Author: "Lapinsky A" / Topic: medicine - Searchworks@Jio Institute Digital Library Search Results

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1. American Sign Language and Deaf Culture Competency of Osteopathic Medical Students

Author: Lapinsky, Jessica, Colonna, Caitlin, and Sexton, Patricia
Abstract: The study examined the effectiveness of a workshop on Deaf culture and basic medical American Sign Language for increasing osteopathic student physicians' confidence and knowledge when interacting with ASL-using patients. Students completed a pretest in which they provided basic demographic information, rated their confidence levels, took a video quiz on basic medical signs, and experienced a practical standardized encounter with a Deaf patient. They then attended a 4-hour workshop and, 2 weeks later, completed a posttest. Thirty-three students completed the pretest; 29 attended the workshop; 26 completed the posttest. Video quiz scores increased significantly from pretest to posttest, as did scores for the standardized patient encounter after completion of the workshop. Students also reported increased levels of confidence in interactions with the Deaf community. The results suggest that a single workshop was effective in increasing both confidence and shortterm knowledge in interactions with Deaf patients.
Published: 2015

2. Feasibility of establishing a Canadian Obstetric Survey System (CanOSS) for severe maternal morbidity: a study protocol

Author: Marian Knight, Maria B Ospina, K S Joseph, Amy Metcalfe, Heather Scott, Deshayne B Fell, Thomas van den Akker, Jon Barrett, Prakesh Shah, Beth Murray-Davis, Rohan D’Souza, Stephen Lapinsky, Sara Thorne, Milena Forte, Jocelynn Cook, Rebecca J Seymour, Susie Dzakpasu, Leslie Skeith, Rizwana Ashraf, Josie Chundamala, Sarah A Hutchinson, Kenneth K Chen, and Isabelle Malhamé
Subjects: Medicine
Abstract: Introduction Severe maternal morbidity (SMM)—an unexpected pregnancy-associated maternal outcome resulting in severe illness, prolonged hospitalisation or long-term disability—is recognised by many, as the preferred indicator of the quality of maternity care, especially in high-income countries. Obtaining comprehensive details on events and circumstances leading to SMM, obtained through maternity units, could complement data from large epidemiological studies and enable targeted interventions to improve maternal health. The aim of this study is to assess the feasibility of gathering such data from maternity units across Canadian provinces and territories, with the goal of establishing a national obstetric survey system for SMM in Canada.Methods and analysis We propose a sequential explanatory mixed-methods study. We will first distribute a cross-sectional survey to leads of all maternity units across Canada to gather information on (1) Whether the unit has a system for reviewing SMM and the nature and format of this system, (2) Willingness to share anonymised data on SMM by direct entry using a web-based platform and (3) Respondents’ perception on the definition and leading causes of SMM at a local level. This will be followed by semistructured interviews with respondent groups defined a priori, to identify barriers and facilitators for data sharing. We will perform an integrated analysis to determine feasibility outcomes, a narrative description of barriers and facilitators for data-sharing and resource implications for data acquisition on an annual basis, and variations in top-5 causes of SMM.Ethics and dissemination The study has been approved by the Mount Sinai and Hamilton Integrated Research Ethics Boards. The study findings will be presented at annual scientific meetings of the Society of Obstetricians and Gynaecologists of Canada, North American Society of Obstetric Medicine, and International Network of Obstetric Survey Systems and published in an open-access peer-reviewed Obstetrics and Gynaecology or General Internal Medicine journal.
Published: 2022
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3. Functional polymorphism of the serotonin reuptake transporter SLC6A4 gene in various clinical variants of irritable bowel syndrome

Author: A. V. Pushkina, A. B. Avalueva, I. G. Bakulin, A. A. Topanova, A. A. Murzina, S. I. Sitkin, I. V. Lapinsky, and E. V. Skazyvaeva
Subjects: irritable bowel syndrome, serotonin, serotonin reuptake transporter, polymorphism, genotype, alleles, 5-httlpr, slc6a4, Medicine
Abstract: Rationale: Irritable bowel syndrome (IBS) is a multifactorial disease, the genetic aspect of which is being actively studied.Aim: To investigate functional polymorphism of the serotonin reuptake transporter (SERT) SLC6A4 gene of various clinical variants of IBS.Materials and methods: We performed a cross-sectional single center study in 79 Caucasian patients with IBS (according to the Rome criteria IV). The patients were divided into two groups: group 1, IBS with diarrhea (IBS-D, n = 45) and group 2, IBS with constipation (IBS-C, n = 34). The control group included 59 Caucasian patients with gastrointestinal disorders without IBS. Polymorphism 5-HTTLPR of the SLC6A4 gene was assessed in all subjects. In group 1 patients, blood serotonin levels were measured and psychological tests were performed, including Spielberger's State / Trait Anxiety Inventory, quality of life by SF36 and GSRS, Asthenia scale, VAS scores for pain intensity.Results: Thirty-five of 45 (77.8%) patients with IBS-D carried the mutant S allele, which was significantly more frequent than in the IBS-C group (p = 0.002) and in the control group (p = 0.005). There were no statistically significant differences (p = 0.54) in the frequency of detection of the homozygous LL genotype (normal allele) and the heteroand homozygous mutant alleles (SL and SS) genotype between the IBS-C and control patients. In the IBS-D group, a gender difference for the mutant SS allele of 5-HTTLPR was found, with significantly higher frequency in female patients (p = 0.0147). No significant gender differences in the genotype distribution between the patients with IBS-C and the control group were found. There were also no differences in blood serotonin levels in the IBS patients with various 5-HTTLPR types (p = 0.086); they were all in the reference range. However, there was a trend towards lower serotonin levels in the LL genotype carriers compared to those with the SS/SL polymorphisms. The Gastroenterological inventory GSRS demonstrated significantly higher total score for the constipation syndrome in the patients with homozygous LL 5-HTTLPR polymorphism, compared to that in the patients with the SS/SL genotype (p = 0.013).Conclusion: The results may be related to lower expression of the SLC6A4 gene in the carriers of the mutant allele in the 5-HTTLPR promoter and subsequent decreased rate of serotonin uptake, with resulting stimulation of the gastrointestinal tract. The SERT polymorphism of the SLC6A4 gene is worth further investigation as a potential candidate gene in the IBS pathophysiology.
Published: 2019
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4. Economic evaluation alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (E-PROSPECT): study protocol

Author: Katie Ross, Dimitra Fleming, John Marshall, Najib Ayas, François Lellouche, Justin Lys, Ryan Zarychanski, Timothy Karachi, Deborah J Cook, Marie-Claude Tremblay, Jeremy Grushka, Dan Deckelbaum, Kosar Khwaja, Tarek Razek, Donald Griesdale, John Muscedere, David Maslove, Roupen Hatzakorzian, Patrick Archambault, Feng Xie, François Lauzier, Heather Smith, David Williamson, Emmanuel Charbonney, John Granton, Alyson Takaoka, Kwadwo Kyeremanteng, Miranda Hunt, Ian Ball, Victoria McCredie, Michaël Chasse, Jennifer LY Tsang, Jordi Mancebo, Peter Dodek, Emilie Belley-Cote, Neala Hoad, Melissa Shears, Mark Soth, Tracy Campbell, Geeta Mehta, Daniel Chen, Shane English, Maureen Meade, John Kim, Jie Meng, Richard Johnston, Jennie Johnstone, Norman Dewhurst, Panagiota Giannakouros, Laura García, John Ma, Dev Jayaraman, Pierre Cardinal, Vincent Issac Lau, John C Marshall, John Basmaji, Deborah Cook, Erick Duan, France Clarke, Mary Copland, Marnie Jakab, Nicole Zytaruk, Christa Connolly, Denise Davis, Catherine Eaton, Tracy Gallinas, Jean Lee-Yoo, Connie Lukinuk, Leia Musielak, Nancy Pavunkovic, Joy Pelayo, Kaitlyn Phillips, Catherine Pracsovics, Julia Raimondo, Vida Stankus, Christine Wallace, Angela Wright, Crystal Young, Katrina Fimiani, Lori Hand, Harjot Jagdey, Lisa Klotz, Alexana Sabev, Nevena Savija, Deanne Cosentino, Diane Lourenco, Julie Misina, Gita Sobhi, Mashari Alghuroba, Alia Khaled, Lauren Locco, Tina Millen, Ryan Vaisler, Maya Biljan, Brittany Marriott, Jan Frieich, Jennifer Hodder, Imrana Khalid, Julie Lee, Yoon Lee, Pragma Roy, Kurtis Salway, Gyan Sandhu, Marlene Santos, Orla Smith, Melissa Wang, Ann Dowbenka, Ann Kosinski, Terri Norrie, Ranjit Parhar, Laura Parsons, Johanna Proceviat, Gitana Ramonas, Mae Yuen, Maria Agda, Victoria Alcuaz, Betty Jean Ashley, Kelsey Brewer, Janice Palmer, Glen Brown, Mara Pavan, Stephen Lapinsky, Laveena Munshi, Maedean Brown, Brittany Giacomino, Alan Kraguljac, Sumesh Shah, Erik Tamberg, Laura Vergeer, Doret Cheng, Gagan Grewal, Anew Han, Holly Leung, Ioanna Mantas, Hilary Roigues, Anew Wyllie, Alexis Turgeon, Danny Barriault, David Bellemare, Anick Boivin, Sarah-Judith Breton, Eve Cloutier, Marjorie Daigle, Charles Delisle-Thibeault, Stéphanie Grenier, Gabrielle Guilbault, Caroline Léger, Catherine Ouellet, Élisabeth Gagne, Julie Gaueau, Claire Grégoire, Véronique Labbé, Ariane Laprise-Rochette, Caroline Ouellet, Mélanie Samson, Marie-David Simoneau, Virginie Turcotte, Tuong-Vi Tran, Lauralyn McIntyre, Joe Pagilarello, Gianni D’Egidio, Mike Hartwick, Jonathon Hooper, Gwynne Jones, Dal Kubelik, Hilary Meggison, Sherissa Microys, Dave Neiliovitz, Guiseppe Pagliarello, Rakesh Patel, Jo Po, Peter Reardon, Erin Rosenberg, Aimee Sarti, Anew Seely, Shelley Acres, Brigette Gomes, Heather Langlois, Liane Leclair, Sydney Miezitis, Kaitlyn Montroy, Rebecca Porteous, Shawna Reddie, Amanda Van Beinum, Allyshia Van Tol, Irene Watpool, Wendy Aikens, Marianne Cox, Anne-Marie Dugal, Susan Fetzer, Kathy Fraser, Jennifer Kuhn, Rob MacLeod, Susanne Richard, Dawn Rose, Sherry Weir, Bill Henderson, Mypinder Sekhon, Denise Foster, Suzie Logie, Judy Yip, Margaret Herridge, s Alberto Goffi, Eyal Golan, Elizabeth Wilcox, Jaimie Archer, Paulina Farias, Brooke Fraser, Cheryl Geen-Smith, Barbara Kosky, Anea Matte, Christina Pugliese, Priscila Robles, Lia Stenyk, Cristian Urrea, Karolina Walczak, Kyung Ae, Jane Ascroft, Fatima Haji, Rajvinder Kaur, Jane Lui, Sophia Mateo, Nga Pham, Tam Pham, Matthew Suen, Jennifer Teng, Gordon Wood, Daniel Ovakim, Fiona Auld, Gayle Camey, Ralph Fleming, Jennifer Good, Mandeep Manhas, Karin Boyd, Jane Dheere, Priscilia Robles, Muhammad Walid, Jill Westlund, Yoan Lamarche, Soazig Leguillan, Karim Serri, Colin Verdant, Yanick Beaulieu, Patrick Bellemare, Philippe Bernard, Marc Giasson, Véronique Brunette, Alexanos Cavayas, Émilie Lévesque, Halina Labikova, Julia Lainer Palacios, Marie-Ève Langlois, Virginie Williams, Thuy Anh Nguyen, Valérie Phaneuf, Frédérick D’Aragon, Charles St-Arnaud, Hector Quiroz, Virginie Bolduc, Elaine Carbonneau, Joannie Marchand, Marie-Hélène Masse, Sylvie Cloutier, Marianne Guay, Line Morin, Jessie Nicolson, Isabelle Paquette, Patricia Roy, France Théberge, Arnold S Kristof, Peter Goldberg, Sheldon Magder, Jason Shahin, Salman Qureshi, Josie Campisi, Vasilica Botan, Anissa Capilnean, Alyssa Corey, Annick Gagné, Jasmine Mian, Kathleen Normandin, Ash Gursahaney, David Hornstein, Robert Salasidis, Patrizia Zanelli, Norine Alam, Tonia Doerksen, Ariane Lessard, Gilbert Matte, Marie-France Robert, Martin Girard, Pierre Aslanian, Sylvain Belisle, François-Martin Carrier, Ané Denault, Jean-Gilles Guimond, Antoine Halwagi, Paul Hébert, Christopher Kolan, Nicholas Robillard, Fatna Benettaib, Dounia Boumahni, Casey Bourdeau Caporuscio, Marie-Ève Cantin, Virginy Côté-Gravel, Ali Ghamraoui, Martine Lebrasseur, Lancelot Legene Courville, Stéphanie Lorio, Maria Trinidad Maid, Nicole Poitras, Romain Rigal, Maya Salame, Valérie Tran, Katie Bacon, Nathalie Boueau, Cecilia Carvajal, Lyne Gauthier, Julie Genon, Karine Jean, Louise Laforest, Antonietta Lembo, Sothun Lim, Jennifer Morrissette, France Pagé, Lucie Pelletier, Marie-Christine Roigue, Jim Kutsiogiannis, Raiyan Chowdhury, Jon Davidow, Curt Johnston, Kim Macala, Sam Marcushamer, Darren Markland, Doug Matheson, Damian Paton-Gay, David Zygun, Nadine Grant, Tayne Hewer, Pat Thompson, Maggie Ge, Janny Hall, Sharon Matenchuk, Osama Loubani, Rick Hall, Robert Green, Diana Gillis, Lisa Julien, Laura Lee Magennis, Tamara Mitterer, Joanna Arsenault, Kim Bruce-Payne, Patti Gallant, Gord Boyd, Christine D’Arsigny, John Over, Jason Erb, Chris Parker, Stephanie Sibley, Tracy Boyd, Ilinca Georgescu, Danielle Muscedere, Cathy Baker, Jennifer Engel, Jennifer Fleming, Lisa Roderick, Shelley Silk, Marcy Spencer, Michelle Tryon, Marcus Blouw, Kendiss Olafson, Bojan Paunovic, Oliver Gutieror, Nicole Marten, Sherri Lynn Wingfield, Marnie Boyle, Halyna Ferens, Debbie Hrabi, Beata Kozak, Chantal MacDonald, Julie Muise, Eileen Campbell, Susie Imerovski, Athena Ovsenek, Rebecca Rondinelli, Teresa Longfield, Amy Moyer, Faith Norris, Janice Sumpton, Karina Teterycz, Brenda Reeve, Karen Bento, Megan Davis, Will Dechert, Krista Gallo, Barbara Longo, Courtney Mullen, Elysia Skrzypek, Laurenne Wierenga, Wesam Abuzaiter, Lynda Amorim, Rosemarie Bauer, Rachel Damota, Thoa Ho, Nicole Macdougall, Mary Thornewell, Lara Pe, Jennifer Visocchi, Auey Bhairo, Halyna Ferenes, Debra Kubin, Dawn-Lee McLaughlin, Maria Valente, Steve Reynolds, Suzette Willems, Tina Sekhon, Sebastien Trop, Alexana Binnie, Ronald Heslegrave, Kim Sharman, Zaynab Panchbhaya, Rakhi Goel, Kim Kozluk, Julianne Labelle, Hina Marsonia, Cecillia Scott, Dave Nagpal, Tracey Bentall, Jessica Sturt-Smith, Michelle Alexander, Tammy Ellis, Mindy Muylaert, Cindy Paczkowski, Wendy Sligl, Sean Bagshaw, Nadia Baig, Lorena McCoshen, Katrina Alexanopoulos, Sherri Bain, Michelle Brandt, Cathy Constable, Kari Douglas, Shaleen Maharaj, Sabrina Travers, Tom Stelfox, Philippe Couillard, Christopher Doig, Ken Parhar, Joshua Booth, Cassidy Codan, Stacy Ruddell, Candice Cameron, Rhonda Edison, Anne Martin, Breanna Mina, Dan Niven, Luc Berthiaume, Jonathan Gaudet, Gina Fleming, Mercedes Carmargo, Beverly Hoekstra, Rita Caporuscio, Rachel Kressner Falvo, Carmelina Maxwell, Karmen Plantic, François Marquis, Han Tin Wang, Francis Toupin, Stephane Ahern, Brian Laufer, Marc Brosseau, Pauline Dul, Johanne Harvey, Lotthida Inthanavong, Danae Tassy, Helen Assayag, Maude Bachand, Marysa Betournay, Karine Daoust, Kristine Goyette, Marceline Quach, Paul Hosek, Bill Plaxton, Catherine Armstrong, Rhonda Barber, William Dechert, Janelle Ellis, Kayla Fisk, Melissa Gabnouri, Emilie Gordon, Rebecca Haegens, Lisa Halford, Brooklynn Hillis, Rebecca Jesso, Jenn McLaren, Elliot McMillan, Mariska Pelkmans, Matthew Rekman, Sylvia Sinkovitis, Monica Truong, Michelle White, Noah Bates, Susan Bryden-Cromwell, Lisa Cha, Colleen Cameron, Aminah Deen, Sheri DiGiovanni, Anders Foss, Esther Lee, Heidi MacGregor, Esther Galbraith, Robyn McArthur, Julie McGregor, Keith Miller, Sharon Morris, Shelley Parker, Candice Smith, Joanna Stoglow, Jennifer Tung, Melissa Vos, Neill Adhikari, Ane Amaral, Ane Carlos, Brian Cuthbertson, Rob Fowler, Damon Scales, Navjot Kaur, Nicole Marinoff, Adic Perez, Jane Wang, Katrina Hatzifilalithis, John Iazzetta, Chrys Kolos, Ingrid Quinton, Paul Lysecki, Joseph Berlingieri, Sameer Shaikh, Steven Skitch, Hala Basheer, Kathy Bruder, Jane Cheng, Kaiser Qureshi, Celeste Thibault, Ying Tung Sia, Mathieu Simon, Pierre-Alexane Bouchard, Patricia Lizotte, Nathalie Chateauvert, Thérèse Grenier, Jean-François Bellemare, Simon Bordeleau, Christine Ouin, Benoît Duhaime, Ann Laberge, Philippe Lachance, Mélanie Constantin, Estel Deblois, Maude Dionne, Lise Lavoie, Isabelle Michel, Alexane Pépin, Sanine Poulin, Sarah Anctil, Amélie Chouinard, Louis-Étienne Marchand, Robin Roy, Roigo Cartin-Ceba, Richard Oeckler, Brenda Anderson, Lavonne Liedl, Laurie Meade, Sueanne Weist, Anna Bartoo, Debbie Bauer, Vince Brickley, Shaun Bridges, Greg Brunn, Jennifer Eickstaedt, Jill Randolph, Sandy Showalter, Melissa Wendling, Robert Taylor, Margaret Cytron, Kim Fowler, Katie Krause, Jackie O’Brien, Marianne Tow, Kaitlin Stassi, Abdulaziz Al-Dawood, Haytham Tlayjeh, Alaaeldien Ghanem, Ahmad Hassanien, Mohamed Hegazy, Ashraf El Sharkawi, Felwa Bin Humaid, Hala Alanizi, Nadyah Alanizy, Njoud Al Bogami, Mohammed Muhaidib, Jawaher Gramish, Randa Alsomali, Nora Devera, and Marjane Villafranca
Subjects: Medicine
Abstract: Introduction Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in the intensive care unit (ICU). Probiotics are defined as live microorganisms that may confer health benefits when ingested. Prior randomised trials suggest that probiotics may prevent infections such as VAP and Clostridioides difficile–associated diarrhoea (CDAD). PROSPECT (Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial) is a multicentre, double-blinded, randomised controlled trial comparing the efficacy of the probiotic Lactobacillus rhamnosus GG with usual care versus usual care without probiotics in preventing VAP and other clinically important outcomes in critically ill patients admitted to the ICU.Methods and analysis The objective of E-PROSPECT is to determine the incremental cost-effectiveness of L. rhamnosus GG plus usual care versus usual care without probiotics in critically ill patients. E-PROSPECT will be performed from the public healthcare payer’s perspective over a time horizon from ICU admission to hospital discharge.We will determine probabilities of in-ICU and in-hospital events from all patients alongside PROSPECT. We will retrieve unit costs for each resource use item using jurisdiction-specific public databases, supplemented by individual site unit costs if such databases are unavailable. Direct costs will include medications, personnel costs, radiology/laboratory testing, operative/non-operative procedures and per-day hospital ‘hoteling’ costs not otherwise encompassed. The primary outcome is the incremental cost per VAP prevented between the two treatment groups. Other clinical events such as CDAD, antibiotic-associated diarrhoea and in-hospital mortality will be included as secondary outcomes. We will perform pre-specified subgroup analyses (medical/surgical/trauma; age; frailty status; antibiotic use; prevalent vs no prevalent pneumonia) and probabilistic sensitivity analyses for VAP, then generate confidence intervals using the non-parametric bootstrapping approach.Ethics and dissemination Study approval for E-PROSPECT was granted by the Hamilton Integrated Research Ethics Board of McMaster University on 29 July 2019. Informed consent was obtained from the patient or substitute decision-maker in PROSPECT. The findings of this study will be published in peer-reviewed journals.Trial registration number NCT01782755; Pre-results.
Published: 2020
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5. Tocilizumab for coronavirus disease 2019 in pregnancy and lactation: a narrative review

Author: Stephen E. Lapinsky and Sarah Cj. Jorgensen
Subjects: musculoskeletal diseases, Microbiology (medical), Pregnancy, medicine.medical_specialty, education.field_of_study, business.industry, Confounding, Population, Breastfeeding, General Medicine, Abortion, medicine.disease, Clinical trial, chemistry.chemical_compound, Infectious Diseases, Tocilizumab, chemistry, Premature birth, Medicine, skin and connective tissue diseases, business, Intensive care medicine, education
Abstract: Background Tocilizumab is a monoclonal antibody that interrupts interleukin-6 signalling, reducing downstream effects on inflammation and the innate immune response. It was shown to reduce mortality in patients with severe or critical coronavirus disease 2019 (COVID-19). Pregnant and breastfeeding people were largely excluded from clinical trials and hence, the extent to which results can be applied to these populations is not clear. Objectives To synthesize published data on tocilizumab in pregnancy and lactation, highlight important knowledge gaps, and help inform clinical decision-making about tocilizumab's use in these populations with COVID-19. Sources PubMed was searched for studies evaluating tocilizumab in pregnancy and lactation for COVID-19 and other indications. Literature on pharmacokinetics and reproductive/fetal safety of monoclonal antibodies in general was also sought. The US Food and Drug Administration and the European Medicines Agency guidance for the industry and regulatory approval documents were reviewed. Content Published data on tocilizumab in pregnancy include 610 cases (n = 20 with COVID-19) together with seven mother–infant breastfeeding pairs. Higher rates of spontaneous abortion and premature birth have been reported compared with the general population, but multiple confounding variables limit interpretation. There is little data on tocilizumab exposure in the second and third trimesters when transplacental transport is highest. The effects of tocilizumab on the developing immune system are unclear. Pregnant patients with COVID-19 who received tocilizumab were often critically ill and corticosteroid use was uncommon. Neonatal follow up was limited. Tocilizumab appears to be compatible with breastfeeding. Implications Although the available data do not raise serious safety signals, they have significant limitations and are not sufficient to delineate the complete spectrum of potential adverse outcomes that may be associated with tocilizumab exposure during pregnancy and lactation. Diligent follow up and documentation of pregnancy outcomes will be important moving forward. A more effective regulatory framework to ensure equitable inclusion of pregnant people in research is clearly needed.
Published: 2022
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6. Risk prediction models for maternal mortality: A systematic review and meta-analysis.

