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101. Immune dysfunction prior to Staphylococcus aureus bacteremia is a determinant of long-term mortality

Author

Jesse B. Hall, Michael Z. David, John P. Kress, and Jared A. Greenberg

Subjects
Bacterial Diseases, Male, Critical Care and Emergency Medicine, lcsh:Medicine, Bacteremia, medicine.disease_cause, 0302 clinical medicine, Risk Factors, Epidemiology, 030212 general & internal medicine, lcsh:Science, 0303 health sciences, Multidisciplinary, Mortality rate, Statistics, Middle Aged, Staphylococcal Infections, 3. Good health, Infectious Diseases, Immune System Diseases, Staphylococcus aureus, Medicine, Female, Research Article, Adult, medicine.medical_specialty, Clinical Research Design, Staphylococcal infections, Sepsis, 03 medical and health sciences, Internal medicine, Confidence Intervals, medicine, Humans, Statistical Methods, Retrospective Studies, Aged, Proportional Hazards Models, 030306 microbiology, Proportional hazards model, business.industry, lcsh:R, Bloodstream Infections, Retrospective cohort study, medicine.disease, Immunology, Clinical Immunology, lcsh:Q, business, Mathematics
Abstract

Purpose The clinical implications for patients who survive serious infections are not well understood. It has been hypothesized that the excess mortality for survivors of sepsis observed in epidemiological studies is due to increased vulnerability to subsequent infections. We undertook this study to identify characteristics of patients who are at high risk for death after surviving a common type of blood-stream infection. Materials and Methods At a single academic medical center, 237 patients with Staphylococcus aureus bacteremia admitted during a three-year period were retrospectively identified. The primary outcomes were 30-day and 31 to 90-day mortality after the first positive blood culture. The primary predictor variable of interest was clinical immune dysfunction prior to bacteremia. Results The 30-day mortality was not significantly different for patients with and without prior immune dysfunction. However, during days 31 to 90, 11 patients (20%) with prior immune dysfunction compared to 10 patients (8.6%) without prior immune dysfunction died (OR 2.59, 95% CI 1.03–6.53, p = 0.04). In a Cox-proportional hazard model controlling for age, there was a significant association between prior immune dysfunction and greater 31 to 90 day mortality (HR 2.44, 95% CI 1.01–5.90, p = 0.05) and a non-significant trend towards occurrence of subsequent infections and greater 31 to 90 day mortality (HR 2.12, 95% CI 0.89–5.07, p = 0.09). Conclusions Patients with prior immune dysfunction are at high risk for death 31 to 90 days, but not

Published
2014

102. Cost Considerations in Sedation, Analgesia, and Neuromuscular Blockade in the Intensive Care Unit

Author

Jesse B. Hall and John P. Kress

Subjects
Pulmonary and Respiratory Medicine, Mechanical ventilation, medicine.medical_specialty, Neuromuscular Blockade, business.industry, medicine.drug_class, Sedation, medicine.medical_treatment, Critical Care and Intensive Care Medicine, medicine.disease, Neuromuscular Blocking Agents, Intensive care unit, law.invention, Sepsis, law, Sedative, medicine, Dosing, medicine.symptom, Intensive care medicine, business
Abstract

Sedation of critically ill patients is a costly endeavor. Costs of commonly used intensive care unit (ICU) sedatives range from pennies to more than $500 per day. Although the agents account for some of this expense, complications related to the use of these drugs in the ICU produce even greater costs. Prolongation of mechanical ventilation and length of stay are some of the common complications resulting from non-ideal use of these drugs. Sedative agents also impair neurological evaluation in many critically ill patients, which may mask detection of acute delirium resulting from intercurrent illness or intracranial catastrophes and can lead to excessive diagnostic testing. Opiates may result in gastrointestinal dysfunction with resulting malnutrition and perhaps bacterial translocation and sepsis. Neuromuscular blocking agents may cause prolonged paralysis and disability in critically ill patients who receive them. Simple dosing strategies based on pharmacological principles may decrease the incidence of these costly problems.

