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Ducharme-Crevier L, Furlong-Dillard J, Jung P, Chiusolo F, Malone MP, Ambati S, Parsons SJ, Krawiec C, Al-Subu A, Polikoff LA, Napolitano N, Tarquinio KM, Shenoi A, Talukdar A, Mallory PP, Giuliano JS, Breuer RK, Kierys K, Kelly SP, Motomura M, Sanders RC, Freeman A, Nagai Y, Glater-Welt LB, Wilson J, Loi M, Adu-Darko M, Shults J, Nadkarni V, Emeriaud G, Nishisaki A. Safety of primary nasotracheal intubation in the pediatric intensive care unit (PICU). Intensive Care Med Paediatr Neonatal 2024; 2:7. [PMID: 38404646 PMCID: PMC10891187 DOI: 10.1007/s44253-024-00035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024]
Abstract
Background Nasal tracheal intubation (TI) represents a minority of all TI in the pediatric intensive care unit (PICU). The risks and benefits of nasal TI are not well quantified. As such, safety and descriptive data regarding this practice are warranted. Methods We evaluated the association between TI route and safety outcomes in a prospectively collected quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from 2013 to 2020. The primary outcome was severe desaturation (SpO2 > 20% from baseline) and/or severe adverse TI-associated events (TIAEs), using NEAR4KIDS definitions. To balance patient, provider, and practice covariates, we utilized propensity score (PS) matching to compare the outcomes of nasal vs. oral TI. Results A total of 22,741 TIs [nasal 870 (3.8%), oral 21,871 (96.2%)] were reported from 60 PICUs. Infants were represented in higher proportion in the nasal TI than the oral TI (75.9%, vs 46.2%), as well as children with cardiac conditions (46.9% vs. 14.4%), both p < 0.001. Severe desaturation or severe TIAE occurred in 23.7% of nasal and 22.5% of oral TI (non-adjusted p = 0.408). With PS matching, the prevalence of severe desaturation and or severe adverse TIAEs was 23.6% of nasal vs. 19.8% of oral TI (absolute difference 3.8%, 95% confidence interval (CI): - 0.07, 7.7%), p = 0.055. First attempt success rate was 72.1% of nasal TI versus 69.2% of oral TI, p = 0.072. With PS matching, the success rate was not different between two groups (nasal 72.2% vs. oral 71.5%, p = 0.759). Conclusion In this large international prospective cohort study, the risk of severe peri-intubation complications was not significantly higher. Nasal TI is used in a minority of TI in PICUs, with substantial differences in patient, provider, and practice compared to oral TI.A prospective multicenter trial may be warranted to address the potential selection bias and to confirm the safety of nasal TI.
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Affiliation(s)
- Laurence Ducharme-Crevier
- Pediatric Intensive Care Unit, Department of Pediatrics, CHU Sainte-Justine Université de Montréal, Montréal, QC H3T 1C5 Canada
| | - Jamie Furlong-Dillard
- Department of Pediatric Critical Care, Norton Children's Hospital, University of Louisville, Louisville, KY USA
| | - Philipp Jung
- Department of Pediatrics, University Hospital Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - Fabrizio Chiusolo
- Department of Anesthesia and Critical Care, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Matthew P Malone
- Division of Critical Care Medicine, Department of Pediatrics, The University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR USA
| | - Shashikanth Ambati
- Division of Pediatric Critical Care, Department of Pediatrics, Albany Medical Center, Albany, NY USA
| | - Simon J Parsons
- Section of Critical Care Medicine, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB Canada
| | - Conrad Krawiec
- Pediatric Critical Care, Department of Pediatrics, College of Medicine, Penn State Health Children's Hospital, Hershey, PA USA
| | - Awni Al-Subu
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI USA
| | - Lee A Polikoff
- Division of Pediatric Critical Care Medicine, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Natalie Napolitano
- Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA USA
| | - Keiko M Tarquinio
- College of Health Professions, the Medical University of South Carolina, Charleston, SC USA
| | - Asha Shenoi
- Division of Pediatric Critical Care, Department of Pediatrics, University of Kentucky School of Medicine, Lexington, KY USA
| | - Andrea Talukdar
- Pediatric Critical Care, Medical Center/Children's Hospital and Medical Center of Omaha, University of Nebraska, Omaha, NE USA
| | - Palen P Mallory
- Division of Pediatric Critical Care Medicine, Duke University, Durham, NC USA
| | - John S Giuliano
- Department of Pediatrics (Critical Care Medicine), Yale University School of Medicine, New Haven, CT USA
