32,270 results on '"Humans"'
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2. Association of an Emergency Critical Care Program With Survival and Early Downgrade Among Critically Ill Medical Patients in the Emergency Department.
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Mitarai, Tsuyoshi, Gordon, Alexandra June, Nudelman, Matthew JR, Urdaneta, Alfredo E, Nesbitt, Jason Lawrence, Niknam, Kian, Graber-Naidich, Anna, Wilson, Jennifer G, and Kohn, Michael A
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Humans ,Critical Illness ,Critical Care ,Hospitalization ,Hospital Mortality ,Retrospective Studies ,Adult ,Emergency Service ,Hospital ,Intensive Care Units ,Clinical Research ,Health Services ,Emergency Care ,7.3 Management and decision making ,Management of diseases and conditions ,Good Health and Well Being ,critical care medicine ,emergency department critical care ,emergency medicine ,health care delivery models ,intensive care unit triage ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine - Abstract
ObjectivesTo determine whether implementation of an Emergency Critical Care Program (ECCP) is associated with improved survival and early downgrade of critically ill medical patients in the emergency department (ED).DesignSingle-center, retrospective cohort study using ED-visit data between 2015 and 2019.SettingTertiary academic medical center.PatientsAdult medical patients presenting to the ED with a critical care admission order within 12 hours of arrival.InterventionsDedicated bedside critical care for medical ICU patients by an ED-based intensivist following initial resuscitation by the ED team.Measurements and main resultsPrimary outcomes were inhospital mortality and the proportion of patients downgraded to non-ICU status while in the ED within 6 hours of the critical care admission order (ED downgrade
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- 2023
3. Flow-Limited and Reverse-Triggered Ventilator Dyssynchrony Are Associated With Increased Tidal and Dynamic Transpulmonary Pressure.
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Sottile, Peter D., Smith, Bradford, Stroh, Jake N., Albers, David J., and Moss, Marc
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DYNAMIC pressure , *ADULT respiratory distress syndrome , *POSITIVE end-expiratory pressure , *MACHINE learning , *MECHANICAL energy , *ESOPHAGEAL motility disorders - Abstract
OBJECTIVES: Ventilator dyssynchrony may be associated with increased delivered tidal volumes (V t s) and dynamic transpulmonary pressure (ΔPL,dyn), surrogate markers of lung stress and strain, despite low V t ventilation. However, it is unknown which types of ventilator dyssynchrony are most likely to increase these metrics or if specific ventilation or sedation strategies can mitigate this potential. DESIGN: A prospective cohort analysis to delineate the association between ten types of breaths and delivered V t , ΔPL,dyn, and transpulmonary mechanical energy. SETTING: Patients admitted to the medical ICU. PATIENTS: Over 580,000 breaths from 35 patients with acute respiratory distress syndrome (ARDS) or ARDS risk factors. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients received continuous esophageal manometry. Ventilator dyssynchrony was identified using a machine learning algorithm. Mixed-effect models predicted V t , ΔPL,dyn, and transpulmonary mechanical energy for each type of ventilator dyssynchrony while controlling for repeated measures. Finally, we described how V t , positive end-expiratory pressure (PEEP), and sedation (Richmond Agitation-Sedation Scale) strategies modify ventilator dyssynchrony's association with these surrogate markers of lung stress and strain. Double-triggered breaths were associated with the most significant increase in V t , ΔPL,dyn, and transpulmonary mechanical energy. However, flow-limited, early reverse-triggered, and early ventilator-terminated breaths were also associated with significant increases in V t , ΔPL,dyn, and energy. The potential of a ventilator dyssynchrony type to increase V t , ΔPL,dyn, or energy clustered similarly. Increasing set V t may be associated with a disproportionate increase in high-volume and high-energy ventilation from double-triggered breaths, but PEEP and sedation do not clinically modify the interaction between ventilator dyssynchrony and surrogate markers of lung stress and strain. CONCLUSIONS: Double-triggered, flow-limited, early reverse-triggered, and early ventilator-terminated breaths are associated with increases in V t , ΔPL,dyn, and energy. As flow-limited breaths are more than twice as common as double-triggered breaths, further work is needed to determine the interaction of ventilator dyssynchrony frequency to cause clinically meaningful changes in patient outcomes. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Diastolic Blood Pressure Threshold During Pediatric Cardiopulmonary Resuscitation and Survival Outcomes: A Multicenter Validation Study.
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Berg, Robert, Morgan, Ryan, Reeder, Ron, Ahmed, Tageldin, Bell, Michael, Bishop, Robert, Bochkoris, Matthew, Burns, Candice, Carcillo, Joseph, Carpenter, Todd, Dean, J, Diddle, J, Federman, Myke, Fernandez, Richard, Fink, Ericka, Franzon, Deborah, Frazier, Aisha, Friess, Stuart, Graham, Kathryn, Hall, Mark, Hehir, David, Horvat, Christopher, Maa, Tensing, Manga, Arushi, McQuillen, Patrick, Meert, Kathleen, Mourani, Peter, Nadkarni, Vinay, Naim, Maryam, Notterman, Daniel, Palmer, Chella, Pollack, Murray, Sapru, Anil, Schneiter, Carleen, Sharron, Matthew, Srivastava, Neeraj, Tabbutt, Sarah, Tilford, Bradley, Viteri, Shirley, Wessel, David, Wolfe, Heather, Yates, Andrew, Zuppa, Athena, Sutton, Robert, and Huard, Leanna
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Infant ,Child ,Humans ,Adolescent ,Prospective Studies ,Blood Pressure ,Cardiopulmonary Resuscitation ,Heart Arrest ,Patient Discharge - Abstract
OBJECTIVES: Arterial diastolic blood pressure (DBP) greater than 25 mm Hg in infants and greater than 30 mm Hg in children greater than 1 year old during cardiopulmonary resuscitation (CPR) was associated with survival to hospital discharge in one prospective study. We sought to validate these potential hemodynamic targets in a larger multicenter cohort. DESIGN: Prospective observational study. SETTING: Eighteen PICUs in the ICU-RESUScitation prospective trial from October 2016 to March 2020. PATIENTS: Children less than or equal to 18 years old with CPR greater than 30 seconds and invasive blood pressure (BP) monitoring during CPR. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Invasive BP waveform data and Utstein-style CPR data were collected, including prearrest patient characteristics, intra-arrest interventions, and outcomes. Primary outcome was survival to hospital discharge, and secondary outcomes were return of spontaneous circulation (ROSC) and survival to hospital discharge with favorable neurologic outcome. Multivariable Poisson regression models with robust error estimates evaluated the association of DBP greater than 25 mm Hg in infants and greater than 30 mm Hg in older children with these outcomes. Among 1,129 children with inhospital cardiac arrests, 413 had evaluable DBP data. Overall, 85.5% of the patients attained thresholds of mean DBP greater than or equal to 25 mm Hg in infants and greater than or equal to 30 mm Hg in older children. Initial return of circulation occurred in 91.5% and 25% by placement on extracorporeal membrane oxygenator. Survival to hospital discharge occurred in 58.6%, and survival with favorable neurologic outcome in 55.4% (i.e. 94.6% of survivors had favorable neurologic outcomes). Mean DBP greater than 25 mm Hg for infants and greater than 30 mm Hg for older children was significantly associated with survival to discharge (adjusted relative risk [aRR], 1.32; 1.01-1.74; p = 0.03) and ROSC (aRR, 1.49; 1.12-1.97; p = 0.002) but did not reach significance for survival to hospital discharge with favorable neurologic outcome (aRR, 1.30; 0.98-1.72; p = 0.051). CONCLUSIONS: These validation data demonstrate that achieving mean DBP during CPR greater than 25 mm Hg for infants and greater than 30 mm Hg for older children is associated with higher rates of survival to hospital discharge, providing potential targets for DBP during CPR.
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- 2023
5. Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey*
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Burns, Karen EA, Moss, Marc, Lorens, Edmund, Jose, Elizabeth Karin Ann, Martin, Claudio M, Viglianti, Elizabeth M, Fox-Robichaud, Alison, Mathews, Kusum S, Akgun, Kathleen, Jain, Snigdha, Gershengorn, Hayley, Mehta, Sangeeta, Han, Jenny E, Martin, Gregory S, Liebler, Janice M, Stapleton, Renee D, Trachuk, Polina, Vranas, Kelly C, Chua, Abigail, Herridge, Margaret S, Tsang, Jennifer LY, Biehl, Michelle, Burnham, Ellen L, Chen, Jen-Ting, Attia, Engi F, Mohamed, Amira, Harkins, Michelle S, Soriano, Sheryll M, Maddux, Aline, West, Julia C, Badke, Andrew R, Bagshaw, Sean M, Binnie, Alexandra, Carlos, W Graham, Çoruh, Başak, Crothers, Kristina, D’Aragon, Frederick, Denson, Joshua Lee, Drover, John W, Eschun, Gregg, Geagea, Anna, Griesdale, Donald, Hadler, Rachel, Hancock, Jennifer, Hasmatali, Jovan, Kaul, Bhavika, Kerlin, Meeta Prasad, Kohn, Rachel, Kutsogiannis, D James, Matson, Scott M, Morris, Peter E, Paunovic, Bojan, Peltan, Ithan D, Piquette, Dominique, Pirzadeh, Mina, Pulchan, Krishna, Schnapp, Lynn M, Sessler, Curtis N, Smith, Heather, Sy, Eric, Thirugnanam, Subarna, McDonald, Rachel K, McPherson, Katie A, Kraft, Monica, Spiegel, Michelle, Dodek, Peter M, and Society, for the Diversity-Related Research Committee of the Women in Critical Care Interest Group of the American Thoracic
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Health Services and Systems ,Health Sciences ,Clinical Research ,Prevention ,Adult ,Male ,Humans ,Child ,United States ,Female ,Cross-Sectional Studies ,Pandemics ,COVID-19 ,Burnout ,Professional ,Physicians ,Intensive Care Units ,Adaptation ,Psychological ,Surveys and Questionnaires ,North America ,burnout ,coping ,moral distress ,pandemic ,wellness ,Diversity-Related Research Committee of the Women in Critical Care (WICC) Interest Group of the American Thoracic Society ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesFew surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic.DesignCross-sectional survey using four validated instruments.SettingSixty-two sites in Canada and the United States.SubjectsAttending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs.InterventionNone.Measurements and main resultsWe analysed 431 questionnaires (43.3% response rate) from 25 states and eight provinces. Respondents were predominantly male (229 [55.6%]) and in practice for 11.8 ± 9.8 years. Compared with prepandemic, respondents reported significant intrapandemic increases in days worked/mo, ICU bed occupancy, and self-reported moral distress (240 [56.9%]) and burnout (259 [63.8%]). Of the 10 top-ranked items that incited moral distress, most pertained to regulatory/organizational ( n = 6) or local/institutional ( n = 2) issues or both ( n = 2). Average moral distress (95.6 ± 66.9), professional fulfilment (6.5 ± 2.1), and burnout scores (3.6 ± 2.0) were moderate with 227 physicians (54.6%) meeting burnout criteria. A significant dose-response existed between COVID-19 patient volume and moral distress scores. Physicians who worked more days/mo and more scheduled in-house nightshifts, especially combined with more unscheduled in-house nightshifts, experienced significantly more moral distress. One in five physicians used at least one maladaptive coping strategy. We identified four coping profiles (active/social, avoidant, mixed/ambivalent, infrequent) that were associated with significant differences across all wellness measures.ConclusionsDespite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness.