Published
2001

103. Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation

Author

Michael O'Connor, Anne S. Pohlman, John P. Kress, and Jesse B. Hall

Subjects
Adult, Male, medicine.drug_class, Critical Illness, Midazolam, medicine.medical_treatment, Richmond Agitation-Sedation Scale, Drug Administration Schedule, law.invention, Randomized controlled trial, law, medicine, Humans, Hypnotics and Sedatives, Propofol, Aged, Mechanical ventilation, Morphine, Adult patients, Critically ill, business.industry, General Medicine, Length of Stay, Middle Aged, Respiration, Artificial, Intensive care unit, Analgesics, Opioid, Clinical trial, Intensive Care Units, Sedative, Anesthesia, Female, business
Abstract

Conous infusions of sedative drugs in the intensive care unit may prolong the duration of mechanical ventilation, prolong the length of stay in the intensive care unit and the hospital, impede efforts to perform daily neurologic examinations, and increase the need for tests to assess alterations in mental status. Whether regular interruption of such infusions might accelerate recovery is not known.We conducted a randomized, controlled trial involving 128 adult patients who were receiving mechanical ventilation and continuous infusions of sedative drugs in a medical intensive care unit. In the intervention group, the sedative infusions were interrupted until the patients were awake, on a daily basis; in the control group, the infusions were interrupted only at the discretion of the clinicians in the intensive care unit.The median duration of mechanical ventilation was 4.9 days in the intervention group, as compared with 7.3 days in the control group (P=0.004), and the median length of stay in the intensive care unit was 6.4 days as compared with 9.9 days, respectively (P=0.02). Six of the patients in the intervention group (9 percent) underwent diagnostic testing to assess changes in mental status, as compared with 16 of the patients in the control group (27 percent, P=0.02). Complications (e.g., removal of the endotracheal tube by the patient) occurred in three of the patients in the intervention group (4 percent) and four of the patients in the control group (7 percent, P=0.88).In patients who are receiving mechanical ventilation, daily interruption of sedative-drug infusions decreases the duration of mechanical ventilation and the length of stay in the intensive care unit.

Published
2000

104. Determination of Hemoglobin Saturation in Patients With Acute Sickle Chest Syndrome

Author

Anne S. Pohlman, John P. Kress, and Jesse B. Hall

Subjects
Pulmonary and Respiratory Medicine, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Exchange transfusion, Oxygen–haemoglobin dissociation curve, Critical Care and Intensive Care Medicine, medicine.disease, Sickle cell anemia, Confidence interval, Hypoxemia, Pulse oximetry, Hemoglobin A, Anesthesia, medicine, Arterial blood, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

Study objectives To evaluate three different methods of measuring oxygen saturation in patients suffering from acute sickle chest syndrome. Design A prospective, descriptive study of 9 months’ duration. Setting A tertiary care university hospital. Patients Adult patients with acute sickle chest syndrome scheduled to undergo RBC exchange transfusion. Interventions None. Measurements Baseline hemoglobin oxygen saturation was determined simultaneously by (1) calculation based on Pa o 2 and an oxyhemoglobin dissociation curve algorithm, (2) co-oximetry, and (3) pulse oximetry. These same measures were repeated after exchange transfusion. Baseline and postexchange hemoglobin electrophoresis was performed in all patients. Results Baseline calculated saturation overestimated true saturation (determined by co-oximetry) with a baseline mean bias (co-oximetry minus calculated saturation) of −6.78 ± 2.63% (95% confidence interval for bias: −8.37% to −5.19%). Pulse oximetry was not different than co-oximetry at baseline with a baseline bias of+ 1.86 ± 3.25% (95% confidence interval: −0.1% to 3.82%). After exchange transfusion, there was no bias between either co-oximetry and calculated saturation (mean difference: −0.17 ± 1.31% [95% confidence interval: −0.95% to 0.61%]), or co-oximetry and pulse oximetry (mean difference: +0.3 ± 1.53% [95% confidence interval:− 0.62% to 1.22%]). Conclusions Calculated saturation overestimates true saturation during acute sickle chest syndrome. This discrepancy abates after exchange transfusion. Pulse oximetry more closely follows co-oximetry than does calculated saturation during acute sickle chest syndrome.