Author: Kazuyoshi Aoyama, Rohan D'Souza, Ruxandra Pinto, Joel G Ray, Andrea Hill, Damon C Scales, Stephen E Lapinsky, Gareth R Seaward, Michelle Hladunewich, Prakesh S Shah, and Robert A Fowler
Subjects: Medicine, Science
Abstract: PurposePregnancy-related critical illness leads to death for 3-14% of affected women. Although identifying patients at risk could facilitate preventive strategies, guide therapy, and help in clinical research, no prior systematic review of this literature exploring the validity of risk prediction models for maternal mortality exists. Therefore, we have systematically reviewed and meta-analyzed risk prediction models for maternal mortality.MethodsSearch strategy: MEDLINE, EMBASE and Scopus, from inception to May 2017. Selection criteria: Trials or observational studies evaluating risk prediction models for maternal mortality. Data collection and analysis: Two reviewers independently assessed studies for eligibility and methodological quality, and extracted data on prediction performance.ResultsThirty-eight studies that evaluated 12 different mortality prediction models were included. Mortality varied across the studies, with an average rate 10.4%, ranging from 0 to 41.7%. The Collaborative Integrated Pregnancy High-dependency Estimate of Risk (CIPHER) model and the Maternal Severity Index had the best performance, were developed and validated from studies of obstetric population with a low risk of bias. The CIPHER applies to critically ill obstetric patients (discrimination: area under the receiver operating characteristic curve (AUC) 0.823 (0.811-0.835), calibration: graphic plot [intercept-0.09, slope 0.92]). The Maternal Severity Index applies to hospitalized obstetric patients (discrimination: AUC 0.826 [0.802-0.851], calibration: standardized mortality ratio 1.02 [0.86-1.20]).ConclusionsDespite the high heterogeneity of the study populations and the limited number of studies validating the finally eligible prediction models, the CIPHER and the Maternal Severity Index are recommended for use among critically ill and hospitalized pregnant and postpartum women for risk adjustment in clinical research and quality improvement studies. Neither index has sufficient discrimination to be applicable for clinical decision making at the individual patient level.
Published: 2018
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7. A Detailed Review of Critical Care Considerations for the Pregnant Cardiac Patient

Author: Jasmine Grewal, Stephen E. Lapinsky, and Kristen M. Kidson
Subjects: medicine.medical_specialty, Critical Care, Peripartum cardiomyopathy, Critical Illness, Pregnancy Complications, Cardiovascular, Intrauterine growth restriction, Disease, Global Health, law.invention, Amniotic fluid embolism, Pregnancy, law, medicine, Humans, Intensive care medicine, business.industry, Cardiorespiratory fitness, medicine.disease, Intensive care unit, Pregnancy Complications, Intensive Care Units, Maternal Mortality, Female, Maternal death, Morbidity, Cardiology and Cardiovascular Medicine, business
Abstract: Maternal cardiovascular disease is a leading cause of maternal death worldwide and recently, maternal mortality has increased secondary to cardiovascular causes. Maternal admissions to critical care encompass 1-2% of all critical care admissions, and while not common, the management of the critically ill pregnant patient is complex. Caring for the critically ill pregnant cardiac patient requires integration of pregnancy associated physiologic changes, understanding pathophysiologic disease states unique to pregnancy and a multidisciplinary approach to timing around delivery as well as antenatal and postpartum care. Herein we describe cardiorespiratory changes that occur during pregnancy and the differential diagnosis for cardiorespiratory failure in pregnancy. Cardiorespiratory diseases that are either associated or exacerbated by pregnancy are highlighted with emphasis on perturbations secondary to pregnancy and appropriate management strategies. Finally, we describe general management of the pregnant cardiac patient admitted to critical care.
Published: 2021
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8. COVID-19 critical illness in pregnancy

Author: Maha Al Mandhari and Stephen E. Lapinsky
Subjects: Pediatrics, medicine.medical_specialty, Pregnancy, education.field_of_study, Coronavirus disease 2019 (COVID-19), Transmission (medicine), business.industry, Incidence (epidemiology), Population, Obstetrics and Gynecology, medicine.disease, Respiratory failure, Critical illness, Pandemic, medicine, business, education
Abstract: Although the pregnant population was affected by early waves of the COVID-19 pandemic, increasing transmission and severity due to new viral variants has resulted in an increased incidence of severe illness during pregnancy in many regions. Critical illness and respiratory failure are relatively uncommon occurrences during pregnancy, and there are limited high-quality data to direct management. This paper reviews the current literature on COVID-19 management as it relates to pregnancy, and provides an overview of critical care support in these patients. COVID-19 drug therapy is similar to that used in the non-pregnant patient, including anti-inflammatory therapy with steroids and IL-6 inhibitors, although safety data are limited for antiviral drugs such as remdesivir and monoclonal antibodies. As both pregnancy and COVID-19 are thrombogenic, thromboprophylaxis is essential. Endotracheal intubation is a higher risk during pregnancy, but mechanical ventilation should follow usual principles. ICU management should be directed at optimizing maternal well-being, which in turn will benefit the fetus.
Published: 2022

9. A review of remdesivir for COVID-19 in pregnancy and lactation

Author: Stephen E. Lapinsky, Sarah C J Jorgensen, and Matthew R Davis
Subjects: Microbiology (medical), medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), MEDLINE, Breastfeeding, Review, Antiviral Agents, Pregnancy, Lactation, Pandemic, Humans, AcademicSubjects/MED00740, Medicine, Pharmacology (medical), Pregnancy Complications, Infectious, Intensive care medicine, Pandemics, Pharmacology, Alanine, SARS-CoV-2, business.industry, Compassionate Use, medicine.disease, Adenosine Monophosphate, COVID-19 Drug Treatment, Clinical trial, Breast Feeding, AcademicSubjects/MED00290, Infectious Diseases, medicine.anatomical_structure, Female, AcademicSubjects/MED00230, business
Abstract: Mounting evidence suggests that pregnant people have an elevated risk of severe COVID-19-related complications compared with their non-pregnant counterparts, underscoring the need for effective prevention and treatment strategies. However, despite progress in innovative and flexible trial designs during the COVID-19 pandemic, regressive policies excluding pregnant and breastfeeding people from biomedical research persist. Remdesivir, a broad-spectrum antiviral, was the first drug licensed for the treatment of COVID-19, based on data showing it reduced the time to recovery in hospitalized patients. Pregnant and breastfeeding people were specifically excluded from all clinical trials of remdesivir in COVID-19, but data are accumulating from post-marketing registries, compassionate use programmes and case series/reports. In this review we synthesize these data and highlight key knowledge gaps to help inform clinical decision-making about its use in pregnancy and lactation.
Published: 2021
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10. Special Populations

Author: Stephanie C. Lapinsky, Timothy M. Dempsey, Stephen E. Lapinsky, Mary Jane Reed, Eric Melnychuk, and Alexander S. Niven
Subjects: Special populations, business.industry, Poison control, Human factors and ergonomics, 030208 emergency & critical care medicine, General Medicine, Morbidly obese, Critical Care and Intensive Care Medicine, medicine.disease, Suicide prevention, Occupational safety and health, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Health care, Injury prevention, Medicine, Medical emergency, business
Abstract: Special populations, which include the morbidly obese and patients with chronic, complex medical conditions that require long-term health care services and infrastructure, are at increased risk for morbidity and mortality when these services are disrupted during a disaster. Past experiences have identified significant challenges in restoring necessary care services to these patients following major environmental events. This article describes the impact of disasters on special populations, provides a framework for future disaster preparation and planning, and identifies areas in need of further research. Gravid patients, who are often overlooked in disaster planning and preparation, are also discussed.
Published: 2019
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11. On the issue of blood circulation disorder in the area of paralyzed nerves

Author: Mikhail Lapinsky
Subjects: medicine.medical_specialty, Blood circulation disorder, business.industry, Internal medicine, medicine, Cardiology, business
Abstract: The authors, who were interested in the state of blood circulation in the area of paralyzed nerves, turned their attention during laboratory studies to the width of the lumen of the vessels in the area of the nerves being experimented with, to the local velocity of blood flow and, finally, to the height of the local intravascular. In addition, they also judged the state of the local circulation by the temperature of the part of the body, the nerve of which was damaged; on the basis of a changed color of it, an increased volume (using a plethysmograph) and, finally, on the basis of edema in this area.
Published: 2020
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12. To the question of excitability of the cortex and epileptic seizures in lower animals

Author: M. Lapinsky
Subjects: Guinea pig, Coma, Prodromal Period, medicine.anatomical_structure, business.industry, Cortex (anatomy), medicine, Physiology, %22">Fish , Tonic (music), fruitless, medicine.symptom, business
Abstract: By irritating the cortex of the cerebral hemispheres, it is possible to cause seizures of epileptic seizures in many animals. Their seizure can consist of a prodromal period, clonic and tonic stages, and a subsequent coma. This typical seizure is extremely easy to get in a monkey. Without big difficulties, it can be reproduced in a dog, rabbit, cat, guinea pig, horse, donkey, rat, calf, goat and even a sheep. Attempts to induce convulsions in birds, irritating their large hemisphere, remained fruitless. Similarly, it was not possible to achieve epileptic seizures in fish, reptiles and amphibians.
Published: 2020
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13. Evolution Over Time of Ventilatory Management and Outcome of Patients With Neurologic Disease