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- 2022
6. Association of Renin Angiotensin Aldosterone System Inhibitors and Outcomes of Hospitalized Patients With COVID-19
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Gupta, Neha, Settle, Lisa, Brown, Brent R, Armaignac, Donna L, Baram, Michael, Perkins, Nicholas E, Kaufman, Margit, Melamed, Roman R, Christie, Amy B, Danesh, Valerie C, Denson, Joshua L, Cheruku, Sreekanth R, Boman, Karen, Bansal, Vikas, Kumar, Vishakha K, Walkey, Allan J, Domecq, Juan P, Kashyap, Rahul, Aston, Christopher E, Mesland, Jean-Baptiste, Henin, Pierre, Petre, Hélène, Buelens, Isabelle, Gerard, Anne-Catherine, Clevenbergh, Philippe, Granado, Rolando Claure-Del, Mercado, Jose A, Vega-Terrazas, Esdenka, Iturricha-Caceres, Maria F, Garza, Ruben, Chu, Eric, Chan, Victoria, Gavidia, Oscar Y, Pachon, Felipe, Sanchez, Yeimy A, knežević, Danijel, Kassas, Mohamed El, Badr, Mohamed, Tawheed, Ahmed, Yahia, Hend, Kantas, Dimitrios, Koulouras, Vasileios, Pineda, Estela, Guillen, Gabina María Reyes, Soto, Helin Archaga, Lizardo, Ana Karen Vallecillo, Kopitkó, Csaba, Bencze, Ágnes, Méhész, István, Gerendai, Zsófia, Doddaga, Phaneendra, Chandra, Neethi, Segu, Smitha S, Chakraborty, Tuhin, Joyce, Epcebha, Vadgaonkar, Girish, Ediga, Rekha, Basety, Shilpa, Dammareddy, Shwetha, Kasumalla, Phani Sreeharsha, Raju, Umamaheswara, Manduva, Janaki, Kolakani, Naresh, Sripathi, Shreeja, Chaitanya, Sheetal, Cherian, Anusha, Parameswaran, Sreejith, Parthiban, Magesh, A., Menu Priya, Prabhu, Madhav, Jakati, Vishal, Rijhwani, Puneet, Jain, Ashish, Gupta, Aviral, Jaiswal, Ram Mohan, Tyagi, Ambika, Mathur, Nimish, Daga, Mradul Kumar, Agarwal, Munisha, Rohtagi, Ishan, Papani, Sridhar, Kamuram, Mahesh, Agrawal, Kamlesh Kumar, Baghel, Vijendra, Patel, Kirti Kumar, Mohan, Surapaneni Krishna, Jyothisree, Ekambaram, Petrolwala, Mukur, Ladva, Bharat, Dalili, Nooshin, Nafa, Mohsen, Matsuda, Wataru, Suzuki, Reina, Tahara, Shu, Sanui, Masamitsu, Horikita, Sho, Itagaki, Yuki, and Kodate, Akira
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Biomedical and Clinical Sciences ,Clinical Sciences ,Emerging Infectious Diseases ,Coronaviruses ,Infectious Diseases ,Good Health and Well Being ,Adult ,Angiotensin Receptor Antagonists ,Angiotensin-Converting Enzyme Inhibitors ,Antihypertensive Agents ,Humans ,Hypertension ,Male ,Middle Aged ,Renin-Angiotensin System ,Retrospective Studies ,COVID-19 Drug Treatment ,Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator Group ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesTo determine the association of prior use of renin-angiotensin-aldosterone system inhibitors (RAASIs) with mortality and outcomes in hospitalized patients with COVID-19.DesignRetrospective observational study.SettingMulticenter, international COVID-19 registry.SubjectsAdult hospitalized COVID-19 patients on antihypertensive agents (AHAs) prior to admission, admitted from March 31, 2020, to March 10, 2021.InterventionsNone.Measurements and main resultsData were compared between three groups: patients on RAASIs only, other AHAs only, and those on both medications. Multivariable logistic and linear regressions were performed after controlling for prehospitalization characteristics to estimate the effect of RAASIs on mortality and other outcomes during hospitalization. Of 26,652 patients, 7,975 patients were on AHAs prior to hospitalization. Of these, 1,542 patients (19.3%) were on RAASIs only, 3,765 patients (47.2%) were on other AHAs only, and 2,668 (33.5%) patients were on both medications. Compared with those taking other AHAs only, patients on RAASIs only were younger (mean age 63.3 vs 66.9 yr; p < 0.0001), more often male (58.2% vs 52.4%; p = 0.0001) and more often White (55.1% vs 47.2%; p < 0.0001). After adjusting for age, gender, race, location, and comorbidities, patients on combination of RAASIs and other AHAs had higher in-hospital mortality than those on RAASIs only (odds ratio [OR] = 1.28; 95% CI [1.19-1.38]; p < 0.0001) and higher mortality than those on other AHAs only (OR = 1.09; 95% CI [1.03-1.15]; p = 0.0017). Patients on RAASIs only had lower mortality than those on other AHAs only (OR = 0.87; 95% CI [0.81-0.94]; p = 0.0003). Patients on ACEIs only had higher mortality compared with those on ARBs only (OR = 1.37; 95% CI [1.20-1.56]; p < 0.0001).ConclusionsAmong patients hospitalized for COVID-19 who were taking AHAs, prior use of a combination of RAASIs and other AHAs was associated with higher in-hospital mortality than the use of RAASIs alone. When compared with ARBs, ACEIs were associated with significantly higher mortality in hospitalized COVID-19 patients.
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- 2022
7. Interfacility Transport of Critically Ill Patients
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Wilcox, Susan R, Wax, Randy S, Meyer, Michael T, Stocking, Jacqueline C, Baez, Amado Alejandro, Cohen, Jason, Moss, M Michele, Frakes, Michael A, Scruth, Elizabeth A, Weir, William B, Zonies, David, Guyette, Francis X, Kaplan, Lewis J, and Cannon, Jeremy W
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Health Services and Systems ,Biomedical and Clinical Sciences ,Health Sciences ,Clinical Research ,Clinical Deterioration ,Critical Care ,Critical Illness ,Humans ,Transportation of Patients ,transport ,critical care ,critical illness ,emergencies ,hospitals ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesTo assess recent advances in interfacility critical care transport.Data sourcesPubMed English language publications plus chapters and professional organization publications.Study selectionManuscripts including practice manuals and standard (1990-2021) focused on interfacility transport of critically ill patients.Data extractionReview of society guidelines, legislative requirements, objective measures of outcomes, and transport practice standards occurred in work groups assessing definitions and foundations of interfacility transport, transport team composition, and transport specific considerations. Qualitative analysis was performed to characterize current science regarding interfacility transport.Data synthesisThe Task Force conducted an integrative review of 496 manuscripts combined with 120 from the authors' collections including nonpeer reviewed publications. After title and abstract screening, 40 underwent full-text review, of which 21 remained for qualitative synthesis.ConclusionsSince 2004, there have been numerous advances in critical care interfacility transport. Clinical deterioration may be mitigated by appropriate patient selection, pretransport optimization, and transport by a well-resourced team and vehicle. There remains a dearth of high-quality controlled studies, but notable advances in monitoring, en route management, transport modality (air vs ground), as well as team composition and training serve as foundations for future inquiry. Guidance from professional organizations remains uncoupled from enforceable regulations, impeding standardization of transport program quality assessment and verification.
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- 2022
8. Beyond the Alveolar Epithelium: Plasma Soluble Receptor for Advanced Glycation End Products Is Associated With Oxygenation Impairment, Mortality, and Extrapulmonary Organ Failure in Children With Acute Respiratory Distress Syndrome.
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Lim, Michelle J, Zinter, Matt S, Chen, Lucia, Wong, Kayley Man Yee, Bhalla, Anoopindar, Gala, Kinisha, Guglielmo, Mona, Alkhouli, Mustafa, Huard, Leanna L, Hanudel, Mark R, Vangala, Sitaram, Schwingshackl, Andreas, Matthay, Michael, and Sapru, Anil
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Lung ,Epithelium ,Humans ,Inflammation ,Pulmonary Surfactant-Associated Protein D ,Surface-Active Agents ,Adolescent ,Child ,Child ,Preschool ,Infant ,Infant ,Newborn ,Lung Injury ,Biomarkers ,Receptor for Advanced Glycation End Products ,Glycation End Products ,Advanced ,Respiratory Distress Syndrome ,Acute Respiratory Distress Syndrome ,Clinical Research ,Pediatric ,Rare Diseases ,2.1 Biological and endogenous factors ,Aetiology ,Respiratory ,Good Health and Well Being ,acute ,respiratory distress syndrome ,inflammation ,multiple organ dysfunction syndrome ,pediatric acute respiratory distress syndrome ,soluble receptor for advanced glycation end products ,surfactant protein-D ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine - Abstract
ObjectivesSoluble receptor for advanced glycation end products is a known plasma marker of alveolar epithelial injury. However, RAGE is also expressed on cell types beyond the lung, and its activation leads to up-regulation of pro-inflammatory mediators. We sought to examine the relationship between plasma soluble receptor for advanced glycation end products and primary pulmonary dysfunction, extrapulmonary organ dysfunction, and mortality in pediatric acute respiratory distress syndrome patients at two early time points following acute respiratory distress syndrome diagnosis and compare these results to plasma surfactant protein-D, a marker of pure alveolar epithelial injury.DesignProspective observational study.SettingFive academic PICUs.PatientsTwo hundred fifty-eight pediatric patients 30 days to 18 years old meeting Berlin Criteria for acute respiratory distress syndrome.InterventionsNone.Measurements and main resultsPlasma was collected for soluble receptor for advanced glycation end products and surfactant protein-D measurements within 24 hours (day 1) and 48 to 72 hours (day 3) after acute respiratory distress syndrome diagnosis. Similar to surfactant protein-D, plasma soluble receptor for advanced glycation end products was associated with a higher oxygenation index (p < 0.01) and worse lung injury score (p < 0.001) at the time of acute respiratory distress syndrome diagnosis. However, unlike surfactant protein-D, plasma soluble receptor for advanced glycation end products was associated with worse extrapulmonary Pediatric Logistic Organ Dysfunction score during ICU stay (day 3; p < 0.01) and positively correlated with plasma levels of interleukin-6 (p < 0.01), tumor necrosis factor-α (p < 0.01), and angiopoietin-2 (p < 0.01). Among children with indirect lung injury, plasma soluble receptor for advanced glycation end products was associated with mortality independent of age, sex, race, cancer/bone marrow transplant, and Pediatric Risk of Mortality score (day 3; odds ratio, 3.14; 95% CI, 1.46-6.75; p < 0.01).ConclusionsUnlike surfactant protein-D, which is primarily localized to the alveolar epithelium plasma soluble receptor for advanced glycation end products is systemically expressed and correlates with markers of inflammation, extrapulmonary multiple organ dysfunction, and death in pediatric acute respiratory distress syndrome with indirect lung injury. This suggests that unlike surfactant protein-D, soluble receptor for advanced glycation end products is a multifaceted marker of alveolar injury and increased inflammation and that receptor for advanced glycation end products activation may contribute to the pathogenesis of multiple organ failure among children with indirect acute respiratory distress syndrome.
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- 2022
9. Effect of a Multicomponent Sepsis Transition and Recovery Program on Mortality and Readmissions After Sepsis: The Improving Morbidity During Post-Acute Care Transitions for Sepsis Randomized Clinical Trial*
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Taylor, Stephanie Parks, Murphy, Stephanie, Rios, Aleta, McWilliams, Andrew, McCurdy, Lewis, Chou, Shih-Hsiung, Hetherington, Timothy, Rossman, Whitney, Russo, Mark, Gibbs, Michael, and Kowalkowski, Marc A
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Health Services and Systems ,Nursing ,Health Sciences ,Clinical Research ,Sepsis ,Infectious Diseases ,Comparative Effectiveness Research ,Clinical Trials and Supportive Activities ,Health Services ,Patient Safety ,Hematology ,Good Health and Well Being ,Aftercare ,Aged ,Emergency Service ,Hospital ,Female ,Humans ,Male ,Middle Aged ,Outcome Assessment ,Health Care ,Patient Discharge ,Patient Readmission ,Risk Factors ,Transitional Care ,critical illness recovery ,mortality ,readmission ,sepsis ,survivorship ,Clinical Sciences ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesTo evaluate whether a nurse navigator-led, multicomponent Sepsis Transition And Recovery program improves 30-day mortality and readmission outcomes after sepsis hospitalization.Design: Multisite pragmatic randomized clinical trial.SettingThree hospitals in North Carolina from January 2019 to March 2020.PatientsEligible patients hospitalized for suspected sepsis and deemed high-risk for mortality or readmission by validated internal risk models.InterventionsPatients were randomized to receive usual care alone (i.e., routine transition support, outpatient care; n = 342) or additional Sepsis Transition And Recovery support (n = 349). The 30-day intervention involved a multicomponent transition service led by a nurse navigator through telephone and electronic health record communication to facilitate best practice postsepsis care strategies during and after hospitalization including: postdischarge medication review, evaluation for new impairments or symptoms, monitoring comorbidities, and palliative care approach when appropriate. Clinical oversight was provided by a Hospital Medicine Transition Services team.Measurements and main resultsThe primary outcome was a composite of mortality or hospital readmission at 30 days. Logistic regression models were constructed to evaluate marginal and conditional odds ratios (adjusted for prognostic covariates: age, comorbidity, and organ dysfunction at enrollment). Among 691 randomized patients (mean age = 63.7 ± 15.1 yr; 52% female), a lower percentage of patients in the Sepsis Transition And Recovery group experienced the primary outcome compared with the usual care group (28.7% vs 33.3%; risk difference, 4.7%; odds ratio, 0.80; 95% CI, 0.58-1.11; adjusted odds ratio, 0.80; 95% CI, 0.64-0.98). There were 74 deaths (Sepsis Transition And Recovery: 33 [9.5%] vs usual care: 41 [12.0%]) and 155 rehospitalizations (Sepsis Transition And Recovery: 71 [20.3%] vs usual care: 84 [24.6%]).ConclusionsIn a multisite randomized clinical trial of patients hospitalized with sepsis, patients provided with a 30-day program using a nurse navigator to provide best practices for postsepsis care experienced a lower proportion of either mortality or rehospitalization within 30 days after discharge. Further research is needed to understand the contextual factors associated with successful implementation.
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- 2022
10. Transfusion-Associated Delirium in Children: No Difference Between Short Storage Versus Standard Issue RBCs.
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Traube, Chani, Tucci, Marisa, Nellis, Marianne E, Avery, K Leslie, McQuillen, Patrick S, Fitzgerald, Julie C, Muszynski, Jennifer A, Cholette, Jill M, Schwarz, Adam J, Stalets, Erika L, Quaid, Maureen A, Hanson, Sheila J, Lacroix, Jacques, Reeder, Ron W, Spinella, Philip C, and Transfusion-Associated Delirium ABC-PICU Study Group
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Transfusion-Associated Delirium ABC-PICU Study Group ,Erythrocytes ,Animals ,Humans ,Rats ,Rats ,Sprague-Dawley ,Delirium ,Disease Models ,Animal ,Blood Transfusion ,Odds Ratio ,Prospective Studies ,Time Factors ,Child ,Blood Banks ,Female ,Male ,Surveys and Questionnaires ,Hematology ,Clinical Trials and Supportive Activities ,Clinical Research ,Brain Disorders ,age of blood ,Cornell assessment of pediatric delirium ,delirium ,pediatric critical care ,red blood cell transfusions ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine - Abstract
ObjectivesPrimary objective is to determine if transfusion of short storage RBCs compared with standard issue RBCs reduced risk of delirium/coma in critically ill children. Secondary objective is to assess if RBC transfusion was independently associated with delirium/coma.DesignThis study was performed in two stages. First, we compared patients receiving either short storage or standard RBCs in a multi-institutional prospective randomized controlled trial. Then, we compared all transfused patients in the randomized controlled trial with a single-center cohort of nontransfused patients matched for confounders of delirium/coma.SettingTwenty academic PICUs who participated in the Age of Transfused Blood in Critically Ill Children trial.PatientsChildren 3 days to 16 years old who were transfused RBCs within the first 7 days of admission.InterventionsSubjects were randomized to either short storage RBC study arm (defined as RBCs stored for up to seven days) or standard issue RBC study arm. In addition, subjects were screened for delirium prior to transfusion and every 12 hours after transfusion for up to 3 days.Measurements and main resultsPrimary outcome measure was development of delirium/coma within 3 days of initial transfusion. Additional outcome measures were dose-response relationship between volume of RBCs transfused and delirium/coma, and comparison of delirium/coma rates between transfused patients and individually matched nontransfused patients. We included 146 subjects in the stage I analysis; 69 were randomized to short storage RBCs and 77 to standard issue. There was no significant difference in delirium/coma development between study arms (79.5% vs 70.1%; p = 0.184). In the stage II analysis, adjusted odds for delirium in the transfused cohort was more than eight-fold higher than in the nontransfused matched cohort, even after controlling for hemoglobin (adjusted odds ratio, 8.9; CI, 2.8-28.4; p < 0.001).ConclusionsRBC transfusions (and not anemia) are independently associated with increased odds of subsequent delirium/coma. However, storage age of RBCs does not affect delirium risk.
