Search

Your search keyword '"Alten, Jeffrey A."' showing total 437 results
Start Over Author "Alten, Jeffrey A."
437 results on '"Alten, Jeffrey A."'

54. sj-docx-1-pch-10.1177_21501351211073615 - Supplemental material for Modifying the Renal Angina Index for Predicting AKI and Related Adverse Outcomes in Pediatric Heart Surgery

Author

Gist, Katja M, SooHoo, Megan, Mack, Emily, Ricci, Zaccaria, Kwiatkowski, David M, Cooper, David S, Krawczeski, Catherine D, Alten, Jeffrey A, Goldstein, Stuart L, and Basu, Rajit K

Subjects
FOS: Clinical medicine, education, Cardiology, 110323 Surgery, 111403 Paediatrics, humanities
Abstract

Supplemental material, sj-docx-1-pch-10.1177_21501351211073615 for Modifying the Renal Angina Index for Predicting AKI and Related Adverse Outcomes in Pediatric Heart Surgery by Katja M Gist, Megan SooHoo, Emily Mack, Zaccaria Ricci, David M Kwiatkowski, David S Cooper, Catherine D Krawczeski, Jeffrey A Alten and Stuart L Goldstein, Rajit K Basu in World Journal for Pediatric and Congenital Heart Surgery

Published
2022
Full Text
View/download PDF

56. Implementation of a 24-hour infection diagnosis protocol in the pediatric cardiac intensive care unit (CICU)

Author

Chitalia, Reema A., Benscoter, Alexis L., Chlebowski, Meghan M., Hart, Kelsey J, Iliopoulos, Ilias, Misfeldt, Andrew M., Sawyer, Jaclyn E., and Alten, Jeffrey A.

Abstract

AbstractObjectives:To reduce unnecessary antibiotic exposure in a pediatric cardiac intensive care unit (CICU).Design:Single-center, quality improvement initiative. Monthly antibiotic utilization rates were compared between 12-month baseline and 18-month intervention periods.Setting:A 25-bed pediatric CICU.Patients:Clinically stable patients undergoing infection diagnosis were included. Patients with immunodeficiency, mechanical circulatory support, open sternum, and recent culture-positive infection were excluded.Interventions:The key drivers for improvement were standardizing the infection diagnosis process, order-set creation, limitation of initial antibiotic prescription to 24 hours, discouraging indiscriminate vancomycin use, and improving bedside communication and situational awareness regarding the infection diagnosis protocol.Results:In total, 109 patients received the protocol; antibiotics were discontinued in 24 hours in 72 cases (66%). The most common reasons for continuing antibiotics beyond 24 hours were positive culture (n = 13) and provider preference (n = 13). A statistical process control analysis showed only a trend in monthly mean antibiotic utilization rate in the intervention period compared to the baseline period: 32.6% (SD, 6.1%) antibiotic utilization rate during the intervention period versus 36.6% (SD, 5.4%) during the baseline period (mean difference, 4%; 95% CI, −0.5% to −8.5%; P= .07). However, a special-cause variation represented a 26% reduction in mean monthly vancomycin use during the intervention period. In the patients who had antibiotics discontinued at 24 hours, delayed culture positivity was rare.Conclusions:Implementation of a protocol limiting empiric antibiotic courses to 24 hours in clinically stable, standard-risk, pediatric CICU patients with negative cultures is feasible. This practice appears safe and may reduce harm by decreasing unnecessary antibiotic exposure.

Published
2023
Full Text
View/download PDF

59. Successful continuous renal replacement therapy using two single-lumen catheters in neonates and infants with cardiac disease

Author

Masri, Kamal El, Jackson, Kimberly, Borasino, Santiago, Law, Mark, Askenazi, David, and Alten, Jeffrey

Subjects
Children -- Diseases, Kidneys -- Transplantation, Medical research, Medicine, Experimental, Acute renal failure -- Case studies, Acute renal failure in children -- Case studies, Health
Abstract

Background Acute kidney injury (AKI) frequently occurs in neonates and infants after cardiopulmonary bypass (CPB) and may require renal replacement therapy (RRT). Peritoneal dialysis (PD) is the RRT modality of choice in neonates with AKI after CPB, but continuous renal replacement therapy (CRRT) may be necessary if PD is ineffective or contraindicated. Vascular access is challenging in this population, in part, due to small central vein size that may preclude placement. The risk of malfunction or morbidity associated with standard dialysis catheters may be excessive in neonates with congenital heart disease. We describe a unique approach to vascular access for CRRT in six small patients with AKI. Case-Diagnosis/Treatment This is a retrospective review of six patients with fluid overload and AKI that received CRRT because PD was contraindicated. In all cases, CRRT was performed via two hemostasis valve sheaths placed into separate veins for dialysis access and return. The low-resistance sheaths provided excellent blood flow with normalization of metabolic derangements and significant fluid removal (median negative 167 ml/kg at 72 h). Mean circuit life before the first change was 55.2 [+ or -] 30.4 h. Conclusions The use of two small single-lumen catheters in separate veins enables consistent and effective hemodiafiltration in neonates and infants with challenging vascular access., Introduction Acute kidney injury (AKI) may occur in 42 % of neonates and infants after cardiopulmonary bypass and is strongly associated with increased morbidity and mortality [1]. While many pediatric [...]