Published
1999

105. Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report

Author

Jesse B. Hall, Nicolas Molinari, Audrey De Jong, Anne S. Pohlman, Samir Jaber, John P. Kress, Gerald Chanques, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), University of Chicago, Statistiques, Taibi, Nadia, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, medicine.medical_specialty, Psychometrics, Critical Care, Critical Illness, Sedation, Critical Care and Intensive Care Medicine, 03 medical and health sciences, 0302 clinical medicine, Cronbach's alpha, Pain assessment, medicine, Hypnotics and Sedatives, Humans, 030212 general & internal medicine, Self report, ComputingMilieux_MISCELLANEOUS, Aged, Pain Measurement, Observer Variation, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Critically ill, business.industry, Research, Communication Barriers, Delirium, Reproducibility of Results, 030208 emergency & critical care medicine, Pain scale, Middle Aged, Respiration, Artificial, 3. Good health, Intensive Care Units, Emergency medicine, Commentary, Female, medicine.symptom, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Introduction Pain assessment is associated with important outcomes in ICU patients but remains challenging, particularly in non-communicative patients. Use of a reliable tool is paramount to allow any implementation of sedation/analgesia protocols in a multidisciplinary team. This study compared psychometric properties (inter-rater agreement primarily; validity, responsiveness and feasibility secondarily) of three pain scales: Behavioural Pain Scale (BPS/BPS-NI, that is BPS for Non-Intubated patients), Critical Care Pain Observation Tool (CPOT) and Non-verbal Pain Scale (NVPS), the pain tool routinely used in this 16-bed medical ICU. Methods Pain was assessed by at least one of four investigators and one of the 20 bedside nurses before, during and 10 minutes after routine care procedures in non-comatose patients (Richmond Agitation Sedation Scale ≥ -3) who were unable to self-report their pain intensity. The Confusion Assessment Method for the ICU was used to assess delirium. Non-parametric tests were used for statistical analysis. Quantitative data are presented as median (25th to 75th). Results A total of 258 paired assessments of pain were performed in 30 patients (43% lightly sedated, 57% with delirium, 63% mechanically ventilated). All three scales demonstrated good psychometric properties. However, BPS and CPOT exhibited the best inter-rater reliability (weighted-κ 0.81 for BPS and CPOT) and the best internal consistency (Cronbach-α 0.80 for BPS, 0.81 for CPOT), which were higher than for NVPS (weighted-κ 0.71, P

Published
2013

106. Old wine in new bottles: should we publish old data?

Author

Matthieu Resche-Rigon, Daniel Talmor, and John P. Kress

Subjects
Wine, Male, medicine.medical_specialty, Noninvasive Ventilation, Ventilators, Mechanical, business.industry, Pain medicine, Humidity, Critical Care and Intensive Care Medicine, Family medicine, Anesthesiology, Medicine, Humans, Female, business, Intubation, Respiratory Insufficiency
Published
2013

107. Early physical and occupational therapy

Author

John P. Kress

Subjects
Occupational therapy, Suspended animation, medicine.medical_specialty, business.industry, Endotracheal intubation, Pain management, Intensive care, Critical illness, medicine, Functional independence, Delirium, medicine.symptom, Intensive care medicine, business
Published
2013

108. Benzodiazepine versus nonbenzodiazepine-based sedation for mechanically ventilated, critically ill adults: a systematic review and meta-analysis of randomized trials

Author

Juliana Barr, Joseph F. Dasta, Waleed Alhazzani, Gilles L. Fraser, Craig P. Worby, Frederick A Spencer, John W. Devlin, Judy E. Davidson, and John P. Kress

Subjects
Adult, medicine.drug_class, Sedation, Critical Illness, Nonbenzodiazepine, Critical Care and Intensive Care Medicine, law.invention, Benzodiazepines, Randomized controlled trial, law, medicine, Humans, Hypnotics and Sedatives, Hospital Mortality, Dexmedetomidine, Randomized Controlled Trials as Topic, Benzodiazepine, business.industry, Delirium, Length of Stay, Respiration, Artificial, Regimen, Intensive Care Units, Meta-analysis, Anesthesia, medicine.symptom, business, Propofol, medicine.drug
Abstract

