1
|
Li Q, Lafrance D, Liberman M, Leduc C, Charbonney E, Titova P, Manganas H, Chassé M. Transbronchial Lung Cryobiopsies, Transbronchial Forceps Lung Biopsies, and Surgical Lung Biopsies in Mechanically Ventilated Patients with Acute Hypoxemic Respiratory Failure: A Retrospective Cohort Study. J Intensive Care Med 2024:8850666241247145. [PMID: 38646814 DOI: 10.1177/08850666241247145] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
IMPORTANCE Lung biopsies are sometimes performed in mechanically ventilated patients with acute hypoxemic respiratory failure (AHRF) of unknown etiology to guide patient management. While surgical lung biopsies (SLB) offer high diagnostic rates, they may also cause significant complications. Transbronchial forceps lung biopsies (TBLB) are less invasive but often produce non-contributive specimens. Transbronchial lung cryobiopsies (TBLC) yield specimens of potentially better quality than TBLB, but due to their novel implementation in the intensive care unit (ICU), their accuracy and safety are still unclear. OBJECTIVES Our main objective was to evaluate the risk of adverse events in patients with AHRF following the three biopsy techniques. Our secondary objectives were to assess the diagnostic yield and associated modifications of patient management of each technique. DESIGN, SETTINGS AND PARTICIPANTS We conducted a retrospective cohort study comparing TBLC, TBLB, and SLB in mechanically ventilated patients with AHRF. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients with at least one complication, and secondary outcomes included complication rates, diagnostic yields, treatment modifications, and mortality. RESULTS Of the 26 patients who underwent lung biopsies from 2018 to 2022, all TBLC and SLB patients and 60% of TBLB patients had at least one complication. TBLC patients had higher unadjusted numbers of total and severe complications, but also worse Sequential Organ Failure Assessment scores and P/F ratios. A total of 25 biopsies (25/26, 96%) provided histopathological diagnoses, 88% (22/25) of which contributed to patient management. ICU mortality was high for all modalities (63% for TBLC, 60% for TBLB and 50% for SLB). CONCLUSIONS AND RELEVANCE All biopsy methods had high diagnostic yields and the great majority contributed to patient management; however, complication rates were elevated. Further research is needed to determine which patients may benefit from lung biopsies and to determine the best biopsy modality.
Collapse
Affiliation(s)
- Qi Li
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Dominique Lafrance
- Department of Medicine, Université de Montréal, Montréal, Canada
- Division of Intensive Care, Centre Hospitalier de l'Université de Montréal, Canada
| | - Moishe Liberman
- Division of Thoracic Surgery, Endoscopic Tracheo-bronchial and Oesophageal Centre, Centre Hospitalier de l'Université de Montréal, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Charles Leduc
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Canada
| | - Emmanuel Charbonney
- Department of Medicine, Université de Montréal, Montréal, Canada
- Division of Intensive Care, Centre Hospitalier de l'Université de Montréal, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Polina Titova
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Hélène Manganas
- Department of Medicine, Université de Montréal, Montréal, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
- Division of Pulmonology, Centre Hospitalier de l'Université de Montréal, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, Montréal, Canada
- Division of Intensive Care, Centre Hospitalier de l'Université de Montréal, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Canada
| |
Collapse
|
2
|
Tse P, Yan J, Liu Y, Jamula E, Heddle N, Bazin R, Robitaille N, Cook R, Turgeon A, Fergusson D, Glesby M, Loftsgard KC, Cushing M, Chassé M, Daneman N, Finzi A, Sachais B, Bégin P, Callum J, Arnold DM, Xie F. Quality of life and cost-effectiveness of convalescent plasma compared to standard care for hospitalized COVID-19 patients in the CONCOR-1 trial. Transfusion 2024; 64:606-614. [PMID: 38511889 DOI: 10.1111/trf.17777] [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] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/22/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The CONvalescent Plasma for Hospitalized Adults With COVID-19 Respiratory Illness (CONCOR-1) trial was a multicenter randomized controlled trial assessing convalescent plasma in hospitalized COVID-19 patients. This study evaluates the cost-effectiveness of convalescent plasma and its impact on quality-of-life to provide insight into its potential as an alternative treatment in resource-constrained settings. METHODS Individual patient data on health outcomes and resource utilization from the CONCOR-1 trial were used to conduct the analysis from the Canadian public payer's perspective with a time horizon of 30 days post-randomization. Baseline and 30-day EQ-5D-5L were measured to calculate quality-adjusted survival. All costs are presented in 2021 Canadian dollars. The base case assessed the EQ-5D-5L scores of hospitalized inpatients reporting at both timepoints, and a utility score of 0 was assigned for patients who died within 30 days. Costs for all patients enrolled were used. The sensitivity analysis utilizes EQ-5D-5L scores from the same population but only uses costs from this population. RESULTS 940 patients were randomized: 627 received CCP and 313 received standard care. The total costs were $28,716 (standard deviation, $25,380) and $24,258 ($22,939) for the convalescent plasma and standard care arms respectively. EQ-5D-5L scores were 0.61 in both arms (p = .85) at baseline. At 30 days, EQ-5D-5L scores were 0.63 and 0.64 for patients in the convalescent plasma and standard care arms, respectively (p = .46). The incremental cost was $4458 and the incremental quality-adjusted life day was -0.078. DISCUSSION Convalescent plasma was less effective and more costly than standard care in treating hospitalized COVID-19.
Collapse
Affiliation(s)
- Preston Tse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jiajun Yan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yang Liu
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Erin Jamula
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Nancy Heddle
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Canadian Blood Services, Ottawa, Ontario, Canada
| | - Renée Bazin
- Medical Affairs and Innovation, Héma-Québec, Québec City, Québec, Canada
| | - Nancy Robitaille
- Héma-Québec, Montreal, Québec, Canada
- Division of Hematology-Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Richard Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Alexis Turgeon
- Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec - Université Laval Research Center, Québec City, Québec, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Dean Fergusson
- Canadian Blood Services, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Marshall Glesby
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Kent Cadogan Loftsgard
- UBC Health Team-Based Care, Vancouver, British Columbia, USA
- CIHR-Strategy for Patient-Oriented Research, Ottawa, Ontario, Canada
| | - Melissa Cushing
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Michaël Chassé
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
- Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Nick Daneman
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrés Finzi
- Centre de Recherche du CHUM, Montreal, Québec, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Québec, Canada
| | - Bruce Sachais
- New York Blood Center, New York, New York, USA
- Weil Cornell Medical College, New York, New York, USA
| | - Philippe Bégin
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
- Department of Pediatrics, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Jeannie Callum
- Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Donald M Arnold
- Michael G. DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
3
|
Carrier FM, Girard M, Zuo RM, Ziegler D, Trottier H, Chassé M. Intraoperative Vasoactive Medications and Perioperative Outcomes in Liver Transplantation: A Systematic Review and Network Meta-analyses. Transplantation 2024; 108:854-873. [PMID: 37525360 DOI: 10.1097/tp.0000000000004744] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
We conducted a systematic review and network meta-analyses evaluating the effects of different intraoperative vasoactive drugs on acute kidney injury (AKI) and other perioperative outcomes in adult liver transplant recipients. We searched multiple electronic databases using words from the "liver transplantation" and "vasoactive drug" domains. We included all randomized controlled trials conducted in adult liver transplant recipients comparing 2 different intravenous vasoactive drugs or 1 against a standard of care that reported AKI, intraoperative blood loss, or any other postoperative outcome. We conducted 4 frequentist network meta-analyses using random effect models, based on the interventions' mechanism of action, and evaluated the quality of evidence (QoE) using Grading of Recommendations, Assessment, Development, and Evaluations recommendations. We included 9 randomized controlled trials comparing different vasopressor drugs (vasoconstrictor or inotrope), 3 comparing a somatostatin infusion (or its analogues) to a standard of care, 11 comparing different vasodilator infusions together or against a standard of care, and 2 comparing vasoconstrictor boluses at graft reperfusion. Intravenous clonidine was associated with shorter duration of mechanical ventilation, intensive care unit, and hospital length of stay (very low QoE), and some vasodilators were associated with lower creatinine level 24 h after surgery (low to very low QoE). Phenylephrine and terlipressin were associated with less intraoperative blood loss when compared with norepinephrine (low and moderate QoE). None of the vasoactive drugs improve any other postoperative outcomes, including AKI. There is still important equipoise regarding the best vasoactive drug to use in liver transplantation for most outcomes. Further studies are required to better inform clinical practice.
Collapse
Affiliation(s)
- François Martin Carrier
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Department of Medicine, Critical Care Division, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Health Innovation and Evaluation Hub, Centre de recherche du CHUM, Montréal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, QC, Canada
| | - Martin Girard
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Department of Medicine, Critical Care Division, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Health Innovation and Evaluation Hub, Centre de recherche du CHUM, Montréal, QC, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, QC, Canada
| | - Rui Min Zuo
- Department of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Daniela Ziegler
- Library, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Helen Trottier
- Department of Social and Preventive Medicine, École de Santé Publique de l'Université de Montréal, Centre hospitalier universitaire Sainte-Justine, Montréal, QC, Canada
| | - Michaël Chassé
- Department of Medicine, Critical Care Division, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Health Innovation and Evaluation Hub, Centre de recherche du CHUM, Montréal, QC, Canada
- Department of Medicine, Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
4
|
Mullie L, Afilalo J, Archambault P, Bouchakri R, Brown K, Buckeridge DL, Cavayas YA, Turgeon AF, Martineau D, Lamontagne F, Lebrasseur M, Lemieux R, Li J, Sauthier M, St-Onge P, Tang A, Witteman W, Chassé M. CODA: an open-source platform for federated analysis and machine learning on distributed healthcare data. J Am Med Inform Assoc 2024; 31:651-665. [PMID: 38128123 PMCID: PMC10873779 DOI: 10.1093/jamia/ocad235] [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] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/28/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES Distributed computations facilitate multi-institutional data analysis while avoiding the costs and complexity of data pooling. Existing approaches lack crucial features, such as built-in medical standards and terminologies, no-code data visualizations, explicit disclosure control mechanisms, and support for basic statistical computations, in addition to gradient-based optimization capabilities. MATERIALS AND METHODS We describe the development of the Collaborative Data Analysis (CODA) platform, and the design choices undertaken to address the key needs identified during our survey of stakeholders. We use a public dataset (MIMIC-IV) to demonstrate end-to-end multi-modal FL using CODA. We assessed the technical feasibility of deploying the CODA platform at 9 hospitals in Canada, describe implementation challenges, and evaluate its scalability on large patient populations. RESULTS The CODA platform was designed, developed, and deployed between January 2020 and January 2023. Software code, documentation, and technical documents were released under an open-source license. Multi-modal federated averaging is illustrated using the MIMIC-IV and MIMIC-CXR datasets. To date, 8 out of the 9 participating sites have successfully deployed the platform, with a total enrolment of >1M patients. Mapping data from legacy systems to FHIR was the biggest barrier to implementation. DISCUSSION AND CONCLUSION The CODA platform was developed and successfully deployed in a public healthcare setting in Canada, with heterogeneous information technology systems and capabilities. Ongoing efforts will use the platform to develop and prospectively validate models for risk assessment, proactive monitoring, and resource usage. Further work will also make tools available to facilitate migration from legacy formats to FHIR and DICOM.
Collapse
Affiliation(s)
- Louis Mullie
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, H2X 3E4, Canada
- Faculty of Medicine, Université de Montréal, Montréal, H3C 3J7, Canada
- Mila Quebec Artificial Intelligence Institute, Montréal, H2S 3H1, Canada
| | - Jonathan Afilalo
- Department of Medicine, Jewish General Hospital, Montréal, H3T 1E4, Canada
| | - Patrick Archambault
- Department of Emergency Medicine and Family Medicine, Université Laval, Québec, G1V 0A6, Canada
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, G1V 0A6, Canada
- Centre de Recherche Intégré pour un Système Apprenant en santé et Services Sociaux, Centre intégré de santé et de Services Sociaux de Chaudière-Appalaches, Lévis, G6V 3Z1, Canada
| | - Rima Bouchakri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, H2X 0A9, Canada
| | - Kip Brown
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, H2X 0A9, Canada
| | - David L Buckeridge
- Mila Quebec Artificial Intelligence Institute, Montréal, H2S 3H1, Canada
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University Health Centre, Montréal, H3A 1G1, Canada
| | | | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, G1V 0A6, Canada
- Centre de recherche du CHU de Québec-Université Laval, Université Laval, Québec, G1V 4G2, Canada
| | - Denis Martineau
- Centre de recherche du CHU de Québec-Université Laval, Université Laval, Québec, G1V 4G2, Canada
| | - François Lamontagne
- Centre de recherche du CHUS, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, J1G 2E8, Canada
| | - Martine Lebrasseur
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, H2X 0A9, Canada
| | - Renald Lemieux
- Centre de recherche du CHUS, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, J1G 2E8, Canada
| | - Jeffrey Li
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, H2X 0A9, Canada
| | - Michaël Sauthier
- Faculty of Medicine, Université de Montréal, Montréal, H3C 3J7, Canada
- Department of Pediatrics, Université de Montréal and CHU Sainte-Justine Research Centre, Montréal, H3C 3J7, Canada
| | - Pascal St-Onge
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, H2X 0A9, Canada
| | - An Tang
- Faculty of Medicine, Université de Montréal, Montréal, H3C 3J7, Canada
- Department of Radiology, Centre Hospitalier de l’Université de Montréal, Montréal, H2X 3E4, Canada
| | - William Witteman
- Centre de Recherche Intégré pour un Système Apprenant en santé et Services Sociaux, Centre intégré de santé et de Services Sociaux de Chaudière-Appalaches, Lévis, G6V 3Z1, Canada
| | - Michaël Chassé
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, H2X 3E4, Canada
- Faculty of Medicine, Université de Montréal, Montréal, H3C 3J7, Canada
| |
Collapse
|
5
|
Siegal DM, Belley-Côté EP, Lee SF, Hill S, D’Aragon F, Zarychanski R, Rochwerg B, Chassé M, Binnie A, Honarmand K, Lauzier F, Ball I, Al-Hazzani W, Archambault P, Duan E, Khwaja K, Lellouche F, Lysecki P, Marquis F, Naud JF, Shahin J, Shea J, Tsang JL, Wang HT, Crowther M, Arnold DM, Di Sante E, Marfo G, Kovalova T, Fonguh S, Vincent J, Connolly SJ. Small-Volume Blood Collection Tubes to Reduce Transfusions in Intensive Care: The STRATUS Randomized Clinical Trial. JAMA 2023; 330:1872-1881. [PMID: 37824152 PMCID: PMC10570918 DOI: 10.1001/jama.2023.20820] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023]
Abstract
Importance Blood collection for laboratory testing in intensive care unit (ICU) patients is a modifiable contributor to anemia and red blood cell (RBC) transfusion. Most blood withdrawn is not required for analysis and is discarded. Objective To determine whether transitioning from standard-volume to small-volume vacuum tubes for blood collection in ICUs reduces RBC transfusion without compromising laboratory testing procedures. Design, Setting, and Participants Stepped-wedge cluster randomized trial in 25 adult medical-surgical ICUs in Canada (February 5, 2019 to January 21, 2021). Interventions ICUs were randomized to transition from standard-volume (n = 10 940) to small-volume tubes (n = 10 261) for laboratory testing. Main Outcomes and Measures The primary outcome was RBC transfusion (units per patient per ICU stay). Secondary outcomes were patients receiving at least 1 RBC transfusion, hemoglobin decrease during ICU stay (adjusted for RBC transfusion), specimens with insufficient volume for testing, length of stay in the ICU and hospital, and mortality in the ICU and hospital. The primary analysis included patients admitted for 48 hours or more, excluding those admitted during a 5.5-month COVID-19-related trial hiatus. Results In the primary analysis of 21 201 patients (mean age, 63.5 years; 39.9% female), which excluded 6210 patients admitted during the early COVID-19 pandemic, there was no significant difference in RBC units per patient per ICU stay (relative risk [RR], 0.91 [95% CI, 0.79 to 1.05]; P = .19; absolute reduction of 7.24 RBC units/100 patients per ICU stay [95% CI, -3.28 to 19.44]). In a prespecified secondary analysis (n = 27 411 patients), RBC units per patient per ICU stay decreased after transition from standard-volume to small-volume tubes (RR, 0.88 [95% CI, 0.77 to 1.00]; P = .04; absolute reduction of 9.84 RBC units/100 patients per ICU stay [95% CI, 0.24 to 20.76]). Median decrease in transfusion-adjusted hemoglobin was not statistically different in the primary population (mean difference, 0.10 g/dL [95% CI, -0.04 to 0.23]) and lower in the secondary population (mean difference, 0.17 g/dL [95% CI, 0.05 to 0.29]). Specimens with insufficient quantity for analysis were rare (≤0.03%) before and after transition. Conclusions and Relevance Use of small-volume blood collection tubes in the ICU may decrease RBC transfusions without affecting laboratory analysis. Trial Registration ClinicalTrials.gov Identifier: NCT03578419.
Collapse
Affiliation(s)
- Deborah M. Siegal
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Emilie P. Belley-Côté
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shun Fu Lee
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Hill
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Frédérick D’Aragon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Michaël Chassé
- Centre Hospitalier de l’Université de Montréal, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Alexandra Binnie
- William Osler Health System – Brampton Civic and Etobicoke General, Brampton, Ontario, Canada
| | - Kimia Honarmand
- London Health Sciences Centre – CCTC and University Hospital, Department of Medicine, Western University, London, Ontario, Canada
| | - François Lauzier
- Centre Hospitalier Universitaire de Québec - Enfant-Jésus and Hôtel-Dieu, Department of Medicine, Department of Anesthesiology, Université Laval, Québec, Canada
| | - Ian Ball
- London Health Sciences Centre – CCTC and University Hospital, Department of Medicine, Western University, London, Ontario, Canada
| | - Waleed Al-Hazzani
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Patrick Archambault
- Hôtel-Dieu de Lévis, Department of Family Medicine and Urgent Care, Université Laval, Québec, Canada
| | - Erick Duan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Niagara Health – St. Catharine’s General Hospital, St. Catharine’s, Ontario, Canada
| | - Kosar Khwaja
- Montreal General Hospital, Departments of Surgery and Critical Care Medicine, McGill University, Montréal, Québec, Canada
| | - François Lellouche
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Medicine, Université Laval, Québec, Canada
| | - Paul Lysecki
- Joseph Brant Hospital, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - François Marquis
- Maisonneuve-Rosemont, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Jean-François Naud
- Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec-CHAUR, Trois-Rivières, Québec, Canada
| | - Jason Shahin
- Royal Victoria Hospital, Department of Critical Care, McGill University, Montréal, Québec, Canada
| | - Jennifer Shea
- Saint John Regional Hospital, Department of Medicine, Memorial University, St. John, New Brunswick, Canada
| | - Jennifer L.Y. Tsang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Niagara Health – St. Catharine’s General Hospital, St. Catharine’s, Ontario, Canada
| | - Han Ting Wang
- Maisonneuve-Rosemont, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Donald M. Arnold
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Emily Di Sante
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Gladys Marfo
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Tanya Kovalova
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Sylvanus Fonguh
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Vincent
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stuart J. Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
6
|
Vianna P, Calce SI, Boustros P, Larocque-Rigney C, Patry-Beaudoin L, Luo YH, Aslan E, Marinos J, Alamri TM, Vu KN, Murphy-Lavallée J, Billiard JS, Montagnon E, Li H, Kadoury S, Nguyen BN, Gauthier S, Therien B, Rish I, Belilovsky E, Wolf G, Chassé M, Cloutier G, Tang A. Comparison of Radiologists and Deep Learning for US Grading of Hepatic Steatosis. Radiology 2023; 309:e230659. [PMID: 37787678 DOI: 10.1148/radiol.230659] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Background Screening for nonalcoholic fatty liver disease (NAFLD) is suboptimal due to the subjective interpretation of US images. Purpose To evaluate the agreement and diagnostic performance of radiologists and a deep learning model in grading hepatic steatosis in NAFLD at US, with biopsy as the reference standard. Materials and Methods This retrospective study included patients with NAFLD and control patients without hepatic steatosis who underwent abdominal US and contemporaneous liver biopsy from September 2010 to October 2019. Six readers visually graded steatosis on US images twice, 2 weeks apart. Reader agreement was assessed with use of κ statistics. Three deep learning techniques applied to B-mode US images were used to classify dichotomized steatosis grades. Classification performance of human radiologists and the deep learning model for dichotomized steatosis grades (S0, S1, S2, and S3) was assessed with area under the receiver operating characteristic curve (AUC) on a separate test set. Results The study included 199 patients (mean age, 53 years ± 13 [SD]; 101 men). On the test set (n = 52), radiologists had fair interreader agreement (0.34 [95% CI: 0.31, 0.37]) for classifying steatosis grades S0 versus S1 or higher, while AUCs were between 0.49 and 0.84 for radiologists and 0.85 (95% CI: 0.83, 0.87) for the deep learning model. For S0 or S1 versus S2 or S3, radiologists had fair interreader agreement (0.30 [95% CI: 0.27, 0.33]), while AUCs were between 0.57 and 0.76 for radiologists and 0.73 (95% CI: 0.71, 0.75) for the deep learning model. For S2 or lower versus S3, radiologists had fair interreader agreement (0.37 [95% CI: 0.33, 0.40]), while AUCs were between 0.52 and 0.81 for radiologists and 0.67 (95% CI: 0.64, 0.69) for the deep learning model. Conclusion Deep learning approaches applied to B-mode US images provided comparable performance with human readers for detection and grading of hepatic steatosis. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Tuthill in this issue.