Published
2013
Full Text
View/download PDF

64. Preventing Cardiac Arrest in the Pediatric Cardiac Intensive Care Unit Through Multicenter Collaboration.

Author

Alten, Jeffrey, Cooper, David S., Klugman, Darren, Raymond, Tia Tortoriello, Wooton, Sharyl, Garza, Janie, Clarke-Myers, Katherine, Anderson, Jeffrey, Pasquali, Sara K., Absi, Mohammed, Affolter, Jeremy T., Bailly, David K., Bertrandt, Rebecca A., Borasino, Santiago, Dewan, Maya, Domnina, Yuliya, Lane, John, McCammond, Amy N., Mueller, Dana M., and Olive, Mary K.

Published
2022
Full Text
View/download PDF

67. Epidemiology of Acute Kidney Injury After Neonatal Cardiac Surgery: A Report From the Multicenter Neonatal and Pediatric Heart and Renal Outcomes Network

Author

Alten, Jeffrey A., primary, Cooper, David S., additional, Blinder, Joshua J., additional, Selewski, David T., additional, Tabbutt, Sarah, additional, Sasaki, Jun, additional, Gaies, Michael G., additional, Bertrandt, Rebecca A., additional, Smith, Andrew H., additional, Reichle, Garrett, additional, Gist, Katja M., additional, Banerjee, Mousumi, additional, Zhang, Wenying, additional, Hock, Kristal M., additional, and Borasino, Santiago, additional

Published
2021
Full Text
View/download PDF

70. Pediatric off-label use of recombinant factor VIIa

Author

Alten, Jeffrey A., Benner, Kim, Green, Kelsey, Toole, Benjamin, Tofil, Nancy M., and Winkler, Margaret K.

Subjects
Blood coagulation factors -- Usage, Blood coagulation factors -- Health aspects, Hemorrhage -- Care and treatment, Hemorrhage -- Prevention, Hemorrhage -- Prognosis, Mortality -- Alabama, Mortality -- Control, Children -- Diseases, Children -- Care and treatment, Children -- Patient outcomes
Published
2009

72. Acute kidney injury after in-hospital cardiac arrest

Author

Mah, Kenneth E., primary, Alten, Jeffrey A., additional, Cornell, Timothy T., additional, Selewski, David T., additional, Askenazi, David, additional, Fitzgerald, Julie C., additional, Topjian, Alexis, additional, Page, Kent, additional, Holubkov, Richard, additional, Slomine, Beth S., additional, Christensen, James R., additional, Dean, J. Michael, additional, and Moler, Frank W., additional

Published
2021
Full Text
View/download PDF

77. Long-Term Kidney Function After the Fontan Operation

Author

Zafar, Faizeen, primary, Lubert, Adam M., additional, Katz, David A., additional, Hill, Garick D., additional, Opotowsky, Alexander R., additional, Alten, Jeffrey A., additional, Goldstein, Stuart L., additional, and Alsaied, Tarek, additional

Published
2020
Full Text
View/download PDF

78. 1220: IMPROVING NURSE EMPOWERMENT DURING CARDIAC ARREST PREVENTION HUDDLES IS RELATED TO DECREASED ARREST

Author

Murphy, Lee, primary, Florez, Amy, additional, Mah, Kenneth, additional, Munoz, JoAnne, additional, Donnellan, Amy, additional, Rose, Samuel, additional, LaMantia, Susan, additional, Brown, James, additional, Reedy, Brianne, additional, Schubert, Amanda, additional, Sanchez, Marcela, additional, Baumer, Corrie, additional, Baumer, Anna, additional, and Alten, Jeffrey, additional

Published
2020
Full Text
View/download PDF

82. Systemic thrombolysis with recombinant tissue plasminogen activator for acute life-threatening Blalock-Taussig shunt obstruction

Author

Diaz, Franco, Sasser, William, Law, Mark, and Alten, Jeffrey

Subjects
Tissue plasminogen activator -- Health aspects, Thrombosis -- Health aspects -- Diagnosis -- Care and treatment -- Research -- Case studies, Health
Abstract

Byline: Franco. Diaz, William. Sasser, Mark. Law, Jeffrey. Alten Modified Blalock-Taussig shunt (mBTS) obstruction can be life-threatening, especially when it represents the only source of pulmonary blood flow. Current therapeutic [...]