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- 2022
11. Trends in Endotracheal Intubation During In-Hospital Cardiac Arrests: 2001-2018.
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Schwab, Kristin, Buhr, Russell G, Grossetreuer, Anne V, Balaji, Lakshman, Lee, Edward S, Moskowitz, Ari L, and American Heart Association’s Get With the Guidelines-Resuscitation Investigators
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American Heart Association’s Get With the Guidelines-Resuscitation Investigators ,Humans ,Heart Arrest ,Cardiopulmonary Resuscitation ,Prospective Studies ,Intubation ,Intratracheal ,Time Factors ,Aged ,Aged ,80 and over ,Middle Aged ,Hospitals ,Female ,Male ,Interrupted Time Series Analysis ,Clinical Research ,Cardiovascular ,Heart Disease ,advanced cardiac life support ,airway management ,cardiac arrest ,intubation ,resuscitation ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine - Abstract
ObjectivesAirway management during in-hospital cardiac arrest represents a fundamental component of resuscitative efforts, yet little is known about temporal trends in intubation during in-hospital cardiac arrest. Our objective was to investigate changes in in-hospital cardiac arrest airway management over time and in response to national guideline updates.DesignObservational cohort study of a prospectively collected database.SettingMulticenter study of hospitals participating in the "Get With The Guidelines-Resuscitation" registry from January 1, 2001, to December 31, 2018.SubjectsAdult patients who experienced an in-hospital cardiac arrest and did not have an invasive airway in place prior to the arrest.InterventionsThe primary outcome was the rate of intra-arrest intubation from 2001 to 2018. We constructed multivariable regression models with generalized estimating equations to determine the annual adjusted odds of intubation. We also assessed the timing of intubation relative to the onset of pulselessness and other arrest measures. We used an interrupted time-series analysis to assess the association between the 2010 Advanced Cardiac Life Support guideline update and intubation rates.Measurements and main resultsOne thousand sixty-six eight hundred patients from 797 hospitals were included. From 2001 to 2018, the percentage of patients intubated during an arrest decreased from 69% to 55% for all rhythms, 73% to 60% for nonshockable rhythms, and 58% to 36% for shockable rhythms (p < 0.001 for trend for all 3 groups). The median time from onset of pulselessness to intubation increased from 5 minutes in 2001 (interquartile range, 2-8 min) to 6 minutes in 2018 (interquartile range, 4-10 min) (p < 0.001 for trend). Following the 2010 guideline update, there was a downward step change and a steeper decrease over time in the rate of intubation as compared to the preintervention period (p < 0.001).ConclusionsEndotracheal intubation rates during in-hospital cardiac arrest have decreased significantly over time, with a more substantial decline following the updated 2010 guideline that prioritized chest compressions over airway management.
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- 2022
12. Association of Early Multiple Organ Dysfunction With Clinical and Functional Outcomes Over the Year Following Traumatic Brain Injury: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study
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Krishnamoorthy, Vijay, Temkin, Nancy, Barber, Jason, Foreman, Brandon, Komisarow, Jordan, Korley, Fred K, Laskowitz, Daniel T, Mathew, Joseph P, Hernandez, Adrian, Sampson, John, James, Michael L, Bartz, Raquel, Raghunathan, Karthik, Goldstein, Benjamin A, Markowitz, Amy J, and Vavilala, Monica S
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Rehabilitation ,Neurosciences ,Traumatic Head and Spine Injury ,Physical Injury - Accidents and Adverse Effects ,Brain Disorders ,Clinical Research ,Traumatic Brain Injury (TBI) ,Injuries and accidents ,Adult ,Brain Injuries ,Traumatic ,Cohort Studies ,Female ,Functional Status ,Glasgow Coma Scale ,Glasgow Outcome Scale ,Humans ,Male ,Multiple Organ Failure ,Organ Dysfunction Scores ,Proportional Hazards Models ,Prospective Studies ,Retrospective Studies ,multiple organ dysfunction ,outcomes ,shock ,trauma ,traumatic brain injury ,Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) Investigators ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine - Abstract
ObjectivesTraumatic brain injury is a leading cause of death and disability in the United States. While the impact of early multiple organ dysfunction syndrome has been studied in many critical care paradigms, the clinical impact of early multiple organ dysfunction syndrome in traumatic brain injury is poorly understood. We examined the incidence and impact of early multiple organ dysfunction syndrome on clinical, functional, and disability outcomes over the year following traumatic brain injury.DesignRetrospective cohort study.SettingPatients enrolled in the Transforming Clinical Research and Knowledge in Traumatic Brain Injury study, an 18-center prospective cohort study of traumatic brain injury patients evaluated in participating level 1 trauma centers.SubjectsAdult (age > 17 yr) patients with moderate-severe traumatic brain injury (Glasgow Coma Scale < 13). We excluded patients with major extracranial injury (Abbreviated Injury Scale score ≥ 3).InterventionsDevelopment of early multiple organ dysfunction syndrome, defined as a maximum modified Sequential Organ Failure Assessment score greater than 7 during the initial 72 hours following admission.Measurements and main resultsThe main outcomes were: hospital mortality, length of stay, 6-month functional and disability domains (Glasgow Outcome Scale-Extended and Disability Rating Scale), and 1-year mortality. Secondary outcomes included: ICU length of stay, 3-month Glasgow Outcome Scale-Extended, 3-month Disability Rating Scale, 1-year Glasgow Outcome Scale-Extended, and 1-year Disability Rating Scale. We examined 373 subjects with moderate-severe traumatic brain injury. The mean (sd) Glasgow Coma Scale in the emergency department was 5.8 (3.2), with 280 subjects (75%) classified as severe traumatic brain injury (Glasgow Coma Scale 3-8). Among subjects with moderate-severe traumatic brain injury, 252 (68%) developed early multiple organ dysfunction syndrome. Subjects that developed early multiple organ dysfunction syndrome had a 75% decreased odds of a favorable outcome (Glasgow Outcome Scale-Extended 5-8) at 6 months (adjusted odds ratio, 0.25; 95% CI, 0.12-0.51) and increased disability (higher Disability Rating Scale score) at 6 months (adjusted mean difference, 2.04; 95% CI, 0.92-3.17). Subjects that developed early multiple organ dysfunction syndrome experienced an increased hospital length of stay (adjusted mean difference, 11.4 d; 95% CI, 7.1-15.8), with a nonsignificantly decreased survival to hospital discharge (odds ratio, 0.47; 95% CI, 0.18-1.2).ConclusionsEarly multiple organ dysfunction following moderate-severe traumatic brain injury is common and independently impacts multiple domains (mortality, function, and disability) over the year following injury. Further research is necessary to understand underlying mechanisms, improve early recognition, and optimize management strategies.
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- 2021
13. Design of Clinical Trials Evaluating Sedation in Critically Ill Adults Undergoing Mechanical Ventilation: Recommendations From Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research (SCEPTER) Recommendation III
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Ward, Denham S, Absalom, Anthony R, Aitken, Leanne M, Balas, Michele C, Brown, David L, Burry, Lisa, Colantuoni, Elizabeth, Coursin, Douglas, Devlin, John W, Dexter, Franklin, Dworkin, Robert H, Egan, Talmage D, Elliott, Doug, Egerod, Ingrid, Flood, Pamela, Fraser, Gilles L, Girard, Timothy D, Gozal, David, Hopkins, Ramona O, Kress, John, Maze, Mervyn, Needham, Dale M, Pandharipande, Pratik, Riker, Richard, Sessler, Daniel I, Shafer, Steven L, Shehabi, Yahya, Spies, Claudia, Sun, Lena S, Tung, Avery, and Urman, Richard D
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Biomedical and Clinical Sciences ,Clinical Sciences ,Prevention ,Clinical Trials and Supportive Activities ,Clinical Research ,Patient Safety ,Generic health relevance ,Quality Education ,Congresses as Topic ,Consensus ,Delphi Technique ,District of Columbia ,Humans ,Hypnotics and Sedatives ,Respiration ,Artificial ,Time Factors ,clinical trial ,intensive care ,outcome assessments ,research methodology ,sedation ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesClinical trials evaluating the safety and effectiveness of sedative medication use in critically ill adults undergoing mechanical ventilation differ considerably in their methodological approach. This heterogeneity impedes the ability to compare results across studies. The Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research Recommendations convened a meeting of multidisciplinary experts to develop recommendations for key methodologic elements of sedation trials in the ICU to help guide academic and industry clinical investigators.DesignA 2-day in-person meeting was held in Washington, DC, on March 28-29, 2019, followed by a three-round, online modified Delphi consensus process.ParticipantsThirty-six participants from academia, industry, and the Food and Drug Administration with expertise in relevant content areas, including two former ICU patients attended the in-person meeting, and the majority completed an online follow-up survey and participated in the modified Delphi process.Measurements and main resultsThe final recommendations were iteratively refined based on the survey results, participants' reactions to those results, summaries written by panel moderators, and a review of the meeting transcripts made from audio recordings. Fifteen recommendations were developed for study design and conduct, subject enrollment, outcomes, and measurement instruments. Consensus recommendations included obtaining input from ICU survivors and/or their families, ensuring adequate training for personnel using validated instruments for assessments of sedation, pain, and delirium in the ICU environment, and the need for methodological standardization.ConclusionsThese recommendations are intended to assist researchers in the design, conduct, selection of endpoints, and reporting of clinical trials involving sedative medications and/or sedation protocols for adult ICU patients who require mechanical ventilation. These recommendations should be viewed as a starting point to improve clinical trials and help reduce methodological heterogeneity in future clinical trials.
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- 2021
14. Long-Term Implications of Abnormal Left Ventricular Strain During Sepsis.
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Beesley, Sarah J, Sorensen, Jeff, Walkey, Allan J, Tonna, Joseph E, Lanspa, Michael J, Hirshberg, Ellie, Grissom, Colin K, Horne, Benjamin D, Burk, Rebecca, Abraham, Theodore P, Paine, Robert, and Brown, Samuel M
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Sepsis ,Cardiovascular ,Clinical Research ,Heart Disease ,Patient Safety ,Hematology ,Infectious Diseases ,Aetiology ,2.1 Biological and endogenous factors ,Inflammatory and immune system ,Good Health and Well Being ,Adult ,Cardiomyopathies ,Echocardiography ,Heart Ventricles ,Humans ,Male ,Middle Aged ,Retrospective Studies ,Risk Factors ,Stroke Volume ,Time Factors ,Ventricular Dysfunction ,Left ,cardiomyopathy ,cardiovascular event ,sepsis ,septic cardiomyopathy ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine - Abstract
ObjectivesSeptic cardiomyopathy develops frequently in patients with sepsis and likely increases short-term mortality. However, whether septic cardiomyopathy is associated with long-term outcomes after sepsis is unknown. We investigated whether septic patients with septic cardiomyopathy have worse long-term outcomes than septic patients without septic cardiomyopathy.DesignRetrospective cohort study.SettingAdult ICU.PatientsAdult ICU patients with sepsis.InterventionsNone.Measurements and main resultsLeft ventricular global longitudinal systolic strain was our primary measure of septic cardiomyopathy. We employed a suite of multivariable survival analyses to explore linear and nonlinear associations between left ventricular global longitudinal systolic strain and major adverse cardiovascular events, which included death, stroke, and myocardial infarction. Our primary outcome was major adverse cardiovascular event through 24 months after ICU discharge. Among 290 study patients, median left ventricular global longitudinal systolic strain was -16.8% (interquartile range, -20.4% to -12.6%), and 38.3% of patients (n = 111) experienced a major adverse cardiovascular event within 24 months after discharge. On our primary, linear analysis, there was a trend (p = 0.08) toward association between left ventricular global longitudinal systolic strain and major adverse cardiovascular event (odds ratio, 1.03; CI, < 1 to 1.07). On our nonlinear analysis, the association was highly significant (p < 0.001) with both high and low left ventricular global longitudinal systolic strain associated with major adverse cardiovascular event among patients with pre-existing cardiac disease. This association was pronounced among patients who were younger (age < 65 yr) and had Charlson Comorbidity Index greater than 5.ConclusionsAmong patients with sepsis and pre-existing cardiac disease who survived to ICU discharge, left ventricular global longitudinal systolic strain demonstrated a U-shaped association with cardiovascular outcomes through 24 months. The relationship was especially strong among younger patients with more comorbidities. These observations are likely of use to design of future trials.