Author: Tejerina E. E., Pelosi P., Robba C., Penuelas O., Muriel A., Barrios D., Frutos-Vivar F., Raymondos K., Du B., Thille A. W., Rios F., Gonzalez M., Del-Sorbo L., Marin M. D. C., Valle Pinheiro B., Soares M. A., Nin N., Maggiore S. M., Bersten A., Amin P., Cakar N., Young Suh G., Abroug F., Jibaja M., Matamis D., Ali Zeggwagh A., Sutherasan Y., Anzueto A., Esteban A, Fernando Ríos, Damian Violi, Marisol Rodríguez-Goñi, Roger Lamoglie, Fernando Villarejo, Norberto Tiribelli, Santiago Ilutovich, Matías Brizuela, Mariana Monllau, Fernando Saldarini, Silvina Borello, Alberto Marino, Mauricio Vinzio, Karina Bonasegla, Julián Hernández, María Belén Yapur, María Eugenia González, Sebastián E Mare, Judith Sagardía, Marco Bezzi, Cecilia Pereyra, Julian Strati, Daniel Vargas, Claudia Diaz, Pablo Gómez, Marcelo Palavecino, Graciela Elizabeth, Aguilera García, M Eugenia, Luis Pablo Cardonnet, Lisandro Betttini, Hernán Nuñez, Lucas Vallejo, Fernando Fernández, Jorge Arroyo, Daniel Duarte, Gerardo Filippa, Cayetano Galetti, Hernan Nunia, Fernando Lambert, Elisa Estenssoro, Marina Busico, Javier Horacio Álvarez, Alejandro Raimondi, Gustavo Badariotti, Martín Lugaro, Fernando Lipovestky, Alan Javier Zazu, Hugo Capponcelli, Patricia Vogl, Cristina Orlandi, Alejandro Gómez, Gustavo Jannello, Alejandro Risso, Leticia Rapetti, Guillermo Chiappero, Juan Domingo Fernández, Rodrigo E Gómez-Paz, Marcos Juan Zec, Pascual Valdez, Jorgelina Guyon, Ariel Chena, Sergio Lasdica, Martin Deheza, Schimdt Alejandra, Francisco Criado, Norma Beatriz Márquez, Pablo Desmery, José Luis Scapellato, Gonzalo Javier Ríos, Cristian Casabella, Jasmin Board, Andrew Davies, Andrew Bersten, Elisha Matheson, Amy Waters, John Santamaria, Jennifer Holmes, Cartan Costello, Manoj K Saxena, John Myburgh, Ellen Kinkel, Forbes McGain, Claire Cattigan, Allison Bone, Ian Seppelt, Leonie Weisbrodt, Cheryl Cuzner, Christopher MacIsaac, Deborah Barge, Tania Caf, Cameron Knott, Graeme Duke, Imogen Mitchell, Helen Rodgers, Rachel Whyte, Elisha Fulton, Alistair Nichol, Hergen Buscher, Priya Nair, Claire Reynolds, Simon J G Hockley, Ian Moore, Katherine Davidson, David Milliss, Raju Pusapati, Helen Wong, Jason Fletcher, Julie Smith, Paul Goldrick, Dianne Stephens, Jane Thomas, Anders Aneman, Sutrisno Gunawan, Tom Cowlam, George Lukas, Rick McAllister, Minka Springham, Joanne Sutton, Jeff Presneill, Tony Sutherland, Dianne Hill, Howard Connor, Jenny Dennett, Tim Coles, Freddy Sandy, Sando Chavarria, Marcelo Choque, Ronald Pairumani, Juan Guerra, Marco Antônio Soares Reis, José Carlos Versiani, Eduardo Fonseca Sad, Maria Aparecida Braga, Dinalva Aparecida Gomes, Fernando Antônio Botoni, Maurício Meireles Góes, Frederico Costa Val Barros, Rogério de Castro Pereira, Hugo Urbano, Valéria de Carvalho Magela, Aline Camile Yehia, Bruno Bonaccorsi Fernandino, Marco Antônio Ribeiro Leão, Rovílson Lara, Rubens Altair Amaral de Pádua, Janine Dias Alves, Aloísio Marques do Nascimento, Bruno do Valle Pinheiro, Carlos Alberto Studart Gomes, Marcelo Alcântara Holanda, Frederico Rodrigues Anselmo, Niall Ferguson, Neill Adhikari, Robert Fowler, Cheromi Sittambalam, Mehar-Un-Nisa Raja, Nicole Marinoff, Lauralyn McIntryre, Shawna Reddie, Laura Jones, Irene Watpool, Jeffrey Singh, Madison Dennis, Andrea Matte, Marc Lipkus, Ryan Albert, Andrew Steel, Emily Stern, Michael Miletin, Antonio Raso, Robyn Klages, Jan Friedrich, Orla Smith, Laura Wilson, Deborah Cook, Mark Bailey, Sangeeta Mehta, Stephen Lapinsky, Hannah Mathers, Cheryl Ethier, Stephanie Lubchansky, Samer Haj-Bakri, Dietrich Henzler, Lisa Julien, Luis Soto-Román, Juan Carlos Maurelia, César Antonio Maquilon, Luis Soto-Germani, Bin Du, Yan Kang, Bo Wang, Fachun Zhou, Fang Xu, Haibo Qiu, Yi Yang, Qingyuan Zhan, Bing Sun, Zhenjie Hu, Bin Yu, Xi Zhu, Yu Bai, Gang Li, Yi Li, Geng Zhang, Jianbiao Meng, Xiaobo Huang, Hong Pu, Daxing Yu, Chuanyun Qian, Wei Zhang, Yongjie Yin, Debiao Song, Yunxuan Yue, Zhengxuan Lv, Chengmin Yu, Qunmei Yao, Xue Wang, Yuan Xu, Wei He, Mian Chen, Zhihua Hu, Dongpo Jiang, Jian Huang, Wei Yu, Juanxian Gu, Yangong Chao, Zhixiang Li, Zhicheng Zhang, Wanxia Li, Zhenyang He, Jianguo Li, Chang Liu, Tiehe Qin, Shouhong Wang, Feng Li, Jun Jin, Jianhong Fu, Hongyang Xu, Hongyuan Lin, Jianying Guo, Yalin Liu, Jinghua Wang, Maoqin Li, Jiaqiong Li, Lei Chen, Qing Song, Liang Pan, Xianyao Wan, Jiuzhi Zhang, Weihai Yao, Yuhong Guo, Pang Wing Yan, Kelly Choy, Kwan Ming Chit, Patricia Leung, Chau Chin Man, Marco González, Ricardo Buitrago, Marcela Granados, Guillermo Ortiz, Cesar Enciso, Mario Gómez, Bladimir Alejandro Gil, Juan Pablo Sedano, Luis Fernando Castro Castro, Carlo Alberto Acosta, Marco Gonzalez, Francisco Molina, Camilo Pizarro, Mario Villabon, Carmelo Dueñas, Carlos Andrés Díaz, Nelson Fonseca, Rubén Camargo, Juan David Uribe, Hans-Henrik Bülow, Simona Beniczky, Jens Brushoj, Mikkel Præst, Birgitte Viebaek, Sine Wichman, Anette Mortensen, Susanne Andi Iversen, Bo Broberg, Edgard Luna, Manuel Jibaja, Leonardo Pazmiño, Katty Trelles, Fabricio Picoita, Gustavo Paredes, Vanesa Ramírez, Guillermo Falconí, Cristian Cevallos, Boris Villamagua, Marco Escobar, Freddy Sánchez, Miguel Llano, Miguel Lazcano, Ramiro Puetate, José Miguel Guerrero, Mijail Játiva, Myriam Montalvo, Franklin Villegas, Luis González Zambrano, Ronnie Mantilla, Gina Quinde, Andrea Gimenez, Luis Gonzalez Mosquera, Henry Caballero, María Fernanda García, Marcelo Ochoa, Soraya Puertas, Jackeline Coello, Mario Acosta, Medhat Soliman, Arnaud W Thille, Achille Kouatchet, Alain Mercat, Laurent Brochard, François Collet, Guillaume Marcotte, Pascal Beuret, Jean-Christophe M Richard, Gaëtan Bedunaeu, Pierre-Gildas Guitard, Fabien Soulis, Frédéric Bellec, Philippe Berger, Dorothée Carpentier, Benoit Veber, Salem Ould Zein, Géraldine Dessertaine, C Canevet, Fabien Grelon, Konstantinos Raymondos, Rolf Dembinski, Rolf Rossaint, Steffen Weber-Carstens, Christian Putensen, Maximillian Ragaller, Michael Quintel, Winfried Schubert, Thomas Bein, Heinrich Paulus, Walter Brandt, Lutz Pfeiffer, Silke Frenzel, Thoralf Kerner, P Kruska, Leila Eckholt, Joachim Hartung, Harald Fritz, Monika Holler, Johannes Busch, Andreas Viehöfer, Jens Buettner, Jörn Schlechtweg, Achim Lunkeit, Roland Schneider, Maria Wussow, Nils Marquardt, Christian Frenkel, Falk Hildebrandt, Tumbass Volker, Thomas Lipp, Cezar Mihailescu, Thomas Moellhoff, Thomas Steinke, Oliver Franke, Marcus Ruecker, Markus Schappacher, Steffen Appel, Heinz Kerger, Andreas Schwartz, Jan Dittmann, Jörg Haberkorn, Wolfgang Baier, Walter Seyde, Dimitros Matamis, Eleni Antoniadou, Pertsas Evangelos, Maria Giannakou, Zoltan Szentkereszty, Zsolt Molnar, Pravin Amin, Farhad N Kapadia, Nagarajan Ramakrishnan, Deepak Govil, Anitha Shenoy, Umesh G, Samir Sahu, Sheila Nainan Myatra, Subhash Kumar Todi, Sanjay Dhanuka, Mayur Patel, P Samaddar, Dhruva Chaudhry, Vivek Joshi, Srinivas Samavedam, Ankur Devendra Bhavsar, Prachee Sathe, Sujoy Mukherjee, Salvatore Maurizio Maggiore, Francesco Idone, Federica Antonicelli, Paolo Navalesi, Rosanna Vaschetto, Arianna Boggero, Rosalba Tufano, Michele Iannuzzi, Edoardo De Robertis, Romano Tetamo, Andrea Neville Cracchiolo, Antonio Braschi, Francesco Mojoli, Ilaria Curro', Mirko Belliato, Chiara Verga, Marta Ferrari, Erika Mannelli, Valerio Mangani, Giorgio Tulli, Francesca Frigieri, Armando Pedulla', Monica Rocco, Giorgia Citterio, Di Russo, Gaetano Perchiazzi, Loredana Pitagora, Antonio Pesenti, Michela Bombino, Davide Chiumello, Federica Tallarini, Serena Azzari, Antonina Pigna, Ivano Aprile, Marco Adversi, Antonio Corcione, Marianna Esposito, Annunziata Mattei, Vito Marco Ranieri, Rosario Urbino, Ilaria Maria Mastromauro, Antonino Giarratano, Maurizio Raineri Santi, Ambrogio Sansone, Younsuck Koh, Moo Suk Park, Je Hyeong Kim, Kyung Chan Kim, Hye Sook Choi, Yun Seong Kim, Jin Hwa Lee, Myung-Goo Lee, Won-Yeon Lee, Jin Young An, Gee Young Suh, Ki-Suck Jung, Asisclo J Villagómez Ortiz, César Cruz Lozano, Zalatiel Maycotte Luna, José Francisco López Baca, José Elizalde, Guillermo Cueto Robledo, Mario Alonso Treviño Salinas, Ricardo Martinez Zubieta, Claudia Olvera-Guzman, Marco Montes De Oca, Silvio A Ñamendys-Silva, José Salvador Martínez Cano, Jose Angel Baltazar Torres, Gustavo Morales Muñoz, Antonio Villa Delgado, Javier Ladape Martinez, Amine Ali Zeggwagh, Tarek Dendane, Abderrahim Azzouzi, Ahmed Sbihi, Wajdi Maazouzi, Mourad Amor, Charki Haimeur, Michael A Kuiper, Matty Koopmans, Uli Strauch, Dennis Bergmans, Serge Heines, Sylvia den Boer, Bas M Kors, Peter van der Voort, Paul J Dennesen, Bert Beishuizen, Ingrid van den Hul, Erna Alberts, Harry P P M Gelissen, Eduard Bootsma, Auke Reidinga, Kim Heus, Diane Mackle, Paul Young, Rachael Parke, Eileen Gilder, Jodi Brown, Lynette Newby, Catherine Simmonds, Jan Mehrtens, Seton Henderson, Tony Williams, Judi Tai, Chantal Hogan, Mary La Pine, John Durning, Sheree Gare, Troy Browne, Shirley Nelson, Jennifer Goodson, Julio Osorio, Chabu Coronado, Rollin Roldán Mori, Rosa Luz López Martínez, Adam Mikstacki, Barbara Tamowicz, Rui Moreno, Eduardo Almeida, Joana Silvestre, Heloisa Castro, Irene Aragão, Susana Alves Ferreira, Nelson Barros, Filomena Faria, Carlos André Correia Casado, Fausto Fialho Moura, Paulo Marcal, Ricardo Matos, Edward Nicolayenko, Mikhail Kirov, Andrey Yaroshetskiy, Andrei Piontek, Valery Subbotin, Yaseen Arabi, Olivia Dulfo, Chafrina Marie Olay, Edgardo E Tabhan, Nicolas Nin, Alfonso Muñoz, César Aragón, Ana Villagrá, Ainhoa Rosselló, Joan Maria Raurich, María Garitacelaya, Miguel Ángel González-Gallego, Francisco Ortuño, Miguel Fernández-Vivas, David Freire, Francisco Guerrero, Francisco Manzano, Juan Carlos, Alfredo Padrón, Pedro Rosa, Rafael Morales, Liliana Caipe, Maurizio Bottiroli, José María Nicolás, Marta Ugalde, Javier Ruiz, Lucia Capilla, Guillermo Muñiz, Jesús Sánchez-Ruiz, Javier Cebrián, Begoña Balerdi, Elena Parreño, Alvaro van Bommel, César Pérez-Calvo, Irene Dot, Javier Blanco, Raquel Manzanedo, José J Blanco, Daniel Fontaneda, Raúl González, Javier Díaz Domínguez, Alfonso Moreno, Antonio Reyes, Ian Carrasco, Itziar Mintegui, Rosa Sebastián, Javier García-Alonso, Carolina Lorencio, Josep Maria Sirvent, Patricia Jimeno, Miguel León, Pedro Galdos, Nuria Alonso, Julia López-Díaz, María Victoria de la Torre, Jorge Vidal Hernández, Nicolás Zamboschi, Francisco Lucena, Gemma Rialp, Raquel Montoiro, Victoria Goñi, María Ángeles Pena, Antonio Maestre, Marc Fabra, Jacinto Baena, Eva Benveniste, Susana Temprano, Jesús Sánchez, Carmen Campos, Sara Cabañes, María Elena Pérez-Losada, José Claudio Leo, Enrique Piacentini, María Del Carmen de la Torre, Laura Álvarez-Montero, Fernando Sánchez, Antonio Viñuales, Bernabé Álvarez, Javier Castañeda, Ángela Alonso, María Isabel Ruiz, Pedro Jesús Domínguez, Marcos Delgado, Eugenio Palazón, Antonio García-Jiménez, Rosa Álvaro, Clara Laplaza Eva Regidor, Enrique Maraví, José María Quiroga, Amalia Martínez de la Gandara, Cecilia Carbayo, María Luisa Navarrete, Manuel Valledor, Raquel Yano, José María Gutiérrez, Javier González-Robledo, Amparo Ferrandiz, Alberto Belenguer, Lidón Mateu, Laura Sayagues, María José Tolón, Nieves Franco, Elena Gallego, Félix Lacoma, Patricia Albert, Vicente Arraez, Mar Gobernado, Susana Moradillo, Carolina Gímenez-Esparza, Teresa Sánchez de Dios, Carlos Marian Crespo, Cecilia Hermosa, Federico Gordo, Genis Carrasco, María Ángeles Alonso, Alejandro Algora, Raúl de Pablo, Sofía García, Ana Carolina Caballero, José María Montón, Teresa Mut, Eva Manteiga, Alejandro de la Serna, Ana Esther Trujillo, Rafael Blancas, Inmaculada Vallverdú, José Manuel Serrano, Miquel Ferrer, Juan Diego Jiménez, Carlos Gallego, Dolores Vila, Luis Marina, Valentín Parra, Juan Ramón Cortés, Chen Chin-Ming, Ai-Chin Cheng, Fekri Abroug, Besbes Mohamed, Imed Chouchene, Mounir Bouaziz, Stambouli Neji, Islem Ouanes, Ayed Samia, Nahit Cakar, Ismail Kati, Ali Aydım Altunkan, Remzi Iscimen, Zafer Dogan, Bilge Çetin, Tayfun Adanir, Sabriye Guvenc, Unase Büyükkoçak, Antonio Anzueto, Ashley Ellis, Gary Kinasewitz, Allan Walkey, Phil Alkana, Gregory A Schmidt, Susan Gillen, Kathleen Lilli, Jennifer Twombley, Denice Wells, Larry Welder, Alejandro Arroliga, Alfredo Vasquez-Sandoval, Vincent John Scott, Craig Cernosek, Christopher Spradley, Dimple Tejwani, Sindhaghatta Venkatram, Gilda Diaz-Fuentes, Amber Monson, Anthony Saleh, Madhav Gudi, George Liziamma, Mohamed A Saad, Crissie De Spirito, Bryan Beatty, Samir Vermani, Crissie Despirito, Zaza Cohen, Amee Patrawalla, Samir Abdelhadi, Rupesh Vakil, Steven Y Chang, Brian Sherman, Rosanna Del Giudice, John Oropell, Timothy D Girard, Cayce Strength, Joyce Okahashi, Leanne Boehm, Matthew Kirchner, Erwin J Oei, Sebastian Circo, Nelson Medina, Mohammed Al-Jagbeer, V J Cardenas Jr, Smyth Smith, Shelby Sutton, Marcela Canola-Mazo, Tim Houlihan, Yogeet Kaur, Travis Parry, Craig A Piquette, Kerry Canady, Rahul Nanchal, Dana K Soetaert, Maria Del Mar Torres-Perez, Carlos Robles-Arias, William Rodriguez-Cintron, Mark Tidswell, Jennifer Germain, Lori-Ann Kozikowski, Erin Braden, Geneva Tatem, Javier Hurtado, Alberto Deicas, Daniel Weiss, Marta Beron, Román Garrido, Cristina Santos, Mario Cancela, Raúl Lombardi, Pedro Alzugaray, Jorge Gerez, Silvia Mareque, Graciela Franca, Oscar Cluzet, Edgardo Nuñez, Julio Pontet, Sergio Cáceres, Elias Caragna, Alberto Soler, Frank Torres, Gastón Pittini, Gabriel D Empaire, Stevens Salva, Fernando Pérez, Clara Pacheco, Zoraida Parra, Ingrid Von der Osten, Luis Williams, José Salinas, Do Danh Quynh, Pham Thi Van Anh, Nguyen Huu Hoang, Nghuyen Ba Tuan, RS: NUTRIM - R2 - Liver and digestive health, MUMC+: MA Arts Assistenten IC (9), Intensive Care, MUMC+: MA Medische Staf IC (9), Tejerina E.E., Pelosi P., Robba C., Penuelas O., Muriel A., Barrios D., Frutos-Vivar F., Raymondos K., Du B., Thille A.W., Rios F., Gonzalez M., Del-Sorbo L., Marin M.D.C., Valle Pinheiro B., Soares M.A., Nin N., Maggiore S.M., Bersten A., Amin P., Cakar N., Young Suh G., Abroug F., Jibaja M., Matamis D., Ali Zeggwagh A., Sutherasan Y., Anzueto A., Esteban A, and Fernando Ríos, Damian Violi, Marisol Rodríguez-Goñi, Roger Lamoglie, Fernando Villarejo, Norberto Tiribelli, Santiago Ilutovich, Matías Brizuela, Mariana Monllau, Fernando Saldarini, Silvina Borello, Alberto Marino, Norberto Tiribelli, Mauricio Vinzio, Karina Bonasegla, Julián Hernández, María Belén Yapur, María Eugenia González, Sebastián E Mare, Judith Sagardía, Marco Bezzi, Cecilia Pereyra, Julian Strati, Daniel Vargas, Claudia Diaz, Pablo Gómez, Marcelo Palavecino, Graciela Elizabeth, Aguilera García, M Eugenia, Luis Pablo Cardonnet, Lisandro Betttini, Hernán Nuñez, Lucas Vallejo, Fernando Fernández, Jorge Arroyo, Daniel Duarte, Gerardo Filippa, Cayetano Galetti, Hernan Nunia, Fernando Lambert, Elisa Estenssoro, Marina Busico, Fernando Villarejo, Javier Horacio Álvarez, Alejandro Raimondi, Gustavo Badariotti, Martín Lugaro, Fernando Lipovestky, Alan Javier Zazu, Hugo Capponcelli, Patricia Vogl, Cristina Orlandi, Alejandro Gómez, Gustavo Jannello, Alejandro Risso, Leticia Rapetti, Guillermo Chiappero, Juan Domingo Fernández, Rodrigo E Gómez-Paz, Marcos Juan Zec, Pascual Valdez, Jorgelina Guyon, Ariel Chena, Sergio Lasdica, Martin Deheza, Schimdt Alejandra, Francisco Criado, Norma Beatriz Márquez, Pablo Desmery, José Luis Scapellato, Gonzalo Javier Ríos, Cristian Casabella, Jasmin Board, Andrew Davies, Andrew Bersten, Elisha Matheson, Amy Waters, John Santamaria, Jennifer Holmes, Cartan Costello, Manoj K Saxena, John Myburgh, Ellen Kinkel, Forbes McGain, Claire Cattigan, Allison Bone, Ian Seppelt, Leonie Weisbrodt, Cheryl Cuzner, Christopher MacIsaac, Deborah Barge, Tania Caf, Cameron Knott, Graeme Duke, Imogen Mitchell, Helen Rodgers, Rachel Whyte, Elisha Fulton, Jasmin Board, Andrew Davies, Alistair Nichol, Hergen Buscher, Priya Nair, Claire Reynolds, Simon J G Hockley, Ian Moore, Katherine Davidson, David Milliss, Raju Pusapati, Helen Wong, Jason Fletcher, Julie Smith, Paul Goldrick, Dianne Stephens, Jane Thomas, Anders Aneman, Sutrisno Gunawan, Tom Cowlam, George Lukas, Rick McAllister, Minka Springham, Joanne Sutton, Jeff Presneill, Tony Sutherland, Dianne Hill, Howard Connor, Jenny Dennett, Tim Coles, Freddy Sandy, Sando Chavarria, Marcelo Choque, Ronald Pairumani, Juan Guerra, Marco Antônio Soares Reis, José Carlos Versiani, Eduardo Fonseca Sad, Maria Aparecida Braga, Dinalva Aparecida Gomes, Fernando Antônio Botoni, Maurício Meireles Góes, Frederico Costa Val Barros, Rogério de Castro Pereira, Hugo Urbano, Valéria de Carvalho Magela, Aline Camile Yehia, Bruno Bonaccorsi Fernandino, Marco Antônio Ribeiro Leão, Rovílson Lara, Rovílson Lara, Rubens Altair Amaral de Pádua, Janine Dias Alves, Aloísio Marques do Nascimento, Bruno do Valle Pinheiro, Carlos Alberto Studart Gomes, Marcelo Alcântara Holanda, Frederico Rodrigues Anselmo, Niall Ferguson, Neill Adhikari, Robert Fowler, Cheromi Sittambalam, Mehar-Un-Nisa Raja, Nicole Marinoff, Lauralyn McIntryre, Shawna Reddie, Laura Jones, Irene Watpool, Jeffrey Singh, Madison Dennis, Andrea Matte, Marc Lipkus, Ryan Albert, Andrew Steel, Emily Stern, Michael Miletin, Antonio Raso, Robyn Klages, Jan Friedrich, Orla Smith, Laura Wilson, Deborah Cook, Mark Bailey, Sangeeta Mehta, Stephen Lapinsky, Hannah Mathers, Cheryl Ethier, Stephanie Lubchansky, Samer Haj-Bakri, Dietrich Henzler, Lisa Julien, Luis Soto-Román, Juan Carlos Maurelia, César Antonio Maquilon, Luis Soto-Germani, Bin Du, Yan Kang, Bo Wang, Fachun Zhou, Fang Xu, Haibo Qiu, Yi Yang, Qingyuan Zhan, Bing Sun, Zhenjie Hu, Bin Yu, Xi Zhu, Yu Bai, Gang Li, Yi Li, Geng Zhang, Jianbiao Meng, Xiaobo Huang, Hong Pu, Bin Du, Daxing Yu, Chuanyun Qian, Wei Zhang, Yongjie Yin, Debiao Song, Yunxuan Yue, Zhengxuan Lv, Chengmin Yu, Qunmei Yao, Xue Wang, Yuan Xu, Wei He, Mian Chen, Zhihua Hu, Dongpo Jiang, Jian Huang, Wei Yu, Juanxian Gu, Yangong Chao, Zhixiang Li, Zhicheng Zhang, Wanxia Li, Zhenyang He, Jianguo Li, Chang Liu, Tiehe Qin, Shouhong Wang, Feng Li, Jun Jin, Jianhong Fu, Hongyang Xu, Hongyuan Lin, Jianying Guo, Yalin Liu, Jinghua Wang, Maoqin Li, Jiaqiong Li, Lei Chen, Qing Song, Liang Pan, Xianyao Wan, Jiuzhi Zhang, Weihai Yao, Yuhong Guo, Pang Wing Yan, Kelly Choy, Kwan Ming Chit, Patricia Leung, Chau Chin Man, Marco González, Ricardo Buitrago, Marcela Granados, Guillermo Ortiz, Cesar Enciso, Mario Gómez, Bladimir Alejandro Gil, Juan Pablo Sedano, Luis Fernando Castro Castro, Carlo Alberto Acosta, Marco Gonzalez, Francisco Molina, Camilo Pizarro, Mario Villabon, Carmelo Dueñas, Carlos Andrés Díaz, Nelson Fonseca, Rubén Camargo, Juan David Uribe, Hans-Henrik Bülow, Simona Beniczky, Jens Brushoj, Mikkel Præst, Birgitte Viebaek, Sine Wichman, Anette Mortensen, Susanne Andi Iversen, Bo Broberg, Edgard Luna, Manuel Jibaja, Leonardo Pazmiño, Katty Trelles, Fabricio Picoita, Gustavo Paredes, Vanesa Ramírez, Guillermo Falconí, Cristian Cevallos, Boris Villamagua, Marco Escobar, Freddy Sánchez, Miguel Llano, Miguel Lazcano, Ramiro Puetate, José Miguel Guerrero, Mijail Játiva, Myriam Montalvo, Franklin Villegas, Luis González Zambrano, Ronnie Mantilla, Gina Quinde, Andrea Gimenez, Luis Gonzalez Mosquera, Henry Caballero, María Fernanda García, Marcelo Ochoa, Soraya Puertas, Jackeline Coello, Mario Acosta, Medhat Soliman, Arnaud W Thille, Achille Kouatchet, Alain Mercat, Laurent Brochard, François Collet, Guillaume Marcotte, Pascal Beuret, Jean-Christophe M Richard, Gaëtan Bedunaeu, Pierre-Gildas Guitard, Fabien Soulis, Frédéric Bellec, Philippe Berger, Dorothée Carpentier, Benoit Veber, Salem Ould Zein, Géraldine Dessertaine, C Canevet, Fabien Grelon, Konstantinos Raymondos, Rolf Dembinski, Rolf Rossaint, Steffen Weber-Carstens, Christian Putensen, Maximillian Ragaller, Michael Quintel, Winfried Schubert, Thomas Bein, Heinrich Paulus, Walter Brandt, Lutz Pfeiffer, Silke Frenzel, Thoralf Kerner, P Kruska, Leila Eckholt, Joachim Hartung, Harald Fritz, Monika Holler, Johannes Busch, Andreas Viehöfer, Jens Buettner, Jörn Schlechtweg, Achim Lunkeit, Roland Schneider, Maria Wussow, Nils Marquardt, Christian Frenkel, Falk Hildebrandt, Tumbass Volker, Thomas Lipp, Cezar Mihailescu, Thomas Moellhoff, Thomas Steinke, Oliver Franke, Marcus Ruecker, Markus Schappacher, Steffen Appel, Heinz Kerger, Andreas Schwartz, Jan Dittmann, Jörg Haberkorn, Wolfgang Baier, Walter Seyde, Dimitros Matamis, Eleni Antoniadou, Pertsas Evangelos, Maria Giannakou, Zoltan Szentkereszty, Zsolt Molnar, Pravin Amin, Farhad N Kapadia, Nagarajan Ramakrishnan, Deepak Govil, Anitha Shenoy, Umesh G, Samir Sahu, Sheila Nainan Myatra, Subhash Kumar Todi, Sanjay Dhanuka, Mayur Patel, P Samaddar, Dhruva Chaudhry, Vivek Joshi, Srinivas Samavedam, Ankur Devendra Bhavsar, Prachee Sathe, Sujoy Mukherjee, Salvatore Maurizio Maggiore, Francesco Idone, Federica Antonicelli, Paolo Navalesi, Rosanna Vaschetto, Arianna Boggero, Rosalba Tufano, Michele Iannuzzi, Edoardo De Robertis, Romano Tetamo, Andrea Neville Cracchiolo, Antonio Braschi, Francesco Mojoli, Ilaria Curro', Mirko Belliato, Chiara Verga, Marta Ferrari, Erika Mannelli, Valerio Mangani, Giorgio Tulli, Francesca Frigieri, Armando Pedulla', Monica Rocco, Giorgia Citterio, Di Russo, Gaetano Perchiazzi, Loredana Pitagora, Antonio Pesenti, Michela Bombino, Davide Chiumello, Federica Tallarini, Serena Azzari, Antonina Pigna, Ivano Aprile, Marco Adversi, Antonio Corcione, Marianna Esposito, Annunziata Mattei, Vito Marco Ranieri, Rosario Urbino, Ilaria Maria Mastromauro, Antonino Giarratano, Maurizio Raineri Santi, Ambrogio Sansone, Younsuck Koh, Moo Suk Park, Je Hyeong Kim, Kyung Chan Kim, Hye Sook Choi, Yun Seong Kim, Jin Hwa Lee, Myung-Goo Lee, Won-Yeon Lee, Jin Young An, Gee Young Suh, Ki-Suck Jung, Asisclo J Villagómez Ortiz, César Cruz Lozano, Zalatiel Maycotte Luna, José Francisco López Baca, José Elizalde, Guillermo Cueto Robledo, Mario Alonso Treviño Salinas, Ricardo Martinez Zubieta, Claudia Olvera-Guzman, Marco Montes De Oca, Silvio A Ñamendys-Silva, José Salvador Martínez Cano, Jose Angel Baltazar Torres, Gustavo Morales Muñoz, Antonio Villa Delgado, Javier Ladape Martinez, Amine Ali Zeggwagh, Tarek Dendane, Abderrahim Azzouzi, Ahmed Sbihi, Wajdi Maazouzi, Mourad Amor, Charki Haimeur, Michael A Kuiper, Matty Koopmans, Uli Strauch, Dennis Bergmans, Serge Heines, Sylvia den Boer, Bas M Kors, Peter van der Voort, Paul J Dennesen, Bert Beishuizen, Ingrid van den Hul, Erna Alberts, Harry P P M Gelissen, Eduard Bootsma, Auke Reidinga, Jasmin Board, Andrew Davies, Kim Heus, Diane Mackle, Paul Young, Rachael Parke, Eileen Gilder, Jodi Brown, Lynette Newby, Catherine Simmonds, Jan Mehrtens, Seton Henderson, Tony Williams, Judi Tai, Chantal Hogan, Mary La Pine, John Durning, Sheree Gare, Troy Browne, Shirley Nelson, Jennifer Goodson, Julio Osorio, Chabu Coronado, Rollin Roldán Mori, Rosa Luz López Martínez, Adam Mikstacki, Barbara Tamowicz, Rui Moreno, Eduardo Almeida, Joana Silvestre, Heloisa Castro, Irene Aragão, Susana Alves Ferreira, Nelson Barros, Filomena Faria, Carlos André Correia Casado, Fausto Fialho Moura, Paulo Marcal, Ricardo Matos, Edward Nicolayenko, Mikhail Kirov, Andrey Yaroshetskiy, Andrei Piontek, Valery Subbotin, Yaseen Arabi, Olivia Dulfo, Chafrina Marie Olay, Edgardo E Tabhan, Nicolas Nin, Alfonso Muñoz, César Aragón, Ana Villagrá, Ainhoa Rosselló, Joan Maria Raurich, María Garitacelaya, Miguel Ángel González-Gallego, Francisco Ortuño, Miguel Fernández-Vivas, David Freire, Francisco Guerrero, Francisco Manzano, Juan Carlos, Alfredo Padrón, Pedro Rosa, Rafael Morales, Liliana Caipe, Maurizio Bottiroli, José María Nicolás, Marta Ugalde, Javier Ruiz, Lucia Capilla, Guillermo Muñiz, Jesús Sánchez-Ruiz, Javier Cebrián, Begoña Balerdi, Elena Parreño, Alvaro van Bommel, César Pérez-Calvo, Irene Dot, Javier Blanco, Raquel Manzanedo, José J Blanco, Daniel Fontaneda, Raúl González, Javier Díaz Domínguez, Alfonso Moreno, Antonio Reyes, Ian Carrasco, Itziar Mintegui, Rosa Sebastián, Javier García-Alonso, Carolina Lorencio, Josep Maria Sirvent, Patricia Jimeno, Miguel León, Pedro Galdos, Nuria Alonso, Julia López-Díaz, María Victoria de la Torre, Jorge Vidal Hernández, Nicolás Zamboschi, Francisco Lucena, Gemma Rialp, Raquel Montoiro, Victoria Goñi, María Ángeles Pena, Antonio Maestre, Marc Fabra, Jacinto Baena, Eva Benveniste, Susana Temprano, Jesús Sánchez, Carmen Campos, Sara Cabañes, María Elena Pérez-Losada, José Claudio Leo, Enrique Piacentini, María Del Carmen de la Torre, Laura Álvarez-Montero, Fernando Sánchez, Antonio Viñuales, Bernabé Álvarez, Javier Castañeda, Ángela Alonso, María Isabel Ruiz, Pedro Jesús Domínguez, Marcos Delgado, Eugenio Palazón, Antonio García-Jiménez, Rosa Álvaro, Clara Laplaza Eva Regidor, Enrique Maraví, José María Quiroga, Amalia Martínez de la Gandara, Cecilia Carbayo, María Luisa Navarrete, Manuel Valledor, Raquel Yano, José María Gutiérrez, Javier González-Robledo, Amparo Ferrandiz, Alberto Belenguer, Lidón Mateu, Laura Sayagues, María José Tolón, Nieves Franco, Elena Gallego, Félix Lacoma, Patricia Albert, Vicente Arraez, Mar Gobernado, Susana Moradillo, Carolina Gímenez-Esparza, Teresa Sánchez de Dios, Carlos Marian Crespo, Cecilia Hermosa, Federico Gordo, Genis Carrasco, María Ángeles Alonso, Alejandro Algora, Raúl de Pablo, Sofía García, Ana Carolina Caballero, José María Montón, Teresa Mut, Eva Manteiga, Alejandro de la Serna, Ana Esther Trujillo, Rafael Blancas, Inmaculada Vallverdú, José Manuel Serrano, Miquel Ferrer, Juan Diego Jiménez, Carlos Gallego, Dolores Vila, Luis Marina, Valentín Parra, Juan Ramón Cortés, Chen Chin-Ming, Ai-Chin Cheng, Fekri Abroug, Besbes Mohamed, Imed Chouchene, Mounir Bouaziz, Stambouli Neji, Islem Ouanes, Ayed Samia, Nahit Cakar, Ismail Kati, Ali Aydım Altunkan, Remzi Iscimen, Zafer Dogan, Bilge Çetin, Tayfun Adanir, Sabriye Guvenc, Unase Büyükkoçak, Antonio Anzueto, Ashley Ellis, Gary Kinasewitz, Allan Walkey, Phil Alkana, Gregory A Schmidt, Susan Gillen, Kathleen Lilli, Jennifer Twombley, Denice Wells, Larry Welder, Alejandro Arroliga, Alfredo Vasquez-Sandoval, Vincent John Scott, Craig Cernosek, Christopher Spradley, Dimple Tejwani, Sindhaghatta Venkatram, Gilda Diaz-Fuentes, Amber Monson, Anthony Saleh, Madhav Gudi, George Liziamma, Mohamed A Saad, Crissie De Spirito, Bryan Beatty, Samir Vermani, Crissie Despirito, Zaza Cohen, Amee Patrawalla, Samir Abdelhadi, Rupesh Vakil, Steven Y Chang, Brian Sherman, Rosanna Del Giudice, John Oropell, Timothy D Girard, Cayce Strength, Joyce Okahashi, Leanne Boehm, Matthew Kirchner, Ashley Ellis, Gary Kinasewitz, Erwin J Oei, Sebastian Circo, Nelson Medina, Mohammed Al-Jagbeer, V J Cardenas Jr, Smyth Smith, Shelby Sutton, Marcela Canola-Mazo, Tim Houlihan, Yogeet Kaur, Travis Parry, Craig A Piquette, Kerry Canady, Rahul Nanchal, Dana K Soetaert, Maria Del Mar Torres-Perez, Carlos Robles-Arias, William Rodriguez-Cintron, Mark Tidswell, Jennifer Germain, Lori-Ann Kozikowski, Erin Braden, Geneva Tatem, Javier Hurtado, Alberto Deicas, Daniel Weiss, Marta Beron, Román Garrido, Cristina Santos, Mario Cancela, Raúl Lombardi, Pedro Alzugaray, Jorge Gerez, Silvia Mareque, Graciela Franca, Oscar Cluzet, Edgardo Nuñez, Julio Pontet, Sergio Cáceres, Elias Caragna, Alberto Soler, Frank Torres, Gastón Pittini, Gabriel D Empaire, Stevens Salva, Fernando Pérez, Clara Pacheco, Zoraida Parra, Ingrid Von der Osten, Luis Williams, José Salinas, Do Danh Quynh, Pham Thi Van Anh, Nguyen Huu Hoang, Nghuyen Ba Tuan
Subjects: Male, medicine.medical_treatment, pulmonary complications, RESPIRATORY-DISTRESS-SYNDROME, Critical Care and Intensive Care Medicine, CASE-FATALITY, 0302 clinical medicine, Risk Factors, Brain Injuries, Traumatic, Multicenter Studies as Topic, Hospital Mortality, Prospective Studies, Simplified Acute Physiology Score, Stroke, POPULATION, Age Factors, ANEURYSMAL SUBARACHNOID HEMORRHAGE, Middle Aged, Hemorrhagic Stroke, Intensive Care Units, Observational Studies as Topic, Anesthesia, Breathing, Female, medicine.symptom, Ventilator Weaning, Cohort study, Adult, TRAUMATIC BRAIN-INJURY, Pressure support ventilation, mechanical ventilation, prognosis factors, ACUTE LUNG INJURY, 03 medical and health sciences, medicine, Humans, Aged, Ischemic Stroke, Mechanical ventilation, Noninvasive Ventilation, business.industry, MORTALITY, neurologic patients, Organ dysfunction, 030208 emergency & critical care medicine, Length of Stay, medicine.disease, TRENDS, Respiration, Artificial, 030228 respiratory system, Etiology, NEUROCRITICAL CARE, Nervous System Diseases, Tracheotomy, business
Abstract: OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease.
Published: 2021
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14. Physician Perspectives on Including Pregnant Women in Covid-19 Clinical Trials: Time for a Paradigm Change

