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1. Use of dexmedetomidine for sedation in mechanically ventilated adult ICU patients:a rapid practice guideline

Author

Møller, Morten H., Alhazzani, Waleed, Lewis, Kimberley, Belley-Cote, Emilie, Granholm, Anders, Centofanti, John, McIntyre, William B., Spence, Jessica, Al Duhailib, Zainab, Needham, Dale M., Evans, Laura, Reintam Blaser, Annika, Pisani, Margaret A., D’Aragon, Frederick, Shankar-Hari, Manu, Alshahrani, Mohammed, Citerio, Giuseppe, Arora, Rakesh C., Mehta, Sangeeta, Girard, Timothy D., Ranzani, Otavio T., Hammond, Naomi, Devlin, John W., Shehabi, Yahya, Pandharipande, Pratik, Ostermann, Marlies, Møller, Morten H., Alhazzani, Waleed, Lewis, Kimberley, Belley-Cote, Emilie, Granholm, Anders, Centofanti, John, McIntyre, William B., Spence, Jessica, Al Duhailib, Zainab, Needham, Dale M., Evans, Laura, Reintam Blaser, Annika, Pisani, Margaret A., D’Aragon, Frederick, Shankar-Hari, Manu, Alshahrani, Mohammed, Citerio, Giuseppe, Arora, Rakesh C., Mehta, Sangeeta, Girard, Timothy D., Ranzani, Otavio T., Hammond, Naomi, Devlin, John W., Shehabi, Yahya, Pandharipande, Pratik, and Ostermann, Marlies

Abstract

Purpose: The aim of this Intensive Care Medicine Rapid Practice Guideline (ICM‑RPG) was to formulate evidence‑based guidance for the use of dexmedetomidine for sedation in invasively mechanically ventilated adults in the intensive care unit (ICU). Methods: We adhered to the methodology for trustworthy clinical practice guidelines, including use of the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of evidence, and the Evidence-to-Decision framework to generate recommendations. The guideline panel comprised 28 international panelists, including content experts, ICU clinicians, methodologists, and patient representatives. Through teleconferences and web‑based discussions, the panel provided input on the balance and magnitude of the desirable and undesirable effects, the certainty of evidence, patients’ values and preferences, costs and resources, feasibility, acceptability, and research priorities. Results: The ICM‑RPG panel issued one weak recommendation (suggestion) based on overall moderate certainty of evidence: "In invasively mechanically ventilated adult ICU patients, we suggest using dexmedetomidine over other sedative agents, if the desirable effects including a reduction in delirium are valued over the undesirable effects including an increase in hypotension and bradycardia". Conclusion: This ICM-RPG provides updated evidence-based guidance on the use of dexmedetomidine for sedation in mechanically ventilated adults, and outlines uncertainties and research priorities.

Published
2022

2. Use of dexmedetomidine for sedation in mechanically ventilated adult ICU patients: a rapid practice guideline

Author

Møller, M, Alhazzani, W, Lewis, K, Belley-Cote, E, Granholm, A, Centofanti, J, Mcintyre, W, Spence, J, Al Duhailib, Z, Needham, D, Evans, L, Reintam Blaser, A, Pisani, M, D’Aragon, F, Shankar-Hari, M, Alshahrani, M, Citerio, G, Arora, R, Mehta, S, Girard, T, Ranzani, O, Hammond, N, Devlin, J, Shehabi, Y, Pandharipande, P, Ostermann, M, Møller, Morten H., Alhazzani, Waleed, Lewis, Kimberley, Belley-Cote, Emilie, Granholm, Anders, Centofanti, John, McIntyre, William B., Spence, Jessica, Al Duhailib, Zainab, Needham, Dale M., Evans, Laura, Reintam Blaser, Annika, Pisani, Margaret A., D’Aragon, Frederick, Shankar-Hari, Manu, Alshahrani, Mohammed, Citerio, Giuseppe, Arora, Rakesh C., Mehta, Sangeeta, Girard, Timothy D., Ranzani, Otavio T., Hammond, Naomi, Devlin, John W., Shehabi, Yahya, Pandharipande, Pratik, Ostermann, Marlies, Møller, M, Alhazzani, W, Lewis, K, Belley-Cote, E, Granholm, A, Centofanti, J, Mcintyre, W, Spence, J, Al Duhailib, Z, Needham, D, Evans, L, Reintam Blaser, A, Pisani, M, D’Aragon, F, Shankar-Hari, M, Alshahrani, M, Citerio, G, Arora, R, Mehta, S, Girard, T, Ranzani, O, Hammond, N, Devlin, J, Shehabi, Y, Pandharipande, P, Ostermann, M, Møller, Morten H., Alhazzani, Waleed, Lewis, Kimberley, Belley-Cote, Emilie, Granholm, Anders, Centofanti, John, McIntyre, William B., Spence, Jessica, Al Duhailib, Zainab, Needham, Dale M., Evans, Laura, Reintam Blaser, Annika, Pisani, Margaret A., D’Aragon, Frederick, Shankar-Hari, Manu, Alshahrani, Mohammed, Citerio, Giuseppe, Arora, Rakesh C., Mehta, Sangeeta, Girard, Timothy D., Ranzani, Otavio T., Hammond, Naomi, Devlin, John W., Shehabi, Yahya, Pandharipande, Pratik, and Ostermann, Marlies