Published
2016

83. Variation in Adjusted Mortality for Medical Admissions to Pediatric Cardiac Intensive Care Units

Author

Gaies, Michael, Ghanayem, Nancy S., Alten, Jeffrey A., Costello, John M., Lasa, Javier J., Chanani, Nikhil K., Shin, Andrew Y., Retzloff, Lauren, Zhang, Wenying, Pasquali, Sara K., Banerjee, Mousumi, and Tabbutt, Sarah

Subjects
Article
Abstract

OBJECTIVE: Pediatric cardiac intensive care units (CICU) should be adept at treating both critical medical and surgical conditions for patients with cardiac disease. There are no case mix adjusted quality metrics specific to medical CICU admissions. We aimed to measure case mix adjusted CICU medical mortality rates and assess variation across CICUs in the Pediatric Cardiac Critical Care Consortium (PC4). DESIGN: Observational analysis SETTING: PC4 clinical registry PATIENTS: All CICU admissions that did not include cardiac surgery. INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: The primary endpoint was CICU mortality. Based on multivariable logistic regression accounting for clustering, we created a case mix adjusted model using variables present at CICU admission. Bootstrap resampling (1000 samples) was used for model validation. We calculated a standardized mortality ratio (SMR) for each CICU based on observed-to-expected mortality from the fitted model. A CICU was considered a statistically significant outlier if the 95% confidence interval around the SMR did not cross 1. Of 11,042 consecutive medical admissions from 25 CICUs (8/2014–5/2017) the observed mortality rate was 4.3% (N=479). Final model covariates included age, underweight, prior surgery, time of and reason for CICU admission, high-risk medical diagnosis or comorbidity, mechanical ventilation or ECMO at admission, and pupillary reflex. The c-statistic for the validated model was 0.87 and it was well calibrated. Expected mortality ranged from 2.6–8.3%, reflecting important case mix variation. SMRs ranged from 0.5–1.7 across CICUs. Three CICUs were outliers; two had lower-than-expected (SMR 1) mortality. CONCLUSIONS: We measured case mix adjusted mortality for CICU patients with critical medical conditions, and provide the first report of variation in this quality metric within this patient population across PC4 CICUs. This metric will be used by PC4 CICUs to assess and improve outcomes by identifying high-performing (low-mortality) centers through collaborative learning.

Published
2019

85. The association of early post-resuscitation hypotension with discharge survival following targeted temperature management for pediatric in-hospital cardiac arrest

Author

Topjian, Alexis A., primary, Telford, Russell, additional, Holubkov, Richard, additional, Nadkarni, Vinay M., additional, Berg, Robert A., additional, Dean, J. Michael, additional, Moler, Frank W., additional, Meert, Kathleen L., additional, Hutchinson, Jamie S., additional, Newth, Christopher J.L., additional, Bennett, Kimberly S., additional, Berger, John T., additional, Topjian, Alexis A., additional, Pineda, Jose A., additional, Koch, Joshua D., additional, Schleien, Charles L., additional, Dalton, Heidi J., additional, Ofori-Amanfo, George, additional, Goodman, Denise M., additional, Fink, Ericka L., additional, McQuillen, Patrick, additional, Zimmerman, Jerry J., additional, Thomas, Neal J., additional, van der Jagt, Elise W., additional, Porter, Melissa B., additional, Meyer, Michael T., additional, Harrison, Rick, additional, Pham, Nga, additional, Schwarz, Adam J., additional, Nowak, Jeffrey E., additional, Alten, Jeffrey, additional, Wheeler, Derek S., additional, Bhalala, Utpal S., additional, Lidsky, Karen, additional, Lloyd, Eric, additional, Mathur, Mudit, additional, Shah, Samir, additional, Theodore, Wu, additional, Theodorou, Andreas A., additional, Sanders, Ronald C., additional, Silverstein, Faye S., additional, Christensen, James R., additional, Slomine, Beth S., additional, Pemberton, Victoria L., additional, Browning, Brittan, additional, and Michael Dean, J., additional

Published
2019
Full Text
View/download PDF

88. Neonatal and Paediatric Heart and Renal Outcomes Network: design of a multi-centre retrospective cohort study

Author

Gist, Katja M., primary, Blinder, Joshua J., additional, Bailly, David, additional, Borasino, Santiago, additional, Askenazi, David J., additional, Cooper, David S., additional, Krawczeski, Catherine D., additional, Gaies, Michael, additional, Morales, David L. S., additional, Hock, Kristal M., additional, and Alten, Jeffrey, additional

