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Zhao JO, Patel BK, Krishack P, Stutz MR, Pearson SD, Lin J, Lecompte-Osorio PA, Dugan KC, Kim S, Gras N, Pohlman A, Kress JP, Hall JB, Sperling AI, Adegunsoye A, Verhoef PA, Wolfe KS. Identification of Clinically Significant Cytokine Signature Clusters in Patients With Septic Shock. Crit Care Med 2023; 51:e253-e263. [PMID: 37678209 PMCID: PMC10840934 DOI: 10.1097/ccm.0000000000006032] [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] [Indexed: 09/09/2023]
Abstract
OBJECTIVES To identify cytokine signature clusters in patients with septic shock. DESIGN Prospective observational cohort study. SETTING Single academic center in the United States. PATIENTS Adult (≥ 18 yr old) patients admitted to the medical ICU with septic shock requiring vasoactive medication support. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS One hundred fourteen patients with septic shock completed cytokine measurement at time of enrollment (t 1 ) and 24 hours later (t 2 ). Unsupervised random forest analysis of the change in cytokines over time, defined as delta (t 2 -t 1 ), identified three clusters with distinct cytokine profiles. Patients in cluster 1 had the lowest initial levels of circulating cytokines that decreased over time. Patients in cluster 2 and cluster 3 had higher initial levels that decreased over time in cluster 2 and increased in cluster 3. Patients in clusters 2 and 3 had higher mortality compared with cluster 1 (clusters 1-3: 11% vs 31%; odds ratio [OR], 3.56 [1.10-14.23] vs 54% OR, 9.23 [2.89-37.22]). Cluster 3 was independently associated with in-hospital mortality (hazard ratio, 5.24; p = 0.005) in multivariable analysis. There were no significant differences in initial clinical severity scoring or steroid use between the clusters. Analysis of either t 1 or t 2 cytokine measurements alone or in combination did not reveal clusters with clear clinical significance. CONCLUSIONS Longitudinal measurement of cytokine profiles at initiation of vasoactive medications and 24 hours later revealed three distinct cytokine signature clusters that correlated with clinical outcomes.
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Affiliation(s)
- Jack O Zhao
- Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Bhakti K Patel
- Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Paulette Krishack
- Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Matthew R Stutz
- Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Steven D Pearson
- Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Julie Lin
- Pulmonary Medicine, MD Anderson Cancer Center, The University of Texas, Houston, TX
| | | | | | - Seoyoen Kim
- Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Nicole Gras
- Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Anne Pohlman
- Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - John P Kress
- Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Jesse B Hall
- Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Anne I Sperling
- Pulmonary & Critical Care, University of Virginia, Charlottesville, VA
| | - Ayodeji Adegunsoye
- Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, IL
| | - Philip A Verhoef
- Critical Care Medicine, Hawaii Permanente Medical Group, Honolulu, HI
| | - Krysta S Wolfe
- Pulmonary and Critical Care, University of Chicago Medical Center, Chicago, IL
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2
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Melone MA, Becker TC, Wendt LH, Ten Eyck P, Patel SB, Poston J, Pohlman AS, Pohlman M, Miller A, Nedeltcheva A, Hall JB, Van Cauter E, Zabner J, Gehlbach BK. Disruption of the circadian rhythm of melatonin: A biomarker of critical illness severity. Sleep Med 2023; 110:60-67. [PMID: 37541132 DOI: 10.1016/j.sleep.2023.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023]
Abstract
Circadian dysrhythmias occur commonly in critically ill patients reflecting variable effects of underlying illness, ICU environment, and treatments. We retrospectively analyzed the relationship between clinical outcomes and 24-h urinary 6-sulfatoxymelatonin (aMT6s) excretion profiles in 37 critically ill patients with shock and/or respiratory failure. Nonlinear regression was used to fit a 24-h cosine curve to each patient's aMT6s profile, with rhythmicity determined by the zero-amplitude test. From these curves we determined acrophase, amplitude, phase, and night/day ratio. After assessing unadjusted relationships, we identified the optimal multivariate models for hospital survival and for discharge to home (vs. death or transfer to another facility). Normalized aMT6s rhythm amplitude was greater (p = 0.005) in patients discharged home than in those who were not, while both groups exhibited a phase delay. Patients with rhythmic aMT6s excretion were more likely to survive (OR 5.25) and be discharged home (OR 8.89; p < 0.05 for both) than patients with arrhythmic profiles, associations that persisted in multivariate modelling. In critically ill patients with shock and/or respiratory failure, arrhythmic and/or low amplitude 24-h aMT6s rhythms were associated with worse clinical outcomes, suggesting a role for the melatonin-based rhythm as a novel biomarker of critical illness severity.