Collapse
Affiliation(s)
- Pedro Vianna
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Sara-Ivana Calce
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Pamela Boustros
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Cassandra Larocque-Rigney
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Laurent Patry-Beaudoin
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Yi Hui Luo
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Emre Aslan
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - John Marinos
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Talal M Alamri
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Kim-Nhien Vu
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Jessica Murphy-Lavallée
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Jean-Sébastien Billiard
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Emmanuel Montagnon
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Hongliang Li
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Samuel Kadoury
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Bich N Nguyen
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Shanel Gauthier
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Benjamin Therien
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Irina Rish
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Eugene Belilovsky
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Guy Wolf
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Michaël Chassé
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - Guy Cloutier
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| | - An Tang
- From the Department of Imaging and Engineering (P.V., S.I.C., C.L.R., L.P.B., E.M., H.L., S.K., M.C., G.C., A.T.), Laboratory of Biorheology and Medical Ultrasonics (P.V., G.C.), and Clinical Laboratory of Image Processing (E.M., A.T.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada; Institute of Biomedical Engineering (P.V., G.C.) and Department of Computer Science and Operations Research (S.G., I.R., G.W.), Université de Montréal, Montréal, Canada; Departments of Radiology (S.I.C., P.B., C.L.R., L.P.B., Y.H.L., E.A., J.M., T.M.A., K.N.V., J.M.L., J.S.B., A.T.) and Pathology (B.N.N.), Centre Hospitalier de l'Université de Montréal (CHUM), 1058 rue Saint-Denis, Montréal, QC, Canada H2X 3J4; Department of Computer Engineering, École Polytechnique de Montréal, Montréal, Canada (S.K.); Mila-Quebec Artificial Intelligence Institute, Montréal, Canada (S.G., B.T., I.R., E.B., G.W.); and Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada (B.T., E.B.)
| |
Collapse
|
7
|
Chassé M. Ancillary testing for neurologic determination of death in adults: in search of a surrogate of clinical function. Intensive Care Med 2023; 49:1117-1119. [PMID: 37310486 DOI: 10.1007/s00134-023-07110-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/24/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Michaël Chassé
- Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, CHUM Research Center, 900 rue St-Denis, Montreal, QC, H2X 0A9, Canada.
| |
Collapse
|
8
|
D’Aragon F, Rousseau W, Breau R, Aminaei D, Ichai C, Boyd GJ, Burns KEA, Cardinal H, Carrier FM, Chassé M, Chaudhury P, Dhanani S, English SW, Frenette AJ, Hanna S, Knoll G, Lauzier F, Oczkowski S, Rochwerg B, Shamseddin K, Slessarev M, Treleaven D, Turgeon AF, Weiss MJ, Selzner M, Meade MO. Calcineurin Inhibition in Deceased Organ Donors: A Systematic Review and Meta-analysis of Preclinical Studies. Transplant Direct 2023; 9:e1519. [PMID: 37649790 PMCID: PMC10465100 DOI: 10.1097/txd.0000000000001519] [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] [Received: 03/13/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 09/01/2023] Open
Abstract
Background Preconditioning deceased organ donors with calcineurin inhibitors (CNIs) may reduce ischemia-reperfusion injury to improve transplant outcomes. Methods We searched MEDLINE, EMBASE, Cochrane Library, and conference proceedings for animal models of organ donation and transplantation, comparing donor treatment with CNIs with either placebo or no intervention, and evaluating outcomes for organ transplantation. Reviewers independently screened and selected studies, abstracted data, and assessed the risk of bias and clinical relevance of included studies. Where possible, we pooled results using meta-analysis; otherwise, we summarized findings descriptively. Results Eighteen studies used various animals and a range of CNI agents and doses and evaluated their effects on a variety of transplant outcomes. The risk of bias and clinical applicability were poorly reported. Pooled analyses suggested benefit of CNI treatment on early graft function in renal transplants (3 studies; serum creatinine: ratio of means [RoM] 0.54; 95% confidence interval [CI], 0.34-0.86) but not for liver transplants (2 studies; serum alanine transaminase: RoM 0.61; 95% CI, 0.30-1.26; and serum aspartate aminotransferase: RoM 0.58; 95% CI, 0.26-1.31). We found no reduction in graft loss at 7 d (2 studies; risk ratio 0.54; 95% CI, 0.08-3.42). CNI treatment was associated with reduced transplant recipient levels of interleukin-6 (4 studies; RoM 0.36; 95% CI, 0.19-0.70), tumor necrosis factor-alpha (5 studies; RoM 0.36; 95% CI, 0.12-1.03), and cellular apoptosis (4 studies; RoM 0.30; 95% CI, 0.19-0.47). Conclusions Although this compendium of animal experiments suggests that donor preconditioning with CNIs may improve early kidney graft function, the limited ability to reproduce a true clinical environment in animal experiments and to assess for risk of bias in these experiments is a serious weakness that precludes current clinical application.
Collapse
Affiliation(s)
- Frédérick D’Aragon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, QC, Canada
| | - William Rousseau
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, QC, Canada
| | - Ruth Breau
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Daniel Aminaei
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Carole Ichai
- Intensive Care Unit, University Hospital of Nice, Nice, France
| | - Gordon J. Boyd
- Division of Neurology, Department of Medicine, Queen’s University, Kingston, ON, Canada
- Department of Critical Care Medicine, Queen’s University, Kingston, ON, Canada
| | - Karen E. A. Burns
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, University Health Toronto—St. Michael’s Hospital, Toronto, ON, Canada
| | - Héloïse Cardinal
- Department of Nephrology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - François-Martin Carrier
- Department of Anesthesiology, Université de Montréal, Montreal, QC, Canada
- Department of Critical Care, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Michaël Chassé
- Department of Critical Care, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Prosanto Chaudhury
- Department of Surgery and Oncology, McGill University, Montreal, QC, Canada
| | - Sonny Dhanani
- Division of Critical Care, Department of Pediatrics, Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Shane W. English
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Steven Hanna
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, QC, Canada
| | - Gregory Knoll
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - François Lauzier
- Department of Medicine, Université Laval, Quebec City, QC, Canada
- Population Health and Optimal Health Practice Research Unit, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
| | - Simon Oczkowski
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Bram Rochwerg
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Khaled Shamseddin
- Division of Nephrology, Department of Medicine, Queen’s University, Kingston, ON, Canada
| | - Marat Slessarev
- Division of Critical Care, Department of Medicine, Western University, London, ON, Canada
| | - Darin Treleaven
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alexis F. Turgeon
- Population Health and Optimal Health Practice Research Unit, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
- Departments of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Matthew J. Weiss
- Population Health and Optimal Health Practice Research Unit, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
- Transplant Québec, QC, Canada
| | - Markus Selzner
- Department of General Surgery, University of Toronto and Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Maureen O. Meade
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
9
|
Carrier FM, Vincelette C, Trottier H, Amzallag É, Carr A, Chaudhury P, Dajani K, Fugère R, Giard JM, Gonzalez-Valencia N, Joosten A, Kandelman S, Karvellas C, McCluskey SA, Özelsel T, Park J, Simoneau È, Chassé M. Perioperative clinical practice in liver transplantation: a cross-sectional survey. Can J Anaesth 2023; 70:1155-1166. [PMID: 37266852 DOI: 10.1007/s12630-023-02499-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/07/2022] [Accepted: 11/02/2022] [Indexed: 06/03/2023] Open
Abstract
PURPOSE The objective of this study was to describe some components of the perioperative practice in liver transplantation as reported by clinicians. METHODS We conducted a cross-sectional clinical practice survey using an online instrument containing questions on selected themes related to the perioperative care of liver transplant recipients. We sent email invitations to Canadian anesthesiologists, Canadian surgeons, and French anesthesiologists specialized in liver transplantation. We used five-point Likert-type scales (from "never" to "always") and numerical or categorical answers. Results are presented as medians or proportions. RESULTS We obtained answers from 130 participants (estimated response rate of 71% in Canada and 26% in France). Respondents reported rarely using transesophageal echocardiography routinely but often using it for hemodynamic instability, often using an intraoperative goal-directed hemodynamic management strategy, and never using a phlebotomy (medians from ordinal scales). Fifty-nine percent of respondents reported using a restrictive fluid management strategy to manage hemodynamic instability during the dissection phase. Forty-two percent and 15% of respondents reported using viscoelastic tests to guide intraoperative and postoperative transfusions, respectively. Fifty-four percent of respondents reported not pre-emptively treating preoperative coagulations disturbances, and 91% reported treating them intraoperatively only when bleeding was significant. Most respondents (48-64%) did not have an opinion on the maximal graft ischemic times. Forty-seven percent of respondents reported that a piggyback technique was the preferred vena cava anastomosis approach. CONCLUSION Different interventions were reported to be used regarding most components of perioperative care in liver transplantation. Our results suggest that significant equipoise exists on the optimal perioperative management of this population.
Collapse
Affiliation(s)
- François M Carrier
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada.
- Critical Care Division, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montreal, Canada.
- Health Innovation and Evaluation Hub, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900, rue St-Denis, porte S03-434, Montreal, QC, H2X 0A9, Canada.
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, QC, Canada.
| | - Christian Vincelette
- School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - Helen Trottier
- Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montreal, QC, Canada
| | - Éva Amzallag
- Health Innovation and Evaluation Hub, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900, rue St-Denis, porte S03-434, Montreal, QC, H2X 0A9, Canada
| | - Adrienne Carr
- Department of Anesthesiology, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Prosanto Chaudhury
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Khaled Dajani
- Department of Surgery, University Health Centre, University of Alberta, Edmonton, AB, Canada
| | - René Fugère
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Jeanne-Marie Giard
- Department of Medicine, Liver Disease Division, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Alexandre Joosten
- Department of Anesthesiology, Paris Saclay University, Paul Brousse Hospital, Villejuif, France
| | - Stanislas Kandelman
- Department of Anesthesiology, McGill University Health Centre, Montreal, QC, Canada
| | - Constantine Karvellas
- Division of Gastroenterology (Liver Unit), Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Stuart A McCluskey
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Timur Özelsel
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jeieung Park
- Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Colombia, Vancouver, BC, Canada
| | - Ève Simoneau
- Hepatobiliary Division, Department of Surgery, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Michaël Chassé
- Critical Care Division, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Health Innovation and Evaluation Hub, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900, rue St-Denis, porte S03-434, Montreal, QC, H2X 0A9, Canada
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
10
|
Sarti AJ, Sutherland S, Meade M, Hornby L, Wilson LC, Landriault A, Vanderspank-Wright B, Valiani S, Keenan S, Weiss MJ, Werestiuk K, Beed S, Kramer AH, Kawchuk J, Cardinal P, Dhanani S, Lotherington K, Pagliarello G, Chassé M, Gatien M, Parsons K, Chandler JA, Nickerson P, Shemie SD. Correction: Death determination by neurologic criteria-what do families understand? Can J Anaesth 2023; 70:1278-1279. [PMID: 37253861 PMCID: PMC10372112 DOI: 10.1007/s12630-023-02491-6] [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: 06/01/2023] Open
Affiliation(s)
- Aimee J Sarti
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada.
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Stephanie Sutherland
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada
| | - Maureen Meade
- Department of Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | | | - Angele Landriault
- Practice, Performance and Innovation Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Brandi Vanderspank-Wright
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sabira Valiani
- Department of Adult Critical Care, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Sean Keenan
- BC Transplant, Vancouver, BC, Canada
- Division of Critical Care, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | | | - Stephen Beed
- Department of Critical Care, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Andreas H Kramer
- Departments of Critical Care Medicine and Clinical Neurosciences, University of Calgary and Southern Alberta Organ and Tissue Donation Program, Calgary, AB, Canada
| | - Joann Kawchuk
- Department of Adult Critical Care, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Pierre Cardinal
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada
| | - Sonny Dhanani
- Division of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Giuseppe Pagliarello
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada
| | - Michaël Chassé
- Department of Medicine, Centre hospitalier de L'Université de Montréal, Montreal, QC, Canada
| | - Mary Gatien
- Horizon Health Network, Miramichi, NB, Canada
| | - Kim Parsons
- Organ Procurement and Exchange of Newfoundland and Labrador, St. John's, NL, Canada
| | - Jennifer A Chandler
- Common Law Section, Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Peter Nickerson
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sam D Shemie
- Canadian Blood Services, Ottawa, ON, Canada
- Division of Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada
| |
Collapse
|
11
|
McCrindle BW, Chassé M. Looking Backward and Forward: The Cardiovascular Complications of COVID-19. Can J Cardiol 2023; 39:710-712. [PMID: 37062487 PMCID: PMC10103627 DOI: 10.1016/j.cjca.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/18/2023] Open
Affiliation(s)
- Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
| | - Michaël Chassé
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
12
|
Beaulieu MC, Neves Briard J, Chassé M. Evidence-Based Medical Therapy for the Treatment of Critically Ill COVID-19 Patients: A Primer for Cardiologists. Can J Cardiol 2023; 39:849-852. [PMID: 36965666 PMCID: PMC10033489 DOI: 10.1016/j.cjca.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 03/25/2023] Open
Affiliation(s)
| | - Joel Neves Briard
- Department of Neuroscience, Université de Montréal, Montréal, Québec, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, Montréal, Québec, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
| |
Collapse
|
13
|
Sauthier N, Bouchakri R, Carrier FM, Sauthier M, Mullie LA, Cardinal H, Fortin MC, Lahrichi N, Chassé M. Automated screening of potential organ donors using a temporal machine learning model. Sci Rep 2023; 13:8459. [PMID: 37231073 DOI: 10.1038/s41598-023-35270-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
Organ donation is not meeting demand, and yet 30-60% of potential donors are potentially not identified. Current systems rely on manual identification and referral to an Organ Donation Organization (ODO). We hypothesized that developing an automated screening system based on machine learning could reduce the proportion of missed potentially eligible organ donors. Using routine clinical data and laboratory time-series, we retrospectively developed and tested a neural network model to automatically identify potential organ donors. We first trained a convolutive autoencoder that learned from the longitudinal changes of over 100 types of laboratory results. We then added a deep neural network classifier. This model was compared to a simpler logistic regression model. We observed an AUROC of 0.966 (CI 0.949-0.981) for the neural network and 0.940 (0.908-0.969) for the logistic regression model. At a prespecified cutoff, sensitivity and specificity were similar between both models at 84% and 93%. Accuracy of the neural network model was robust across donor subgroups and remained stable in a prospective simulation, while the logistic regression model performance declined when applied to rarer subgroups and in the prospective simulation. Our findings support using machine learning models to help with the identification of potential organ donors using routinely collected clinical and laboratory data.
Collapse
Affiliation(s)
- Nicolas Sauthier
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Rima Bouchakri
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Michaël Sauthier
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | | | - Héloïse Cardinal
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | | | - Michaël Chassé
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
| |
Collapse
|
14
|
Gofton T, Dhanani S, Meade M, Boyd JG, Chamberlain E, Chandler J, Chassé M, Scales NB, Choi YH, D'Aragon F, Debicki D, English S, Fantaneanu TA, Kramer AH, Kromm J, Murphy N, Norton L, Singh J, Smith MJ, Weijer C, Shemie S, Bentall TC, Campbell E, Slessarev M. Neurologic Physiology after Removal of Therapy (NeuPaRT) study: study protocol of a multicentre, prospective, observational, pilot feasibility study of neurophysiology after withdrawal of life-sustaining measures. BMJ Open 2023; 13:e073643. [PMID: 37105694 PMCID: PMC10152060 DOI: 10.1136/bmjopen-2023-073643] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION In donation after circulatory determination of death, death is declared 5 min after circulatory arrest. This practice assumes, but does not explicitly confirm, permanent loss of brain activity. While this assumption is rooted a strong physiological rationale, paucity of direct human data regarding temporal relationship between cessation of brain activity and circulatory arrest during the dying process threatens public and healthcare provider trust in deceased organ donation. METHODS AND ANALYSIS In this cohort study, we will prospectively record cerebral and brainstem electrical activity, cerebral blood flow velocity and arterial blood pressure using electroencephalography (EEG), brainstem evoked potentials, transcranial doppler and bedside haemodynamic monitors in adult patients undergoing planned withdrawal of life sustaining measures in the intensive care units at five hospital sites for 18 months. We will use MATLAB to synchronise waveform data and compute the time of cessation of each signal relative to circulatory arrest. Our primary outcome is the feasibility of patient accrual, while secondary outcomes are (a) proportion of patients with complete waveform recordings and data transfer to coordinating site and (b) time difference between cessation of neurophysiological signals and circulatory arrest. We expect to accrue 1 patient/site/month for a total of 90 patients. ETHICS AND DISSEMINATION We have ethics approval from Clinical Trials Ontario (protocol #3862, version 1.0, date 19 January 2022.) and the relevant Research Ethics Board for each site. We will obtain written informed consent from legal substitute decision makers. We will present study results at research conferences including donor family partner forum and in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05306327.
Collapse
Affiliation(s)
- Teneille Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sonny Dhanani
- Pediatric Critical Care, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Maureen Meade
- Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - John Gordon Boyd
- Departments of Neurology and Critical Care, Queen's University, Kingston, Ontario, Canada
| | | | | | - Michaël Chassé
- Department of Medicine, Centre Hospitalier de Montréal, Montréal, Québec, Canada
| | - Nathan B Scales
- Dynamical Analysis Laboratory, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Sherbrooke, Quebec, Canada
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Derek Debicki
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Shane English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tadeu A Fantaneanu
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andreas H Kramer
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Julie Kromm
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicholas Murphy
- Philosophy and Medicine, Western University, London, Ontario, Canada
| | - Loretta Norton
- Department of Psychology, King's University College at Western University, London, Ontario, Canada
| | - Jeffrey Singh
- Interdepartmental Division of Critical Care Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Maxwell J Smith
- School of Health Studies, Faculty of Health Sciences and Rotman Institute of Philosophy, Western University, London, ON, Canada
| | - Charles Weijer
- Department of Philosophy, Western University, London, Ontario, Canada
| | - Sam Shemie
- Pediatric Intensive Care, McGill University, Montreal, Québec, Canada
| | - Tracey C Bentall
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Eileen Campbell
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Marat Slessarev
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| |
Collapse
|
15
|
Mutchmore A, Lamontagne F, Chassé M, Moore L, Mayette M. Automated APACHE II and SOFA score calculation using real-world electronic medical record data in a single center. J Clin Monit Comput 2023:10.1007/s10877-023-01010-8. [PMID: 37074523 PMCID: PMC10113718 DOI: 10.1007/s10877-023-01010-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/01/2023] [Indexed: 04/20/2023]
Abstract
The integration of illness severity and organ dysfunction scores into clinical practice, including the APACHE II and SOFA scores, has been challenging due to constraints associated to manual score calculation. With electronic medical records (EMR), score calculation automation using data extraction scripts has emerged as a solution. We aimed to demonstrate that APACHE II and SOFA scores calculated with an automated EMR-based data extraction script predict important clinical endpoints. In this retrospective cohort study, every adult patient admitted to one of our three ICUs, between July 1, 2019, and December 31, 2020, were enrolled. For every patient, an automated ICU admission APACHE II score was calculated using EMR data and minimal clinician input. Fully automated daily SOFA scores were calculated for every patient. 4 794 ICU admissions met our selection criteria. Of these ICU admissions, 522 deaths were recorded (10.9% in-hospital mortality rate). The automated APACHE II was discriminant for in-hospital mortality (AU-ROC = 0.83 (95% CI 0.81-0.85)). We observed an association between the APACHE II score and ICU LOS, with a statistically significant mean increase of 1.1 days of ICU LOS (1.1 [1-1.2]; p = < .0001) for each 10 units increase in APACHE score. SOFA score curves did not discrimate significantly between survivors and non-survivors. A partially automated APACHE II score, calculated with real-world EMR data using an extraction script, is associated with in-hospital mortality risk. The automated APACHE II score could potentially constitute an acceptable surrogate of ICU acuity to be used in resource allocation and triaging, especially in time of high demand for ICU beds.
Collapse
Affiliation(s)
- Alexandre Mutchmore
- Department of Medicine, Division of Critical Care Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - François Lamontagne
- Department of Medicine, Division of Critical Care Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001, 12Th Avenue N, Sherbrooke, QC, J1H 5N4, Canada
| | - Michaël Chassé
- Department of Medicine (Critical Care), University of Montreal Hospital, Montreal, Canada
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Canada
| | - Lynne Moore
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec City, Canada
| | - Michael Mayette
- Department of Medicine, Division of Critical Care Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada.
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001, 12Th Avenue N, Sherbrooke, QC, J1H 5N4, Canada.
| |
Collapse
|
16
|
Chassé M, Fergusson DA, Tinmouth A, Acker JP, Perelman I, Tuttle A, English SW, Hawken S, Forster AJ, Shehata N, Thavorn K, Wilson K, Cober N, Maddison H, Tokessy M. Effect of Donor Sex on Recipient Mortality in Transfusion. N Engl J Med 2023; 388:1386-1395. [PMID: 37043654 DOI: 10.1056/nejmoa2211523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Conflicting observational evidence exists regarding the association between the sex of red-cell donors and mortality among transfusion recipients. Evidence to inform transfusion practice and policy is limited. METHODS In this multicenter, double-blind trial, we randomly assigned patients undergoing red-cell transfusion to receive units of red cells from either male donors or female donors. Patients maintained their trial-group assignment throughout the trial period, including during subsequent inpatient and outpatient encounters. Randomization was conducted in a 60:40 ratio (male donor group to female donor group) to match the historical allocation of red-cell units from the blood supplier. The primary outcome was survival, with the male donor group as the reference group. RESULTS A total of 8719 patients underwent randomization before undergoing transfusion; 5190 patients were assigned to the male donor group, and 3529 to the female donor group. At baseline, the mean (±SD) age of the enrolled patients was 66.8±16.4 years. The setting of the first transfusion was as an inpatient in 6969 patients (79.9%), of whom 2942 (42.2%) had been admitted under a surgical service. The baseline hemoglobin level before transfusion was 79.5±19.7 g per liter, and patients received a mean of 5.4±10.5 units of red cells in the female donor group and 5.1±8.9 units in the male donor group (difference, 0.3 units; 95% confidence interval [CI], -0.1 to 0.7). Over the duration of the trial, 1141 patients in the female donor group and 1712 patients in the male donor group died. In the primary analysis of overall survival, the adjusted hazard ratio for death was 0.98 (95% CI, 0.91 to 1.06). CONCLUSIONS This trial showed no significant difference in survival between a transfusion strategy involving red-cell units from female donors and a strategy involving red-cell units from male donors. (Funded by the Canadian Institutes of Health Research; iTADS ClinicalTrials.gov number, NCT03344887.).
Collapse
Affiliation(s)
- Michaël Chassé
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Dean A Fergusson
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Alan Tinmouth
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Jason P Acker
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Iris Perelman
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Angie Tuttle
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Shane W English
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Steven Hawken
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Alan J Forster
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Nadine Shehata
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Kednapa Thavorn
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Kumanan Wilson
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Nancy Cober
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Heather Maddison
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Melanie Tokessy
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| |
Collapse
|
17
|
Yamga E, Mullie L, Durand M, Cadrin-Chenevert A, Tang A, Montagnon E, Chartrand-Lefebvre C, Chassé M. Interpretable clinical phenotypes among patients hospitalized with COVID-19 using cluster analysis. Front Digit Health 2023; 5:1142822. [PMID: 37114183 PMCID: PMC10128042 DOI: 10.3389/fdgth.2023.1142822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/13/2023] [Indexed: 04/29/2023] Open
Abstract
Background Multiple clinical phenotypes have been proposed for coronavirus disease (COVID-19), but few have used multimodal data. Using clinical and imaging data, we aimed to identify distinct clinical phenotypes in patients admitted with COVID-19 and to assess their clinical outcomes. Our secondary objective was to demonstrate the clinical applicability of this method by developing an interpretable model for phenotype assignment. Methods We analyzed data from 547 patients hospitalized with COVID-19 at a Canadian academic hospital. We processed the data by applying a factor analysis of mixed data (FAMD) and compared four clustering algorithms: k-means, partitioning around medoids (PAM), and divisive and agglomerative hierarchical clustering. We used imaging data and 34 clinical variables collected within the first 24 h of admission to train our algorithm. We conducted a survival analysis to compare the clinical outcomes across phenotypes. With the data split into training and validation sets (75/25 ratio), we developed a decision-tree-based model to facilitate the interpretation and assignment of the observed phenotypes. Results Agglomerative hierarchical clustering was the most robust algorithm. We identified three clinical phenotypes: 79 patients (14%) in Cluster 1, 275 patients (50%) in Cluster 2, and 203 (37%) in Cluster 3. Cluster 2 and Cluster 3 were both characterized by a low-risk respiratory and inflammatory profile but differed in terms of demographics. Compared with Cluster 3, Cluster 2 comprised older patients with more comorbidities. Cluster 1 represented the group with the most severe clinical presentation, as inferred by the highest rate of hypoxemia and the highest radiological burden. Intensive care unit (ICU) admission and mechanical ventilation risks were the highest in Cluster 1. Using only two to four decision rules, the classification and regression tree (CART) phenotype assignment model achieved an AUC of 84% (81.5-86.5%, 95 CI) on the validation set. Conclusions We conducted a multidimensional phenotypic analysis of adult inpatients with COVID-19 and identified three distinct phenotypes associated with different clinical outcomes. We also demonstrated the clinical usability of this approach, as phenotypes can be accurately assigned using a simple decision tree. Further research is still needed to properly incorporate these phenotypes in the management of patients with COVID-19.