Author: Emily G. McDonald, Haim A. Abenhaim, Stephen E. Lapinsky, Matthew P. Cheng, Isabelle Malhamé, Annabelle Cumyn, Marie-Julie Trahan, and Nick Daneman
Subjects: medicine.medical_specialty, Canada, Health (social science), Coronavirus disease 2019 (COVID-19), Computer-assisted web interviewing, Article, research with pregnant women, Pregnancy, inclusion of pregnant women in trials, Physicians, Medicine, Humans, pregnant research participants, reproductive and urinary physiology, business.industry, SARS-CoV-2, COVID-19, Covid‐19 clinical trials, Articles, medicine.disease, Clinical trial, Clinical research, Paradigm shift, Family medicine, maternal‐fetal ethics, Female, Pregnant Women, human subjects research, business, Inclusion (education)
Abstract: Excluding pregnant people from Covid‐19 clinical trials may lead to unintended harmful consequences. For this study, an online questionnaire was sent to physicians belonging to Canadian professional medical associations in order to evaluate their perspectives on the participation of pregnant women in Covid‐19 clinical trials. The majority of respondents expressed support for including pregnant women in Covid‐19 trials (119/165; 72%), especially those investigating therapies with a prior safety record in pregnancy (139/164; 85%). The main perceived barriers to inclusion identified were unwillingness of pregnant patients to participate and of treating teams to offer participation, the burden of regulatory approval, and a general “culture of exclusion” of pregnant women from trials. We describe why some physicians may be reluctant to include pregnant individuals in trials, and we identify barriers to the appropriate participation of pregnant people in clinical research.
Published: 2021

15. The Incidence, Severity, and Management of COVID-19 in Critically Ill Pregnant Individuals

Author: Peter Juni, Kali Barrett, Stephen E. Lapinsky, Gabrielle M. Katz, Menaka Pai, Julie Wright, Laveena Munshi, Sarah C J Jorgensen, Andrew Healey, Tali Bogler, Katherine J. Miller, Wendy Whittle, Andrew M. Morris, Anna Perkhun, Joel G. Ray, Prakeshkumar S Shah, Shital Gandhi, Jonathan S. Zipursky, Serena Gundy, and Maha Al Mandhari
Subjects: medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, Critically ill, Incidence (epidemiology), Emergency medicine, Medicine, business
Published: 2021
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16. Timing of Antenatal Corticosteroids for Optimal Neonatal Outcomes: A Markov Decision Analysis Model

Author: Melanie Penner, Wallace B Wee, and Stephanie C. Lapinsky
Subjects: Relative risk reduction, medicine.medical_specialty, Antepartum hemorrhage, Markov chain, business.industry, Infant, Newborn, Obstetrics and Gynecology, Gestational age, Gestational Age, Quality-adjusted life year, Decision Support Techniques, Adrenal Cortex Hormones, Pregnancy, Emergency medicine, medicine, Gestation, Humans, Premature Birth, Female, Uterine Hemorrhage, business, Decision model, Decision analysis
Abstract: Objectives Antenatal corticosteroids (ACS) are administered to pregnant women at high risk of preterm delivery and are important for reducing neonatal morbidity and mortality. They have a limited timeframe of effectiveness and timing can be difficult due to the uncertainty surrounding a patient's clinical course and risk of preterm delivery. The objective of the current study was to design a decision analysis model to optimize timing of ACS administration and identify important variables which impact timing. Methods We created a Markov decision analysis model with a base case consisting of a patient at 24 weeks gestation with an antepartum hemorrhage. The decision strategies included immediate ACS administration compared to delayed or no administration. Outcomes are from the perspective of the neonate and consist of lifetime quality adjusted life years (QALYs). Model assumptions and data for model inputs were derived from current literature and clinical recommendations. Results Our base-case analysis revealed a preferred strategy of delaying ACS for two weeks, which resulted in an expected value of 39.176 lifetime discounted QALYs. This was associated with reduced neonatal morbidity, but also resulted in 0.1% more neonatal deaths compared to immediate ACS. Sensitivity analyses identified a baseline probability of delivery of 6.19% above which immediate steroids were preferred. Other important sensitive variables include gestational age and the relative risk reduction of ACS. Conclusions Clinicians should carefully consider these factors prior to ACS administration, with a low threshold for immediate administration if the probability of delivery in the next week is estimated to be greater than 6.19%.
Published: 2021

17. Characterizing the inclusion of pregnant and breastfeeding people in infectious diseases randomized controlled trials: a targeted literature review

Author: Sarah Cj. Jorgensen, Najla Tabbara, Isabelle Malhamé, Simona Miljanic, Lisa Burry, Charmaine De. Castro, Christopher L.Y. Tse, Deborah S. Somanader, and Stephen E. Lapinsky
Subjects: Microbiology (medical), medicine.medical_specialty, media_common.quotation_subject, Psychological intervention, Breastfeeding, Communicable Diseases, law.invention, Randomized controlled trial, law, Pregnancy, Medicine, Humans, media_common, Randomized Controlled Trials as Topic, business.industry, Infant, Newborn, General Medicine, Abstinence, medicine.disease, Infectious Diseases, Breast Feeding, Infectious disease (medical specialty), Family medicine, Negative Pregnancy Test, Female, business, Unintended pregnancy
Abstract: Severe complications of infectious diseases can occur during pregnancy. Evidence-based prevention and treatment strategies are critical to improve maternal and neonatal health outcomes. Despite this medical need, pregnant and breastfeeding people have been systematically excluded from biomedical research. The objective of this study was to characterize representation of pregnant and breastfeeding people in randomized controlled trials (RCTs) evaluating a broad range of interventions for infectious diseases.Pregnancy and breastfeeding inclusion criteria were examined in infectious diseases RCTs published between 1 January 2017, and 31 December 2019, in the top five highest impact general medicine and the top three highest impact infectious diseases and HIV journals.Of 376 RCTs, 5.3% and 1.9% included pregnant and breastfeeding people, respectively. Justification for exclusion was documented in 36/271 (13.3%) studies that explicitly excluded pregnant people. Most studies excluding pregnant people (177/271, 65.3%) required at least one form of contraception, abstinence and/or negative pregnancy test(s) as part of participation. Only 11/271 (4.1%) studies excluding pregnant people allowed participants to continue the intervention if unintended pregnancy occurred during the study. When both pregnant and non-pregnant people were eligible, pregnant people made up3% of participants. Only 2/48 (4.2%) vaccine studies included pregnant people; 13/234 (5.5%) drug studies included pregnant people. All studies of procedures, devices, behaviour/education and supplements/vitamins explicitly excluded or did not address pregnancy eligibility criteria. Only 2/20 (10.0%) RCTs including pregnant people collected pharmacokinetic data.This study demonstrates widespread exclusion of pregnant and breastfeeding people from infectious disease RCTs.
Published: 2021

18. Illness in Intensive Care Staff after Brief Exposure to Severe Acute Respiratory Syndrome

Author: Damon C. Scales, Karen Green, Adrienne K. Chan, Susan M. Poutanen, Donna Foster, Kylie Nowak, Janet M. Raboud, Refik Saskin, Stephen E. Lapinsky, and Thomas E. Stewart
Subjects: Canada, Medicine, Infectious and parasitic diseases, RC109-216
Published: 2003
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19. Functional polymorphism of the serotonin reuptake transporter SLC6A4 gene in various clinical variants of irritable bowel syndrome

Author: Igor G. Bakulin, A. A. Topanova, A. B. Avalueva, I. V. Lapinsky, Ekaterina V. Skazyvaeva, Stanislav Sitkin, A. A. Murzina, and A. V. Pushkina
Subjects: irritable bowel syndrome, business.industry, genotype, Transporter, General Medicine, Serotonin reuptake, Bioinformatics, medicine.disease, serotonin, polymorphism, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, alleles, medicine, Medicine, 030211 gastroenterology & hepatology, business, slc6a4, Gene, serotonin reuptake transporter, Irritable bowel syndrome, Functional polymorphism, 5-httlpr
Abstract: Rationale: Irritable bowel syndrome (IBS) is a multifactorial disease, the genetic aspect of which is being actively studied.Aim: To investigate functional polymorphism of the serotonin reuptake transporter (SERT) SLC6A4 gene of various clinical variants of IBS.Materials and methods: We performed a cross-sectional single center study in 79 Caucasian patients with IBS (according to the Rome criteria IV). The patients were divided into two groups: group 1, IBS with diarrhea (IBS-D, n = 45) and group 2, IBS with constipation (IBS-C, n = 34). The control group included 59 Caucasian patients with gastrointestinal disorders without IBS. Polymorphism 5-HTTLPR of the SLC6A4 gene was assessed in all subjects. In group 1 patients, blood serotonin levels were measured and psychological tests were performed, including Spielberger's State / Trait Anxiety Inventory, quality of life by SF36 and GSRS, Asthenia scale, VAS scores for pain intensity.Results: Thirty-five of 45 (77.8%) patients with IBS-D carried the mutant S allele, which was significantly more frequent than in the IBS-C group (p = 0.002) and in the control group (p = 0.005). There were no statistically significant differences (p = 0.54) in the frequency of detection of the homozygous LL genotype (normal allele) and the heteroand homozygous mutant alleles (SL and SS) genotype between the IBS-C and control patients. In the IBS-D group, a gender difference for the mutant SS allele of 5-HTTLPR was found, with significantly higher frequency in female patients (p = 0.0147). No significant gender differences in the genotype distribution between the patients with IBS-C and the control group were found. There were also no differences in blood serotonin levels in the IBS patients with various 5-HTTLPR types (p = 0.086); they were all in the reference range. However, there was a trend towards lower serotonin levels in the LL genotype carriers compared to those with the SS/SL polymorphisms. The Gastroenterological inventory GSRS demonstrated significantly higher total score for the constipation syndrome in the patients with homozygous LL 5-HTTLPR polymorphism, compared to that in the patients with the SS/SL genotype (p = 0.013).Conclusion: The results may be related to lower expression of the SLC6A4 gene in the carriers of the mutant allele in the 5-HTTLPR promoter and subsequent decreased rate of serotonin uptake, with resulting stimulation of the gastrointestinal tract. The SERT polymorphism of the SLC6A4 gene is worth further investigation as a potential candidate gene in the IBS pathophysiology.
Published: 2019

20. Variability in intensive care unit admission among pregnant and postpartum women in Canada: a nationwide population-based observational study

Author: Andrea D. Hill, Joel G. Ray, Gareth Seaward, Kazuyoshi Aoyama, Michelle Hladunewich, Robert A. Fowler, Stephen E. Lapinsky, Damon C. Scales, and Ruxandra Pinto
Subjects: Adult, medicine.medical_specialty, Canada, Adolescent, Critical Illness, Multi-level regression models, Critical Care and Intensive Care Medicine, law.invention, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, law, Pregnancy, Acute care, medicine, Humans, Pregnant and postpartum women, Variability, 030219 obstetrics & reproductive medicine, ICU admission, business.industry, Incidence (epidemiology), Incidence, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, Odds ratio, lcsh:RC86-88.9, Middle Aged, medicine.disease, Intensive care unit, 3. Good health, Hospitalization, Pregnancy Complications, Intensive Care Units, Nationwide population-based study, Emergency medicine, Maternal death, Observational study, Female, Pregnant Women, Maternal health, business, Cohort study
Abstract: Background Pregnancy-related critical illness results in approximately 300,000 deaths globally each year. The objective was to describe the variation in ICU admission and the contribution of patient- and hospital-based factors in ICU admission among acute care hospitals for pregnant and postpartum women in Canada. Methods A nationwide cohort study between 2004 and 2015, comprising all pregnant or postpartum women admitted to Canadian hospitals. The primary outcome was ICU admission. Secondary outcomes were severe maternal morbidity (a potentially life-threatening condition) and maternal death (during and within 6 weeks after pregnancy). The proportion of total variability in ICU admission rates due to the differences among hospitals was described using the median odds ratio from multi-level logistic regression models, adjusting for individual hospital clusters. Results There were 3,157,248 identifiable pregnancies among women admitted to 342 Canadian hospitals. The overall ICU admission rate was 3.2 per 1000 pregnancies. The rate of severe maternal morbidity was 15.8 per 1000 pregnancies, of which 10% of women were admitted to an ICU. The most common severe maternal morbidity events included postpartum hemorrhage (n = 16,364, 0.52%) and sepsis (n = 11,557, 0.37%). Of the 195 maternal deaths (6.2 per 100,000 pregnancies), only 130 (67%) were admitted to ICUs. Patients dying in hospital, without admission to ICU, included those with cardiovascular compromise, hemorrhage, and sepsis. For 2 pregnant women with similar characteristics at different hospitals, the average (median) odds of being admitted to ICU was 1.92 in 1 hospital compared to another. Hospitals admitting the fewest number of pregnant patients had the highest incidence of severe maternal morbidity and mortality. Patient-level factors associated with ICU admission were maternal comorbidity index (OR 1.88 per 1 unit increase, 95%CI 1.86–1.99), urban residence (OR 1.09, 95%CI 1.02–1.16), and residing at the lowest income quintile (OR 1.44, 95%CI 1.34–1.55). Conclusions Most women who experience severe maternal morbidity are not admitted to an ICU. There exists a wide hospital-level variability in ICU admission, with patients living in urban locations and patients of lowest income levels most likely to be admitted to ICU. Cardiovascular compromise, hemorrhage, and sepsis represent an opportunity for improved patient care and outcomes.
Published: 2019
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21. Temporal Variations in Incidence andOutcomes of Critical Illness Among Pregnant and Postpartum Women inCanada: A Population-Based Observational Study

Author: Stephen E. Lapinsky, Kazuyoshi Aoyama, Damon C. Scales, Ruxandra Pinto, Joel G. Ray, Robert A. Fowler, and Andrea D. Hill
Subjects: Adult, Canada, medicine.medical_specialty, Critical Illness, Population, law.invention, Cohort Studies, Sepsis, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, law, Acute care, Peripartum Period, medicine, Humans, 030212 general & internal medicine, education, education.field_of_study, 030219 obstetrics & reproductive medicine, business.industry, Incidence, Incidence (epidemiology), Postpartum Period, Obstetrics and Gynecology, medicine.disease, Intensive care unit, Confidence interval, Pregnancy Complications, Cohort, Maternal Death, Female, Observational study, Morbidity, business, Demography
Abstract: Objective Pregnancy-associated morbidity results in hundreds of thousands of deaths annually worldwide. Reducing maternal mortality is a key United Nations Millennium Development Goal. Although maternal mortality has declined in high-income countries, contemporary estimates of maternal morbidity and mortality trends in Canada are lacking. Methods This population-based study investigated all antepartum, peripartum, and postpartum women presenting to an acute care hospital in Canada from April 1, 2004 to March 31, 2015. The primary outcome was the change in rates of severe maternal morbidity over time. Secondary outcomes included severe maternal mortality and intensive care unit admission, including by province and territory (level of evidence: II2). Results The cohort comprised 2 035 453 mothers with 3 162 303 pregnancies. There were 17.7 per 1000 episodes of severe maternal morbidity, with annual increases of 1.3% (95% confidence interval [CI] 0.60–2.0) for severe maternal morbidity. The maternal mortality rate was 6.2 per 100 000 deliveries and stable over time (estimated percentage of annual change of −0.46%; 95% CI −5.0 to 4.3). The most common causes of severe maternal morbidity were postpartum hemorrhage (5.5 per 1000 deliveries), sepsis (3.8 per 1,000 deliveries), and cardiac failure (1.5 per 1000 deliveries). Severe maternal morbidity varied across Canadian regions but was highest in the Territories at 22.8 per 1000 deliveries. Conclusion Although maternal mortality has been stable in Canada over time, rates of severe maternal morbidity are increasing and are associated with substantial regional variation, with the highest rates experienced by women in the northern Territories.
Published: 2019
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22. Selection and Receipt of Kidney Replacement in Critically Ill Older Patients with AKI

Author: Sean M, Bagshaw, Neill K J, Adhikari, Karen E A, Burns, Jan O, Friedrich, Josée, Bouchard, Francois, Lamontagne, Lauralyn A, McIntrye, Jean-François, Cailhier, Peter, Dodek, Henry T, Stelfox, Margaret, Herridge, Stephen, Lapinsky, John, Muscedere, James, Barton, Donald, Griesdale, Mark, Soth, Althea, Ambosta, Gerald, Lebovic, Ron, Wald, and Kristine, Wachmann
Subjects: Male, medicine.medical_specialty, Epidemiology, Critical Illness, medicine.medical_treatment, Population, Critical Care and Intensive Care Medicine, Severity of Illness Index, law.invention, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, law, Internal medicine, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Renal replacement therapy, education, Prospective cohort study, Aged, Aged, 80 and over, Transplantation, education.field_of_study, business.industry, Patient Selection, Hazard ratio, Editorials, Acute kidney injury, 030208 emergency & critical care medicine, Acute Kidney Injury, medicine.disease, Intensive care unit, Renal Replacement Therapy, Nephrology, Female, Anuria, medicine.symptom, business
Abstract: Background and objectives Older patients in the intensive care unit are at greater risk of AKI; however, use of kidney replacement therapy in this population is poorly characterized. We describe the triggers and outcomes associated with kidney replacement therapy in older patients with AKI in the intensive care unit. Design, setting, participants, & measurements Our study was a prospective cohort study in 16 Canadian hospitals from September 2013 to November 2015. Patients were ≥65 years old, were critically ill, and had severe AKI; exclusion criteria were urgent kidney replacement therapy for a toxin and ESKD. We recorded triggers for kidney replacement therapy (primary exposure), reasons for not receiving kidney replacement therapy, 90-day mortality (primary outcome), and kidney recovery. Results Of 499 patients, mean (SD) age was 75 (7) years old, Charlson comorbidity score was 3.0 (2.3), and median (interquartile range) Clinical Frailty Scale score was 4 (3–5). Most were receiving mechanical ventilation (64%; n=319) and vasoactive support (63%; n=314). Clinicians were willing to offer kidney replacement therapy to 361 (72%) patients, and 229 (46%) received kidney replacement therapy. Main triggers for kidney replacement therapy were oligoanuria, fluid overload, and acidemia, whereas main reasons for not receiving therapy were anticipated recovery (67%; n=181) and therapy not consistent with patient preferences for care (24%; n=66). Ninety-day mortality was similar in patients who did and did not receive kidney replacement therapy (50% versus 51%; adjusted hazard ratio, 0.78; 95% confidence interval, 0.58 to 1.06); however, decisions to offer kidney replacement therapy varied significantly by patient mix, acuity, and perceived benefit. There were no differences in health-related quality of life or rehospitalization among survivors. Conclusions Most older, critically ill patients with severe AKI were perceived as candidates for kidney replacement therapy, and approximately one half received therapy. Both willingness to offer kidney replacement therapy and reasons for not starting showed heterogeneity due to a range in patient-specific factors and clinician perceptions of benefit.
Published: 2019
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23. A Challenging Case of Non-resolving Pneumonia: Keeping Antisynthetase Syndrome In the Differential Diagnosis

Author: Jessica Leen, Stephanie Lapinsky, Jessica Mak, and Mohammed A. Shafiee
Subjects: medicine.medical_specialty, Pneumonia, business.industry, medicine, Antisynthetase syndrome, General Medicine, Differential diagnosis, medicine.disease, Intensive care medicine, business
Abstract: A 62-year-old Caucasian female ex-smoker presented to the emergency department with progressive shortness of breath with associated pleuritic chest pain, new arthralgias, and muscle weakness for two months. She had already been treated with two courses of antibiotics for suspected community acquired pneumonia (CAP) with no improvement in her respiratory symptoms. This is a case that illustrates the eventual diagnosis of antisynthetase syndrome, a subtype of the idiopathic inflammatory myopathies. Current standard of diagnostic criteria and treatment for this autoimmune condition will also be discussed.
Published: 2019
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24. Long-Term Effects of Phased Implementation of Antimicrobial Stewardship in Academic ICUs

