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AlZahrani AM, Rajendran P, Bekhet GM, Balasubramanian R, Govindaram LK, Ahmed EA, Hanieh H. Protective effect of 5,4'-dihydroxy-6,8-dimethoxy7-O-rhamnosylflavone from Indigofera aspalathoides Vahl on lipopolysaccharide-induced intestinal injury in mice. Inflammopharmacology 2024:10.1007/s10787-024-01530-y. [PMID: 39090500 DOI: 10.1007/s10787-024-01530-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/05/2024] [Indexed: 08/04/2024]
Abstract
Intestinal inflammation is one of the main health challenges affecting the quality of life of millions of people worldwide. Accumulating evidence introduces several flavonoids with multifaceted therapeutic properties in inflammatory diseases including intestinal inflammation. Herein, we examined potential anti-inflammatory properties of 5,4'-dihydroxy-6,8-dimethoxy7-O-rhamnosylflavone (DDR) flavone derived from Indigofera aspalathoides Vahl (I. aspalathoides Vahl) on lipopolysaccharide (LPS)-induced intestinal inflammation and injury in mice. Oral DDR treatment decreased serum levels of pro-inflammatory cytokines including TNF-α, IL-6, and IL-1β. It reduced oxidative stress through augmenting the activities of catalase (CAT) and superoxide dismutase (SOD) and reducing the level of malondialdehyde (MDA) in the duodenum and colon tissues. Moreover, DDR enhanced the activities of digestive enzymes including trypsin, pancreatic lipase, and amylase, and increased the production of short-chain fatty acids (SCFAs) by colon microbiota. Histopathological investigation of duodenum and colon revealed that DDR inhibited inflammatory infiltration and largely restored mucosal architecture and protected lining integrity. Importantly, DDR suppressed activation of nuclear factor-κB (NF-κB) signaling pathway through reduced expression of Toll-like receptor 4 (TLR4) and expression and phosphorylation of P65. The current study identified DDR as anti-inflammatory flavonoid capable of ameliorating LPS-induced intestinal inflammation through suppression of NF-κB signaling.
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Affiliation(s)
- Abdullah M AlZahrani
- Department of Biological Sciences, College of Science, King Faisal University, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Peramaiyan Rajendran
- Department of Biological Sciences, College of Science, King Faisal University, Al-Hofuf, Al-Ahsa, Saudi Arabia.
- Department of Biochemistry, Centre of Molecular Medicine and Diagnostics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India.
| | - Gamal M Bekhet
- Department of Biological Sciences, College of Science, King Faisal University, Al-Hofuf, Al-Ahsa, Saudi Arabia
- Department of Anatomy, College of Veterinary Medicine, King Faisal University, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | | | - Lalitha Keddal Govindaram
- Department of Pharmaceutical Chemistry, Ultra College of Pharmacy, Thasildhar Nagar, Madurai, India
- The Tamilnadu Dr MGR Medical University, Chennai, India
| | - Emad A Ahmed
- Department of Biological Sciences, College of Science, King Faisal University, Al-Hofuf, Al-Ahsa, Saudi Arabia
- Laboratory of Molecular Physiology, Zoology Department, Faculty of Science, Assiut University, Assiut, 71515, Egypt
| | - Hamza Hanieh
- Basic Medical Sciences Department, Faculty of Medicine, Aqaba Medical Sciences University, Aqaba, 77110, Jordan
- International Medical Research Center (iMReC), Aqaba, 77110, Jordan
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202
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Schuermans S, Kestens C, Marques PE. Systemic mechanisms of necrotic cell debris clearance. Cell Death Dis 2024; 15:557. [PMID: 39090111 PMCID: PMC11294570 DOI: 10.1038/s41419-024-06947-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024]
Abstract
Necrosis is an overarching term that describes cell death modalities caused by (extreme) adverse conditions in which cells lose structural integrity. A guaranteed consequence of necrosis is the production of necrotic cell remnants, or debris. Necrotic cell debris is a strong trigger of inflammation, and although inflammatory responses are required for tissue healing, necrotic debris may lead to uncontrolled immune responses and collateral damage. Besides local phagocytosis by recruited leukocytes, there is accumulating evidence that extracellular mechanisms are also involved in necrotic debris clearance. In this review, we focused on systemic clearance mechanisms present in the bloodstream and vasculature that often cooperate to drive the clearance of cell debris. We reviewed the contribution and cooperation of extracellular DNases, the actin-scavenger system, the fibrinolytic system and reticuloendothelial cells in performing clearance of necrotic debris. Moreover, associations of the (mis)functioning of these clearance systems with a variety of diseases were provided, illustrating the importance of the mechanisms of clearance of dead cells in the organism.
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Affiliation(s)
- Sara Schuermans
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Caine Kestens
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Pedro Elias Marques
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
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203
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Miner D, Smith K, Wu PT, Price JH, Piscitelli D, Chui K. Pragmatic approach to mobilizing individuals with critical illness due to COVID-19: clinical perspective. Disabil Rehabil 2024; 46:4040-4048. [PMID: 37752855 DOI: 10.1080/09638288.2023.2263370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE To provide pragmatic guidance for acute rehabilitation management and implementation of early mobility for individuals with critical illness due to COVID-19. METHODS Clinical perspective developed through reflective clinical practice and narrative review of best available evidence. RESULTS Current clinical practice guidelines do not provide guidance for implementation of early mobility interventions for individuals with critical illness due to COVID-19 who require enhanced ventilatory support or support of inhaled pulmonary artery vasodilators. Many individuals who may benefit from implementation of early mobility interventions are excluded by strict interpretation of current guidelines. CONCLUSIONS Risk vs benefit of implementing early mobility interventions in individuals with critical illness due to COVID-19 can be mitigated through coordinated efforts of interdisciplinary teams to promote shared decision-making through therapeutic alliances with patients and their families. Clinicians must clearly define the goals of care, understand the limitations of monitoring equipment in the intensive care unit, prepare to titrate levels of oxygen based on an individual's physiologic response to mobility interventions, and help individuals maintain external goal-directed focus of attention to optimize outcomes of early mobility interventions.
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Affiliation(s)
- Daniel Miner
- Department of Physical Therapy, Carilion Clinic, Radford University Carilion, Radford, VA, USA
| | - Kellen Smith
- Department of Physical Therapy, Carilion Clinic, Radford University, Roanoke, VA, USA
| | - Pei-Tzu Wu
- Department of Physical Therapy, Pacific University, Hillsboro, OR, USA
| | - Justin H Price
- Carilion Clinic, VA Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Daniele Piscitelli
- Department of Physical Therapy, University of Connecticut, Storrs, CT, USA
| | - Kevin Chui
- Department of Physical Therapy, Radford University, Radford, VA, USA
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204
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Pagliaro P, Weber NC, Femminò S, Alloatti G, Penna C. Gasotransmitters and noble gases in cardioprotection: unraveling molecular pathways for future therapeutic strategies. Basic Res Cardiol 2024; 119:509-544. [PMID: 38878210 PMCID: PMC11319428 DOI: 10.1007/s00395-024-01061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 08/13/2024]
Abstract
Despite recent progress, ischemic heart disease poses a persistent global challenge, driving significant morbidity and mortality. The pursuit of therapeutic solutions has led to the emergence of strategies such as ischemic preconditioning, postconditioning, and remote conditioning to shield the heart from myocardial ischemia/reperfusion injury (MIRI). These ischemic conditioning approaches, applied before, after, or at a distance from the affected organ, inspire future therapeutic strategies, including pharmacological conditioning. Gasotransmitters, comprising nitric oxide, hydrogen sulfide, sulfur dioxide, and carbon monoxide, play pivotal roles in physiological and pathological processes, exhibiting shared features such as smooth muscle relaxation, antiapoptotic effects, and anti-inflammatory properties. Despite potential risks at high concentrations, physiological levels of gasotransmitters induce vasorelaxation and promote cardioprotective effects. Noble gases, notably argon, helium, and xenon, exhibit organ-protective properties by reducing cell death, minimizing infarct size, and enhancing functional recovery in post-ischemic organs. The protective role of noble gases appears to hinge on their modulation of molecular pathways governing cell survival, leading to both pro- and antiapoptotic effects. Among noble gases, helium and xenon emerge as particularly promising in the field of cardioprotection. This overview synthesizes our current understanding of the roles played by gasotransmitters and noble gases in the context of MIRI and cardioprotection. In addition, we underscore potential future developments involving the utilization of noble gases and gasotransmitter donor molecules in advancing cardioprotective strategies.
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Affiliation(s)
- Pasquale Pagliaro
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO), Italy.
- National Institute for Cardiovascular Research (INRC), 40126, Bologna, Italy.
| | - Nina C Weber
- Department of Anesthesiology, Laboratory of Experimental Intensive Care and Anesthesiology-L.E.I.C.A, Amsterdam University Medical Centers, Amsterdam Cardiovascular Science (ACS), Amsterdam, The Netherlands
| | - Saveria Femminò
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO), Italy
| | | | - Claudia Penna
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO), Italy
- National Institute for Cardiovascular Research (INRC), 40126, Bologna, Italy
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205
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Julián-Jiménez A, Lorenzo Álvarez R, Gutiérrez Bueno V, Sánchez Trujillo M, Eduardo García D. [Early source control of infection in patients seen in the emergency department: a systematic review]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2024; 37:323-333. [PMID: 38742536 PMCID: PMC11231492 DOI: 10.37201/req/027.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/05/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The term source (or focus) control encompasses all those physical measures that can be used to reduce the inoculum and modify those factors in the infectious medium that promote microbial growth or foreign antimicrobial defenses of the host. The main objective of this systematic review (SR) is to know and compare whether early detection and control of the focus (in less than 6 hours) in adult patients treated in the ED for severe infection or sepsis, compared to not controlling the focus or delayed focus control (more than 12 hours) is more effective and safer (improves clinical evolution, mortality, complications, hospital stay or need for ICU admission). METHODS A systematic review is carried out following the PRISMA regulations in the databases of PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov from January 2000 to December 31, 2023 without language restrictions and using a combination of MESH terms: "Source Control", "Early" "Infection OR Bacterial Infection OR Sepsis", "Emergencies OR Emergency OR Emergency Department" and "Adults". Observational cohort studies were included. No meta-analysis techniques were performed, but results were compared narratively. RESULTS A total of 1,658 articles were identified, of which 2 that met the inclusion criteria and were classified as high quality were finally analyzed. The included studies represent a total of 2,404 patients with 678 cases in which an intervention was performed to control the focus (28.20%). In the first study, 28-day mortality was lower in patients who underwent an intervention to control the focus (12.3% vs. 22.5%; P <0.001), with an adjusted HR of 0.538 (95% CI: 0.389-0.744; P<0.001). In the second, it was demonstrated that the time elapsed from when the patient was evaluated for the first time and was hemodynamically stabilized, until the start of surgery was associated with his survival at 60 days with an OR of 0.31 (95% CI: 0.19-0.45; P <0.0001). In fact, for each hour of delay an adjusted OR of 0.29 (95% CI: 0.16-0.47; P<0.0001) is established. So if the intervention is performed before 2 hours at 60 days, 98% of the patients are still alive, if it is performed between 2-4 hours it is reduced to 78%, if it is between 4-6 hours it drops to 55%, but if it is done for more than 6 hours there will be no survivors at 60 days. CONCLUSIONS This review shows that source control carried out after the evaluation of patients attending the ED reduces short-term mortality (30-60 days) and that it would be advisable to implement any required source control intervention as soon as possible, ideally early (within 6 hours).
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Affiliation(s)
- A Julián-Jiménez
- Dr. Agustín Julián-Jiménez, MD, PhD. Servicio de Urgencias-Coordinador de Docencia, Formación, Investigación y Calidad. Complejo Hospitalario Universitario de Toledo, Avda. Río Guadiana s/n. C.P: 45.071. Toledo. Spain.
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206
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Juanola A, Ma AT, Gratacós-Ginès J, Soria A, Solé C, Pose E, Ginès P. Renal Complications in Portal Hypertension. Clin Liver Dis 2024; 28:503-523. [PMID: 38945640 DOI: 10.1016/j.cld.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Acute kidney injury (AKI) is a common complication among patients with decompensated cirrhosis and its development is associated with worse prognosis in terms of survival. Patients with decompensated cirrhosis may develop a unique type of AKI, known as hepatorenal syndrome (HRS-AKI), characterized by marked impairment of kidney function due to haemodynamic changes that occur in late stages of liver cirrhosis. Besides, patients with cirrhosis also may develop chronic alterations of kidney function (chronic kidney disease, CKD), the incidence of which is increasing markedly and may be associated with clinical complications. The aim of this review is to provide the reader with an update of the most relevant aspects of alterations of kidney function in patients with cirrhossi that may be useful for theri clinical practice.
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Affiliation(s)
- Adrià Juanola
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Ann Thu Ma
- Toronto Centre for Liver Disease Francis Family Liver Clinic, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jordi Gratacós-Ginès
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Anna Soria
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Cristina Solé
- Department of Gastroenterology and Hepatology, Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Elisa Pose
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain; School of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalunya, Spain.
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207
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Wilkinson DJC. POINT: Is It Ethically Permissible to Use Frailty Scoring to Determine the Allocation of Medical Resources Under Conditions of Scarcity in the Medical ICU? Yes. Chest 2024; 166:250-252. [PMID: 39122296 DOI: 10.1016/j.chest.2024.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 03/10/2024] [Indexed: 08/12/2024] Open
Affiliation(s)
- Dominic J C Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, England; John Radcliffe Hospital, Oxford, England; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore.
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208
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Remmington C, Cameron L, Hanks F, Liang YH, Barrow L, Coxhead R, Mehta R, Bhudia N, Lyster H, Cooke S, Gilmartin J, Lee P, Sloss R, McKenzie C. Critical care pharmacy service provision and workforce in adult extracorporeal membrane oxygenation centres: a multicentre cross-sectional survey. Int J Clin Pharm 2024; 46:854-861. [PMID: 38551749 DOI: 10.1007/s11096-024-01719-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/27/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND There is good evidence describing pharmacy workforce and service provision in general critical care units. However, no data exist from adult extracorporeal membrane oxygenation (ECMO) centres. AIM To describe workforce characteristics, pharmacy service provision, and pharmaceutical care activities in critical care units (CCUs) providing an adult ECMO service in the United Kingdom (UK) and compare to national staffing standards for CCUs. METHOD We conducted a multicentre, cross-sectional electronic survey inviting one pharmacy professional response per UK ECMO centre. We collated information on workforce, service provision, and pharmaceutical care activities provided by pharmacy teams in adult CCUs with an ECMO service. RESULTS The survey response rate was 90.9%: representatives of 10/11 tertiary hospitals providing ECMO services responded. Median critical care pharmacist to critical care bed was 1:12.1 (IQR: 1:9.4-1:14.9). Most centres (90.0%) did not meet national standards for pharmacy professionals to critical care bed staffing ratios for weekday services. Total critical care beds covered by the critical care pharmacy team varied across the UK: median (IQR) - 45 (37-80) beds. Two centres funded pharmacist time for ECMO activity, and one centre funded a pharmacy technician post. Median peak ECMO activity was 4 ECMO patients in a single day (IQR: 3-5). Most respondents reported reduced pharmacy service at weekends compared to weekday, with limited on-site support. CONCLUSION Most responding ECMO centres in the UK reported pharmacy staffing ratios below nationally agreed critical care standards. There was high variability in clinical pharmacy services to ECMO patients over 7 days.