Collapse
Affiliation(s)
- Eric Yamga
- Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Louis Mullie
- Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Madeleine Durand
- Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | | | - An Tang
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Radiology and Nuclear Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Emmanuel Montagnon
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Carl Chartrand-Lefebvre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Radiology and Nuclear Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Michaël Chassé
- Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| |
Collapse
|
18
|
Neves Briard J, Nitulescu R, Lemoine É, Titova P, McIntyre L, English SW, Knoll G, Shemie SD, Martin C, Turgeon AF, Lauzier F, Fergusson DA, Chassé M. Diagnostic accuracy of ancillary tests for death by neurologic criteria: a systematic review and meta-analysis. Can J Anaesth 2023; 70:736-748. [PMID: 37155120 PMCID: PMC10202988 DOI: 10.1007/s12630-023-02426-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 05/10/2023] Open
Abstract
PURPOSE Ancillary tests are frequently used in death determination by neurologic criteria (DNC), particularly when the clinical neurologic examination is unreliable. Nevertheless, their diagnostic accuracy has not been extensively studied. Our objective was to synthesize the sensitivity and specificity of commonly used ancillary tests for DNC. SOURCE We performed a systematic review and meta-analysis by searching MEDLINE, EMBASE, Cochrane databases, and CINAHL Ebsco from their inception to 4 February 2022. We selected cohort and case-control studies including patients with 1) clinically diagnosed death by neurologic criteria or 2) clinically suspected death by neurologic criteria who underwent ancillary testing for DNC. We excluded studies without a priori diagnostic criteria and studies conducted solely on pediatric patients. Accepted reference standards were clinical examination, four-vessel conventional angiography, and radionuclide imaging. Data were directly extracted from published reports. We assessed the methodological quality of studies with the QUADAS-2 tool and estimated ancillary test sensitivities and specificities using hierarchical Bayesian models with diffuse priors. PRINCIPAL FINDINGS Overall, 137 records met the selection criteria. One study (0.7%) had a low risk of bias in all QUADAS-2 domains. Among clinically diagnosed death by neurologic criteria patients (n = 8,891), ancillary tests had similar pooled sensitivities (range, 0.82-0.93). Sensitivity heterogeneity was greater within (σ = 0.10-0.15) than between (σ = 0.04) ancillary test types. Among clinically suspected death by neurologic criteria patients (n = 2,732), pooled ancillary test sensitivities ranged between 0.81 and 1.00 and specificities between 0.87 and 1.00. Most estimates had high statistical uncertainty. CONCLUSION Studies assessing ancillary test diagnostic accuracy have an unclear or high risk of bias. High-quality studies are required to thoroughly validate ancillary tests for DNC. STUDY REGISTRATION PROSPERO (CRD42013005907); registered 7 October 2013.
Collapse
Affiliation(s)
- Joel Neves Briard
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, H2X 3H8, Canada
| | - Roy Nitulescu
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, H2X 3H8, Canada
| | - Émile Lemoine
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
| | - Polina Titova
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, H2X 3H8, Canada
| | - Lauralyn McIntyre
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Greg Knoll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sam D Shemie
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Claudio Martin
- Department of Medicine, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
- Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
| | - François Lauzier
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
- Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
- Department of Medicine, Université Laval, Quebec City, QC, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michaël Chassé
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, H2X 3H8, Canada.
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.
| |
Collapse
|
19
|
Shemie SD, Wilson LC, Hornby L, Basmaji J, Baker AJ, Bensimon CM, Chandler JA, Chassé M, Dawson R, Dhanani S, Mooney OT, Sarti AJ, Simpson C, Teitelbaum J, Torrance S, Boyd JG, Brennan J, Brewster H, Carignan R, Dawe KJ, Doig CJ, Elliott-Pohl K, Gofton TE, Hartwick M, Healey A, Honarmand K, Hornby K, Isac G, Kanji A, Kawchuk J, Klowak JA, Kramer AH, Kromm J, LeBlanc AE, Lee-Ameduri K, Lee LA, Leeies M, Lewis A, Manara A, Matheson S, McKinnon NKA, Murphy N, Briard JN, Pope TM, Sekhon MS, Shanker JJS, Singh G, Singh J, Slessarev M, Soliman K, Sutherland S, Weiss MJ, Shaul RZ, Zuckier LS, Zorko DJ, Rochwerg B. A brain-based definition of death and criteria for its determination after arrest of circulation or neurologic function in Canada: a 2023 clinical practice guideline. Can J Anaesth 2023; 70:483-557. [PMID: 37131020 PMCID: PMC10203028 DOI: 10.1007/s12630-023-02431-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 05/04/2023] Open
Abstract
This 2023 Clinical Practice Guideline provides the biomedical definition of death based on permanent cessation of brain function that applies to all persons, as well as recommendations for death determination by circulatory criteria for potential organ donors and death determination by neurologic criteria for all mechanically ventilated patients regardless of organ donation potential. This Guideline is endorsed by the Canadian Critical Care Society, the Canadian Medical Association, the Canadian Association of Critical Care Nurses, Canadian Anesthesiologists' Society, the Canadian Neurological Sciences Federation (representing the Canadian Neurological Society, Canadian Neurosurgical Society, Canadian Society of Clinical Neurophysiologists, Canadian Association of Child Neurology, Canadian Society of Neuroradiology, and Canadian Stroke Consortium), Canadian Blood Services, the Canadian Donation and Transplantation Research Program, the Canadian Association of Emergency Physicians, the Nurse Practitioners Association of Canada, and the Canadian Cardiovascular Critical Care Society.
Collapse
Affiliation(s)
- Sam D Shemie
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
- McGill University, Montreal, QC, Canada.
- MUHC Research Institute, Montreal, QC, Canada.
- Canadian Blood Services, Ottawa, ON, Canada.
| | | | | | | | - Andrew J Baker
- Unity Health Toronto, Toronto, ON, Canada
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Sonny Dhanani
- University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Owen T Mooney
- University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba Gift of Life Program, Winnipeg, MB, Canada
- St. Boniface Hospital, Winnipeg, MB, Canada
| | - Aimee J Sarti
- University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christy Simpson
- Canadian Blood Services, Ottawa, ON, Canada
- Dalhousie University, Halifax, NS, Canada
| | - Jeanne Teitelbaum
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
- McGill University, Montreal, QC, Canada
| | | | - J Gordon Boyd
- Kingston General Hospital, Kingston, ON, Canada
- Queen's University, Kingston, ON, Canada
| | | | | | | | - Kirk J Dawe
- Eastern Health, St. John's, NL, Canada
- Memorial University of Newfoundland, St. John's, NL, Canada
| | - Christopher J Doig
- University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Edmonton, AB, Canada
| | | | | | - Michael Hartwick
- University of Ottawa, Ottawa, ON, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
| | - Andrew Healey
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
- McMaster University, Hamilton, ON, Canada
- William Osler Health System, Brampton, ON, Canada
| | - Kimia Honarmand
- Western University, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | | | - George Isac
- University of British Columbia, Vancouver, BC, Canada
| | - Aly Kanji
- McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
- McGill University, Montreal, QC, Canada
| | - Joann Kawchuk
- Saskatchewan Health Authority, Saskatoon, SK, Canada
| | | | - Andreas H Kramer
- University of Calgary, Calgary, AB, Canada
- Southern Alberta Organ & Tissue Donation Program, Calgary, AB, Canada
| | - Julie Kromm
- University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Edmonton, AB, Canada
| | - Allana E LeBlanc
- University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, Vancouver, BC, Canada
- Canadian Association of Critical Care Nurses, London, ON, Canada
| | - Katarina Lee-Ameduri
- University of Manitoba, Winnipeg, MB, Canada
- St. Boniface Hospital, Winnipeg, MB, Canada
| | - Laurie A Lee
- University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital, Calgary, AB, Canada
| | - Murdoch Leeies
- University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba Gift of Life Program, Winnipeg, MB, Canada
- Canadian Critical Care Society, Markham, ON, Canada
| | - Ariane Lewis
- NYU Langone Medical Center, New York City, NY, USA
| | | | | | - Nicole K A McKinnon
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
- Peter Gilgan Center for Research and Learning, Toronto, ON, Canada
| | | | | | - Thaddeus M Pope
- University of Ottawa, Ottawa, ON, Canada
- Mitchell Hamline School of Law, Saint Paul, MN, USA
- Queensland University of Technology, Brisbane, Qld, Australia
- Albany Medical College, Albany, NY, USA
- University of Minnesota Center for Bioethics, Minneapolis, MN, USA
| | - Mypinder S Sekhon
- University of British Columbia, Vancouver, BC, Canada
- Vancouver General Hospital, Vancouver, BC, Canada
| | | | - Gurmeet Singh
- Mazankowski Alberta Heart Institute, Edmonton, AB, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Jeffrey Singh
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Marat Slessarev
- Western University, London, ON, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
| | - Karim Soliman
- Queen's University, Kingston, ON, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
- Lakeridge Health, Oshawa, ON, Canada
| | | | - Matthew J Weiss
- Transplant Québec, Montreal, QC, Canada
- CHU de Québec - Université Laval, Quebec City, QC, Canada
- Université Laval, Quebec City, QC, Canada
| | - Randi Zlotnik Shaul
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Lionel S Zuckier
- University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
| | - David J Zorko
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Bram Rochwerg
- McMaster University, Hamilton, ON, Canada
- Canadian Critical Care Society, Markham, ON, Canada
- Canadian Critical Care Trials Group, Markham, ON, Canada
| |
Collapse
|
20
|
Taran S, Gros P, Gofton T, Boyd G, Briard JN, Chassé M, Singh JM. The reticular activating system: a narrative review of discovery, evolving understanding, and relevance to current formulations of brain death. Can J Anaesth 2023; 70:788-795. [PMID: 37155119 PMCID: PMC10203024 DOI: 10.1007/s12630-023-02421-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 05/10/2023] Open
Abstract
A series of landmark experiments conducted throughout the 20th century progressively localized the regions involved in consciousness to the reticular activating system (RAS) and its ascending projections. The first description of the RAS emerged in 1949 through seminal experiments performed by Moruzzi and Magoun in feline brainstems; additional experiments in the 1950s revealed connections between the RAS and the thalamus and neocortical structures. This knowledge has allowed for the explanation of disorders of consciousness with exquisite anatomic precision. The clinical relevance of the RAS is further apparent in modern definitions of brain death/death by neurologic criteria (BD/DNC), which require demonstration of the complete and permanent loss of capacity for consciousness as one of their core criteria. BD/DNC is currently understood across jurisdictions in terms of "whole brain" and "brainstem" formulations. Although their clinical examination between formulations is indistinguishable, policies for BD/DNC declaration may differ in the rare scenario of patients with isolated infratentorial brain injuries, in which ancillary testing is advised in the whole brain formulation but not the brainstem formulation. Canadian guidelines acknowledge that the distinction between whole brain and brainstem formulations is unclear with respect to clinical implications for patients with isolated infratentorial injuries. This has led to variability in Canadian clinicians' use of ancillary testing when the mechanism of BD/DNC is suspected to be an isolated infratentorial injury. The present narrative review highlights these concepts and explores implications for determination of BD/DNC in Canada, with specific emphasis on the RAS and its relevance to both formulations.
Collapse
Affiliation(s)
- Shaurya Taran
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Western Hospital, Office 411-L, 2nd Floor McLaughlin, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada
| | - Priti Gros
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Division of Neurology, University Health Network, Toronto, ON, Canada
| | - Teneille Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Gordon Boyd
- Department of Medicine (Neurology) and Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Joel Neves Briard
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
- Université de Montréal Hospital Research Centre, Montreal, QC, Canada
| | - Jeffrey M Singh
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Ontario Health - Trillium Gift of Life Network, Toronto, ON, Canada
| |
Collapse
|
21
|
Sarti AJ, Sutherland S, Meade M, Hornby L, Wilson LC, Landriault A, Vanderspank-Wright B, Valiani S, Keenan S, Weiss MJ, Werestiuk K, Beed S, Kramer AH, Kawchuk J, Cardinal P, Dhanani S, Lotherington K, Pagliarello G, Chassé M, Gatien M, Parsons K, Chandler JA, Nickerson P, Shemie SD. Death determination by neurologic criteria-what do families understand? Can J Anaesth 2023; 70:637-650. [PMID: 37131029 PMCID: PMC10203015 DOI: 10.1007/s12630-023-02416-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/15/2022] [Accepted: 11/26/2022] [Indexed: 05/04/2023] Open
Abstract
PURPOSE Currently, there is little empirical data on family understanding about brain death and death determination. The purpose of this study was to describe family members' (FMs') understanding of brain death and the process of determining death in the context of organ donation in Canadian intensive care units (ICUs). METHODS We conducted a qualitative study using semistructured, in-depth interviews with FMs who were asked to make an organ donation decision on behalf of adult or pediatric patients with death determination by neurologic criteria (DNC) in Canadian ICUs. RESULTS From interviews with 179 FMs, six main themes emerged: 1) state of mind, 2) communication, 3) DNC may be counterintuitive, 4) preparation for the DNC clinical assessment, 5) DNC clinical assessment, and 6) time of death. Recommendations on how clinicians can help FMs to understand and accept DNC through communication at key moments were described including preparing FMs for death determination, allowing FMs to be present, and explaining the legal time of death, combined with multimodal strategies. For many FMs, understanding of DNC unfolded over time, facilitated with repeated encounters and explanation, rather than during a single meeting. CONCLUSION Family members' understanding of brain death and death determination represented a journey that they reported in sequential meeting with health care providers, most notably physicians. Modifiable factors to improve communication and bereavement outcomes during DNC include attention to the state of mind of the family, pacing and repeating discussions according to families' expressed understanding, and preparing and inviting families to be present for the clinical determination including apnea testing. We have provided family-generated recommendations that are pragmatic and can be easily implemented.
Collapse
Affiliation(s)
- Aimee J Sarti
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada.
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Stephanie Sutherland
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada
| | - Maureen Meade
- Department of Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | | | - Angele Landriault
- Practice, Performance and Innovation Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Brandi Vanderspank-Wright
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sabira Valiani
- Department of Adult Critical Care, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Sean Keenan
- BC Transplant, Vancouver, BC, Canada
- Division of Critical Care, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | | | - Stephen Beed
- Department of Critical Care, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Andreas H Kramer
- Departments of Critical Care Medicine and Clinical Neurosciences, University of Calgary and Southern Alberta Organ and Tissue Donation Program, Calgary, AB, Canada
| | - Joann Kawchuk
- Department of Adult Critical Care, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Pierre Cardinal
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada
| | - Sonny Dhanani
- Division of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Giuseppe Pagliarello
- Department of Critical Care, The Ottawa Hospital, General Campus, Ottawa, ON, K1H 8L6, Canada
| | - Michaël Chassé
- Department of Medicine, Centre hospitalier de L'Université de Montréal, Montreal, QC, Canada
| | - Mary Gatien
- Horizon Health Network, Miramichi, NB, Canada
| | - Kim Parsons
- Organ Procurement and Exchange of Newfoundland and Labrador, St. John's, NL, Canada
| | - Jennifer A Chandler
- Common Law Section, Faculty of Law, University of Ottawa, Ottawa, ON, Canada
| | - Peter Nickerson
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sam D Shemie
- Canadian Blood Services, Ottawa, ON, Canada
- Division of Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada
| |
Collapse
|
22
|
Shemie SD, Briard JN, Boyd JG, Gofton T, Kramer A, Chassé M, Taran S, Gros P, Singh JM. Infratentorial brain injury and death by neurologic criteria in Canada: a narrative review. Can J Anaesth 2023; 70:781-787. [PMID: 37138155 PMCID: PMC10203019 DOI: 10.1007/s12630-023-02427-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 05/05/2023] Open
Abstract
There are two anatomic formulations of death by neurologic criteria accepted worldwide: whole-brain death and brainstem death. As part of the Canadian Death Definition and Determination Project, we convened an expert working group and performed a narrative review of the literature. Infratentorial brain injury (IBI) with an unconfounded clinical assessment consistent with death by neurologic criteria represents a nonrecoverable injury. The clinical determination of death cannot distinguish between IBI and whole-brain cessation of function. Current clinical, functional, and neuroimaging assessments cannot reliably confirm the complete and permanent destruction of the brainstem. No patient with isolated brainstem death has been reported to recover consciousness and all patients have died. Studies suggest a significant majority of isolated brainstem death will evolve into whole-brain death, influenced by time/duration of somatic support and impacted by ventricular drainage and/or posterior fossa decompressive craniectomy. Acknowledging variability in intensive care unit (ICU) physician opinion on this matter, a majority of Canadian ICU physicians would perform ancillary testing for death determination by neurologic criteria in the context of IBI. There is currently no reliable ancillary test to confirm complete destruction of the brainstem; ancillary testing currently includes evaluation of both infratentorial and supratentorial flow. Acknowledging international variability in this regard, the existing evidence reviewed does not provide sufficient confidence that the clinical exam in IBI represents a complete and permanent destruction of the reticular activating system and thus the capacity for consciousness. On this basis, IBI consistent with clinical signs of death by neurologic criteria without significant supratentorial involvement does not fulfill criteria for death in Canada and ancillary testing is required.
Collapse
Affiliation(s)
- Sam D Shemie
- Division of Pediatric Critical Care, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.
- MUHC Research Institute, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
- System Development, Canadian Blood Services, Ottawa, ON, Canada.
| | - Joel Neves Briard
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - J Gordon Boyd
- Departments of Medicine (Neurology) and Critical Care Medicine, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Tenielle Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Andreas Kramer
- Departments of Critical Care Medicine and Clinical Neurosciences, University of Calgary and Southern Alberta Organ and Tissue Donation Program, Calgary, AB, Canada
| | - Michaël Chassé
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Shaurya Taran
- Division of Neurology, Department of Medicine, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Priti Gros
- Division of Neurology, Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Jeffrey M Singh
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
| |
Collapse
|
23
|
Tanguay P, Décary S, Lemaire-Paquette S, Léonard G, Piché A, Dubois MF, Kairy D, Bravo G, Corriveau H, Marquis N, Tousignant M, Chassé M, Carvalho LP. Trajectories of health-related quality of life and their predictors in adult COVID-19 survivors: A longitudinal analysis of the Biobanque Québécoise de la COVID-19 (BQC-19). Qual Life Res 2023:10.1007/s11136-023-03406-0. [PMID: 37004627 PMCID: PMC10066943 DOI: 10.1007/s11136-023-03406-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE A significant number of people will experience prolonged symptoms after COVID-19 infection that will greatly impact functional capacity and quality of life. The aim of this study was to identify trajectories of health-related quality of life (HRQOL) and their predictors among adults diagnosed with COVID-19. METHODS This is a retrospective analysis of an ongoing prospective cohort study (BQC-19) including adults (≥18y) recruited from April 2020 to March 2022. Our primary outcome is HRQOL using the EQ-5D-5L scale. Sociodemographic, acute disease severity, vaccination status, fatigue, and functional status at onset of the disease were considered as potential predictors. The latent class mixed model was used to identify the trajectories over an 18-month period in the cohort as a whole, as well as in the inpatient and outpatient subgroups. Multivariable and univariable regressions models were undertaken to detect predictors of decline. RESULTS 2163 participants were included. Thirteen percent of the outpatient subgroup (2 classes) and 28% in the inpatient subgroup (3 classes) experienced a more significant decline in HRQOL over time than the rest of the participants. Among all patients, age, sex, disease severity and fatigue, measured on the first assessment visit or on the first day after hospital admission (multivariable models), were identified as the most important predictors of HRQOL decline. Each unit increase in the SARC-F and CFS scores increase the likelihood of belonging to the declining trajectory (univariable models). CONCLUSION Although to different degrees, similar factors explain the decline in HRQOL over time among the overall population, people who have been hospitalized or not. Clinical functional capacity scales could help to determine the risk of HRQOL decline.
Collapse
Affiliation(s)
- Pamela Tanguay
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Simon Décary
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | | | - Guillaume Léonard
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
- Centre de Recherche sur le Vieillessement de CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
| | - Alain Piché
- Département de Microbiologie et d'Infectiologie, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-France Dubois
- Centre de Recherche sur le Vieillessement de CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
- Département Des Sciences de la Santé Communautaire, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Dahlia Kairy
- École de Réadaptation, Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Université de Montréal, Montreal, Canada
| | - Gina Bravo
- Centre de Recherche sur le Vieillessement de CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
- Département Des Sciences de la Santé Communautaire, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Hélène Corriveau
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
- Centre de Recherche sur le Vieillessement de CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
| | - Nicole Marquis
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Michel Tousignant
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
- Centre de Recherche sur le Vieillessement de CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada
| | - Michaël Chassé
- Centre de Recherche du Centre Hospitalier, Université de Montréal, Montreal, Canada
| | - Livia Pinheiro Carvalho
- École de Réadaptation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada.
- Centre de Recherche sur le Vieillessement de CIUSSS de l'Estrie-CHUS, Sherbrooke, Canada.
| |
Collapse
|
24
|
McKinnon NK, Maratta C, Zuckier LS, Boyd JG, Chassé M, Hornby L, Kramer A, Kromm J, Mooney OT, Muthusami P, Nitulescu R, Park J, Slessarev M, Basmaji J. Ancillary investigations for death determination in infants and children: a systematic review and meta-analysis. Can J Anaesth 2023; 70:749-770. [PMID: 37131035 PMCID: PMC10203011 DOI: 10.1007/s12630-023-02418-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/17/2022] [Accepted: 11/20/2022] [Indexed: 05/04/2023] Open
Abstract
PURPOSE We performed a systematic review and meta-analysis to determine the diagnostic test accuracy of ancillary investigations for declaration of death by neurologic criteria (DNC) in infants and children. SOURCE We searched MEDLINE, EMBASE, Web of Science, and Cochrane databases from their inception to June 2021 for relevant randomized controlled trials, observational studies, and abstracts published in the last three years. We identified relevant studies using Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology and a two-stage review. We assessed the risk of bias using the QUADAS-2 tool, and applied Grading of Recommendations Assessment, Development, and Evaluation methodology to determine the certainty of evidence. A fixed-effects model was used to meta-analyze pooled sensitivity and specificity data for each ancillary investigation with at least two studies. PRINCIPAL FINDINGS Thirty-nine eligible manuscripts assessing 18 unique ancillary investigations (n = 866) were identified. The sensitivity and specificity ranged from 0.00 to 1.00 and 0.50 to 1.00, respectively. The quality of evidence was low to very low for all ancillary investigations, with the exception of radionuclide dynamic flow studies for which it was graded as moderate. Radionuclide scintigraphy using the lipophilic radiopharmaceutical 99mTc-hexamethylpropyleneamine oxime (HMPAO) with or without tomographic imaging were the most accurate ancillary investigations with a combined sensitivity of 0.99 (95% highest density interval [HDI], 0.89 to 1.00) and specificity of 0.97 (95% HDI, 0.65 to 1.00). CONCLUSION The ancillary investigation for DNC in infants and children with the greatest accuracy appears to be radionuclide scintigraphy using HMPAO with or without tomographic imaging; however, the certainty of the evidence is low. Nonimaging modalities performed at the bedside require further investigation. STUDY REGISTRATION PROSPERO (CRD42021278788); registered 16 October 2021.