Published
2019
Full Text
View/download PDF

90. A Novel Model Demonstrates Variation in Risk-Adjusted Mortality Across Pediatric Cardiac ICUs After Surgery*

Author

Tabbutt, Sarah, primary, Schuette, Jennifer, additional, Zhang, Wenying, additional, Alten, Jeffrey, additional, Donohue, Janet, additional, Gaynor, J. William, additional, Ghanayem, Nancy, additional, Jacobs, Jeffrey, additional, Pasquali, Sara K., additional, Thiagarajan, Ravi, additional, Dimick, Justin B., additional, Banerjee, Mousumi, additional, Cooper, David, additional, and Gaies, Michael, additional

Published
2019
Full Text
View/download PDF

95. Acute Kidney Injury Biomarkers Predict an Increase in Serum Milrinone Concentration Earlier Than Serum Creatinine–Defined Acute Kidney Injury in Infants After Cardiac Surgery

Author

Gist, Katja M., primary, Cooper, David S., additional, Wrona, Julia, additional, Faubel, Sarah, additional, Altmann, Christopher, additional, Gao, Zhiqian, additional, Marino, Bradley S., additional, Alten, Jeffrey, additional, Hock, Kristal M., additional, Mizuno, Tomoyuki, additional, Vinks, Alexander A., additional, Joy, Melanie S., additional, Wempe, Michael F., additional, Bennett, Michael R., additional, and Goldstein, Stuart L., additional

Published
2018
Full Text
View/download PDF

96. MEASURING PEDIATRIC CARDIAC INTENSIVE CARE UNIT QUALITY IN MEDICAL ADMISSIONS

Author

Gaies, Michael, primary, Ghanayem, Nancy, additional, Alten, Jeffrey, additional, Costello, John, additional, Lasa, Javier, additional, Chanani, Nikhil, additional, Shin, Andrew, additional, Retzloff, Lauren, additional, Zhang, Wenying, additional, Pasquali, Sara, additional, Banerjee, Mousumi, additional, and Tabbutt, Sarah, additional

Published
2018
Full Text
View/download PDF

99. Clinical epidemiology and centre variation in chylothorax rates after cardiac surgery in children: a report from the Pediatric Cardiac Critical Care Consortium

Author

Buckley, Jason R., primary, Graham, Eric M., additional, Gaies, Michael, additional, Alten, Jeffrey A., additional, Cooper, David S., additional, Costello, John M., additional, Domnina, Yuliya, additional, Klugman, Darren, additional, Pasquali, Sara K., additional, Donohue, Janet E., additional, Zhang, Wenying, additional, and Scheurer, Mark A., additional

Published
2017
Full Text
View/download PDF

100. Peritoneal Dialysis: An Alternative Modality of Fluid Removal in Neonates Requiring Extracorporeal Membrane Oxygenation after Cardiac Surgery

Author

Sasser, William C., Robert, Stephen M., Askenazi, David J., O’Meara, L. Carlisle, Borasino, Santiago, and Alten, Jeffrey A.

Subjects
Male, Postoperative Care, Infant, Newborn, Water-Electrolyte Imbalance, Case Reports, Combined Modality Therapy, Infant, Newborn, Diseases, surgical procedures, operative, Extracorporeal Membrane Oxygenation, Treatment Outcome, Intensive Care, Neonatal, Humans, Female, Cardiac Surgical Procedures, Peritoneal Dialysis, Retrospective Studies
Abstract

Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy for patients with cardiopulmonary failure after cardiac surgery. Fluid overload (FO) is associated with increased morbidity and mortality in this population. We present our experience using peritoneal dialysis (PD) as an adjunct for fluid removal in eight consecutive neonates requiring ECMO after cardiac surgery between 2010 and 2012. PD was added to FO management when fluid removal goals were not being met by hemofiltration (HF) or hemodialysis (HD). Percent FO was 36% at ECMO initiation; 88% (seven of eight) achieved negative fluid balance before discontinuation of ECMO. PD removed median 119 mL/kg/day (interquartile range [IQR], 70-166) compared with median 132 mL/kg/day (IQR, 47-231) removed by HF/HD. PD and HF/HD fluid removal were performed concurrently 38% of the time. Unlike HF/HD, PD was never stopped secondary to hemodynamic compromise. Median duration of ECMO was 155 hours (IQR, 118-215). Six of eight patients were successfully decannulated. These results suggest PD safely and effectively removes fluid in neonates on ECMO after cardiac surgery. PD may increase total fluid removal potential when combined with other modalities.

Published
2014

Catalog

Books, media, physical & digital resources
See catalog results