Use of dexmedetomidine or propofol rather than a benzodiazepine sedation strategy may improve ICU outcomes. We reviewed randomized trials comparing a benzodiazepine and nonbenzodiazepine regimen in mechanically ventilated adult ICU patients to determine if differences exist between these sedation strategies with respect to ICU length of stay, time on the ventilator, delirium prevalence, and short-term mortality.We searched CINAHL, MEDLINE, the Cochrane databases, and the American College of Critical Care Medicine's Pain, Agitation, Delirium Management Guidelines' literature database from 1996 to 2013. Citations were screened for randomized trials that enrolled critically ill, mechanically ventilated adults comparing an IV benzodiazepine-based to a nonbenzodiazepine-based sedative regimen and reported duration of ICU length of stay, duration of mechanical ventilation, delirium prevalence, and/or short-term mortality. Trial characteristics and results were abstracted in duplicate and independently, and the Cochrane risk of bias tool was used for quality assessment. We performed random effects model meta-analyses where possible.We included six trials enrolling 1,235 patients: midazolam versus dexmedetomidine (n = 3), lorazepam versus dexmedetomidine (n = 1), midazolam versus propofol (n = 1), and lorazepam versus propofol (n = 1). Compared to a benzodiazepine sedative strategy, a nonbenzodiazepine sedative strategy was associated with a shorter ICU length of stay (n = 6 studies; difference = 1.62 d; 95% CI, 0.68-2.55; I = 0%; p = 0.0007) and duration of mechanical ventilation (n = 4 studies; difference = 1.9 d; 95% CI, 1.70-2.09; I2 = 0%; p0.00001) but a similar prevalence of delirium (n = 2; risk ratio = 0.83; 95% CI, 0.61-1.11; I2 = 84%; p = 0.19) and short-term mortality rate (n = 4; risk ratio = 0.98; 95% CI, 0.76-1.27; I2 = 30%; p = 0.88).Current controlled data suggest that use of a dexmedetomidine- or propofol-based sedation regimen rather than a benzodiazepine-based sedation regimen in critically ill adults may reduce ICU length of stay and duration of mechanical ventilation. Larger controlled studies are needed to further define the impact of nonbenzodiazepine sedative regimens on delirium and short-term mortality.

Published
2013

109. Impact of ventilator adjustment and sedation-analgesia practices on severe asynchrony in patients ventilated in assist-control mode

Author

Samir Jaber, Gerald Chanques, John P. Kress, Anne S. Pohlman, Shruti B. Patel, Jason T. Poston, and Jesse B. Hall

Subjects
Adult, Male, medicine.medical_specialty, Respiratory rate, Sedation, Ventilator-Induced Lung Injury, Lung injury, Critical Care and Intensive Care Medicine, Severity of Illness Index, law.invention, Respiratory Rate, law, Outcome Assessment, Health Care, medicine, Humans, Practice Patterns, Physicians', Intensive care medicine, Interactive Ventilatory Support, Tidal volume, Aged, Pulmonary gas pressures, business.industry, respiratory system, Middle Aged, Asynchrony (computer programming), Respiratory Function Tests, Intensive Care Units, Anesthesia, Ventilation (architecture), Regression Analysis, Female, medicine.symptom, Analgesia, Deep Sedation, business
Abstract

Breath-stacking asynchrony during assist-control-mode ventilation may be associated with increased tidal volume and alveolar pressure that could contribute to ventilator-induced lung injury. Methods to reduce breath stacking have not been well studied. The objective of this investigation was to evaluate 1) which interventions were used by managing clinicians to address severe breath stacking; and 2) how effective these measures were.Sixteen-bed medical ICU.Physiological study in consecutively admitted patients without severe brain injury, who had severe breath stacking defined as an asynchrony index greater than or equal to 10% of total breaths. During 30 minutes before (baseline) and after any intervention employed by the managing clinician, the ventilator flow, airway pressure, and volume/time waveforms were continuously recorded and analyzed to detect normal and stacked breaths. The initial approach taken was assigned to one of three categories: no intervention, increase of sedation-analgesia, or change of ventilator setting. Nonparametric Wilcoxon-Mann-Whitney tests and multiple regression were used for statistical analysis. Quantitative data are presented as median [25-75].Sixty-six of 254 (26%) mechanically ventilated patients exhibited severe breath-stacking asynchrony. A total of 100 30-minute sequences were recorded and analyzed in 30 patients before and after 50 clinical decisions for ongoing management (no intervention, n=8; increasing sedation/analgesia, n=16; ventilator adjustment, n=26). Breath-stacking asynchrony index was 44 [27-87]% at baseline. Compared with baseline, the decrease of asynchrony index was greater after changing the ventilator setting (-99 [-92, -100]%) than after increasing the sedation-analgesia (-41 [-66, 7]%, p0.001) or deciding to tolerate the asynchrony (4 [-4, 12]%, p0.001). Pressure-support ventilation and increased inspiratory time were independently associated with the reduction of asynchrony index.Compared with increasing sedation-analgesia, adapting the ventilator to patient breathing effort reduces breath-stacking asynchrony significantly and often dramatically. These results support an algorithm beginning with ventilator adjustment to rationalize the management of severe breath-stacking asynchrony in ICU patients.