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Affiliation(s)
- Christopher Remmington
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK.
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK.
| | - Lynda Cameron
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Fraser Hanks
- Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Ya-Hui Liang
- Pharmacy Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Linda Barrow
- Pharmacy Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Ruth Coxhead
- Pharmacy Department, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Reena Mehta
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Nisha Bhudia
- Pharmacy Department, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas, NHS Foundation Trust, London, UK
| | - Haifa Lyster
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Pharmacy Department, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas, NHS Foundation Trust, London, UK
| | - Sarah Cooke
- Pharmacy Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - James Gilmartin
- Pharmacy Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Phillisa Lee
- Pharmacy Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rhona Sloss
- Pharmacy Department, Barts Health NHS Trust, London, UK
| | - Cathrine McKenzie
- Institute of Pharmaceutical Science, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
- Department of Pharmacy and Critical Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Medicine, University of Southampton, National Institute for Health and Care Research (NIHR), Biomedical Research Centre, Perioperative, and Pharmacy and Critical Care, Southampton and NIHR Wessex Applied Research Collaborative (ARC), Southampton, UK
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209
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Mangino A, Balaji L, Stenson B, Nathanson LA, Chiu D, Grossman SA. Does initiating care in alternate care sites decrease time to disposition in the emergency department? J Am Coll Emerg Physicians Open 2024; 5:e13195. [PMID: 39104919 PMCID: PMC11298685 DOI: 10.1002/emp2.13195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 08/07/2024] Open
Abstract
Objectives During the coronavirus disease 2019 (COVID-19) pandemic surge, alternate care sites (ACS) such as the waiting room or hospital lobby were created amongst hospitals nationwide to help alleviate emergency department (ED) overflow. Despite the end of the pandemic surge, many of these ACS remain functional given the burden of prolonged ED wait times, with providers now utilizing the waiting room or ACS to initiate care. Therefore, the objective of this study is to evaluate if initiating patient care in ACS helps to decrease time to disposition. Methods Retrospective data were collected on 61,869 patient encounters presenting to an academic medical center ED. Patients with an emergency severity index (ESI) of 1 were excluded. The "pre-ACS" or control data consisted of 38,625 patient encounters from September 30, 2018 to October 1, 2019, prior to the development of ACS, in which the patient was seen by a physician after they were brought to an assigned ED room. The "post-ACS" study cohort consisted of 23,244 patient encounters from September 30, 2022 to October 1, 2023, after the initiation of ACS, during which patients were initially seen by a provider in an ACS. ACS at this institution included the three following areas: waiting room, ambulance waiting area, and a newly constructed ACS that was built next to the ED entrance on the first floor of the hospital. The newly constructed ACS consisted of 16 care spaces each containing an upright exam chair with dividers between each care space. Door-to-disposition time (DTD) was calculated by identifying the time when the patient entered the ED and the time when disposition was decided (admission requested or patient discharged). Using regression analysis, we compared the two data sets to determine significant differences among DTD time. Results The largest proportion of encounters were among ESI 3 patients, that is, 56.1%. There was a significant increase in median DTD for ESI 2 and 3 patients who were seen initially in an ACS compared to those who were not seen until they were in an assigned ER room. Specifically, there was a median increase of 40.9 min for ESI 2 patients and 18.8 min for ESI 3 patients who were seen initially in an ACS (p < 0.001). There was a 29-min decrease in median DTD for ESI 5 patients who were seen in ACS (p = 0.09). Conclusions Initiating patient care earlier in ACS did not appear to decrease DTD time for patients in the ED. Overall, the benefits of early initiation of care likely lie elsewhere within patient care and the ED throughput process.
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Affiliation(s)
- Alyssa Mangino
- Department of Emergency Medicine, Harvard Medical SchoolBeth Israel Deaconess Medical Center BostonBostonMassachusettsUSA
| | - Lakshman Balaji
- Department of Emergency Medicine, Harvard Medical SchoolBeth Israel Deaconess Medical Center BostonBostonMassachusettsUSA
| | - Bryan Stenson
- Department of Emergency Medicine, Harvard Medical SchoolBeth Israel Deaconess Medical Center BostonBostonMassachusettsUSA
| | - Larry A. Nathanson
- Department of Emergency Medicine, Harvard Medical SchoolBeth Israel Deaconess Medical Center BostonBostonMassachusettsUSA
| | - David Chiu
- Department of Emergency Medicine, Harvard Medical SchoolBeth Israel Deaconess Medical Center BostonBostonMassachusettsUSA
| | - Shamai A. Grossman
- Department of Emergency Medicine, Harvard Medical SchoolBeth Israel Deaconess Medical Center BostonBostonMassachusettsUSA
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210
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Sayde GE, Shapiro PA, Kronish I, Agarwal S. A shift towards targeted post-ICU treatment: Multidisciplinary care for cardiac arrest survivors. J Crit Care 2024; 82:154798. [PMID: 38537526 DOI: 10.1016/j.jcrc.2024.154798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 06/01/2024]
Abstract
Intensive Care Unit (ICU) survivorship comprises a burgeoning area of critical care medicine, largely due to our improved understanding of and concern for patients' recovery trajectory, and efforts to mitigate the post-acute complications of critical illness. Expansion of care beyond hospitalization is necessary, yet evidence for post-ICU clinics remains limited and mixed, as both interventions and target populations studied to date are too heterogenous to meaningfully demonstrate efficacy. Here, we briefly present the existing evidence and limitations related to post-ICU clinics, identify cardiac arrest survivors as a unique ICU subpopulation warranting further investigation and treatment, and propose a clinical framework that addresses the multifaceted needs of this well-defined patient population.
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Affiliation(s)
- George E Sayde
- Division of Consultation-Liaison Psychiatry, Department of Psychiatry, Columbia University Irving Medical Center, 622 West 168(th) Street, PH 16-Center, New York, NY 10032, USA.
| | - Peter A Shapiro
- Division of Consultation-Liaison Psychiatry, Department of Psychiatry, Columbia University Irving Medical Center, 622 West 168(th) Street, PH 16-Center, New York, NY 10032, USA.
| | - Ian Kronish
- Center for Behavioral Cardiovascular Health, Division of General Medicine, Columbia University Irving Medical Center, 622 West 168(th) Street, PH9-311, New York, NY 10032, USA.
| | - Sachin Agarwal
- Department of Neurology, Division of Critical Care and Hospitalist Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, 8GS-300, New York, NY 10032, USA.
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Fritsch SJ, Riedel M, Marx G, Bickenbach J, Schuppert A. Development of a machine learning model for prediction of the duration of unassisted spontaneous breathing in patients during prolonged weaning from mechanical ventilation. J Crit Care 2024; 82:154795. [PMID: 38531748 DOI: 10.1016/j.jcrc.2024.154795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Treatment of patients undergoing prolonged weaning from mechanical ventilation includes repeated spontaneous breathing trials (SBTs) without respiratory support, whose duration must be balanced critically to prevent over- and underload of respiratory musculature. This study aimed to develop a machine learning model to predict the duration of unassisted spontaneous breathing. MATERIALS AND METHODS Structured clinical data of patients from a specialized weaning unit were used to develop (1) a classifier model to qualitatively predict an increase of duration, (2) a regressor model to quantitatively predict the precise duration of SBTs on the next day, and (3) the duration difference between the current and following day. 61 features, known to influence weaning, were included into a Histogram-based gradient boosting model. The models were trained and evaluated using separated data sets. RESULTS 18.948 patient-days from 1018 individual patients were included. The classifier model yielded an ROC-AUC of 0.713. The regressor models displayed a mean absolute error of 2:50 h for prediction of absolute durations and 2:47 h for day-to-day difference. CONCLUSIONS The developed machine learning model showed informed results when predicting the spontaneous breathing capacity of a patient in prolonged weaning, however lacking prognostic quality required for direct translation to clinical use.
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Affiliation(s)
- Sebastian Johannes Fritsch
- Jülich Supercomputing Centre, Forschungszentrum Jülich, 52428 Jülich, Germany; Department of Intensive Care Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany; Center for Advanced Simulation and Analytics (CASA), Forschungszentrum Jülich, 52428 Jülich, Germany.
| | - Morris Riedel
- Jülich Supercomputing Centre, Forschungszentrum Jülich, 52428 Jülich, Germany; Center for Advanced Simulation and Analytics (CASA), Forschungszentrum Jülich, 52428 Jülich, Germany; School of Engineering and Natural Science, University of Iceland, 107 Reykjavik, Iceland
| | - Gernot Marx
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Johannes Bickenbach
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Andreas Schuppert
- Joint Research Centre for Computational Biomedicine, University Hospital RWTH Aachen, 52074 Aachen, Germany
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212
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Kellum JA, Bagshaw SM, Demirjian S, Forni L, Joannidis M, Kampf JP, Koyner JL, Kwan T, McPherson P, Ostermann M, Prowle J, Ronco C, de la Salle J, Schneider A, Tolwani A, Zarbock A. CCL14 testing to guide clinical practice in patients with AKI: Results from an international expert panel. J Crit Care 2024; 82:154816. [PMID: 38678981 DOI: 10.1016/j.jcrc.2024.154816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Urinary C-C motif chemokine ligand 14 (CCL14) is a strong predictor of persistent stage 3 acute kidney injury (AKI). Multiple clinical actions are recommended for AKI but how these are applied in individual patients and how the CCL14 test results may impact their application is unknown. METHODS We assembled an international panel of 12 experts and conducted a modified Delphi process to evaluate patients at risk for persistent stage 3 AKI (lasting 72 hours or longer). Using a Likert scale, we rated 11 clinical actions based on international guidelines applied to each case before and after CCL14 testing and analyzed the association between the strength and direction of recommendations and CCL14 results. RESULTS The strength and direction of clinical recommendations were strongly influenced by CCL14 results (P < 0.001 for the interaction). Nine (82%) recommendations for clinical actions were significantly impacted by CCL14 results (P < 0.001 comparing low to highest CCL14 risk category). CONCLUSIONS Most recommendations for care of patients with stage 2-3 by an international panel of experts were strongly modified by CCL14 test results. This work should set the stage for clinical practice protocols and studies to determine the effects of recommended actions informed by CCL14.
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Affiliation(s)
- John A Kellum
- The Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Sevag Demirjian
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Lui Forni
- Department of Intensive Care, Royal Surrey Hospital, Guildford and Department of Clinical & Experimental Medicine, Faculty of Health Sciences, University of Surrey, UK
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - J Patrick Kampf
- Astute Medical, Inc. (A bioMérieux Company), 3550 General Atomics Ct., San Diego, CA 92121, USA
| | - Jay L Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Thomas Kwan
- Astute Medical, Inc. (A bioMérieux Company), 3550 General Atomics Ct., San Diego, CA 92121, USA
| | - Paul McPherson
- Astute Medical, Inc. (A bioMérieux Company), 3550 General Atomics Ct., San Diego, CA 92121, USA
| | | | - John Prowle
- Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Claudio Ronco
- Department of Nephrology, Dialysis and transplantation, San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | | | - Antoine Schneider
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Ashita Tolwani
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Munster, Munster, Germany
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213
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Yuriditsky E, Bakker J. What every intensivist should know about…Systolic arterial pressure targets in shock. J Crit Care 2024; 82:154790. [PMID: 38816174 DOI: 10.1016/j.jcrc.2024.154790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/10/2023] [Accepted: 12/17/2023] [Indexed: 06/01/2024]
Affiliation(s)
- Eugene Yuriditsky
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
| | - Jan Bakker
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, NYU Grossman School of Medicine, New York, USA; Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, USA; Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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214
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Bauer ME, Perez SL, Main EK, Norman GS, Fish LJ, Caldwell MA, Allen C, Hughes BL, Gibbs RS, Smith KL. Near-miss and maternal sepsis mortality: A qualitative study of survivors and support persons. Eur J Obstet Gynecol Reprod Biol 2024; 299:136-142. [PMID: 38865740 PMCID: PMC11262036 DOI: 10.1016/j.ejogrb.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/24/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Prior studies have shown that maternal deaths due to sepsis occur due to delays in recognition, treatment, and escalation of care through medical chart reviews. This study was conducted to obtain the patient perspective for near-miss and maternal mortality cases due to sepsis. OBJECTIVE To identify quality improvement opportunities for improving maternal sepsis through patient and support person experiences. STUDY DESIGN Twenty semi-structured interviews and three follow-up focus groups with patients who experienced critical illness from maternal sepsis in the United States and their support persons (when available) were conducted from May 23, 2022, through October 14, 2022. In this qualitative study, data were analyzed using inductive thematic analysis. RESULTS In this qualitative study of patients with maternal sepsis and their support persons, four main quality improvement themes were identified. The themes were the following: (1) participants reported a lack of awareness of pregnancy-related warning signs and symptoms of when to seek care, (2) many of the presenting symptoms participants experienced were not typical of expected warning signs of maternal sepsis, such as severe pain, overwhelming tiredness, and lack of fever (3) participant concerns were met with dismissal leading to delays in diagnosis, (4) participants experienced long-term sequelae but had difficulty receiving screening and referrals for treatment. CONCLUSIONS The findings of this study suggest that standardized patient education about the warning signs of maternal sepsis and provider education about the presentation of maternal sepsis, improved listening to patients, and follow-up for sequalae of sepsis are needed.