Abstract

Purpose: The aim of this Intensive Care Medicine Rapid Practice Guideline (ICM‐RPG) was to formulate evidence‐based guidance for the use of dexmedetomidine for sedation in invasively mechanically ventilated adults in the intensive care unit (ICU). Methods: We adhered to the methodology for trustworthy clinical practice guidelines, including use of the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of evidence, and the Evidence-to-Decision framework to generate recommendations. The guideline panel comprised 28 international panelists, including content experts, ICU clinicians, methodologists, and patient representatives. Through teleconferences and web‐based discussions, the panel provided input on the balance and magnitude of the desirable and undesirable effects, the certainty of evidence, patients’ values and preferences, costs and resources, feasibility, acceptability, and research priorities. Results: The ICM‐RPG panel issued one weak recommendation (suggestion) based on overall moderate certainty of evidence: "In invasively mechanically ventilated adult ICU patients, we suggest using dexmedetomidine over other sedative agents, if the desirable effects including a reduction in delirium are valued over the undesirable effects including an increase in hypotension and bradycardia". Conclusion: This ICM-RPG provides updated evidence-based guidance on the use of dexmedetomidine for sedation in mechanically ventilated adults, and outlines uncertainties and research priorities.

Published
2022

3. Medical Intensive Care Unit Admission Among Patients With and Without HIV, Hepatitis C Virus, and Alcohol-Related Diagnoses in the United States: A National, Retrospective Cohort Study, 1997-2014.

Author

Rentsch, Christopher T, Rentsch, Christopher T, Tate, Janet P, Steel, Tessa, Butt, Adeel A, Gibert, Cynthia L, Huang, Laurence, Pisani, Margaret, Soo Hoo, Guy W, Crystal, Stephen, Rodriguez-Barradas, Maria C, Brown, Sheldon T, Freiberg, Matthew S, Graber, Christopher J, Kim, Joon W, Rimland, David, Justice, Amy C, Fiellin, David A, Crothers, Kristina A, Akgün, Kathleen M, Rentsch, Christopher T, Rentsch, Christopher T, Tate, Janet P, Steel, Tessa, Butt, Adeel A, Gibert, Cynthia L, Huang, Laurence, Pisani, Margaret, Soo Hoo, Guy W, Crystal, Stephen, Rodriguez-Barradas, Maria C, Brown, Sheldon T, Freiberg, Matthew S, Graber, Christopher J, Kim, Joon W, Rimland, David, Justice, Amy C, Fiellin, David A, Crothers, Kristina A, and Akgün, Kathleen M

Abstract

BackgroundHIV, hepatitis C virus (HCV), and alcohol-related diagnoses (ARD) independently contribute increased risk of all-cause hospitalization. We sought to determine annual medical intensive care unit (MICU) admission rates and relative risk of MICU admission between 1997 and 2014 among people with and without HIV, HCV, and ARD, using data from the largest HIV and HCV care provider in the United States.SettingVeterans Health Administration.MethodsAnnual MICU admission rates were calculated among 155,550 patients in the Veterans Aging Cohort Study by HIV, HCV, and ARD status. Adjusted rate ratios and 95% confidence intervals (CIs) were estimated with Poisson regression. Significance of trends in age-adjusted admission rates were tested with generalized linear regression. Models were stratified by calendar period to identify shifts in MICU admission risk over time.ResultsCompared to HIV-/HCV-/ARD- patients, relative risk of MICU admission decreased among HIV-mono-infected patients from 61% (95% CI: 1.56 to 1.65) in 1997-2009% to 21% (95% CI: 1.16 to 1.27) in 2010-2014, increased among HCV-mono-infected patients from 22% (95% CI: 1.16 to 1.29) in 1997-2009% to 54% (95% CI: 1.43 to 1.67) in 2010-2014, and remained consistent among patients with ARD only at 46% (95% CI: 1.42 to 1.50). MICU admission rates decreased by 48% among HCV-uninfected patients (P-trend <0.0001) but did not change among HCV+ patients (P-trend = 0.34).ConclusionHCV infection and ARD remain key contributors to MICU admission risk. The impact of each of these conditions could be mitigated with combination of treatment of HIV, HCV, and interventions targeting unhealthy alcohol use.