| | - Ryan K Breuer
- Division of Critical Care Medicine, Department of Pediatrics, Oishei Children's Hospital, Buffalo, NY USA
| | - Krista Kierys
- Pediatric Intensive Care Unit, Penn State Health, Philadelphia, PA USA
| | - Serena P Kelly
- Division of Pediatric Critical Care, OHSU Doernbecher Children's Hospital, Portland, OR USA
| | - Makoto Motomura
- Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, Obu, Aichi Japan
| | - Ron C Sanders
- Section of Critical Care, Department of Pediatrics, UAMS/Arkansas Children's Hospital, Little Rock, AR USA
| | - Ashley Freeman
- Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Georgia at the Medical College of Georgia, Augusta, GA USA
| | - Yuki Nagai
- Division of Pediatric Critical Care Medicine, Kobe Children's Hospital, Kobe, Hyogo Japan
| | - Lily B Glater-Welt
- Pediatric Critical Care Medicine, Cohen Children's Medical Center of New York/Northwell, Queens, NY USA
| | - Joseph Wilson
- Pediatric Critical Care Medicine, University of Louisville, Louisville, KY USA
| | - Mervin Loi
- Department of Pediatric Subspecialties, Children's Intensive Care Unit KK Women's and Children's Hospital, Singapore, Singapore
| | - Michelle Adu-Darko
- Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia Hospital, Charlottesville, VA USA
| | - Justine Shults
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA USA
| | - Guillaume Emeriaud
- Pediatric Intensive Care Unit, Department of Pediatrics, CHU Sainte-Justine Université de Montréal, Montréal, QC H3T 1C5 Canada
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA USA
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Gladen KM, Tellez D, Napolitano N, Edwards LR, Sanders RC, Kojima T, Malone MP, Shults J, Krawiec C, Ambati S, McCarthy R, Branca A, Polikoff LA, Jung P, Parsons SJ, Mallory PP, Komeswaran K, Page-Goertz C, Toal MC, Bysani GK, Meyer K, Chiusolo F, Glater-Welt LB, Al-Subu A, Biagas K, Hau Lee J, Miksa M, Giuliano JS, Kierys KL, Talukdar AM, DeRusso M, Cucharme-Crevier L, Adu-Arko M, Shenoi AN, Kimura D, Flottman M, Gangu S, Freeman AD, Piehl MD, Nuthall GA, Tarquinio KM, Harwayne-Gidansky I, Hasegawa T, Rescoe ES, Breuer RK, Kasagi M, Nadkarni VM, Nishisaki A. Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013-2020). Pediatr Crit Care Med 2024; 25:147-158. [PMID: 37909825 PMCID: PMC10841296 DOI: 10.1097/pcc.0000000000003387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Extremes of patient body mass index are associated with difficult intubation and increased morbidity in adults. We aimed to determine the association between being underweight or obese with adverse airway outcomes, including adverse tracheal intubation (TI)-associated events (TIAEs) and/or severe peri-intubation hypoxemia (pulse oximetry oxygen saturation < 80%) in critically ill children. DESIGN/SETTING Retrospective cohort using the National Emergency Airway for Children registry dataset of 2013-2020. PATIENTS Critically ill children, 0 to 17 years old, undergoing TI in PICUs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Registry data from 24,342 patients who underwent TI between 2013 and 2020 were analyzed. Patients were categorized using the Centers for Disease Control and Prevention weight-for-age chart: normal weight (5th-84th percentile) 57.1%, underweight (< 5th percentile) 27.5%, overweight (85th to < 95th percentile) 7.2%, and obese (≥ 95th percentile) 8.2%. Underweight was most common in infants (34%); obesity was most common in children older than 8 years old (15.1%). Underweight patients more often had oxygenation and ventilation failure (34.0%, 36.2%, respectively) as the indication for TI and a history of difficult airway (16.7%). Apneic oxygenation was used more often in overweight and obese patients (19.1%, 19.6%) than in underweight or normal weight patients (14.1%, 17.1%; p < 0.001). TIAEs and/or hypoxemia occurred more often in underweight (27.1%) and obese (24.3%) patients ( p < 0.001). TI in underweight children was associated with greater odds of adverse airway outcome compared with normal weight children after adjusting for potential confounders (underweight: adjusted odds ratio [aOR], 1.09; 95% CI, 1.01-1.18; p = 0.016). Both underweight and obesity were associated with hypoxemia after adjusting for covariates and site clustering (underweight: aOR, 1.11; 95% CI, 1.02-1.21; p = 0.01 and obesity: aOR, 1.22; 95% CI, 1.07-1.39; p = 0.002). CONCLUSIONS In underweight and obese children compared with normal weight children, procedures around the timing of TI are associated with greater odds of adverse airway events.