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Affiliation(s)
- Melissa E Bauer
- Department of Anesthesiology, Duke University, Durham, NC, United States.
| | - Susan L Perez
- Department of Public Health, California State University, Sacramento, CA, United States
| | - Elliott K Main
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Stanford University, Palo Alto, CA, United States
| | - Gwendolyn S Norman
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, United States
| | - Laura J Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, United States
| | - Morgan A Caldwell
- Department of Anesthesiology, Duke University, Durham, NC, United States
| | - Christie Allen
- American College of Obstetrics and Gynecology, United States
| | - Brenna L Hughes
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, United States
| | - Ronald S Gibbs
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Stanford University, Palo Alto, CA, United States
| | - Kendra L Smith
- Smith Research & Consulting, LLC, Houston, TX, United States
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215
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Philpott JD, Hovnanian KMR, Stefater-Richards M, Mehta NM, Martinez EE. The enteroendocrine axis and its effect on gastrointestinal function, nutrition, and inflammation. Curr Opin Crit Care 2024; 30:290-297. [PMID: 38872371 PMCID: PMC11295110 DOI: 10.1097/mcc.0000000000001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
PURPOSE OF REVIEW Gastrointestinal (GI) dysfunction limits enteral nutrition (EN) delivery in critical illness and contributes to systemic inflammation. The enteroendocrine (EE) axis plays an integral role in this interface between nutrition, inflammation, and GI function in critical illness. In this review, we present an overview of the EE system with a focus on its role in GI inflammation and function. RECENT FINDINGS Enteroendocrine cells have been primarily described in their role in macronutrient digestion and absorption. Recent research has expanded on the diverse functions of EE cells including their ability to sense microbial peptides and metabolites and regulate immune function and inflammation. Therefore, EE cells may be both affected by and contribute to many pathophysiologic states and interventions of critical illness such as dysbiosis , inflammation, and alternative EN strategies. In this review, we present an overview of EE cells including their growing role in nonnutrient functions and integrate this understanding into relevant aspects of critical illness with a focus on EN. SUMMARY The EE system is key in maintaining GI homeostasis in critical illness, and how it is impacted and contributes to outcomes in the setting of dysbiosis , inflammation and different feeding strategies in critical illness should be considered.
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Affiliation(s)
- Jordan D. Philpott
- Department of Anesthesiology, Critical Care and Pain Medicine, Division of Critical Care, Boston Children’s Hospital, Boston, Massachusetts, USA
- Mucosal Immunology and Biology Research Center, Mass General for Children, Boston, Massachusetts, USA
| | - K. Marco Rodriguez Hovnanian
- Department of Anesthesiology, Critical Care and Pain Medicine, Division of Critical Care, Boston Children’s Hospital, Boston, Massachusetts, USA
- Mucosal Immunology and Biology Research Center, Mass General for Children, Boston, Massachusetts, USA
| | - Margaret Stefater-Richards
- Department of Medicine, Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Nilesh M. Mehta
- Department of Anesthesiology, Critical Care and Pain Medicine, Division of Critical Care, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Enid E. Martinez
- Department of Anesthesiology, Critical Care and Pain Medicine, Division of Critical Care, Boston Children’s Hospital, Boston, Massachusetts, USA
- Mucosal Immunology and Biology Research Center, Mass General for Children, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Edison DC, Philip J, Mallhi RS, Basnotra R, Pynadath V, Sane K. Severe amlodipine toxicity: A medical dilemma managed with therapeutic plasma exchange. Transfus Apher Sci 2024; 63:103958. [PMID: 38880037 DOI: 10.1016/j.transci.2024.103958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/23/2024] [Accepted: 06/02/2024] [Indexed: 06/18/2024]
Abstract
Amlodipine poisoning is a nightmare for treating clinicians because of the intractable hypotension and bradycardia induced by the drug, which requires a balanced treatment algorithm. We encountered a case of severe Amlodipine toxicity (450 mg) who presented with complaints of nausea, multiple episodes of vomiting, and chest discomfort. On arrival at the EMD, the patient had significant hypotension (80/46 mmHg), bradycardia (40 beats/min), and a fall in oxygen saturation (75 %). He was symptomatically managed with inotropes, IV calcium, IV fluids, and oxygen supplementation. We decided to go forward with Therapeutic Plasma Exchange (TPE) in an attempt to remove the inciting agent. Two sessions of TPE were performed and the patient showed significant improvement post-procedure which led to the discharge of the patient within 10 days of admission. This case report highlights the noteworthiness of TPE in treating significantly high doses of drug poisoning.
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Affiliation(s)
- Dilna Christy Edison
- Department of Immunohematology & Blood Transfusion, Bharati Vidyapeeth (Deemed University) Medical College Pune, Maharashtra, India.
| | - Joseph Philip
- Department of Immunohematology & Blood Transfusion, Bharati Vidyapeeth (Deemed University) Medical College Pune, Maharashtra, India
| | - R S Mallhi
- Department of Immunohematology & Blood Transfusion, Bharati Vidyapeeth (Deemed University) Medical College Pune, Maharashtra, India
| | - Ritika Basnotra
- Department of Immunohematology & Blood Transfusion, Bharati Vidyapeeth (Deemed University) Medical College Pune, Maharashtra, India
| | - Vineeth Pynadath
- Department of Immunohematology & Blood Transfusion, Bharati Vidyapeeth (Deemed University) Medical College Pune, Maharashtra, India
| | - Kalyani Sane
- Department of Immunohematology & Blood Transfusion, Bharati Vidyapeeth (Deemed University) Medical College Pune, Maharashtra, India
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217
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Rodríguez-Fernández A, Visos-Varela I, Zapata-Cachafeiro M, Pintos-Rodríguez S, García-Álvarez RM, Herdeiro TM, Piñeiro-Lamas M, Figueiras A, Salgado-Barreira Á. Outpatient glucocorticoid use and COVID-19 outcomes: a population-based study. Inflammopharmacology 2024; 32:2305-2315. [PMID: 38698179 PMCID: PMC11300658 DOI: 10.1007/s10787-024-01474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Owing to controversy information surrounds effect of glucocorticoids on the evolution of COVID-19, we evaluate the effects of outpatient glucocorticoid use on the severity and progression of COVID-19 and risk of infection and analyse the effect of window of exposure and dose. METHODS We conducted a population-based case - control study, involving 4 substudies: (i) Hospitalisation; (ii) Mortality, using subjects hospitalised with a PCR + as cases and subjects without a PCR + as controls; (iii) Progression, including subjects with a PCR + (hospitalised versus non-hospitalised); and (iv) Susceptibility, with all subjects with a PCR + and subjects without a PCR + . Adjusted odds ratios (ORa) and their 95% confidence intervals (95% CI) were calculated. RESULTS The outpatient glucocorticoid use was associated with an increased risk of hospitalisation (aOR 1.79; 95% CI 1.56-2.05), mortality (aOR 2.30; 95% CI 1.68-3.15), progression (aOR 1.69; 95% CI 1.43-2.00) and susceptibility (aOR 1.29, 95% CI 1.19-1.41). Furthermore, the effects was observed to be greater at higher doses and the closer that drug use approached the outcome date, with an almost fourfold increase in mortality among users in the previous month (aOR 3.85; 95% CI 2.63-5.62). CONCLUSIONS According to the results of this real-world data study, outpatient glucocorticoid use should be considered in making decisions about intrahospital treatment.
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Affiliation(s)
- Almudena Rodríguez-Fernández
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Rúa de San Francisco, S/N, 15782, Santiago de Compostela (A Coruña), Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Irene Visos-Varela
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Rúa de San Francisco, S/N, 15782, Santiago de Compostela (A Coruña), Spain
| | - Maruxa Zapata-Cachafeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Rúa de San Francisco, S/N, 15782, Santiago de Compostela (A Coruña), Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Santiago de Compostela, Spain.
- Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Samuel Pintos-Rodríguez
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Rúa de San Francisco, S/N, 15782, Santiago de Compostela (A Coruña), Spain
| | - Rosa M García-Álvarez
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Rúa de San Francisco, S/N, 15782, Santiago de Compostela (A Coruña), Spain
- Service of Preventive Medicine and Public Health. Clinic Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Teresa M Herdeiro
- Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193, Aveiro, Portugal
| | - María Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Rúa de San Francisco, S/N, 15782, Santiago de Compostela (A Coruña), Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ángel Salgado-Barreira
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Rúa de San Francisco, S/N, 15782, Santiago de Compostela (A Coruña), Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
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218
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Alshamrani MM, El-Saed A, Alalmai A, Almanna MA, Alqahtani SMD, Asiri MS, Almasoud SS, Othman F. Clinical characteristics and outcomes of COVID-19 cases admitted to adult intensive care units during the pandemic: A single center experience. J Infect Public Health 2024; 17:102475. [PMID: 39024896 DOI: 10.1016/j.jiph.2024.102475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/20/2024] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND COVID-19 is the largest recorded pandemic in history. It causes several complications such as shock, pneumonia, acute respiratory distress syndrome, and organ failure. The objective was to determine COVID-19 outcomes and risk factors in the intensive care (ICU) setting. METHODS A retrospective review of prospectively collected data was conducted. Adult patients with a positive RT-PCR test for COVID-19 admitted to ICUs of a tertiary care hospital between 2020 and 2022 were included. Patients who had severe complex trauma were excluded. The outcomes examined included ventilation use and duration, length of stay (LOS), and mortality. RESULTS A total of 964 patients were included. The mean ( ± standard deviation, SD) age was 63.7 ± 16.9 years. The majority of the patients were males (59.0 %) and Saudi (75.7 %). Ventilation use was documented in 443 (57.1 %) patients, with a mean ( ± SD) ventilation duration of 9.7 ± 8.4 days. Death occurred in 361 (37.4 %) patients after a mean ( ± SD) of 33.3 ± 44.5 days from infection. The mean ( ± SD) LOS was 30.6 ± 54.1 days in hospital and 5.2 ± 5.4 days in ICU. Ventilation use was associated with older age, males, longer ICU LOS, mortality, and admission to medical-surgical ICU. Crude mortality use was associated with older age, longer ICU LOS, use of ventilator, shorter ventilation duration, and admission to medical-surgical or respiratory ICUs. CONCLUSIONS COVID-19 patients admitted to adult ICUs are at high risk of death and mechanical ventilation. The crude risks of both outcomes are higher in older age and longer ICU LOS and are very variable by ICU type.
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Affiliation(s)
- Majid M Alshamrani
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Aiman El-Saed
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Abdulrahman Alalmai
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia.
| | | | | | - Mohammed Saad Asiri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia.
| | | | - Fatmah Othman
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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219
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Unsinger J, Osborne D, Walton AH, Han E, Sheets L, Mazer MB, Remy KE, Griffith TS, Rao M, Badovinac VP, Brakenridge SC, Turnbull I, Efron PA, Moldawer LL, Caldwell CC, Hotchkiss RS. TEMPORAL CHANGES IN INNATE AND ADAPTIVE IMMUNITY DURING SEPSIS AS DETERMINED BY ELISPOT. Shock 2024; 62:255-264. [PMID: 38754032 PMCID: PMC11348958 DOI: 10.1097/shk.0000000000002377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
ABSTRACT Background: The inability to evaluate host immunity in a rapid quantitative manner in patients with sepsis has severely hampered development of novel immune therapies. The enzyme-linked immunospot (ELISpot) assay is a functional bioassay that measures the number of cytokine-secreting cells and the relative amount of cytokine produced at the single-cell level. A key advantage of ELISpot is its excellent dynamic range enabling a more precise quantifiable assessment of host immunity. Herein, we tested the hypothesis that the ELISpot assay can detect dynamic changes in both innate and adaptive immunity as they often occur during sepsis. We also tested whether ELISpot could detect the effect of immune drug therapies to modulate innate and adaptive immunity. Methods: Mice were made septic using sublethal cecal ligation and puncture. Blood and spleens were harvested serially, and ex vivo interferon γ and TNF-α production were compared by ELISpot and enzyme-linked immunosorbent assay. The capability of ELISpot to detect changes in innate and adaptive immunity due to in vivo immune therapy with dexamethasone, IL-7, and arginine was also evaluated. Results: ELISpot confirmed a decreased innate and adaptive immunity responsiveness during sepsis progression. More importantly, ELISpot was also able to detect changes in adaptive and innate immunity in response to immune-modulatory reagents, for example, dexamethasone, arginine, and IL-7, in a readily quantifiable manner, as predicted by the reagents known mechanisms of action. ELISpot and enzyme-linked immunosorbent assay results tended to parallel one another although some differences were noted. Conclusion: ELISpot offers a unique capability to assess the functional status of both adaptive and innate immunity over time. The results presented herein demonstrate that ELISpot can also be used to detect and follow the in vivo effects of drugs to ameliorate sepsis-induced immune dysfunction. This capability would be a major advance in guiding new immune therapies in sepsis.
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Affiliation(s)
- Jacqueline Unsinger
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Dale Osborne
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew H Walton
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Ethan Han
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Lauren Sheets
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
| | - Monty B Mazer
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Kenneth E Remy
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Mahil Rao
- Department of Pediatrics, University of Iowa Carver College of Medicine
| | | | - Scott C Brakenridge
- Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington
| | - Isaiah Turnbull
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Philip A Efron
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Lyle L Moldawer
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Charles C Caldwell
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Richard S Hotchkiss
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
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220
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Howard R. Implementing debriefing after cardiac arrest: benefits and challenges. Nurs Stand 2024; 39:34-38. [PMID: 38946428 DOI: 10.7748/ns.2024.e12273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 07/02/2024]
Abstract
Healthcare professionals, including nurses, will be involved in the care and management of patients in cardiac arrest. This highly stressful and demanding situation can lead to breakdowns in communication, difficulty in decision-making and emotional distress for members of the healthcare team. Debriefing is a recommended tool that team members can use to acknowledge what went well, what could be improved and areas for learning or development. However, debriefing is often not prioritised due to pressures in clinical practice. This article discusses the benefits of debriefing and outlines some of the approaches and tools that may be used. The author argues that by recognising the importance of debriefing after cardiac arrests in the hospital setting and committing to best practices, nurses can be better prepared for the challenges of resuscitation and improve patient outcomes.
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Affiliation(s)
- Rachel Howard
- Liverpool John Moores University, Liverpool, England
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Howroyd F, Chacko C, MacDuff A, Gautam N, Pouchet B, Tunnicliffe B, Weblin J, Gao-Smith F, Ahmed Z, Duggal NA, Veenith T. Ventilator-associated pneumonia: pathobiological heterogeneity and diagnostic challenges. Nat Commun 2024; 15:6447. [PMID: 39085269 PMCID: PMC11291905 DOI: 10.1038/s41467-024-50805-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
Ventilator-associated pneumonia (VAP) affects up to 20% of critically ill patients and induces significant antibiotic prescription pressure, accounting for half of all antibiotic use in the ICU. VAP significantly increases hospital length of stay and healthcare costs yet is also associated with long-term morbidity and mortality. The diagnosis of VAP continues to present challenges and pitfalls for the currently available clinical, radiological and microbiological diagnostic armamentarium. Biomarkers and artificial intelligence offer an innovative potential direction for ongoing future research. In this Review, we summarise the pathobiological heterogeneity and diagnostic challenges associated with VAP.
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Affiliation(s)
- Fiona Howroyd
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK.