Author: Lisa Burry, Anthony D. Bai, Niall D. Ferguson, Chaim M. Bell, Jeffrey M. Singh, Katie Mok, Miranda So, Andrew Morris, Mark McIntyre, Stephen E. Lapinsky, Neil M. Lazar, Brian J. Minnema, John Matelski, Linda Dresser, Marilyn Steinberg, Sandra Nelson, and Susan M. Poutanen
Subjects: medicine.medical_specialty, Cost–benefit analysis, business.industry, Psychological intervention, Intervention effect, Critical Care and Intensive Care Medicine, Antimicrobial, Antibiotic resistance, Defined daily dose, Emergency medicine, medicine, Antimicrobial stewardship, business, Cohort study
Abstract: OBJECTIVES Antimicrobial stewardship is advocated to reduce antimicrobial resistance in ICUs by reducing unnecessary antimicrobial consumption. Evidence has been limited to short, single-center studies. We evaluated whether antimicrobial stewardship in ICUs could reduce antimicrobial consumption and costs. DESIGN We conducted a phased, multisite cohort study of a quality improvement initiative. SETTING Antimicrobial stewardship was implemented in four academic ICUs in Toronto, Canada beginning in February 2009 and ending in July 2012. PATIENTS All patients admitted to each ICU from January 1, 2007, to December 31, 2015, were included. INTERVENTIONS Antimicrobial stewardship was delivered using in-person coaching by pharmacists and physicians three to five times weekly, and supplemented with unit-based performance reports. Total monthly antimicrobial consumption (measured by defined daily doses/100 patient-days) and costs (Canadian dollars/100 patient-days) before and after antimicrobial stewardship implementation were measured. MEASUREMENTS AND MAIN RESULTS A total of 239,123 patient-days (57,195 patients) were analyzed, with 148,832 patient-days following introduction of antimicrobial stewardship. Antibacterial use decreased from 120.90 to 110.50 defined daily dose/100 patient-days following introduction of antimicrobial stewardship (adjusted intervention effect -12.12 defined daily dose/100 patient-days; 95% CI, -16.75 to -7.49; p < 0.001) and total antifungal use decreased from 30.53 to 27.37 defined daily doses/100 patient-days (adjusted intervention effect -3.16 defined daily dose/100 patient-days; 95% CI, -8.33 to 0.04; p = 0.05). Monthly antimicrobial costs decreased from $3195.56 to $1998.59 (adjusted intervention effect -$642.35; 95% CI, -$905.85 to -$378.84; p < 0.001) and total antifungal costs were unchanged from $1771.86 to $2027.54 (adjusted intervention effect -$355.27; 95% CI, -$837.88 to $127.33; p = 0.15). Mortality remained unchanged, with no consistent effects on antimicrobial resistance and candidemia. CONCLUSIONS Antimicrobial stewardship in ICUs with coaching plus audit and feedback is associated with sustained improvements in antimicrobial consumption and cost. ICUs with high antimicrobial consumption or expenditure should consider implementing antimicrobial stewardship programs.
Published: 2019
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25. Pregnancy and COVID ‐19: pharmacologic considerations

Author: Srinivas Murthy, Cynthia Maxwell, Isabelle Malhamé, Lauren Clarfield, Matthew P. Cheng, Katryn Paquette, Rohan D'Souza, Cristian Arzola, Stephen E. Lapinsky, Hilary Rowe, Jonathan S. Zipursky, and Rizwana Ashraf
Subjects: medicine.medical_specialty, Psychological intervention, MEDLINE, Medications, Disease, 03 medical and health sciences, 0302 clinical medicine, COVID‐19, Pregnancy, Pandemic, Obstetrics and Gynaecology, medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Pregnancy Complications, Infectious, Intensive care medicine, COVID-19 Serotherapy, Clinical Trials as Topic, Aspirin, 030219 obstetrics & reproductive medicine, Radiological and Ultrasound Technology, SARS-CoV-2, business.industry, Immunization, Passive, COVID-19, Obstetrics and Gynecology, Prenatal Care, General Medicine, medicine.disease, COVID-19 Drug Treatment, Clinical trial, Reproductive Medicine, Radiology Nuclear Medicine and imaging, Practice Guidelines as Topic, Pharmacologic considerations, Female, Narrative Review, business, Postpartum period, medicine.drug
Abstract: In this review, we summarize evidence regarding the use of routine and investigational pharmacologic interventions for pregnant and lactating patients with coronavirus disease 2019 (COVID-19). Antenatal corticosteroids may be used routinely for fetal lung maturation between 24 and 34 weeks' gestation, but decisions in those with critical illness and those 24 or 34 weeks' gestation should be made on a case-by-case basis. Magnesium sulfate may be used for seizure prophylaxis and fetal neuroprotection, albeit cautiously in those with hypoxia and renal compromise. There are no contraindications to using low-dose aspirin to prevent placenta-mediated pregnancy complications when indicated. An algorithm for thromboprophylaxis in pregnant patients with COVID-19 is presented, which considers disease severity, timing of delivery in relation to disease onset, inpatient vs outpatient status, underlying comorbidities and contraindications to the use of anticoagulation. Nitrous oxide may be administered for labor analgesia while using appropriate personal protective equipment. Intravenous remifentanil patient-controlled analgesia should be used with caution in patients with respiratory depression. Liberal use of neuraxial labor analgesia may reduce the need for emergency general anesthesia which results in aerosolization. Short courses of non-steroidal anti-inflammatory drugs can be administered for postpartum analgesia, but opioids should be used with caution due to the risk of respiratory depression. For mechanically ventilated pregnant patients, neuromuscular blockade should be used for the shortest duration possible and reversal agents should be available on hand if delivery is imminent. To date, dexamethasone is the only proven and recommended experimental treatment for pregnant patients with COVID-19 who are mechanically ventilated or who require supplemental oxygen. Although hydroxycholoroquine, lopinavir/ritonavir and remdesivir may be used during pregnancy and lactation within the context of clinical trials, data from non-pregnant populations have not shown benefit. The role of monoclonal antibodies (tocilizumab), immunomodulators (tacrolimus), interferon, inhaled nitric oxide and convalescent plasma in pregnancy and lactation needs further evaluation. © 2020 The Authors. Ultrasound in ObstetricsGynecology published by John WileySons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Published: 2021
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26. Helmet interface increases lung volumes at equivalent ventilator pressures compared to the face mask interface during non-invasive ventilation

Author: Ewan C. Goligher, Lisa Palozzi, Kate C. Tatham, Stephen E. Lapinsky, Matthew Ko, and Laurent Brochard
Subjects: Helmet, Acute hypoxemic respiratory failure, Noninvasive Ventilation, business.industry, Interface (computing), lcsh:Medical emergencies. Critical care. Intensive care. First aid, Masks, lcsh:RC86-88.9, Equipment Design, Critical Care and Intensive Care Medicine, Emergency & Critical Care Medicine, Face mask, Anesthesia, Research Letter, Non-invasive ventilation, Medicine, Humans, Lung volumes, Head Protective Devices, business, Lung Volume Measurements, 11 Medical and Health Sciences, Monitoring, Physiologic
Published: 2020

27. Dyspnoea of Pregnancy

Author: Stephen E. Lapinsky and Ghada Bourjeily
Subjects: Pregnancy, medicine.medical_specialty, business.industry, Obstetrics, Medicine, business, medicine.disease
Published: 2020
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28. Management of Ventilation

Author: Stephen E. Lapinsky and Julien Viau-Lapointe
Subjects: Mechanical ventilation, Pregnancy, education.field_of_study, medicine.medical_specialty, business.industry, medicine.medical_treatment, Population, Respiratory physiology, medicine.disease, Hypoxemia, Respiratory failure, Hypocapnia, medicine, Breathing, medicine.symptom, education, business, Intensive care medicine
Abstract: Respiratory failure affects approximately 1:500 pregnancies. Causes include pregnancy-specific and pregnancy-aggravated conditions, as well as those causes also observed in the general population. Management issues include the altered maternal respiratory physiology, the increased risk of endotracheal intubation, and ensuring that maternal interests are prioritized. Noninvasive ventilation may be considered for short-term ventilator support. Limited data exist to inform on prolonged management of invasive mechanical ventilation in pregnancy. Hypoxemia is likely harmful to the fetus (targets unknown). Hypocapnia should be avoided, but some hypercapnia is acceptable. Delivery for fetal benefit should only be considered if maternal benefit/lack of harm is also anticipated.
Published: 2020
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29. Respiratory diseases in pregnancy

Author: Catherine Nelson-Piercy and Stephen E. Lapinsky
Subjects: Pregnancy, medicine.medical_specialty, Obstetrics, business.industry, medicine, Respiratory system, medicine.disease, business, respiratory tract diseases
Abstract: Respiratory diseases, particularly asthma, are common in women of childbearing age. Respiratory symptoms, particularly breathlessness, are also common in pregnancy. This chapter discusses the normal physiological changes that occur in the respiratory system during gestation and cover the common and less common respiratory diseases that predate pregnancy: asthma, sarcoidosis, cystic fibrosis, restrictive and interstitial lung disease, pulmonary arteriovenous malformations. lymphangioleiomyomatosis, and sleep-disordered breathing. It also covers intercurrent problems such as bacterial and viral pneumonia, as well as conditions that may arise due to complications of the pregnancy itself: adult respiratory distress syndrome, amniotic fluid embolism, gastric acid aspiration, transfusion-related acute lung injury, and pneumothorax.
Published: 2020
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30. CLINICAL FEATURES OF THE ANTIOXIDANT SYSTEM AND SOME CANDIDATE GENES POLYMORPHISMS IN THE PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE

Author: E.V. Skazyvaeva Skazyvaeva, E.B. Avalueva Avalueva, I.G. Bakulin Bakulin, A.V. Pushkina Pushkina, A.A. Topanova Topanova, V.A. Dadali Dadali, and I.V. Lapinsky Lapinsky
Subjects: Candidate gene, Antioxidant, business.industry, medicine.medical_treatment, Fatty liver, Medicine, Non alcoholic, Disease, Pharmacology, business, medicine.disease
Published: 2018
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31. APPLICATION OF PROTON PUMP INHIBITORS AGAINST THE BACKGROUND OF USE OF GCSs IN PATIENTS WITH IBDs: TRIBUTE TO TRADITION IN GASTROENTEROLOGY OR NECESSITY?

Author: E.V. Skazyvayeva Skazyvayeva, I.G. Bakulin Bakulin, I.V. Lapinsky Lapinsky, and M.I. Skalinskaya Skalinskaya
Subjects: medicine.medical_specialty, business.industry, medicine, In patient, Intensive care medicine, business
Published: 2018
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32. Sepsis now a priority: a quality improvement initiative for early sepsis recognition and care

Author: Kate van den Broek, Mark McIntyre, Andrew Morris, Christine Soong, Sarah West, Christine M. McDonald, Melanie Ashby, Gillian Wilde-Friel, Stephen E. Lapinsky, Carrie Kan, and David Dushenski
Subjects: Male, Resuscitation, medicine.medical_specialty, law.invention, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Clinical Protocols, Interquartile range, law, Humans, Medicine, Blood culture, 030212 general & internal medicine, Hospitals, Teaching, Aged, Retrospective Studies, Ontario, medicine.diagnostic_test, business.industry, Health Policy, Public Health, Environmental and Occupational Health, 030208 emergency & critical care medicine, Retrospective cohort study, General Medicine, Emergency department, Length of Stay, Middle Aged, medicine.disease, Quality Improvement, Triage, Intensive care unit, Intensive Care Units, Emergency medicine, Female, Emergency Service, Hospital, business, Algorithms, Patient Care Bundles
Abstract: Objective To develop a triage-based screening algorithm and treatment order-sets aimed at improving the quality of care of all patients with sepsis presenting to our emergency department (ED). Design Retrospective cohort study conducted during a pre-intervention period from 1 April 2010 to 31 March 2011 and a post-intervention period from 1 September 2014 to 30 April 2015. Setting A large teaching hospital located in Toronto, Ontario, Canada with a 35-bed ED. Participants All patients meeting pre-specified sepsis criteria during the ED encounter. Main Outcome Measures Process of care measures included time to assessment by emergency physician, lactate measurement, blood culture collection, fluid and antibiotic administration. Intensive care unit (ICU) outcomes including admissions, length of stay (LOS) and deaths were reviewed. Results There were 346 patients pre-intervention, and 270 patients post-intervention. We significantly improved all process measures including mean time to antibiotics by 60 min (P = 0.003) and proportion of patients receiving fluid resuscitation (64.7% vs. 94.4%, P < 0.001). There was no significant difference in the number of patients admitted to ICU (P = 0.14). The median ICU LOS was shorter in the post-intervention group [2.0 days (interquartile range (IQR) 1.0-4.5 days) vs. 5.0 days (IQR 1.5-10.8 days), P = 0.04], and there was no difference in in-hospital mortality between groups (P = 0.27). Conclusions We have demonstrated that a triage-based sepsis screening tool results in expedited and consistent delivery of care, with a significant improvement in initial resuscitation measures.
Published: 2018
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33. Development of a Core Outcome Set for research on critically ill obstetric patients: A study protocol

Author: Rohan D'Souza, Stephen E. Lapinsky, Louise Rose, and Julien Viau-Lapointe
Subjects: Protocol (science), medicine.medical_specialty, Pregnancy, 030219 obstetrics & reproductive medicine, business.industry, Critically ill, Obstetrics and Gynecology, Original Articles, medicine.disease, Outcome (game theory), 03 medical and health sciences, Core (game theory), 0302 clinical medicine, Critical illness, medicine, 030212 general & internal medicine, Intensive care medicine, business, Set (psychology), High risk pregnancy
Abstract: Background Current data on critical illness during pregnancy are insufficient for evidence-based decision making. Core outcome sets are promoted to improve reporting of outcomes important to decision makers. We aim to develop a Core Outcome Set for research on critically ill obstetric patients (COSCO study). Methods We will perform a systematic review of studies on critical illness in pregnancy and focus groups or interviews with women who were critically ill while being pregnant. These data will inform an international Delphi survey where stakeholders will rank proposed outcomes. Selected outcomes will be brought forward to a consensus meeting where core outcomes will be defined. We will then complete a second consensus process to define measures for each core outcome. Conclusion The Core Outcome Set on Critically ill Obstetric patients study aims to develop a set of core outcomes to be part of all studies on critically ill obstetric patients. Implementation of this core outcome set will help improve future research efforts. Trial registration: This study is registered on the COMET-initiative website (COS #916). This systematic review is registered on PROSPERO (CRD #42017071944).
Published: 2018
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34. Treatment plan consistency with guidelines for older adults with cancer

Author: Andrea M. Barsevick, Scott W. Keith, Ronald E. Myers, Evan Lapinsky, Amy R. MacKenzie, Sarah E. Hegarty, Sheel Patel, Andrew E. Chapman, Joshua Schoppe, and Ulysses Williams Iii
Subjects: Male, Gerontology, MEDLINE, Pilot Projects, Comorbidity, Medical Oncology, Article, Consistency (negotiation), Treatment plan, Neoplasms, medicine, Humans, Geriatric Assessment, Referral and Consultation, Aged, Neoplasm Staging, Aged, 80 and over, Frailty, business.industry, Cancer, Patient Preference, Geriatric assessment, medicine.disease, Patient preference, Logistic Models, Oncology, Practice Guidelines as Topic, Female, Neoplasm staging, Guideline Adherence, Geriatrics and Gerontology, business
Published: 2019
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35. Canadian physician perspectives on the inclusion of pregnant women in trials of intervention for COVID-19

Author: Matthew P. Cheng, Nick Daneman, Stephen E. Lapinsky, Annabelle Cumyn, Marie-Julie Trahan, Haim A Abenhaim, Emily G. McDonald, and Isabelle Malhamé
Subjects: medicine.medical_specialty, Pregnancy, clinical trials, Descriptive statistics, business.industry, experimental drugs, coronavirus, Obstetrics and Gynecology, COVID-19, Computer-assisted web interviewing, medicine.disease, Clinical trial, Clinical research, ▪ o-Obs-Jm-107, Intervention (counseling), Family medicine, Medicine, Professional association, pregnancy, business, Inclusion (education)
Abstract: Objectives Excluding pregnant persons from COVID-19 trials of intervention may lead to unintended harmful consequences. Beliefs and attitudes of clinicians have the potential to shape clinical research involving pregnant women. This study evaluates the current perspectives of Canadian physicians on the participation of pregnant women in COVID-19 clinical trials. Methods An anonymous 22-item online questionnaire was sent to Canadian physicians belonging to four Canadian professional associations. Physicians were surveyed regarding the inclusion of pregnant women in COVID-19 trials using a semi-quantitative approach with multiple choice and open-ended questions. Descriptive statistics were performed. Themes from free-text answers were extracted using a semi-inductive approach. Results 202 physicians agreed to participate, 168 of which completed the survey. The majority of respondents expressed support for including pregnant women in COVID-19 trials (119/165; 72%), especially those investigating therapies with a prior safety record in pregnancy (139/164; 85%). In addition, 66% (107/161) of physicians responded that including pregnant women in COVID-19 trials was urgent. The main barriers to including pregnant women in COVID-19 trials were perceived unwillingness of pregnant patients to take part in clinical trials, perceived unwillingness of treating teams to offer participation, burden of regulatory approval, and a general ‘culture of exclusion’ of pregnant women from clinical trials. Conclusions Most physicians surveyed were supportive of the inclusion of pregnant women in COVID-19 trials of intervention. Importantly, we describe why some physicians may be reluctant to include pregnant women in clinical trials and identify important barriers to be addressed for the appropriate participation of pregnant women in clinical research.
Published: 2021

36. Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada.

Author: Janet Raboud, Altynay Shigayeva, Allison McGeer, Erika Bontovics, Martin Chapman, Denise Gravel, Bonnie Henry, Stephen Lapinsky, Mark Loeb, L Clifford McDonald, Marianna Ofner, Shirley Paton, Donna Reynolds, Damon Scales, Sandy Shen, Andrew Simor, Thomas Stewart, Mary Vearncombe, Dick Zoutman, and Karen Green
Subjects: Medicine, Science
Abstract: BACKGROUND: In the 2003 Toronto SARS outbreak, SARS-CoV was transmitted in hospitals despite adherence to infection control procedures. Considerable controversy resulted regarding which procedures and behaviours were associated with the greatest risk of SARS-CoV transmission. METHODS: A retrospective cohort study was conducted to identify risk factors for transmission of SARS-CoV during intubation from laboratory confirmed SARS patients to HCWs involved in their care. All SARS patients requiring intubation during the Toronto outbreak were identified. All HCWs who provided care to intubated SARS patients during treatment or transportation and who entered a patient room or had direct patient contact from 24 hours before to 4 hours after intubation were eligible for this study. Data was collected on patients by chart review and on HCWs by interviewer-administered questionnaire. Generalized estimating equation (GEE) logistic regression models and classification and regression trees (CART) were used to identify risk factors for SARS transmission. RESULTS: 45 laboratory-confirmed intubated SARS patients were identified. Of the 697 HCWs involved in their care, 624 (90%) participated in the study. SARS-CoV was transmitted to 26 HCWs from 7 patients; 21 HCWs were infected by 3 patients. In multivariate GEE logistic regression models, presence in the room during fiberoptic intubation (OR = 2.79, p = .004) or ECG (OR = 3.52, p = .002), unprotected eye contact with secretions (OR = 7.34, p = .001), patient APACHE II score > or = 20 (OR = 17.05, p = .009) and patient Pa0(2)/Fi0(2) ratio < or = 59 (OR = 8.65, p = .001) were associated with increased risk of transmission of SARS-CoV. In CART analyses, the four covariates which explained the greatest amount of variation in SARS-CoV transmission were covariates representing individual patients. CONCLUSION: Close contact with the airway of severely ill patients and failure of infection control practices to prevent exposure to respiratory secretions were associated with transmission of SARS-CoV. Rates of transmission of SARS-CoV varied widely among patients.
Published: 2010
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37. Measurement properties of comorbidity indices in maternal health research: a systematic review

Author: Eiichi Inada, Kazuyoshi Aoyama, Rohan D'Souza, Robert A. Fowler, and Stephen E. Lapinsky
Subjects: Predictive validity, Gerontology, medicine.medical_specialty, Index (economics), Maternal Health, MEDLINE, Reproductive medicine, Comorbidity index, lcsh:Gynecology and obstetrics, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, medicine, Maternal comorbidity index, Humans, 030212 general & internal medicine, Psychiatry, Elixhauser comorbidity index, lcsh:RG1-991, business.industry, Research, Reproducibility of Results, Obstetrics and Gynecology, 030208 emergency & critical care medicine, medicine.disease, Comorbidity, United States, Confidence interval, 3. Good health, Vital Statistics, Maternal Mortality, National Comorbidity Survey, Cohort, Systematic review, Female, Risk Adjustment, Maternal Health Research, business, Charlson comorbidity index, Measurement properties, Research Article
Abstract: Background Maternal critical illness occurs in 1.2 to 4.7 of every 1000 live births in the United States and approximately 1 in 100 women who become critically ill will die. Patient characteristics and comorbid conditions are commonly summarized as an index or score for the purpose of predicting the likelihood of dying; however, most such indices have arisen from non-pregnant patient populations. We sought to systematically review comorbidity indices used in health administrative datasets of pregnant women, in order to critically appraise their measurement properties and recommend optimal tools for clinicians and maternal health researchers. Methods We conducted a systematic search of MEDLINE and EMBASE to identify studies published from 1946 and 1947, respectively, to May 2017 that describe predictive validity of comorbidity indices using health administrative datasets in the field of maternal health research. We applied a methodological PubMed search filter to identify all studies of measurement properties for each index. Results Our initial search retrieved 8944 citations. The full text of 61 articles were identified and assessed for final eligibility. Finally, two eligible articles, describing three comorbidity indices appropriate for health administrative data remained: The Maternal comorbidity index, the Charlson comorbidity index and the Elixhauser Comorbidity Index. These studies of identified indices had a low risk of bias. The lack of an established consensus-building methodology in generating each index resulted in marginal sensibility for all indices. Only the Maternal Comorbidity Index was derived and validated specifically from a cohort of pregnant and postpartum women, using an administrative dataset, and had an associated c-statistic of 0.675 (95% Confidence Interval 0.647–0.666) in predicting mortality. Conclusions Only the Maternal Comorbidity Index directly evaluated measurement properties relevant to pregnant women in health administrative datasets; however, it has only modest predictive ability for mortality among development and validation studies. Further research to investigate the feasibility of applying this index in clinical research, and its reliability across a variety of health administrative datasets would be incrementally helpful. Evolution of this and other tools for risk prediction and risk adjustment in pregnant and post-partum patients is an important area for ongoing study. Electronic supplementary material The online version of this article (10.1186/s12884-017-1558-3) contains supplementary material, which is available to authorized users.
Published: 2017
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38. Use of a structured panel process to define antimicrobial prescribing appropriateness in critical care