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- 2021
15. Catecholaminergic Vasopressors Reduce Toll-Like Receptor Agonist-Induced Microvascular Endothelial Cell Permeability But Not Cytokine Production
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Joffre, Jérémie, Lloyd, Elliot, Wong, Erika, Chung-Yeh, Che, Nguyen, Nina, Xu, Fenguyn, Legrand, Matthieu, and Hellman, Judith
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Mental Health ,Development of treatments and therapeutic interventions ,Aetiology ,5.1 Pharmaceuticals ,2.1 Biological and endogenous factors ,Cardiovascular ,Capillary Permeability ,Cell Movement ,Cells ,Cultured ,Endothelial Cells ,Endothelium ,Vascular ,Epinephrine ,Humans ,Norepinephrine ,Toll-Like Receptors ,Vasoconstrictor Agents ,catecholamines ,endothelial cells ,inflammation ,permeability ,sepsis ,vasopressors ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine - Abstract
ObjectivesCatecholaminergic vasopressors are the cornerstone of circulatory shock management. Nevertheless, catecholamines have problematic side effects, arousing a growing interest in noncatecholaminergic agents such as vasopressin or angiotensin-II. However, their respective effects on sepsis-associated microvascular endothelial dysfunction such as permeability or inflammation remain elusive. We investigated the role of catecholamines and other vasopressors on Toll-like receptor agonists-induced microvascular endothelial permeability and inflammation.SettingUniversity research laboratory/cell research.SubjectsHuman pulmonary microvascular endothelial cells from multiple donors.InterventionConfluent monolayers of human pulmonary microvascular endothelial cells were treated with Toll-like receptor agonists (lipopolysaccharide, Poly[I:C], or tripalmitoyl-S-glyceryl cysteine) in the presence or absence of epinephrine, norepinephrine, vasopressin, and angiotensin-II. Permeability was inferred from transendothelial resistance, measured using electrical cell impedance sensing, where decreased transendothelial resistance is consistent with increased permeability. Cell-cell junction molecule expression was assessed via immunofluorescence microscopy and flow cytometry. We quantified cytokines in supernatants of Toll-like receptor agonist-treated human pulmonary microvascular endothelial cells.Measurements and main resultsEpinephrine and norepinephrine both ameliorate lipopolysaccharide, polyinosinic:polycytidylic acid, or tripalmitoyl-S-glyceryl cysteine-induced reductions in transendothelial resistance, a surrogate for endothelial permeability. In contrast, the noncatecholaminergic agents, vasopressin, and angiotensin-II did not affect Toll-like receptor agonists-induced reductions in transendothelial resistance. β1- and β2-adrenergic receptor antagonists reduced the effects of the catecholamines on transendothelial resistance, whereas α-adrenergic receptor antagonists did not. We observed that epinephrine and norepinephrine induced actin cytoskeletal rearrangement and normalized the membrane expression of proteins involved with adherens-junctions (vascular endothelial-cadherin) and tight-junctions (zona occludens-1). Despite having a substantial effect on endothelial permeability, epinephrine and norepinephrine did not affect human pulmonary microvascular endothelial cell survival or production of interleukin-8, interleukin-6, or monocyte chemoattractant protein-1 (CCL-2) induced by Toll-like receptor agonists, suggesting that these functions are regulated separately from permeability.ConclusionsOur findings demonstrate that treatment with epinephrine or norepinephrine strongly reduces endothelial permeability induced by agonists of multiple Toll-like receptors (Toll-like receptor-2, Toll-like receptor-3, Toll-like receptor-4) in vitro. Our studies suggest that both β1- and β2-adrenergic receptors mediate the stabilizing effects of epinephrine and norepinephrine on the endothelial barrier.
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- 2021
16. Practitioner's Guide to Latent Class Analysis: Methodological Considerations and Common Pitfalls.
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Sinha, Pratik, Calfee, Carolyn S, and Delucchi, Kevin L
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Biomedical and Clinical Sciences ,Nursing ,Clinical Sciences ,Health Sciences ,Data Interpretation ,Statistical ,Humans ,Latent Class Analysis ,Statistics as Topic ,clustering algorithms ,data science ,heterogeneity ,latent class analysis ,phenotypes ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
Latent class analysis is a probabilistic modeling algorithm that allows clustering of data and statistical inference. There has been a recent upsurge in the application of latent class analysis in the fields of critical care, respiratory medicine, and beyond. In this review, we present a brief overview of the principles behind latent class analysis. Furthermore, in a stepwise manner, we outline the key processes necessary to perform latent class analysis including some of the challenges and pitfalls faced at each of these steps. The review provides a one-stop shop for investigators seeking to apply latent class analysis to their data.
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- 2021
17. Individualized Care Is Superior to Standardized Care for the Majority of Critically Ill Patients.
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Cortés-Puch, Irene, Applefeld, Willard, Wang, Jeffrey, Danner, Robert, Eichacker, Peter, and Natanson, Charles
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Clinical Protocols ,Critical Care ,Critical Illness ,Humans ,Precision Medicine - Abstract
Tools for standardizing patient care can take many forms, including but not limited to, bundles, quality improvement and performance measures, guidelines, and protocols. Each is intended to improve compliance with interventions believed to be supported by the best available evidence, ensuring consistency of management across all patients with the ultimate goal of improving outcomes. However, in the ICU, patients typically present with complex acute illnesses and accompanying comorbidities, requiring careful tailoring of interventions and treatments for each individual patient. The rapidly changing nature of the underlying conditions also demands continuous reassessment and modification of each patient’s management on a frequent and sometimes moment-by-moment basis. Disrupting this individualized treatment approach by imposing prescriptive, overly restrictive, “one-size-fits-all” standardized treatments in the critical care setting may prevent the clinician from meeting individual patients’ needs and decrease care quality (1). This problem is compounded if the standardization tools adopted are not only inflexible but also have a poorly supported or entirely absent scientific basis. Importantly, identifiable patient subcategories often exist that fit poorly into the populations for which many interventions were developed and tested. Of equal concern, critical care trainees may become dependent on a standardized/cookbook approach to care and fail to recognize and learn how treatments must be tailored for the unique needs of each critically ill patient. Rather than rigidly standardizing critical care, approaches that recognize this complexity and are both scientifically sound and responsive to patient differences should be readily available to critical care clinicians without replacing sensible clinical judgment. Such strategies that acknowledge the limitations of available evidence hold more hope of improving, rather than inadvertently worsening, the outcome.
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- 2020
18. A Core Outcome Set for Pediatric Critical Care.
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Fink, Ericka L, Maddux, Aline B, Pinto, Neethi, Sorenson, Samuel, Notterman, Daniel, Dean, J Michael, Carcillo, Joseph A, Berg, Robert A, Zuppa, Athena, Pollack, Murray M, Meert, Kathleen L, Hall, Mark W, Sapru, Anil, McQuillen, Patrick S, Mourani, Peter M, Wessel, David, Amey, Deborah, Argent, Andrew, Brunow de Carvalho, Werther, Butt, Warwick, Choong, Karen, Curley, Martha AQ, Del Pilar Arias Lopez, Maria, Demirkol, Demet, Grosskreuz, Ruth, Houtrow, Amy J, Knoester, Hennie, Lee, Jan Hau, Long, Debbie, Manning, Joseph C, Morrow, Brenda, Sankar, Jhuma, Slomine, Beth S, Smith, McKenna, Olson, Lenora M, and Watson, R Scott
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Clinical Research ,Behavioral and Social Science ,Pediatric ,Good Health and Well Being ,Adult ,Aged ,Child ,Child Health ,Critical Care ,Critical Illness ,Delphi Technique ,Female ,Humans ,Intensive Care Units ,Pediatric ,Male ,Middle Aged ,Stakeholder Participation ,Treatment Outcome ,Young Adult ,child ,critical care ,family ,outcome assessment ,postintensive care syndrome ,Pediatric Outcomes STudies after PICU (POST-PICU) Investigators of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine - Abstract
ObjectivesMore children are surviving critical illness but are at risk of residual or new health conditions. An evidence-informed and stakeholder-recommended core outcome set is lacking for pediatric critical care outcomes. Our objective was to create a multinational, multistakeholder-recommended pediatric critical care core outcome set for inclusion in clinical and research programs.DesignA two-round modified Delphi electronic survey was conducted with 333 invited research, clinical, and family/advocate stakeholders. Stakeholders completing the first round were invited to participate in the second. Outcomes scoring greater than 69% "critical" and less than 15% "not important" advanced to round 2 with write-in outcomes considered. The Steering Committee held a virtual consensus conference to determine the final components.SettingMultinational survey.PatientsStakeholder participants from six continents representing clinicians, researchers, and family/advocates.Measurements and main resultsOverall response rates were 75% and 82% for each round. Participants voted on seven Global Domains and 45 Specific Outcomes in round 1, and six Global Domains and 30 Specific Outcomes in round 2. Using overall (three stakeholder groups combined) results, consensus was defined as outcomes scoring greater than 90% "critical" and less than 15% "not important" and were included in the final PICU core outcome set: four Global Domains (Cognitive, Emotional, Physical, and Overall Health) and four Specific Outcomes (Child Health-Related Quality of Life, Pain, Survival, and Communication). Families (n = 21) suggested additional critically important outcomes that did not meet consensus, which were included in the PICU core outcome set-extended.ConclusionsThe PICU core outcome set and PICU core outcome set-extended are multistakeholder-recommended resources for clinical and research programs that seek to improve outcomes for children with critical illness and their families.
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- 2020
19. Variation in Fluid and Vasopressor Use in Shock With and Without Physiologic Assessment: A Multicenter Observational Study.
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Chen, Jen-Ting, Roberts, Russel, Fazzari, Melissa J, Kashani, Kianoush, Qadir, Nida, Cairns, Charles B, Mathews, Kusum, Park, Pauline, Khan, Akram, Gilmore, James F, Brown, Anne Rain T, Tsuei, Betty, Handzel, Michele, Lee Chang, Alfredo, Duggal, Abhijit, Lanspa, Michael, Herbert, James Taylor, Martinez, Anthony, Tonna, Joseph, Ammar, Mahmoud A, Hammond, Drayton, Nazer, Lama H, Heavner, Mojdeh, Pender, Erin, Chambers, Lauren, Kenes, Michael T, Kaufman, David, Downey, April, Brown, Brent, Chaykosky, Darlene, Wolff, Armand, Smith, Michael, Nault, Katie, Sevransky, Jonathan, and Gong, Michelle N
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Clinical Research ,Hematology ,Good Health and Well Being ,APACHE ,Adult ,Aged ,Aged ,80 and over ,Blood Pressure ,Central Venous Pressure ,Dose-Response Relationship ,Drug ,Female ,Fluid Therapy ,Hospital Mortality ,Humans ,Intensive Care Units ,Male ,Middle Aged ,Organ Dysfunction Scores ,Prospective Studies ,Shock ,Vasoconstrictor Agents ,fluid ,hemodynamic monitor ,mortality ,resuscitation ,shock ,vasopressor ,VOLUME-CHASERS Study Group and Society of Critical Care Medicine Discovery Network ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesTo characterize the association between the use of physiologic assessment (central venous pressure, pulmonary artery occlusion pressure, stroke volume variation, pulse pressure variation, passive leg raise test, and critical care ultrasound) with fluid and vasopressor administration 24 hours after shock onset and with in-hospital mortality.DesignMulticenter prospective cohort study between September 2017 and February 2018.SettingsThirty-four hospitals in the United States and Jordan.PatientsConsecutive adult patients requiring admission to the ICU with systolic blood pressure less than or equal to 90 mm Hg, mean arterial blood pressure less than or equal to 65 mm Hg, or need for vasopressor.InterventionsNone.Measurement and main resultsOf 1,639 patients enrolled, 39% had physiologic assessments. Use of physiologic assessment was not associated with cumulative fluid administered within 24 hours of shock onset, after accounting for baseline characteristics, etiology and location of shock, ICU types, Acute Physiology and Chronic Health Evaluation III, and hospital (beta coefficient, 0.04; 95% CI, -0.07 to 0.15). In multivariate analysis, the use of physiologic assessment was associated with a higher likelihood of vasopressor use (adjusted odds ratio, 1.98; 95% CI, 1.45-2.71) and higher 24-hour cumulative vasopressor dosing as norepinephrine equivalent (beta coefficient, 0.37; 95% CI, 0.19-0.55). The use of vasopressor was associated with increased odds of in-hospital mortality (adjusted odds ratio, 1.88; 95% CI, 1.27-2.78). In-hospital mortality was not associated with the use of physiologic assessment (adjusted odds ratio, 0.86; 95% CI, 0.63-1.18).ConclusionsThe use of physiologic assessment in the 24 hours after shock onset is associated with increased use of vasopressor but not with fluid administration.
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- 2020
20. The Surviving Sepsis Campaign: Basic/Translational Science Research Priorities*
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Deutschman, Clifford S, Hellman, Judith, Ferrer Roca, Ricard, De Backer, Daniel, and Coopersmith, Craig M
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Biomedical and Clinical Sciences ,Nursing ,Clinical Sciences ,Health Sciences ,Advisory Committees ,Forecasting ,Humans ,Microbiota ,Research ,Sepsis ,Translational Research ,Biomedical ,basic science ,research ,sepsis ,surviving sepsis campaign ,translational science ,Research Committee of the Surviving Sepsis Campaign ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesExpound upon priorities for basic/translational science identified in a recent paper by a group of experts assigned by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine.Data sourcesOriginal paper, search of the literature.Study selectionBy several members of the original task force with specific expertise in basic/translational science.Data extractionNone.Data synthesisNone.ConclusionsIn the first of a series of follow-up reports to the original paper, several members of the original task force with specific expertise provided a more in-depth analysis of the five identified priorities directly related to basic/translational science. This analysis expounds on what is known about the question and what was identified as priorities for ongoing research. It is hoped that this analysis will aid the development of future research initiatives.
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- 2020
21. Clinician Recognition of the Acute Respiratory Distress Syndrome: Risk Factors for Under-Recognition and Trends Over Time.