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Cyril Chacko
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK
| | - Andrew MacDuff
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK
| | - Nandan Gautam
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Brian Pouchet
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Bill Tunnicliffe
- Critical Care Department, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Jonathan Weblin
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, UK
| | - Fang Gao-Smith
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK
| | - Zubair Ahmed
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Niharika A Duggal
- Institute of Inflammation and Ageing, The University of Birmingham, Edgbaston, Birmingham, UK.
| | - Tonny Veenith
- Department of Critical Care Medicine and Anaesthesia, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
- Institute of Acute Care, Royal Wolverhampton Hospital and University of Wolverhampton, Wolverhampton, UK.
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Beltran C, Hood J, Danesh V, Shrestha A, Ogola G, Boethel C, Arroliga AC, Ghamande S. Association of coinfections with differences in outcomes across COVID-19 variants. Proc AMIA Symp 2024; 37:750-754. [PMID: 39165810 PMCID: PMC11332641 DOI: 10.1080/08998280.2024.2379723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 08/22/2024] Open
Abstract
Background In previous studies, there was an increase in mortality with secondary coinfections in all COVID-19 variants. However, no prior study has explored the association of coinfection with outcomes of hospitalized patients among the COVID-19 variants (Alpha, Delta, and Omicron). Methods This observational cohort study involved 21,186 patients hospitalized with COVID-19 in 25 hospitals in Texas. Patients were divided into groups by surges of COVID-19: Alpha (November 1, 2020-February 10, 2021), Delta (July 10, 2021-October 14, 2021), and Omicron (December 21, 2021-March 3, 2022). Data were collected from electronic health records using methodology from the Viral Respiratory Illness Universal Study COVID-19 registry (NCT04323787) of COVID-19 hospitalizations. Multivariable Cox-proportional hazard regression model assessed the adjusted effect of different surge periods on mortality. Results Bacterial coinfections varied among hospitalization surges associated with Alpha (8.5%), Delta (11.7%), and Omicron (11.9%) variants. Adjusted analyses showed a higher 30-day and 90-day mortality in all variants when coinfections were present compared with isolated COVID-19 infection. In particular, 30-day and 90-day mortality were significantly worse with Delta compared to Alpha and Omicron. Conclusions All variants were associated with a higher mortality when bacterial coinfections were present. Delta was associated with a higher risk-adjusted mortality at 30 days and thereafter.
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Affiliation(s)
- Christian Beltran
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Baylor Scott & White Medical Center – Temple, Temple, Texas, USA
| | - Jennifer Hood
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Baylor Scott & White Medical Center – Temple, Temple, Texas, USA
| | - Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Health, Dallas, Texas, USA
- Baylor Scott & White Research Institute, Dallas, Texas, USA
- Baylor College of Medicine, Temple, Texas, USA
| | | | - Gerald Ogola
- Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Carl Boethel
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Baylor Scott & White Medical Center – Temple, Temple, Texas, USA
| | - Alejandro C. Arroliga
- Chief Clinical Innovation Office, Baylor Scott & White Health, Temple, Texas, USA
- Baylor College of Medicine, Temple, Texas, USA
| | - Shekhar Ghamande
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Baylor Scott & White Medical Center – Temple, Temple, Texas, USA
- Baylor College of Medicine, Temple, Texas, USA
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Svedung Wettervik T, Hånell A, Ahlgren KM, Hillered L, Lewén A. Preliminary Observations of the Loke Microdialysis in an Experimental Pig Model: Are We Ready for Continuous Monitoring of Brain Energy Metabolism? Neurocrit Care 2024:10.1007/s12028-024-02080-5. [PMID: 39085507 DOI: 10.1007/s12028-024-02080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/10/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Brain energy metabolism is often disturbed after acute brain injuries. Current neuromonitoring methods with cerebral microdialysis (CMD) are based on intermittent measurements (1-4 times/h), but such a low frequency could miss transient but important events. The solution may be the recently developed Loke microdialysis (MD), which provides high-frequency data of glucose and lactate. Before clinical implementation, the reliability and stability of Loke remain to be determined in vivo. The purpose of this study was to validate Loke MD in relation to the standard intermittent CMD method. METHODS Four pigs aged 2-3 months were included. They received two adjacent CMD catheters, one for standard intermittent assessments and one for continuous (Loke MD) assessments of glucose and lactate. The standard CMD was measured every 15 min. Continuous Loke MD was sampled every 2-3 s and was averaged over corresponding 15-min intervals for the statistical comparisons with standard CMD. Intravenous glucose injections and intracranial hypertension by inflation of an intracranial epidural balloon were performed to induce variations in intracranial pressure, cerebral perfusion pressure, and systemic and cerebral glucose and lactate levels. RESULTS In a linear mixed-effect model of standard CMD glucose (mM), there was a fixed effect value (± standard error [SE]) at 0.94 ± 0.07 (p < 0.001) for Loke MD glucose (mM), with an intercept at - 0.19 ± 0.15 (p = 0.20). The model showed a conditional R2 at 0.81 and a marginal R2 at 0.72. In a linear mixed-effect model of standard CMD lactate (mM), there was a fixed effect value (± SE) at 0.41 ± 0.16 (p = 0.01) for Loke MD lactate (mM), with an intercept at 0.33 ± 0.21 (p = 0.25). The model showed a conditional R2 at 0.47 and marginal R2 at 0.17. CONCLUSIONS The established standard CMD glucose thresholds may be used as for Loke MD with some caution, but this should be avoided for lactate.
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Affiliation(s)
- Teodor Svedung Wettervik
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, 751 85, Uppsala, Sweden.
| | - Anders Hånell
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, 751 85, Uppsala, Sweden
| | - Kerstin M Ahlgren
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
| | - Lars Hillered
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, 751 85, Uppsala, Sweden
| | - Anders Lewén
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, 751 85, Uppsala, Sweden
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Rypicz Ł, Witczak I, Šupínová M, Salehi HP, Jarabicová O. Alarm fatigue and sleep quality in medical staff-a Polish-Czech-Slovak study on workplace ergonomics. Front Public Health 2024; 12:1345396. [PMID: 39145177 PMCID: PMC11322343 DOI: 10.3389/fpubh.2024.1345396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
Background Alarms are crucial in informing Healthcare Workers (HCWs) about critical patient needs, but unmanaged frequency and noise of alarms can de-sensitize medical staff and compromise patient safety. Alarm fatigue is identified as the major cause of the clinical alarm management problem. It occurs when the medical staff is overwhelmed by the number of clinical alarms. Methods The survey was conducted online using Google's form-making tools from June to July 2023. There were three parts to the survey used in the study: a socio-demographic metric, the Alarm Fatigue Assessment Questionnaire (AFAQ), and The Pittsburgh Sleep Quality Index (PSQI). A significance level of 0.05 was used in the analysis. Results The survey included 756 medical professionals from three European countries (Slovakia, the Czech Republic and Poland). The participants in the study were 42 years old on average, and they had 12 years of work experience. 603 out of 756 survey participants had poor sleep quality, 147 had good sleep quality, and 6 did not provide an answer. This study analyzed the alarm fatigue levels of respondents in every country. In the Czech Republic, Poland and Slovakia, a statistically significant association (p = 0.039, p = 0.001, p < 0.001) was found between alarm fatigue and sleep quality in medical staff. Conclusion Based on our study, alarm fatigue and sleep quality of HCWs are correlated. Therefore, alarm fatigue and sleep hygiene should be monitored.
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Affiliation(s)
- Łukasz Rypicz
- Department of Population Health, Division of Public Health, Faculty of Health Sciences, Medical University, Wroclaw, Poland
| | - Izabela Witczak
- Department of Population Health, Division of Public Health, Faculty of Health Sciences, Medical University, Wroclaw, Poland
| | - Mária Šupínová
- Faculty of Health Sciences, Catholic University in Ružomberok, Ružomberok, Slovakia
| | - Hugh Pierre Salehi
- Department of Biomedical, Industrial, and Human Factors Engineering, Wright State University, Dayton, OH, United States
| | - Oľga Jarabicová
- Department of Nursing, Faculty of Health Studies, Jan Evangelista Purkyne University in Ústí nad Labem, Ústí nad Labem, Czechia
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Wang J, Lu Y, Chen X, Wu Y. Effectiveness of nurse-led non-pharmacological interventions on outcomes of delirium in adults: A meta-analysis of randomized controlled trials. Worldviews Evid Based Nurs 2024. [PMID: 39086052 DOI: 10.1111/wvn.12739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 06/08/2024] [Accepted: 07/14/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Delirium is a common complication among adults. It is essential to improve the outcomes of delirium. AIM To systematically synthesize the evidence on the effectiveness of the nurse-led non-pharmacological interventions on outcomes of delirium in adults. METHODS Electronic databases including CINAHL, Cochrane Library, MEDLINE, EMBASE, PubMed, Web of Science, PsycINFO, and Clinical Trial Registration were searched comprehensively by the authors. The authors reviewed the full text and assessed the risk of bias using the Cochrane Risk of Bias Tool 2.0. The meta-analysis was performed using RevMan and Stata software. The forest plots showed the overall effect of the included study and the I2 test was used to assess the degree of heterogeneity between studies. Random effects models were used to analyze studies with significant heterogeneity. RESULTS A total of 32 studies (10,122 participants) were included in the meta-analysis. Nurse-led non-pharmacological interventions resulted in a significantly lower incidence of delirium compared with the usual care/control group (risk ratio = 0.74, p < .001) and reduced mortality in the hospital compared with usual care (risk ratio = 0.81, p = .04). However, the implementation of nurse-led, non-pharmacological interventions had no significant effect on the duration, severity of delirium, or length of hospital stay. LINKING EVIDENCE TO ACTION Our findings suggest that the nurse-led, non-pharmacological strategy was effective in reducing the incidence of delirium and mortality in the hospital. Multicomponent interventions were the most effective strategy for reducing the incidence of delirium in adults.
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Affiliation(s)
- Jiamin Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Yating Lu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaohong Chen
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
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Cheng G, Smith MA, Phelan R, Brazauskas R, Strom J, Ahn KW, Hamilton B, Peterson A, Savani B, Schoemans H, Schoettler M, Sorror M, Higham C, Kharbanda S, Dvorak CC, Zinter MS. Epidemiology of Diffuse Alveolar Hemorrhage in Pediatric Allogeneic Hematopoietic Cell Transplantation Recipients. Transplant Cell Ther 2024:S2666-6367(24)00553-0. [PMID: 39089527 DOI: 10.1016/j.jtct.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/15/2024] [Accepted: 07/27/2024] [Indexed: 08/04/2024]
Abstract
Diffuse alveolar hemorrhage (DAH) is a life-threatening pulmonary toxicity that can arise after hematopoietic cell transplantation (HCT). Risk factors and outcomes are not well understood owing to a sparsity of cases spread across multiple centers. The objectives of this epidemiologic study were to characterize the incidence, outcomes, transplantation-related risk factors and comorbid critical care diagnoses associated with post-HCT DAH. Retrospective analysis was performed in a multicenter cohort of 6995 patients age ≤21 years who underwent allogeneic HCT between 2008 and 2014 identified through the Center for International Blood and Marrow Transplant Research registry and cross-matched with the Virtual Pediatric Systems database to obtain critical care characteristics. A multivariable Cox proportional hazard model was used to determine risk factors for DAH. Logistic regression models were used to determine critical care diagnoses associated with DAH. Survival outcomes were analyzed using both a landmark approach and Cox regression, with DAH as a time-varying covariate. DAH occurred in 81 patients at a median of 54 days post-HCT (interquartile range, 23 to 160 days), with a 1-year post-transplantation cumulative incidence probability of 1.0% (95% confidence interval [CI], .81% to 1.3%) and was noted in 7.6% of all pediatric intensive care unit patients. Risk factors included receipt of transplantation for nonmalignant hematologic disease (reference: malignant hematologic disease; hazard ratio [HR], 1.98; 95% CI, 1.22 to 3.22; P = .006), use of a calcineurin inhibitor (CNI) plus mycophenolate mofetil (MMF) as graft-versus-host disease (GVHD) prophylaxis (referent: CNI plus methotrexate; HR, 1.89; 95% CI, 1.07 to 3.34; P = .029), and grade III-IV acute GVHD (HR, 2.67; 95% CI, 1.53-4.66; P < .001). Critical care admitted patients with DAH had significantly higher rates of systemic hypertension, pulmonary hypertension, pericardial disease, renal failure, and bacterial/viral/fungal infections (P < .05) than those without DAH. From the time of DAH, median survival was 2.2 months, and 1-year overall survival was 26% (95% CI, 17% to 36%). Among all HCT recipients, the development of DAH when considered was associated with a 7-fold increase in unadjusted all-cause post-HCT mortality (HR, 6.96; 95% CI, 5.42 to 8.94; P < .001). In a landmark analysis of patients alive at 2 months post-HCT, patients who developed DAH had a 1-year overall survival of 33% (95% CI, 18% to 49%), compared to 82% (95% CI, 81% to 83%) for patients without DAH (P < .001). Although DAH is rare, it is associated with high mortality in the post-HCT setting. Our data suggest that clinicians should have a heightened index of suspicion of DAH in patients with pulmonary symptoms in the context of nonmalignant hematologic indication for HCT, use of CNI + MMF as GVHD prophylaxis, and severe acute GVHD. Further investigations and validation of modifiable risk factors are warranted given poor outcomes.
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Affiliation(s)
- Geoffrey Cheng
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of California, San Francisco, California.
| | - Michael A Smith
- Division of Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, California
| | - Rachel Phelan
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ruta Brazauskas
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Joelle Strom
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kwang Woo Ahn
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Andrew Peterson
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bipin Savani
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Christine Higham
- Department of Pediatrics, Division of Allergy, Immunology, and BMT, University of California, San Francisco, California
| | - Sandhya Kharbanda
- Department of Pediatrics, Division of Allergy, Immunology, and BMT, University of California, San Francisco, California
| | - Christopher C Dvorak
- Department of Pediatrics, Division of Allergy, Immunology, and BMT, University of California, San Francisco, California
| | - Matt S Zinter
- Division of Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, California; Department of Pediatrics, Division of Allergy, Immunology, and BMT, University of California, San Francisco, California
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Bachman TE, Newth CJL, Ross PA, Patel N, Bhalla A. Association of extreme hyperoxemic events and mortality in pediatric critical care: an observational cohort study. Front Pediatr 2024; 12:1429882. [PMID: 39144469 PMCID: PMC11322569 DOI: 10.3389/fped.2024.1429882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/16/2024] [Indexed: 08/16/2024] Open
Abstract
Objective Our aim was to confirm whether extreme hyperoxemic events had been associated with excess mortality in our diverse critical care population. Methods Retrospective analysis of 9 years of data collected in the pediatric and cardiothoracic ICUs in Children's Hospital Los Angeles was performed. The analysis was limited to those mechanically ventilated for at least 24 h, with at least 1 arterial blood gas measurement. An extreme hyperoxemic event was defined as a PaO2 of ≥300 torr. Multivariable logistic regression was used to assess the association of extreme hyperoxemia events and mortality, adjusting for confounding variables. Selected a-priori, these were Pediatric Risk of Mortality III predicted mortality, general or cardiothoracic ICU, number of blood gas measurements, as well as an abnormal blood gas measurements (pH < 7.25, pH > 7.45, and PaO2 < 50 torr). Results There were 4,003 admissions included with a predicted mortality of 7.1% and an actual mortality of 9.7%. Their care was associated with 75,129 blood gas measurements, in which abnormal measurements were common. With adjustments for these covariates, any hyperoxemic event was associated with excess mortality (p < 0.001). Excess mortality increased with multiple hyperoxemic events (p < 0.046). Additionally, treatment resulting in SpO2 > 98% markedly increased the risk of a hyperoxemic event. Conclusion Retrospective analysis of critical care admissions showed that extreme hyperoxemic events were associated with higher mortality. Supplemental oxygen levels resulting in SpO2 > 98% should be avoided.