Published
2013

110. A comparison of initial monotherapy with norepinephrine versus vasopressin for resuscitation in septic shock

Author

Heath R. Jennings, John P. Kress, Jesse B. Hall, Mitchell J. Daley, Ishaq Lat, and Katherine D. Mieure

Subjects
Adult, Male, Resuscitation, Vasopressin, Mean arterial pressure, Surviving Sepsis Campaign, Vasopressins, Norepinephrine (medication), 03 medical and health sciences, Norepinephrine, 0302 clinical medicine, medicine, Humans, Vasoconstrictor Agents, Pharmacology (medical), Arterial Pressure, Aged, Retrospective Studies, business.industry, Septic shock, 030208 emergency & critical care medicine, Retrospective cohort study, Middle Aged, medicine.disease, Shock, Septic, 030228 respiratory system, Anesthesia, Shock (circulatory), Female, medicine.symptom, business, medicine.drug
Abstract

BACKGROUND Early goal-directed therapy is a time-sensitive therapeutic algorithm with a tiered approach to target hypoperfusion and cardiovascular collapse within the first 6 hours of septic shock. The Surviving Sepsis Campaign guidelines recommend norepinephrine or dopamine as the initial vasoactive agent for resuscitation in septic shock, reserving the administration of vasopressin as adjunctive therapy. OBJECTIVE To determine whether vasopressin was noninferior to norepinephrine as the initial vasopressor to achieve a mean arterial pressure (MAP) goal in the first 6 hours of shock onset. METHODS This retrospective cohort study evaluated adults who received monotherapy with either norepinephrine or vasopressin as initial vasoactive therapy for the management of septic shock. Patients were excluded if the treatment arm was not monotherapy, if they were admitted to a cardiology or cardiothoracic surgery service, or if they lacked a comparator-based 1:1 frequency matching. RESULTS A total of 130 patients were included, 65 in each treatment arm. The proportion of patients who achieved a goal MAP in the vasopressin group was 63% (95% CI 51%–75%) and was 67.7% (95% CI 56%–79%) in the norepinephrine group. This observed difference between goal MAP attainment did not exceed the predefined noninferiority margin of −25% (CI for 4.7% difference −21.2% to 12%), suggesting noninferiority of vasopressin. No significant difference was identified between vasopressin and norepinephrine for final mean (SD) MAP achieved (75 [9.6] and 76.0 [8.2] mm Hg, respectively; p = 0.06) or the mean total change from baseline MAP to goal (14.1 [8.4] and 15.1 [9.1] mm Hg, respectively; p = 0.6). CONCLUSIONS Vasopressin was noninferior to norepinephrine for the achievement of a MAP goal in the first 6 hours from onset of septic shock. Further prospective analysis is warranted; however, the results are useful for consideration of alternative vasopressors in the setting of drug shortages.