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Schwede, Matthew, Lee, Robert Y, Zhuo, Hanjing, Kangelaris, Kirsten N, Jauregui, Alejandra, Vessel, Kathryn, Belzer, Annika, Deiss, Thomas, Matthay, Michael A, Liu, Kathleen D, and Calfee, Carolyn S
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Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Acute Respiratory Distress Syndrome ,Lung ,Rare Diseases ,Management of diseases and conditions ,7.3 Management and decision making ,Respiratory ,Age Factors ,Delayed Diagnosis ,Diagnosis ,Differential ,Humans ,Intensive Care Units ,Racial Groups ,Respiration ,Artificial ,Respiratory Distress Syndrome ,Retrospective Studies ,Risk Factors ,San Francisco ,Severity of Illness Index ,Sex Factors ,Tertiary Care Centers ,Tidal Volume ,acute respiratory distress syndrome ,critical care ,diagnosis ,documentation ,electronic health record ,risk factors ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesThe acute respiratory distress syndrome is common in critically ill patients. Recognition is crucial because acute respiratory distress syndrome is associated with a high mortality rate, and low tidal volume ventilation improves mortality. However, acute respiratory distress syndrome often goes unrecognized. Risk factors for under-recognition and trends over time have not been fully described.DesignRetrospective chart review of patients with acute respiratory distress syndrome from a prospective cohort study of critically ill patients. For each patient's ICU stay, we searched the chart for terms that indicated that acute respiratory distress syndrome was diagnosed, in the differential diagnosis, or treated with low tidal volume ventilation.SettingICUs at a tertiary hospital at the University of California, San Francisco between 2008 and 2016.PatientsCritically ill patients with acute respiratory distress syndrome.InterventionsNone.Measurements and main resultsAcute respiratory distress syndrome was recognized in 70% of patients, and recognition increased from 60% in 2008-2009 to 92% in 2016 (p = 0.004). Use of tidal volumes less than 6.5 mL/kg also increased (p < 0.001) from 20% to 92%. Increased acute respiratory distress syndrome severity (p = 0.01) and vasopressor use (p = 0.04) were associated with greater recognition. Clinician diagnosis of acute respiratory distress syndrome and inclusion of acute respiratory distress syndrome in the differential diagnosis were associated with tidal volumes less than 6.5 mL/kg (51% use of tidal volume ≤ 6.5 mL/kg if acute respiratory distress syndrome recognized vs 15% if not recognized; p = 0.002). Diagnosing acute respiratory distress syndrome was associated with lower tidal volume in multivariate analysis.ConclusionsAlthough acute respiratory distress syndrome recognition and low tidal volume ventilation use have increased over time, they remain less than universal. Clinician recognition of acute respiratory distress syndrome is associated with both systemic and respiratory severity of illness and is also associated with use of low tidal volume ventilation.
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- 2020
22. Time to Recognition of Sepsis in the Emergency Department Using Electronic Health Record Data: A Comparative Analysis of Systemic Inflammatory Response Syndrome, Sequential Organ Failure Assessment, and Quick Sequential Organ Failure Assessment.
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Prasad, Priya A, Fang, Margaret C, Abe-Jones, Yumiko, Calfee, Carolyn S, Matthay, Michael A, and Kangelaris, Kirsten N
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Biomedical and Clinical Sciences ,Clinical Sciences ,Health Sciences ,Infectious Diseases ,Sepsis ,Hematology ,Health Services ,Clinical Research ,Infection ,Inflammatory and immune system ,Good Health and Well Being ,Adult ,Aged ,Comorbidity ,Early Diagnosis ,Electronic Health Records ,Emergency Service ,Hospital ,Female ,Humans ,Intensive Care Units ,Male ,Middle Aged ,Organ Dysfunction Scores ,Retrospective Studies ,Systemic Inflammatory Response Syndrome ,Time Factors ,critical care ,electronic health records ,emergency medicine ,organ dysfunction scores ,sepsis ,systemic inflammatory response syndrome ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
OBJECTIVES:Early identification of sepsis is critical to improving patient outcomes. Impact of the new sepsis definition (Sepsis-3) on timing of recognition in the emergency department has not been evaluated. Our study objective was to compare time to meeting systemic inflammatory response syndrome (Sepsis-2) criteria, Sequential Organ Failure Assessment (Sepsis-3) criteria, and quick Sequential Organ Failure Assessment criteria using electronic health record data. DESIGN:Retrospective, observational study. SETTING:The emergency department at the University of California, San Francisco. PATIENTS:Emergency department encounters between June 2012 and December 2016 for patients greater than or equal to 18 years old with blood cultures ordered, IV antibiotic receipt, and identification with sepsis via systemic inflammatory response syndrome or Sequential Organ Failure Assessment within 72 hours of emergency department presentation. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:We analyzed timestamped electronic health record data from 16,612 encounters identified as sepsis by greater than or equal to 2 systemic inflammatory response syndrome criteria or a Sequential Organ Failure Assessment score greater than or equal to 2. The primary outcome was time from emergency department presentation to meeting greater than or equal to 2 systemic inflammatory response syndrome criteria, Sequential Organ Failure Assessment greater than or equal to 2, and/or greater than or equal to 2 quick Sequential Organ Failure Assessment criteria. There were 9,087 patients (54.7%) that met systemic inflammatory response syndrome-first a median of 26 minutes post-emergency department presentation (interquartile range, 0-109 min), with 83.1% meeting Sequential Organ Failure Assessment criteria a median of 118 minutes later (interquartile range, 44-401 min). There were 7,037 patients (42.3%) that met Sequential Organ Failure Assessment-first, a median of 113 minutes post-emergency department presentation (interquartile range, 60-251 min). Quick Sequential Organ Failure Assessment was met in 46.4% of patients a median of 351 minutes post-emergency department presentation (interquartile range, 67-1,165 min). Adjusted odds of in-hospital mortality were 39% greater in patients who met systemic inflammatory response syndrome-first compared with those who met Sequential Organ Failure Assessment-first (odds ratio, 1.39; 95% CI, 1.20-1.61). CONCLUSIONS:Systemic inflammatory response syndrome and Sequential Organ Failure Assessment initially identified distinct populations. Using systemic inflammatory response syndrome resulted in earlier electronic health record sepsis identification in greater than 50% of patients. Using Sequential Organ Failure Assessment alone may delay identification. Using systemic inflammatory response syndrome alone may lead to missed sepsis presenting as acute organ dysfunction. Thus, a combination of inflammatory (systemic inflammatory response syndrome) and organ dysfunction (Sequential Organ Failure Assessment) criteria may enhance timely electronic health record-based sepsis identification.
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- 2020
23. Ramelteon for Prevention of Postoperative Delirium: A Randomized Controlled Trial in Patients Undergoing Elective Pulmonary Thromboendarterectomy.
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Jaiswal, Stuti, Vyas, Anuja, Heisel, Andrew, Ackula, Haritha, Aggarwal, Ashna, Kim, Nick, Kerr, Kim, Pretorius, Victor, Auger, William, Owens, Robert, Malhotra, Atul, Madani, Michael, and Fernandes, Timothy
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Adult ,Aged ,Delirium ,Double-Blind Method ,Elective Surgical Procedures ,Endarterectomy ,Female ,Humans ,Indenes ,Male ,Middle Aged ,Postoperative Complications - Abstract
OBJECTIVES: To assess the efficacy of ramelteon in preventing delirium, an acute neuropsychiatric condition associated with increased morbidity and mortality, in the perioperative, ICU setting. DESIGN: Parallel-arm, randomized, double-blinded, placebo-controlled trial. SETTING: Academic medical center in La Jolla, California. PATIENTS: Patients greater than or equal to 18 years undergoing elective pulmonary thromboendarterectomy. INTERVENTIONS: Ramelteon 8 mg or matching placebo starting the night prior to surgery and for a maximum of six nights while in the ICU. MEASUREMENTS AND MAIN RESULTS: Incident delirium was measured twice daily using the Confusion Assessment Method-ICU. The safety outcome was coma-free days assessed by the Richmond Agitation-Sedation Scale. One-hundred twenty participants were enrolled and analysis completed in 117. Delirium occurred in 22 of 58 patients allocated to placebo versus 19 of 59 allocated to ramelteon (relative risk, 0.8; 95% CI, 0.5-1.4; p = 0.516). Delirium duration, as assessed by the number of delirium-free days was also similar in both groups (placebo median 2 d [interquartile range, 2-3 d] vs ramelteon 3 d [2-5 d]; p = 0.181). Coma-free days was also similar between groups (placebo median 2 d [interquartile range, 1-3 d] vs ramelteon 3 d [2-4 d]; p = 0.210). We found no difference in ICU length of stay (median 4 d [interquartile range, 3-5 d] vs 4 d [3-6 d]; p = 0.349), or in-hospital mortality (four vs three deaths; relative risk ratio, 0.7; 95% CI, 0.2-3.2; p = 0.717), all placebo versus ramelteon, respectively. CONCLUSIONS: Ramelteon 8 mg did not prevent postoperative delirium in patients admitted for elective cardiac surgery.
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- 2019
24. Ventilation Rates and Pediatric In-Hospital Cardiac Arrest Survival Outcomes.
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Sutton, Robert M, Reeder, Ron W, Landis, William P, Meert, Kathleen L, Yates, Andrew R, Morgan, Ryan W, Berger, John T, Newth, Christopher J, Carcillo, Joseph A, McQuillen, Patrick S, Harrison, Rick E, Moler, Frank W, Pollack, Murray M, Carpenter, Todd C, Notterman, Daniel A, Holubkov, Richard, Dean, J Michael, Nadkarni, Vinay M, and Berg, Robert A
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Health Sciences ,Cardiovascular ,Pediatric ,Clinical Research ,Arterial Pressure ,Capnography ,Cardiopulmonary Resuscitation ,Female ,Heart Arrest ,Hospital Mortality ,Humans ,Hypotension ,Infant ,Intensive Care Units ,Pediatric ,Male ,Patient Discharge ,Prospective Studies ,Pulmonary Ventilation ,Respiratory Insufficiency ,Systole ,cardiac arrest ,cardiopulmonary resuscitation ,pediatric ,ventilation ,Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesThe objective of this study was to associate ventilation rates during in-hospital cardiopulmonary resuscitation with 1) arterial blood pressure during cardiopulmonary resuscitation and 2) survival outcomes.DesignProspective, multicenter observational study.SettingPediatric and pediatric cardiac ICUs of the Collaborative Pediatric Critical Care Research Network.PatientsIntubated children (≥ 37 wk gestation and < 19 yr old) who received at least 1 minute of cardiopulmonary resuscitation.InterventionsNone.Measurements and main resultsArterial blood pressure and ventilation rate (breaths/min) were manually extracted from arterial line and capnogram waveforms. Guideline rate was defined as 10 ± 2 breaths/min; high ventilation rate as greater than or equal to 30 breaths/min in children less than 1 year old, and greater than or equal to 25 breaths/min in older children. The primary outcome was survival to hospital discharge. Regression models using Firth penalized likelihood assessed the association between ventilation rates and outcomes. Ventilation rates were available for 52 events (47 patients). More than half of patients (30/47; 64%) were less than 1 year old. Eighteen patients (38%) survived to discharge. Median event-level average ventilation rate was 29.8 breaths/min (interquartile range, 23.8-35.7). No event-level average ventilation rate was within guidelines; 30 events (58%) had high ventilation rates. The only significant association between ventilation rate and arterial blood pressure occurred in children 1 year old or older and was present for systolic blood pressure only (-17.8 mm Hg/10 breaths/min; 95% CI, -27.6 to -8.1; p < 0.01). High ventilation rates were associated with a higher odds of survival to discharge (odds ratio, 4.73; p = 0.029). This association was stable after individually controlling for location (adjusted odds ratio, 5.97; p = 0.022), initial rhythm (adjusted odds ratio, 3.87; p = 0.066), and time of day (adjusted odds ratio, 4.12; p = 0.049).ConclusionsIn this multicenter cohort, ventilation rates exceeding guidelines were common. Among the range of rates delivered, higher rates were associated with improved survival to hospital discharge.
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- 2019
25. A Multicenter Study of the Causes and Consequences of Optimistic Expectations About Prognosis by Surrogate Decision-Makers in ICUs.
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White, Douglas B, Carson, Shannon, Anderson, Wendy, Steingrub, Jay, Bird, Garrett, Curtis, J Randall, Matthay, Michael, Peterson, Michael, Buddadhumaruk, Praewpannarai, Shields, Anne-Marie, Ernecoff, Natalie, Shotsberger, Kaitlin, Weissfeld, Lisa, Chang, Chung-Chou H, Pike, Francis, Lo, Bernard, and Hough, Catherine L
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Health Services and Systems ,Biomedical and Clinical Sciences ,Health Sciences ,Clinical Research ,Prevention ,Management of diseases and conditions ,7.3 Management and decision making ,APACHE ,Adult ,Aged ,Communication ,Decision Making ,Female ,Humans ,Intensive Care Units ,Length of Stay ,Male ,Middle Aged ,Optimism ,Physicians ,Professional-Family Relations ,Prognosis ,Prospective Studies ,Proxy ,Survival Analysis ,United States ,Withholding Treatment ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesOptimistic expectations about prognosis by surrogate decision-makers in ICUs are common, but there are few data about the causes and clinical consequences. Our objective was to determine the causes of optimistic expectations about prognosis among surrogates and whether it is associated with more use of life support at the end of life.DesignProspective, multicenter cohort study from 2009 to 2012.SettingTwelve ICUs from multiple regions of the United States.SubjectsThe surrogates and physicians of 275 incapacitated ICU patients at high risk of death.InterventionsNone.Measurements and main resultsSurrogates and physicians completed a validated instrument assessing their prognostic expectations for hospital survival. We determined the proportion of surrogates with optimistic expectations, defined as a prognostic estimate that was at least 20% more optimistic than the physician's, then determined how frequently this arose from surrogates miscomprehending the physicians' prognosis versus holding more hopeful beliefs compared with the physician. We used multivariable regression to examine whether optimistic expectations were associated with length of stay, stratified by survival status, and time to withdrawal of life support among nonsurvivors. Overall, 45% of surrogates (95% CI, 38-51%) held optimistic expectations about prognosis, which arose from a combination of misunderstanding the physician's prognostic expectations and from holding more hopeful beliefs compared with the physician. Optimistic expectations by surrogates were associated with significantly longer duration of ICU treatment among nonsurvivors before death (β coefficient = 0.44; 95% CI, 0.05-0.83; p = 0.027), corresponding to a 56% longer ICU stay. This difference was associated with a significantly longer time to withdrawal of life support among dying patients whose surrogates had optimistic prognostic expectations compared with those who did not (β coefficient = 0.61; 95% CI, 0.16-1.07; p = 0.009).ConclusionsThe prevalent optimism about prognosis among surrogates in ICUs arises both from surrogates' miscomprehension of physicians' prognostications and from surrogates holding more hopeful beliefs. This optimism is associated with longer duration of life support at the end of life.