Published
2019

4. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness.

Author

Girard, Timothy D, Girard, Timothy D, Exline, Matthew C, Carson, Shannon S, Hough, Catherine L, Rock, Peter, Gong, Michelle N, Douglas, Ivor S, Malhotra, Atul, Owens, Robert L, Feinstein, Daniel J, Khan, Babar, Pisani, Margaret A, Hyzy, Robert C, Schmidt, Gregory A, Schweickert, William D, Hite, R Duncan, Bowton, David L, Masica, Andrew L, Thompson, Jennifer L, Chandrasekhar, Rameela, Pun, Brenda T, Strength, Cayce, Boehm, Leanne M, Jackson, James C, Pandharipande, Pratik P, Brummel, Nathan E, Hughes, Christopher G, Patel, Mayur B, Stollings, Joanna L, Bernard, Gordon R, Dittus, Robert S, Ely, E Wesley, MIND-USA Investigators, Girard, Timothy D, Girard, Timothy D, Exline, Matthew C, Carson, Shannon S, Hough, Catherine L, Rock, Peter, Gong, Michelle N, Douglas, Ivor S, Malhotra, Atul, Owens, Robert L, Feinstein, Daniel J, Khan, Babar, Pisani, Margaret A, Hyzy, Robert C, Schmidt, Gregory A, Schweickert, William D, Hite, R Duncan, Bowton, David L, Masica, Andrew L, Thompson, Jennifer L, Chandrasekhar, Rameela, Pun, Brenda T, Strength, Cayce, Boehm, Leanne M, Jackson, James C, Pandharipande, Pratik P, Brummel, Nathan E, Hughes, Christopher G, Patel, Mayur B, Stollings, Joanna L, Bernard, Gordon R, Dittus, Robert S, Ely, E Wesley, and MIND-USA Investigators

Abstract

BackgroundThere are conflicting data on the effects of antipsychotic medications on delirium in patients in the intensive care unit (ICU).MethodsIn a randomized, double-blind, placebo-controlled trial, we assigned patients with acute respiratory failure or shock and hypoactive or hyperactive delirium to receive intravenous boluses of haloperidol (maximum dose, 20 mg daily), ziprasidone (maximum dose, 40 mg daily), or placebo. The volume and dose of a trial drug or placebo was halved or doubled at 12-hour intervals on the basis of the presence or absence of delirium, as detected with the use of the Confusion Assessment Method for the ICU, and of side effects of the intervention. The primary end point was the number of days alive without delirium or coma during the 14-day intervention period. Secondary end points included 30-day and 90-day survival, time to freedom from mechanical ventilation, and time to ICU and hospital discharge. Safety end points included extrapyramidal symptoms and excessive sedation.ResultsWritten informed consent was obtained from 1183 patients or their authorized representatives. Delirium developed in 566 patients (48%), of whom 89% had hypoactive delirium and 11% had hyperactive delirium. Of the 566 patients, 184 were randomly assigned to receive placebo, 192 to receive haloperidol, and 190 to receive ziprasidone. The median duration of exposure to a trial drug or placebo was 4 days (interquartile range, 3 to 7). The median number of days alive without delirium or coma was 8.5 (95% confidence interval [CI], 5.6 to 9.9) in the placebo group, 7.9 (95% CI, 4.4 to 9.6) in the haloperidol group, and 8.7 (95% CI, 5.9 to 10.0) in the ziprasidone group (P=0.26 for overall effect across trial groups). The use of haloperidol or ziprasidone, as compared with placebo, had no significant effect on the primary end point (odds ratios, 0.88 [95% CI, 0.64 to 1.21] and 1.04 [95% CI, 0.73 to 1.48], respectively). There were no significant between-group differen

Published
2018

5. 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.

Author

Devlin, John W, 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, Alhazzani, Waleed, Devlin, John W, 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

Published
2018

6. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.

