Cancio L, McNeill J, Colombo C, Osborn E, Ricca R, Allan P, DellaVolpe J, Chung K, and Stockinger Z
- Subjects
- Blood Transfusion methods, Extracorporeal Membrane Oxygenation methods, Extracorporeal Membrane Oxygenation trends, Fluid Therapy methods, Guidelines as Topic, Hospital Mortality, Humans, Patient Transfer methods, Respiration, Artificial methods, Critical Illness therapy, Respiratory Distress Syndrome complications, Respiratory Distress Syndrome therapy
- Abstract
Acute respiratory distress syndrome (ARDS) is a condition affecting critically ill patients, characterized by pulmonary inflammation and defects in oxygenation due to either direct or indirect injury to the lungs. These guidelines will define the diagnosis and management of ARDS, particularly among combat casualties and patients in the deployed environment. The cornerstone of management of ARDS involves maintaining adequate oxygenation while avoiding further pulmonary injury through lung-protective ventilation. Additional strategies for advanced respiratory failure, such as prone positioning, neuromuscular blockade, and extracorporeal membrane oxygenation will be reviewed here as well. Particularly important to the care of the patient with ARDS in the deployed environment is a familiarity with the challenges and indications for transport/aeromedical evacuation.
- Published
- 2018
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3. Acute eosinophilic pneumonia in the deployed military setting.
- Author
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Sine CR, Hiles PD, Scoville SL, Haynes RL, Allan PF, Franks TJ, Morris MJ, and Osborn EC
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- Acute Disease, Adrenal Cortex Hormones administration & dosage, Adult, Bronchoalveolar Lavage Fluid immunology, Bronchoscopy instrumentation, Eosinophilia diagnosis, Eosinophilia metabolism, Female, Germany, Humans, Hypoxia physiopathology, Male, Middle Aged, Pulmonary Eosinophilia diagnostic imaging, Pulmonary Eosinophilia therapy, Respiration, Artificial statistics & numerical data, Respiratory Insufficiency etiology, Retrospective Studies, Severity of Illness Index, Tobacco Smoking epidemiology, United States epidemiology, Adrenal Cortex Hormones therapeutic use, Military Personnel statistics & numerical data, Pulmonary Eosinophilia epidemiology, Respiration, Artificial methods
- Abstract
Rationale: Acute eosinophilic pneumonia (AEP) is a rare but important cause of severe respiratory failure most typically caused by cigarette smoking, but can also be caused by medications, illicit drugs, infections and environmental exposures. There is growing evidence that disease severity varies and not all patients require mechanical ventilation or even supplemental oxygen., Objectives: To compare patients with AEP treated at Landstuhl Regional Medical Center (LRMC) to those in other published series, and to provide recommendations regarding diagnosis and treatment of AEP., Methods: A retrospective chart review was completed on forty-three cases of AEP which were identified from March 2003 through March 2010 at LRMC, Germany., Results: Tobacco smoking was reported by 91% of our patients. Only 33% of patients in our series had a fever (temperature > 100.4 °F) at presentation. Peripheral eosinophilia (>5%) was present in 35% on initial CBC, but was seen in 72% of patients during their hospital course. Hypoxemia, as measured by PaO2/FiO2 ratio, seemed to be less severe in patients with higher levels of bronchoalveolar (BAL) eosinophilia percentage., Conclusions: Based on our experience and literature review, we recommend adjustments to the diagnostic criteria which may increase consideration of this etiology for acute respiratory illnesses as well as provide clinical clues we have found particularly helpful. Similar to recent reports of initial peripheral eosinophilia correlating with less severe presentation we found that higher BAL eosinophilia correlated with less severe hypoxemia., (Published by Elsevier Ltd.)
- Published
- 2018
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4. Reciprocal Risk of Acute Kidney Injury and Acute Respiratory Distress Syndrome in Critically Ill Burn Patients.