Collapse
Affiliation(s)
- Nicole K McKinnon
- Department of Critical Care, The Hospital for Sick Children (SickKids), 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Neuroscience and Mental Health, Peter Gilgan Centre for Research and Learning, Toronto, ON, Canada.
| | - Christina Maratta
- Department of Critical Care, The Hospital for Sick Children (SickKids), 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lionel S Zuckier
- Division of Nuclear Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Departments of Medicine and Radiology, University of Ottawa, Ottawa, ON, Canada
| | - J Gordon Boyd
- Departments of Medicine (Neurology) and Critical Care Medicine, Kingston General Hospital, Kingston, ON, Canada
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Montreal, QC, Canada
| | | | - Andreas Kramer
- Departments of Critical Care Medicine and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Julie Kromm
- Departments of Critical Care Medicine and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Alberta Health Services, Calgary, AB, Canada
| | - Owen T Mooney
- Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Prakash Muthusami
- Department of Diagnostic Imaging, Hospital for Sick Children (SickKids), Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Roy Nitulescu
- Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Montreal, QC, Canada
| | - Jaewoo Park
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Marat Slessarev
- Department of Medicine, Western University, London, ON, Canada
| | - John Basmaji
- Department of Medicine, Western University, London, ON, Canada
| |
Collapse
|
25
|
Maitre G, Shemie SD, Baker A, Chassé M, Hornby L, Sarti AJ, Teitelbaum J, Dhanani S. Knowledge gaps in the definition and determination of death. Can J Anaesth 2023; 70:610-616. [PMID: 37131033 PMCID: PMC10203022 DOI: 10.1007/s12630-023-02422-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/23/2022] [Accepted: 11/27/2022] [Indexed: 05/04/2023] Open
Affiliation(s)
- Guillaume Maitre
- McGill University, Montreal, QC, Canada.
- McGill University Health Center, Montreal, QC, Canada.
- Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
- Division of Pediatric Critical Care, Montreal Children's Hospital, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
| | - Sam D Shemie
- McGill University, Montreal, QC, Canada
- McGill University Health Center, Montreal, QC, Canada
- McGill University Health Center Research Institute, Montreal, QC, Canada
- Canadian Blood Services, Ottawa, ON, Canada
| | - Andrew Baker
- University of Toronto, Toronto, ON, Canada
- Unity Health Toronto, Toronto, ON, Canada
| | | | | | - Aimee J Sarti
- University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jeanne Teitelbaum
- McGill University, Montreal, QC, Canada
- McGill University Health Center, Montreal, QC, Canada
| | - Sonny Dhanani
- University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| |
Collapse
|
26
|
Briard JN, Chassé M. Author Response: Infratentorial Brain Injury Among Patients Suspected of Death by Neurologic Criteria: A Systematic Review and Meta-analysis. Neurology 2023; 100:495. [PMID: 36878723 PMCID: PMC9990856 DOI: 10.1212/wnl.0000000000207092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
|
27
|
Carrier FM, Deshêtres A, Ferreira Guerra S, Rioux-Massé B, Zaouter C, Lee N, Amzallag É, Joosten A, Massicotte L, Chassé M. Preoperative Fibrinogen Level and Bleeding in Liver Transplantation for End-stage Liver Disease: A Cohort Study. Transplantation 2023; 107:693-702. [PMID: 36150121 DOI: 10.1097/tp.0000000000004333] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Liver transplantation is a high-risk surgery associated with important perioperative bleeding and transfusion needs. Uncertainties remain on the association between preoperative fibrinogen level and bleeding in this population. METHODS We conducted a cohort study that included all consecutive adult patients undergoing a liver transplantation for end-stage liver disease in 1 center. We analyzed the association between the preoperative fibrinogen level and bleeding-related outcomes. Our primary outcome was intraoperative blood loss, and our secondary outcomes were estimated perioperative blood loss, intraoperative and perioperative red blood cell transfusions, reinterventions for bleeding and 1-y graft and patient survival. We estimated linear regression models and marginal risk models adjusted for all important potential confounders. We used restricted cubic splines to explore potential nonlinear associations and reported dose-response curves. RESULTS We included 613 patients. We observed that a lower fibrinogen level was associated with a higher intraoperative blood loss, a higher estimated perioperative blood loss and a higher risk of intraoperative and perioperative red blood cell transfusions (nonlinear effects). Based on an exploratory analysis of the dose-response curves, these effects were observed below a threshold value of 3 g/L for these outcomes. We did not observe any association between preoperative fibrinogen level and reinterventions, 1-y graft survival or 1-y patient survival. CONCLUSIONS This study suggests that a lower fibrinogen level is associated with bleeding in liver transplantation. The present results may help improving the selection of patients for further studies on preoperative fibrinogen administration in liver transplant recipients with end-stage liver disease.
Collapse
Affiliation(s)
- François Martin Carrier
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montréal, Canada
- Department of Medicine, Critical Care Division, Centre hospitalier de l'Université de Montréal, Montréal, Canada
- Carrefour de l'innovation et santé des populations, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Departement of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, Canada
| | - Annie Deshêtres
- Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Steve Ferreira Guerra
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | - Benjamin Rioux-Massé
- Department of Medicine, Hematology Division, Centre hospitalier de l'Université de Montréal, Montréal, Canada
- Department of Medicine, Université de Montréal, Montréal, Canada
| | - Cédrick Zaouter
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montréal, Canada
- Departement of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, Canada
| | - Nick Lee
- Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Éva Amzallag
- Carrefour de l'innovation et santé des populations, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Alexandre Joosten
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Bicêtre and Paul Brousse Hospitals, Assistance Publique Hôpitaux de Paris, Villejuif, France
| | - Luc Massicotte
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montréal, Canada
- Departement of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, Canada
| | - Michaël Chassé
- Department of Medicine, Critical Care Division, Centre hospitalier de l'Université de Montréal, Montréal, Canada
- Carrefour de l'innovation et santé des populations, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Department of Medicine, Université de Montréal, Montréal, Canada
| |
Collapse
|
28
|
Niznick N, Saigle V, Marti ML, Laframboise J, Zha X, Andersen C, Presseau J, Chassé M, McIntyre L, Fergusson D, Turgeon AF, Lauzier F, Mayer SA, Lahiri S, Ramsay T, English S. Patient Relevance of the Modified Rankin Scale in Subarachnoid Hemorrhage Research: An International Cross-sectional Survey. Neurology 2023; 100:e1565-e1573. [PMID: 36750387 PMCID: PMC10103120 DOI: 10.1212/wnl.0000000000206879] [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] [Received: 06/23/2022] [Accepted: 12/15/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is significant heterogeneity in the reporting of outcomes measure in aneurysmal subarachnoid hemorrhage (aSAH) research. The modified Rankin Scale (mRS) is the most commonly reported functional outcome measure. The mRS focuses on physical disability, however many aSAH survivors experience sequalae in other domains, and the mRS may therefore not capture outcomes important to aSAH survivors. The objective of this study was to assess the clinical relevance of the mRS as a research outcome measure to people with lived aSAH. METHODS We conducted an international cross-sectional survey of 355 aSAH survivors, family members and caregivers to evaluate patient-perceived outcomes in relation to the mRS. The mRS was assessed using a previously validated web-based tool. RESULTS Response rate was 60%; respondents from 7 continents were comprised of 86% aSAH survivors and 14% family members/caregivers. Agreement between self-assessed outcome and the mRS was poor (Kappa 0.26 (CI 0.14-0.39)). Of the 172 respondents who self-assessed as having had a good aSAH outcome, 122 (71%) had a score of 0-2 on the mRS. 19% of respondents with a good outcome, based on a measured mRS score of 0-2, self-assessed as having had a poor aSAH outcome. When the mRS score was dichotomized as 0-3 corresponding to a good outcome, agreement between the score and self-assessed outcome remained poor with a Kappa score of 0.40 (CI 0.20-0.60). Thirty per cent of respondents felt that the mRS should not be used as an outcome measure in future aSAH trials. DISCUSSION The findings suggest that there is poor agreement between aSAH survivors' self-assessed outcome, their actual mRS score and the dichotomization of the mRS score into good/poor outcomes. Patient-centered and -informed outcome measurement tools are needed to guide the aSAH research agenda.
Collapse
Affiliation(s)
- Naomi Niznick
- Department of Medicine (Neurology), The Ottawa Hospital, Ottawa, ON, Canada
| | - Victoria Saigle
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Maria Luisa Marti
- Patient partner, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Josephine Laframboise
- Patient partner, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Xiaohui Zha
- Patient partner, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Chris Andersen
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Justin Presseau
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, Montréal, Canada.,CHUM Research Center, Montréal, Canada
| | - Lauralyn McIntyre
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada.,Department of Medicine (Critical Care), The Ottawa Hospital, Ottawa, ON, Canada
| | - Dean Fergusson
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada.,Department of Anesthesiology & Critical Care, Université Laval, Québec City, Québec, Canada
| | - François Lauzier
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada.,Department of Anesthesiology & Critical Care, Université Laval, Québec City, Québec, Canada.,Department of Medicine, Université Laval, Québec City, Québec, Canada
| | - Stephan A Mayer
- Departments of Neurology and Neurosurgery, Westchester Health Network, New York Medical College, Valhalla, NY, USA
| | - Shouri Lahiri
- Departments of Neurology, Neurosurgery, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tim Ramsay
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Shane English
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada.,Department of Medicine (Critical Care), The Ottawa Hospital, Ottawa, ON, Canada
| |
Collapse
|
29
|
Neves Briard J, Plourde G, Nitulescu R, Boyd JG, Carrier FM, Couillard P, Keezer MR, Kramer AH, Shemie SD, Stapf C, Chassé M. Infratentorial Brain Injury Among Patients Suspected of Death by Neurologic Criteria: A Systematic Review and Meta-analysis. Neurology 2023; 100:e443-e453. [PMID: 36220596 DOI: 10.1212/wnl.0000000000201449] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/08/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is a paucity of data on the frequency and prognosis of infratentorial brain injury among patients suspected of death by neurologic criteria (DNC), which likely contributes to scientific uncertainty regarding the role of isolated brainstem death in DNC determination. Our aim was to synthesize the prevalence, characteristics, and evolution of infratentorial brain injury, including isolated brainstem death, among patients suspected of DNC. METHODS We conducted a systematic review by searching Medline, Embase, EBM Reviews, CINAHL Complete, and the gray literature from inception to March 26, 2021. We selected cohort and cross-sectional studies, case reports, and case series that included patients suspected of DNC. Two study investigators independently performed study selection, data collection, and risk of bias assessment. Our primary outcomes were the respective prevalence of infratentorial brain injury and isolated brainstem death, which we meta-analyzed using mixed-effects Bayesian hierarchical models with diffuse priors. Our secondary outcomes were the characteristics and evolution of patients with infratentorial brain injury and isolated brainstem death. RESULTS Twenty-one studies met the selection criteria, most of which were of moderate to high risk of bias. Among patients suspected of DNC, the prevalence of infratentorial brain injury ranged from 2% to 16% (n = 3,602, mean prevalence: 6.3%, 95% highest density interval [2.4%-14.2%]), whereas the prevalence of isolated brainstem death ranged from 1% to 4% (n = 3,692, mean prevalence: 1.5%, 95% highest density interval [0.5%-3.9%]). A total of 38 isolated brainstem death cases with data on clinical characteristics and/or evolution were included. All had infratentorial strokes. Twenty patients had EEG background activity in the α or θ frequencies, 19 had preserved cerebral blood flow, 2 had preserved supratentorial cerebral perfusion, 2 had cortical responses to visual evoked potentials, and 1 had cortical responses to somatosensory evoked potentials. At the latest follow-up, 28 had progressed to whole-brain death. DISCUSSION Studies with moderate to high risk of bias suggest that infratentorial brain injury is relatively uncommon among patients suspected of DNC. Isolated brainstem death is rarer and seems to carry a high risk of progression to whole-brain death. These findings require further high-quality investigation.
Collapse
Affiliation(s)
- Joel Neves Briard
- From the Departments of Neuroscience (J.N.B., M.R.K., C.S.) Medicine (G.P., M.C.), and Anesthesiology and Pain Medicine (F.M.C.), Université de Montréal, Québec, Canada; Centre de Recherche Du Centre Hospitalier de l'Université de Montréal (CRCHUM) (J.N.B., G.P., R.N., F.M.C., M.R.K., C.S., M.C.), Québec, Canada; Department of Social and Preventative Medicine (J.N.B., M.R.K., M.C.), École de Santé Publique de l'Université de Montréal, Québec, Canada; Departments of Medicine and Critical Care (J.G.B.), Queen's University, Kingston, Ontario, Canada; Departments of Critical Care Medicine & Clinical Neurosciences (P.C., A.H.K.), University of Calgary, Alberta, Canada; and Department of Pediatrics (S.D.S.), McGill University, Montréal, Québec, Canada
| | - Guillaume Plourde
- From the Departments of Neuroscience (J.N.B., M.R.K., C.S.) Medicine (G.P., M.C.), and Anesthesiology and Pain Medicine (F.M.C.), Université de Montréal, Québec, Canada; Centre de Recherche Du Centre Hospitalier de l'Université de Montréal (CRCHUM) (J.N.B., G.P., R.N., F.M.C., M.R.K., C.S., M.C.), Québec, Canada; Department of Social and Preventative Medicine (J.N.B., M.R.K., M.C.), École de Santé Publique de l'Université de Montréal, Québec, Canada; Departments of Medicine and Critical Care (J.G.B.), Queen's University, Kingston, Ontario, Canada; Departments of Critical Care Medicine & Clinical Neurosciences (P.C., A.H.K.), University of Calgary, Alberta, Canada; and Department of Pediatrics (S.D.S.), McGill University, Montréal, Québec, Canada
| | - Roy Nitulescu
- From the Departments of Neuroscience (J.N.B., M.R.K., C.S.) Medicine (G.P., M.C.), and Anesthesiology and Pain Medicine (F.M.C.), Université de Montréal, Québec, Canada; Centre de Recherche Du Centre Hospitalier de l'Université de Montréal (CRCHUM) (J.N.B., G.P., R.N., F.M.C., M.R.K., C.S., M.C.), Québec, Canada; Department of Social and Preventative Medicine (J.N.B., M.R.K., M.C.), École de Santé Publique de l'Université de Montréal, Québec, Canada; Departments of Medicine and Critical Care (J.G.B.), Queen's University, Kingston, Ontario, Canada; Departments of Critical Care Medicine & Clinical Neurosciences (P.C., A.H.K.), University of Calgary, Alberta, Canada; and Department of Pediatrics (S.D.S.), McGill University, Montréal, Québec, Canada
| | - J Gordon Boyd
- From the Departments of Neuroscience (J.N.B., M.R.K., C.S.) Medicine (G.P., M.C.), and Anesthesiology and Pain Medicine (F.M.C.), Université de Montréal, Québec, Canada; Centre de Recherche Du Centre Hospitalier de l'Université de Montréal (CRCHUM) (J.N.B., G.P., R.N., F.M.C., M.R.K., C.S., M.C.), Québec, Canada; Department of Social and Preventative Medicine (J.N.B., M.R.K., M.C.), École de Santé Publique de l'Université de Montréal, Québec, Canada; Departments of Medicine and Critical Care (J.G.B.), Queen's University, Kingston, Ontario, Canada; Departments of Critical Care Medicine & Clinical Neurosciences (P.C., A.H.K.), University of Calgary, Alberta, Canada; and Department of Pediatrics (S.D.S.), McGill University, Montréal, Québec, Canada
| | - François Martin Carrier
- From the Departments of Neuroscience (J.N.B., M.R.K., C.S.) Medicine (G.P., M.C.), and Anesthesiology and Pain Medicine (F.M.C.), Université de Montréal, Québec, Canada; Centre de Recherche Du Centre Hospitalier de l'Université de Montréal (CRCHUM) (J.N.B., G.P., R.N., F.M.C., M.R.K., C.S., M.C.), Québec, Canada; Department of Social and Preventative Medicine (J.N.B., M.R.K., M.C.), École de Santé Publique de l'Université de Montréal, Québec, Canada; Departments of Medicine and Critical Care (J.G.B.), Queen's University, Kingston, Ontario, Canada; Departments of Critical Care Medicine & Clinical Neurosciences (P.C., A.H.K.), University of Calgary, Alberta, Canada; and Department of Pediatrics (S.D.S.), McGill University, Montréal, Québec, Canada
| | - Philippe Couillard
- From the Departments of Neuroscience (J.N.B., M.R.K., C.S.) Medicine (G.P., M.C.), and Anesthesiology and Pain Medicine (F.M.C.), Université de Montréal, Québec, Canada; Centre de Recherche Du Centre Hospitalier de l'Université de Montréal (CRCHUM) (J.N.B., G.P., R.N., F.M.C., M.R.K., C.S., M.C.), Québec, Canada; Department of Social and Preventative Medicine (J.N.B., M.R.K., M.C.), École de Santé Publique de l'Université de Montréal, Québec, Canada; Departments of Medicine and Critical Care (J.G.B.), Queen's University, Kingston, Ontario, Canada; Departments of Critical Care Medicine & Clinical Neurosciences (P.C., A.H.K.), University of Calgary, Alberta, Canada; and Department of Pediatrics (S.D.S.), McGill University, Montréal, Québec, Canada
| | - Mark R Keezer
- From the Departments of Neuroscience (J.N.B., M.R.K., C.S.) Medicine (G.P., M.C.), and Anesthesiology and Pain Medicine (F.M.C.), Université de Montréal, Québec, Canada; Centre de Recherche Du Centre Hospitalier de l'Université de Montréal (CRCHUM) (J.N.B., G.P., R.N., F.M.C., M.R.K., C.S., M.C.), Québec, Canada; Department of Social and Preventative Medicine (J.N.B., M.R.K., M.C.), École de Santé Publique de l'Université de Montréal, Québec, Canada; Departments of Medicine and Critical Care (J.G.B.), Queen's University, Kingston, Ontario, Canada; Departments of Critical Care Medicine & Clinical Neurosciences (P.C., A.H.K.), University of Calgary, Alberta, Canada; and Department of Pediatrics (S.D.S.), McGill University, Montréal, Québec, Canada
| | - Andreas H Kramer
- From the Departments of Neuroscience (J.N.B., M.R.K., C.S.) Medicine (G.P., M.C.), and Anesthesiology and Pain Medicine (F.M.C.), Université de Montréal, Québec, Canada; Centre de Recherche Du Centre Hospitalier de l'Université de Montréal (CRCHUM) (J.N.B., G.P., R.N., F.M.C., M.R.K., C.S., M.C.), Québec, Canada; Department of Social and Preventative Medicine (J.N.B., M.R.K., M.C.), École de Santé Publique de l'Université de Montréal, Québec, Canada; Departments of Medicine and Critical Care (J.G.B.), Queen's University, Kingston, Ontario, Canada; Departments of Critical Care Medicine & Clinical Neurosciences (P.C., A.H.K.), University of Calgary, Alberta, Canada; and Department of Pediatrics (S.D.S.), McGill University, Montréal, Québec, Canada
| | - Sam D Shemie
- From the Departments of Neuroscience (J.N.B., M.R.K., C.S.) Medicine (G.P., M.C.), and Anesthesiology and Pain Medicine (F.M.C.), Université de Montréal, Québec, Canada; Centre de Recherche Du Centre Hospitalier de l'Université de Montréal (CRCHUM) (J.N.B., G.P., R.N., F.M.C., M.R.K., C.S., M.C.), Québec, Canada; Department of Social and Preventative Medicine (J.N.B., M.R.K., M.C.), École de Santé Publique de l'Université de Montréal, Québec, Canada; Departments of Medicine and Critical Care (J.G.B.), Queen's University, Kingston, Ontario, Canada; Departments of Critical Care Medicine & Clinical Neurosciences (P.C., A.H.K.), University of Calgary, Alberta, Canada; and Department of Pediatrics (S.D.S.), McGill University, Montréal, Québec, Canada
| | - Christian Stapf
- From the Departments of Neuroscience (J.N.B., M.R.K., C.S.) Medicine (G.P., M.C.), and Anesthesiology and Pain Medicine (F.M.C.), Université de Montréal, Québec, Canada; Centre de Recherche Du Centre Hospitalier de l'Université de Montréal (CRCHUM) (J.N.B., G.P., R.N., F.M.C., M.R.K., C.S., M.C.), Québec, Canada; Department of Social and Preventative Medicine (J.N.B., M.R.K., M.C.), École de Santé Publique de l'Université de Montréal, Québec, Canada; Departments of Medicine and Critical Care (J.G.B.), Queen's University, Kingston, Ontario, Canada; Departments of Critical Care Medicine & Clinical Neurosciences (P.C., A.H.K.), University of Calgary, Alberta, Canada; and Department of Pediatrics (S.D.S.), McGill University, Montréal, Québec, Canada
| | - Michaël Chassé
- From the Departments of Neuroscience (J.N.B., M.R.K., C.S.) Medicine (G.P., M.C.), and Anesthesiology and Pain Medicine (F.M.C.), Université de Montréal, Québec, Canada; Centre de Recherche Du Centre Hospitalier de l'Université de Montréal (CRCHUM) (J.N.B., G.P., R.N., F.M.C., M.R.K., C.S., M.C.), Québec, Canada; Department of Social and Preventative Medicine (J.N.B., M.R.K., M.C.), École de Santé Publique de l'Université de Montréal, Québec, Canada; Departments of Medicine and Critical Care (J.G.B.), Queen's University, Kingston, Ontario, Canada; Departments of Critical Care Medicine & Clinical Neurosciences (P.C., A.H.K.), University of Calgary, Alberta, Canada; and Department of Pediatrics (S.D.S.), McGill University, Montréal, Québec, Canada.
| |
Collapse
|
30
|
Martel G, Lenet T, Wherrett C, Carrier FM, Monette L, Workneh A, Brousseau K, Ruel M, Chassé M, Collin Y, Vandenbroucke-Menu F, Hamel-Perreault É, Perreault MA, Park J, Lim S, Maltais V, Leung P, Gilbert RWD, Segedi M, Abou-Khalil J, Bertens KA, Balaa FK, Ramsay T, Fergusson DA. Phlebotomy resulting in controlled hypovolemia to prevent blood loss in major hepatic resections (PRICE-2): study protocol for a phase 3 randomized controlled trial. Trials 2023; 24:38. [PMID: 36653812 PMCID: PMC9848035 DOI: 10.1186/s13063-022-07008-y] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Blood loss and red blood cell (RBC) transfusion in liver surgery are areas of concern for surgeons, anesthesiologists, and patients alike. While various methods are employed to reduce surgical blood loss, the evidence base surrounding each intervention is limited. Hypovolemic phlebotomy, the removal of whole blood from the patient without volume replacement during liver transection, has been strongly associated with decreased bleeding and RBC transfusion in observational studies. This trial aims to investigate whether hypovolemic phlebotomy is superior to usual care in reducing RBC transfusions in liver resection. METHODS This study is a double-blind multicenter randomized controlled trial. Adult patients undergoing major hepatic resections for any indication will be randomly allocated in a 1:1 ratio to either hypovolemic phlebotomy and usual care or usual care alone. Exclusion criteria will be minor resections, preoperative hemoglobin <100g/L, renal insufficiency, and other contraindication to hypovolemic phlebotomy. The primary outcome will be the proportion of patients receiving at least one allogeneic RBC transfusion unit within 30 days of the onset of surgery. Secondary outcomes will include transfusion of other allogeneic blood products, blood loss, morbidity, mortality, and intraoperative physiologic parameters. The surgical team will be blinded to the intervention. Randomization will occur on the morning of surgery. The sample size will comprise 440 patients. Enrolment will occur at four Canadian academic liver surgery centers over a 4-year period. Ethics approval will be obtained at participating sites before enrolment. DISCUSSION The results of this randomized control trial will provide high-quality evidence regarding the use of hypovolemic phlebotomy in major liver resection and its effects on RBC transfusion. If proven to be effective, this intervention could become standard of care in liver operations internationally and become incorporated within perioperative patient blood management programs. TRIAL REGISTRATION ClinicalTrials.gov NCT03651154 . Registered on August 29 2018.