Author: Stephen E. Lapinsky, Neil M. Lazar, Niall D. Ferguson, Chaim M. Bell, Jeffrey M. Singh, Patricia Murphy, Marilyn Steinberg, Andrew Morris, and Linda Dresser
Subjects: 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Critical Care, Process (engineering), 030106 microbiology, Modified delphi, Validity, Intensivist, Inappropriate Prescribing, Computer-assisted web interviewing, 030501 epidemiology, Care setting, 03 medical and health sciences, Surveys and Questionnaires, medicine, Humans, Pharmacology (medical), Practice Patterns, Physicians', Pharmacology, business.industry, Antimicrobial, Anti-Bacterial Agents, Prescriptions, Infectious Diseases, Family medicine, 0305 other medical science, business
Abstract: Background Antimicrobial prescribing is frequently reported as appropriate or inappropriate, particularly in the ICU. However, the definitions used are non-standardized and lack validity and reliability. Objectives To develop standardized definitions of appropriateness for antimicrobial prescribing in the critical care setting. Methods We used consensus-based modified Delphi and RAND appropriateness methodology to develop criteria to define appropriateness of antimicrobial prescribing. A multiphased approach with an online questionnaire followed by a facilitated in-person meeting was utilized and included clinicians from a variety of practice areas (e.g. surgeons, infectious diseases specialists, intensivists, transplant specialists and pharmacists). Results There were a total of 23 criteria agreed upon to define the following categories of antimicrobial prescribing: appropriate; effective but unnecessary; inappropriate; and under-treatment. Conclusions These standardized criteria for appropriateness may be generalizable to other patient populations and utilized with other tools to adjudicate prescribing practices.
Published: 2017
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39. Management of Acute Respiratory Failure in Pregnancy

Author: Stephen E. Lapinsky
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Peripartum cardiomyopathy, Respiratory physiology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Amniotic fluid embolism, 0302 clinical medicine, Permissive hypercapnia, Pregnancy, medicine, Humans, Respiratory function, Intensive care medicine, 030219 obstetrics & reproductive medicine, business.industry, medicine.disease, Respiration, Artificial, Oxygen, Pregnancy Complications, Respiratory failure, Anesthesia, Female, Respiratory Insufficiency, business, 030217 neurology & neurosurgery, Postpartum period
Abstract: Respiratory failure affects up to 1 in 500 pregnancies, more commonly in the postpartum period. The causes of respiratory failure include several pregnancy-specific conditions such as preeclampsia, amniotic fluid embolism, and peripartum cardiomyopathy. Pregnancy may also increase the risk or severity of other conditions, such as asthma, thromboembolism, viral pneumonitis, and gastric acid aspiration. Changes to maternal respiratory physiology and the presence of a fetus may affect the assessment and management of these patients. In addition to identifying pregnancy-specific causes, some differences exist in the management of the pregnant woman with acute respiratory failure. Endotracheal intubation in pregnancy carries a significant risk, due to upper airway edema and rapid oxygen desaturation following apnea. Few studies have addressed prolonged mechanical ventilation management in pregnancy. Optimizing oxygenation is important, but whether permissive hypercapnia is tolerated during pregnancy remains unclear. Delivery of the fetus is often considered but does not always improve maternal respiratory function and should be reserved only for cases where benefit to the fetus is anticipated.
Published: 2017
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40. Pregnancy and Risk*

Author: Moza Al-Kalbani and Stephen E. Lapinsky
Subjects: Pregnancy, medicine.medical_specialty, business.industry, Obstetrics, medicine, MEDLINE, Critical Care and Intensive Care Medicine, medicine.disease, business
Published: 2020
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41. Association of Maternal Age With Severe Maternal Morbidity and Mortality in Canada

Author: Stephen E. Lapinsky, Michelle Hladunewich, Andrea D. Hill, Robert A. Fowler, Kazuyoshi Aoyama, Joel G. Ray, Damon C. Scales, Ruxandra Pinto, and Gareth Seaward
Subjects: Adult, Canada, Adolescent, Population, Prenatal care, macromolecular substances, Ambulatory Care Facilities, Severity of Illness Index, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Pregnancy, Outcome Assessment, Health Care, medicine, Peripartum Period, Humans, 030212 general & internal medicine, Prospective Studies, education, Child, Original Investigation, education.field_of_study, 030219 obstetrics & reproductive medicine, business.industry, Research, Postpartum Period, Obstetrics and Gynecology, Abortion, Induced, Prenatal Care, General Medicine, Odds ratio, medicine.disease, Comorbidity, 3. Good health, Hospitalization, Pregnancy Complications, Online Only, Maternal Mortality, Case-Control Studies, Income, Maternal death, Female, Morbidity, business, Postpartum period, Demography, Cohort study, Maternal Age
Abstract: Key Points Question Is maternal age associated with severe maternal morbidity and with maternal death in Canada? Findings In this nationwide population-based cohort study of 3.1 million pregnancies in Canada, severe maternal morbidity has increased over the past decade, and this trend coincided with an increase over time in maternal age and in the proportion of pregnancies to older mothers. Extremes of maternal age, especially those 45 years or older compared with those aged 20 to 24 years, were associated with severe maternal morbidity and with maternal mortality. Meaning Increasing maternal age was an independent characteristic associated with severe maternal morbidity and mortality., This nationwide population-based cohort study investigates the association of maternal age, adjusting for patient-level and hospital-level factors, with severe maternal morbidity and maternal death in Canada., Importance Over the past 2 decades, there has been a trend toward increasing maternal age in many high-income countries. Maternal age may lead to greater attendant morbidity and mortality for Canadian mothers. Objective To investigate the association of maternal age, adjusting for patient-level and hospital-level factors, with severe maternal morbidity (SMM) and maternal death in Canada. Design, Setting, and Participants A nationwide population-based cohort study of all antepartum, peripartum, and postpartum women and adolescents seen at Canadian acute care hospitals from April 1, 2004, to March 31, 2015. All analyses were completed on September 13, 2018. Exposures Maternal age at the index delivery. Main Outcomes and Measures Severe maternal morbidity and maternal death during pregnancy and within 6 weeks after termination of pregnancy. Results During the study period, there were 3 162 303 new pregnancies (mean [SD] maternal age, 29.5 [5.6] years) and 3 533 259 related hospital admissions. There were 54 219 episodes of SMM (17.7 cases per 1000 deliveries) in the entire study period, with a 9.8% relative increase from 2004-2005 to 2014-2015, in addition to an increasing proportion of pregnancies to older mothers. Independent patient-level factors associated with SMM included increasing Maternal Comorbidity Index; maternal age 19 years or younger and 30 years or older, with the greatest risk experienced by women 45 years or older (odds ratio [OR], 2.69; 95% CI, 2.34-3.06 compared with maternal age 20-24 years); and lowest income quintile (OR, 1.19; 95% CI, 1.14-1.22 compared with highest income quintile). Hospital-level factors associated with SMM included specific provinces. Independent patient-level factors associated with maternal mortality included increasing Maternal Comorbidity Index, age 40 to 44 years (OR, 3.39; 95% CI, 1.68-6.82 compared with age 20-24 years), age 45 years or older (OR, 4.39; 95% CI, 1.01-19.10 compared with age 20-24 years), and lowest income quintile (OR, 4.14; 95% CI, 2.03-8.50 compared with highest income quintile). Hospital-level factors associated with maternal mortality included lowest hospital pregnancy volume. Conclusions and Relevance In Canada, maternal age and SMM have increased over the past decade. Results of this study suggest that province of residence, maternal comorbidity, residence income quintile, and extremes of maternal age, especially those 45 years or older, were associated with SMM and mortality. These findings are relevant to prospective parents, their health care team, and public health planning.
Published: 2019

42. Health-Related Quality of Life in Older Adults with Colorectal Cancer

Author: Amy R. MacKenzie, Evan Lapinsky, and Lillian C. Man
Subjects: 0301 basic medicine, Adult, medicine.medical_specialty, Colorectal cancer, medicine.medical_treatment, Psychological intervention, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Cancer Survivors, Internal medicine, medicine, Humans, Aged, Health related quality of life, Aged, 80 and over, Chemotherapy, business.industry, Cancer, medicine.disease, Prognosis, humanities, 030104 developmental biology, Oncology, Geriatric oncology, 030220 oncology & carcinogenesis, Quality of Life, business, Colorectal Neoplasms, After treatment
Abstract: Health-related quality of life (HRQoL) is a topic of great importance among older patients with cancer. Here we review the literature on HRQoL in older patients with colon and rectal cancer. HRQoL in older cancer patients with colon and rectal cancer can be impacted by care delivery model, use of selected treatments (i.e., chemotherapy), and the trajectory of the patient after surgery for colorectal cancer (CRC). HRQoL is an important outcome for older cancer patients. Greater numbers of older patients are undergoing treatment for CRC and may experience wide variations in quality of life during and after treatment. Trials should be developed with HRQoL as a primary outcome, and interventions need to be developed to maintain or improve HRQoL in older patients with cancer.
Published: 2019

43. Helium-oxygen mixture bag, a novel way for extubation of COVID-19 patients: Simulation and proof of concept

Author: Matthew Y J. Ko, Ahmad A Nahhas, Marame K Gattan, Stephen E. Lapinsky, Mohammed Bawazeer, Hejab J Almutairi, and Talal Dahhan
Subjects: Coronavirus disease 2019 (COVID-19), business.industry, medicine.medical_treatment, education, Economic shortage, General Medicine, Heliox, Tertiary care, Care setting, Light source, Anesthesia, medicine, Intubation, HELIUM/OXYGEN, business
Abstract: Background: Coronavirus disease 2019 (COVID-19) has been a worldwide pandemic in 2020; necessitating significant changes in patient-care procedures. Because of the risk of transmission to health care workers (HCWs) and the shortage of personal protective devices worldwide, novel protective barriers during aerosol-generating procedures have been developed. The intubation box has been proposed and gained popularity. A safe way for extubating patients with COVID-19 in critical care settings does not exist. This report discusses the development and assessment of the efficacy of using a Helium-Oxygen mixture (Heliox) filled bag during the extubation phase for the protection of HCW. Study Design and Methods: This methodology was developed at two tertiary care hospitals in Riyadh, Saudi Arabia and Toronto, Canada. We describe a novel way using a bag filled with Heliox bag. We performed extubation of an intubated manikin with and without using the Heliox bag. The cough during extubation was simulated using a fluorescent dye-filled balloon, which was inflated with a hidden oxygen tube until it bursts. We used an ultraviolet (UV) light source to assess the aerosols generated during extubation. Results: During extubation using the Heliox bag, droplets of the fluorescent dye were all contained within the Heliox bag and only found on the manikin chest. While during extubation without using Heliox bag, using the UV light, we found droplets of the fluorescent dye on the HCW mask and hand, the bed, the floor, and wall of the room. Conclusion: In our simulated experiment, we found that the Heliox bag is an easy and reproducible way for extubating patients with COVID-19 and any other airborne disease. We also found that the Heliox bag is an effective way to protect HCW.
Published: 2021
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44. Severe Staphylococcus aureus Endocarditis Presenting as Peripartum Thrombotic Thrombocytopenic Purpura

Author: Mark Osmond, Stephen E. Lapinsky, Mathew Sermer, Kieran L. Quinn, and Mitesh V. Badiwala
Subjects: Adult, Staphylococcus aureus, Pediatrics, medicine.medical_specialty, Thrombotic thrombocytopenic purpura, Staphylococcus aureus endocarditis, Disease, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, hemic and lymphatic diseases, Peripartum Period, medicine, Humans, Pregnancy Complications, Infectious, Endocarditis, Purpura, Thrombotic Thrombocytopenic, business.industry, Pregnancy Complications, Hematologic, Obstetrics and Gynecology, Microangiopathic hemolytic anemia, Staphylococcal Infections, medicine.disease, Schistocyte, Surgery, 030220 oncology & carcinogenesis, Infective endocarditis, Gestation, Female, Tricuspid Valve, business, Echocardiography, Transesophageal
Abstract: Background Thrombotic thrombocytopenic purpura (TTP) is a life-threatening illness that occurs in both pregnant and non-pregnant women. Several other conditions can mimic the disease, which makes the diagnosis challenging. Case We describe a case of severe Staphylococcus aureus endocarditis that initially presented as peripartum TTP in a 39-year-old woman at 29+6 weeks' gestation. We give an overview of the diagnostic considerations and management of thrombocytopenia in pregnancy and review the literature related to TTP and peripartum infective endocarditis. Conclusion Given the significant differences in definitive therapies for the spectrum of thrombocytopenic conditions that occur in pregnancy, timely and accurate diagnosis of TTP is critical for optimal management.
Published: 2016
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45. ESICM LIVES 2016: part one