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Affiliation(s)
- Marie-Anne Melone
- Department of Pulmonary, Thoracic Oncology and Respiratory Intensive Care, Rouen University Hospital, Univ Rouen, F-76000, Rouen, France; CETAPS EA3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, F-76821, Mont-Saint-Aignan, France.
| | - Taylor C Becker
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Linder H Wendt
- Institute of Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Patrick Ten Eyck
- Institute of Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Shruti B Patel
- Department of Internal Medicine, Loyola University of Chicago, Chicago, IL, USA
| | - Jason Poston
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Anne S Pohlman
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Annette Miller
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Jesse B Hall
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Eve Van Cauter
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Joseph Zabner
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Brian K Gehlbach
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA; Department of Neurology, University of Iowa, Iowa City, IA, USA
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Patel BK, Wolfe KS, Patel SB, Dugan KC, Esbrook CL, Pawlik AJ, Stulberg M, Kemple C, Teele M, Zeleny E, Hedeker D, Pohlman AS, Arora VM, Hall JB, Kress JP. Effect of early mobilisation on long-term cognitive impairment in critical illness in the USA: a randomised controlled trial. Lancet Respir Med 2023:S2213-2600(22)00489-1. [PMID: 36693400 DOI: 10.1016/s2213-2600(22)00489-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Patients who have received mechanical ventilation can have prolonged cognitive impairment for which there is no known treatment. We aimed to establish whether early mobilisation could reduce the rates of cognitive impairment and other aspects of disability 1 year after critical illness. METHODS In this single-centre, parallel, randomised controlled trial, patients admitted to the adult medical-surgical intensive-care unit (ICU), at the University of Chicago (IL, USA), were recruited. Inclusion criteria were adult patients (aged ≥18 years) who were functionally independent and mechanically ventilated at baseline and within the first 96 h of mechanical ventilation, and expected to continue for at least 24 h. Patients were randomly assigned (1:1) via computer-generated permuted balanced block randomisation to early physical and occupational therapy (early mobilisation) or usual care. An investigator designated each assignment in consecutively numbered, sealed, opaque envelopes; they had no further involvement in the trial. Only the assessors were masked to group assignment. The primary outcome was cognitive impairment 1 year after hospital discharge, measured with a Montreal Cognitive Assessment. Patients were assessed for cognitive impairment, neuromuscular weakness, institution-free days, functional independence, and quality of life at hospital discharge and 1 year. Analysis was by intention to treat. This trial was registered with ClinicalTrials.gov, number NCT01777035, and is now completed. FINDINGS Between Aug 11, 2011, and Oct 24, 2019, 1222 patients were screened, 200 were enrolled (usual care n=100, intervention n=100), and one patient withdrew from the study in each group; thus 99 patients in each group were included in the intention-to-treat analysis (113 [57%] men and 85 [43%] women). 65 (88%) of 74 in the usual care group and 62 (89%) of 70 in the intervention group underwent testing for cognitive impairment at 1 year. The rate of cognitive impairment at 1 year with early mobilisation was 24% (24 of 99 patients) compared with 43% (43 of 99) with usual care (absolute difference -19·2%, 95% CI -32·1 to -6·3%; p=0·0043). Cognitive impairment was lower at hospital discharge in the intervention group (53 [54%] 99 patients vs 68 [69%] 99 patients; -15·2%, -28·6 to -1·7; p=0·029). At 1 year, the intervention group had fewer ICU-acquired weaknesses (none [0%] of 99 patients vs 14 [14%] of 99 patients; -14·1%; -21·0 to -7·3; p=0·0001) and higher physical component scores on quality-of-life testing than did the usual care group (median 52·4 [IQR 45·3-56·8] vs median 41·1 [31·8-49·4]; p<0·0001). There was no difference in the rates of functional independence (64 [65%] of 99 patients vs 61 [62%] of 99 patients; 3%, -10·4 to 16·5%; p=0·66) or mental component scores (median 55·9 [50·2-58·9] vs median 55·2 [49·5-59·7]; p=0·98) between the intervention and usual care groups at 1 year. Seven adverse events (haemodynamic changes [n=3], arterial catheter removal [n=1], rectal tube dislodgement [n=1], and respiratory distress [n=2]) were reported in six (6%) of 99 patients in the intervention group and in none of the patients in the usual care group (p=0·029). INTERPRETATION Early mobilisation might be the first known intervention to improve long-term cognitive impairment in ICU survivors after mechanical ventilation. These findings clearly emphasise the importance of avoiding delays in initiating mobilisation. However, the increased adverse events in the intervention group warrants further investigation to replicate these findings. FUNDING None.