Published
2013

111. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit

Author

Daniel Herr, John P. Kress, Avery Tung, Céline Gélinas, Bryce R.H. Robinson, Juliana Barr, E. Wesley Ely, Dorrie K. Fontaine, Roman Jaeschke, Brenda T. Pun, Kathleen Puntillo, John W. Devlin, Judy E. Davidson, Richard R. Riker, Gilles L. Fraser, Joseph F. Dasta, Yoanna Skrobik, Aaron M. Joffe, Curtis N. Sessler, Douglas B. Coursin, and Michael A. E. Ramsay

Subjects
Adult, medicine.medical_specialty, Sedation, Critical Illness, Alternative medicine, MEDLINE, Richmond Agitation-Sedation Scale, Critical Care and Intensive Care Medicine, Risk Assessment, law.invention, Clinical Protocols, law, Intensive care, medicine, Humans, Hypnotics and Sedatives, Pain Management, Intensive care medicine, Psychomotor Agitation, Pain Measurement, business.industry, Delirium, Evidence-based medicine, Intensive care unit, United States, Intensive Care Units, medicine.symptom, business
Abstract

To revise the "Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult" published in Critical Care Medicine in 2002.The American College of Critical Care Medicine assembled a 20-person, multidisciplinary, multi-institutional task force with expertise in guideline development, pain, agitation and sedation, delirium management, and associated outcomes in adult critically ill patients. The task force, divided into four subcommittees, collaborated over 6 yr in person, via teleconferences, and via electronic communication. Subcommittees were responsible for developing relevant clinical questions, using the Grading of Recommendations Assessment, Development and Evaluation method (http://www.gradeworkinggroup.org) to review, evaluate, and summarize the literature, and to develop clinical statements (descriptive) and recommendations (actionable). With the help of a professional librarian and Refworks database software, they developed a Web-based electronic database of over 19,000 references extracted from eight clinical search engines, related to pain and analgesia, agitation and sedation, delirium, and related clinical outcomes in adult ICU patients. The group also used psychometric analyses to evaluate and compare pain, agitation/sedation, and delirium assessment tools. All task force members were allowed to review the literature supporting each statement and recommendation and provided feedback to the subcommittees. Group consensus was achieved for all statements and recommendations using the nominal group technique and the modified Delphi method, with anonymous voting by all task force members using E-Survey (http://www.esurvey.com). All voting was completed in December 2010. Relevant studies published after this date and prior to publication of these guidelines were referenced in the text. The quality of evidence for each statement and recommendation was ranked as high (A), moderate (B), or low/very low (C). The strength of recommendations was ranked as strong (1) or weak (2), and either in favor of (+) or against (-) an intervention. A strong recommendation (either for or against) indicated that the intervention's desirable effects either clearly outweighed its undesirable effects (risks, burdens, and costs) or it did not. For all strong recommendations, the phrase "We recommend …" is used throughout. A weak recommendation, either for or against an intervention, indicated that the trade-off between desirable and undesirable effects was less clear. For all weak recommendations, the phrase "We suggest …" is used throughout. In the absence of sufficient evidence, or when group consensus could not be achieved, no recommendation (0) was made. Consensus based on expert opinion was not used as a substitute for a lack of evidence. A consistent method for addressing potential conflict of interest was followed if task force members were coauthors of related research. The development of this guideline was independent of any industry funding.These guidelines provide a roadmap for developing integrated, evidence-based, and patient-centered protocols for preventing and treating pain, agitation, and delirium in critically ill patients.

Published
2012

112. Weaning patients from the ventilator

Author

John P. Kress and John F. McConville

Subjects
Mechanical ventilation, medicine.medical_specialty, Time Factors, Critically ill, business.industry, medicine.medical_treatment, Psychological intervention, General Medicine, Positive-Pressure Respiration, Respiratory failure, medicine, Weaning, Humans, Duration (project management), Intensive care medicine, business, Respiratory Insufficiency, Ventilator Weaning, Algorithms
Abstract

After the underlying cause of respiratory failure in critically ill patients has been addressed, the priority is to minimize the duration of mechanical ventilation. This review outlines strategies and interventions to reduce this duration.