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Affiliation(s)
- Thomas E. Bachman
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czechia
| | - Christopher J. L. Newth
- Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Patrick A. Ross
- Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Nimesh Patel
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anoopindar Bhalla
- Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
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Buiteman-Kruizinga LA, Serpa Neto A, Botta M, List SS, de Boer BH, van Velzen P, Bühler PK, Wendel Garcia PD, Schultz MJ, van der Heiden PLJ, Paulus F. Effect of automated versus conventional ventilation on mechanical power of ventilation-A randomized crossover clinical trial. PLoS One 2024; 19:e0307155. [PMID: 39078857 PMCID: PMC11288413 DOI: 10.1371/journal.pone.0307155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/29/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Mechanical power of ventilation, a summary parameter reflecting the energy transferred from the ventilator to the respiratory system, has associations with outcomes. INTELLiVENT-Adaptive Support Ventilation is an automated ventilation mode that changes ventilator settings according to algorithms that target a low work-and force of breathing. The study aims to compare mechanical power between automated ventilation by means of INTELLiVENT-Adaptive Support Ventilation and conventional ventilation in critically ill patients. MATERIALS AND METHODS International, multicenter, randomized crossover clinical trial in patients that were expected to need invasive ventilation > 24 hours. Patients were randomly assigned to start with a 3-hour period of automated ventilation or conventional ventilation after which the alternate ventilation mode was selected. The primary outcome was mechanical power in passive and active patients; secondary outcomes included key ventilator settings and ventilatory parameters that affect mechanical power. RESULTS A total of 96 patients were randomized. Median mechanical power was not different between automated and conventional ventilation (15.8 [11.5-21.0] versus 16.1 [10.9-22.6] J/min; mean difference -0.44 (95%-CI -1.17 to 0.29) J/min; P = 0.24). Subgroup analyses showed that mechanical power was lower with automated ventilation in passive patients, 16.9 [12.5-22.1] versus 19.0 [14.1-25.0] J/min; mean difference -1.76 (95%-CI -2.47 to -10.34J/min; P < 0.01), and not in active patients (14.6 [11.0-20.3] vs 14.1 [10.1-21.3] J/min; mean difference 0.81 (95%-CI -2.13 to 0.49) J/min; P = 0.23). CONCLUSIONS In this cohort of unselected critically ill invasively ventilated patients, automated ventilation by means of INTELLiVENT-Adaptive Support Ventilation did not reduce mechanical power. A reduction in mechanical power was only seen in passive patients. STUDY REGISTRATION Clinicaltrials.gov (study identifier NCT04827927), April 1, 2021. URL OF TRIAL REGISTRY RECORD https://clinicaltrials.gov/study/NCT04827927?term=intellipower&rank=1.
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Affiliation(s)
- Laura A. Buiteman-Kruizinga
- Department of Intensive Care, Reinier de Graaf Hospital, Delft, the Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers ‘Location AMC’, Amsterdam, the Netherlands
| | - Ary Serpa Neto
- Department of Intensive Care, Amsterdam University Medical Centers ‘Location AMC’, Amsterdam, the Netherlands
- Australian and New Zealand Intensive Care–Research Centre (ANZIC–RC), Monash University, Melbourne, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Michela Botta
- Department of Intensive Care, Amsterdam University Medical Centers ‘Location AMC’, Amsterdam, the Netherlands
| | - Stephanie S. List
- Department of Intensive Care, Dijklander Hospital ‘Location Hoorn’, Hoorn, the Netherlands
| | - Ben H. de Boer
- Department of Intensive Care, Dijklander Hospital ‘Location Hoorn’, Hoorn, the Netherlands
| | - Patricia van Velzen
- Department of Intensive Care, Dijklander Hospital ‘Location Hoorn’, Hoorn, the Netherlands
| | - Philipp Karl Bühler
- Institute of Intensive Care Medicine, University Hospital Zürich, Zürich, Switzerland
| | | | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Centers ‘Location AMC’, Amsterdam, the Netherlands
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Anesthesia, General Intensive Care and Pain Management, Medical University Wien, Vienna, Austria
| | | | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers ‘Location AMC’, Amsterdam, the Netherlands
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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Zhou Y, Hou D, Chen C, Yang Y, Wang Y, Song Y. Association of immune deficiency with prognosis and corticosteroid treatment benefits among patients with acute respiratory distress syndrome. J Thorac Dis 2024; 16:4250-4262. [PMID: 39144327 PMCID: PMC11320230 DOI: 10.21037/jtd-24-109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/17/2024] [Indexed: 08/16/2024]
Abstract
Background The role of corticosteroids in acute respiratory distress syndrome (ARDS) remains contentious. This study aims to investigate the prognostic significance of immune deficiency in patients with ARDS and its response to varying doses of corticosteroids. Methods This single-center, retrospective cohort study enrolled 657 ARDS patients from January 24, 2008, to September 12, 2022, at Zhongshan Hospital of Fudan University, Shanghai, China. The patients were categorized into a discovery dataset (n=357) and a validation dataset (n=300), based on admission date. Further validation of the results in the validation dataset was used to enhance the credibility of the study conclusions. The study examined the association between immune deficiency and the patients' clinical characteristics, treatment measures, and prognosis. The primary outcome was 28-day mortality post disease onset. Data analysis was conducted from June 15, 2023 to August 15, 2023. Results The initial risk factor analysis in the discovery dataset was primarily based on the clinical characteristics, and the results suggested that immune deficiency likely impacted overall survival among patients receiving different doses of corticosteroid treatment. Multivariate analysis identified immune deficiency as an independent prognostic factor for overall survival in both the discovery and validation datasets. The final analysis revealed that patients with mild to moderate ARDS [discovery dataset: hazard ratio (HR) =1.719; 95% confidence interval (CI): 1.229-2.406; log-rank test P=0.001; validation dataset: HR =1.874; 95% CI: 1.238-2.837; log-rank test P=0.002] or severe ARDS (discovery dataset: HR =1.874; 95% CI: 1.007-3.488; log-rank test P=0.04; validation dataset: HR =1.698; 95% CI: 1.042-2.768; log-rank test P=0.03) with immune deficiency exhibited lower overall survival rates. Patients with mild to moderate ARDS and immune deficiency showed greater benefits from low-dose corticosteroid treatment (HR =0.409; 95% CI: 0.249-0.671; P<0.001 for interaction), whereas those with severe ARDS and immune deficiency benefitted from both low and high-dose treatments (low corticosteroid: HR =0.299; 95% CI: 0.136-0.654; high corticosteroid: HR =0.458; 95% CI: 0.214-0.981; P=0.005 for interaction). Conclusions Immune deficiency is an independent risk factor in ARDS. Incorporating it into the disease severity grading system based on the Berlin criteria may enhance personalized treatment approaches for ARDS patients. These findings warrant further validation through prospective, large-scale, multicenter randomized controlled trials (RCTs).
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Affiliation(s)
- Yanan Zhou
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Dongni Hou
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cuicui Chen
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yanping Yang
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Ying Wang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuanlin Song
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Respiratory Research Institute, Shanghai, China
- National and Shanghai Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Center of Emergency and Critical Medicine, Jinshan Hospital of Fudan University, Shanghai, China
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Nguyen M, Amanian A, Wei M, Prisman E, Mendez-Tellez PA. Predicting Tracheostomy Need on Admission to the Intensive Care Unit-A Multicenter Machine Learning Analysis. Otolaryngol Head Neck Surg 2024. [PMID: 39077854 DOI: 10.1002/ohn.919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 06/12/2024] [Accepted: 07/06/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE It is difficult to predict which mechanically ventilated patients will ultimately require a tracheostomy which further predisposes them to unnecessary spontaneous breathing trials, additional time on the ventilator, increased costs, and further ventilation-related complications such as subglottic stenosis. In this study, we aimed to develop a machine learning tool to predict which patients need a tracheostomy at the onset of admission to the intensive care unit (ICU). STUDY DESIGN Retrospective Cohort Study. SETTING Multicenter Study of 335 Intensive Care Units between 2014 and 2015. METHODS The eICU Collaborative Research Database (eICU-CRD) was utilized to obtain the patient cohort. Inclusion criteria included: (1) Age >18 years and (2) ICU admission requiring mechanical ventilation. The primary outcome of interest included tracheostomy assessed via a binary classification model. Models included logistic regression (LR), random forest (RF), and Extreme Gradient Boosting (XGBoost). RESULTS Of 38,508 invasively mechanically ventilated patients, 1605 patients underwent a tracheostomy. The XGBoost, RF, and LR models had fair performances at an AUROC 0.794, 0.780, and 0.775 respectively. Limiting the XGBoost model to 20 features out of 331, a minimal reduction in performance was observed with an AUROC of 0.778. Using Shapley Additive Explanations, the top features were an admission diagnosis of pneumonia or sepsis and comorbidity of chronic respiratory failure. CONCLUSIONS Our machine learning model accurately predicts the probability that a patient will eventually require a tracheostomy upon ICU admission, and upon prospective validation, we have the potential to institute earlier interventions and reduce the complications of prolonged ventilation.
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Affiliation(s)
| | - Ameen Amanian
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of British Columbia, Vancouver, Canada
| | - Meihan Wei
- Department of Biomedical Engineering-Whiting School of Engineering, Johns Hopkins University, Baltimore, USA
| | - Eitan Prisman
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of British Columbia, Vancouver, Canada
| | - Pedro Alejandro Mendez-Tellez
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Hsiao WL, Hsieh PY, Hsu LF, Lai YH, Wang ML, Yeh YC. Effectiveness of a delirium risk assessment and multidisciplinary care approach in reducing delirium incidence among surgical intensive care unit patients: A retrospective pre-post intervention study. J Clin Anesth 2024; 98:111566. [PMID: 39084094 DOI: 10.1016/j.jclinane.2024.111566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 07/21/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Delirium is a common complication in intensive care unit (ICU) patients. It can lead to various adverse events. In this study, we investigated the effectiveness of combining the use of the PREdiction of DELIRium (PRE-DELIRIC) model for delirium risk assessment and the use of a multicomponent care bundle for delirium assessment, prevention, and care in terms of reductions in the incidence of delirium among surgical ICU patients. METHODS This retrospective study included surgical ICU patients who had received PRE-DELIRIC-guided SMART/SmART care (SMART care: SmART bundle plus multidisciplinary team; SmART care: Sleep/sweet sense of home (creating a comforting and restful environment for patients), Assessment (regular and thorough evaluation of patient needs and conditions), Release (revised endotracheal tube care/removal, restraint device care, and immobility reduction for patient comfort), and Time (reorientation of time to optimize patient care schedules) in our hospital between May 2022 and March 2023 (intervention group) and individuals who had received usual care between January 2021 and April 2022 (historical control group). The SmART intervention involves providing care in the following domains: sleep/sweet sense of home, assessment, release, and time. Patients with a PRE-DELIRIC score of >30% received SMART care, which includes multidisciplinary (physicians, pharmacists, respiratory therapists, and physiotherapists) care in addition to SmART care. For the control group, usual care was provided following the guidelines for the prevention and management of pain, agitation, delirium, immobility, and sleep disruption. The primary outcome was delirium incidence during ICU stay, which was assessed using the Intensive Care Delirium Screening Checklist. The secondary outcomes were the duration of ICU stay, rate of unplanned self-extubation, and status of ICU discharge. RESULTS The intervention and control groups comprised 184 and 197 patients, respectively; their mean ages were 63.7 ± 18.4 years and 62.4 ± 19.5 years, respectively. The incidence of delirium was significantly lower (p = 0.001) in the intervention group (22.3%) than in the control group (47.7%). CONCLUSION Our findings suggest that the PRE-DELIRIC-guided SMART/SmART care intervention is effective in preventing and managing delirium among surgical ICU patients.
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Affiliation(s)
- Wei-Ling Hsiao
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan; School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Yin Hsieh
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Ling-Fang Hsu
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Yeur-Hur Lai
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Nursing, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yu-Chang Yeh
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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232
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Yih WK, Duffy J, Su JR, Bazel S, Fireman B, Hurley L, Maro JC, Marquez P, Moro P, Nair N, Nelson J, Smith N, Sundaram M, Vasquez-Benitez G, Weintraub E, Xu S, Shimabukuro T. Tinnitus after COVID-19 vaccination: Findings from the vaccine adverse event reporting system and the vaccine safety datalink. Am J Otolaryngol 2024; 45:104448. [PMID: 39096568 DOI: 10.1016/j.amjoto.2024.104448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 07/29/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE To assess the occurrence of tinnitus following COVID-19 vaccination using data mining and descriptive analyses in two U.S. vaccine safety surveillance systems. METHODS Reports of tinnitus after COVID-19 vaccination to the Vaccine Adverse Event Reporting System (VAERS) from 2020 through 2024 were examined using empirical Bayesian data mining and by calculating reporting rates. In the Vaccine Safety Datalink (VSD) population, ICD-10 coded post-vaccination medical visits were examined using tree-based data mining, and tinnitus visit incidence rates during post-vaccination days 1-140 were calculated by age group for COVID-19 vaccines and for comparison, influenza vaccine. RESULTS VAERS data mining did not find disproportionate reporting of tinnitus for any COVID-19 vaccine. VAERS received up to 84.82 tinnitus reports per million COVID-19 vaccine doses administered. VSD tree-based data mining found no signals for tinnitus. VSD tinnitus visit incidence rates after COVID-19 vaccines were similar to those after influenza vaccine except for the group aged ≥65 years (Moderna COVID-19 vaccine, 165 per 10,000 person-years; Pfizer-BioNTech COVID-19 vaccine, 154; influenza vaccine, 135). CONCLUSIONS Overall, these findings do not support an increased risk of tinnitus following COVID-19 vaccination but cannot definitively exclude the possibility. Descriptive comparisons between COVID-19 and influenza vaccines were limited by lack of adjustment for potential confounding factors.