Author: L. Bos, L. Schouten, L. van Vught, M. Wiewel, D. Ong, O. Cremer, A. Artigas, I. Martin-Loeches, A. Hoogendijk, T. van der Poll, J. Horn, N. Juffermans, M. Schultz, N. de Prost, T. Pham, G. Carteaux, A. Mekontso Dessap, C. Brun-Buisson, E. Fan, G. Bellani, J. Laffey, A. Mercat, L. Brochard, B. Maitre, LUNG SAFE investigators and the ESICM study group, P. A. Howells, D. R. Thickett, C. Knox, D. P. Park, F. Gao, O. Tucker, T. Whitehouse, D. F. McAuley, G. D. Perkins, LUNG SAFE Investigators and the ESICM Trials Group, L. Pisani, J. P. Roozeman, F. D. Simonis, A. Giangregorio, L. R. Schouten, S. M. Van der Hoeven, A. Serpa Neto, E. Festic, A. M. Dondorp, S. Grasso, L. D. Bos, M. J. Schultz, M. Koster-Brouwer, D. Verboom, B. Scicluna, K. van de Groep, J. Frencken, M. Bonten, J. I. Ko, K. S. Kim, G. J. Suh, W. Y. Kwon, K. Kim, J. H. Shin, O. T. Ranzani, E. Prina, R. Menendez, A. Ceccato, R. Mendez, C. Cilloniz, A. Gabarrus, M. Ferrer, A. Torres, A. Urbano, L. A. Zhang, D. Swigon, F. Pike, R. S. Parker, G. Clermont, C. Scheer, S. O. Kuhn, A. Modler, M. Vollmer, C. Fuchs, K. Hahnenkamp, S. Rehberg, M. Gründling, A. Taggu, N. Darang, N. Öveges, I. László, K. Tánczos, M. Németh, G. Lebák, B. Tudor, D. Érces, J. Kaszaki, W. Huber, D. Trásy, Z. Molnár, G. Ferrara, V. S. Kanoore Edul, H. S. Canales, E. Martins, C. Canullán, G. Murias, M. O. Pozo, J. F. Caminos Eguillor, M. G. Buscetti, C. Ince, A. Dubin, H. D. Aya, A. Rhodes, N. Fletcher, R. M. Grounds, M. Cecconi, M. Jacquet-Lagrèze, M. Riche, R. Schweizer, P. Portran, W. Fornier, M. Lilot, J. Neidecker, J. L. Fellahi, A. Escoresca-Ortega, A. Gutiérrez-Pizarraya, L. Charris-Castro, Y. Corcia-Palomo, E. Fernandez-Delgado, J. Garnacho-Montero, C. Roger, L. Muller, L. Elotmani, J. Lipman, J. Y. Lefrant, J. A. Roberts, R. Muñoz-Bermúdez, M. Samper, C. Climent, F. Vasco, V. Sara, S. Luque, N. Campillo, S. Grau Cerrato, J. R. Masclans, F. Alvarez-Lerma, S. Carvalho Brugger, G. Jimenez Jimenez, M. Miralbés Torner, J. Trujillano Cabello, B. Balsera Garrido, X. Nuvials Casals, F. Barcenilla Gaite, M. Vallverdú Vidal, M. Palomar Martínez, V. Gusarov, D. Shilkin, M. Dementienko, E. Nesterova, N. Lashenkova, A. Kuzovlev, M. Zamyatin, A. Demoule, S. Carreira, S. Lavault, O. Palancca, E. Morawiec, J. Mayaux, I. Arnulf, T. Similowski, B. S. Rasmussen, R. G. Maltesen, M. Hanifa, S. Pedersen, S. R. Kristensen, R. Wimmer, M. Panigada, G. Li Bassi, T. Kolobow, A. Zanella, M. Cressoni, L. Berra, V. Parrini, H. Kandil, G. Salati, S. Livigni, A. Amatu, A. Andreotti, F. Tagliaferri, G. Moise, G. Mercurio, A. Costa, A. Vezzani, S. Lindau, J. Babel, M. Cavana, D. Consonni, A. Pesenti, L. Gattinoni, for the GRAVITY-VAP TRIAL NETWORK, P. Mansouri, F. Zand, L. Zahed, F. Dehghanrad, M. Bahrani, M. Ghorbani, B. Cambiaghi, O. Moerer, T. Mauri, N. Kunze-Szikszay, C. Ritter, M. Quintel, L. M. Vilander, M. A. Kaunisto, S. T. Vaara, V. Pettilä, FINNAKI Study Group, J. L. G. Haitsma Mulier, S. Rozemeijer, A. M. E. Spoelstra-de Man, P. E. Elbers, P. R. Tuinman, M. C. de Waard, H. M. Oudemans-van Straaten, A. M. A. Liberatore, R. B. Souza, A. M. C. R. P. F. Martins, J. C. F. Vieira, I. H. J. Koh, M. Galindo Martínez, R. Jiménez Sánchez, L. Martínez Gascón, M. D. Rodríguez Mulero, A. Ortín Freire, A. Ojados Muñoz, S. Rebollo Acebes, Á. Fernández Martínez, S. Moreno Aliaga, L. Herrera Para, J. Murcia Payá, F. Rodríguez Mulero, P. Guerci, Y. Ince, P. Heeman, B. Ergin, Z. Uz, M. Massey, R. Papatella, E. Bulent, F. Toraman, E. R. Longbottom, H. D. Torrance, H. C. Owen, C. J. Hinds, R. M. Pearse, M. J. O’Dywer, Z. Trogrlic, M. van der Jagt, H. Lingsma, H. H. Ponssen, J. F. Schoonderbeek, F. Schreiner, S. J. Verbrugge, S. Duran, T. van Achterberg, J. Bakker, D. A. M. P. J. Gommers, E. Ista, A. Krajčová, P. Waldauf, F. Duška, A. Shah, N. Roy, S. McKechnie, C. Doree, S. Fisher, S. J. Stanworth, J. F. Jensen, D. Overgaard, M. H. Bestle, D. F. Christensen, I. Egerod, The RAPIT Group, A. Pivkina, I. Zhivotneva, N. Pasko, A. Alklit, R. L. Hansen, H. Knudsen, L. B. Grode, The RAPIT group, M. Hravnak, L. Chen, A. Dubrawski, M. R. Pinsky, S. M. Parry, L. D. Knight, B. C. Connolly, C. E. Baldwin, Z. A. Puthucheary, L. Denehy, N. Hart, P. E. Morris, J. Mortimore, C. L. Granger, H. I. Jensen, R. Piers, B. Van den Bulcke, J. Malmgren, V. Metaxa, A. K. Reyners, M. Darmon, K. Rusinova, D. Talmor, A. P. Meert, L. Cancelliere, L. Zubek, P. Maia, A. Michalsen, J. Decruyenaere, E. Kompanje, S. Vanheule, E. Azoulay, S. Vansteelandt, D. Benoit, C. Ryan, D. Dawson, J. Ball, K. Noone, B. Aisling, S. Prudden, A. Ntantana, D. Matamis, S. Savvidou, M. Giannakou, M. Gouva, G. Nakos, V. Koulouras, J. Aron, G. Lumley, D. Milliken, K. Dhadwal, B. A. McGrath, S. J. Lynch, B. Bovento, G. Sharpe, E. Grainger, S. Pieri-Davies, S. Wallace, B. McGrath, M. Jung, J. Cho, H. Park, G. Suh, O. Kousha, J. Paddle, L. Gamrin Gripenberg, M. Sundström Rehal, J. Wernerman, O. Rooyackers, H. J. de Grooth, W. P. Choo, A. M. Spoelstra-de Man, E. L. Swart, L. Talan, G. Güven, N. D. Altıntas, M. Padar, G. Uusvel, L. Starkopf, J. Starkopf, A. Reintam Blaser, M. S. Kalaiselvan, A. S. Arunkumar, M. K. Renuka, R. L. Shivkumar, M. Volbeda, D. ten Kate, M. Hoekstra, J. M. van der Maaten, M. W. Nijsten, A. Komaromi, Å. Norberg, M. Smedberg, M. Mori, L. Pettersson, M. Theodorakopoulou, T. Christodoulopoulou, A. Diamantakis, F. Frantzeskaki, M. Kontogiorgi, E. Chrysanthopoulou, M. Lygnos, C. Diakaki, A. Armaganidis, K. Gundogan, E. Dogan, R. Coskun, S. Muhtaroglu, M. Sungur, T. Ziegler, M. Guven, A. Kleyman, W. Khaliq, D. Andreas, M. Singer, R. Meierhans, R. Schuepbach, I. De Brito-Ashurst, G. Sabetian, R. Nikandish, F. Hagar, M. Masjedi, B. Maghsudi, A. Vazin, E. Asadpour, K. C. Kao, L. C. Chiu, C. Y. Hung, C. H. Chang, S. H. Li, H. C. Hu, S. El Maraghi, M. Ali, D. Rageb, M. Helmy, J. Marin-Corral, C. Vilà, A. Vàzquez, I. Martín-Loeches, E. Díaz, J. C. Yébenes, A. Rodriguez, F. Álvarez-Lerma, H1N1 SEMICYUC/GETGAG Working Group, N. Varga, A. Cortina-Gutiérrez, L. Dono, M. Martínez-Martínez, C. Maldonado, E. Papiol, M. Pérez-Carrasco, R. Ferrer, K. Nweze, B. Morton, I. Welters, M. Houard, B. Voisin, G. Ledoux, S. Six, E. Jaillette, S. Nseir, S. Romdhani, R. Bouneb, D. Loghmari, N. Ben Aicha, J. Ayachi, K. Meddeb, I. Chouchène, A. Khedher, M. Boussarsar, K. S. Chan, W. L. Yu, J. Nolla, L. Vidaur, J. Bonastre, B. Suberbiola, J. E. Guerrero, H1N1 SEMICYUC/GETGAG working group, N. Ramon Coll, G. Jiménez Jiménez, J. Codina Calero, M. García, M. C. de la Torre, E. Vendrell, E. Palomera, E. Güell, M. Serra-Prat, J. F. Bermejo-Martín, J. Almirall, E. Tomas, A. Escoval, F. Froe, M. H. Vitoria Pereira, N. Velez, E. Viegas, E. Filipe, C. Groves, M. Reay, A. Ballin, F. Facchin, G. Sartori, F. Zarantonello, E. Campello, C. M. Radu, S. Rossi, C. Ori, P. Simioni, N. Umei, I. Shingo, A. C. Santos, C. Candeias, I. Moniz, R. Marçal, Z. Costa e Silva, J. M. Ribeiro, J. F. Georger, J. P. Ponthus, M. Tchir, V. Amilien, M. Ayoub, E. Barsam, G. Martucci, G. Panarello, F. Tuzzolino, G. Capitanio, V. Ferrazza, T. Carollo, L. Giovanni, A. Arcadipane, M. López Sánchez, M. A. González-Gay, F. J. Llorca Díaz, M. I. Rubio López, E. Zogheib, L. Villeret, J. Nader, M. Bernasinski, P. Besserve, T. Caus, H. Dupont, P. Morimont, S. Habran, R. Hubert, T. Desaive, F. Blaffart, N. Janssen, J. Guiot, A. Pironet, P. Dauby, B. Lambermont, T. Pettenuzzo, G. Citton, C. Kirakli, O. Ediboglu, S. Ataman, M. Yarici, F. Tuksavul, S. Keating, A. Gibson, M. Gilles, M. Dunn, G. Price, N. Young, P. Remeta, P. Bishop, M. D. Fernández Zamora, J. Muñoz-Bono, E. Curiel-Balsera, E. Aguilar-Alonso, R. Hinojosa, A. Gordillo-Brenes, J. A. Arboleda-Sánchez, ARIAM-CARDIAC SURGERY PROJECT AUTHORS, I. Skorniakov, D. Vikulova, C. Whiteley, O. Shaikh, A. Jones, M. Ostermann, L. Forni, M. Scott, J. Sahatjian, W. Linde-Zwirble, D. Hansell, P. Laoveeravat, N. Srisawat, M. Kongwibulwut, S. Peerapornrattana, N. Suwachittanont, T. O. Wirotwan, P. Chatkaew, P. Saeyub, K. Latthaprecha, K. Tiranathanagul, S. Eiam-ong, J. A. Kellum, R. E. Berthelsen, A. Perner, A. E. K. Jensen, J. U. Jensen, D. J. Gebhard, J. Price, C. E. Kennedy, A. Akcan-Arikan, Y. R. Kang, M. N. Nakamae, K. Hamed, M. M. Khaled, R. Aly Soliman, M. Sherif Mokhtar, G. Seller-Pérez, D. Arias-Verdú, E. Llopar-Valdor, I. De-Diós-Chacón, G. Quesada-García, M. E. Herrera-Gutierrez, R. Hafes, G. Carroll, P. Doherty, C. Wright, I. G. Guerra Vera, M. Ralston, M. L. Gemmell, A. MacKay, E. Black, R. I. Docking, R. Appleton, M. R. Ralston, L. Gemmell, A. Mackay, J. G. Röttgering, P. W. G. Elbers, N. Mejeni, J. Nsiala, A. Kilembe, P. Akilimali, G. Thomas, A. E. Andersson, A. M. Fagerdahl, V. Knudsen, P-INFECT, A. Ben Cheikh, Y. Hamdaoui, A. Guiga, N. Fraj, N. Sma, I. Chouchene, N. Bouafia, A. Amirian, B. Ziaian, C. Fleischmann, D. O. Thomas-Rueddel, A. Schettler, D. Schwarzkopf, A. Stacke, K. Reinhart, A. Martins, P. Sousa, G. Snell, R. Matsa, T. T. S. Paary, A. M. Cavalheiro, L. L. Rocha, C. S. Vallone, A. Tonilo, M. D. S. Lobato, D. T. Malheiro, G. Sussumo, N. M. Lucino, V. D. Rosenthal, A. Sanaei Dashti, A. Yousefipour, J. R. Goodall, M. Williamson, E. Tant, N. Thomas, C. Balci, C. Gonen, E. Haftacı, H. Gurarda, E. Karaca, B. Paldusová, I. Zýková, D. Šímová, S. Houston, L. D’Antona, J. Lloyd, V. Garnelo-Rey, M. Sosic, V. Sotosek-Tokmazic, J. Kuharic, I. Antoncic, S. Dunatov, A. Sustic, C. T. Chong, M. Sim, T. Lyovarin, F. M. Acosta Díaz, S. Narbona Galdó, M. Muñoz Garach, O. Moreno Romero, A. M. Pérez Bailón, A. Carranza Pinel, M. Colmenero, A. Gritsan, A. Gazenkampf, E. Korchagin, N. Dovbish, R. M. Lee, M. P. P. Lim, B. C. L. Lim, J. J. See, R. Assis, F. Filipe, N. Lopes, L. Pessoa, T. Pereira, N. Catorze, M. S. Aydogan, C. Aldasoro, P. Marchio, A. Jorda, M. D. Mauricio, S. Guerra-Ojeda, M. Gimeno-Raga, M. Colque-Cano, A. Bertomeu-Artecero, M. Aldasoro, S. L. Valles, D. Tonon, T. Triglia, J. C. Martin, M. C. Alessi, N. Bruder, P. Garrigue, L. Velly, S. Spina, V. Scaravilli, C. Marzorati, E. Colombo, D. Savo, A. Vargiolu, G. Cavenaghi, G. Citerio, A. H. V. Andrade, P. Bulgarelli, J. A. P. Araujo, V. Gonzalez, V. A. Souza, C. Massant, C. A. C. Abreu Filho, R. A. Morbeck, L. E. Burgo, R. van Groenendael, L. T. van Eijk, G. P. Leijte, B. Koeneman, M. Kox, P. Pickkers, A. García-de la Torre, M. de la Torre-Prados, A. Fernández-Porcel, C. Rueda-Molina, P. Nuevo-Ortega, T. Tsvetanova-Spasova, E. Cámara-Sola, A. García-Alcántara, L. Salido-Díaz, X. Liao, T. Feng, J. Zhang, X. Cao, Q. Wu, Z. Xie, H. Li, Y. Kang, M. S. Winkler, A. Nierhaus, E. Mudersbach, A. Bauer, L. Robbe, C. Zahrte, E. Schwedhelm, S. Kluge, C. Zöllner, E. Mitsi, S. H. Pennington, J. Reine, A. D. Wright, R. Parker, I. D. Welters, J. D. Blakey, G. Rajam, E. W. Ades, D. M. Ferreira, D. Wang, A. Kadioglu, S. B. Gordon, R. Koch, J. Rahamat-Langedoen, J. Schloesser, M. de Jonge, J. Bringue, R. Guillamat-Prats, E. Torrents, M. L. Martinez, M. Camprubí-Rimblas, L. Blanch, S. Y. Park, Y. B. Park, D. K. Song, S. Shrestha, S. H. Park, Y. Koh, M. J. Park, C. W. Hong, O. Lesur, D. Coquerel, X. Sainsily, J. Cote, T. Söllradl, A. Murza, L. Dumont, R. Dumaine, M. Grandbois, P. Sarret, E. Marsault, D. Salvail, M. Auger-Messier, F. Chagnon, Apelin Group, M. P. Lauretta, E. Greco, A. Dyson, S. Preau, M. Ambler, A. Sigurta, S. Saeed, L. Topcu Sarıca, N. Zibandeh, D. Genc, F. Gul, T. Akkoc, E. Kombak, L. Cinel, I. Cinel, S. J. Pollen, N. Arulkumaran, G. Warnes, D. J. Pennington, K. Brohi, M. J. O’Dwyer, H. Y. Kim, S. Na, J. Kim, Y. F. Chang, A. Chao, P. Y. Shih, C. T. Lee, Y. C. Yeh, L. W. Chen, M. Adriaanse, W. Rietdijk, S. Funcke, S. Sauerlaender, B. Saugel, H. Pinnschmidt, D. A. Reuter, R. Nitzschke, S. Perbet, C. Biboulet, A. Lenoire, D. Bourdeaux, B. Pereira, B. Plaud, J. E. Bazin, V. Sautou, A. Mebazaa, J. M. Constantin, M. Legrand, Y. Boyko, P. Jennum, M. Nikolic, H. Oerding, R. Holst, P. Toft, H. K. Nedergaard, T. Haberlandt, S. Park, S. Kim, Y. J. Cho, Y. J. Lim, A. Chan, S. Tang, S. L. Nunes, S. Forsberg, H. Blomqvist, L. Berggren, M. Sörberg, T. Sarapohja, C. J. Wickerts, J. G. M. Hofhuis, L. Rose, B. Blackwood, E. Akerman, J. Mcgaughey, M. Fossum, H. Foss, E. Georgiou, H. J. Graff, M. Kalafati, R. Sperlinga, A. Schafer, A. G. Wojnicka, P. E. Spronk, F. Khalili, R. Afshari, H. Haddad Khodaei, S. Javadpour, P. Petramfar, S. Nasimi, H. Tabei, A. Gunther, J. O. Hansen, P. Sackey, H. Storm, J. Bernhardsson, Ø. Sundin, A. Bjärtå, A. Bienert, P. Smuszkiewicz, P. Wiczling, K. Przybylowski, A. Borsuk, I. Trojanowska, J. Matysiak, Z. Kokot, M. Paterska, E. Grzeskowiak, A. Messina, E. Bonicolini, D. Colombo, G. Moro, S. Romagnoli, A. R. De Gaudio, F. Della Corte, S. M. Romano, J. A. Silversides, E. Major, E. E. Mann, A. J. Ferguson, D. F. Mcauley, J. C. Marshall, J. A. Diaz-Rodriguez, R. Silva-Medina, E. Gomez-Sandoval, N. Gomez-Gonzalez, R. Soriano-Orozco, P. L. Gonzalez-Carrillo, M. Hernández-Flores, K. Pilarczyk, J. Lubarksi, D. Wendt, F. Dusse, J. Günter, B. Huschens, E. Demircioglu, H. Jakob, A. Palmaccio, A. M. Dell’Anna, D. L. Grieco, F. Torrini, C. Iaquaniello, F. Bongiovanni, M. Antonelli, L. Toscani, D. Antonakaki, D. Bastoni, M. Jozwiak, F. Depret, J. L. Teboul, J. Alphonsine, C. Lai, C. Richard, X. Monnet, G. Demeter, I. Kertmegi, A. Hasanin, A. Lotfy, A. El-adawy, H. Nassar, S. Mahmoud, A. Abougabal, A. Mukhtar, F. Quinty, S. Habchi, A. Luzi, E. Antok, G. Hernandez, B. Lara, L. Enberg, M. Ortega, P. Leon, C. Kripper, P. Aguilera, E. Kattan, M. Lehmann, S. Sakka, B. Bein, R. M. Schmid, J. Preti, J. Creteur, A. Herpain, J. Marc, F. Trojette, S. Bar, L. Kontar, D. Titeca, J. Richecoeur, B. Gelee, N. Verrier, R. Mercier, E. Lorne, J. Maizel, M. Slama, M. E. Abdelfattah, A. Eladawy, M. A. Ali Elsayed, A. Pedraza Montenegro, E. Monares Zepeda, J. Franco Granillo, J. S. Aguirre Sánchez, G. Camarena Alejo, A. Rugerio Cabrera, A. A. Tanaka Montoya, C. Lee, F. Hatib, M. Cannesson, P. Theerawit, T. Morasert, Y. Sutherasan, G. Zani, S. Mescolini, M. Diamanti, R. Righetti, A. Scaramuzza, M. Papetti, M. Terenzoni, C. Gecele, M. Fusari, K. A. Hakim, A. Chaari, M. Ismail, A. H. Elsaka, T. M. Mahmoud, K. Bousselmi, V. Kauts, W. F. Casey, S. D. Hutchings, D. Naumann, J. Wendon, S. Watts, E. Kirkman, Z. Jian, S. Buddi, J. Settels, P. Bertini, F. Guarracino, C. Trepte, P. Richter, S. A. Haas, V. Eichhorn, J. C. Kubitz, M. S. Soliman, W. I. Hamimy, A. Z. Fouad, A. M. Mukhtar, M. Charlton, L. Tonks, L. Mclelland, T. J. Coats, J. P. Thompson, M. R. Sims, D. Williams, D. Z. Roushdy, R. A. Soliman, R. A. Nahas, M. Y. Arafa, W. T. Hung, C. C. Chiang, W. C. Huang, K. C. Lin, S. C. Lin, C. C. Cheng, P. L. Kang, S. R. Wann, G. Y. Mar, C. P. Liu, M. Lopez Carranza, H. Sancho Fernandez, J. A. Sanchez Roman, F. Lucena, A. Campanario Garcia, A. Loza Vazquez, A. Lesmes Serrano, ARIAM-SEMICYUC Registry Investigators, L. Sayagues Moreira, R. Vidal-Perez, U. Anido Herranz, J. M. Garcia Acuna, C. Pena Gil, J. L. Garcia Allut, P. Rascado Sedes, C. Martin Lopez, E. Saborido Paz, C. Galban Rodriguez, J. R. Gonzalez-Juanatey, A. Vallejo-Baez, M. V. de la Torre-Prados, ARIAM Group, R. Marharaj, K. Gervasio, M. Bottiroli, M. Mondino, D. De Caria, A. Calini, E. Montrasio, F. Milazzo, M. P. Gagliardone, A. Vallejo-Báez, ARIAM group, U. Anido, M. Cheikh-Bouhlel, M. P. R. D. L. Dela Cruz, J. M. Bernardo, F. Galfo, A. Marino, C. C. Chao, P. Hou, C. C. Hung, C. H. Chiang, Y. J. Liou, S. M. Hung, Y. S. Lin, F. Y. Kuo, K. R. Chiou, C. J. Chen, L. S. Yan, C. Y. Liu, H. H. Wang, H. L. Chen, C. K. Ho, S. Grewal, S. Gopal, C. Corbett, A. Wilson, J. Capps, W. Ayoub, A. Lomas, S. Ghani, J. Moore, D. Atkinson, M. Sharman, W. Swinnen, J. Pauwels, K. Mignolet, E. Pannier, A. Koch, T. Sarens, W. Temmerman, A. M. Elmenshawy, A. M. Fayed, M. Elboriuny, E. Hamdy, E. Zakaria, A. C. Falk, A. Petosic, K. Olafsen, H. Wøien, H. Flaatten, K. Sunde, J. J. Cáceres Agra, J. L. Santana Cabrera, J. D. Martín Santana, L. Melián Alzola, H. Rodríguez Pérez, T. Castro Pires, H. Calderón, A. Pereira, S. Castro, C. Granja, I. Norkiene, I. Urbanaviciute, G. Kezyte, D. Ringaitiene, T. Jovaisa, G. Vogel, U. B. Johansson, A. Sandgren, C. Svensen, E. Joelsson-Alm, M. A. Leite, L. D. Murbach, E. F. Osaku, C. R. L. M. Costa, M. Pelenz, N. M. Neitzke, M. M. Moraes, J. L. Jaskowiak, M. M. M. Silva, R. S. Zaponi, L. R. L. Abentroth, S. M. Ogasawara, A. C. Jorge, P. A. D. Duarte, J. Barreto, S. T. Duarte, S. Taba, D. Miglioranza, D. P. Gund, C. F. Lordani, H. Vollmer, M. Gager, C. Waldmann, A. T. Mazzeo, R. Tesio, C. Filippini, M. E. Vallero, C. Giolitti, S. Caccia, M. Medugno, T. Tenaglia, R. Rosato, I. Mastromauro, L. Brazzi, P. P. Terragni, R. Urbino, V. Fanelli, V. M. Ranieri, L. Mascia, J. Ballantyne, L. Paton, P. Perez-Teran, O. Roca, J. C. Ruiz-Rodriguez, A. Zapatero, J. Serra, S. Bianzina, P. Cornara, G. Rodi, G. Tavazzi, M. Pozzi, G. A. Iotti, F. Mojoli, A. Braschi, A. Vishnu, D. Buche, R. Pande, D. L. J. Moolenaar, F. Bakhshi-Raiez, D. A. Dongelmans, N. F. de Keizer, D. W. de Lange, I. Fuentes Fernández, D. Martínez Baño, J. L. Buendía Moreno, R. Jara Rubio, J. Scott, D. Phelan, D. Morely, J. O’Flynn, P. Stapleton, M. Lynch, B. Marsh, E. Carton, C. O’Loughlin, K. C. Cheng, M. I. Sung, M. O. Elghonemi, M. H. Saleh, T. S. Meyhoff, M. Krag, P. B. Hjortrup, M. H. Møller, T. Öhman, T. Sigmundsson, E. Redondo, M. Hallbäck, F. Suarez-Sipmann, H. Björne, C. Hällsjö Sander, KARISMA, D. Chiumello, C. Chiurazzi, M. Brioni, I. Algieri, M. Guanziroli, G. Vergani, T. Tonetti, I. Tomic, A. Colombo, F. Crimella, E. Carlesso, V. Gasparovic, R. El-Sherif, M. Abd Al-Basser, A. Raafat, A. El-Sherif, L. R. A. Schouten, O. L. Cremer, D. S. Y. Ong, G. Amoruso, G. Cinnella, L. D. J. Bos, P. Schmidle, M. Findeisen, P. Hoppmann, J. Jaitner, F. Brettner, T. Lahmer, EXODUS-investigators, G. Rajagopalan, V. Bansal, R. Frank, R. Hinds, J. Levitt, United States Critical Illness and Injury Trials Group/LIPS-B investigators, S. Siddiqui, SICM NICER Group, J. P. Gilbert, K. Sim, C. H. Wang, I. J. Li, W. R. Tang, P. Persona, A. De Cassai, M. Franco, A. Goffi, B. Llorente Ruiz, J. Lujan Varas, R. Molina Montero, C. Pintado Delgado, O. Navarrete, M. Vazquez Mezquita, E. Alonso Peces, M. A. M. Nakamura, L. A. Hajjar, F. R. B. G. Galas, T. A. Ortiz, M. B. P. Amato, L. Bitker, N. Costes, D. Le Bars, F. Lavenne, D. Mojgan, J. C. Richard, D. Massari, M. Gotti, P. Cadringher, A. Zerman, M. Türkoğlu, G. Arık, F. Yıldırım, Z. Güllü, I. Kara, N. Boyacı, B. Basarık Aydoğan, Ü. Gaygısız, K. Gönderen, G. Aygencel, M. Aydoğdu, Z. Ülger, G. Gürsel, J. Riera, C. Maldonado Toral, C. Mazo, M. Martínez, J. Baldirà, L. Lagunes, A. Roman, M. Deu, J. Rello, D. J. Levine, R. M. Mohus, Å. Askim, J. Paulsen, A. Mehl, A. T. Dewan, J. K. Damås, E. Solligård, B. O. Åsvold, Mid-Norway Sepsis Research Center, A. DeWan, O. Aktepe, A. Kara, H. Yeter, A. Topeli, M. Norrenberg, M. Devroey, H. Khader, J. C. Preiser, Z. Tang, C. Qiu, L. Tong, C. Cai, O. Apostolopoulou, J. Y. Moon, M. R. Park, I. S. Kwon, G. R. Chon, J. Y. Ahn, S. J. Kwon, Y. J. Chang, J. Y. Lee, S. Y. Yoon, J. W. Lee, The Korean Chungcheong Critical Care Research Group, M. Kostalas, J. Mckinlay, G. Kooner, G. Dudas, A. Horton, C. Kerr, N. Karanjia, B. Creagh-Brown, N. D. Altintas, S. Izdes, O. Keremoglu, A. Alkan, S. Neselioglu, O. Erel, N. Tardif, T. Gustafsson, K. N. MacEachern, M. Traille, I. Bromberg, S. E. Lapinsky, M. J. Moore, J. L. García-Garmendia, F. Villarrasa-Clemente, F. Maroto-Monserrat, O. Rufo-Tejeiro, V. Jorge-Amigo, M. Sánchez-Santamaría, C. Colón-Pallarés, A. Barrero-Almodóvar, S. Gallego-Lara, C. T. Anthon, R. B. Müller, N. Haase, K. Møller, J. Wetterslev, M. Nakanishi, A. Kuriyama, T. Fukuoka, M. A. Abd el Halim, M. H. Elsaid hafez, A. M. Moktar, H. M. Elazizy, K. Abdel Hakim, M. Elbahr, T. Mahmoud, E. Khalil, W. Casey, S. H. Zaky, A. Rizk, R. Ahmed, G. A. Ospina-Tascón, A. F. Garcia Marin, G. J. Echeverry, W. F. Bermudez, H. J. Madriñan-Navia, J. D. Valencia, E. Quiñonez, A. Marulanda, C. A. Arango-Dávila, A. Bruhn, D. De Backer, D. Orbegozo Cortes, F. Su, J. L. Vincent, L. Tullo, L. Mirabella, P. Di Molfetta, M. Dambrosio, C. Villavicencio Lujan, J. Leache irigoyen, M. Cartanya ferré, R. Carbonell García, M. Ahmed, M. El Ayashi, E. Ayman, M. Salem, S. Fathy, A. Zaghlol, M. F. Aguilar Arzapalo, Å. Valsø, T. Rustøen, I. Schou-Bredal, L. Skogstad, K. Tøien, C. Padilla, Y. Palmeiro, W. Egbaria, R. Kigli, B. Maertens, K. Blot, S. Blot, E. Santana-Santos, E. R. dos Santos, R. E. D. L. Ferretti-Rebustini, R. D. C. C. D. O. dos Santos, R. G. S. Verardino, L. A. Bortolotto, A. M. Doyle, I. Naldrett, J. Tillman, S. Price, P. Pearson, J. Greaves, D. Goodall, A. Berry, A. Richardson, G. O. Odundo, P. Omengo, P. Obonyo, N. M. Chanzu, R. Kleinpell, S. J. Sarris, P. Nedved, M. Heitschmidt, H. Ben-Ghezala, S. Snouda, S. Djobbi, N. K. J. Adhikari, D. Leasa, D. Fergusson, D. A. Mckim, J. Weblin, D. McWilliams, F. Doesburg, F. Cnossen, W. Dieperink, W. Bult, M. W. N. Nijsten, G. A. Galvez-Blanco, C. I. Olvera Guzman, J. Santos Stroud, R. Thomson, M. Llaurado-Serra, A. Lobo-Civico, M. Pi-Guerrero, I. Blanco-Sanchez, A. Piñol-Tena, C. Paños-Espinosa, Y. Alabart-Segura, B. Coloma-Gomez, A. Fernandez-Blanco, F. Braga-Dias, M. Treso-Geira, A. Valeiras-Valero, L. Martinez-Reyes, A. Sandiumenge, M. F. Jimenez-Herrera, CAPCRI Study, R. Prada, P. Juárez, R. Argandoña, J. J. Díaz, C. Sánchez Ramirez, P. Saavedra, S. Ruiz Santana, O. Obukhova, S. Kashiya, I. A. Kurmukov, A. M. Pronina, P. Simeone, L. Puybasset, G. Auzias, O. Coulon, B. Lesimple, G. Torkomian, A. Bartkowska-Sniatkowska, O. Szerkus, D. Siluk, J. Bartkowiak-Wieczorek, J. Rosada-Kurasinska, J. Warzybok, R. Kaliszan, C. Hernandez Caballero, S. Roberts, G. Isgro, D. Hall, G. Guillaume, O. Passouant, F. Dumas, W. Bougouin, B. Champigneulle, M. Arnaout, J. Chelly, J. D. Chiche, O. Varenne, J. P. Mira, E. Marijon, A. Cariou, M. Beerepoot, H. R. Touw, K. Parlevliet, C. Boer, P. W. Elbers, Á. J. Roldán Reina, Y. Corcia Palomo, R. Martín Bermúdez, L. Martín Villén, I. Palacios García, J. R. Naranjo Izurieta, J. B. Pérez Bernal, F. J. Jiménez Jiménez, Cardiac Arrest Group HUVR, F. Cota-Delgado, T. Kaneko, H. Tanaka, M. Kamikawa, R. Karashima, S. Iwashita, H. Irie, S. Kasaoka, O. Arola, R. Laitio, A. Saraste, J. Airaksinen, M. Pietilä, M. Hynninen, J. Wennervirta, M. Bäcklund, E. Ylikoski, P. Silvasti, E. Nukarinen, J. Grönlund, V. P. Harjola, J. Niiranen, K. Korpi, M. Varpula, R. O. Roine, T. Laitio, for the Xe-HYPOTHECA study group, S. Salah, B. G. Hassen, A. Mohamed Fehmi, Y. C. Hsu, J. Barea-Mendoza, C. García-Fuentes, M. Castillo-Jaramillo, H. Dominguez-Aguado, R. Viejo-Moreno, L. Terceros-Almanza, S. Bermejo Aznárez, C. Mudarra-Reche, W. Xu, M. Chico-Fernández, J. C. Montejo-González, K. Crewdson, M. Thomas, M. Merghani, L. Fenner, P. Morgan, D. Lockey, E. J. van Lieshout, B. Oomen, J. M. Binnekade, R. J. de Haan, N. P. Juffermans, M. B. Vroom, R. Algarte, L. Martínez, B. Sánchez, I. Romero, F. Martínez, S. Quintana, J. Trenado, O. Sheikh, D. Pogson, R. Clinton, F. Riccio, A. Arthur, L. Young, A. Sinclair, D. Markopoulou, K. Venetsanou, L. Filippou, E. Salla, S. Stratouli, I. Alamanos, A. H. Guirgis, R. Gutiérrez Rodriguez, M. J. Furones Lorente, I. Macias Guarasa, A. Ukere, S. Meisner, G. Greiwe, B. Opitz, D. Benten, B. Nashan, L. Fischer, C. J. C. Trepte, C. R. Behem, B. Ana, A. Vazir, D. Gibson, M. R. Hadavi, M. Riahi alam, M. R. Sasani, N. Parenti, F. Agrusta, C. Palazzi, B. Pifferi, R. Sganzerla, F. Tagliazucchi, A. Luciani, M. Möller, J. Müller-Engelmann, G. Montag, P. Adams, C. Lange, J. Neuzner, R. Gradaus, K. H. Wodack, F. Thürk, A. D. Waldmann, M. F. Grässler, S. Nishimoto, S. H. Böhm, E. Kaniusas, C. J. Trepte, M. Wallin, F. Suarez Sipman, A. Oldner, L. Colinas, R. Vicho, M. Serna, R. Cuena, A. Canabal, ECOCRITIC group, M. Etman, M. El Bahr, A. El Sakka, A. Arali, O. Bond, P. De Santis, E. Iesu, F. Franchi, S. Scolletta, F. S. Taccone, Z. Marutyan, L. Hamidova, A. Shakotko, V. Movsisyan, I. Uysupova, A. Evdokimov, S. Petrikov, F. J. Redondo Calvo, N. Bejarano, V. Baladron, R. Villazala, J. Redondo, D. Padilla, P. Villarejo, C. Gomez-Gonzalez, S. Mas-Font, A. Puppo-Moreno, M. Herrera-Gutierrez, M. Garcia-Garcia, S. Aldunate-Calvo, NEFROCON Investigators, E. P. Plata-Menchaca, X. L. Pérez-Fernández, M. Estruch, A. Betbese-Roig, P. Cárdenas Campos, M. Rojas Lora, N. D. Toapanta Gaibor, R. S. Contreras Medina, V. D. Gumucio Sanguino, E. J. Casanova, J. Sabater Riera, SIRAKI group, K. Kritmetapak, S. Peerapornratana, P. Kittiskulnam, T. Dissayabutra, P. Susantithapong, K. Praditpornsilpa, K. Tungsanga, S. Eiam-Ong, T. Winkelmann, T. Busch, J. Meixensberger, S. Bercker, E. M. Flores Cabeza, M. Sánchez Sánchez, N. Cáceres Giménez, C. Gutierrez Melón, E. Herrero de Lucas, P. Millán Estañ, M. Hernández Bernal, A. Garcia de Lorenzo y Mateos, P. A. C. Specht, M. Balik, M. Zakharchenko, F. Los, H. Brodska, C. de Tymowski, P. Augustin, M. Desmard, P. Montravers, S. N. Stapel, R. de Boer, H. M. Oudemans, A. Hollinger, T. Schweingruber, F. Jockers, M. Dickenmann, M. Siegemund, Clinical Intensive Care Research Basel, N. Runciman, L. Alban, C. Turrini, T. Sasso, T. Langer, P. Taccone, C. Marenghi, G. Grasselli, P. Wibart, T. Reginault, M. Garcia, B. Barbrel, A. Benard, C. Bader, F. Vargas, H. N. Bui, G. Hilbert, J. M. Serrano Simón, P. Carmona Sánchez, F. Ruiz Ferrón, M. García de Acilu, J. Marin, V. Antonia, L. Ruano, M. Monica, G. Hong, D. H. Kim, Y. S. Kim, J. S. Park, Y. K. Jee, Z. Yu xiang, W. Jia-xing, W. Xiao dan, N. Wen long, W. Yu, Z. Yan, X. Cheng, T. Kobayashi, Y. Onodera, R. Akimoto, A. Sugiura, H. Suzuki, M. Iwabuchi, M. Nakane, K. Kawamae, P. Carmona Sanchez, M. D. Bautista Rodriguez, M. Rodriguez Delgado, V. Martínez de Pinillos Sánchez, A. Mula Gómez, P. Beuret, C. Fortes, M. Lauer, M. Reboul, J. C. Chakarian, X. Fabre, B. Philippon-Jouve, S. Devillez, M. Clerc, N. Rittayamai, M. Sklar, M. Dres, M. Rauseo, C. Campbell, B. West, D. E. Tullis, M. Okada, N. Ahmad, M. Wood, A. Glossop, J. Higuera Lucas, A. Blandino Ortiz, D. Cabestrero Alonso, R. De Pablo Sánchez, L. Rey González, R. Costa, G. Spinazzola, A. Pizza, G. Ferrone, M. Rossi, G. Conti, H. Ribeiro, J. Alves, M. Sousa, P. Reis, C. S. Socolovsky, R. P. Cauley, J. E. Frankel, A. L. Beam, K. O. Olaniran, F. K. Gibbons, K. B. Christopher, J. Pennington, P. Zolfaghari, H. S. King, H. H. Y. Kong, H. P. Shum, W. W. Yan, C. Kaymak, N. Okumus, A. Sari, B. Erdogdu, S. Aksun, H. Basar, A. Ozcan, N. Ozcan, D. Oztuna, J. A. Malmgren, S. Lundin, K. Torén, M. Eckerström, A. Wallin, A. C. Waldenström, for the Section on Ethics of the ESICM, F. C. Riccio, A. C. P. Antonio, A. F. Leivas, F. Kenji, E. James, S. Jonnada, C. S. Gerrard, N. Jones, J. D. Salciccioli, D. C. Marshall, M. Komorowski, A. Hartley, M. C. Sykes, R. Goodson, J. Shalhoub, J. R. Fernández Villanueva, R. Fernández Garda, A. M. López Lago, E. Rodríguez Ruiz, R. Hernández Vaquero, C. Galbán Rodríguez, E. Varo Pérez, C. Hilasque, I. Oliva, G. Sirgo, M. C. Martin, M. Olona, M. C. Gilavert, M. Bodí, C. Ebm, G. Aggarwal, S. Huddart, N. Quiney, S. M. Fernandes, J. Santos Silva, J. Gouveia, D. Silva, R. Marques, H. Bento, A. Alvarez, Z. Costa Silva, D. Díaz Diaz, M. Villanova Martínez, E. Palencia Herrejon, A. Martinez de la Gandara, G. Gonzalo, M. A. Lopez, P. Ruíz de Gopegui Miguelena, C. I. Bernal Matilla, P. Sánchez Chueca, M. D. C. Rodríguez Longares, R. Ramos Abril, A. L. Ruíz Aguilar, R. Garrido López de Murillas, R. Fernández Fernández, P. Morales Laborías, M. A. Díaz Castellanos, M. E. Morales Laborías, J. Park, S. Woo, T. West, E. Powell, A. Rimmer, C. Orford, J. Williams, P. Ruiz de Gopegui Miguelena, R. S. Bourne, R. Shulman, M. Tomlin, G. H. Mills, M. Borthwick, W. Berry, D. García Huertas, F. Manzano, F. Villagrán-Ramírez, A. Ruiz-Perea, C. Rodríguez-Mejías, F. Santiago-Ruiz, M. Colmenero-Ruiz, C. König, B. Matt, A. Kortgen, C. S. Hartog, A. Wong, C. Balan, G. Barker, S. Tachaboon, J. Paratz, G. Kayambu, R. Boots, R. Vlasenko, E. Gromova, S. Loginov, M. Kiselevskiy, Y. Dolgikova, K. B. Tang, C. M. Chau, K. N. Lam, E. Gil, G. Y. Suh, C. M. Park, C. R. Chung, C. H. Lai, Y. J. Cheng, V. Colella, N. Zarrillo, M. D’Amico, F. Forfori, B. Pezza, T. Laddomada, V. Beltramelli, M. L. Pizzaballa, A. Doronzio, B. Balicco, D. Kiers, W. van der Heijden, J. Gerretsen, Q. de Mast, S. el Messaoudi, G. Rongen, M. Gomes, N. P. Riksen, Y. Kashiwagi, K. Hayashi, Y. Inagaki, S. Fujita, A. Blet, M. Sadoune, J. Lemarié, N. Bihry, R. Bern, E. Polidano, R. Merval, J. M. Launay, B. Lévy, J. L. Samuel, J. Hartmann, S. Harm, and V. Weber
Subjects: LUNG SAFE investigators and the ESICM study group, medicine.medical_specialty, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], KARISMA, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], 030204 cardiovascular system & hematology, ARIAM Group, Critical Care and Intensive Care Medicine, Meeting Abstracts, Vascular occlusion, GRAVITY-VAP TRIAL NETWORK, 03 medical and health sciences, 0302 clinical medicine, H1N1 SEMICYUC/GETGAG working group, Xe-HYPOTHECA study group, Clinical Intensive Care Research Basel, Healthy volunteers, Journal Article, United States Critical Illness and Injury Trials Group/LIPS-B investigators, Medicine, ARIAM-CARDIAC SURGERY PROJECT AUTHORS, GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries), RAPIT group, FINNAKI Study Group, Cardiac Arrest Group HUVR, business.industry, Mid-Norway Sepsis Research Center, NEFROCON Investigators, lcsh:Medical emergencies. Critical care. Intensive care. First aid, SIRAKI group, Vascular damage Radboud Institute for Molecular Life Sciences [Radboudumc 16], 030208 emergency & critical care medicine, lcsh:RC86-88.9, SICM NICER Group, LUNG SAFE Investigators and the ESICM Trials Group, ARIAM-SEMICYUC Registry Investigators, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], CAPCRI Study, Apelin Group, Section on Ethics of the ESICM, Anesthesia, EXODUS-investigators, Infrared thermal imaging, Radiology, medicine.symptom, Korean Chungcheong Critical Care Research Group, ECOCRITIC group, business, P-INFECT
Abstract: Contains fulltext : 172380.pdf (Publisher’s version ) (Open Access)
Published: 2016
Full Text: View/download PDF