Published
2012

113. Effect of Noninvasive Ventilation Delivered by Helmet vs Face Mask on the Rate of Endotracheal Intubation in Patients With Acute Respiratory Distress Syndrome

Author

Jesse B. Hall, Bhakti K. Patel, John P. Kress, K. S. Wolfe, and Anne S. Pohlman

Subjects
Male, ARDS, Time Factors, medicine.medical_treatment, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Skin Ulcer, Intubation, Intratracheal, Humans, Medicine, Intubation, Adverse effect, Aged, Mechanical ventilation, Respiratory Distress Syndrome, Noninvasive Ventilation, business.industry, Masks, 030208 emergency & critical care medicine, General Medicine, Length of Stay, Middle Aged, Skin ulcer, medicine.disease, Intensive care unit, Intensive Care Units, 030228 respiratory system, Anesthesia, Early Termination of Clinical Trials, Female, Head Protective Devices, Noninvasive ventilation, medicine.symptom, business
Abstract

Noninvasive ventilation (NIV) with a face mask is relatively ineffective at preventing endotracheal intubation in patients with acute respiratory distress syndrome (ARDS). Delivery of NIV with a helmet may be a superior strategy for these patients.To determine whether NIV delivered by helmet improves intubation rate among patients with ARDS.Single-center randomized clinical trial of 83 patients with ARDS requiring NIV delivered by face mask for at least 8 hours while in the medical intensive care unit at the University of Chicago between October 3, 2012, through September 21, 2015.Patients were randomly assigned to continue face mask NIV or switch to a helmet for NIV support for a planned enrollment of 206 patients (103 patients per group). The helmet is a transparent hood that covers the entire head of the patient and has a rubber collar neck seal. Early trial termination resulted in 44 patients randomized to the helmet group and 39 to the face mask group.The primary outcome was the proportion of patients who required endotracheal intubation. Secondary outcomes included 28-day invasive ventilator-free days (ie, days alive without mechanical ventilation), duration of ICU and hospital length of stay, and hospital and 90-day mortality.Eighty-three patients (45% women; median age, 59 years; median Acute Physiology and Chronic Health Evaluation [APACHE] II score, 26) were included in the analysis after the trial was stopped early based on predefined criteria for efficacy. The intubation rate was 61.5% (n = 24) for the face mask group and 18.2% (n = 8) for the helmet group (absolute difference, -43.3%; 95% CI, -62.4% to -24.3%; P .001). The number of ventilator-free days was significantly higher in the helmet group (28 vs 12.5, P .001). At 90 days, 15 patients (34.1%) in the helmet group died compared with 22 patients (56.4%) in the face mask group (absolute difference, -22.3%; 95% CI, -43.3 to -1.4; P = .02). Adverse events included 3 interface-related skin ulcers for each group (ie, 7.6% in the face mask group had nose ulcers and 6.8% in the helmet group had neck ulcers).Among patients with ARDS, treatment with helmet NIV resulted in a significant reduction of intubation rates. There was also a statistically significant reduction in 90-day mortality with helmet NIV. Multicenter studies are needed to replicate these findings.clinicaltrials.gov Identifier: NCT01680783.

Published
2016

114. Sedation and mobility: changing the paradigm

Author

John P, Kress

Subjects
Immobilization, Intensive Care Units, Muscle Weakness, Occupational Therapy, Critical Illness, Activities of Daily Living, Humans, Hypnotics and Sedatives, Deep Sedation, Respiratory Insufficiency, Respiration, Artificial, Early Ambulation, Physical Therapy Modalities
Abstract

A large fraction of intensive care unit (ICU) patients with respiratory failure who survive their critical illness leave the hospital with substantial neuromuscular weakness. In light of this reality, a shift in the approach to critical care management has begun. This viewpoint has broadened the perspective of ICU care providers beyond the narrow goal of leaving the ICU alive to a broader notion focused on minimizing the complications that accompany the inherent noxious nature of ICU care. Mobilization of mechanically ventilated patients is feasible, safe, and carries the potential for tremendous benefit for our patients.

Published
2012

115. Medical and economic implications of physical disability of survivorship

Author

John P. Kress and Margaret S. Herridge

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Critical Illness Myopathy, Physical disability, Critical Care, medicine.medical_treatment, Critical Illness, Psychological intervention, Critical Care and Intensive Care Medicine, Quality of life (healthcare), Cost of Illness, medicine, Humans, Disabled Persons, Survivors, Intensive care medicine, Family Health, Rehabilitation, Family caregivers, business.industry, Caregiver burden, Long-Term Care, Respiration, Artificial, Quality of Life, Medical model of disability, business
Abstract