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- 2019
26. Association of Elevated Plasma Interleukin-18 Level With Increased Mortality in a Clinical Trial of Statin Treatment for Acute Respiratory Distress Syndrome.
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Rogers, Angela J, Guan, Jiazhen, Trtchounian, Anna, Hunninghake, Gary M, Kaimal, Rajani, Desai, Manisha, Kozikowski, Lori-Ann, DeSouza, Lesley, Mogan, Susan, Liu, Kathleen D, Matthay, Michael A, Steingrub, Jay, Wheeler, Art, Yoon, Joo Heon, Nakahira, Kiichi, Choi, Augustine M, and Baron, Rebecca M
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Biomedical and Clinical Sciences ,Clinical Sciences ,Lung ,Acute Respiratory Distress Syndrome ,Infectious Diseases ,Sepsis ,Clinical Research ,Clinical Trials and Supportive Activities ,Hematology ,Rare Diseases ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Respiratory ,Good Health and Well Being ,Acute Lung Injury ,Adult ,Female ,Humans ,Intensive Care Units ,Interleukin-18 ,Male ,Middle Aged ,Pulmonary Alveoli ,Respiratory Distress Syndrome ,Retrospective Studies ,acute respiratory distress syndrome ,inflammasome ,intensive care unit outcomes ,interleukin-18 ,sepsis ,statin ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectiveA high plasma level of inflammasome mediator interleukin-18 was associated with mortality in observational acute respiratory distress syndrome cohorts. Statin exposure increases both inflammasome activation and lung injury in mouse models. We tested whether randomization to statin therapy correlated with increased interleukin-18 in the ARDS Network Statins for Acutely Injured Lungs from Sepsis trial.DesignRetrospective analysis of randomized controlled clinical trial.SettingMulticenter North American clinical trial, the ARDS Network Statins for Acutely Injured Lungs from Sepsis.PatientsSix hundred eighty-three subjects with infection-related acute respiratory distress syndrome, representing 92% of the original trial population.InterventionsRandom assignment of rosuvastatin or placebo for up to 28 days or 3 days after ICU discharge.Measurements and main resultsWe measured plasma interleukin-18 levels in all Statins for Acutely Injured Lungs from Sepsis patients with sample available at day 0 (baseline, n = 683) and day 3 (after randomization, n = 588). We tested the association among interleukin-18 level at baseline, rising interleukin-18, and the impact of statin therapy on 60-day mortality, adjusting for severity of illness. Baseline plasma interleukin-18 level greater than or equal to 800 pg/mL was highly associated with 60-day mortality, with a hazard of death of 2.3 (95% CI, 1.7-3.1). Rising plasma interleukin-18 was also associated with increased mortality. For each unit increase in log2 (interleukin-18) at day 3 compared with baseline, the hazard of death increased by 2.3 (95% CI, 1.5-3.5). Subjects randomized to statin were significantly more likely to experience a rise in plasma interleukin-18 levels. Subjects with acute kidney injury, shock, low baseline interleukin-18, and those not receiving systemic corticosteroids were more likely to experience rising interleukin-18. Randomization to statin therapy was associated with rising in interleukin-18 in all of those subsets, however.ConclusionsElevated baseline plasma interleukin-18 was associated with higher mortality in sepsis-induced acute respiratory distress syndrome. A rise in plasma interleukin-18 was also associated with increased mortality and was more common in subjects randomized to statin therapy in this clinical trial.
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- 2019
27. Comparison of Two Techniques to Measure Optic Nerve Sheath Diameter in Patients at Risk for Increased Intracranial Pressure.
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Agrawal, Ashish, Cheng, Roger, Tang, Julin, and Madhok, Debbie Y
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Biomedical and Clinical Sciences ,Ophthalmology and Optometry ,Neurosciences ,Bioengineering ,Biomedical Imaging ,Clinical Research ,Eye Disease and Disorders of Vision ,Eye ,Adult ,Aged ,Aged ,80 and over ,Area Under Curve ,Female ,Humans ,Intracranial Hypertension ,Male ,Middle Aged ,Optic Nerve ,Prospective Studies ,ROC Curve ,Risk Factors ,Single-Blind Method ,Ultrasonography ,Young Adult ,intracranial pressure ,optic nerve sheath diameter ,optic ultrasound ,point of care ultrasound ,ultrasonography ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesIntracranial pressure over 20 mm Hg is associated with poor neurologic prognosis, but measuring intracranial pressure directly requires an invasive procedure. Dilation of the optic nerve sheath on axial ultrasound of the eye has been correlated with elevated intracranial pressure, but optimal cutoffs have been inconsistent possibly related to the measurement technique. A coronal technique has been studied on healthy volunteers but not on patients with high intracranial pressure. We compared two measurement techniques (axial and coronal) in patients with suspected high intracranial pressure due to trauma, bleeding, tumor, or infection.DesignProspective blinded observational study.SettingTwo tertiary referral center ICUs.PatientsTwenty adults admitted to the ICU at risk for increased intracranial pressure expected to receive invasive intracranial monitoring.InterventionsUltrasound measurements of the optic nerve sheath in axial and coronal views either averaged between eyes or the highest in either eye.Measurements and main resultsCoronal measurements showed less variability between each eye than axial measurements (mean difference 0.5 mm vs 1 mm; p = 0.03) and were associated with high intracranial pressure at first measurement and over 24 hours (area under the receiver operating characteristic range 0.7-0.8). Mean and highest axial measurements showed improved association with first (area under the receiver operating characteristic 0.87-0.94) and highest intracranial pressure measurement (area under the receiver operating characteristic 0.89-0.96) within 24 hours. A cutoff of highest axial measurement in either eye greater than 6.2 mm or mean axial measurement between eyes of 5.6 mm had a sensitivity of 100% in predicting high intracranial pressure over the following 24 hours.ConclusionsThe highest axial measurement of optic nerve sheath diameter in either eye is the most predictive of patients with high intracranial pressure in our population. This comparison of measurement techniques has not previously been described and should be further explored to set test cutoffs for ultrasound of the optic nerve sheath diameter.
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- 2019
28. Female Physician Leadership During Cardiopulmonary Resuscitation Is Associated With Improved Patient Outcomes*
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Meier, Angela, Yang, Jenny, Liu, Jinyuan, Beitler, Jeremy R, Tu, Xin M, Owens, Robert L, Sundararajan, Radhika L, Malhotra, Atul, and Sell, Rebecca E
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Biomedical and Clinical Sciences ,Nursing ,Clinical Sciences ,Health Sciences ,Heart Disease ,Women's Health ,Cardiovascular ,Gender Equality ,California ,Cardiopulmonary Resuscitation ,Cohort Studies ,Female ,Heart Arrest ,Humans ,Leadership ,Male ,Middle Aged ,Physicians ,Women ,Retrospective Studies ,Survival Analysis ,cardiac arrest ,cardiopulmonary resuscitation ,gender ,leadership ,team behavior ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesA recently published simulation study suggested that women are inferior leaders of cardiopulmonary resuscitation efforts. The aim of this study was to compare female and male code leaders in regard to cardiopulmonary resuscitation outcomes in a real-world clinical setting.DesignRetrospective cohort review.SettingTwo academic, urban hospitals in San Diego, California.SubjectsOne-thousand eighty-two adult inpatients who suffered cardiac arrest and underwent cardiopulmonary resuscitation.InterventionsNone.Measurements and main resultsWe analyzed whether physician code leader gender was independently associated with sustained return of spontaneous circulation and survival to discharge and with markers of quality cardiopulmonary resuscitation. Of all arrests, 327 (30.1%) were run by female physician code leaders with 251 (76.8%) obtaining return of spontaneous circulation, and 122 (37.3%) surviving to discharge. Male physicians ran 757 codes obtaining return of spontaneous circulation in 543 (71.7%) with 226 (29.9%) surviving to discharge. When adjusting for variables, female physician code leader gender was independently associated with a higher likelihood of return of spontaneous circulation (odds ratio, 1.36; 95% CI, 1.01-1.85; p = 0.049) and survival to discharge (odds ratio, 1.53; 95% CI, 1.15-2.02; p < 0.01). Additionally, the odds ratio for survival to discharge was 1.62 (95% CI, 1.13-2.34; p < 0.01) for female physicians with a female code nurse when compared with male physician code leaders paired with a female code nurse. Gender of code leader was not associated with cardiopulmonary resuscitation quality.ConclusionsIn contrast to data derived from a simulated setting with medical students, real life female physician leadership of cardiopulmonary resuscitation is not associated with inferior outcomes. Appropriately, trained physicians can lead high-quality cardiopulmonary resuscitation irrespective of gender.
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- 2019
29. Caring for Critically Ill Patients with the ABCDEF Bundle
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Pun, Brenda T, Balas, Michele C, Barnes-Daly, Mary Ann, Thompson, Jennifer L, Aldrich, J Matthew, Barr, Juliana, Byrum, Diane, Carson, Shannon S, Devlin, John W, Engel, Heidi J, Esbrook, Cheryl L, Hargett, Ken D, Harmon, Lori, Hielsberg, Christina, Jackson, James C, Kelly, Tamra L, Kumar, Vishakha, Millner, Lawson, Morse, Alexandra, Perme, Christiane S, Posa, Patricia J, Puntillo, Kathleen A, Schweickert, William D, Stollings, Joanna L, Tan, Alai, D'Agostino McGowan, Lucy, and Ely, E Wesley
- Subjects
Brain Disorders ,Patient Safety ,Clinical Research ,Assistive Technology ,Neurosciences ,Bioengineering ,Good Health and Well Being ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,Cohort Studies ,Coma ,Critical Illness ,Delirium ,Female ,Hospital Mortality ,Humans ,Intensive Care Units ,Male ,Middle Aged ,Pain ,Patient Care Bundles ,Patient Discharge ,Patient Readmission ,Quality Improvement ,Respiration ,Artificial ,Restraint ,Physical ,Young Adult ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine - Abstract
ObjectiveDecades-old, common ICU practices including deep sedation, immobilization, and limited family access are being challenged. We endeavoured to evaluate the relationship between ABCDEF bundle performance and patient-centered outcomes in critical care.DesignProspective, multicenter, cohort study from a national quality improvement collaborative.Setting68 academic, community, and federal ICUs collected data during a 20-month period.Patients15,226 adults with at least one ICU day.InterventionsWe defined ABCDEF bundle performance (our main exposure) in two ways: 1) complete performance (patient received every eligible bundle element on any given day) and 2) proportional performance (percentage of eligible bundle elements performed on any given day). We explored the association between complete and proportional ABCDEF bundle performance and three sets of outcomes: patient-related (mortality, ICU and hospital discharge), symptom-related (mechanical ventilation, coma, delirium, pain, restraint use), and system-related (ICU readmission, discharge destination). All models were adjusted for a minimum of 18 a priori determined potential confounders.Measurements and resultsComplete ABCDEF bundle performance was associated with lower likelihood of seven outcomes: hospital death within 7 days (adjusted hazard ratio, 0.32; CI, 0.17-0.62), next-day mechanical ventilation (adjusted odds ratio [AOR], 0.28; CI, 0.22-0.36), coma (AOR, 0.35; CI, 0.22-0.56), delirium (AOR, 0.60; CI, 0.49-0.72), physical restraint use (AOR, 0.37; CI, 0.30-0.46), ICU readmission (AOR, 0.54; CI, 0.37-0.79), and discharge to a facility other than home (AOR, 0.64; CI, 0.51-0.80). There was a consistent dose-response relationship between higher proportional bundle performance and improvements in each of the above-mentioned clinical outcomes (all p < 0.002). Significant pain was more frequently reported as bundle performance proportionally increased (p = 0.0001).ConclusionsABCDEF bundle performance showed significant and clinically meaningful improvements in outcomes including survival, mechanical ventilation use, coma, delirium, restraint-free care, ICU readmissions, and post-ICU discharge disposition.
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- 2019
30. The Effects of Storage Age of Blood in Massively Transfused Burn Patients
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Cartotto, Robert, Taylor, Sandra L, Holmes, James H, Peck, Michael, Cochran, Amalia, King, Booker T, Bhavsar, Daval, Tredget, Edward E, Mozingo, David, Greenhalgh, David, Pollock, Brad H, and Palmieri, Tina L
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Digestive Diseases ,Clinical Research ,Physical Injury - Accidents and Adverse Effects ,Hematology ,Clinical Trials and Supportive Activities ,Blood ,Adult ,Blood Preservation ,Blood Transfusion ,Burns ,Critical Illness ,Female ,Hospital Mortality ,Humans ,Intensive Care Units ,Male ,Middle Aged ,Organ Dysfunction Scores ,Respiration ,Artificial ,Tertiary Care Centers ,Time Factors ,Trauma Severity Indices ,Wound Healing ,blood ,burns ,storage age ,transfusion ,Transfusion Requirement in Burn Care Evaluation ,Clinical Sciences ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesMajor trials examining storage age of blood transfused to critically ill patients administered relatively few blood transfusions. We sought to determine if the storage age of blood affects outcomes when very large amounts of blood are transfused.DesignA secondary analysis of the multicenter randomized Transfusion Requirement in Burn Care Evaluation study which compared restrictive and liberal transfusion strategies.SettingEighteen tertiary-care burn centers.PatientsTransfusion Requirement in Burn Care Evaluation evaluated 345 adults with burns greater than or equal to 20% of the body surface area. We included only the 303 patients that received blood transfusions.InterventionsThe storage ages of all transfused red cell units were collected during Transfusion Requirement in Burn Care Evaluation. A priori measures of storage age were the the mean storage age of all transfused blood and the proportion of all transfused blood considered very old (stored ≥ 35 d).Measurements and main resultsThe primary outcome was the severity of multiple organ dysfunction. Secondary outcomes included time to wound healing, the duration of mechanical ventilation, and in-hospital mortality. There were 6,786 red cell transfusions with a mean (± SD) storage age of 25.6 ± 10.2 days. Participants received a mean of 23.4 ± 31.2 blood transfusions (range, 1-219) and a mean of 5.3 ± 10.7 units of very old blood. Neither mean storage age nor proportion of very old blood had any influence on multiple organ dysfunction severity, time to wound healing, or mortality. Duration of ventilation was significantly predicted by both mean blood storage age and the proportion of very old blood, but this was of questionable clinical relevance given extreme variability in duration of ventilation (adjusted r ≤ 0.01).ConclusionsDespite massive blood transfusion, including very old blood, the duration of red cell storage did not influence outcome in burn patients. Provision of the oldest blood first by Blood Banks is rational, even for massive transfusion.