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Affiliation(s)
- Bhakti K Patel
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Krysta S Wolfe
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Shruti B Patel
- Loyola University Chicago Stritch School of Medicine, Department of Medicine, Division of Pulmonary/Critical Care, Maywood, IL, USA
| | - Karen C Dugan
- Section of Pulmonary/Critical Care, Northwest Permanente, Hillsboro, OR, USA
| | - Cheryl L Esbrook
- Department of Therapy Services, University of Chicago, Chicago, IL, USA
| | - Amy J Pawlik
- Vitality Women's Physical Therapy and Wellness, Elmhurst, IL, USA
| | - Megan Stulberg
- Department of Therapy Services, University of Chicago, Chicago, IL, USA
| | - Crystal Kemple
- Department of Therapy Services, University of Chicago, Chicago, IL, USA
| | - Megan Teele
- Department of Therapy Services, University of Chicago, Chicago, IL, USA
| | - Erin Zeleny
- Department of Therapy Services, University of Chicago, Chicago, IL, USA
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Anne S Pohlman
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Vineet M Arora
- Section of General Internal Medicine, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Jesse B Hall
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - John P Kress
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA.
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Stutz MR, Dylla NP, Pearson SD, Lecompte-Osorio P, Nayak R, Khalid M, Adler E, Boissiere J, Lin H, Leiter W, Little J, Rose A, Moran D, Mullowney MW, Wolfe KS, Lehmann C, Odenwald M, De La Cruz M, Giurcanu M, Pohlman AS, Hall JB, Chaubard JL, Sundararajan A, Sidebottom A, Kress JP, Pamer EG, Patel BK. Immunomodulatory fecal metabolites are associated with mortality in COVID-19 patients with respiratory failure. Nat Commun 2022; 13:6615. [PMID: 36329015 PMCID: PMC9633022 DOI: 10.1038/s41467-022-34260-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 07/21/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Respiratory failure and mortality from COVID-19 result from virus- and inflammation-induced lung tissue damage. The intestinal microbiome and associated metabolites are implicated in immune responses to respiratory viral infections, however their impact on progression of severe COVID-19 remains unclear. We prospectively enrolled 71 patients with COVID-19 associated critical illness, collected fecal specimens within 3 days of medical intensive care unit admission, defined microbiome compositions by shotgun metagenomic sequencing, and quantified microbiota-derived metabolites (NCT #04552834). Of the 71 patients, 39 survived and 32 died. Mortality was associated with increased representation of Proteobacteria in the fecal microbiota and decreased concentrations of fecal secondary bile acids and desaminotyrosine (DAT). A microbiome metabolic profile (MMP) that accounts for fecal secondary bile acids and desaminotyrosine concentrations was independently associated with progression of respiratory failure leading to mechanical ventilation. Our findings demonstrate that fecal microbiota composition and microbiota-derived metabolite concentrations can predict the trajectory of respiratory function and death in patients with severe SARS-Cov-2 infection and suggest that the gut-lung axis plays an important role in the recovery from COVID-19.
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Affiliation(s)
- Matthew R. Stutz
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, 5841 South Maryland Ave, Chicago, IL 60637 USA
| | - Nicholas P. Dylla
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA
| | - Steven D. Pearson
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, 5841 South Maryland Ave, Chicago, IL 60637 USA
| | - Paola Lecompte-Osorio
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, 5841 South Maryland Ave, Chicago, IL 60637 USA
| | - Ravi Nayak
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA
| | - Maryam Khalid
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA
| | - Emerald Adler
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA
| | - Jaye Boissiere
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA
| | - Huaiying Lin
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA
| | - William Leiter
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA
| | - Jessica Little
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA
| | - Amber Rose
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA
| | - David Moran
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA
| | - Michael W. Mullowney
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA
| | - Krysta S. Wolfe
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, 5841 South Maryland Ave, Chicago, IL 60637 USA
| | - Christopher Lehmann
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Infectious Diseases & Global Health, University of Chicago Medicine, 5841 South Maryland Ave, Chicago, IL 60637 USA
| | - Matthew Odenwald
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, 5841 South Maryland Ave, Chicago, IL 60637 USA
| | - Mark De La Cruz
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5841 South Maryland Ave, Chicago, IL 60637 USA
| | - Mihai Giurcanu
- grid.170205.10000 0004 1936 7822Biological Sciences Division, Biostatistics Laboratory & Research Computing Group, University of Chicago, 5841 South Maryland Ave, Chicago, IL 60637 USA
| | - Anne S. Pohlman
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, 5841 South Maryland Ave, Chicago, IL 60637 USA
| | - Jesse B. Hall
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, 5841 South Maryland Ave, Chicago, IL 60637 USA
| | - Jean-Luc Chaubard
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA
| | - Anitha Sundararajan
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA
| | - Ashley Sidebottom
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA
| | - John P. Kress