46. Two years later

Author: Stephen E. Lapinsky and Charlotte Frise
Subjects: medicine.medical_specialty, Editorial, business.industry, General surgery, MEDLINE, Obstetrics and Gynecology, Medicine, business
Published: 2020
Full Text: View/download PDF

47. Core outcome set for research on critically ill obstetric patients (COSCO): Patient interviews

Author: Jose Rojas-Suarez, Rohan D'Souza, Clara Juando-Prats, Julia Kfouri, Stephen E. Lapinsky, and Julien Viau-Lapointe
Subjects: Pregnancy, medicine.medical_specialty, business.industry, Critically ill, Patient interviews, media_common.quotation_subject, Obstetrics and Gynecology, medicine.disease, Intensive care unit, law.invention, Feeling, law, Family medicine, Health care, Critical illness, medicine, Thematic analysis, business, media_common
Abstract: Objectives Critical illness during pregnancy is fortunately rare. The conduct of high-quality research in this area requires standardized outcomes important to all involved stakeholders. We therefore performed interviews with women who were critically ill during pregnancy to identify patient-important outcomes for the development of the core outcome set for research on critically ill obstetric patients (COSCO). Methods Women were identified by reviewing previous intensive care unit (ICU) admissions in the participating centers in Toronto, Canada and Cartagena, Colombia. Individual interviews using a predefined script were led by local researchers to identify outcomes important to the interviewees. Discussions were recorded, transcribed and translated into English, where necessary. The transcripts underwent inductive thematic analysis by a qualitative analyst to delineate themes and patient-important outcomes. These outcomes were coded into domains using a recently published taxonomy. Results Twelve women were interviewed. Main themes included the intensive care unit experience, communication of the diagnosis, independence, relationship with healthcare workers and patient privacy. Many women experienced a negative experience with feelings of fear, pain and separation from their newborn. Physical independence and role functioning as a mother during and after their ICU stay were highly important. These themes were coded into four outcome domains : physiological (pain), pregnancy-related (mother-newborn separation), life impact (physical functioning, role functioning, fear, isolation) and delivery of care (communication, satisfaction, privacy). Conclusions We identified patient-important outcomes which should be part of further prospective research on maternal critical illness. The results of these interviews are an essential step towards development of COSCO.
Published: 2020
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48. Development and internal validation of the multivariable CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) clinical risk prediction model

Author: Wessel Ganzevoort, Vivian Zhou, K.S. Joseph, Keith R. Walley, Cynthia Chazotte, Euan M. Wallace, Rahat Qureshi, Sarka Liskonova, Jennifer A. Hutcheon, Fionnuala M. McAuliffe, Jeffrey N Bone, Tim M. Crozier, Paul J. Yong, Daniela N. Vasquez, Zulfiqar A Bhutta, Tao Duan, Peter von Dadelszen, U. Vivian Ukah, Helen M. Ryan, Oktay Demirkiran, Isam Lataifeh, P. Gareth R. Seaward, Türkan Toğal, Marlot Kallen, Laura A. Magee, Anne Cornélie J.M. De Pont, Colm O'Herlihy, J. Mark Ansermino, J. Guilherme Cecatti, Emily Michaela Hamel, Michael Geary, Ramzy Tadros, Ben W.J. Mol, Stephen E. Lapinsky, Alice B R Aarvold, Beth A. Payne, Jing Li, Mary Bowen, and Dena Goffman
Subjects: Maternal mortality, Adult, medicine.medical_specialty, Pregnancy, High-Risk, Critical Care and Intensive Care Medicine, Logistic regression, Risk Assessment, law.invention, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, law, Pregnancy, Risk Factors, medicine, Humans, Glasgow Coma Scale, 030212 general & internal medicine, Retrospective Studies, 030219 obstetrics & reproductive medicine, Receiver operating characteristic, business.industry, Research, Sodium, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Age Factors, Bilirubin, lcsh:RC86-88.9, medicine.disease, Prognosis, Intensive care unit, Confidence interval, 3. Good health, Critical care, Intensive Care Units, Logistic Models, ROC Curve, High-risk pregnancy, Area Under Curve, Creatinine, Cohort, Emergency medicine, Maternal death, Observational study, Female, business, Risk prediction model, Maternal morbidity
Abstract: Background Intensive care unit (ICU) outcome prediction models, such as Acute Physiology And Chronic Health Evaluation (APACHE), were designed in general critical care populations and their use in obstetric populations is contentious. The aim of the CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) study was to develop and internally validate a multivariable prognostic model calibrated specifically for pregnant or recently delivered women admitted for critical care. Methods A retrospective observational cohort was created for this study from 13 tertiary facilities across five high-income and six low- or middle-income countries. Women admitted to an ICU for more than 24 h during pregnancy or less than 6 weeks post-partum from 2000 to 2012 were included in the cohort. A composite primary outcome was defined as maternal death or need for organ support for more than 7 days or acute life-saving intervention. Model development involved selection of candidate predictor variables based on prior evidence of effect, availability across study sites, and use of LASSO (Least Absolute Shrinkage and Selection Operator) model building after multiple imputation using chained equations to address missing data for variable selection. The final model was estimated using multivariable logistic regression. Internal validation was completed using bootstrapping to correct for optimism in model performance measures of discrimination and calibration. Results Overall, 127 out of 769 (16.5%) women experienced an adverse outcome. Predictors included in the final CIPHER model were maternal age, surgery in the preceding 24 h, systolic blood pressure, Glasgow Coma Scale score, serum sodium, serum potassium, activated partial thromboplastin time, arterial blood gas (ABG) pH, serum creatinine, and serum bilirubin. After internal validation, the model maintained excellent discrimination (area under the curve of the receiver operating characteristic (AUROC) 0.82, 95% confidence interval (CI) 0.81 to 0.84) and good calibration (slope of 0.92, 95% CI 0.91 to 0.92 and intercept of −0.11, 95% CI −0.13 to −0.08). Conclusions The CIPHER model has the potential to be a pragmatic risk prediction tool. CIPHER can identify critically ill pregnant women at highest risk for adverse outcomes, inform counseling of patients about risk, and facilitate bench-marking of outcomes between centers by adjusting for baseline risk. Electronic supplementary material The online version of this article (10.1186/s13054-018-2215-6) contains supplementary material, which is available to authorized users.
Published: 2018

49. Deresuscitation of Patients With Iatrogenic Fluid Overload Is Associated With Reduced Mortality in Critical Illness

Author: Thomas J Trinder, Jonathan A Silversides, Emma Fitzgerald, Uma Manickavasagam, Daniel F. McAuley, Noel Hemmings, Andrew Ferguson, Rosane Nisenbaum, Christopher Nutt, David Pogson, Stephen E. Lapinsky, John Marshall, and Eddy Fan
Subjects: Adult, Male, medicine.medical_specialty, Fluid administration, Canada, medicine.medical_treatment, Critical Illness, Resuscitation, MEDLINE, Water-Electrolyte Imbalance, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Positive fluid balance, medicine, Humans, 030212 general & internal medicine, Renal replacement therapy, Intensive care medicine, Diuretics, Balance (ability), Aged, Retrospective Studies, business.industry, 030208 emergency & critical care medicine, Retrospective cohort study, Middle Aged, Respiration, Artificial, United Kingdom, Intensive Care Units, Current practice, Critical illness, Fluid Therapy, Female, business
Abstract: To characterize current practice in fluid administration and deresuscitation (removal of fluid using diuretics or renal replacement therapy), the relationship between fluid balance, deresuscitative measures, and outcomes and to identify risk factors for positive fluid balance in critical illness.Retrospective cohort study.Ten ICUs in the United Kingdom and Canada.Adults receiving invasive mechanical ventilation for a minimum of 24 hours.None.Four-hundred patients were included. Positive cumulative fluid balance (fluid input greater than output) occurred in 87.3%: the largest contributions to fluid input were from medications and maintenance fluids rather than resuscitative IV fluids. In a multivariate logistic regression model, fluid balance on day 3 was an independent risk factor for 30-day mortality (odds ratio 1.26/L [95% CI, 1.07-1.46]), whereas negative fluid balance achieved in the context of deresuscitative measures was associated with lower mortality. Independent predictors of greater fluid balance included treatment in a Canadian site.Fluid balance is a practice-dependent and potentially modifiable risk factor for adverse outcomes in critical illness. Negative fluid balance achieved with deresuscitation on day 3 of ICU stay is associated with improved patient outcomes. Minimization of day 3 fluid balance by limiting maintenance fluid intake and drug diluents, and using deresuscitative measures, represents a potentially beneficial therapeutic strategy which merits investigation in randomized trials.
Published: 2018

50. An international meta-analysis confirms the association of BNC2 with adolescent idiopathic scoliosis

Author: Shohei Minami, Teppei Suzuki, Nobuyuki Fujita, Amy L. McIntosh, Haruhisa Yanagida, Ikuyo Kou, Nan Wu, Kotaro Nishida, John A. Herring, Koki Uno, Katsuki Kono, Hiroshi Taneichi, Tsuyoshi Sakuma, Shiro Ikegawa, Hang Zhou, Gang Liu, Hideki Sudo, Lori A. Karol, Ikuho Yonezawa, J. Channing Tassone, Anas M. Khanshour, Yong Qiu, John G. Birch, Guixing Qiu, Randall T. Loder, Takashi Kaito, You-Qiang Song, Taichi Tsuji, Richard Shindell, Kota Watanabe, Leilei Xu, Brandon A. Ramo, X. C. Liu, Takahiro Iida, Carol Wise, Craig P. Eberson, Charles E. Johnston, Elisabet Einarsdottir, William Schrader, Hideki Shigematsu, Benjamin S Richards, Juha Kere, Kenichiro Kakutani, Daniel J. Sucato, Naobumi Hosogane, Henry J. Iwinski, Anna Grauers, Eijiro Okada, Kazuhiro Chiba, Ryan D. Muchow, Peiqiang Su, Vishwas R. Talwakar, Yuki Taniguchi, Paul Gerdhem, Yanhui Fan, Anthony Lapinsky, Zhihong Wu, Yoji Ogura, Toshiaki Kotani, Todd A. Milbrandt, Masaya Nakamura, Yohei Takahashi, Katsumi Harimaya, Taifeng Zhou, Tsutomu Akazawa, Manabu Ito, Noriaki Kawakami, Karl E. Rathjen, Dongsheng Huang, Joseph Davey, Mitsuru Yagi, Morio Matsumoto, Kazuki Takeda, Satoru Demura, Kei Watanabe, Päivi Marjaana Saavalainen / Principal Investigator, Research Programs Unit, Medicum, Department of Medical and Clinical Genetics, University of Helsinki, Research Programme for Molecular Neurology, and Juha Kere / Principal Investigator
Subjects: 0301 basic medicine, medicine.medical_specialty, Adolescent, Genotype, lcsh:Medicine, SNP, Idiopathic scoliosis, Genome-wide association study, Locus (genetics), Scoliosis, SUSCEPTIBILITY, VARIANTS, GENOTYPE IMPUTATION, Polymorphism, Single Nucleotide, Article, 03 medical and health sciences, Asian People, Internal medicine, HISTORY, medicine, Humans, Genetic Predisposition to Disease, GENOME-WIDE ASSOCIATION, lcsh:Science, Multidisciplinary, business.industry, lcsh:R, International Agencies, medicine.disease, LBX1, GENE, 3. Good health, DNA-Binding Proteins, 030104 developmental biology, Meta-analysis, Cohort, lcsh:Q, 3111 Biomedicine, business, Genome-Wide Association Study
Abstract: Adolescent idiopathic scoliosis (AIS) is a common spinal deformity with the prevalence of approximately 3%. We previously conducted a genome-wide association study (GWAS) using a Japanese cohort and identified a novel locus on chromosome 9p22.2. However, a replication study using multi-population cohorts has not been conducted. To confirm the association of 9p22.2 locus with AIS in multi-ethnic populations, we conducted international meta-analysis using eight cohorts. In total, we analyzed 8,756 cases and 27,822 controls. The analysis showed a convincing evidence of association between rs3904778 and AIS. Seven out of eight cohorts had significant P value, and remaining one cohort also had the same trend as the seven. The combined P was 3.28 × 10−18 (odds ratio = 1.19, 95% confidence interval = 1.14–1.24). In silico analyses suggested that BNC2 is the AIS susceptibility gene in this locus.
Published: 2018
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