Author

Devlin, John W, 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, Alhazzani, Waleed, Devlin, John W, 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

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 l

Published
2018

7. 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

Author

Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, Shehabi, Yahya, Szumita, Paul M, Winkelman, Chris, Centofanti, John E, Price, Carrie, Nikayin, Sina, Misak, Cheryl J, Flood, Pamela D, Kiedrowski, Ken, Alhazzani, Waleed, Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, 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

Published
2018

8. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Author

Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, Shehabi, Yahya, Szumita, Paul M, Winkelman, Chris, Centofanti, John E, Price, Carrie, Nikayin, Sina, Misak, Cheryl J, Flood, Pamela D, Kiedrowski, Ken, Alhazzani, Waleed, Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, 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

Published
2018

9. 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

Author

Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, Shehabi, Yahya, Szumita, Paul M, Winkelman, Chris, Centofanti, John E, Price, Carrie, Nikayin, Sina, Misak, Cheryl J, Flood, Pamela D, Kiedrowski, Ken, Alhazzani, Waleed, Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, 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

Published
2018

10. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Author

Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, Shehabi, Yahya, Szumita, Paul M, Winkelman, Chris, Centofanti, John E, Price, Carrie, Nikayin, Sina, Misak, Cheryl J, Flood, Pamela D, Kiedrowski, Ken, Alhazzani, Waleed, Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, 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

Published
2018

11. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.

Author

Devlin, John W, 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, Alhazzani, Waleed, Devlin, John W, 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

Abstract

ObjectiveTo update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU.DesignThirty-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.MethodsContent 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.ResultsThe 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.ConclusionsWe found substantial agreement among a large, int

Published
2018

12. 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.

Author

Devlin, John W, 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, Alhazzani, Waleed, Devlin, John W, 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

Published
2018

13. Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness.

Author

Girard, Timothy D, Girard, Timothy D, Exline, Matthew C, Carson, Shannon S, Hough, Catherine L, Rock, Peter, Gong, Michelle N, Douglas, Ivor S, Malhotra, Atul, Owens, Robert L, Feinstein, Daniel J, Khan, Babar, Pisani, Margaret A, Hyzy, Robert C, Schmidt, Gregory A, Schweickert, William D, Hite, R Duncan, Bowton, David L, Masica, Andrew L, Thompson, Jennifer L, Chandrasekhar, Rameela, Pun, Brenda T, Strength, Cayce, Boehm, Leanne M, Jackson, James C, Pandharipande, Pratik P, Brummel, Nathan E, Hughes, Christopher G, Patel, Mayur B, Stollings, Joanna L, Bernard, Gordon R, Dittus, Robert S, Ely, E Wesley, MIND-USA Investigators, Girard, Timothy D, Girard, Timothy D, Exline, Matthew C, Carson, Shannon S, Hough, Catherine L, Rock, Peter, Gong, Michelle N, Douglas, Ivor S, Malhotra, Atul, Owens, Robert L, Feinstein, Daniel J, Khan, Babar, Pisani, Margaret A, Hyzy, Robert C, Schmidt, Gregory A, Schweickert, William D, Hite, R Duncan, Bowton, David L, Masica, Andrew L, Thompson, Jennifer L, Chandrasekhar, Rameela, Pun, Brenda T, Strength, Cayce, Boehm, Leanne M, Jackson, James C, Pandharipande, Pratik P, Brummel, Nathan E, Hughes, Christopher G, Patel, Mayur B, Stollings, Joanna L, Bernard, Gordon R, Dittus, Robert S, Ely, E Wesley, and MIND-USA Investigators

Abstract

BackgroundThere are conflicting data on the effects of antipsychotic medications on delirium in patients in the intensive care unit (ICU).MethodsIn a randomized, double-blind, placebo-controlled trial, we assigned patients with acute respiratory failure or shock and hypoactive or hyperactive delirium to receive intravenous boluses of haloperidol (maximum dose, 20 mg daily), ziprasidone (maximum dose, 40 mg daily), or placebo. The volume and dose of a trial drug or placebo was halved or doubled at 12-hour intervals on the basis of the presence or absence of delirium, as detected with the use of the Confusion Assessment Method for the ICU, and of side effects of the intervention. The primary end point was the number of days alive without delirium or coma during the 14-day intervention period. Secondary end points included 30-day and 90-day survival, time to freedom from mechanical ventilation, and time to ICU and hospital discharge. Safety end points included extrapyramidal symptoms and excessive sedation.ResultsWritten informed consent was obtained from 1183 patients or their authorized representatives. Delirium developed in 566 patients (48%), of whom 89% had hypoactive delirium and 11% had hyperactive delirium. Of the 566 patients, 184 were randomly assigned to receive placebo, 192 to receive haloperidol, and 190 to receive ziprasidone. The median duration of exposure to a trial drug or placebo was 4 days (interquartile range, 3 to 7). The median number of days alive without delirium or coma was 8.5 (95% confidence interval [CI], 5.6 to 9.9) in the placebo group, 7.9 (95% CI, 4.4 to 9.6) in the haloperidol group, and 8.7 (95% CI, 5.9 to 10.0) in the ziprasidone group (P=0.26 for overall effect across trial groups). The use of haloperidol or ziprasidone, as compared with placebo, had no significant effect on the primary end point (odds ratios, 0.88 [95% CI, 0.64 to 1.21] and 1.04 [95% CI, 0.73 to 1.48], respectively). There were no significant between-group differen