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, 5841 South Maryland Ave, Chicago, IL 60637 USA
| | - Eric G. Pamer
- grid.170205.10000 0004 1936 7822Duchossois Family Institute, University of Chicago, 900 E. 57th St, Chicago, IL 60637 USA ,grid.170205.10000 0004 1936 7822Department of Medicine, Section of Infectious Diseases & Global Health, University of Chicago Medicine, 5841 South Maryland Ave, Chicago, IL 60637 USA
| | - Bhakti K. Patel
- grid.170205.10000 0004 1936 7822Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, 5841 South Maryland Ave, Chicago, IL 60637 USA
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5
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Pearson SD, Lin J, Stutz MR, Lecompte-Osorio P, Pohlman AS, Wolfe KS, Hall JB, Kress JP, Patel BK. Immediate Effect of Mechanical Ventilation Mode and Sedative Infusion on Measured Diaphragm Thickness. Ann Am Thorac Soc 2022; 19:1543-1550. [PMID: 35404772 PMCID: PMC9447392 DOI: 10.1513/annalsats.202111-1280oc] [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: 11/19/2021] [Accepted: 04/11/2022] [Indexed: 11/20/2022] Open
Abstract
Rationale: In patients who are mechanically ventilated, diaphragm thinning on ultrasound is thought to correlate with diaphragm atrophy and has been associated with prolonged intubation. Factors other than atrophy, however, may cause changes in diaphragm thickness, which may confound studies examining changes in diaphragm thickness over time. Objectives: To determine if changes in the mode of mechanical ventilation or an interruption of sedatives have immediate effects on diaphragm thickness measurements in adult patients in the intensive care unit who are mechanically ventilated. Methods: Adult patients receiving invasive mechanical ventilation for less than 48 hours were included. Diaphragm thickness was measured at end-expiration and peak inspiration using ultrasound while patients were receiving both volume assist-control and pressure-support modes in a randomized crossover fashion. In patients receiving sedatives, additional measurements were taken after an interruption of sedatives. Measurements were compared between modes and on assist-control before and after an interruption of sedatives. Results: Of 85 patients enrolled, 66 had measurements on assist-control and spontaneous modes, and 40 had measurements before and after an interruption of sedatives. End-expiratory diaphragm thickness increased by a median of 0.08 mm after an interruption of sedatives (95% confidence interval [CI], 0.002 mm to 0.164 mm; P = 0.017), corresponding to a median increase of 6.5%. No difference was seen when comparing measurements taken on volume assist-control and pressure support (median difference, 0 mm; 95% CI, -0.07 mm to 0.08 mm; P = 0.98). Conclusions: End-expiratory diaphragm thickness increased by 6.5% after an interruption of sedatives. The effect of sedatives on measured diaphragm thickness should be considered in future studies examining changes in diaphragm thickness over time. Clinical trial registered with Clinicaltrials.gov (NCT04319939).
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Affiliation(s)
- Steven D. Pearson
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Julie Lin
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Matthew R. Stutz
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Anne S. Pohlman
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Krysta S. Wolfe
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jesse B. Hall
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - John P. Kress
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Bhakti K. Patel
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
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6
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Hall JB, Bloomsburg MR, Goddard SA. Effect of a lactobacillus fermentation product on postweaning heifer performance. Transl Anim Sci 2022; 6:txac015. [PMID: 35274081 PMCID: PMC8903881 DOI: 10.1093/tas/txac015] [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: 11/15/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
The objective of the experiment was to compare the effect of dietary inclusion of a prebiotic fermentation product of Lactobacillus acidophilus (LaP, RumaCell; 5 mL•animal -1•d -1) or monensin on performance of replacement beef heifers. Heifers received a total mixed ration containing either LaP (n =77) or monensin (MON; Rumensin; 200 mg•animal -1•d -1; n = 79). Heifers were fed for 71 days in a GrowSafe unit so individual feed intake could be measured. Heifers were weighed every two weeks and feed efficiency calculated by residual feed intake (RFI). At the end of the RFI trial, heifers remained on their diets for an additional 27 days and were estrus synchronized using the 14-d CIDR + PG protocol and bred by artificial insemination (AI) followed by natural service. Prior to estrous synchronization reproductive tract scores (RTS; 1 = infantile to 5 = cycling/presence of corpus luteum) were measured. Continuous variables were analyzed using generalized mixed models whereas categorical data were analyzed by logistic regression. Body weights, average daily gain, feed intake and RFI value were similar (P > 0.30) among MON and LaP supplemented heifers. Across treatments heifers gained 0.9 ± 0.1 kg/d while consuming 9.3 ± 0.5 kg of diets daily. Reproductive development as indicated by RTS was similar (P > 0.28) between treatments. However, estrus response increased (P < 0.01) and AI pregnancy rates tended to be greater (P < 0.07) for MON compared to LaP heifers. In contrast, the percentage of heifers pregnant by 60 d and 100 d (80.4% and 90.5%, respectively) were not different (P > 0.33) for MON and LaP heifers. In conclusion, addition of LaP to replacement heifer diets may result in growth and reproductive performance similar to an ionophore, if dietary energy is adequate for normal heifer growth.