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Clemens MS, Stewart IJ, Sosnov JA, Howard JT, Belenkiy SM, Sine CR, Henderson JL, Buel AR, Batchinsky AI, Cancio LC, and Chung KK
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- Acute Kidney Injury epidemiology, Adult, Age Factors, Aged, Burns complications, Burns mortality, Female, Hospital Mortality, Humans, Intensive Care Units, Male, Middle Aged, Respiratory Distress Syndrome epidemiology, Retrospective Studies, Risk Factors, Sex Factors, Acute Kidney Injury complications, Acute Kidney Injury mortality, Critical Illness mortality, Respiration, Artificial mortality, Respiratory Distress Syndrome complications, Respiratory Distress Syndrome mortality
- Abstract
Objective: To evaluate the association between acute respiratory distress syndrome and acute kidney injury with respect to their contributions to mortality in critically ill patients., Design: Retrospective analysis of consecutive adult burn patients requiring mechanical ventilation., Setting: A 16-bed burn ICU at tertiary military teaching hospital., Patients: Adult patients more than 18 years old requiring mechanical ventilation during their initial admission to our burn ICU from January 1, 2003, to December 31, 2011., Interventions: None., Measurements and Main Results: A total 830 patients were included, of whom 48.2% had acute kidney injury (n = 400). These patients had a 73% increased risk of developing acute respiratory distress syndrome after controlling for age, gender, total body surface area burned, and inhalation injury (hazard ratio, 1.73; 95% CI, 1.18-2.54; p = 0.005). In a reciprocal multivariate analysis, acute respiratory distress syndrome (n = 299; 36%) demonstrated a strong trend toward developing acute kidney injury (hazard ratio, 1.39; 95% CI, 0.99-1.95; p = 0.05). There was a 24% overall in-hospital mortality (n = 198). After adjusting for the aforementioned confounders, both acute kidney injury (hazard ratio, 3.73; 95% CI, 2.39-5.82; p < 0.001) and acute respiratory distress syndrome (hazard ratio, 2.16; 95% CI, 1.58-2.94; p < 0.001) significantly contributed to mortality. Age, total body surface area burned, and inhalation injury were also significantly associated with increased mortality., Conclusions: Acute kidney injury increases the risk of acute respiratory distress syndrome in mechanically ventilated burn patients, whereas acute respiratory distress syndrome similarly demonstrates a strong trend toward the development of acute kidney injury. Acute kidney injury and acute respiratory distress syndrome are both independent risks for subsequent death. Future research should look at this interplay for possible early interventions.
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- 2016
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5. Acute Respiratory Distress Syndrome in Burn Patients: A Comparison of the Berlin and American-European Definitions.
- Author
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Sine CR, Belenkiy SM, Buel AR, Waters JA, Lundy JB, Henderson JL, Stewart IJ, Aden JK, Liu NT, Batchinsky A, Cannon JW, Cancio LC, and Chung KK
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- Acute Lung Injury etiology, Adult, Female, Humans, Injury Severity Score, Male, Middle Aged, Prevalence, Respiration, Artificial, Respiratory Distress Syndrome etiology, Acute Lung Injury diagnosis, Burns complications, Respiratory Distress Syndrome diagnosis, Respiratory Distress Syndrome mortality
- Abstract
The purpose of this study was to compare the Berlin definition to the American-European Consensus Conference (AECC) definition in determining the prevalence of acute respiratory distress syndrome (ARDS) and associated mortality in the critically ill burn population. Consecutive patients admitted to our institution with burn injury that required mechanical ventilation for more than 24 hours were included for analysis. Included patients (N = 891) were classified by both definitions. The median age, % TBSA burn, and injury severity score (interquartile ranges) were 35 (24-51), 25 (11-45), and 18 (9-26), respectively. Inhalation injury was present in 35.5%. The prevalence of ARDS was 34% using the Berlin definition and 30.5% using the AECC definition (combined acute lung injury and ARDS), with associated mortality rates of 40.9 and 42.9%, respectively. Under the Berlin definition, mortality rose with increased ARDS severity (14.6% no ARDS; 16.7% mild; 44% moderate; and 59.7% severe, P < 0.001). By contrast, under the AECC definition increased mortality was seen only for ARDS category (14.7% no ARDS; 15.1% acute lung injury; and 46.0% ARDS, P < 0.001). The mortality of the 22 subjects meeting the AECC, but not the Berlin definition was not different from patients without ARDS (P = .91). The Berlin definition better stratifies ARDS in terms of severity and correctly excludes those with minimal disease previously captured by the AECC.
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- 2016
- Full Text
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6. A comparison of acute respiratory distress syndrome outcomes between military and civilian burn patients.