Published
2018

14. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Author

Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, Shehabi, Yahya, Szumita, Paul M, Winkelman, Chris, Centofanti, John E, Price, Carrie, Nikayin, Sina, Misak, Cheryl J, Flood, Pamela D, Kiedrowski, Ken, Alhazzani, Waleed, Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, 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

Published
2018

15. 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

Author

Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, Shehabi, Yahya, Szumita, Paul M, Winkelman, Chris, Centofanti, John E, Price, Carrie, Nikayin, Sina, Misak, Cheryl J, Flood, Pamela D, Kiedrowski, Ken, Alhazzani, Waleed, Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, 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

Published
2018

16. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Author

Medische Staf Intensive Care, Brain, Circulatory Health, Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, Shehabi, Yahya, Szumita, Paul M, Winkelman, Chris, Centofanti, John E, Price, Carrie, Nikayin, Sina, Misak, Cheryl J, Flood, Pamela D, Kiedrowski, Ken, Alhazzani, Waleed, Medische Staf Intensive Care, Brain, Circulatory Health, Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, 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

Published
2018

17. 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

Author

Medische Staf Intensive Care, Brain, Circulatory Health, Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, Shehabi, Yahya, Szumita, Paul M, Winkelman, Chris, Centofanti, John E, Price, Carrie, Nikayin, Sina, Misak, Cheryl J, Flood, Pamela D, Kiedrowski, Ken, Alhazzani, Waleed, Medische Staf Intensive Care, Brain, Circulatory Health, Devlin, John W, Skrobik, Yoanna, Gélinas, Céline, Needham, Dale M, Slooter, Arjen J C, 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 R H, 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

Published
2018

18. Association of COPD With Risk for Pulmonary Infections Requiring Hospitalization in HIV-Infected Veterans.

Author

Attia, Engi F, Attia, Engi F, McGinnis, Kathleen A, Feemster, Laura C, Akgün, Kathleen M, Butt, Adeel A, Graber, Christopher J, Fine, Michael J, Goetz, Matthew B, Rodriguez-Barradas, Maria C, Pisani, Margaret A, Tindle, Hilary A, Brown, Sheldon T, Soo Hoo, Guy W, Rimland, David, Gibert, Cynthia L, Huang, Laurence, Freiberg, Matthew S, Hough, Catherine L, Crothers, Kristina, Attia, Engi F, Attia, Engi F, McGinnis, Kathleen A, Feemster, Laura C, Akgün, Kathleen M, Butt, Adeel A, Graber, Christopher J, Fine, Michael J, Goetz, Matthew B, Rodriguez-Barradas, Maria C, Pisani, Margaret A, Tindle, Hilary A, Brown, Sheldon T, Soo Hoo, Guy W, Rimland, David, Gibert, Cynthia L, Huang, Laurence, Freiberg, Matthew S, Hough, Catherine L, and Crothers, Kristina

Abstract

BackgroundPulmonary infections remain more common in HIV-infected (HIV+) compared with uninfected individuals. The increase in chronic lung diseases among aging HIV+ individuals may contribute to this persistent risk. We sought to determine whether chronic obstructive pulmonary disease (COPD) is an independent risk factor for different pulmonary infections requiring hospitalization among HIV+ patients.MethodsWe analyzed data from 41,993 HIV+ Veterans in the nationwide Veterans Aging Cohort Study Virtual Cohort from 1996 to 2009. Using International Classification of Diseases, Ninth Revision codes, we identified baseline comorbid conditions, including COPD, and incident community-acquired pneumonia (CAP), pulmonary tuberculosis (TB), and Pneumocystis jirovecii pneumonia (PCP) requiring hospitalization within 2 years after baseline. We used multivariable Poisson regression to determine incidence rate ratios (IRRs) associated with COPD for each type of pulmonary infection, adjusting for comorbidities, CD4 cell count, HIV viral load, smoking status, substance use, vaccinations, and calendar year at baseline.ResultsUnadjusted incidence rates of CAP, TB, and PCP requiring hospitalization were significantly higher among persons with COPD compared to those without COPD (CAP: 53.9 vs. 19.4 per 1000 person-years; TB: 8.7 vs. 2.8; PCP: 15.5 vs. 9.2; P ≤ 0.001). In multivariable Poisson regression models, COPD was independently associated with increased risk of CAP, TB, and PCP (IRR: 1.94, 95% confidence interval [CI]: 1.64 to 2.30; IRR: 2.60, 95% CI: 1.70 to 3.97; and IRR: 1.48, 95% CI: 1.10 to 2.01, respectively).ConclusionsCOPD is an independent risk factor for CAP, TB, and PCP requiring hospitalization among HIV+ individuals. As the HIV+ population ages, the growing burden of COPD may confer substantial risk for pulmonary infections.