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Affiliation(s)
- J B Hall
- Nancy M. Cummings Research, Extension and Education Center, University of Idaho, Carmen, ID, USA
- Department of Animal, Veterinary and Food Science, University of Idaho, Moscow, ID, USA
| | - M R Bloomsburg
- Department of Animal, Veterinary and Food Science, University of Idaho, Moscow, ID, USA
| | - S A Goddard
- Nancy M. Cummings Research, Extension and Education Center, University of Idaho, Carmen, ID, USA
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7
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Stutz MR, Leonhard AG, Ward CM, Pearson SD, Osorio PL, Herbst PR, Wolfe KS, Pohlman AS, Hall JB, Kress JP, Patel BK. Early Rehabilitation Feasibility in a COVID-19 ICU. Chest 2021; 160:2146-2148. [PMID: 34116067 PMCID: PMC8185320 DOI: 10.1016/j.chest.2021.05.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/15/2021] [Accepted: 05/25/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Matthew R Stutz
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Aristotle G Leonhard
- Department of Medicine, Internal Medicine Residency Program, University of Chicago, Chicago, IL
| | - Colleen M Ward
- Department of Physical Therapy, University of Chicago, Chicago, IL
| | - Steven D Pearson
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Paola Lecompte Osorio
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Peter R Herbst
- Department of Physical Therapy, University of Chicago, Chicago, IL
| | - Krysta S Wolfe
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Anne S Pohlman
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Jesse B Hall
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - John P Kress
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Bhakti K Patel
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL.
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8
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Lecompte-Osorio P, Pearson SD, Pieroni CH, Stutz MR, Pohlman AS, Lin J, Hall JB, Htwe YM, Belvitch PG, Dudek SM, Wolfe K, Patel BK, Kress JP. Bedside estimates of dead space using end-tidal CO 2 are independently associated with mortality in ARDS. Crit Care 2021; 25:333. [PMID: 34526077 PMCID: PMC8442447 DOI: 10.1186/s13054-021-03751-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023]
Abstract
Purpose In acute respiratory distress syndrome (ARDS), dead space fraction has been independently associated with mortality. We hypothesized that early measurement of the difference between arterial and end-tidal CO2 (arterial-ET difference), a surrogate for dead space fraction, would predict mortality in mechanically ventilated patients with ARDS. Methods We performed two separate exploratory analyses. We first used publicly available databases from the ALTA, EDEN, and OMEGA ARDS Network trials (N = 124) as a derivation cohort to test our hypothesis. We then performed a separate retrospective analysis of patients with ARDS using University of Chicago patients (N = 302) as a validation cohort. Results The ARDS Network derivation cohort demonstrated arterial-ET difference, vasopressor requirement, age, and APACHE III to be associated with mortality by univariable analysis. By multivariable analysis, only the arterial-ET difference remained significant (P = 0.047). In a separate analysis, the modified Enghoff equation ((PaCO2–PETCO2)/PaCO2) was used in place of the arterial-ET difference and did not alter the results. The University of Chicago cohort found arterial-ET difference, age, ventilator mode, vasopressor requirement, and APACHE II to be associated with mortality in a univariate analysis. By multivariable analysis, the arterial-ET difference continued to be predictive of mortality (P = 0.031). In the validation cohort, substitution of the arterial-ET difference for the modified Enghoff equation showed similar results. Conclusion Arterial to end-tidal CO2 (ETCO2) difference is an independent predictor of mortality in patients with ARDS.