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Affiliation(s)
- W Katherine Yih
- Harvard Pilgrim Health Care Institute and Department of Population Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Jonathan Duffy
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
| | - John R Su
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Samaneh Bazel
- Office of Biostatistics and Pharmacovigilance, Food and Drug Administration, Silver Spring, MD, United States of America
| | - Bruce Fireman
- Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Laura Hurley
- Ambulatory Care Services, Denver Health and Hospitals, Denver, CO, United States of America; Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Judith C Maro
- Harvard Pilgrim Health Care Institute and Department of Population Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Paige Marquez
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Pedro Moro
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Narayan Nair
- Office of Biostatistics and Pharmacovigilance, Food and Drug Administration, Silver Spring, MD, United States of America
| | - Jennifer Nelson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Ning Smith
- Kaiser Permanente Northwest, Portland, OR, United States of America
| | - Maria Sundaram
- Marshfield Clinic Research Institute, Marshfield, WI, United States of America
| | | | - Eric Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Stanley Xu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Tom Shimabukuro
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Fodil S, Urbina T, Bredin S, Mayaux J, Lafarge A, Missri L, Maury E, Demoule A, Pene F, Mariotte E, Ait-Oufella H. Bloodstream infections among patients receiving therapeutic plasma exchanges in the intensive care unit: a 10 year multicentric study. Ann Intensive Care 2024; 14:117. [PMID: 39073720 PMCID: PMC11286886 DOI: 10.1186/s13613-024-01346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/29/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Therapeutic plasma exchanges (TPE), which affect the humoral response, are often performed in combination with immunosuppressive drugs. For this reason, TPE may be associated with an increased susceptibility to infections. We aimed to describe blood stream infection (BSI) incidence in ICU patients treated with TPE and to identify associated risk factors. METHODS We retrospectively included patients that had received at least one session of TPE in the ICU of one of the 4 participating centers (all in Paris, France) between January 1st 2010 and December 31th 2019. Patients presenting with a BSI during ICU stay were compared to patients without such an infection. Risk factors for BSI were identified by a multivariate logistic regression model. RESULTS Over 10 years in the 4 ICUs, 387 patients were included, with a median of 5 [2-7] TPE sessions per patient. Most frequent indications for TPE were thrombotic microangiopathy (47%), central nervous system inflammatory disorders (11%), hyperviscosity syndrome (11%) and ANCA associated vasculitis (8.5%). Thirty-one patients (8%) presented with a BSI during their ICU stay, a median of 7 [3-11] days after start of TPE. In a multivariate logistic regression model, diabetes (OR 3.32 [1.21-8.32]) and total number of TPE sessions (OR 1.14 [1.08-1.20]) were independent risk factors for BSI. There was no difference between TPE catheter infection related BSI (n = 11 (35%)) and other sources of BSI (n = 20 (65%)) regarding catheter insertion site (p = 0.458) or rate of TPE catheter related deep vein thrombosis (p = 0.601). ICU course was severe in patients presenting with BSI when compared to patients without BSI, with higher need for mechanical ventilation (45% vs 18%, p = 0.001), renal replacement therapy (42% vs 20%, p = 0.011), vasopressors (32% vs 12%, p = 0.004) and a higher mortality (19% vs 5%, p = 0.010). CONCLUSION Blood stream infections are frequent in patients receiving TPE in the ICU, and are associated with a severe ICU course. Vigilant monitoring is crucial particularly for patients receiving a high number of TPE sessions.
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Affiliation(s)
- Sofiane Fodil
- Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Tomas Urbina
- Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Swann Bredin
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Julien Mayaux
- Service de Médecine Intensive-Réanimation, Groupe Hospitalier Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Antoine Lafarge
- Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Louaï Missri
- Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Eric Maury
- Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Alexandre Demoule
- Service de Médecine Intensive-Réanimation, Groupe Hospitalier Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frederic Pene
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Mariotte
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive-Réanimation, Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.
- Inserm U970, Cardiovascular Research Center, Université Paris-Cité, Paris, France.
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Jordano JO, Vasilevskis EE, Simmons SF, Taylor WD, Monte AA, Duggan MC, Han JH. Selective serotonin/serotonin-norepinephrine reuptake inhibitor serum concentrations' association with delirium duration. J Am Geriatr Soc 2024. [PMID: 39073750 DOI: 10.1111/jgs.19107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/22/2024] [Accepted: 06/30/2024] [Indexed: 07/30/2024]
Affiliation(s)
- James O Jordano
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eduard E Vasilevskis
- Department of Medicine, Division of Hospital Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Sandra F Simmons
- Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Warren D Taylor
- Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew A Monte
- Rocky Mountain Poison and Drug Safety, Denver Health & Hospital Authority, Denver, Colorado, USA
| | - Maria C Duggan
- Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Jin H Han
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
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235
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Kittrell HD, Shaikh A, Adintori PA, McCarthy P, Kohli-Seth R, Nadkarni GN, Sakhuja A. Role of artificial intelligence in critical care nutrition support and research. Nutr Clin Pract 2024. [PMID: 39073166 DOI: 10.1002/ncp.11194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 06/06/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Nutrition plays a key role in the comprehensive care of critically ill patients. Determining optimal nutrition strategy, however, remains a subject of intense debate. Artificial intelligence (AI) applications are becoming increasingly common in medicine, and specifically in critical care, driven by the data-rich environment of intensive care units. In this review, we will examine the evidence regarding the application of AI in critical care nutrition. As of now, the use of AI in critical care nutrition is relatively limited, with its primary emphasis on malnutrition screening and tolerance of enteral nutrition. Despite the current scarcity of evidence, the potential for AI for more personalized nutrition management for critically ill patients is substantial. This stems from the ability of AI to integrate multiple data streams reflecting patients' changing needs while addressing inherent heterogeneity. The application of AI in critical care nutrition holds promise for optimizing patient outcomes through tailored and adaptive nutrition interventions. A successful implementation of AI, however, necessitates a multidisciplinary approach, coupled with careful consideration of challenges related to data management, financial aspects, and patient privacy.
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Affiliation(s)
- Hannah D Kittrell
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Data Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmed Shaikh
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter A Adintori
- Food and Nutrition Services Department, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Program in Rehabilitation Sciences, New York University Steinhardt, New York, New York, USA
| | - Paul McCarthy
- Department of Cardiovascular and Thoracic Surgery, Division of Cardiovascular Critical Care, West Virginia University, Morgantown, West Virginia, USA
| | - Roopa Kohli-Seth
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Girish N Nadkarni
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Mount Sinai Clinical Intelligence Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Data Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ankit Sakhuja
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Data Driven and Digital Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Groth CM, Droege CA, Sarangarm P, Cucci MD, Gustafson KA, Connor KA, Kaukeinen K, Acquisto NM, Chui SHJ, Dixit D, Flannery AH, Glass NE, Horng H, Heavner MS, Kinney J, Peppard WJ, Sikora A, Erstad BL. Multicenter Retrospective Review of Ketamine Use in Pediatric Intensive Care Units (Ketamine-PICU Study). Crit Care Res Pract 2024; 2024:6626899. [PMID: 39104664 PMCID: PMC11300064 DOI: 10.1155/2024/6626899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/10/2024] [Accepted: 07/10/2024] [Indexed: 08/07/2024] Open
Abstract
Objective Describe continuous infusion (CI) ketamine practices in pediatric intensive care units (PICUs) and evaluate its effect on pain/sedation scores, exposure to analgesics/sedatives, and adverse effects (AEs). Methods Multicenter, retrospective, observational study in children <18 years who received CI ketamine between 2014 and 2017. Time spent in goal pain/sedation score range and daily cumulative doses of analgesics/sedatives were compared from the 24 hours (H) prior to CI ketamine to the first 24H and 25-48H of the CI. Adverse effects were collected over the first 7 days of CI ketamine. Results Twenty-four patients from 4 PICUs were included; median (IQR) age 7 (1-13.25) years, 54% female (n = 13), 92% intubated (n = 22), 25% on CI vasopressors (n = 6), and 33% on CI paralytics (n = 8). Ketamine indications were analgesia/sedation (n = 21, 87.5%) and status epilepticus (n = 3, 12.5%). Median starting dose was 0.5 (0.48-0.70) mg/kg/hr and continued for a median of 2.4 (1.3-4.4) days. There was a significant difference in mean proportion of time spent within goal pain score range (24H prior: 74% ± 14%, 0-24H: 85% ± 10%, and 25-48H: 72% ± 20%; p=0.014). A significant reduction in median morphine milligram equivalents (MME) was seen (24H prior: 58 (8-195) mg vs. 0-24H: 4 (0-69) mg and p=0.01), but this was not sustained (25-48H: 24 (2-246) mg and p=0.29). Common AEs were tachycardia (63%), hypotension (54%), secretions/suctioning (29%), and emergence reactions (13%). Conclusions Ketamine CI improved time in goal pain score range and significantly reduced MME, but this was not sustained. Larger prospective studies are needed in the pediatric population.
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Affiliation(s)
- Christine M. Groth
- Adult Critical Care and Emergency MedicineDepartment of PharmacyUniversity of Rochester Medical Center, 601 Elmwood Ave. Box 638, Rochester 14642, NY, USA
| | - Christopher A. Droege
- Department of Pharmacy ServicesUC Health-University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Preeyaporn Sarangarm
- Emergency MedicineDepartment of PharmacyUniversity of New Mexico Hospitals, Albuquerque, NM, USA
| | | | - Kyle A. Gustafson
- Department of Pharmacy PracticeNortheastern Ohio Medical University, Rootstown, OH, USA
| | - Kathryn A. Connor
- Department of Pharmacy Practice and AdministrationSt. John Fisher University, Rochester, NY, USA
| | - Kimberly Kaukeinen
- Department of Biostatistics and Computational BiologyUniversity of Rochester Medical Center, Rochester, NY, USA
| | - Nicole M. Acquisto
- Department of PharmacyUniversity of Rochester Medical Center, Rochester, NY, USA
| | - Sai Ho J. Chui
- Department of PharmacyUniversity of Maryland Medical Center, Baltimore, MD, USA
| | - Deepali Dixit
- Department of PharmacyRobert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Alexander H. Flannery
- Department of Pharmacy Practice and ScienceUniversity of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Nina E. Glass
- Department of SurgeryRutgers New Jersey Medical School, Newark, NJ, USA
| | - Helen Horng
- Department of Pharmaceutical ServicesUniversity Hospital of New Jersey, Newark, NJ, USA
| | - Mojdeh S. Heavner
- Department of Pharmacy Practice and ScienceUniversity of Maryland School of Pharmacy, Baltimore 21201, MD, USA
| | - Justin Kinney
- Critical Care MedicineDepartment of Pharmacy PracticeLoma Linda University School of Pharmacy, Loma Linda, CA, USA
| | - William J. Peppard
- Department of PharmacyFroedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrea Sikora
- Department of Clinical and Administrative PharmacyUniversity of Georgia College of PharmacyAugusta University Medical Center, Augusta, GA, USA
| | - Brian L. Erstad
- Department of Pharmacy Practice and ScienceUniversity of Arizona College of Pharmacy, Tucson, AZ, USA
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Danay L, Ramon-Gonen R, Gorodetski M, Schwartz DG. Evaluating the effectiveness of a sliding window technique in machine learning models for mortality prediction in ICU cardiac arrest patients. Int J Med Inform 2024; 191:105565. [PMID: 39094548 DOI: 10.1016/j.ijmedinf.2024.105565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/22/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
Extensive research has been devoted to predicting ICU mortality, to assist clinical teams managing critical patients. Electronic health records (EHR) contain both static and dynamic medical data, with the latter accumulating during ICU stays. Existing models often rely on a fixed time window (e.g., first 24 h) for prediction, potentially missing vital post-24-hour data. The present study aims to improve mortality prediction for ICU patients following Cardiac Arrest (CA) using a dynamic sliding window approach that accommodates evolving data characteristics. Our cohort included 2331 CA patients, of whom 684 died in the ICU and 1647 survived. Applying the sliding window technique, we created six different time windows and used each separately for model training and validation. We compared our results to a baseline accumulative window. The different time windows created by the sliding window technique differed in their prediction performance and outperformed the baseline 24-hour window significantly. The XGBoost model outperformed all other models, with the 30-42 h time window achieving the best results (AUC = 0.8, accuracy = 0.77). Our work shows that the sliding window technique is effective in improving mortality prediction. We demonstrated how important time-window selection is and showed that enhancing it can save time and thus improve mortality prediction. These findings promise to improve the clinical team's efficiency in prioritizing patients and giving greater attention to higher-risk patients. To conclude, mortality prediction in the ICU can be improved if we consider alternative time windows instead of the 24-hour window, which is currently the most widely accepted among scoring systems today.
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Affiliation(s)
- Lihi Danay
- The Graduate School of Business Administration, Bar-Ilan University, Ramat-Gan, Israel
| | - Roni Ramon-Gonen
- The Graduate School of Business Administration, Bar-Ilan University, Ramat-Gan, Israel.
| | | | - David G Schwartz
- The Graduate School of Business Administration, Bar-Ilan University, Ramat-Gan, Israel
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238
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Yang M, Derespina K, Grant C, Vicencio A, Murthy R, Kaushik S. Bronchopleural fistula management in a pediatric patient requiring extracorporeal membrane oxygenation. Perfusion 2024:2676591241268367. [PMID: 39058277 DOI: 10.1177/02676591241268367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Bronchopleural fistula (BPF) is a connection between the bronchus and pleural cavity. It is associated with high morbidity and mortality and management of BPF has not been well described in the pediatric population. We describe a 2-year-old girl who presented with fever and increased work of breathing, found to have atypical hemolytic uremic syndrome and Streptococcus necrotizing pneumonia with development of persistent air leak due to bronchopleural fistulas requiring extracorporeal membrane oxygenation (ECMO). Three endobronchial valves were placed with successful resolution of bronchopleural fistulas. She required tracheostomy for chronic respiratory failure and endobronchial valves were eventually removed. Approximately 3.5 months after discharge to acute care rehabilitation, tracheostomy was successfully decannulated. This case highlights the successful use of endobronchial valves for resolution of BPF while on ECMO as well as the importance of further studies on optimal candidates, timing and duration of intervention in addition to sequelae of endobronchial valve placement.