Published
2015

19. Association of COPD With Risk for Pulmonary Infections Requiring Hospitalization in HIV-Infected Veterans.

Author

Attia, Engi F, Attia, Engi F, McGinnis, Kathleen A, Feemster, Laura C, Akgün, Kathleen M, Butt, Adeel A, Graber, Christopher J, Fine, Michael J, Goetz, Matthew B, Rodriguez-Barradas, Maria C, Pisani, Margaret A, Tindle, Hilary A, Brown, Sheldon T, Soo Hoo, Guy W, Rimland, David, Gibert, Cynthia L, Huang, Laurence, Freiberg, Matthew S, Hough, Catherine L, Crothers, Kristina, Attia, Engi F, Attia, Engi F, McGinnis, Kathleen A, Feemster, Laura C, Akgün, Kathleen M, Butt, Adeel A, Graber, Christopher J, Fine, Michael J, Goetz, Matthew B, Rodriguez-Barradas, Maria C, Pisani, Margaret A, Tindle, Hilary A, Brown, Sheldon T, Soo Hoo, Guy W, Rimland, David, Gibert, Cynthia L, Huang, Laurence, Freiberg, Matthew S, Hough, Catherine L, and Crothers, Kristina

Abstract

BackgroundPulmonary infections remain more common in HIV-infected (HIV+) compared with uninfected individuals. The increase in chronic lung diseases among aging HIV+ individuals may contribute to this persistent risk. We sought to determine whether chronic obstructive pulmonary disease (COPD) is an independent risk factor for different pulmonary infections requiring hospitalization among HIV+ patients.MethodsWe analyzed data from 41,993 HIV+ Veterans in the nationwide Veterans Aging Cohort Study Virtual Cohort from 1996 to 2009. Using International Classification of Diseases, Ninth Revision codes, we identified baseline comorbid conditions, including COPD, and incident community-acquired pneumonia (CAP), pulmonary tuberculosis (TB), and Pneumocystis jirovecii pneumonia (PCP) requiring hospitalization within 2 years after baseline. We used multivariable Poisson regression to determine incidence rate ratios (IRRs) associated with COPD for each type of pulmonary infection, adjusting for comorbidities, CD4 cell count, HIV viral load, smoking status, substance use, vaccinations, and calendar year at baseline.ResultsUnadjusted incidence rates of CAP, TB, and PCP requiring hospitalization were significantly higher among persons with COPD compared to those without COPD (CAP: 53.9 vs. 19.4 per 1000 person-years; TB: 8.7 vs. 2.8; PCP: 15.5 vs. 9.2; P ≤ 0.001). In multivariable Poisson regression models, COPD was independently associated with increased risk of CAP, TB, and PCP (IRR: 1.94, 95% confidence interval [CI]: 1.64 to 2.30; IRR: 2.60, 95% CI: 1.70 to 3.97; and IRR: 1.48, 95% CI: 1.10 to 2.01, respectively).ConclusionsCOPD is an independent risk factor for CAP, TB, and PCP requiring hospitalization among HIV+ individuals. As the HIV+ population ages, the growing burden of COPD may confer substantial risk for pulmonary infections.

Published
2015

20. Risk factors for hospitalization and medical intensive care unit (MICU) admission among HIV-infected Veterans.

Author

Akgün, Kathleen M, Akgün, Kathleen M, Gordon, Kirsha, Pisani, Margaret, Fried, Terri, McGinnis, Kathleen A, Tate, Janet P, Butt, Adeel A, Gibert, Cynthia L, Huang, Laurence, Rodriguez-Barradas, Maria C, Rimland, David, Justice, Amy C, Crothers, Kristina, Akgün, Kathleen M, Akgün, Kathleen M, Gordon, Kirsha, Pisani, Margaret, Fried, Terri, McGinnis, Kathleen A, Tate, Janet P, Butt, Adeel A, Gibert, Cynthia L, Huang, Laurence, Rodriguez-Barradas, Maria C, Rimland, David, Justice, Amy C, and Crothers, Kristina