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- 2018
31. Ultrasound Assessment of the Change in Carotid Corrected Flow Time in Fluid Responsiveness in Undifferentiated Shock
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Barjaktarevic, Igor, Toppen, William E, Hu, Scott, Aquije Montoya, Elizabeth, Ong, Stephanie, Buhr, Russell, David, Ian J, Wang, Tisha, Rezayat, Talayeh, Chang, Steven Y, Elashoff, David, Markovic, Daniela, Berlin, David, and Cannesson, Maxime
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Biomedical and Clinical Sciences ,Clinical Sciences ,Cardiovascular ,Clinical Research ,Neurosciences ,Detection ,screening and diagnosis ,4.2 Evaluation of markers and technologies ,Aged ,Carotid Arteries ,Critical Illness ,Female ,Fluid Therapy ,Hemodynamics ,Humans ,Male ,Middle Aged ,Monitoring ,Physiologic ,Prospective Studies ,Regional Blood Flow ,Shock ,Septic ,Ultrasonography ,Doppler ,corrected flow time ,fluid responsiveness ,shock ,ultrasound ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesAdequate assessment of fluid responsiveness in shock necessitates correct interpretation of hemodynamic changes induced by preload challenge. This study evaluates the accuracy of point-of-care Doppler ultrasound assessment of the change in carotid corrected flow time induced by a passive leg raise maneuver as a predictor of fluid responsiveness. Noninvasive cardiac output monitoring (NICOM, Cheetah Medical, Newton Center, MA) system based on a bioreactance method was used.DesignProspective, noninterventional study.SettingICU at a large academic center.PatientsPatients with new, undifferentiated shock, and vasopressor requirements despite fluid resuscitation were included. Patients with significant cardiac disease and conditions that precluded adequate passive leg raising were excluded.InterventionsCarotid corrected flow time was measured via ultrasound before and after a passive leg raise maneuver. Predicted fluid responsiveness was defined as greater than 10% increase in stroke volume on noninvasive cardiac output monitoring following passive leg raise. Images and measurements were reanalyzed by a second, blinded physician. The accuracy of change in carotid corrected flow time to predict fluid responsiveness was evaluated using receiver operating characteristic analysis.Measurements and main resultsSeventy-seven subjects were enrolled with 54 (70.1%) classified as fluid responders by noninvasive cardiac output monitoring. The average change in carotid corrected flow time after passive leg raise for fluid responders was 14.1 ± 18.7 ms versus -4.0 ± 8 ms for nonresponders (p < 0.001). Receiver operating characteristic analysis demonstrated that change in carotid corrected flow time is an accurate predictor of fluid responsiveness status (area under the curve, 0.88; 95% CI, 0.80-0.96) and a 7 ms increase in carotid corrected flow time post passive leg raise was shown to have a 97% positive predictive value and 82% accuracy in detecting fluid responsiveness using noninvasive cardiac output monitoring as a reference standard. Mechanical ventilation, respiratory rate, and high positive end-expiratory pressure had no significant impact on test performance. Post hoc blinded evaluation of bedside acquired measurements demonstrated agreement between evaluators.ConclusionsChange in carotid corrected flow time can predict fluid responsiveness status after a passive leg raise maneuver. Using point-of-care ultrasound to assess change in carotid corrected flow time is an acceptable and reproducible method for noninvasive identification of fluid responsiveness in critically ill patients with undifferentiated shock.
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- 2018
32. Executive Summary
- Author
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Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen JC, Pandharipande, Pratik P, Watson, Paula L, Weinhouse, Gerald L, Nunnally, Mark E, Rochwerg, Bram, Balas, Michele C, van den Boogaard, Mark, Bosma, Karen J, Brummel, Nathaniel E, Chanques, Gerald, Denehy, Linda, Drouot, Xavier, Fraser, Gilles L, Harris, Jocelyn E, Joffe, Aaron M, Kho, Michelle E, Kress, John P, Lanphere, Julie A, McKinley, Sharon, Neufeld, Karin J, Pisani, Margaret A, Payen, Jean-Francois, Pun, Brenda T, Puntillo, Kathleen A, Riker, Richard R, Robinson, Bryce RH, Shehabi, Yahya, Szumita, Paul M, Winkelman, Chris, Centofanti, John E, Price, Carrie, Nikayin, Sina, Misak, Cheryl J, Flood, Pamela D, Kiedrowski, Ken, and Alhazzani, Waleed
- Subjects
Biomedical and Clinical Sciences ,Nursing ,Clinical Sciences ,Health Sciences ,Adult ,Conscious Sedation ,Critical Care ,Deep Sedation ,Delirium ,Humans ,Intensive Care Units ,Pain ,Pain Management ,Psychomotor Agitation ,Restraint ,Physical ,Sleep Wake Disorders ,delirium ,guidelines ,intensive care ,mobilization ,pain ,sedation ,sleep ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Published
- 2018
33. Executive Summary: Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.
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Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen JC, Pandharipande, Pratik P, Watson, Paula L, Weinhouse, Gerald L, Nunnally, Mark E, Rochwerg, Bram, Balas, Michele C, van den Boogaard, Mark, Bosma, Karen J, Brummel, Nathaniel E, Chanques, Gerald, Denehy, Linda, Drouot, Xavier, Fraser, Gilles L, Harris, Jocelyn E, Joffe, Aaron M, Kho, Michelle E, Kress, John P, Lanphere, Julie A, McKinley, Sharon, Neufeld, Karin J, Pisani, Margaret A, Payen, Jean-Francois, Pun, Brenda T, Puntillo, Kathleen A, Riker, Richard R, Robinson, Bryce RH, Shehabi, Yahya, Szumita, Paul M, Winkelman, Chris, Centofanti, John E, Price, Carrie, Nikayin, Sina, Misak, Cheryl J, Flood, Pamela D, Kiedrowski, Ken, and Alhazzani, Waleed
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Humans ,Psychomotor Agitation ,Delirium ,Pain ,Restraint ,Physical ,Critical Care ,Conscious Sedation ,Adult ,Intensive Care Units ,Deep Sedation ,Pain Management ,Sleep Wake Disorders ,delirium ,guidelines ,intensive care ,mobilization ,pain ,sedation ,sleep ,Emergency & Critical Care Medicine ,Clinical Sciences ,Nursing ,Public Health and Health Services - Published
- 2018
34. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.
- Author
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Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen JC, Pandharipande, Pratik P, Watson, Paula L, Weinhouse, Gerald L, Nunnally, Mark E, Rochwerg, Bram, Balas, Michele C, van den Boogaard, Mark, Bosma, Karen J, Brummel, Nathaniel E, Chanques, Gerald, Denehy, Linda, Drouot, Xavier, Fraser, Gilles L, Harris, Jocelyn E, Joffe, Aaron M, Kho, Michelle E, Kress, John P, Lanphere, Julie A, McKinley, Sharon, Neufeld, Karin J, Pisani, Margaret A, Payen, Jean-Francois, Pun, Brenda T, Puntillo, Kathleen A, Riker, Richard R, Robinson, Bryce RH, Shehabi, Yahya, Szumita, Paul M, Winkelman, Chris, Centofanti, John E, Price, Carrie, Nikayin, Sina, Misak, Cheryl J, Flood, Pamela D, Kiedrowski, Ken, and Alhazzani, Waleed
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Humans ,Psychomotor Agitation ,Delirium ,Pain ,Restraint ,Physical ,Critical Care ,Conscious Sedation ,Intensive Care Units ,Deep Sedation ,Pain Management ,Sleep Wake Disorders ,delirium ,guidelines ,immobility ,intensive care ,mobilization ,pain ,sedation ,sleep ,Restraint ,Physical ,Emergency & Critical Care Medicine ,Clinical Sciences ,Nursing ,Public Health and Health Services - Abstract
OBJECTIVE:To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU. DESIGN:Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups gathered face-to-face at annual Society of Critical Care Medicine congresses; virtual connections included those unable to attend. A formal conflict of interest policy was developed a priori and enforced throughout the process. Teleconferences and electronic discussions among subgroups and whole panel were part of the guidelines' development. A general content review was completed face-to-face by all panel members in January 2017. METHODS:Content experts, methodologists, and ICU survivors were represented in each of the five sections of the guidelines: Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption). Each section created Population, Intervention, Comparison, and Outcome, and nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, and patients prioritized their importance. For each Population, Intervention, Comparison, and Outcome question, sections searched the best available evidence, determined its quality, and formulated recommendations as "strong," "conditional," or "good" practice statements based on Grading of Recommendations Assessment, Development and Evaluation principles. In addition, evidence gaps and clinical caveats were explicitly identified. RESULTS:The Pain, Agitation/Sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) panel issued 37 recommendations (three strong and 34 conditional), two good practice statements, and 32 ungraded, nonactionable statements. Three questions from the patient-centered prioritized question list remained without recommendation. CONCLUSIONS:We found substantial agreement among a large, interdisciplinary cohort of international experts regarding evidence supporting recommendations, and the remaining literature gaps in the assessment, prevention, and treatment of Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) in critically ill adults. Highlighting this evidence and the research needs will improve Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) management and provide the foundation for improved outcomes and science in this vulnerable population.
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- 2018
35. Contemporary Risk Factors and Outcomes of Transfusion-Associated Circulatory Overload*
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Roubinian, Nareg H, Hendrickson, Jeanne E, Triulzi, Darrell J, Gottschall, Jerome L, Michalkiewicz, Michael, Chowdhury, Dhuly, Kor, Daryl J, Looney, Mark R, Matthay, Michael A, Kleinman, Steven H, Brambilla, Donald, and Murphy, Edward L
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Rare Diseases ,Cardiovascular ,Hematology ,Patient Safety ,Good Health and Well Being ,Aged ,Aged ,80 and over ,Cardiovascular Diseases ,Case-Control Studies ,Critical Illness ,Diuretics ,Female ,Hospital Mortality ,Humans ,Kidney Diseases ,Male ,Middle Aged ,Pulmonary Edema ,Risk Factors ,Severity of Illness Index ,Sex Factors ,Tertiary Care Centers ,Transfusion Reaction ,blood component transfusion ,outcomes ,pulmonary edema ,risk factors ,transfusion reaction ,National Heart ,Lung ,and Blood Institute (NHLBI) Recipient Epidemiology and Donor Evaluation Study-III ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
OBJECTIVES:Transfusion-associated circulatory overload is characterized by hydrostatic pulmonary edema following blood transfusion. Restrictive transfusion practice may affect the occurrence and severity of transfusion-associated circulatory overload in critically ill patients. We sought to examine contemporary risk factors and outcomes for transfusion-associated circulatory overload. DESIGN:Case-control study. SETTING:Four tertiary care hospitals. PATIENTS:We prospectively enrolled 200 patients with transfusion-associated circulatory overload identified by active surveillance and 405 controls matched by transfusion intensity. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Among 20,845 transfused patients who received 128,263 blood components from May 2015 until July 2016, transfusion-associated circulatory overload incidence was one case per 100 transfused patients. In addition to cardiovascular comorbidities, multivariable analysis identified the following independent predictors of transfusion-associated circulatory overload: acute kidney injury, emergency surgery, pretransfusion diuretic use, and plasma transfusion-the latter especially in females. Compared with matched controls, transfusion-associated circulatory overload cases were more likely to require mechanical ventilation (71% vs 49%; p < 0.001), experienced longer intensive care and hospital lengths of stay following transfusion, and had higher mortality (21% vs 11%; p = 0.02) even after adjustment for other potentially confounding variables. CONCLUSIONS:Despite restrictive transfusion practice, transfusion-associated circulatory overload remains a frequent complication of transfusion and is an independent risk factor for in-hospital morbidity and mortality. In addition to cardiovascular and renal risk factors, plasma transfusion was associated with transfusion-associated circulatory overload after controlling for other covariates. Additional research is needed to examine the benefit of reduced erythrocyte or plasma exposure in patients at high risk for transfusion-associated circulatory overload.
- Published
- 2018
36. Does Regulatory Really Intersect Reality in Glucose Measurement in the ICU? Is the Issue Testing Method Accuracy or Specimen Type?