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Affiliation(s)
- Margaret Yang
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - Kim Derespina
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - Chantal Grant
- Division of Pediatric Pulmonology, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - Alfin Vicencio
- Division of Pediatric Pulmonology, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
| | - Raghav Murthy
- Division of Pediatric Cardiac Surgery, Department of Cardiovascular Surgery, Mount Sinai Icahn School of Medicine, New York City, NY, USA
| | - Shubhi Kaushik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York City, NY, USA
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239
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Wolak T, Dicker D, Shifer Y, Grossman A, Rokach A, Shitrit M, Tal A. A safety evaluation of intermittent high-dose inhaled nitric oxide in viral pneumonia due to COVID-19: a randomised clinical study. Sci Rep 2024; 14:17201. [PMID: 39060420 PMCID: PMC11282178 DOI: 10.1038/s41598-024-68055-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
High-dose inhaled Nitric Oxide (iNO) has been shown to have anti-inflammatory, vasodilator, and antimicrobial properties, resulting in improved arterial oxygenation as well as a beneficial therapeutic effect on lower respiratory tract infections. This study evaluated the safety and efficacy of 150-ppm intermittent iNO administered with a novel iNO-generator, for treating adults hospitalised for viral pneumonia. In this prospective, open-label, multicenter study, subjects aged 18-80, diagnosed with viral pneumonia received either standard supportive treatment alone (Control-Group) or combined with iNO for 40 min, 4 times per day up to 7 days (Treatment-Group). Out of 40 recruited subjects, 35 were included in the intention-to-treat population (34 with COVID-19). Adverse Events rate was similar between the groups (56.3% vs. 42.1%; respectively). No treatment-related adverse events were reported, while 2 serious adverse events were accounted for by underlying pre-existing conditions. Among the Treatment-Group, oxygen support duration was reduced by 2.7 days (Hazard Ratio = 2.8; p = 0.0339), a greater number of subjects reached oxygen saturation ≥ 93% within hospitalisation period (Hazard Ratio = 5.4; p = 0.049), and a trend for earlier discharge was demonstrated. Intermittent 150-ppm iNO-treatment is well-tolerated, safe, and beneficial compared to usual care for spontaneously breathing hospitalised adults diagnosed with COVID-19 viral pneumonia.
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Affiliation(s)
- Talya Wolak
- Department of Internal Medicine D, Shaare Zedek Medical Center, 12 Bait Shmuel St, P.O. Box 3235, 9103102, Jerusalem, Israel.
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - D Dicker
- Internal Medicine D, Hasharon Hospital, Rabin Medical Center, Petah-Tikva, Israel
- Tel Aviv University Faculty of Medicine, Tel Aviv, Israel
| | - Y Shifer
- Internal Medicine D, Hasharon Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - A Grossman
- Internal Medicine B, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel
| | - A Rokach
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Pulmonary Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - M Shitrit
- Respiratory Therapy Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - A Tal
- Beyond Air, Ltd, Rehovot, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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240
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Khattar G, El Gharib K, Pokima N, Kotys J, Kandala V, Mina J, Haddadin F, Abu Baker S, Asmar S, Rizvi T, Flamenbaum M, Elsayegh D, Chalhoub M, El Hage H, El Sayegh S. Fluid Resuscitation Dilemma in End-stage Renal Disease Patients Presenting with Sepsis: A Systematic Review and Meta-analysis. J Intensive Care Med 2024:8850666241261673. [PMID: 39053444 DOI: 10.1177/08850666241261673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Background: This study aims to investigate the safety and efficacy of guideline-directed fluid resuscitation (GDFR) compared with conservative fluid management in end-stage renal disease (ESRD) patients with sepsis by evaluating 90-day mortality and intubation rate. Methods: Following PRISMA guidelines, a systematic review was conducted across multiple databases using specific keywords and controlled vocabulary. The search strategy, implemented until October 1, 2023, aimed to identify studies examining fluid resuscitation in ESRD patients with sepsis. The review process was streamlined using Covidence software. A fourth reviewer resolved discrepancies in study inclusion. A random-effects model with the generic Mantel-Haenszel method was preferred for integrating odds ratios (ORs). Sensitivity analysis and publication bias analysis were performed. Results: Of the 1274 identified studies, 10 were selected for inclusion, examining 1184 patients, 593 of whom received GDFR. Four studies were selected to investigate the intubation rate, including 304 patients. No significant mortality or intubation rate difference was spotted between both groups [OR = 1.23; confidence interval (CI) = 0.92-1.65; I2 = 0% and OR = 1.91; CI = 0.91-4.04]. In most studies, sensitivity analysis using the leave-one-out approach revealed higher mortality and intubation rates. The Egger test results indicated no statistically significant publication bias across the included studies. Conclusion: Our research contradicts the common assumption about the effectiveness of GDFR for sepsis patients with ESRD. It suggests that this approach, while not superior to the conservative strategy, may potentially be harmful.
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Affiliation(s)
- Georges Khattar
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Khalil El Gharib
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Ngowari Pokima
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Juliet Kotys
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Vineeth Kandala
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Jonathan Mina
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Fadi Haddadin
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Saif Abu Baker
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Samer Asmar
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Taqi Rizvi
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Matthew Flamenbaum
- Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Dany Elsayegh
- Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Michel Chalhoub
- Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Halim El Hage
- Department of Pulmonary and Critical Care, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Suzanne El Sayegh
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
- Department of Nephrology, Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
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241
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Mayers JR, Varon J, Zhou RR, Daniel-Ivad M, Beaulieu C, Bhosle A, Glasser NR, Lichtenauer FM, Ng J, Vera MP, Huttenhower C, Perrella MA, Clish CB, Zhao SD, Baron RM, Balskus EP. A metabolomics pipeline highlights microbial metabolism in bloodstream infections. Cell 2024; 187:4095-4112.e21. [PMID: 38885650 PMCID: PMC11283678 DOI: 10.1016/j.cell.2024.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/03/2024] [Accepted: 05/17/2024] [Indexed: 06/20/2024]
Abstract
The growth of antimicrobial resistance (AMR) highlights an urgent need to identify bacterial pathogenic functions that may be targets for clinical intervention. Although severe infections profoundly alter host metabolism, prior studies have largely ignored microbial metabolism in this context. Here, we describe an iterative, comparative metabolomics pipeline to uncover microbial metabolic features in the complex setting of a host and apply it to investigate gram-negative bloodstream infection (BSI) in patients. We find elevated levels of bacterially derived acetylated polyamines during BSI and discover the enzyme responsible for their production (SpeG). Blocking SpeG activity reduces bacterial proliferation and slows pathogenesis. Reduction of SpeG activity also enhances bacterial membrane permeability and increases intracellular antibiotic accumulation, allowing us to overcome AMR in culture and in vivo. This study highlights how tools to study pathogen metabolism in the natural context of infection can reveal and prioritize therapeutic strategies for addressing challenging infections.
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Affiliation(s)
- Jared R Mayers
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA; Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA 02138, USA
| | - Jack Varon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Ruixuan R Zhou
- Department of Statistics, University of Illinois at Urbana Champaign, Champaign, IL 61820, USA
| | - Martin Daniel-Ivad
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA 02138, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | | | - Amrisha Bhosle
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Nathaniel R Glasser
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA 02138, USA
| | | | - Julie Ng
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Mayra Pinilla Vera
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Curtis Huttenhower
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mark A Perrella
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Sihai D Zhao
- Department of Statistics, University of Illinois at Urbana Champaign, Champaign, IL 61820, USA; Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana Champaign, Champaign, IL 61820, USA
| | - Rebecca M Baron
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA.
| | - Emily P Balskus
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA 02138, USA; Howard Hughes Medical Institute, Harvard University, Cambridge, MA 02138, USA.
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242
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Rashidi S, Bagherpour G, Abbasi-Malati Z, Khosrowshahi ND, Chegeni SA, Roozbahani G, Lotfimehr H, Sokullu E, Rahbarghazi R. Endothelial progenitor cells for fabrication of engineered vascular units and angiogenesis induction. Cell Prolif 2024:e13716. [PMID: 39051852 DOI: 10.1111/cpr.13716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/21/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
The promotion of vascularization and angiogenesis in the grafts is a crucial phenomenon in the healing process and tissue engineering. It has been shown that stem cells, especially endothelial progenitor cells (EPCs), can stimulate blood vessel formation inside the engineered hydrogels after being transplanted into the target sites. The incorporation of EPCs into the hydrogel can last the retention time, long-term survival, on-target delivery effects, migration and differentiation into mature endothelial cells. Despite these advantages, further modifications are mandatory to increase the dynamic growth and angiogenesis potential of EPCs in in vitro and in vivo conditions. Chemical modifications of distinct composites with distinct physical properties can yield better regenerative potential and angiogenesis during several pathologies. Here, we aimed to collect recent findings related to the application of EPCs in engineered vascular grafts and/or hydrogels for improving vascularization in the grafts. Data from the present article can help us in the application of EPCs as valid cell sources in the tissue engineering of several ischemic tissues.
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Affiliation(s)
- Somayyeh Rashidi
- Department of Medical Biotechnology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Ghasem Bagherpour
- Department of Medical Biotechnology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
- Zanjan Pharmaceutical Biotechnology Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Zahra Abbasi-Malati
- Student Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Sara Aghakhani Chegeni
- Department of Clinical Biochemistry and Laboratory Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Golbarg Roozbahani
- Department of Plant, Cell and Molecular Biology, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran
| | - Hamid Lotfimehr
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Emel Sokullu
- Research Center for Translational Medicine (KUTTAM), Koç University, Istanbul, Turkey
- Biophysics Department, Koç University School of Medicine, Istanbul, Turkey
| | - Reza Rahbarghazi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Applied Cell Sciences, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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243
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Abdulelah M, Abbas R, Samuel S, Abu-Hishmeh M. When are pulmonologists consulted? Trends and outcomes of pulmonary consultations for unspecified hypoxia. Proc AMIA Symp 2024; 37:763-768. [PMID: 39165825 PMCID: PMC11332629 DOI: 10.1080/08998280.2024.2377010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 08/22/2024] Open
Abstract
Background Clinical judgment is essential in determining the need for specialist consultation. We evaluated patients for whom the pulmonary team was consulted for unspecified hypoxia or acute hypoxic respiratory failure to better understand the characteristics and outcomes of such encounters. Methods We retrospectively studied patients who received consults for unspecified hypoxia or acute hypoxic respiratory failure at a tertiary center. Outcomes evaluated were length of stay, duration of follow-up, and clinical trajectory. Results We identified 103 patients over a 2-year period. The level of care was escalated in 69.9% (n = 72) of patients, and the majority had procedural interventions such as bronchoscopies and chest tube placement. Common diagnoses were pneumonia and volume overload. The mortality rate was 17.5% (n = 18). The mean length of stay was 24 days (standard deviation [SD] 24.1), with an average of 6.6 hospital days (SD 9.9) to consultation. The mean duration of consecutive follow-up was 4.5 days (SD 7.5). Patients who underwent procedures had a shorter duration of follow-up. Conclusion Pulmonary consults were noted for common diagnoses with a high need for escalation in care and procedural interventions, highlighting the importance and appropriateness of specialist consultations. Further studies are needed to explore what triggers an unspecified consult.
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Affiliation(s)
- Mohammad Abdulelah
- Department of Internal Medicine, University of Massachusetts Chan Medical School, Springfield, Massachusetts, USA
| | - Ramsha Abbas
- Department of Internal Medicine, University of Massachusetts Chan Medical School, Springfield, Massachusetts, USA
| | - Sherin Samuel
- Department of Internal Medicine, University of Massachusetts Chan Medical School, Springfield, Massachusetts, USA
| | - Mohammad Abu-Hishmeh
- Department of Internal Medicine, University of Massachusetts Chan Medical School, Springfield, Massachusetts, USA
- Department of Pulmonary and Critical Care Medicine, University of Massachusetts Chan Medical School, Springfield, Massachusetts, USA
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244
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Mirabile A, Sangiorgio G, Bonacci PG, Bivona D, Nicitra E, Bonomo C, Bongiorno D, Stefani S, Musso N. Advancing Pathogen Identification: The Role of Digital PCR in Enhancing Diagnostic Power in Different Settings. Diagnostics (Basel) 2024; 14:1598. [PMID: 39125474 PMCID: PMC11311727 DOI: 10.3390/diagnostics14151598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/19/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024] Open
Abstract
Digital polymerase chain reaction (dPCR) has emerged as a groundbreaking technology in molecular biology and diagnostics, offering exceptional precision and sensitivity in nucleic acid detection and quantification. This review highlights the core principles and transformative potential of dPCR, particularly in infectious disease diagnostics and environmental surveillance. Emphasizing its evolution from traditional PCR, dPCR provides accurate absolute quantification of target nucleic acids through advanced partitioning techniques. The review addresses the significant impact of dPCR in sepsis diagnosis and management, showcasing its superior sensitivity and specificity in early pathogen detection and identification of drug-resistant genes. Despite its advantages, challenges such as optimization of experimental conditions, standardization of data analysis workflows, and high costs are discussed. Furthermore, we compare various commercially available dPCR platforms, detailing their features and applications in clinical and research settings. Additionally, the review explores dPCR's role in water microbiology, particularly in wastewater surveillance and monitoring of waterborne pathogens, underscoring its importance in public health protection. In conclusion, future prospects of dPCR, including methodological optimization, integration with innovative technologies, and expansion into new sectors like metagenomics, are explored.
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Affiliation(s)
- Alessia Mirabile
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, 95125 Catania, Italy; (A.M.); (G.S.); (P.G.B.); (D.B.); (E.N.); (C.B.); (S.S.); (N.M.)
| | - Giuseppe Sangiorgio
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, 95125 Catania, Italy; (A.M.); (G.S.); (P.G.B.); (D.B.); (E.N.); (C.B.); (S.S.); (N.M.)
| | - Paolo Giuseppe Bonacci
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, 95125 Catania, Italy; (A.M.); (G.S.); (P.G.B.); (D.B.); (E.N.); (C.B.); (S.S.); (N.M.)
| | - Dalida Bivona
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, 95125 Catania, Italy; (A.M.); (G.S.); (P.G.B.); (D.B.); (E.N.); (C.B.); (S.S.); (N.M.)
| | - Emanuele Nicitra
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, 95125 Catania, Italy; (A.M.); (G.S.); (P.G.B.); (D.B.); (E.N.); (C.B.); (S.S.); (N.M.)
| | - Carmelo Bonomo
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, 95125 Catania, Italy; (A.M.); (G.S.); (P.G.B.); (D.B.); (E.N.); (C.B.); (S.S.); (N.M.)
| | - Dafne Bongiorno
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, 95125 Catania, Italy; (A.M.); (G.S.); (P.G.B.); (D.B.); (E.N.); (C.B.); (S.S.); (N.M.)
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, 95125 Catania, Italy; (A.M.); (G.S.); (P.G.B.); (D.B.); (E.N.); (C.B.); (S.S.); (N.M.)
- U.O.C. Laboratory Analysis Unit, University Hospital Policlinico-San Marco, Via Santa Sofia 78, 95123 Catania, Italy
| | - Nicolò Musso
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), University of Catania, 95125 Catania, Italy; (A.M.); (G.S.); (P.G.B.); (D.B.); (E.N.); (C.B.); (S.S.); (N.M.)