Collapse
Affiliation(s)
- Guillaume Martel
- grid.28046.380000 0001 2182 2255Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital– General Campus, University of Ottawa, 501 Smyth Road, CCW 1667, Ottawa, ON K1H 8L6 Canada ,grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Tori Lenet
- grid.28046.380000 0001 2182 2255Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital– General Campus, University of Ottawa, 501 Smyth Road, CCW 1667, Ottawa, ON K1H 8L6 Canada ,grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Christopher Wherrett
- grid.28046.380000 0001 2182 2255Departments of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON Canada
| | - François-Martin Carrier
- grid.410559.c0000 0001 0743 2111Department of Anesthesiology, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montréal, QC Canada ,grid.410559.c0000 0001 0743 2111Department of Medicine, Critical Care Division, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montréal, QC Canada
| | - Leah Monette
- grid.28046.380000 0001 2182 2255Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital– General Campus, University of Ottawa, 501 Smyth Road, CCW 1667, Ottawa, ON K1H 8L6 Canada ,grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Aklile Workneh
- grid.28046.380000 0001 2182 2255Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital– General Campus, University of Ottawa, 501 Smyth Road, CCW 1667, Ottawa, ON K1H 8L6 Canada ,grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Karine Brousseau
- grid.28046.380000 0001 2182 2255Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital– General Campus, University of Ottawa, 501 Smyth Road, CCW 1667, Ottawa, ON K1H 8L6 Canada ,grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Monique Ruel
- grid.410559.c0000 0001 0743 2111Department of Anesthesiology, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montréal, QC Canada
| | - Michaël Chassé
- grid.410559.c0000 0001 0743 2111Department of Medicine, Critical Care Division, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montréal, QC Canada
| | - Yves Collin
- grid.411172.00000 0001 0081 2808Division of General Surgery, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC Canada
| | - Franck Vandenbroucke-Menu
- grid.410559.c0000 0001 0743 2111Hepato-Pancreato-Biliary and Liver Transplantation Surgery Unit, Department of Surgery - Centre Hospitalier de l’Université de Montréal, Montréal, QC Canada
| | - Élodie Hamel-Perreault
- grid.411172.00000 0001 0081 2808Departement of Anesthesiology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC Canada
| | - Michel-Antoine Perreault
- grid.411172.00000 0001 0081 2808Departement of Anesthesiology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC Canada
| | - Jeieung Park
- grid.17091.3e0000 0001 2288 9830Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, University of British Columbia, Vancouver, BC Canada
| | - Shirley Lim
- grid.17091.3e0000 0001 2288 9830Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, University of British Columbia, Vancouver, BC Canada
| | - Véronique Maltais
- grid.17091.3e0000 0001 2288 9830Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC Canada
| | - Philemon Leung
- grid.17091.3e0000 0001 2288 9830Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC Canada
| | - Richard W. D. Gilbert
- grid.17091.3e0000 0001 2288 9830Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC Canada
| | - Maja Segedi
- grid.17091.3e0000 0001 2288 9830Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC Canada
| | - Jad Abou-Khalil
- grid.28046.380000 0001 2182 2255Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital– General Campus, University of Ottawa, 501 Smyth Road, CCW 1667, Ottawa, ON K1H 8L6 Canada
| | - Kimberly A. Bertens
- grid.28046.380000 0001 2182 2255Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital– General Campus, University of Ottawa, 501 Smyth Road, CCW 1667, Ottawa, ON K1H 8L6 Canada
| | - Fady K. Balaa
- grid.28046.380000 0001 2182 2255Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital– General Campus, University of Ottawa, 501 Smyth Road, CCW 1667, Ottawa, ON K1H 8L6 Canada
| | - Tim Ramsay
- grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Dean A. Fergusson
- grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| |
Collapse
|
31
|
Massicotte-Azarniouch D, Sood MM, Fergusson DA, Chassé M, Tinmouth A, Knoll GA. The association of venous thromboembolism with blood transfusion in kidney transplant patients. Transfusion 2022; 62:2480-2489. [PMID: 36325656 DOI: 10.1111/trf.17154] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Red blood cell transfusion (RBCT) is common after kidney transplantation and could have pro-thrombotic effects predisposing to venous thromboembolism (VTE). The risks for developing of VTE after RBCT in kidney transplant patients are unknown. STUDY DESIGN AND METHODS This was a retrospective cohort study of adult kidney transplant recipients from 2002 to 2018. The exposure of interest was receipt of RBCT after transplant. Cox proportional hazards models were used to calculate hazard ratios (HR) for the outcomes of venous thromboembolism [VTE] (deep venous thrombosis [DVT] or pulmonary embolism [PE]) using RBCT as a time-varying, cumulative exposure. RESULTS Out of 1258 kidney transplants recipients, 468 (37%) were transfused during the study period. Seventy-nine study participants (6.3%) developed VTE, 72 DVT (5.7%), and 22 PE (1.8%). For the receipt of 1, 2, 3-5, and >5 RBCT, compared to individuals never transfused, the number of events and adjusted HR (95%CI) for VTE were 6 (6.2%) HR 1.57 (0.69-3.58), 9 (7.6%) HR 2.54 (1.30-4.96), 15 (11.9%) HR 2.73 (1.38-5.41), and 23 (18.1%) HR 5.77 (2.99-11.14) respectively; for DVT, it was 6 (6.2%) HR 1.94 (0.84-4.48), 9 (7.6%) HR 2.92 (1.44-5.94), 14 (11.1%) HR 3.29 (1.63-6.65), and 21 (16.5%) HR 6.97 (3.53-13.76), respectively. For PE, among transfused individuals, there were 14 events (3.0%) and the HR was 2.40 (1.02-5.61). CONCLUSION The risks for developing VTE, DVT, and PE were significantly increased in kidney transplant patients receiving RBCT after transplant. Receipt of RBCT should prompt considerations for judicious monitoring and assessment for thrombosis.
Collapse
Affiliation(s)
| | - Manish M Sood
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michaël Chassé
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Alan Tinmouth
- Department of Medicine, Division of Hematology, University of Ottawa, Ottawa, Ontario, Canada
| | - Greg A Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
32
|
Girard M, Roy Cardinal MH, Chassé M, Garneau S, Cavayas YA, Cloutier G, Denault AY. Regional pleural strain measurements during mechanical ventilation using ultrasound elastography: A randomized, crossover, proof of concept physiologic study. Front Med (Lausanne) 2022; 9:935482. [PMID: 36186794 PMCID: PMC9520064 DOI: 10.3389/fmed.2022.935482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mechanical ventilation is a common therapy in operating rooms and intensive care units. When ill-adapted, it can lead to ventilator-induced lung injury (VILI), which is associated with poor outcomes. Excessive regional pulmonary strain is thought to be a major mechanism responsible for VILI. Scarce bedside methods exist to measure regional pulmonary strain. We propose a novel way to measure regional pleural strain using ultrasound elastography. The objective of this study was to assess the feasibility and reliability of pleural strain measurement by ultrasound elastography and to determine if elastography parameters would correlate with varying tidal volumes. Methods A single-blind randomized crossover proof of concept study was conducted July to October 2017 at a tertiary care referral center. Ten patients requiring general anesthesia for elective surgery were recruited. After induction, patients received tidal volumes of 6, 8, 10, and 12 mL.kg–1 in random order, while pleural ultrasound cineloops were acquired at 4 standardized locations. Ultrasound radiofrequency speckle tracking allowed computing various pleural translation, strain and shear components. We screened 6 elastography parameters (lateral translation, lateral absolute translation, lateral strain, lateral absolute strain, lateral absolute shear and Von Mises Strain) to identify those with the best dose-response with tidal volumes using linear mixed effect models. Goodness-of-fit was assessed by the coefficient of determination. Intraobserver, interobserver and test-retest reliability were calculated using intraclass correlation coefficients. Results Analysis was possible in 90.7% of ultrasound cineloops. Lateral absolute shear, lateral absolute strain and Von Mises strain varied significantly with tidal volume and offered the best dose-responses and data modeling fits. Point estimates for intraobserver reliability measures were excellent for all 3 parameters (0.94, 0.94, and 0.93, respectively). Point estimates for interobserver (0.84, 0.83, and 0.77, respectively) and test-retest (0.85, 0.82, and 0.76, respectively) reliability measures were good. Conclusion Strain imaging is feasible and reproducible. Future studies will have to investigate the clinical relevance of this novel imaging modality. Clinical trial registration www.Clinicaltrials.gov, identifier NCT03092557.
Collapse
Affiliation(s)
- Martin Girard
- Department of Anesthesiology, University of Montreal Hospital, Montréal, QC, Canada
- Division of Critical Care, Department of Medicine, University of Montreal Hospital, Montréal, QC, Canada
- University of Montreal Hospital Research Center, Montréal, QC, Canada
- *Correspondence: Martin Girard,
| | - Marie-Hélène Roy Cardinal
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, QC, Canada
| | - Michaël Chassé
- Division of Critical Care, Department of Medicine, University of Montreal Hospital, Montréal, QC, Canada
- Department of Medicine, University of Montreal, Montréal, QC, Canada
| | - Sébastien Garneau
- Department of Anesthesiology, University of Montreal Hospital, Montréal, QC, Canada
| | | | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, QC, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal, Montréal, QC, Canada
| | - André Y. Denault
- Department of Anesthesiology, Montreal Heart Institute, Montréal, QC, Canada
| |
Collapse
|
33
|
Sarti AJ, Sutherland S, Meade M, Shemie S, Landriault A, Vanderspank-Wright B, Valiani S, Keenan S, Weiss MJ, Werestiuk K, Kramer AH, Kawchuk J, Beed S, Dhanani S, Pagliarello G, Chassé M, Lotherington K, Gatien M, Parsons K, Chandler JA, Nickerson P, Cardinal P. The experiences of family members of deceased organ donors and suggestions to improve the donation process: a qualitative study. CMAJ 2022; 194:E1054-E1061. [PMID: 35940617 PMCID: PMC9365431 DOI: 10.1503/cmaj.220508] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Decisions about organ donation are stressful for family members of potential organ donors. We sought to comprehensively explore the donation process from interviews conducted with family members of patients admitted to pediatric and adult intensive care units in Canada. Methods: We conducted a qualitative study using semistructured, in-depth interviews with 271 family members asked to make an organ donation decision. We recruited participants from all provinces with an organ donation organization (n = 10), and analyzed themes using a modified grounded theory approach. On the basis of these interviews, suggestions were made by researchers and family members on how to improve the process of organ donation. Results: We identified 3 main themes and 9 subthemes. Families need more comprehensive support around the time of donation, including having access to someone with shared experiences, support during specific moments as needed and better support during critical transitions (e.g., when the donor body goes to the operating room). The theme of better connection to recipient(s) included receiving information about the donation surgery (e.g., which organs were recovered), establishing connection with recipients (e.g., via social networks or letters) and planned encounters. Support after donation, such as updates on organ transplantation, early mental health checks and continued connection to donor organizations, could be improved. We derived 20 suggestions for improving the organ donation process, derived from interviews with family members of pediatric and adult organ donors. Interpretation: We found gaps in family support during end-of-life and donation care. Feelings of abandonment, lack of support and poor-to-little follow-up provide the empirical findings needed for hospitals and organ donor organizations to provide better support to donor families.
Collapse
Affiliation(s)
- Aimee J Sarti
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL.
| | - Stephanie Sutherland
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Maureen Meade
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Sam Shemie
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Angele Landriault
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Brandi Vanderspank-Wright
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Sabira Valiani
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Sean Keenan
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Matthew J Weiss
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Kim Werestiuk
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Andreas H Kramer
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Joann Kawchuk
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Stephen Beed
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Sonny Dhanani
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Giuseppe Pagliarello
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Michaël Chassé
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Ken Lotherington
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Mary Gatien
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Kim Parsons
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Jennifer A Chandler
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Peter Nickerson
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| | - Pierre Cardinal
- Department of Critical Care (Sarti, Pagliarello, Cardinal), Ottawa Hospital; Ottawa Hospital Research Institute (Sarti, Sutherland, Vanderspank-Wright); Common Law Section (Chandler), Faculty of Law, and School of Nursing (Vanderspank-Wright), Faculty of Health Sciences, University of Ottawa; Canadian Blood Services (Shemie); Practice, Performance and Innovation Unit (Landriault), Royal College of Physicians and Surgeons of Canada; Division of Critical Care (Dhanani), Children's Hospital of Eastern Ontario, Ottawa, Ont.; Department of Critical Care (Meade), Hamilton Health Sciences, Hamilton, Ont.; Department of Pediatrics (Shemie), McGill University; Department of Medicine (Chassé), Centre hospitalier de L'Université de Montréal, Montréal, Que.; Department of Adult Critical Care (Valiani, Kawchuk), Saskatchewan Health Authority, Saskatoon, Sask.; BC Transplant (Keenan); Division of Critical Care (Keenan), Department of Medicine, Univeristy of British Columbia, Vancouver, BC; Population Health and Optimal Health Practices Research Unit (Weiss), Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Que.; Faculty of Health Sciences (Nickerson), University of Manitoba; Transplant Manitoba (Werestiuk), Winnipeg, Man.; University of Calgary (Kramer), Calgary, Alta.; Department of Critical Care (Beed), Faculty of Medicine, Dalhousie University, Halifax, NS; Canadian Blood Services (Lotherington), Halifax, NS; Horizon Health Network (Gatien), Miramichi, NB; Organ Procurement and Exchange of Newfoundland and Labrador (OPEN) (Parsons), St. John's, NL
| |
Collapse
|
34
|
Pathak GA, Karjalainen J, Stevens C, Neale BM, Daly M, Ganna A, Andrews SJ, Kanai M, Cordioli M, Polimanti R, Harerimana N, Pirinen M, Liao RG, Chwialkowska K, Trankiem A, Balaconis MK, Nguyen H, Solomonson M, Veerapen K, Wolford B, Roberts G, Park D, Ball CA, Coignet M, McCurdy S, Knight S, Partha R, Rhead B, Zhang M, Berkowitz N, Gaddis M, Noto K, Ruiz L, Pavlovic M, Hong EL, Rand K, Girshick A, Guturu H, Baltzell AH, Niemi MEK, Rahmouni S, Guntz J, Beguin Y, Cordioli M, Pigazzini S, Nkambule L, Georges M, Moutschen M, Misset B, Darcis G, Guiot J, Azarzar S, Gofflot S, Claassen S, Malaise O, Huynen P, Meuris C, Thys M, Jacques J, Léonard P, Frippiat F, Giot JB, Sauvage AS, Frenckell CV, Belhaj Y, Lambermont B, Nakanishi T, Morrison DR, Mooser V, Richards JB, Butler-Laporte G, Forgetta V, Li R, Ghosh B, Laurent L, Belisle A, Henry D, Abdullah T, Adeleye O, Mamlouk N, Kimchi N, Afrasiabi Z, Rezk N, Vulesevic B, Bouab M, Guzman C, Petitjean L, Tselios C, Xue X, Afilalo J, Afilalo M, Oliveira M, Brenner B, Brassard N, Durand M, Schurr E, Lepage P, Ragoussis J, Auld D, Chassé M, Kaufmann DE, Lathrop GM, Adra D, Hayward C, Glessner JT, Shaw DM, Campbell A, Morris M, Hakonarson H, Porteous DJ, Below J, Richmond A, Chang X, Polikowski H, Lauren PE, Chen HH, Wanying Z, Fawns-Ritchie C, North K, McCormick JB, Chang X, Glessner JR, Hakonarson H, Gignoux CR, Wicks SJ, Crooks K, Barnes KC, Daya M, Shortt J, Rafaels N, Chavan S, Timmers PRHJ, Wilson JF, Tenesa A, Kerr SM, D’Mellow K, Shahin D, El-Sherbiny YM, von Hohenstaufen KA, Sobh A, Eltoukhy MM, Nkambul L, Elhadidy TA, Abd Elghafar MS, El-Jawhari JJ, Mohamed AAS, Elnagdy MH, Samir A, Abdel-Aziz M, Khafaga WT, El-Lawaty WM, Torky MS, El-shanshory MR, Yassen AM, Hegazy MAF, Okasha K, Eid MA, Moahmed HS, Medina-Gomez C, Ikram MA, Uitterlinden AG, Mägi R, Milani L, Metspalu A, Laisk T, Läll K, Lepamets M, Esko T, Reimann E, Naaber P, Laane E, Pesukova J, Peterson P, Kisand K, Tabri J, Allos R, Hensen K, Starkopf J, Ringmets I, Tamm A, Kallaste A, Alavere H, Metsalu K, Puusepp M, Batini C, Tobin MD, Venn LD, Lee PH, Shrine N, Williams AT, Guyatt AL, John C, Packer RJ, Ali A, Free RC, Wang X, Wain LV, Hollox EJ, Bee CE, Adams EL, Palotie A, Ripatti S, Ruotsalainen S, Kristiansson K, Koskelainen S, Perola M, Donner K, Kivinen K, Palotie A, Kaunisto M, Rivolta C, Bochud PY, Bibert S, Boillat N, Nussle SG, Albrich W, Quinodoz M, Kamdar D, Suh N, Neofytos D, Erard V, Voide C, Bochud PY, Rivolta C, Bibert S, Quinodoz M, Kamdar D, Neofytos D, Erard V, Voide C, Friolet R, Vollenweider P, Pagani JL, Oddo M, zu Bentrup FM, Conen A, Clerc O, Marchetti O, Guillet A, Guyat-Jacques C, Foucras S, Rime M, Chassot J, Jaquet M, Viollet RM, Lannepoudenx Y, Portopena L, Bochud PY, Vollenweider P, Pagani JL, Desgranges F, Filippidis P, Guéry B, Haefliger D, Kampouri EE, Manuel O, Munting A, Papadimitriou-Olivgeris M, Regina J, Rochat-Stettler L, Suttels V, Tadini E, Tschopp J, Van Singer M, Viala B, Boillat-Blanco N, Brahier T, Hügli O, Meuwly JY, Pantet O, Gonseth Nussle S, Bochud M, D’Acremont V, Estoppey Younes S, Albrich WC, Suh N, Cerny A, O’Mahony L, von Mering C, Bochud PY, Frischknecht M, Kleger GR, Filipovic M, Kahlert CR, Wozniak H, Negro TR, Pugin J, Bouras K, Knapp C, Egger T, Perret A, Montillier P, di Bartolomeo C, Barda B, de Cid R, Carreras A, Moreno V, Kogevinas M, Galván-Femenía I, Blay N, Farré X, Sumoy L, Cortés B, Mercader JM, Guindo-Martinez M, Torrents D, Garcia-Aymerich J, Castaño-Vinyals G, Dobaño C, Gori M, Renieri A, Mari F, Mondelli MU, Castelli F, Vaghi M, Rusconi S, Montagnani F, Bargagli E, Franchi F, Mazzei MA, Cantarini L, Tacconi D, Feri M, Scala R, Spargi G, Nencioni C, Bandini M, Caldarelli GP, Canaccini A, Ognibene A, D’Arminio Monforte A, Girardis M, Antinori A, Francisci D, Schiaroli E, Scotton PG, Panese S, Scaggiante R, Monica MD, Capasso M, Fiorentino G, Castori M, Aucella F, Biagio AD, Masucci L, Valente S, Mandalà M, Zucchi P, Giannattasio F, Coviello DA, Mussini C, Tavecchia L, Crotti L, Rizzi M, Rovere MTL, Sarzi-Braga S, Bussotti M, Ravaglia S, Artuso R, Perrella A, Romani D, Bergomi P, Catena E, Vincenti A, Ferri C, Grassi D, Pessina G, Tumbarello M, Pietro MD, Sabrina R, Luchi S, Furini S, Dei S, Benetti E, Picchiotti N, Sanarico M, Ceri S, Pinoli P, Raimondi F, Biscarini F, Stella A, Zguro K, Capitani K, Nkambule L, Tanfoni M, Fallerini C, Daga S, Baldassarri M, Fava F, Frullanti E, Valentino F, Doddato G, Giliberti A, Tita R, Amitrano S, Bruttini M, Croci S, Meloni I, Mencarelli MA, Rizzo CL, Pinto AM, Beligni G, Tommasi A, Sarno LD, Palmieri M, Carriero ML, Alaverdian D, Busani S, Bruno R, Vecchia M, Belli MA, Mantovani S, Ludovisi S, Quiros-Roldan E, Antoni MD, Zanella I, Siano M, Emiliozzi A, Fabbiani M, Rossetti B, Bergantini L, D’Alessandro M, Cameli P, Bennett D, Anedda F, Marcantonio S, Scolletta S, Guerrini S, Conticini E, Frediani B, Spertilli C, Donati A, Guidelli L, Corridi M, Croci L, Piacentini P, Desanctis E, Cappelli S, Verzuri A, Anemoli V, Pancrazzi A, Lorubbio M, Miraglia FG, Venturelli S, Cossarizza A, Vergori A, Gabrieli A, Riva A, Paciosi F, Andretta F, Gatti F, Parisi SG, Baratti S, Piscopo C, Russo R, Andolfo I, Iolascon A, Carella M, Merla G, Squeo GM, Raggi P, Marciano C, Perna R, Bassetti M, Sanguinetti M, Giorli A, Salerni L, Parravicini P, Menatti E, Trotta T, Coiro G, Lena F, Martinelli E, Mancarella S, Gabbi C, Maggiolo F, Ripamonti D, Bachetti T, Suardi C, Parati G, Bottà G, Domenico PD, Rancan I, Bianchi F, Colombo R, Barbieri C, Acquilini D, Andreucci E, Segala FV, Tiseo G, Falcone M, Lista M, Poscente M, Vivo OD, Petrocelli P, Guarnaccia A, Baroni