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Affiliation(s)
- Paola Lecompte-Osorio
- Section of Pulmonology and Critical Care, University of Chicago, 5841 South Maryland Ave. MC 6026, Chicago, IL, 60637, USA
| | - Steven D Pearson
- Section of Pulmonology and Critical Care, University of Chicago, 5841 South Maryland Ave. MC 6026, Chicago, IL, 60637, USA
| | | | - Matthew R Stutz
- Section of Pulmonology and Critical Care, University of Chicago, 5841 South Maryland Ave. MC 6026, Chicago, IL, 60637, USA
| | - Anne S Pohlman
- Section of Pulmonology and Critical Care, University of Chicago, 5841 South Maryland Ave. MC 6026, Chicago, IL, 60637, USA
| | - Julie Lin
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jesse B Hall
- Section of Pulmonology and Critical Care, University of Chicago, 5841 South Maryland Ave. MC 6026, Chicago, IL, 60637, USA
| | - Yu M Htwe
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Chicago, Chicago, USA
| | - Patrick G Belvitch
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Chicago, Chicago, USA
| | - Steven M Dudek
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Chicago, Chicago, USA
| | - Krysta Wolfe
- Section of Pulmonology and Critical Care, University of Chicago, 5841 South Maryland Ave. MC 6026, Chicago, IL, 60637, USA
| | - Bhakti K Patel
- Section of Pulmonology and Critical Care, University of Chicago, 5841 South Maryland Ave. MC 6026, Chicago, IL, 60637, USA
| | - John P Kress
- Section of Pulmonology and Critical Care, University of Chicago, 5841 South Maryland Ave. MC 6026, Chicago, IL, 60637, USA.
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9
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Affiliation(s)
- Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, Sinai Health System/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jesse B Hall
- Pritzker School of Medicine, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
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10
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Oosthuizen N, Fontes PLP, Oliveira Filho RV, Dahlen CR, Grieger DM, Hall JB, Lake SL, Looney CR, Mercadante VRG, Neville BW, Perry GA, Powell JG, Prezotto LD, Seidel GE, Walker RS, Cardoso RC, Pohler KG, Lamb GC. Pre-synchronization of ovulation timing and delayed fixed-time artificial insemination increases pregnancy rates when sex-sorted semen is used for insemination of heifers. Anim Reprod Sci 2021; 226:106699. [PMID: 33517066 DOI: 10.1016/j.anireprosci.2021.106699] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
This study was conducted to determine effects of pre-synchronization of ovulation timing among heifers and delayed fixed-time artificial insemination (TAI) with sex-sorted semen on proportion of heifers pregnant after TAI (PR/AI). Heifers were assigned to one of eight treatments: 1 and 2), 7-d CO-Synch + CIDR treatment regimen with administration of gonadotropin-releasing hormone and a CIDR insert on Day 0, prostaglandin F2α (PGF) at CIDR removal on Day 7, and TAI occurring 54 h later with conventionally processed (CTRL54-CNV) or sex-sorted semen (CTRL54-SEX); 3 and 4), same as CTRL54 but TAI delayed to 72 h with conventionally processed (CTRL72-CNV) or sex-sorted semen (CTRL72-SEX); 5 and 6), same as CTRL54 but additional administration of PGF on Day -7 and TAI with conventionally processed (PRE54-CNV) or sex-sorted semen (PRE54-SEX); 7 and 8), same as PRE54 treatments but TAI delayed to 72 h with conventionally processed (PRE72-CNV) or sex-sorted semen (PRE72-SEX). Proportion of heifers pregnant after TAI was greater (P ≤ 0.02) with conventionally processed semen compared with sex-sorted semen, yet PR/AI did not differ (P = 0.14) between heifers in PRE72-CNV and PRE72-SEX groups. There were greater PR/AI in the PRE72-SEX (P = 0.03) than CTRL54-SEX group (46.1 % and 36.9 %) and there was no difference (P = 0.31) in PR/AI between CTRL54-CNV and PRE72-SEX groups (50.4 % and 46.1 %). In conclusion, pre-synchronization of ovulation timing among heifers combined with delayed TAI resulted in increased PR/AI with sex-sorted semen compared with the 7-d CO-Synch+CIDR treatment regimen.
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Affiliation(s)
- N Oosthuizen
- Department of Animal Science, Texas A&M University, College Station, TX 77843-2471, United States.