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245
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Bajgai B, Suri M, Singh H, Hanifa M, Bhatti JS, Randhawa PK, Bali A. Naringin: A flavanone with a multifaceted target against sepsis-associated organ injuries. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 130:155707. [PMID: 38788393 DOI: 10.1016/j.phymed.2024.155707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/16/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Sepsis causes multiple organ dysfunctions and raises mortality and morbidity rates through a dysregulated host response to infection. Despite the growing research interest over the last few years, no satisfactory treatment exists. Naringin, a naturally occurring bioflavonoid with vast therapeutic potential in citrus fruits and Chinese herbs, has received much attention for treating sepsis-associated multiple organ dysfunctions. PURPOSE The review describes preclinical evidence of naringin from 2011 to 2024, particularly emphasizing the mechanism of action mediated by naringin against sepsis-associated specific injuries. The combination therapy, safety profile, drug interactions, recent advancements in formulation, and future perspectives of naringin are also discussed. METHODS In vivo and in vitro studies focusing on the potential role of naringin and its mechanism of action against sepsis-associated organ injuries were identified and summarised in the present manuscript, which includes contributions from 2011 to 2024. All the articles were extracted from the Medline database using PubMed, Science Direct, and Web of Science with relevant keywords. RESULTS Research findings revealed that naringin modulates many signaling cascades, such as Rho/ROCK and PPAR/STAT1, PIP3/AKT and KEAP1/Nrf2, and IkB/NF-kB and MAPK/Nrf2/HO-1, to potentially protect against sepsis-induced intestinal, cardiac, and lung injury, respectively. Furthermore, naringin treatment exhibits anti-inflammatory, anti-apoptotic, and antioxidant action against sepsis harm, highlighting naringin's promising effects in septic settings. Naringin could be employed as a treatment against sepsis, based on studies on combination therapy, synergistic effects, and toxicological investigation that show no reported severe side effects. CONCLUSION Naringin might be a promising therapeutic approach for preventing sepsis-induced multiple organ failure. Naringin should be used alongside other therapeutic therapies with caution despite its great therapeutic potential and lower toxicity. Nonetheless, clinical studies are required to comprehend the therapeutic benefits of naringin against sepsis.
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Affiliation(s)
- Bivek Bajgai
- Laboratory of Neuroendocrinology, Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, India
| | - Manisha Suri
- Laboratory of Neuroendocrinology, Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, India
| | - Harshita Singh
- Laboratory of Neuroendocrinology, Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, India
| | - Mohd Hanifa
- Laboratory of Neuroendocrinology, Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, India
| | - Jasvinder Singh Bhatti
- Department of Human Genetics and Molecular Medicine, Central University of Punjab, Ghudda, Bathinda, India
| | - Puneet Kaur Randhawa
- Department of Pharmaceutical Sciences, Amritsar Group of Colleges, Amritsar, Punjab, 143001, India; Division of Metabolic and Cardiovascular Sciences, Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL, 32827, USA
| | - Anjana Bali
- Laboratory of Neuroendocrinology, Department of Pharmacology, Central University of Punjab, Ghudda, Bathinda, India.
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246
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Kirk J. What on Earth do I do now? Proc AMIA Symp 2024; 37:725. [PMID: 39165806 PMCID: PMC11332613 DOI: 10.1080/08998280.2024.2381175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 08/22/2024] Open
Affiliation(s)
- Jason Kirk
- Department of Palliative Care, Baylor Scott & White Health Medical Center –Temple, Temple, Texas, USA
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Li ZY, Li Z, Xu C, Fu J, Maimaiti Z, Hao LB, Zhang QM, Chen JY. Hypoalbuminemia is Highly Prevalent in Patients with Periprosthetic Joint Infection and Strongly Associated with Treatment Failure. Orthop Surg 2024. [PMID: 39054735 DOI: 10.1111/os.14162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/16/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE The role of hypoalbuminemia throughout the course of chronic periprosthetic joint infection (PJI) remains poorly understood. This study aimed to determine the prevalence and risk factors of hypoalbuminemia in periprosthetic joint infection (PJI) patients and to explore the association between hypoalbuminemia and treatment outcomes. METHODS This retrospective cohort study included 387 PJI cases who underwent two-stage exchange arthroplasty between January 2007 and August 2020, of which 342 were reimplanted. The mean follow-up period was 7.9 years. Multivariate logistic regression analyses were performed to identify risk factors for hypoalbuminemia and to assess the effect of hypoalbuminemia at 1st- and 2nd-stage exchange on the treatment outcome. Furthermore, the impact of dynamic changes in hypoalbuminemia was investigated. RESULTS The prevalence of hypoalbuminemia at 1st- and 2nd-stage exchange was 22.2% and 4.7%, respectively. Patients with age ≥ 68 years and those with isolation of Staphylococcus aureus, Streptococcus, or Gram-negative bacteria exhibited a higher risk of hypoalbuminemia. Hypoalbuminemia at 1st-stage was significantly related to treatment failure (OR = 3.3), while hypoalbuminemia at 2nd-stage raised the OR to 10.0. Patients with persistent hypoalbuminemia at both the 1st- and 2nd-stage exchanges had a significantly higher rate of treatment failure than patients with hypoalbuminemia at the 1st-stage but normal albumin levels at the 2nd-stage exchange (55.6% vs 20.0%, p = 0.036). CONCLUSION One in five patients with chronic PJI exhibits hypoalbuminemia. Hypoalbuminemia is more likely to develop in patients of advanced age and those infected by specific highly virulent organisms. Also, our results highlight the close association between hypoalbuminemia and treatment outcomes.
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Affiliation(s)
- Zhi-Yuan Li
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhuo Li
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Medicine, Nankai University, Tianjin, China
| | - Chi Xu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jun Fu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zulipikaer Maimaiti
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Li-Bo Hao
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qing-Meng Zhang
- Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan, China
| | - Ji-Ying Chen
- Medical School of Chinese PLA, Beijing, China
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
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Campisi M, Cannella L, Bordin A, Moretto A, Scapellato ML, Mason P, Liviero F, Pavanello S. Revealing the Hidden Impacts: Insights into Biological Aging and Long-Term Effects in Pauci- and Asymptomatic COVID-19 Healthcare Workers. Int J Mol Sci 2024; 25:8056. [PMID: 39125624 PMCID: PMC11311509 DOI: 10.3390/ijms25158056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/16/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
This study explores the role of inflammation and oxidative stress, hallmarks of COVID-19, in accelerating cellular biological aging. We investigated early molecular markers-DNA methylation age (DNAmAge) and telomere length (TL)-in blood leukocytes, nasal cells (NCs), and induced sputum (IS) one year post-infection in pauci- and asymptomatic healthcare workers (HCWs) infected during the first pandemic wave (February-May 2020), compared to COPD patients, model for "aged lung". Data from questionnaires, Work Ability Index (WAI), blood analyses, autonomic cardiac balance assessments, heart rate variability (HRV), and pulmonary function tests were collected. Elevated leukocyte DNAmAge significantly correlated with advancing age, male sex, daytime work, and an aged phenotype characterized by chronic diseases, elevated LDL and glycemia levels, medications affecting HRV, and declines in lung function, WAI, lymphocyte count, hemoglobin levels, and HRV (p < 0.05). Increasing age, LDL levels, job positions involving intensive patient contact, and higher leukocyte counts collectively contributed to shortened leukocyte TL (p < 0.05). Notably, HCWs exhibited accelerated biological aging in IS cells compared to both blood leukocytes (p ≤ 0.05) and NCs (p < 0.001) and were biologically older than COPD patients (p < 0.05). These findings suggest the need to monitor aging in pauci- and asymptomatic COVID-19 survivors, who represent the majority of the general population.
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Affiliation(s)
- Manuela Campisi
- Department of Cardiac-, -Thoracic-, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (M.C.); (L.C.); (A.B.); (A.M.); (M.L.S.); (P.M.); (F.L.)
| | - Luana Cannella
- Department of Cardiac-, -Thoracic-, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (M.C.); (L.C.); (A.B.); (A.M.); (M.L.S.); (P.M.); (F.L.)
| | - Anna Bordin
- Department of Cardiac-, -Thoracic-, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (M.C.); (L.C.); (A.B.); (A.M.); (M.L.S.); (P.M.); (F.L.)
- Occupational Medicine, University Hospital of Padua, 35128 Padua, Italy
| | - Angelo Moretto
- Department of Cardiac-, -Thoracic-, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (M.C.); (L.C.); (A.B.); (A.M.); (M.L.S.); (P.M.); (F.L.)
- Occupational Medicine, University Hospital of Padua, 35128 Padua, Italy
| | - Maria Luisa Scapellato
- Department of Cardiac-, -Thoracic-, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (M.C.); (L.C.); (A.B.); (A.M.); (M.L.S.); (P.M.); (F.L.)
- Occupational Medicine, University Hospital of Padua, 35128 Padua, Italy
| | - Paola Mason
- Department of Cardiac-, -Thoracic-, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (M.C.); (L.C.); (A.B.); (A.M.); (M.L.S.); (P.M.); (F.L.)
- Occupational Medicine, University Hospital of Padua, 35128 Padua, Italy
| | - Filippo Liviero
- Department of Cardiac-, -Thoracic-, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (M.C.); (L.C.); (A.B.); (A.M.); (M.L.S.); (P.M.); (F.L.)
- Occupational Medicine, University Hospital of Padua, 35128 Padua, Italy
| | - Sofia Pavanello
- Department of Cardiac-, -Thoracic-, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy; (M.C.); (L.C.); (A.B.); (A.M.); (M.L.S.); (P.M.); (F.L.)
- Occupational Medicine, University Hospital of Padua, 35128 Padua, Italy
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Clark KM, Brown P, Gill D, Karper W. Assessing Evidence-Based Practice Knowledge, Self-Efficacy, and Use Among Respiratory Therapists. Respir Care 2024; 69:913-923. [PMID: 38296331 PMCID: PMC11298226 DOI: 10.4187/respcare.10327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Evidence-based practice is at the forefront of providing quality patient care by using the best available evidence and clinical expertise, while also considering patient needs and preferences for clinical decisions. However, evidence-based practice may not be consistently used even when the evidence supports the therapy. The purpose of this study was to assess the factors associated with the use of evidence-based practice among respiratory therapy faculty teaching in a large community college system and post-professional students enrolled in a university-based, respiratory therapy baccalaureate degree-advancement program. METHODS A non-probability, descriptive survey research design was used to develop and administer an online questionnaire. RESULTS All respondents demonstrated sufficient knowledge and understanding of introductory concepts of evidence-based practice but knowledge of specific components of the evidence-based practice process was not as strong. Self-efficacy in knowledge and the use of evidence-based practice among faculty and degree-advancement students varied. Faculty and students rated their self-efficacy high in assessing patients' needs, values, and treatment preferences but ratings were lower for using the PICO (patient/population/problem, intervention, comparison, outcome) technique and interpreting common statistical tests. Students viewed their previous evidence-based practice learning experiences more favorably compared with faculty (P = .008). Faculty and students searched and read the research literature more often compared with critically appraising and using the research literature. Logistic regression analysis indicated no statistically significant relationship of knowledge, self-efficacy, and learning experiences to the use of evidence-based practice among respiratory therapy students, Χ 2 (4, N = 54) = 7.73; P = .10. CONCLUSIONS Analysis of the results suggested that respiratory therapy faculty and students were knowledgeable and confident with regard to evidence-based practice but their use of evidence-based practice in clinical decisions was limited. Although the evidence-based practice knowledge, self-efficacy, and learning experiences had minimal influence on the use of evidence-based practice, the results of the study provide a foundation for future research.
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Affiliation(s)
- Kimberly M Clark
- University of North Carolina at Charlotte, College of Health and Human Services, Department of Applied Physiology, Health, and Clinical Respiratory Care Programs, Charlotte, North Carolina
| | - Pamela Brown
- University of North Carolina at Greensboro, School of Health and Human Sciences, Department of Kinesiology, Greensboro, North Carolina
| | - Diane Gill
- University of North Carolina at Greensboro, School of Health and Human Sciences, Department of Kinesiology, Greensboro, North Carolina
| | - William Karper
- University of North Carolina at Greensboro, School of Health and Human Sciences, Department of Kinesiology, Greensboro, North Carolina
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Haghedooren E, Haghedooren R, Langer D, Gosselink R. Feasibility and safety of interactive virtual reality upper limb rehabilitation in patients with prolonged critical illness. Aust Crit Care 2024:S1036-7314(24)00117-6. [PMID: 39054204 DOI: 10.1016/j.aucc.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES This study investigated the feasibility and safety of interactive virtual reality rehabilitation (VRR) for patients with a critical illness and a long stay in the intensive care unit (ICU), as a motivational tool for rehabilitation. DESIGN Single-centre, non-randomised proof-of-concept clinical trial. PARTICIPANTS Adult, calm, and alert critically ill patients with a prolonged stay (≥8 days) in the ICU. METHODS Patients received interactive VRR therapy for upper limb rehabilitation with a VR-app designed specifically for use in bedridden patients in the supine position. Feasibility was assessed by time registrations, questionnaires for patients and physiotherapists, as well as recording of all perceived barriers. Safety was assessed by recording (changes in) vital clinical parameters, as well as minor and major adverse events. RESULTS Twenty patients participated in 79 VRR sessions. Median durations of different session components were 2 minutes (interquartile range [IQR] = 2min, 3min) for set-up and explanation to the patient, 10 minutes (IQR = 10min, 15min) for training time, and 2 minutes (IQR = 2min, 2min) for ending the session and cleaning. The median fun score given by the patients after each session was 9 (IQR = 8, 10) out of 10. Physiotherapists reported no barriers other than a few time-consuming technical problems. Reported problems by patients were all minor and mostly technical. No major and no minor adverse events occurred. CONCLUSIONS Interactive upper limb VRR is a feasible, safe, and appreciated tool to use in rehabilitation of critically ill patients during their prolonged ICU stay. Subsequent future studies should focus on the effects of VRR on neuromuscular and cognitive function and the socioeconomic impact of exergaming for rehabilitation purposes of ICU patients.
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Affiliation(s)
- Eline Haghedooren
- KU Leuven, Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium; University Hospitals of KU Leuven, Department of Intensive Care Medicine, Leuven, Belgium.
| | - Renata Haghedooren
- University Hospitals of KU Leuven, Department of Intensive Care Medicine, Leuven, Belgium
| | - Daniel Langer
- KU Leuven, Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium; University Hospitals of KU Leuven, Department of Intensive Care Medicine, Leuven, Belgium
| | - Rik Gosselink
- KU Leuven, Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium; University Hospitals of KU Leuven, Department of Intensive Care Medicine, Leuven, Belgium
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