S, Hayward C, Porteous DJ, Fawns-Ritchie C, Richmond A, Campbell A, van Heel DA, Hunt KA, Trembath RC, Huang QQ, Martin HC, Mason D, Trivedi B, Wright J, Finer S, Akhtar S, Anwar M, Arciero E, Ashraf S, Breen G, Chung R, Curtis CJ, Chowdhury M, Colligan G, Deloukas P, Durham C, Finer S, Griffiths C, Huang QQ, Hurles M, Hunt KA, Hussain S, Islam K, Khan A, Khan A, Lavery C, Lee SH, Lerner R, MacArthur D, MacLaughlin B, Martin H, Mason D, Miah S, Newman B, Safa N, Tahmasebi F, Trembath RC, Trivedi B, van Heel DA, Wright J, Griffiths CJ, Smith AV, Boughton AP, Li KW, LeFaive J, Annis A, Niavarani A, Aliannejad R, Sharififard B, Amirsavadkouhi A, Naderpour Z, Tadi HA, Aleagha AE, Ahmadi S, Moghaddam SBM, Adamsara A, Saeedi M, Abdollahi H, Hosseini A, Chariyavilaskul P, Jantarabenjakul W, Hirankarn N, Chamnanphon M, Suttichet TB, Shotelersuk V, Pongpanich M, Phokaew C, Chetruengchai W, Putchareon O, Torvorapanit P, Puthanakit T, Suchartlikitwong P, Nilaratanakul V, Sodsai P, Brumpton BM, Hveem K, Willer C, Wolford B, Zhou W, Rogne T, Solligard E, Åsvold BO, Franke L, Boezen M, Deelen P, Claringbould A, Lopera E, Warmerdam R, Vonk JM, van Blokland I, Lanting P, Ori APS, Feng YCA, Mercader J, Weiss ST, Karlson EW, Smoller JW, Murphy SN, Meigs JB, Woolley AE, Green RC, Perez EF, Wolford B, Zöllner S, Wang J, Beck A, Sloofman LG, Ascolillo S, Sebra RP, Collins BL, Levy T, Buxbaum JD, Sealfon SC, Jordan DM, Thompson RC, Gettler K, Chaudhary K, Belbin GM, Preuss M, Hoggart C, Choi S, Underwood SJ, Salib I, Britvan B, Keller K, Tang L, Peruggia M, Hiester LL, Niblo K, Aksentijevich A, Labkowsky A, Karp A, Zlatopolsky M, Zyndorf M, Charney AW, Beckmann ND, Schadt EE, Abul-Husn NS, Cho JH, Itan Y, Kenny EE, Loos RJF, Nadkarni GN, Do R, O’Reilly P, Huckins LM, Ferreira MAR, Abecasis GR, Leader JB, Cantor MN, Justice AE, Carey DJ, Chittoor G, Josyula NS, Kosmicki JA, Horowitz JE, Baras A, Gass MC, Yadav A, Mirshahi T, Hottenga JJ, Bartels M, de geus EEJC, Nivard MMG, Verma A, Ritchie MD, Rader D, Li B, Verma SS, Lucas A, Bradford Y, Abedalthagafi M, Alaamery M, Alshareef A, Sawaji M, Massadeh S, AlMalik A, Alqahtani S, Baraka D, Harthi FA, Alsolm E, Safieh LA, Alowayn AM, Alqubaishi F, Mutairi AA, Mangul S, Almutairi M, Aljawini N, Albesher N, Arabi YM, Mahmoud ES, Khattab AK, Halawani RT, Alahmadey ZZ, Albakri JK, Felemban WA, Suliman BA, Hasanato R, Al-Awdah L, Alghamdi J, AlZahrani D, AlJohani S, Al-Afghani H, AlDhawi N, AlBardis H, Alkwai S, Alswailm M, Almalki F, Albeladi M, Almohammed I, Barhoush E, Albader A, Alotaibi S, Alghamdi B, Jung J, fawzy MS, Alrashed M, Zeberg H, Nkambul L, Frithiof R, Hultström M, Lipcsey M, Tardif N, Rooyackers O, Grip J, Maricic T, Helgeland Ø, Magnus P, Trogstad LIS, Lee Y, Harris JR, Mangino M, Spector TD, Emma D, Moutsianas L, Caulfield MJ, Scott RH, Kousathanas A, Pasko D, Walker S, Stuckey A, Odhams CA, Rhodes D, Fowler T, Rendon A, Chan G, Arumugam P, Karczewski KJ, Martin AR, Wilson DJ, Spencer CCA, Crook DW, Wyllie DH, O’Connell AM, Atkinson EG, Kanai M, Tsuo K, Baya N, Turley P, Gupta R, Walters RK, Palmer DS, Sarma G, Solomonson M, Cheng N, Lu W, Churchhouse C, Goldstein JI, King D, Zhou W, Seed C, Daly MJ, Neale BM, Finucane H, Bryant S, Satterstrom FK, Band G, Earle SG, Lin SK, Arning N, Koelling N, Armstrong J, Rudkin JK, Callier S, Bryant S, Cusick C, Soranzo N, Zhao JH, Danesh J, Angelantonio ED, Butterworth AS, Sun YV, Huffman JE, Cho K, O’Donnell CJ, Tsao P, Gaziano JM, Peloso G, Ho YL, Smieszek SP, Polymeropoulos C, Polymeropoulos V, Polymeropoulos MH, Przychodzen BP, Fernandez-Cadenas I, Planas AM, Perez-Tur J, Llucià-Carol L, Cullell N, Muiño E, Cárcel-Márquez J, DeDiego ML, Iglesias LL, Soriano A, Rico V, Agüero D, Bedini JL, Lozano F, Domingo C, Robles V, Ruiz-Jaén F, Márquez L, Gomez J, Coto E, Albaiceta GM, García-Clemente M, Dalmau D, Arranz MJ, Dietl B, Serra-Llovich A, Soler P, Colobrán R, Martín-Nalda A, Martínez AP, Bernardo D, Rojo S, Fiz-López A, Arribas E, de la Cal-Sabater P, Segura T, González-Villa E, Serrano-Heras G, Martí-Fàbregas J, Jiménez-Xarrié E, de Felipe Mimbrera A, Masjuan J, García-Madrona S, Domínguez-Mayoral A, Villalonga JM, Menéndez-Valladares P, Chasman DI, Sesso HD, Manson JE, Buring JE, Ridker PM, Franco G, Davis L, Lee S, Priest J, Sankaran VG, van Heel D, Biesecker L, Kerchberger VE, Baillie JK. A first update on mapping the human genetic architecture of COVID-19. Nature 2022; 608:E1-E10. [PMID: 35922517 PMCID: PMC9352569 DOI: 10.1038/s41586-022-04826-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/29/2022] [Indexed: 01/04/2023]
|
35
|
Lamontagne F, Masse MH, Menard J, Sprague S, Pinto R, Heyland DK, Cook DJ, Battista MC, Day AG, Guyatt GH, Kanji S, Parke R, McGuinness SP, Tirupakuzhi Vijayaraghavan BK, Annane D, Cohen D, Arabi YM, Bolduc B, Marinoff N, Rochwerg B, Millen T, Meade MO, Hand L, Watpool I, Porteous R, Young PJ, D'Aragon F, Belley-Cote EP, Carbonneau E, Clarke F, Maslove DM, Hunt M, Chassé M, Lebrasseur M, Lauzier F, Mehta S, Quiroz-Martinez H, Rewa OG, Charbonney E, Seely AJE, Kutsogiannis DJ, LeBlanc R, Mekontso-Dessap A, Mele TS, Turgeon AF, Wood G, Kohli SS, Shahin J, Twardowski P, Adhikari NKJ. Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. N Engl J Med 2022; 386:2387-2398. [PMID: 35704292 DOI: 10.1056/nejmoa2200644] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Studies that have evaluated the use of intravenous vitamin C in adults with sepsis who were receiving vasopressor therapy in the intensive care unit (ICU) have shown mixed results with respect to the risk of death and organ dysfunction. METHODS In this randomized, placebo-controlled trial, we assigned adults who had been in the ICU for no longer than 24 hours, who had proven or suspected infection as the main diagnosis, and who were receiving a vasopressor to receive an infusion of either vitamin C (at a dose of 50 mg per kilogram of body weight) or matched placebo administered every 6 hours for up to 96 hours. The primary outcome was a composite of death or persistent organ dysfunction (defined by the use of vasopressors, invasive mechanical ventilation, or new renal-replacement therapy) on day 28. RESULTS A total of 872 patients underwent randomization (435 to the vitamin C group and 437 to the control group). The primary outcome occurred in 191 of 429 patients (44.5%) in the vitamin C group and in 167 of 434 patients (38.5%) in the control group (risk ratio, 1.21; 95% confidence interval [CI], 1.04 to 1.40; P = 0.01). At 28 days, death had occurred in 152 of 429 patients (35.4%) in the vitamin C group and in 137 of 434 patients (31.6%) in the placebo group (risk ratio, 1.17; 95% CI, 0.98 to 1.40) and persistent organ dysfunction in 39 of 429 patients (9.1%) and 30 of 434 patients (6.9%), respectively (risk ratio, 1.30; 95% CI, 0.83 to 2.05). Findings were similar in the two groups regarding organ-dysfunction scores, biomarkers, 6-month survival, health-related quality of life, stage 3 acute kidney injury, and hypoglycemic episodes. In the vitamin C group, one patient had a severe hypoglycemic episode and another had a serious anaphylaxis event. CONCLUSIONS In adults with sepsis receiving vasopressor therapy in the ICU, those who received intravenous vitamin C had a higher risk of death or persistent organ dysfunction at 28 days than those who received placebo. (Funded by the Lotte and John Hecht Memorial Foundation; LOVIT ClinicalTrials.gov number, NCT03680274.).
Collapse
Affiliation(s)
- François Lamontagne
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Marie-Hélène Masse
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Julie Menard
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Sheila Sprague
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Ruxandra Pinto
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Daren K Heyland
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Deborah J Cook
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Marie-Claude Battista
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Andrew G Day
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Gordon H Guyatt
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Salmaan Kanji
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Rachael Parke
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Shay P McGuinness
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Bharath-Kumar Tirupakuzhi Vijayaraghavan
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Djillali Annane
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Dian Cohen
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Yaseen M Arabi
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Brigitte Bolduc
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Nicole Marinoff
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Bram Rochwerg
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Tina Millen
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Maureen O Meade
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Lori Hand
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Irene Watpool
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Rebecca Porteous
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Paul J Young
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Frederick D'Aragon
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Emilie P Belley-Cote
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Elaine Carbonneau
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - France Clarke
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - David M Maslove
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Miranda Hunt
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Michaël Chassé
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Martine Lebrasseur
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - François Lauzier
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Sangeeta Mehta
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Hector Quiroz-Martinez
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Oleksa G Rewa
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Emmanuel Charbonney
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Andrew J E Seely
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Demetrios J Kutsogiannis
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Remi LeBlanc
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Armand Mekontso-Dessap
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Tina S Mele
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Alexis F Turgeon
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Gordon Wood
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Sandeep S Kohli
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Jason Shahin
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Pawel Twardowski
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Neill K J Adhikari
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| |
Collapse
|
36
|
Conombo B, Guertin JR, Tardif PA, Gagnon MA, Duval C, Archambault P, Berthelot S, Lauzier F, Turgeon AF, Stelfox HT, Chassé M, Hoch JS, Gabbe B, Champion H, Lecky F, Cameron P, Moore L. Economic Evaluation of In-Hospital Clinical Practices in Acute Injury Care: A Systematic Review. Value Health 2022; 25:844-854. [PMID: 35500953 DOI: 10.1016/j.jval.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/27/2021] [Accepted: 10/31/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Underuse of high-value clinical practices and overuse of low-value practices are major sources of inefficiencies in modern healthcare systems. To achieve value-based care, guidelines and recommendations should target both underuse and overuse and be supported by evidence from economic evaluations. We aimed to conduct a systematic review of the economic value of in-hospital clinical practices in acute injury care to advance knowledge on value-based care in this patient population. METHODS Pairs of independent reviewers systematically searched MEDLINE, Embase, Web of Science, and Cochrane Central Register for full economic evaluations of in-hospital clinical practices in acute trauma care published from 2009 to 2019 (last updated on June 17, 2020). Results were converted into incremental net monetary benefit and were summarized with forest plots. The protocol was registered with PROSPERO (CRD42020164494). RESULTS Of 33 910 unique citations, 75 studies met our inclusion criteria. We identified 62 cost-utility, 8 cost-effectiveness, and 5 cost-minimization studies. Values of incremental net monetary benefit ranged from international dollars -467 000 to international dollars 194 000. Of 114 clinical interventions evaluated (vs comparators), 56 were cost-effective. We identified 15 cost-effective interventions in emergency medicine, 6 in critical care medicine, and 35 in orthopedic medicine. A total of 58 studies were classified as high quality and 17 as moderate quality. From studies with a high level of evidence (randomized controlled trials), 4 interventions were clearly dominant and 8 were dominated. CONCLUSIONS This research advances knowledge on value-based care for injury admissions. Results suggest that almost half of clinical interventions in acute injury care that have been studied may not be cost-effective.
Collapse
Affiliation(s)
- Blanchard Conombo
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Jason R Guertin
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Marc-Aurèle Gagnon
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Cécile Duval
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada; VITAM-Centre de recherche en santé durable, Université Laval, Québec City, Québec, Canada; Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Université Laval, Québec City, Québec, Canada
| | - Simon Berthelot
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada
| | - François Lauzier
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, Québec City, Québec, Canada
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine at Monash University, Melbourne, Victoria, Australia
| | - Howard Champion
- Uniformed Services University of the Health Sciences Annapolis, Bethesda, MD, USA
| | - Fiona Lecky
- School of Health and Related Research, Sheffield, England, UK
| | - Peter Cameron
- School of Public Health and Preventive Medicine at Monash University, Melbourne, Victoria, Australia
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada.
| |
Collapse
|
37
|
Brilland B, Laplante P, Thebault P, Geoffroy K, Brissette MJ, Latour M, Chassé M, Qi S, Hébert MJ, Cardinal H, Cailhier JF. MFG-E8 Reduces Aortic Intimal Proliferation in a Murine Model of Transplant Vasculopathy. Int J Mol Sci 2022; 23:ijms23084094. [PMID: 35456911 PMCID: PMC9027378 DOI: 10.3390/ijms23084094] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 12/10/2022] Open
Abstract
Transplant vasculopathy is characterized by endothelial apoptosis, which modulates the local microenvironment. Milk fat globule epidermal growth factor 8 (MFG-E8), which is released by apoptotic endothelial cells, limits tissue damage and inflammation by promoting anti-inflammatory macrophages. We aimed to study its role in transplant vasculopathy using the murine aortic allotransplantation model. BALB/c mice were transplanted with fully mismatched aortic transplants from MFG-E8 knockout (KO) or wild type (WT) C57BL/6J mice. Thereafter, mice received MFG-E8 (or vehicle) injections for 9 weeks prior to histopathological analysis of allografts for intimal proliferation (hematoxylin and eosin staining) and leukocyte infiltration assessment (immunofluorescence). Phenotypes of blood leukocytes and humoral responses were also evaluated (flow cytometry and ELISA). Mice receiving MFG-E8 KO aortas without MFG-E8 injections had the most severe intimal proliferation (p < 0.001). Administration of MFG-E8 decreased intimal proliferation, especially in mice receiving MFG-E8 KO aortas. Administration of MFG-E8 also increased the proportion of anti-inflammatory macrophages among graft-infiltrating macrophages (p = 0.003) and decreased systemic CD4+ and CD8+ T-cell activation (p < 0.001). An increase in regulatory T cells occurred in both groups of mice receiving WT aortas (p < 0.01). Thus, the analarmin MFG-E8 appears to be an important protein for reducing intimal proliferation in this murine model of transplant vasculopathy. MFG-E8 effects are associated with intra-allograft macrophage reprogramming and systemic T-cell activation dampening.
Collapse
Affiliation(s)
- Benoit Brilland
- Service de Néphrologie-Dialyse-Transplantation, CHU d’Angers, F-49000 Angers, France;
- University of Angers, Université de Nantes, CHU Angers, INSERM, CRCINA, SFR ICAT, F-49000 Angers, France
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (P.L.); (P.T.); (K.G.); (M.-J.B.); (M.C.); (S.Q.); (M.-J.H.); (H.C.)
| | - Patrick Laplante
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (P.L.); (P.T.); (K.G.); (M.-J.B.); (M.C.); (S.Q.); (M.-J.H.); (H.C.)
- Institut du Cancer de Montréal, Montréal, QC H2X 0A9, Canada
| | - Pamela Thebault
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (P.L.); (P.T.); (K.G.); (M.-J.B.); (M.C.); (S.Q.); (M.-J.H.); (H.C.)
- Institut du Cancer de Montréal, Montréal, QC H2X 0A9, Canada
| | - Karen Geoffroy
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (P.L.); (P.T.); (K.G.); (M.-J.B.); (M.C.); (S.Q.); (M.-J.H.); (H.C.)
- Institut du Cancer de Montréal, Montréal, QC H2X 0A9, Canada
| | - Marie-Joëlle Brissette
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (P.L.); (P.T.); (K.G.); (M.-J.B.); (M.C.); (S.Q.); (M.-J.H.); (H.C.)
| | - Mathieu Latour
- Department of Pathology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3J4, Canada;
| | - Michaël Chassé
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (P.L.); (P.T.); (K.G.); (M.-J.B.); (M.C.); (S.Q.); (M.-J.H.); (H.C.)
- Department of Medicine, Critical Care Division, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3J4, Canada
| | - Shijie Qi
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (P.L.); (P.T.); (K.G.); (M.-J.B.); (M.C.); (S.Q.); (M.-J.H.); (H.C.)
| | - Marie-Josée Hébert
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (P.L.); (P.T.); (K.G.); (M.-J.B.); (M.C.); (S.Q.); (M.-J.H.); (H.C.)
- Canadian National Transplant Research Program, Edmonton, AB T6G 2E1, Canada
- Department of Medicine, Renal Division, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3J4, Canada
| | - Héloïse Cardinal
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (P.L.); (P.T.); (K.G.); (M.-J.B.); (M.C.); (S.Q.); (M.-J.H.); (H.C.)
- Canadian National Transplant Research Program, Edmonton, AB T6G 2E1, Canada
- Department of Medicine, Renal Division, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3J4, Canada
| | - Jean-François Cailhier
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC H2X 0A9, Canada; (P.L.); (P.T.); (K.G.); (M.-J.B.); (M.C.); (S.Q.); (M.-J.H.); (H.C.)
- Institut du Cancer de Montréal, Montréal, QC H2X 0A9, Canada
- Canadian National Transplant Research Program, Edmonton, AB T6G 2E1, Canada
- Department of Medicine, Renal Division, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3J4, Canada
- Correspondence: ; Tel.: +514-890-8000 (ext. 25971); Fax: +514-412-7938
| |
Collapse
|
38
|
Carrier FM, Ferreira Guerra S, Coulombe J, Amzallag É, Massicotte L, Chassé M, Trottier H. Intraoperative phlebotomies and bleeding in liver transplantation: a historical cohort study and causal analysis. Can J Anaesth 2022; 69:438-447. [PMID: 35112303 DOI: 10.1007/s12630-022-02197-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Liver transplantation is associated with major bleeding and red blood cell (RBC) transfusions. No well-designed causal analysis on interventions used to reduce transfusions, such as an intraoperative phlebotomy, has been conducted in this population. METHODS We conducted a historical cohort study among liver transplantations performed from July 2008 to January 2021 in a Canadian centre. The exposure was intraoperative phlebotomy. The outcomes were blood loss, perioperative RBC transfusions (intraoperative and up to 48 hr after surgery), intraoperative RBC transfusions, and one-year survival. We estimated marginal multiplicative factors (MFs), risk differences (RDs), and hazard ratios by inverse probability of treatment weighting both among treated patients and the whole population. Estimates are reported with 95% confidence intervals (CIs). RESULTS We included 679 patients undergoing liver transplantations of which 365 (54%) received an intraoperative phlebotomy. A phlebotomy did not reduce bleeding, transfusion risks, or mortality when estimated among the treated but reduced bleeding and transfusion risks when estimated among the whole population (MF, 0.85; 95% CI, 0.72 to 0.99; perioperative RD, -15.2%; 95% CI, -26.1 to -0.8; intraoperative RD, -14.7%; 95% CI, -23.2 to -2.8). In a subgroup analysis on 584 patients with end-stage liver disease, slightly larger effects were observed on both transfusion risks when estimated among the whole population while beneficial effects were observed on the intraoperative transfusion risk when estimated among the treated population. CONCLUSION The use of intraoperative phlebotomy was not consistently associated with better outcomes in all targets of inference but may improve outcomes among the whole population. STUDY REGISTRATION www. CLINICALTRIALS gov (NCT04826666); registered 1 April 2021.