| | - P L P Fontes
- Department of Animal and Dairy Science, University of Georgia, Athens, GA 30602, United States
| | - R V Oliveira Filho
- Department of Animal Science, Texas A&M University, College Station, TX 77843-2471, United States
| | - C R Dahlen
- Department of Animal Sciences, North Dakota State University, Fargo, ND 58105, United States
| | - D M Grieger
- Department of Animal Sciences and Industry, Kansas State University, Manhattan, KS 66506, United States
| | - J B Hall
- Department of Animal and Veterinary Sciences, University of Idaho, Moscow, ID 83844, United States
| | - S L Lake
- Department of Animal Science, University of Wyoming, Laramie, WY 82071, United States
| | - C R Looney
- Department of Animal Science, University of Arkansas, Fayetteville, AR 72701, United States
| | - V R G Mercadante
- Department of Animal and Poultry Sciences, Virginia Tech, Blacksburg, VA 24061, United States
| | - B W Neville
- Carrington Research Extension Center, North Dakota State University, Carrington, ND 58421, United States
| | - G A Perry
- Department of Animal Science, South Dakota State University, Brookings, SD 57007, United States
| | - J G Powell
- Department of Animal Science, University of Arkansas, Fayetteville, AR 72701, United States
| | - L D Prezotto
- Department of Research Centers, Montana State University, Havre, MT 59501, United States
| | - G E Seidel
- Animal Reproduction and Biotechnology Laboratory, Colorado State University, Fort Collins, CO 80523, United States
| | - R S Walker
- Noble Research Institute, Ardmore, OK 73401, United States
| | - R C Cardoso
- Department of Animal Science, Texas A&M University, College Station, TX 77843-2471, United States
| | - K G Pohler
- Department of Animal Science, Texas A&M University, College Station, TX 77843-2471, United States
| | - G C Lamb
- Department of Animal Science, Texas A&M University, College Station, TX 77843-2471, United States.
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11
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Jaitovich A, Dumas CL, Itty R, Chieng HC, Khan MMHS, Naqvi A, Fantauzzi J, Hall JB, Feustel PJ, Judson MA. ICU admission body composition: skeletal muscle, bone, and fat effects on mortality and disability at hospital discharge-a prospective, cohort study. Crit Care 2020; 24:566. [PMID: 32958059 PMCID: PMC7507825 DOI: 10.1186/s13054-020-03276-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/04/2020] [Indexed: 02/08/2023]
Abstract
Background Reduced body weight at the time of intensive care unit (ICU) admission is associated with worse survival, and a paradoxical benefit of obesity has been suggested in critical illness. However, no research has addressed the survival effects of disaggregated body constituents of dry weight such as skeletal muscle, fat, and bone density. Methods Single-center, prospective observational cohort study of medical ICU (MICU) patients from an academic institution in the USA. Five hundred and seven patients requiring CT scanning of chest or abdomen within the first 24 h of ICU admission were evaluated with erector spinae muscle (ESM) and subcutaneous adipose tissue (SAT) areas and with bone density determinations at the time of ICU admission, which were correlated with clinical outcomes accounting for potential confounders. Results Larger admission ESM area was associated with decreased odds of 6-month mortality (OR per cm2, 0.96; 95% CI, 0.94–0.97; p < 0.001) and disability at discharge (OR per cm2, 0.98; 95% CI, 0.96–0.99; p = 0.012). Higher bone density was similarly associated with lower odds of mortality (OR per 100 HU, 0.69; 95% CI, 0.49–0.96; p = 0.027) and disability at discharge (OR per 100 HU, 0.52; 95% CI, 0.37–0.74; p < 0.001). SAT area was not significantly associated with these outcomes’ measures. Multivariable modeling indicated that ESM area remained significantly associated with 6-month mortality and survival after adjusting for other covariates including preadmission comorbidities, albumin, functional independence before admission, severity scores, age, and exercise capacity. Conclusion In our cohort, ICU admission skeletal muscle mass measured with ESM area and bone density were associated with survival and disability at discharge, although muscle area was the only component that remained significantly associated with survival after multivariable adjustments. SAT had no association with the analyzed outcome measures.
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Affiliation(s)
- Ariel Jaitovich
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA. .,Department of Molecular and Cellular Physiology, Albany Medical College, 47 New Scotland Av, Albany, NY, USA.