Interventions developed in the last decade have led to impressive rates of survival from extreme critical illness. However, surviving an episode of critical illness is just the beginning. Discharge from the intensive care unit (ICU) is often the start of a long and challenging rehabilitation, mood disorders, cognitive impairment, financial hardship, and caregiver burden, burnout, and psychological distress. It has become increasingly apparent that the majority of patients who survive an episode of critical illness will have some degree of compromised physical function secondary to ICU Acquired Weakness (ICUAW) and a constellation of other physical disabilities. The spectrum of muscle, nerve, and brain dysfunction may be permanent and can significantly change the disposition for those who were previously independent. Furthermore, it may impose a substantial health care cost burden and compromise the reserve of even the most resilient family members. Important limitations in the current literature relate to our poor understanding of how to risk stratify, how to systematically educate and inform our patients and family caregivers about physical morbidity and complex patient care in the community, and how to develop, test, and implement rehabilitation programs tailored to individual need.

Published
2012

119. Ability To Obtain Echocardiographic Views In ICU Patients With Shock

Author

Gerald Chanques, Jesse B. Hall, Jason T. Poston, John P. Kress, Anne S. Pohlman, and Shruti B. Patel

Subjects
Icu patients, medicine.medical_specialty, business.industry, Shock (circulatory), Internal medicine, Cardiology, Medicine, medicine.symptom, business
Published
2012

120. MASCC Index

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

121. Musculoskeletal Trauma, Dislocation

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

122. Muscle Atrophy

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

123. Methicillin-Resistant Staphylococcus aureus (MRSA)

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

124. Mass-Casualty Event (MCE)

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

125. Musculoskeletal Trauma, Pelvic Ring Disruption

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

126. Medical Management of Brain Death

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

128. Multiple Organ Dysfunction

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

129. Mannitol in the Critically Ill Patient with Acute Kidney Injury

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

130. Minimally Invasive Hemodynamic Monitoring System

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

131. Motor Vehicle Collision

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

132. MRSA Prevention

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

133. Malnutrition

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

134. Myocarditis and Acute Cardiomyopathies

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

135. Malta Fever

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

136. Musculoskeletal Trauma, Damage Control, and Pelvic Binder

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

137. Myocardial Concussion

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

138. Myasthenia Gravis

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

139. Myocarditis in Children

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

140. Musculoskeletal Trauma, Preperitonal Pelvic Packing

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

141. Meat-Cutter’s Disease

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

142. Mangled Extremity

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

143. Multidrug-Resistant Tuberculosis (MDR TB)

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

144. Muscle Necrosis

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

145. Mycobacterium tuberculosis: Tuberculosis, TB

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

146. Multiple Organ Dysfunction Syndrome

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

147. Multiple Dosed Activated Charcoal (MDAC)

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

148. Multiple Organ Failure (MOF)

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

149. Metabolic Concerns in Acute Renal Failure

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

150. Massive Transfusion

Author

Denis D. Bensard, Philip F. Stahel, Jorge Cerdá, Babak Sarani, Sajid Shahul, Daniel Talmor, Peter M. Hammer, C. William Schwab, Steven Reynolds, Omar Ahmad, Tsuyoshi Kaneko, Anthony L. Estrera, William A. Knight, Bradley P. Dixon, Richard L. Gamelli, Joseph A. Posluszny, Mansoor N. Bangash, Rupert M. Pearse, Albert J. Ruggieri, Richard J. Levy, Clifford S. Deutschman, Prasanna Simha Mohan Rao, John P. Kress, Sabino Scolletta, Norman E. McSwain, Jeffry L. Kashuk, Angela Sauaia, Ernest E. Moore, Per-Olof J. Hasselgren, Wade R. Smith, John T. Riehl, Berton R. Moed, B. Kirke Bieneman, Clay C. Cothren, Nima Majlesi, Richard D. Shih, Eelco F. M. Wijdicks, Melissa Nyendak, Tarek Eid, Payam Nahid, Kevin Winthrop, David Lewinsohn, Julie P. Chou, Tom Lim, Andrew G. Lee, Christopher H. Mody, Nathan T. Mowery, Alexander L. Colonna, J. Wayne Meredith, Alain Combes, Jonathan R. Egan, Marino S. Festa, A. Montcriol, Y. Asencio, and F. Kerbaul

Published
2012

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