Collapse
Affiliation(s)
- François Martin Carrier
- Carrefour de l'innovation et santé des populations, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900, rue St-Denis, porte S03-434, Montréal, QC, Canada. .,Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada. .,Critical Care Division, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada.
| | - Steve Ferreira Guerra
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Janie Coulombe
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Éva Amzallag
- Carrefour de l'innovation et santé des populations, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900, rue St-Denis, porte S03-434, Montréal, QC, Canada
| | - Luc Massicotte
- Department of Anesthesiology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Michaël Chassé
- Carrefour de l'innovation et santé des populations, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900, rue St-Denis, porte S03-434, Montréal, QC, Canada.,Critical Care Division, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Helen Trottier
- Department of Social and Preventive Medicine, Université de Montréal, Sainte-Justine University Hospital Center, Montréal, QC, Canada
| |
Collapse
|
39
|
Plourde G, Briard JN, Shemie SD, Shankar JJS, Chassé M. In reply: Mistaken concepts on the use of ancillary testing in brain death diagnosis. Can J Anaesth 2022; 69:407-408. [PMID: 34970726 DOI: 10.1007/s12630-021-02186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Guillaume Plourde
- Division of Critical Care, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Joel Neves Briard
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
| | - Sam D Shemie
- Division of Critical Care, Montreal Children's Hospital, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Deceased Organ Donation, Canadian Blood Services, Ottawa, ON, Canada
| | | | - Michaël Chassé
- Division of Critical Care, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
- Centre de recherche du CHUM, Université de Montréal, Montreal, QC, Canada.
| |
Collapse
|
40
|
Chassé M, Neves Briard J, Yu M, P Carvalho L, W English S, D'Aragon F, Lauzier F, F Turgeon A, Dhanani S, McIntyre L, D Shemie S, Knoll G, Fergusson DA, Anthony SJ, Weiss MJ. Clinical evaluation and ancillary testing for the diagnosis of death by neurologic criteria: a cross-sectional survey of Canadian intensivists. Can J Anaesth 2022; 69:353-363. [PMID: 34931292 DOI: 10.1007/s12630-021-02166-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Trust in the deceased organ donation process relies on the expectation that the diagnosis of death by neurologic criteria (DNC) is accurate and reliable. The objective of this study was to assess the perceptions and approaches to DNC diagnosis among Canadian intensivists. METHODS We conducted a self-administered, online, cross-sectional survey of Canadian intensivists. Our sampling frame included all intensivists practicing in Canadian institutions. Results are reported using descriptive statistics. RESULTS Among 550 identified intensivists, 249 (45%) completed the survey. Respondents indicated they would be comfortable diagnosing DNC based on clinical criteria alone in cases where there is movement in response to stimulation (119/248; 48%); inability to evaluate upper/lower extremity responses (84/249; 34%); spontaneous peripheral movement (76/249; 31%); inability to evaluate both oculocephalic and oculo-caloric reflexes (40/249; 16%); presence of high cervical spinal cord injury (40/249; 16%); and within 24 hr of hypoxemic-ischemic brain injury (38/247; 15%). Most respondents agreed that an ancillary test should always be conducted when a complete clinical evaluation is impossible (225/241; 93%); when there is possibility of a residual sedative effect (216/242; 89%); when the mechanism for brain injury is unclear (172/241; 71%); and if isolated brainstem injury is suspected (142/242; 59%). Sixty-six percent (158/241) believed that ancillary tests are sensitive and 55% (132/241) that they are specific for DNC. Respondents considered the following ancillary tests useful for DNC: four-vessel conventional angiography (211/241; 88%), nuclear imaging (179/240; 75%), computed tomography (CT) angiography (156/240; 65%), and CT perfusion (134/240; 56%). CONCLUSION There is variability in perceptions and approaches to DNC diagnosis among Canadian intensivists, and some practices are inconsistent with national recommendations.
Collapse
Affiliation(s)
- Michaël Chassé
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue St-Denis, Montreal, QC, H2X 3H8, Canada.
- Medicine, Université de Montréal, Montreal, QC, Canada.
| | - Joel Neves Briard
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue St-Denis, Montreal, QC, H2X 3H8, Canada
- Neuroscience, Université de Montréal, Montreal, QC, Canada
| | - Michael Yu
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue St-Denis, Montreal, QC, H2X 3H8, Canada
| | - Livia P Carvalho
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue St-Denis, Montreal, QC, H2X 3H8, Canada
| | - Shane W English
- Critical Care, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Frédérick D'Aragon
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - François Lauzier
- CHU de Québec Research Center, Université Laval, Quebec City, QC, Canada
- Critical Care, Université Laval, Quebec City, QC, Canada
| | - Alexis F Turgeon
- CHU de Québec Research Center, Université Laval, Quebec City, QC, Canada
- Critical Care, Université Laval, Quebec City, QC, Canada
| | - Sonny Dhanani
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lauralyn McIntyre
- Critical Care, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sam D Shemie
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
- Critical Care, Montreal Children's Hospital, Montreal, QC, Canada
- McGill University Health Centre and Research Institute, Montreal, QC, Canada
| | - Gregory Knoll
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Critical Care, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Dean A Fergusson
- Critical Care, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Samantha J Anthony
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Matthew J Weiss
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- CHU de Québec Research Center, Université Laval, Quebec City, QC, Canada
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
- Transplant Québec, Montreal, QC, Canada
| |
Collapse
|
41
|
Bégin P, Callum J, Jamula E, Cook R, Heddle NM, Tinmouth A, Zeller MP, Beaudoin-Bussières G, Amorim L, Bazin R, Loftsgard KC, Carl R, Chassé M, Cushing MM, Daneman N, Devine DV, Dumaresq J, Fergusson DA, Gabe C, Glesby MJ, Li N, Liu Y, McGeer A, Robitaille N, Sachais BS, Scales DC, Schwartz L, Shehata N, Turgeon AF, Wood H, Zarychanski R, Finzi A, Arnold DM. Author Correction: Convalescent plasma for hospitalized patients with COVID-19: an open-label, randomized controlled trial. Nat Med 2022; 28:212. [PMID: 35022578 PMCID: PMC8753330 DOI: 10.1038/s41591-021-01667-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Philippe Bégin
- Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada. .,Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada. .,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. .,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. .,Canadian Blood Services, Ottawa, Ontario, Canada.
| | - Erin Jamula
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Richard Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Nancy M Heddle
- Canadian Blood Services, Ottawa, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alan Tinmouth
- Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Centre for Transfusion Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michelle P Zeller
- Canadian Blood Services, Ottawa, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Guillaume Beaudoin-Bussières
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada.,CHUM Research Center, Montreal, Quebec, Canada
| | - Luiz Amorim
- Hemorio, Hospital and Regional Blood Center, Rio de Janeiro, Brazil
| | - Renée Bazin
- Héma-Québec, Medical Affairs and Innovation, Quebec City, Quebec, Canada
| | | | - Richard Carl
- Patient representative, Montreal, Quebec, Canada
| | - Michaël Chassé
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Melissa M Cushing
- Transfusion Medicine and Cellular Therapy, New York-Presbyterian, New York, NY, USA.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Nick Daneman
- Department of Medicine, Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dana V Devine
- Canadian Blood Services, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeannot Dumaresq
- Département de médecine, CISSS de Chaudière-Appalaches, Lévis, Quebec, Canada.,Département de microbiologie-infectiologie et d'immunologie, Faculté de Médecine, Université Laval, Quebec City, Quebec, Canada
| | - Dean A Fergusson
- Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Caroline Gabe
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Marshall J Glesby
- Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA
| | - Na Li
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Computing and Software, McMaster University, Hamilton, Ontario, Canada
| | - Yang Liu
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Allison McGeer
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nancy Robitaille
- Héma-Québec, Montreal, Quebec, Canada.,Division of Hematology and Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Bruce S Sachais
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.,New York Blood Center Enterprises, New York, NY, USA
| | - Damon C Scales
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nadine Shehata
- Canadian Blood Services, Ottawa, Ontario, Canada.,Departments of Medicine, Laboratory Medicine and Pathobiology, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Hematology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.,CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Heidi Wood
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Sections of Hematology/Medical Oncology and Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrés Finzi
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada.,CHUM Research Center, Montreal, Quebec, Canada
| | | | - Donald M Arnold
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada. .,Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
42
|
Masse MH, Adhikari NKJ, Théroux X, Battista MC, D'Aragon F, Pinto R, Cohen A, Mayette M, St-Arnaud C, Kho M, Chassé M, Lebrasseur M, Watpool I, Porteous R, Wilcox ME, Lamontagne F. The evolution of mean arterial pressure in critically ill patients on vasopressors before and during a trial comparing a specific mean arterial pressure target to usual care. BMC Anesthesiol 2022; 22:6. [PMID: 34979938 PMCID: PMC8722048 DOI: 10.1186/s12871-021-01529-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background In randomized clinical controlled trials, the choice of usual care as the comparator may be associated with better clinician uptake of the study protocol and lead to more generalizable results. However, if care processes evolve to resemble the intervention during the course of a trial, differences between the intervention group and usual care control group may narrow. We evaluated the effect on mean arterial pressure of an unblinded trial comparing a lower mean arterial pressure target to reduce vasopressor exposure, vs. a clinician-selected mean arterial pressure target, in critically ill patients at least 65 years old. Methods For this multicenter observational study using data collected both prospectively and retrospectively, patients were recruited from five of the seven trial sites. We compared the mean arterial pressure of patients receiving vasopressors, who met or would have met trial eligibility criteria, from two periods: [1] at least 1 month before the trial started, and [2] during the trial period and randomized to usual care, or not enrolled in the trial. Results We included 200 patients treated before and 229 after trial initiation. There were no differences in age (mean 74.5 vs. 75.2 years; p = 0.28), baseline Acute Physiology and Chronic Health Evaluation II score (median 26 vs. 26; p = 0.47) or history of chronic hypertension (n = 126 [63.0%] vs. n = 153 [66.8%]; p = 0.41). Mean of the mean arterial pressure was similar between the two periods (72.5 vs. 72.4 mmHg; p = 0.76). Conclusions The initiation of a trial of a prescribed lower mean arterial pressure target, compared to a usual clinician-selected target, was not associated with a change in mean arterial pressure, reflecting stability in the net effect of usual clinician practices over time. Comparing prior and concurrent control groups may alleviate concerns regarding drift in usual practices over the course of a trial or permit quantification of any change. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01529-w.
Collapse
Affiliation(s)
- Marie-Hélène Masse
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Neill K J Adhikari
- Interdepartmental Division of Critical Care Medicine, University of Toronto, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Xavier Théroux
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Marie-Claude Battista
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Frédérick D'Aragon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Alan Cohen
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Michaël Mayette
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Charles St-Arnaud
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Michelle Kho
- Faculty of Health Sciences, School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, 2900 Boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Martine Lebrasseur
- Centre de recherche, Centre hospitalier de l'Université de Montréal, 900 rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Irene Watpool
- Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada
| | - Rebecca Porteous
- Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada
| | - M Elizabeth Wilcox
- Interdepartmental Division of Critical Care Medicine, University of Toronto, 209 Victoria Street, Toronto, Ontario, M5B 1T8, Canada
| | - François Lamontagne
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada.
| |
Collapse
|
43
|
Abstract
Michael Yu and colleagues examine the challenges in developing AI tools for use at point of care
Collapse
Affiliation(s)
- Michael Yu
- Center for Integration and Analysis of Medical Data (CITADEL), Department of Medicine, University of Montreal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - An Tang
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Canada
| | - Kip Brown
- Center for Integration and Analysis of Medical Data (CITADEL), Department of Medicine, University of Montreal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Rima Bouchakri
- Center for Integration and Analysis of Medical Data (CITADEL), Department of Medicine, University of Montreal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Pascal St-Onge
- Center for Integration and Analysis of Medical Data (CITADEL), Department of Medicine, University of Montreal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Sheng Wu
- World Health Organization, Geneva, Switzerland
| | - John Reeder
- World Health Organization, Geneva, Switzerland
| | - Louis Mullie
- Center for Integration and Analysis of Medical Data (CITADEL), Department of Medicine, University of Montreal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Michaël Chassé
- Center for Integration and Analysis of Medical Data (CITADEL), Department of Medicine, University of Montreal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| |
Collapse
|
44
|
Kang-Auger G, Chassé M, Quach C, Ayoub A, Auger N. Necrotizing Fasciitis: Association with Pregnancy-related Risk Factors Early in Life. Yale J Biol Med 2021; 94:573-584. [PMID: 34970094 PMCID: PMC8686767] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Pregnancy-related risk factors for necrotizing fasciitis are poorly understood. We investigated pregnancy-related characteristics associated with the long-term risk of developing necrotizing fasciitis, a rare life-threatening infectious disease. Methods: We analyzed a longitudinal cohort of 1,344,996 parous women in Quebec, Canada between 1989 and 2020. The main exposure measures included complications of pregnancy such as gestational diabetes, preterm delivery, metabolic disorder, and other maternal characteristics. We followed the women over time to identify future hospitalizations for necrotizing fasciitis up to three decades after delivery. We estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association of pregnancy characteristics with risk of necrotizing fasciitis in time-varying Cox proportional hazards regression models. Results: A total of 420 women were hospitalized for necrotizing fasciitis during follow-up, including 83 (19.8%) with diabetes-related necrotizing fasciitis. The incidence of necrotizing fasciitis was elevated for women with gestational diabetes (2.9 per 100,000 person-years), preterm delivery (3.2 per 100,000 person-years), and metabolic disorders (5.4 per 100,000 person-years), compared with no pregnancy complication (1.1 per 100,000 person-years). Compared with no pregnancy complication, gestational diabetes was associated with 1.87 times the risk (95% CI 1.38-2.53), preterm delivery with 2.10 times the risk (95% CI 1.65-2.66), and metabolic disorder with 3.72 times the risk (95% CI 2.92-4.74) of developing necrotizing fasciitis over time. Pregnancy complications were more strongly associated with the risk of necrotizing fasciitis 5 years or more after delivery. Conclusions: Complications of pregnancy may be associated with the long-term risk of necrotizing fasciitis in women.
Collapse
Affiliation(s)
| | - Michaël Chassé
- University of Montreal Hospital Research Centre,
Montreal, Quebec, Canada,Critical Care Division, Department of Medicine,
University of Montreal, Montreal, Quebec, Canada
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases, and
Immunology, University of Montreal, Montreal, Quebec, Canada,Infection Prevention and Control, Clinical Department
of Laboratory Medicine, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre,
Montreal, Quebec, Canada,Institut national de santé publique du Québec,
Montreal, Quebec, Canada
| | - Nathalie Auger
- University of Montreal Hospital Research Centre,
Montreal, Quebec, Canada,Institut national de santé publique du Québec,
Montreal, Quebec, Canada,Department of Epidemiology, Biostatistics, and
Occupational Health, McGill University, Montreal, Quebec, Canada,Department of Social and Preventive Medicine,
University of Montreal, Montreal, Quebec, Canada,To whom all correspondence should be addressed:
Dr. Nathalie Auger, 190 Cremazie Blvd E., Montreal, Quebec H2P 1E2, Canada;
; ORCID iD:
http://orcid.org/0000-0002-2412-0459
| |
Collapse
|
45
|
Crawshaw J, Li AH, Garg AX, Chassé M, Grimshaw JM, Presseau J. Identifying behaviour change techniques within randomized trials of interventions promoting deceased organ donation registration. Br J Health Psychol 2021; 27:822-843. [PMID: 34889488 DOI: 10.1111/bjhp.12575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/29/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Increasing deceased organ donation registration may increase the number of available organs for transplant to help save lives. This study aimed to identify which behaviour change techniques (BCTs; or 'active ingredients') are reported within randomized trials of interventions promoting deceased organ donation registration and of those, which are associated with a larger intervention effect. METHODS We conducted a secondary analysis of 45 trials included in a Cochrane systematic review of deceased organ donation registration interventions. Two researchers used the BCT Taxonomy v1 to independently code intervention content in all trial groups. Outcome data were pooled and we used meta-regression to explore associations between individual and combinations of recurring BCTs and effect on registration intention and/or registration behaviour. RESULTS A total of 27 different BCTs (mean = 3.7, range = 1-9) were identified in intervention groups across the 45 trials. The five most common BCTs were: 'Information about health consequences' (71%); 'Instruction on how to perform the behaviour' (47%); 'Salience of consequences' (40%); 'Adding objects to the environment' (28%); and 'Credible source' (27%). Comparator groups in 20/45 trials also included identifiable BCTs (n = 12, mean = 3.1, range = 1-7). Meta-regression revealed that a combination of the three most common BCTs was associated with a larger intervention effect size for registration behaviour (k = 8, β = .19, p = .02). CONCLUSIONS Trials of deceased organ donation registration interventions focus predominantly on providing information, instruction, and a means to register. While potentially effective, a much wider set of possible BCTs could be leveraged to address known barriers to registration.
Collapse
Affiliation(s)
- Jacob Crawshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ontario, Canada
| | - Alvin H Li
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada
| | - Amit X Garg
- Lawson Health Research Institute, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Division of Nephrology, Western University, London, Ontario, Canada
| | - Michaël Chassé
- Department of Medicine (Critical Care), University of Montreal Hospital, Quebec, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ontario, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada.,School of Epidemiology & Public Health, University of Ottawa, Ontario, Canada.,School of Psychology, University of Ottawa, Ontario, Canada
| |
Collapse
|
46
|
Brunet-Ratnasingham E, Anand SP, Gantner P, Dyachenko A, Moquin-Beaudry G, Brassard N, Beaudoin-Bussières G, Pagliuzza A, Gasser R, Benlarbi M, Point F, Prévost J, Laumaea A, Niessl J, Nayrac M, Sannier G, Orban C, Messier-Peet M, Butler-Laporte G, Morrison DR, Zhou S, Nakanishi T, Boutin M, Descôteaux-Dinelle J, Gendron-Lepage G, Goyette G, Bourassa C, Medjahed H, Laurent L, Rébillard RM, Richard J, Dubé M, Fromentin R, Arbour N, Prat A, Larochelle C, Durand M, Richards JB, Chassé M, Tétreault M, Chomont N, Finzi A, Kaufmann DE. Integrated immunovirological profiling validates plasma SARS-CoV-2 RNA as an early predictor of COVID-19 mortality. Sci Adv 2021; 7:eabj5629. [PMID: 34826237 PMCID: PMC8626074 DOI: 10.1126/sciadv.abj5629] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Despite advances in COVID-19 management, identifying patients evolving toward death remains challenging. To identify early predictors of mortality within 60 days of symptom onset (DSO), we performed immunovirological assessments on plasma from 279 individuals. On samples collected at DSO11 in a discovery cohort, high severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA (vRNA), low receptor binding domain–specific immunoglobulin G and antibody-dependent cellular cytotoxicity, and elevated cytokines and tissue injury markers were strongly associated with mortality, including in patients on mechanical ventilation. A three-variable model of vRNA, with predefined adjustment by age and sex, robustly identified patients with fatal outcome (adjusted hazard ratio for log-transformed vRNA = 3.5). This model remained robust in independent validation and confirmation cohorts. Since plasma vRNA’s predictive accuracy was maintained at earlier time points, its quantitation can help us understand disease heterogeneity and identify patients who may benefit from new therapies.
Collapse
Affiliation(s)
- Elsa Brunet-Ratnasingham
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Sai Priya Anand
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Microbiology and Immunology, McGill University, Montréal, QC, Canada
| | - Pierre Gantner
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Alina Dyachenko
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Gaël Moquin-Beaudry
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada
| | - Nathalie Brassard
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Guillaume Beaudoin-Bussières
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Amélie Pagliuzza
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Romain Gasser
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Mehdi Benlarbi
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Floriane Point
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Jérémie Prévost
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Annemarie Laumaea
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Julia Niessl
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Manon Nayrac
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Gérémy Sannier
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Catherine Orban
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
- Centre hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Marc Messier-Peet
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Centre hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Guillaume Butler-Laporte
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - David R. Morrison
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Sirui Zhou
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Tomoko Nakanishi
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Kyoto-McGill International Collaborative School in Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, 102-0083 Tokyo, Japan
| | - Marianne Boutin
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Jade Descôteaux-Dinelle
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Gabrielle Gendron-Lepage
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Guillaume Goyette
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Catherine Bourassa
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Halima Medjahed
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Laetitia Laurent
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Rose-Marie Rébillard
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada
| | - Jonathan Richard
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Mathieu Dubé
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Rémi Fromentin
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Nathalie Arbour
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada
| | - Alexandre Prat
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada
| | - Catherine Larochelle
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada
| | - Madeleine Durand
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Centre hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - J. Brent Richards
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Department of Twin Research, King’s College London, London, UK
| | - Michaël Chassé
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Centre hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Martine Tétreault
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Neuroscience, Université de Montréal, Montréal, QC, Canada
| | - Nicolas Chomont
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
- Corresponding author. (N.C.); (A.F.); (D.E.K.)
| | - Andrés Finzi
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
- Department of Microbiology and Immunology, McGill University, Montréal, QC, Canada
- Corresponding author. (N.C.); (A.F.); (D.E.K.)
| | - Daniel E. Kaufmann
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
- Centre hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
- Département de Médecine, Université de Montréal, Montréal, QC, Canada
- Corresponding author. (N.C.); (A.F.); (D.E.K.)
| |
Collapse
|
47
|
Massicotte-Azarniouch D, Sood MM, Fergusson DA, Chassé M, Tinmouth A, Knoll GA. Blood transfusion and the risk for infections in kidney transplant patients. PLoS One 2021; 16:e0259270. [PMID: 34767576 PMCID: PMC8589196 DOI: 10.1371/journal.pone.0259270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/17/2021] [Indexed: 01/28/2023] Open
Abstract
Background Receipt of a red blood cell transfusion (RBCT) post-kidney transplantation may alter immunity which could predispose to subsequent infection. Methods We carried out a single-center, retrospective cohort study of 1,258 adult kidney transplant recipients from 2002 to 2018 (mean age 52, 64% male). The receipt of RBCT post-transplant (468 participants transfused, total 2,373 RBCT) was analyzed as a time-varying, cumulative exposure. Adjusted cox proportional hazards models were used to calculate hazard ratios (HR) for outcomes of bacterial or viral (BK or CMV) infection. Results Over a median follow-up of 3.8 years, bacterial infection occurred in 34% of participants at a median of 409 days post-transplant and viral infection occurred in 25% at a median of 154 days post-transplant. Transfusion was associated with a step-wise higher risk of bacterial infection (HR 1.35, 95%CI 0.95–1.91; HR 1.29, 95%CI 0.92–1.82; HR 2.63, 95%CI 1.94–3.56; HR 3.38, 95%CI 2.30–4.95, for 1, 2, 3–5 and >5 RBCT respectively), but not viral infection. These findings were consistent in multiple additional analyses, including accounting for reverse causality. Conclusion Blood transfusion after kidney transplant is associated with a higher risk for bacterial infection, emphasizing the need to use transfusions judiciously in this population already at risk for infections.