Abstract

ObjectiveWith improved survival of HIV-infected persons on antiretroviral therapy and growing prevalence of non-AIDS diseases, we asked whether the VACS Index, a composite measure of HIV-associated and general organ dysfunction predictive of all-cause mortality, predicts hospitalization and medical intensive care unit (MICU) admission. We also asked whether AIDS and non-AIDS conditions increased risk after accounting for VACS Index score.MethodsWe analyzed data from the Veterans Aging Cohort Study (VACS), a prospective study of HIV-infected Veterans receiving care between 2002 and 2008. Data were obtained from the electronic medical record, VA administrative databases, and patient questionnaires and were used to identify comorbidities and calculate baseline VACS Index scores. The primary outcome was first hospitalization within 2 years of VACS enrollment. We used multivariable Cox regression to determine risk factors associated with hospitalization and logistic regression to determine risk factors for MICU admission, given hospitalization.ResultsOf 3410 patients, 1141 were hospitalized within 2 years; 203 (17.8%)/1141 patients included an MICU admission. Median VACS Index scores were 25 (no hospitalization), 34 (hospitalization only), and 51 (MICU). In adjusted analyses, a 5-point increment in VACS Index score was associated with 10% higher risk of hospitalization and MICU admission. In addition to VACS Index score, Hispanic ethnicity, current smoking, hazardous alcohol use, chronic obstructive pulmonary disease, hypertension, diabetes, and prior AIDS-defining event predicted hospitalization. Among those hospitalized, VACS Index score, cardiac disease, and prior cancer predicted MICU admission.ConclusionsThe VACS Index predicted hospitalization and MICU admission as did current smoking, hazardous alcohol use, and AIDS and certain non-AIDS diagnoses.

Published
2013

21. Medical ICU admission diagnoses and outcomes in human immunodeficiency virus-infected and virus-uninfected veterans in the combination antiretroviral era.

Author

Akgün, Kathleen M, Akgün, Kathleen M, Tate, Janet P, Pisani, Margaret, Fried, Terri, Butt, Adeel A, Gibert, Cynthia L, Huang, Laurence, Rodriguez-Barradas, Maria C, Rimland, David, Justice, Amy C, Crothers, Kristina, Akgün, Kathleen M, Akgün, Kathleen M, Tate, Janet P, Pisani, Margaret, Fried, Terri, Butt, Adeel A, Gibert, Cynthia L, Huang, Laurence, Rodriguez-Barradas, Maria C, Rimland, David, Justice, Amy C, and Crothers, Kristina

Abstract

ObjectivesHuman immunodeficiency virus (HIV)-infected (HIV+) patients on combination antiretroviral therapy are living longer but have increased risk for aging-associated disease which may lead to increasing critical care requirements. We compare medical ICU admission characteristics and outcomes among HIV infected and demographically similar uninfected patients (uninfected) and considered whether an index which combines routine clinical biomarkers (the Veterans Aging Cohort Study Index) predicts 30-day medical ICU mortality.DesignObservational data analyses (Veterans Aging Cohort Study).SettingEight Veterans Affairs medical centers nationwide.PatientsHIV infected and uninfected with a medical ICU admission between 2002 and 2010.InterventionNone.Measurements and main resultsMedical ICU admission was determined using bedsection (Veterans Affairs) and revenue center codes (Medicare). For Veterans Affairs admissions, we used clinical data to calculate Veterans Aging Cohort Study Index scores and multivariable logistic regression to determine factors associated with 30-day mortality. Overall, 539 of 3,620 (15%) HIV infected and 375 of 3,639 (10%) uninfected had a medical ICU admission; 72% and 78%, respectively, were Veterans Affairs based. HIV+ patients were younger at admission (p < 0.0001). Although most HIV+ patients were on antiretroviral therapy (71%) with undetectable HIV-1 RNA (54%), compared with uninfected they were more commonly admitted with respiratory diagnoses or infections (21% vs. 12%), were more likely to require mechanical ventilation (17% vs. 9%; p = 0.001), and had a higher mortality rate (18.6% vs. 11.2%, p = 0.003). Cardiovascular diagnoses were less common among HIV infected (18% vs. 29%; p < 0.0001). In logistic regression (c-statistic 0.87), a 5-point increment in Veterans Aging Cohort Study Index was associated with an odds ratio of death of 1.22 (95% confidence interval 1.14-1.30) among HIV infected and of 1.50 (95% confidence interval

Published
2013

22. Risk factors for hospitalization and medical intensive care unit (MICU) admission among HIV-infected Veterans.

Author

Akgün, Kathleen M, Akgün, Kathleen M, Gordon, Kirsha, Pisani, Margaret, Fried, Terri, McGinnis, Kathleen A, Tate, Janet P, Butt, Adeel A, Gibert, Cynthia L, Huang, Laurence, Rodriguez-Barradas, Maria C, Rimland, David, Justice, Amy C, Crothers, Kristina, Akgün, Kathleen M, Akgün, Kathleen M, Gordon, Kirsha, Pisani, Margaret, Fried, Terri, McGinnis, Kathleen A, Tate, Janet P, Butt, Adeel A, Gibert, Cynthia L, Huang, Laurence, Rodriguez-Barradas, Maria C, Rimland, David, Justice, Amy C, and Crothers, Kristina