- Author
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DuBois, Jeffrey Anton, Slingerland, Robbert Jan, Fokkert, Marion, Roman, Alain, Tran, Nam Khoa, Clarke, William, Sartori, David Alan, Palmieri, Tina Louise, Malic, Andrei, Lyon, Martha Elizabeth, and Lyon, Andrew William
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Blood Glucose ,Hematologic Tests ,Intensive Care Units ,blood glucose monitoring ,critically ill ,insulin dosing error ,Monte Carlo simulation modeling ,stratified glycemic accuracy analysis ,Humans ,Hypoglycemia ,Insulin ,Hypoglycemic Agents ,Monitoring ,Physiologic ,Critical Care ,Clinical Laboratory Techniques ,Monte Carlo Method ,Risk Assessment ,Sensitivity and Specificity ,Retrospective Studies ,Algorithms ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,Middle Aged ,Child ,Child ,Preschool ,Infant ,Point-of-Care Systems ,Female ,Male ,Young Adult ,Nursing ,Public Health and Health Services ,Emergency & Critical Care Medicine ,Clinical sciences - Abstract
ObjectivesNew data have emerged from ambulatory and acute care settings about adverse patient events, including death, attributable to erroneous blood glucose meter measurements and leading to questions over their use in critically ill patients. The U.S. Food and Drug Administration published new, more stringent guidelines for glucose meter manufacturers to evaluate the performance of blood glucose meters in critically ill patient settings. The primary objective of this international, multicenter, multidisciplinary clinical study was to develop and apply a rigorous clinical accuracy assessment algorithm, using four distinct statistical tools, to evaluate the clinical accuracy of a blood glucose monitoring system in critically ill patients.DesignObservational study.SettingFive international medical and surgical ICUs.PatientsAll patients admitted to critical care settings in the centers.InterventionsNone.Measurements and main resultsGlucose measurements were performed on 1,698 critically ill patients with 257 different clinical conditions and complex treatment regimens. The clinical accuracy assessment algorithm comprised four statistical tools to assess the performance of the study blood glucose monitoring system compared with laboratory reference methods traceable to a definitive standard. Based on POCT12-A3, the Clinical Laboratory Standards Institute standard for hospitals about hospital glucose meter procedures and performance, and Parkes error grid clinical accuracy performance criteria, no clinically significant differences were observed due to patient condition or therapy, with 96.1% and 99.3% glucose results meeting the respective criteria. Stratified sensitivity and specificity analysis (10 mg/dL glucose intervals, 50-150 mg/dL) demonstrated high sensitivity (mean = 95.2%, SD = ± 0.02) and specificity (mean = 95. 8%, SD = ± 0.03). Monte Carlo simulation modeling of the study blood glucose monitoring system showed low probability of category 2 and category 3 insulin dosing error, category 2 = 2.3% (41/1,815) and category 3 = 1.8% (32/1,815), respectively. Patient trend analysis demonstrated 99.1% (223/225) concordance in characterizing hypoglycemic patients.ConclusionsThe multicomponent, clinical accuracy assessment algorithm demonstrated that the blood glucose monitoring system was acceptable for use in critically ill patient settings when compared to the central laboratory reference method. This clinical accuracy assessment algorithm is an effective tool for comprehensively assessing the validity of whole blood glucose measurement in critically ill patient care settings.
- Published
- 2017
37. Vasopressor Responsiveness 101: Prediction of Responsiveness to Angiotensin II Infusion.
- Author
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Russell JA
- Subjects
- Humans, Infusions, Intravenous, Angiotensin II administration & dosage, Angiotensin II pharmacology, Vasoconstrictor Agents administration & dosage, Vasoconstrictor Agents therapeutic use
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- 2024
- Full Text
- View/download PDF
38. Society of Critical Care Medicine and American Society of Health-System Pharmacists Guideline for the Prevention of Stress-Related Gastrointestinal Bleeding in Critically Ill Adults.
- Author
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MacLaren R, Dionne JC, Granholm A, Alhazzani W, Szumita PM, Olsen K, Barletta JF, Møller MH, Karvellas CJ, Wischmeyer P, DePriest A, Carlos V, Argetsinger D, Carothers JJ, Lee R, Napolitano L, Perri D, and Naylor DF
- Subjects
- Humans, Adult, Proton Pump Inhibitors therapeutic use, Stress, Psychological complications, Stress, Psychological prevention & control, Histamine H2 Antagonists therapeutic use, Evidence-Based Medicine, Critical Illness, Gastrointestinal Hemorrhage prevention & control, Critical Care methods, Critical Care standards
- Abstract
Rationale: Critically ill adults can develop stress-related mucosal damage from gastrointestinal hypoperfusion and reperfusion injury, predisposing them to clinically important stress-related upper gastrointestinal bleeding (UGIB)., Objectives: The objective of this guideline was to develop evidence-based recommendations for the prevention of UGIB in adults in the ICU., Design: A multiprofessional panel of 18 international experts from dietetics, critical care medicine, nursing, and pharmacy, and two methodologists developed evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Conflict-of-interest policies were strictly followed during all phases of guideline development including task force selection and voting., Methods: The panel members identified and formulated 13 Population, Intervention, Comparison, and Outcome questions. We conducted a systematic review for each question to identify the best available evidence, statistically analyzed the evidence, and then assessed the certainty of the evidence using the GRADE approach. We used the evidence-to-decision framework to formulate the recommendations. Good practice statements were included to provide additional guidance., Results: The panel generated nine conditional recommendations and made four good practice statements. Factors that likely increase the risk for clinically important stress-related UGIB in critically ill adults include coagulopathy, shock, and chronic liver disease. There is no firm evidence for mechanical ventilation alone being a risk factor. Enteral nutrition probably reduces UGIB risk. All critically ill adults with factors that likely increase the risk for stress-related UGIB should receive either proton pump inhibitors or histamine-2 receptor antagonists, at low dosage regimens, to prevent UGIB. Prophylaxis should be discontinued when critical illness is no longer evident or the risk factor(s) is no longer present despite ongoing critical illness. Discontinuation of stress ulcer prophylaxis before transfer out of the ICU is necessary to prevent inappropriate prescribing., Conclusions: The guideline panel achieved consensus regarding the recommendations for the prevention of stress-related UGIB. These recommendations are intended for consideration along with the patient's existing clinical status., Competing Interests: Dr. Szumita received funding from Trevena. Dr. Barletta received funding from Wolters Kluwer and Lexicomp. Dr. DePriest received funding from Baxter Channel One. Dr. Wischmeyer received funding from Abbott, Baxter, Fresenius Kabi Deutschland GmbH, Danone and Nutricia, Musclesound, Dutch State Mines, and Nestle. Dr. Argetsinger disclosed that she is an employee of the University of Michigan Health West and Bronson Methodist Hospital and of Georgetown University School of Nursing. Dr. Dionne received funding from the Canadian Institutes of Health Research. Dr. Granholm received funding from Sygeforsikringen “Danmark.” The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
- Published
- 2024
- Full Text
- View/download PDF
39. From Traditional Typing to Intelligent Insights: A Narrative Review of Directions Toward Targeted Therapies in Delirium.
- Author
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Potter KM, Prendergast NT, and Boyd JG
- Subjects
- Humans, Intensive Care Units, Critical Illness therapy, Hypnotics and Sedatives therapeutic use, Hypnotics and Sedatives administration & dosage, Machine Learning, Delirium drug therapy, Delirium diagnosis
- Abstract
Delirium is a heterogeneous syndrome characterized by an acute change in level of consciousness that is associated with inattention and disorganized thinking. Delirium affects most critically ill patients and is associated with poor patient-oriented outcomes such as increased mortality, longer ICU and hospital length of stay, and worse long-term cognitive outcomes. The concept of delirium and its subtypes has existed since nearly the beginning of recorded medical literature, yet robust therapies have yet to be identified. Analogous to other critical illness syndromes, we suspect the lack of identified therapies stems from patient heterogeneity and prior subtyping efforts that do not capture the underlying etiology of delirium. The time has come to leverage machine learning approaches, such as supervised and unsupervised clustering, to identify clinical and pathophysiological distinct clusters of delirium that will likely respond differently to various interventions. We use sedation in the ICU as an example of how precision therapies can be applied to critically ill patients, highlighting the fact that while for some patients a sedative drug may cause delirium, in another cohort sedation is the specific treatment. Finally, we conclude with a proposition to move away from the term delirium, and rather focus on the treatable traits that may allow precision therapies to be tested., Competing Interests: Dr. Prendergast received funding from McGraw-Hill; he received support for article research from the National Institutes of Health; he disclosed off-label use of antipsychotic agents to treat delirium. Dr. Boyd’s institution received funding from the Canadian Institute of Health Research; he received funding from Ontario Health-Trillium Gift of Life Network. Dr. Potter has disclosed that she does not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
- Published
- 2024
- Full Text
- View/download PDF
40. Advancing Global Validation and Implementation of Adult Sepsis Event Surveillance.
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Polito CC, Klompas M, and Rhee C
- Subjects
- Humans, Adult, Population Surveillance methods, Sepsis diagnosis, Sepsis epidemiology
- Abstract
Competing Interests: Drs. Klompas’s and Rhee’s institution received funding from the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality; they received funding from UpToDate. Dr. Klompas’ institution received funding from the Massachusetts Department of Public Health. Dr. Polito has disclosed that she does not have any potential conflicts of interest.
- Published
- 2024
- Full Text
- View/download PDF
41. Exploring the Pathophysiological Mechanisms of Hyperlactatemia in Critically Ill Patients Following Cardiopulmonary Bypass.
- Author
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Mallat J
- Subjects
- Humans, Lactic Acid blood, Postoperative Complications physiopathology, Postoperative Complications blood, Postoperative Complications etiology, Cardiopulmonary Bypass adverse effects, Critical Illness, Hyperlactatemia etiology
- Abstract
Competing Interests: Dr. Mallat has disclosed that he does not have any potential conflicts of interest.
- Published
- 2024
- Full Text
- View/download PDF
42. Lessons From the LIPid Intensive Drug therapy for Sepsis Pilot (LIPIDS-P) Trial.
- Author
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Walley KR
- Subjects
- Humans, Pilot Projects, Fat Emulsions, Intravenous therapeutic use, Sepsis drug therapy
- Published
- 2024
- Full Text
- View/download PDF
43. A Different Look at the Family in the Family Participation Program in the ICU Is One of the Factors Influencing the Psychological Outcomes.
- Author
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Rahimi-Bashar F, Gohari-Moghadam K, Ashtari S, and Vahedian-Azimi A
- Subjects
- Humans, Professional-Family Relations, Intensive Care Units, Family psychology
- Abstract
Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest.
- Published
- 2024
- Full Text
- View/download PDF
44. Physiologic Insults and Individualized Treatments in Traumatic Brain Injury.
- Author
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Azad TD and Stevens RD
- Subjects
- Humans, Brain Injuries, Traumatic therapy, Brain Injuries, Traumatic physiopathology, Brain Injuries, Traumatic complications, Precision Medicine methods
- Abstract
Competing Interests: Dr. Stevens received funding from Ceribell and B-Secur. Dr. Azad disclosed that he does not have any potential conflicts of interest.
- Published
- 2024
- Full Text
- View/download PDF
45. The Omicron Paradox: Is It Omicron or Is It What Happened During the Omicron Period?
- Author
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Kawano-Dourado L and Zeraatkar D
- Subjects
- Humans, COVID-19 Vaccines, COVID-19 epidemiology, SARS-CoV-2
- Abstract
Competing Interests: Dr. Kawano-Dourado’s institution received funding from Fisher & Paykel, nonfinancial support to the High-Flow Nasal Oxygen Cannula Compared to Non-Invasive Ventilation in Adult Patients With AcuTE Respiratory Failure (RENOVATE) Trial (NCT03643939), and a research grant from the Brazilian Ministry of Health (O Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde [PROADI-SUS]). Dr. Zeraatkar has disclosed that she does not have any potential conflicts of interest.
- Published
- 2024
- Full Text
- View/download PDF
46. Risk- and Probability-Based Timing of Antibiotics and Outcomes of Patients With Suspected Serious Infection: Did the COVID-19 Pandemic Affect Processes and Outcomes?
- Author
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Oud L
- Subjects
- Humans, Pandemics, Intensive Care Units, Time Factors, COVID-19 epidemiology, Anti-Bacterial Agents therapeutic use
- Abstract
Competing Interests: Dr. Oud has disclosed that he does not have any potential conflicts of interest.
- Published
- 2024
- Full Text
- View/download PDF
47. Executive Summary-Society of Critical Care Medicine Guideline and American Society of Health-System Pharmacists for the Prevention of Stress-Related Gastrointestinal Bleeding in Critically Ill Adults.
- Author
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MacLaren R, Dionne JC, Granholm A, Alhazzani W, Szumita PM, Olsen K, Barletta JF, Møller MH, Karvellas CJ, Wischmeyer P, DePriest A, Carlos V, Argetsinger D, Carothers JJ, Lee R, Napolitano L, Perri D, and Naylor DF
- Subjects
- Humans, Stress, Psychological prevention & control, Adult, United States, Critical Illness therapy, Critical Care standards, Critical Care methods, Gastrointestinal Hemorrhage prevention & control
- Abstract
Competing Interests: Dr. Szumita received funding from Trevena. Dr. Barletta received funding from Wolters Kluwer and Lexicomp. Dr. DePriest received funding from Baxter Channel One. Dr. Wischmeyer received funding from Abbott, Baxter, Fresenius Kabi Deutschland GmbH, Danone and Nutricia, Musclesound, Dutch State Mines, and Nestle. Dr. Argetsinger disclosed that she is an employee of the University of Michigan Health West and Bronson Methodist Hospital and Georgetown University School of Nursing. Dr. Dionne received funding from the Canadian Institutes of Health Research. Dr. Granholm received funding from Sygeforsikringen “Danmark.” The remaining authors have disclosed that they do not have any potential conflicts of interest.
- Published
- 2024
- Full Text
- View/download PDF
48. Acute Respiratory Distress Syndrome and the Meaning of Hospital Mortality.
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Qadir N and Bauer PR
- Subjects
- Humans, Intensive Care Units, Respiratory Distress Syndrome mortality, Respiratory Distress Syndrome therapy, Hospital Mortality
- Abstract
Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest.
- Published
- 2024
- Full Text
- View/download PDF
49. The Natural History of Unnatural Sleep: Surviving, But Not Thriving, After Critical Illness.
- Author
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Maas MB
- Subjects
- Humans, Sleep physiology, Survivors, Critical Illness
- Abstract
Competing Interests: Dr. Maas has disclosed that he does not have any potential conflicts of interest.
- Published
- 2024
- Full Text
- View/download PDF
50. Optimal Levetiracetam Dosing in Neurological ICU Patients With Augmented Renal Clearance.
- Author
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Honore PM and Blackman S
- Subjects
- Humans, Piracetam analogs & derivatives, Piracetam administration & dosage, Piracetam therapeutic use, Levetiracetam administration & dosage, Levetiracetam therapeutic use, Intensive Care Units, Anticonvulsants administration & dosage, Anticonvulsants pharmacokinetics, Anticonvulsants therapeutic use
- Abstract
Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest.
- Published
- 2024
- Full Text
- View/download PDF
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