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Waters JA, Lundy JB, Aden JK, Sine CR, Buel AR, Henderson JL, Stewart IJ, Cannon JW, Batchinsky A, Cancio LC, and Chung KK
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- Adult, Burns epidemiology, Female, Humans, Male, Middle Aged, Prevalence, Respiration, Artificial, Respiratory Distress Syndrome etiology, Respiratory Distress Syndrome therapy, Retrospective Studies, Survival Rate trends, Trauma Severity Indices, United States epidemiology, Burns complications, Intensive Care Units, Military Personnel, Respiratory Distress Syndrome epidemiology
- Abstract
Background: The objective of this report was to compare the prevalence of acute respiratory distress syndrome (ARDS) and associated mortality between military service members with burns sustained during or in support of combat operations and civilian burn patients treated at a single burn center., Methods: Demographic and physiologic data were collected retrospectively on mechanically ventilated military and civilian patients admitted to our burn intensive care unit between January 2003 and December 2011. Patients with ARDS were identified and categorized as mild, moderate, or severe using the Berlin criteria. Demographics and clinical outcomes were compared. After initial comparison, propensity matching was performed and mortality compared., Results: A total of 891 burn patients required mechanical ventilation during the study period; 291 military and 600 civilian. The prevalence of ARDS was 34% (n=304) for the entire cohort, 33% (n=96) for military, and 35% (n=208) for civilians (p=0.55). For the entire cohort, despite more severe injury burden, military patients had a significantly lower overall mortality (17% vs. 28%; p=0.0002) as well as ARDS mortality (33 vs. 48%, p=0.02) when compared to civilians. This difference was not significant after propensity matching based on age., Conclusion: In a retrospective cohort study, burned military patients on mechanical ventilation had a significantly lower overall and ARDS mortality despite larger burns and more severe injury when compared to civilian burn patients. This difference appears to be largely because of age., (Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.)
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- 2015
- Full Text
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7. Extracorporeal membrane oxygenation in a patient with refractory acute respiratory distress syndrome secondary to toxic epidermal necrolysis.
- Author
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Sine CR, Chung KK, Pamplin JC, Batchinsky AI, Hull JE, King BT, Derdak S, Walker J, McNeil JD, Renz EM, and Cannon JW
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- Adult, Diagnosis, Differential, Female, Humans, Extracorporeal Membrane Oxygenation, Respiratory Distress Syndrome etiology, Respiratory Distress Syndrome therapy, Stevens-Johnson Syndrome complications, Stevens-Johnson Syndrome therapy
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- 2014
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8. Acute respiratory distress syndrome in wartime military burns: application of the Berlin criteria.
- Author
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Belenkiy SM, Buel AR, Cannon JW, Sine CR, Aden JK, Henderson JL, Liu NT, Lundy JB, Renz EM, Batchinsky AI, Cancio LC, and Chung KK
- Subjects
- Adult, Afghan Campaign 2001-, Burns mortality, Burns, Inhalation complications, Burns, Inhalation mortality, Female, Humans, Injury Severity Score, Iraq War, 2003-2011, Logistic Models, Male, Military Personnel statistics & numerical data, Prevalence, Respiration, Artificial, Respiratory Distress Syndrome classification, Respiratory Distress Syndrome epidemiology, Respiratory Distress Syndrome mortality, Retrospective Studies, Risk Factors, Severity of Illness Index, United States, Burns complications, Respiratory Distress Syndrome etiology
- Abstract
Background: Acute respiratory distress syndrome (ARDS) prevalence and related outcomes in burned military casualties from Iraq and Afghanistan have not been described previously. The objective of this article was to report ARDS prevalence and its associated in-hospital mortality in military burn patients., Methods: Demographic and physiologic data were collected retrospectively on mechanically ventilated military casualties admitted to our burn intensive care unit from January 2003 to December 2011. Patients with ARDS were identified in accordance with the new Berlin definition of ARDS. Subjects were categorized as having mild, moderate, or severe ARDS. Multivariate logistic regression identified independent risk factors for developing moderate-to-severe ARDS. The main outcome measure was the prevalence of ARDS in a cohort of patients burned as a result of recent combat operations., Results: A total of 876 burned military casualties presented during the study period, of whom 291 (33.2%) required mechanical ventilation. Prevalence of ARDS in this cohort was 32.6%, with a crude overall mortality of 16.5%. Mortality increased significantly with ARDS severity: mild (11.1%), moderate (36.1%), and severe (43.8%) compared with no ARDS (8.7%) (p < 0.001). Predictors for the development of moderate or severe ARDS were inhalation injury (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.01-3.54; p = 0.046), Injury Severity Score (ISS) (OR, 1.04; 95% CI, 1.01-1.07; p = 0.0021), pneumonia (OR, 198; 95% CI, 1.07-3.66; p = 0.03), and transfusion of fresh frozen plasma (OR, 1.32; 95% CI, 1.01-1.72; p = 0.04). Size of burn was associated with moderate or severe ARDS by univariate analysis but was not an independent predictor of ARDS by multivariate logistic regression (p > 0.05). Age, size of burn, and moderate or severe ARDS were independent predictors of mortality., Conclusion: In this cohort of military casualties with thermal injuries, nearly a third required mechanical ventilation; of those, nearly one third developed ARDS, and nearly one third of patients with ARDS did not survive. Moderate and severe ARDS increased the odds of death by more than fourfold and ninefold, respectively., Level of Evidence: Epidemiologic/prognostic study, level III.
- Published
- 2014
- Full Text
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