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1. Identification and Assessment of Strategies to Address Gender Inequity in the Specialty of Critical Care Medicine: A Scoping Review, Modified Consensus Process, and Stakeholder Meeting

Author

Jeanna Parsons Leigh, PhD, Chloe de Grood, MSc, Rebecca Brundin-Mather, MASc, Alexandra Dodds, MPH, Emily A. FitzGerald, MSc, Laryssa Kemp, MSc, Sara J. Mizen, MA, Liam Whalen-Browne, MBT, Henry T. Stelfox, MD, PhD, Kirsten M. Fiest, PhD, on behalf of the Canadian Critical Care Gender Equity Forum Panel, Jeanna Parsons Leigh, Sofia Ahmed, Rebecca Aslakson, Kali Barrett, Jill Ola Barter, Rosaleen Baruah, Marie-Claude Battista, Karen J. Bosma, Karen E. A. Burns, Laurent Jean Brochard, Han-Oh Chung, Deborah Cook, Andréanne Côté, Joanna C. Dionne, John Drover, Ghislaine Douflé, James Downar, Shelley Duggan, Robert Fowler, Allan Garland, Elaine Gilfoyle, Gillian Hawker, Margaret Herridge, Kimia Honarmand, Tim Karachi, Joann Kawchuk, Rachel G. Khadaroo, Abigail Lara, Sangeeta Mehta, Tina Mele, Kusum Menon, Srinivas Murthy, David Neilipovitz, Kendiss Olafson, Tony O’Leary, Bojan Paunovic, Clare Ramsey, Alison Fox-Robichaud, Francesca Rubulotta, Khara Sauro, Damon Scales, Sharon Straus, Jennifer Tsang, Hannah Wunsch, Samara Zavalkoff, Janice Zimmerman, Kirsten Fiest, and, and Henry Thomas Stelfox

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

OBJECTIVES:. We sought to identify and prioritize improvement strategies that Critical Care Medicine (CCM) programs could use to inform and advance gender equity among physicians in CCM. DESIGN:. This study involved three sequential phases: 1) scoping review that identified strategies to improve gender equity in all medical specialties; 2) modified consensus process with 48 CCM stakeholders to rate and rank identified strategies; and 3) in-person stakeholder meeting to refine strategies and discuss facilitators and barriers to their implementation. SETTING:. CCM. SUBJECTS:. CCM stakeholders (physicians, researchers, and decision-makers; mutually inclusive). INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. We identified 190 unique strategies from 416 articles. Strategies were grouped thematically into 20 categories across four overarching pillars of equity: access, participation, reimbursement, and culture. Participants prioritized 22 improvement strategies for implementation in CCM. The top-rated strategy from each pillar included: 1) nominate gender diverse candidates for faculty positions and prestigious opportunities (equitable access); 2) mandate training in unconscious bias and equitable treatment for committee (e.g., hiring, promotion) members (equitable participation); 3) ensure equitable starting salaries regardless of sex or gender (equitable reimbursement); and, 4) conduct 360° evaluations of leaders (including their direct work circle of supervisors, peers, and subordinates) through a diversity lens (equitable culture). Interprofessional collaboration, leadership, and local champions were identified as key enablers for implementation. CONCLUSIONS:. We identified stakeholder-prioritized strategies that can be used to inform and enhance gender equity among physicians in CCM under four overarching equity pillars: access, participation, reimbursement, and culture. Implementation approaches should include education, policy creation, and measurement, and reporting.

Published
2022
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2. High-flow nasal cannula compared with continuous positive airway pressure: a bench and physiological study

Author

Fernando Vieira, Frank Silva Bezerra, Remi Coudroy, Annia Schreiber, Irene Telias, Sebastián Dubo, Giulia Cavalot, Sergio Martins Pereira, Thomas Piraino, and Laurent Jean Brochard

Subjects
Physiology, Physiology (medical)
Abstract

High-flow nasal cannula (HFNC) is extensively used for acute respiratory failure. However, questions remain regarding its physiological effects. We explored 1) whether HFNC produced similar effects to continuous positive airway pressure (CPAP); 2) possible explanations of respiratory rate changes; 3) the effects of mouth opening. Two studies were conducted: a bench study using a manikin's head with lungs connected to a breathing simulator while delivering HFNC flow rates from 0 to 60L/min; a physiological cross-over study in 10 healthy volunteers receiving HFNC (20 to 60L/min) with the mouth open or closed and CPAP 4cmH

Published
2022

3. Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study

Author

Tài, Pham, Ary, Serpa Neto, Paolo, Pelosi, John Gerard, Laffey, Candelaria, De Haro, Jose Angel, Lorente, Giacomo, Bellani, Eddy, Fan, Laurent Jean, Brochard, Antonio, Pesenti, Marcus Josephus, Schultz, Antonio, Artigas, and Milic, Veljovic

Subjects
Male, Patient Outcome Assessment, Respiratory Distress Syndrome, Internationality, Humans, Female, Hospital Mortality, Prospective Studies, Middle Aged, Severity of Illness Index
Abstract

Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population.This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: "worsening" if moderate or severe acute respiratory distress syndrome criteria were met, "persisting" if mild acute respiratory distress syndrome criteria were the most severe category, and "improving" if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2.Among 580 patients with initial mild acute respiratory distress syndrome, 18% (103 of 580) continuously improved, 36% (210 of 580) had persisting mild acute respiratory distress syndrome, and 46% (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality was 30% (172 of 576; specifically 10% [10 of 101], 30% [63 of 210], and 37% [99 of 265] for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively), and the median (interquartile range) duration of mechanical ventilation was 7 (4, 14) days (specifically 3 [2, 5], 7 [4, 14], and 11 [6, 18] days for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively). Admissions for trauma or pneumonia, higher nonpulmonary sequential organ failure assessment score, lower partial pressure of alveolar oxygen/fraction of inspired oxygen, and higher peak inspiratory pressure were independently associated with worsening.Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population.

Published
2018

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