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Affiliation(s)
- Kelsey M Gladen
- Pediatric Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
| | - David Tellez
- Pediatric Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
| | - Natalie Napolitano
- Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lauren R Edwards
- Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, NE
| | - Ronald C Sanders
- Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR
| | - Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Matthew P Malone
- Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR
| | - Justine Shults
- Department of Biostatistics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Conrad Krawiec
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA
| | - Shashikanth Ambati
- Pediatric Critical Care Medicine, Department of Pediatrics, Albany Medical Center, Albany, NY
| | - Riley McCarthy
- Pediatric Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
| | - Aline Branca
- Pediatric Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
| | - Lee A Polikoff
- Division of Critical Care Medicine, Department of Pediatrics, The Warren Alpert Medical School at Brown University, Providence, RI
| | - Philipp Jung
- Department of Pediatrics, University Children's Hospital, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Simon J Parsons
- Department of Pediatrics, Section of Critical Care Medicine, Alberta Children's Hospital, Calgary, AB, Canada
| | | | | | - Christopher Page-Goertz
- Pediatric Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, OH
| | - Megan C Toal
- Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - G Kris Bysani
- Pediatric Critical Care Medicine, Department of Pediatrics, Medical City Children's Hospital, Dallas, TX
| | - Keith Meyer
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Herber Wertheim College of Medicine Florida International University, Miami, FL
| | - Fabrizio Chiusolo
- Anesthesia and Critical Care Medicine, ARCO, Bambino Gesú Children's Hospital, Rome, Italy
| | - Lily B Glater-Welt
- Division of Pediatric Critical Care, Cohen Children's Medical Center of New York, Queens, NY
| | - Awni Al-Subu
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Katherine Biagas
- Pediatric Critical Care Medicine, Department of Pediatrics, The Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
| | - Michael Miksa
- Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY
| | - John S Giuliano
- Department of Pediatrics, Section of Critical Care Medicine, Yale University School of Medicine, New Haven, CT
| | - Krista L Kierys
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA
| | - Andrea M Talukdar
- Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, NE
| | | | - Laurence Cucharme-Crevier
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Michelle Adu-Arko
- Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia, Charlottesville, VA
| | - Asha N Shenoi
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Kentucky, Lexington, KY
| | - Dai Kimura
- Critical Care Medicine, Department of Pediatrics, Orlando Health Arnold Palmer Hospital for Children, Orlando, FL
| | - Molly Flottman
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Louisville, Norton Children's Hospital, Louisville, KY
| | - Shantaveer Gangu
- Critical Care Medicine, Department of Pediatrics, Orlando Health Arnold Palmer Hospital for Children, Orlando, FL
| | - Ashley D Freeman
- Pediatric Critical Care Medicine, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA
| | - Mark D Piehl
- Pediatric Critical Care Medicine, Department of Pediatrics, WakeMed Children's Hospital, Raleigh, NC
| | - G A Nuthall
- Pediatric Critical Care, Department of Pediatrics, Starship Children's Hospital, Auckland, New Zealand
| | - Keiko M Tarquinio
- Pediatric Critical Care Medicine, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, GA
| | - Ilana Harwayne-Gidansky
- Pediatric Critical Care Medicine, Department of Pediatrics, Bernard and Millie Duker Children's Hospital, Albany, NY
| | - Tatsuya Hasegawa
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Erin S Rescoe
- Division of Pediatric Critical Care, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY
| | - Ryan K Breuer
- Division of Critical Care Medicine, John R. Oishei Children's Hospital, Buffalo, NY
| | - Mioko Kasagi
- Pediatric Critical Care and Emergency Medicine, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Liboiron M, Malone MP, Brown CC, Prodhan P. Extracorporeal Membrane Oxygenation and Hemolytic Uremic Syndrome in Children: Outcome Review of a Multicenter National Database. J Pediatr Intensive Care 2023. [DOI: 10.1055/s-0042-1758478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
AbstractHemolytic uremic syndrome (HUS) is a triad of hemolytic anemia, thrombocytopenia, and acute renal failure. In critically ill children with HUS, extrarenal manifestations may require intensive care unit admission and extracorporeal membrane oxygenation (ECMO) support. Outcomes specific to HUS and ECMO in children have not been well investigated. The primary aim of this project was to query a multicenter database to identify risk factors associated with mortality in HUS patients supported on ECMO. A secondary aim was to identify factors associated with ECMO utilization in children with HUS. Utilizing the Pediatric Health Information System database (January 2004 and September 2018), this retrospective, multicenter cohort study identified the index HUS hospitalization among children aged 0 to 18 years. Univariate analysis was used to compare demographics, clinical characteristics, and procedures to identify risk factors associated with adverse outcomes. Among 4,144 subjects, 37 were supported on ECMO. Survival for those on ECMO support was 54%. Among nonsurvivors, 59% of deaths occurred within 14 days of hospitalization. The mean hospital LOS was 15.9 days in nonsurvivors versus 53.9 days for survivors (p < 0.001). When comparing subjects supported on ECMO to those who were not, patients with ECMO support had statistically longer hospital LOS and higher rates of extrarenal involvement (p < 0.001). This study found a mortality rate of 46% among HUS patients requiring ECMO. The investigated clinical risk factors were not associated with mortality among the ECMO population. The study identifies risk factors associated with ECMO utilization in children with HUS.