Collapse
Affiliation(s)
| | - Manish M. Sood
- Division of Nephrology, Department of Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - Dean A. Fergusson
- Department of Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - Michaël Chassé
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Alan Tinmouth
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Greg A. Knoll
- Division of Nephrology, Department of Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
- * E-mail:
| |
Collapse
|
48
|
Estcourt LJ, Turgeon AF, McQuilten ZK, McVerry BJ, Al-Beidh F, Annane D, Arabi YM, Arnold DM, Beane A, Bégin P, van Bentum-Puijk W, Berry LR, Bhimani Z, Birchall JE, Bonten MJM, Bradbury CA, Brunkhorst FM, Buxton M, Callum JL, Chassé M, Cheng AC, Cove ME, Daly J, Derde L, Detry MA, De Jong M, Evans A, Fergusson DA, Fish M, Fitzgerald M, Foley C, Goossens H, Gordon AC, Gosbell IB, Green C, Haniffa R, Harvala H, Higgins AM, Hills TE, Hoad VC, Horvat C, Huang DT, Hudson CL, Ichihara N, Laing E, Lamikanra AA, Lamontagne F, Lawler PR, Linstrum K, Litton E, Lorenzi E, MacLennan S, Marshall J, McAuley DF, McDyer JF, McGlothlin A, McGuinness S, Miflin G, Montgomery S, Mouncey PR, Murthy S, Nichol A, Parke R, Parker JC, Priddee N, Purcell DFJ, Reyes LF, Richardson P, Robitaille N, Rowan KM, Rynne J, Saito H, Santos M, Saunders CT, Serpa Neto A, Seymour CW, Silversides JA, Tinmouth AA, Triulzi DJ, Turner AM, van de Veerdonk F, Walsh TS, Wood EM, Berry S, Lewis RJ, Menon DK, McArthur C, Zarychanski R, Angus DC, Webb SA, Roberts DJ, Shankar-Hari M. Effect of Convalescent Plasma on Organ Support-Free Days in Critically Ill Patients With COVID-19: A Randomized Clinical Trial. JAMA 2021. [PMID: 34606578 DOI: 10.1101/2021.06.11.21258760] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
IMPORTANCE The evidence for benefit of convalescent plasma for critically ill patients with COVID-19 is inconclusive. OBJECTIVE To determine whether convalescent plasma would improve outcomes for critically ill adults with COVID-19. DESIGN, SETTING, AND PARTICIPANTS The ongoing Randomized, Embedded, Multifactorial, Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) enrolled and randomized 4763 adults with suspected or confirmed COVID-19 between March 9, 2020, and January 18, 2021, within at least 1 domain; 2011 critically ill adults were randomized to open-label interventions in the immunoglobulin domain at 129 sites in 4 countries. Follow-up ended on April 19, 2021. INTERVENTIONS The immunoglobulin domain randomized participants to receive 2 units of high-titer, ABO-compatible convalescent plasma (total volume of 550 mL ± 150 mL) within 48 hours of randomization (n = 1084) or no convalescent plasma (n = 916). MAIN OUTCOMES AND MEASURES The primary ordinal end point was organ support-free days (days alive and free of intensive care unit-based organ support) up to day 21 (range, -1 to 21 days; patients who died were assigned -1 day). The primary analysis was an adjusted bayesian cumulative logistic model. Superiority was defined as the posterior probability of an odds ratio (OR) greater than 1 (threshold for trial conclusion of superiority >99%). Futility was defined as the posterior probability of an OR less than 1.2 (threshold for trial conclusion of futility >95%). An OR greater than 1 represented improved survival, more organ support-free days, or both. The prespecified secondary outcomes included in-hospital survival; 28-day survival; 90-day survival; respiratory support-free days; cardiovascular support-free days; progression to invasive mechanical ventilation, extracorporeal mechanical oxygenation, or death; intensive care unit length of stay; hospital length of stay; World Health Organization ordinal scale score at day 14; venous thromboembolic events at 90 days; and serious adverse events. RESULTS Among the 2011 participants who were randomized (median age, 61 [IQR, 52 to 70] years and 645/1998 [32.3%] women), 1990 (99%) completed the trial. The convalescent plasma intervention was stopped after the prespecified criterion for futility was met. The median number of organ support-free days was 0 (IQR, -1 to 16) in the convalescent plasma group and 3 (IQR, -1 to 16) in the no convalescent plasma group. The in-hospital mortality rate was 37.3% (401/1075) for the convalescent plasma group and 38.4% (347/904) for the no convalescent plasma group and the median number of days alive and free of organ support was 14 (IQR, 3 to 18) and 14 (IQR, 7 to 18), respectively. The median-adjusted OR was 0.97 (95% credible interval, 0.83 to 1.15) and the posterior probability of futility (OR <1.2) was 99.4% for the convalescent plasma group compared with the no convalescent plasma group. The treatment effects were consistent across the primary outcome and the 11 secondary outcomes. Serious adverse events were reported in 3.0% (32/1075) of participants in the convalescent plasma group and in 1.3% (12/905) of participants in the no convalescent plasma group. CONCLUSIONS AND RELEVANCE Among critically ill adults with confirmed COVID-19, treatment with 2 units of high-titer, ABO-compatible convalescent plasma had a low likelihood of providing improvement in the number of organ support-free days. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02735707.
Collapse
Affiliation(s)
- Lise J Estcourt
- NHS Blood and Transplant, Oxford, England
- Radcliffe Department of Medicine and BRC Hematology Theme, University of Oxford, Oxford, England
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Zoe K McQuilten
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Clinical Hematology, Monash Health, Melbourne, Australia
| | - Bryan J McVerry
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Farah Al-Beidh
- Division of Anesthetics, Pain Medicine, and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, England
| | - Djillali Annane
- Intensive Care Unit, Raymond Poincaré Hospital, Paris, France
- Simone Veil School of Medicine, University of Versailles, Versailles, France
- University Paris Saclay, Garches, France
| | - Yaseen M Arabi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | - Abigail Beane
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, England
| | | | - Wilma van Bentum-Puijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Zahra Bhimani
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Charlotte A Bradbury
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
- Faculty of Health Sciences, University of Bristol, Bristol, England
| | - Frank M Brunkhorst
- Center for Clinical Studies and Center for Sepsis Control and Care, Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Meredith Buxton
- Global Coalition for Adaptive Research, San Francisco, California
| | - Jeannie L Callum
- Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queens University, Kingston, Ontario, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew E Cove
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - James Daly
- Australian Red Cross Lifeblood, Sydney and Perth, Australia
| | - Lennie Derde
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Intensive Care Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Menno De Jong
- Department of Medical Microbiology, University of Amsterdam Medical Center, University of Amsterdam, the Netherlands
| | - Amy Evans
- NHSBT Clinical Trials Unit, NHS Blood and Transplant, Cambridge, England
| | - Dean A Fergusson
- Ottawa Hospital Research Institute, Clinical Epidemiology Unit, Ottawa, Ontario, Canada
| | - Matthew Fish
- School of Immunology and Microbial Sciences, Kings College London, London, England
| | | | - Claire Foley
- NHSBT Clinical Trials Unit, NHS Blood and Transplant, Cambridge, England
| | - Herman Goossens
- Department of Microbiology, Antwerp University Hospital, Antwerp, Belgium
| | - Anthony C Gordon
- Division of Anesthetics, Pain Medicine, and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, England
| | - Iain B Gosbell
- Australian Red Cross Lifeblood, Sydney and Perth, Australia
- Western Sydney University, Sydney, Australia
| | - Cameron Green
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | | | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | - David T Huang
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Nao Ichihara
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Emma Laing
- NHSBT Clinical Trials Unit, NHS Blood and Transplant, Cambridge, England
| | | | | | - Patrick R Lawler
- Cardiac Intensive Care Unit, Peter Munk Cardiac Centre, University Health Network, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Linstrum
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward Litton
- School of Medicine and Pharmacology, University of Western Australia, Crawley
| | | | | | - John Marshall
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Daniel F McAuley
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, Ireland
| | - John F McDyer
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Shay McGuinness
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- Medical Research Institute of New Zealand, Wellington
| | | | - Stephanie Montgomery
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, England
| | - Srinivas Murthy
- School of Medicine, University of British Columbia, Vancouver, Canada
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Anesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Intensive Care, Alfred Health, Melbourne, Australia
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- Medical Research Institute of New Zealand, Wellington
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jane C Parker
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nicole Priddee
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | - Damian F J Purcell
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Luis F Reyes
- Universidad de La Sabana, Chia, Colombia
- Clinica Universidad de La Sabana, Chia, Colombia
| | | | - Nancy Robitaille
- Héma-Québec, Montreal, Quebec, Canada
- Division of Hematology and Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, England
| | - Jennifer Rynne
- School of Immunology and Microbial Sciences, Kings College London, London, England
| | - Hiroki Saito
- Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Marlene Santos
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Christopher W Seymour
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Jon A Silversides
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, Ireland
| | - Alan A Tinmouth
- Ottawa Hospital Research Institute, Clinical Epidemiology Unit, Ottawa, Ontario, Canada
| | - Darrell J Triulzi
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anne M Turner
- Medical Research Institute of New Zealand, Wellington
| | - Frank van de Veerdonk
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Clinical Hematology, Monash Health, Melbourne, Australia
| | | | - Roger J Lewis
- Berry Consultants LLC, Austin, Texas
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David K Menon
- University Division of Anesthesia, Addenbrooke's Hospital Cambridge, Cambridge, England
| | - Colin McArthur
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, England
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Ryan Zarychanski
- Department of Medicine, Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, Canada
| | - Derek C Angus
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Steve A Webb
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- St John of God Hospital, Subiaco, Australia
| | - David J Roberts
- NHS Blood and Transplant, Oxford, England
- Radcliffe Department of Medicine and BRC Hematology Theme, University of Oxford, Oxford, England
| | - Manu Shankar-Hari
- School of Immunology and Microbial Sciences, Kings College London, London, England
- Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, London, England
| |
Collapse
|
49
|
Estcourt LJ, Turgeon AF, McQuilten ZK, McVerry BJ, Al-Beidh F, Annane D, Arabi YM, Arnold DM, Beane A, Bégin P, van Bentum-Puijk W, Berry LR, Bhimani Z, Birchall JE, Bonten MJM, Bradbury CA, Brunkhorst FM, Buxton M, Callum JL, Chassé M, Cheng AC, Cove ME, Daly J, Derde L, Detry MA, De Jong M, Evans A, Fergusson DA, Fish M, Fitzgerald M, Foley C, Goossens H, Gordon AC, Gosbell IB, Green C, Haniffa R, Harvala H, Higgins AM, Hills TE, Hoad VC, Horvat C, Huang DT, Hudson CL, Ichihara N, Laing E, Lamikanra AA, Lamontagne F, Lawler PR, Linstrum K, Litton E, Lorenzi E, MacLennan S, Marshall J, McAuley DF, McDyer JF, McGlothlin A, McGuinness S, Miflin G, Montgomery S, Mouncey PR, Murthy S, Nichol A, Parke R, Parker JC, Priddee N, Purcell DFJ, Reyes LF, Richardson P, Robitaille N, Rowan KM, Rynne J, Saito H, Santos M, Saunders CT, Serpa Neto A, Seymour CW, Silversides JA, Tinmouth AA, Triulzi DJ, Turner AM, van de Veerdonk F, Walsh TS, Wood EM, Berry S, Lewis RJ, Menon DK, McArthur C, Zarychanski R, Angus DC, Webb SA, Roberts DJ, Shankar-Hari M. Effect of Convalescent Plasma on Organ Support-Free Days in Critically Ill Patients With COVID-19: A Randomized Clinical Trial. JAMA 2021; 326:1690-1702. [PMID: 34606578 PMCID: PMC8491132 DOI: 10.1001/jama.2021.18178] [Citation(s) in RCA: 132] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/24/2021] [Indexed: 02/06/2023]
Abstract
IMPORTANCE The evidence for benefit of convalescent plasma for critically ill patients with COVID-19 is inconclusive. OBJECTIVE To determine whether convalescent plasma would improve outcomes for critically ill adults with COVID-19. DESIGN, SETTING, AND PARTICIPANTS The ongoing Randomized, Embedded, Multifactorial, Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) enrolled and randomized 4763 adults with suspected or confirmed COVID-19 between March 9, 2020, and January 18, 2021, within at least 1 domain; 2011 critically ill adults were randomized to open-label interventions in the immunoglobulin domain at 129 sites in 4 countries. Follow-up ended on April 19, 2021. INTERVENTIONS The immunoglobulin domain randomized participants to receive 2 units of high-titer, ABO-compatible convalescent plasma (total volume of 550 mL ± 150 mL) within 48 hours of randomization (n = 1084) or no convalescent plasma (n = 916). MAIN OUTCOMES AND MEASURES The primary ordinal end point was organ support-free days (days alive and free of intensive care unit-based organ support) up to day 21 (range, -1 to 21 days; patients who died were assigned -1 day). The primary analysis was an adjusted bayesian cumulative logistic model. Superiority was defined as the posterior probability of an odds ratio (OR) greater than 1 (threshold for trial conclusion of superiority >99%). Futility was defined as the posterior probability of an OR less than 1.2 (threshold for trial conclusion of futility >95%). An OR greater than 1 represented improved survival, more organ support-free days, or both. The prespecified secondary outcomes included in-hospital survival; 28-day survival; 90-day survival; respiratory support-free days; cardiovascular support-free days; progression to invasive mechanical ventilation, extracorporeal mechanical oxygenation, or death; intensive care unit length of stay; hospital length of stay; World Health Organization ordinal scale score at day 14; venous thromboembolic events at 90 days; and serious adverse events. RESULTS Among the 2011 participants who were randomized (median age, 61 [IQR, 52 to 70] years and 645/1998 [32.3%] women), 1990 (99%) completed the trial. The convalescent plasma intervention was stopped after the prespecified criterion for futility was met. The median number of organ support-free days was 0 (IQR, -1 to 16) in the convalescent plasma group and 3 (IQR, -1 to 16) in the no convalescent plasma group. The in-hospital mortality rate was 37.3% (401/1075) for the convalescent plasma group and 38.4% (347/904) for the no convalescent plasma group and the median number of days alive and free of organ support was 14 (IQR, 3 to 18) and 14 (IQR, 7 to 18), respectively. The median-adjusted OR was 0.97 (95% credible interval, 0.83 to 1.15) and the posterior probability of futility (OR <1.2) was 99.4% for the convalescent plasma group compared with the no convalescent plasma group. The treatment effects were consistent across the primary outcome and the 11 secondary outcomes. Serious adverse events were reported in 3.0% (32/1075) of participants in the convalescent plasma group and in 1.3% (12/905) of participants in the no convalescent plasma group. CONCLUSIONS AND RELEVANCE Among critically ill adults with confirmed COVID-19, treatment with 2 units of high-titer, ABO-compatible convalescent plasma had a low likelihood of providing improvement in the number of organ support-free days. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02735707.
Collapse
Affiliation(s)
- Lise J Estcourt
- NHS Blood and Transplant, Oxford, England
- Radcliffe Department of Medicine and BRC Hematology Theme, University of Oxford, Oxford, England
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Zoe K McQuilten
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Clinical Hematology, Monash Health, Melbourne, Australia
| | - Bryan J McVerry
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Farah Al-Beidh
- Division of Anesthetics, Pain Medicine, and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, England
| | - Djillali Annane
- Intensive Care Unit, Raymond Poincaré Hospital, Paris, France
- Simone Veil School of Medicine, University of Versailles, Versailles, France
- University Paris Saclay, Garches, France
| | - Yaseen M Arabi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | - Abigail Beane
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, England
| | | | - Wilma van Bentum-Puijk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Zahra Bhimani
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Charlotte A Bradbury
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England
- Faculty of Health Sciences, University of Bristol, Bristol, England
| | - Frank M Brunkhorst
- Center for Clinical Studies and Center for Sepsis Control and Care, Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Meredith Buxton
- Global Coalition for Adaptive Research, San Francisco, California
| | - Jeannie L Callum
- Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queens University, Kingston, Ontario, Canada
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew E Cove
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - James Daly
- Australian Red Cross Lifeblood, Sydney and Perth, Australia
| | - Lennie Derde
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Intensive Care Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Menno De Jong
- Department of Medical Microbiology, University of Amsterdam Medical Center, University of Amsterdam, the Netherlands
| | - Amy Evans
- NHSBT Clinical Trials Unit, NHS Blood and Transplant, Cambridge, England
| | - Dean A Fergusson
- Ottawa Hospital Research Institute, Clinical Epidemiology Unit, Ottawa, Ontario, Canada
| | - Matthew Fish
- School of Immunology and Microbial Sciences, Kings College London, London, England
| | | | - Claire Foley
- NHSBT Clinical Trials Unit, NHS Blood and Transplant, Cambridge, England
| | - Herman Goossens
- Department of Microbiology, Antwerp University Hospital, Antwerp, Belgium
| | - Anthony C Gordon
- Division of Anesthetics, Pain Medicine, and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, England
| | - Iain B Gosbell
- Australian Red Cross Lifeblood, Sydney and Perth, Australia
- Western Sydney University, Sydney, Australia
| | - Cameron Green
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | | | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | - David T Huang
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Nao Ichihara
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Emma Laing
- NHSBT Clinical Trials Unit, NHS Blood and Transplant, Cambridge, England
| | | | | | - Patrick R Lawler
- Cardiac Intensive Care Unit, Peter Munk Cardiac Centre, University Health Network, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Linstrum
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward Litton
- School of Medicine and Pharmacology, University of Western Australia, Crawley
| | | | | | - John Marshall
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Daniel F McAuley
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, Ireland
| | - John F McDyer
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Shay McGuinness
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- Medical Research Institute of New Zealand, Wellington
| | | | - Stephanie Montgomery
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, England
| | - Srinivas Murthy
- School of Medicine, University of British Columbia, Vancouver, Canada
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Anesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Intensive Care, Alfred Health, Melbourne, Australia
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- Medical Research Institute of New Zealand, Wellington
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jane C Parker
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nicole Priddee
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | - Damian F J Purcell
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Luis F Reyes
- Universidad de La Sabana, Chia, Colombia
- Clinica Universidad de La Sabana, Chia, Colombia
| | | | - Nancy Robitaille
- Héma-Québec, Montreal, Quebec, Canada
- Division of Hematology and Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, England
| | - Jennifer Rynne
- School of Immunology and Microbial Sciences, Kings College London, London, England
| | - Hiroki Saito
- Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Marlene Santos
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Christopher W Seymour
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Jon A Silversides
- Centre for Experimental Medicine, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, Ireland
| | - Alan A Tinmouth
- Ottawa Hospital Research Institute, Clinical Epidemiology Unit, Ottawa, Ontario, Canada
| | - Darrell J Triulzi
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anne M Turner
- Medical Research Institute of New Zealand, Wellington
| | - Frank van de Veerdonk
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Clinical Hematology, Monash Health, Melbourne, Australia
| | | | - Roger J Lewis
- Berry Consultants LLC, Austin, Texas
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - David K Menon
- University Division of Anesthesia, Addenbrooke's Hospital Cambridge, Cambridge, England
| | - Colin McArthur
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, England
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Ryan Zarychanski
- Department of Medicine, Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, Canada
| | - Derek C Angus
- Clinical Research Investigation and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania
| | - Steve A Webb
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- St John of God Hospital, Subiaco, Australia
| | - David J Roberts
- NHS Blood and Transplant, Oxford, England
- Radcliffe Department of Medicine and BRC Hematology Theme, University of Oxford, Oxford, England
| | - Manu Shankar-Hari
- School of Immunology and Microbial Sciences, Kings College London, London, England
- Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, London, England
| |
Collapse
|
50
|
Bégin P, Callum J, Jamula E, Cook R, Heddle NM, Tinmouth A, Zeller MP, Beaudoin-Bussières G, Amorim L, Bazin R, Loftsgard KC, Carl R, Chassé M, Cushing MM, Daneman N, Devine DV, Dumaresq J, Fergusson DA, Gabe C, Glesby MJ, Li N, Liu Y, McGeer A, Robitaille N, Sachais BS, Scales DC, Schwartz L, Shehata N, Turgeon AF, Wood H, Zarychanski R, Finzi A, Arnold DM. Convalescent plasma for hospitalized patients with COVID-19: an open-label, randomized controlled trial. Nat Med 2021; 27:2012-2024. [PMID: 34504336 PMCID: PMC8604729 DOI: 10.1038/s41591-021-01488-2] [Citation(s) in RCA: 171] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/02/2021] [Indexed: 12/24/2022]
Abstract
The efficacy of convalescent plasma for coronavirus disease 2019 (COVID-19) is unclear. Although most randomized controlled trials have shown negative results, uncontrolled studies have suggested that the antibody content could influence patient outcomes. We conducted an open-label, randomized controlled trial of convalescent plasma for adults with COVID-19 receiving oxygen within 12 d of respiratory symptom onset (NCT04348656). Patients were allocated 2:1 to 500 ml of convalescent plasma or standard of care. The composite primary outcome was intubation or death by 30 d. Exploratory analyses of the effect of convalescent plasma antibodies on the primary outcome was assessed by logistic regression. The trial was terminated at 78% of planned enrollment after meeting stopping criteria for futility. In total, 940 patients were randomized, and 921 patients were included in the intention-to-treat analysis. Intubation or death occurred in 199/614 (32.4%) patients in the convalescent plasma arm and 86/307 (28.0%) patients in the standard of care arm—relative risk (RR) = 1.16 (95% confidence interval (CI) 0.94–1.43, P = 0.18). Patients in the convalescent plasma arm had more serious adverse events (33.4% versus 26.4%; RR = 1.27, 95% CI 1.02–1.57, P = 0.034). The antibody content significantly modulated the therapeutic effect of convalescent plasma. In multivariate analysis, each standardized log increase in neutralization or antibody-dependent cellular cytotoxicity independently reduced the potential harmful effect of plasma (odds ratio (OR) = 0.74, 95% CI 0.57–0.95 and OR = 0.66, 95% CI 0.50–0.87, respectively), whereas IgG against the full transmembrane spike protein increased it (OR = 1.53, 95% CI 1.14–2.05). Convalescent plasma did not reduce the risk of intubation or death at 30 d in hospitalized patients with COVID-19. Transfusion of convalescent plasma with unfavorable antibody profiles could be associated with worse clinical outcomes compared to standard care. A randomized trial in patients hospitalized with COVID-19 showed no benefit and potentially increased harm associated with the use of convalescent plasma, with subgroup analyses suggesting that the antibody profile in donor plasma is critical in determining clinical outcomes.
Collapse
Affiliation(s)
- Philippe Bégin
- Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada. .,Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada. .,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. .,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. .,Canadian Blood Services, Ottawa, Ontario, Canada.
| | - Erin Jamula
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Richard Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Nancy M Heddle
- Canadian Blood Services, Ottawa, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alan Tinmouth
- Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Centre for Transfusion Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michelle P Zeller
- Canadian Blood Services, Ottawa, Ontario, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Guillaume Beaudoin-Bussières
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada.,CHUM Research Center, Montreal, Quebec, Canada
| | - Luiz Amorim
- Hemorio, Hospital and Regional Blood Center, Rio de Janeiro, Brazil
| | - Renée Bazin
- Héma-Québec, Medical Affairs and Innovation, Quebec City, Quebec, Canada
| | | | - Richard Carl
- Patient representative, Montreal, Quebec, Canada
| | - Michaël Chassé
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Innovation Hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Melissa M Cushing
- Transfusion Medicine and Cellular Therapy, New York-Presbyterian, New York, NY, USA.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Nick Daneman
- Department of Medicine, Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dana V Devine
- Canadian Blood Services, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeannot Dumaresq
- Département de médecine, CISSS de Chaudière-Appalaches, Lévis, Quebec, Canada.,Département de microbiologie-infectiologie et d'immunologie, Faculté de Médecine, Université Laval, Quebec City, Quebec, Canada
| | - Dean A Fergusson
- Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Caroline Gabe
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Marshall J Glesby
- Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA
| | - Na Li
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Computing and Software, McMaster University, Hamilton, Ontario, Canada
| | - Yang Liu
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Allison McGeer
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nancy Robitaille
- Héma-Québec, Montreal, Quebec, Canada.,Division of Hematology and Oncology, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Bruce S Sachais
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.,New York Blood Center Enterprises, New York, NY, USA
| | - Damon C Scales
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nadine Shehata
- Canadian Blood Services, Ottawa, Ontario, Canada.,Departments of Medicine, Laboratory Medicine and Pathobiology, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Hematology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.,CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Heidi Wood
- Zoonotic Diseases and Special Pathogens, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Sections of Hematology/Medical Oncology and Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrés Finzi
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada.,CHUM Research Center, Montreal, Quebec, Canada
| | | | - Donald M Arnold
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada. .,Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|