Abstract

ObjectiveWith improved survival of HIV-infected persons on antiretroviral therapy and growing prevalence of non-AIDS diseases, we asked whether the VACS Index, a composite measure of HIV-associated and general organ dysfunction predictive of all-cause mortality, predicts hospitalization and medical intensive care unit (MICU) admission. We also asked whether AIDS and non-AIDS conditions increased risk after accounting for VACS Index score.MethodsWe analyzed data from the Veterans Aging Cohort Study (VACS), a prospective study of HIV-infected Veterans receiving care between 2002 and 2008. Data were obtained from the electronic medical record, VA administrative databases, and patient questionnaires and were used to identify comorbidities and calculate baseline VACS Index scores. The primary outcome was first hospitalization within 2 years of VACS enrollment. We used multivariable Cox regression to determine risk factors associated with hospitalization and logistic regression to determine risk factors for MICU admission, given hospitalization.ResultsOf 3410 patients, 1141 were hospitalized within 2 years; 203 (17.8%)/1141 patients included an MICU admission. Median VACS Index scores were 25 (no hospitalization), 34 (hospitalization only), and 51 (MICU). In adjusted analyses, a 5-point increment in VACS Index score was associated with 10% higher risk of hospitalization and MICU admission. In addition to VACS Index score, Hispanic ethnicity, current smoking, hazardous alcohol use, chronic obstructive pulmonary disease, hypertension, diabetes, and prior AIDS-defining event predicted hospitalization. Among those hospitalized, VACS Index score, cardiac disease, and prior cancer predicted MICU admission.ConclusionsThe VACS Index predicted hospitalization and MICU admission as did current smoking, hazardous alcohol use, and AIDS and certain non-AIDS diagnoses.

Published
2013

23. Medical ICU admission diagnoses and outcomes in human immunodeficiency virus-infected and virus-uninfected veterans in the combination antiretroviral era.

Author

Akgün, Kathleen M, Akgün, Kathleen M, Tate, Janet P, Pisani, Margaret, Fried, Terri, Butt, Adeel A, Gibert, Cynthia L, Huang, Laurence, Rodriguez-Barradas, Maria C, Rimland, David, Justice, Amy C, Crothers, Kristina, Akgün, Kathleen M, Akgün, Kathleen M, Tate, Janet P, Pisani, Margaret, Fried, Terri, Butt, Adeel A, Gibert, Cynthia L, Huang, Laurence, Rodriguez-Barradas, Maria C, Rimland, David, Justice, Amy C, and Crothers, Kristina

Abstract

ObjectivesHuman immunodeficiency virus (HIV)-infected (HIV+) patients on combination antiretroviral therapy are living longer but have increased risk for aging-associated disease which may lead to increasing critical care requirements. We compare medical ICU admission characteristics and outcomes among HIV infected and demographically similar uninfected patients (uninfected) and considered whether an index which combines routine clinical biomarkers (the Veterans Aging Cohort Study Index) predicts 30-day medical ICU mortality.DesignObservational data analyses (Veterans Aging Cohort Study).SettingEight Veterans Affairs medical centers nationwide.PatientsHIV infected and uninfected with a medical ICU admission between 2002 and 2010.InterventionNone.Measurements and main resultsMedical ICU admission was determined using bedsection (Veterans Affairs) and revenue center codes (Medicare). For Veterans Affairs admissions, we used clinical data to calculate Veterans Aging Cohort Study Index scores and multivariable logistic regression to determine factors associated with 30-day mortality. Overall, 539 of 3,620 (15%) HIV infected and 375 of 3,639 (10%) uninfected had a medical ICU admission; 72% and 78%, respectively, were Veterans Affairs based. HIV+ patients were younger at admission (p < 0.0001). Although most HIV+ patients were on antiretroviral therapy (71%) with undetectable HIV-1 RNA (54%), compared with uninfected they were more commonly admitted with respiratory diagnoses or infections (21% vs. 12%), were more likely to require mechanical ventilation (17% vs. 9%; p = 0.001), and had a higher mortality rate (18.6% vs. 11.2%, p = 0.003). Cardiovascular diagnoses were less common among HIV infected (18% vs. 29%; p < 0.0001). In logistic regression (c-statistic 0.87), a 5-point increment in Veterans Aging Cohort Study Index was associated with an odds ratio of death of 1.22 (95% confidence interval 1.14-1.30) among HIV infected and of 1.50 (95% confidence interval

Published
2013

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