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Affiliation(s)
- Mireille Liboiron
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Matthew P. Malone
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Clare C. Brown
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Parthak Prodhan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
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Malone MP, Bennett E, Irby OK, Pasala S, Sanders RC, Spray BJ, Dalabih A. Perspectives on Current Mechanical Ventilation Use and Training in Pediatric Critical Care Medicine Fellowship Programs in the United States. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1755442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
AbstractMechanical ventilation (MV) is an integral part of the care of the critically ill child, and contemporary MV includes a myriad of sophisticated modalities that should be tailored to specific disease pathology and severity. This requires Pediatric Critical Care Medicine (PCCM) physicians to have comprehensive training and experience with various modes. We sought to assess and describe the current landscape of MV practices and training from PCCM fellowship programs. To describe current MV practices and training in PCCM fellowship programs and assess the different modes of MV to which trainees are exposed, a piloted survey was sent to all 67 American PCCM fellowship program directors (PDs) in 2019. Forty-eight (71.6%) of PCCM PDs responded. Our survey shows that PCCM fellows are not uniformly exposed to the same MV modalities, and PDs' perception of fellows' competency in managing MV is variable. Our results suggest that there is a lack of exposure to the various modes of “conventional” MV, as well as inconsistent education about less-utilized “nonconventional” MV. Additionally, we found that PDs are aware of their fellows' limited exposure to various modalities, as many practice patterns are institution specific. This study identified gaps in MV education and training and advocates for PCCM fellowship programs to identify these deficiencies to equip all trainees with a solid knowledge base that will prepare them to utilize any mode of MV in their future practice.
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Affiliation(s)
- Matthew P. Malone
- Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas, United States
| | - Erin Bennett
- Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas, United States
| | - Olivia Katherine Irby
- Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas, United States
| | - Sanjiv Pasala
- Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas, United States
| | - Ronald C. Sanders
- Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas, United States
| | - Beverly J. Spray
- Arkansas Children's Research Institute, Little Rock, Arkansas, United States
| | - Abdallah Dalabih
- Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas, United States
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Goode PS, Johnson TM, Newman DK, Vaughan CP, Echt KV, Markland AD, Kennedy R, Van Arsdalen KN, Rais-Bahrami S, Issa MM, Barnacastle S, Wright KC, McCabe P, Malone MP, Redden DT, Burgio KL. Perioperative Mobile Telehealth Program for Post-Prostatectomy Incontinence: A Randomized Clinical Trial. J Urol 2022; 208:379-387. [DOI: 10.1097/ju.0000000000002697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Patricia S. Goode
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Theodore M. Johnson
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Diane K. Newman
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz VA Medical Center, Department of Veterans Affairs, Philadelphia, Pennsylvania
| | - Camille P. Vaughan
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Katharina V. Echt
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- University of Alabama at Birmingham, Birmingham, Alabama
- Emory University School of Medicine, Atlanta, Georgia
| | - Alayne D. Markland
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard Kennedy
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Keith N. Van Arsdalen
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz VA Medical Center, Department of Veterans Affairs, Philadelphia, Pennsylvania
| | - Soroush Rais-Bahrami
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Muta M. Issa
- Emory University School of Medicine, Atlanta, Georgia
- Department of Veterans Affairs, Atlanta, Georgia
| | - Susan Barnacastle
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Kate Clark Wright
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Matthew P. Malone
- The University of Arkansas for Medical Sciences/Arkansas Children’s Hospital, Little Rock, Arkansas
| | - David T. Redden
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Kathryn L. Burgio
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, Alabama and Atlanta, Georgia
- University of Alabama at Birmingham, Birmingham, Alabama
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Bauer HK, Malone MP. Friend or Foe? Venoarterial ECMO via Carotid Artery "Jump Graft": A Case Series. J Extra Corpor Technol 2022; 54:67-72. [PMID: 36380829 PMCID: PMC9639696 DOI: 10.1182/ject-67-72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/04/2021] [Indexed: 06/16/2023]
Abstract
Extracorporeal life support is used in adult and pediatric patients for refractory cardiac and respiratory failure. The great arteries and veins of the neck and groin are often used for cannulation to extracorporeal membrane oxygenation (ECMO). Newer cannulation techniques use the subclavian or axillary arteries, in addition to synthetic grafts anastomosed in end-to-side fashion, from which the cannula is positioned. These newer techniques can prevent need for ligation and sacrifice of important major vessels that is often undertaken in "traditional" direct surgical cannulation strategies. To our knowledge this graft technique has not been performed in pediatric ECMO patients. We describe a case series of nine patients from 2012 to 2017 supported with venoarterial (V-A) ECMO utilizing a synthetic Gore-Tex® "jump graft" sewn in an end-to-side fashion to the right carotid artery, for the arterial cannula insertion. Each patient's hospital course was reviewed with particular consideration given to disease process, site of cannulation, neurologic examination abnormalities noted during ECMO, computed tomography (CT) or magnetic resonance imaging (MRI) evidence of intracranial hemorrhage, and outcomes. Eight of nine patients were successfully cannulated utilizing this technique without neurologic complication. One suffered catastrophic intracerebral hemorrhage. This series is limited by small sample size and single center experience. Further work is needed to determine the advantages and disadvantages of utilizing a synthetic graft in pediatric V-A ECMO.
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Affiliation(s)
- Hannah K. Bauer
- Louisiana State University Health Sciences Center, Children’s Hospital New Orleans, New Orleans, Louisiana
| | - Matthew P. Malone
- The University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Arkansas
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7
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Abstract
ABSTRACT Sudden cardiac arrest of cardiac etiology is rare in children and adolescents and most often occurs with exertion. Conversely, syncope is a common pediatric emergency department complaint but rarely is associated with a serious underlying cardiac disorder. This report describes a case of the channelopathy Brugada syndrome (BrS) as a cause of sudden cardiac arrest in a febrile preadolescent child taking medications known to affect cardiac conduction. The patient received cardiopulmonary resuscitation and was successfully defibrillated. Initial electrocardiogram (ECG) demonstrated findings consistent with BrS. Confirmatory electrophysiologic testing was performed, and an implantable cardiac defibrillator was placed. Pediatric emergency specialists must recognize both the importance of ECG in the workup of syncope and be familiar with the specific ECG findings suggestive of BrS. Ventricular arrhythmias that occur at rest should raise the suspicion of this genetic cardiac channelopathy, regardless of age.
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Affiliation(s)
- David P Fitzgerald
- From the University of Arkansas for Medical Sciences, College of Medicine
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Cunningham L, Malone MP. Newsletters aren't enough: best practices in internal communication lead to impressive patient satisfaction scores. Strateg Healthc Excell 1999; 12:1-7. [PMID: 10620897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Alexander W, Bence K, Hirsch TS, Malone MP. How can information systems aid in the collection & analysis of patient satisfaction? Infocare 1996:30-2. [PMID: 10161564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Press I, Malone MP. Patient satisfaction and the cost/quality equation. J Health Care Benefits 1993; 3:40-3. [PMID: 10130049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Measuring patient satisfaction with health care treatment and delivery and making necessary adjustments can pay back big dividends to employers, payers, and providers in the form of cost savings and improved quality of care.
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Affiliation(s)
- I Press
- Press, Ganey Associates, Inc., South Bend, IN
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Press I, Ganey RF, Malone MP. Patient satisfaction: where does it fit in the quality picture? Trustee 1992; 45:8-10, 21. [PMID: 10117320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Press I, Ganey RF, Malone MP. Satisfied patients can spell financial well-being. Healthc Financ Manage 1991; 45:34-6, 38, 40-2. [PMID: 10145381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
As a healthcare performance indicator, patient satisfaction may be overlooked by providers that regard patients' perceptions as evidence of service quality rather than quality of care. Because a patient's trust in caregivers and overall attitude toward care received may affect outcome, however, healthcare providers are paying more attention to interpersonal issues of care delivery. Meanwhile, changes in the industry, such as increased competition, consumerism, and demand for accountability, mean patient satisfaction can contribute to a healthcare organization's bottom line.
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Malone MP. A look at nursing home trends and expenses. Health Facil Manage 1989; 2:10, 13-5. [PMID: 10291820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Malone MP, Rucci AJ. Designing and implementing a performance management system. Hosp Mater Manage Q 1986; 8:13-21. [PMID: 10279273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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