| | - Camille L Dumas
- Department of Radiology, Albany Medical College, Albany, NY, USA
| | - Ria Itty
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Hau C Chieng
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - Malik M H S Khan
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA.,Present Address: Division of Pulmonary and Critical Care Medicine Spectrum Health-Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Ali Naqvi
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
| | - John Fantauzzi
- Department of Radiology, Albany Medical College, Albany, NY, USA
| | - Jesse B Hall
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Paul J Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
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12
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Affiliation(s)
- Bhakti K Patel
- Pritzker School of Medicine, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - John P Kress
- Pritzker School of Medicine, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jesse B Hall
- Pritzker School of Medicine, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
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13
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Pearson SD, Hall JB, Parker WF. Two for one with split- or co-ventilation at the peak of the COVID-19 tsunami: is there any role for communal care when the resources for personalised medicine are exhausted? Thorax 2020; 75:444-445. [PMID: 32327565 DOI: 10.1136/thoraxjnl-2020-214929] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Steven Dale Pearson
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jesse B Hall
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois, USA
| | - William F Parker
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois, USA
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14
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Gehlbach BK, Patel SB, Van Cauter E, Pohlman AS, Hall JB, Zabner J. The Effects of Timed Light Exposure in Critically Ill Patients: A Randomized Controlled Pilot Clinical Trial. Am J Respir Crit Care Med 2019. [PMID: 29529381 DOI: 10.1164/rccm.201801-0170le] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Irwin RS, Heffner JE, Maxwell L, French CL, Augustyn N, Frantsve-Hawley J, Barnes PJ, Brightling CE, Davidson BL, Gutterman DD, Hall JB, Hill NS, Johnson RG, Manaker S, Mehra R, Moss J, Murin S, O’Byrne PM, Rubin BK, Schwarz MI, Anderson B, Lipsey L, Miller C, Goorsky P, Musacchio R, de Hon FD, Poppalardo P, Adamitis K, Clark C, Fournier E, Nightlinger M, Nuttall S, Richardson M, Rolya N, Schottenfeld D, Segal-Isaacson A, Tomasheski M, Poppalardo P, Goorsky P, Rice J, Welch S. Spread the Word About CHEST in 2019. Chest 2019; 155:1-4. [DOI: 10.1016/j.chest.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/13/2018] [Indexed: 12/01/2022] Open
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16
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Affiliation(s)
- Karen C Dugan
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jesse B Hall
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois
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17
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Wolfe KS, Patel BK, MacKenzie EL, Giovanni SP, Pohlman AS, Churpek MM, Hall JB, Kress JP. Impact of Vasoactive Medications on ICU-Acquired Weakness in Mechanically Ventilated Patients. Chest 2018; 154:781-787. [PMID: 30217640 DOI: 10.1016/j.chest.2018.07.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 01/26/2018] [Revised: 06/01/2018] [Accepted: 07/05/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vasoactive medications are commonly used in the treatment of critically ill patients, but their impact on the development of ICU-acquired weakness is not well described. The objective of this study is to evaluate the relationship between vasoactive medication use and the outcome of ICU-acquired weakness. METHODS This is a secondary analysis of mechanically ventilated patients (N = 172) enrolled in a randomized clinical trial of early occupational and physical therapy vs conventional therapy, which evaluated the end point of ICU-acquired weakness on hospital discharge. Patients underwent bedside muscle strength testing by a therapist blinded to study allocation to evaluate for ICU-acquired weakness. The effects of vasoactive medication use on the incidence of ICU-acquired weakness in this population were assessed. RESULTS On logistic regression analysis, the use of vasoactive medications increased the odds of developing ICU-acquired weakness (odds ratio [OR], 3.2; P = .01) independent of all other established risk factors for weakness. Duration of vasoactive medication use (in days) (OR, 1.35; P = .004) and cumulative norepinephrine dose (μg/kg/d) (OR, 1.01; P = .02) (but not vasopressin or phenylephrine) were also independently associated with the outcome of ICU-acquired weakness. CONCLUSIONS In mechanically ventilated patients enrolled in a randomized clinical trial of early mobilization, the use of vasoactive medications was independently associated with the development of ICU-acquired weakness. Prospective trials to further evaluate this relationship are merited. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01777035; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Krysta S Wolfe
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL.
| | - Bhakti K Patel
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | | | - Shewit P Giovanni
- Section of Pulmonary and Critical Care, Department of Medicine, University of Washington, Seattle, WA
| | - Anne S Pohlman
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | - Matthew M Churpek
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | - Jesse B Hall
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | - John P Kress
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
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18
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Gaffney AW, Verhoef PA, Hall JB. Rebuttal From Drs Gaffney, Verhoef, and Hall. Chest 2018; 150:14-5. [PMID: 27396774 DOI: 10.1016/j.chest.2016.02.661] [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] [Received: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Adam W Gaffney
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA
| | - Philip A Verhoef
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL.
| | - Jesse B Hall
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
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19
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Greenberg JA, Hohmann SF, James BD, Shah RC, Hall JB, Kress JP, David MZ. Hospital Volume of Immunosuppressed Patients with Sepsis and Sepsis Mortality. Ann Am Thorac Soc 2018; 15:962-969. [PMID: 29856657 PMCID: PMC6322036 DOI: 10.1513/annalsats.201710-819oc] [Citation(s) in RCA: 12] [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: 10/23/2017] [Accepted: 06/01/2018] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Immunosuppressive medical conditions are risk factors for mortality from severe infections. It is unknown whether hospital characteristics affect this risk. OBJECTIVES To determine whether the odds of death for an immunosuppressed patient with sepsis relative to a nonimmunosuppressed patient with sepsis varies according to the hospital's yearly case volume of immunosuppressed patients with sepsis. METHODS Patients with sepsis at hospitals in the Vizient database were characterized as immunosuppressed or not immunosuppressed on the basis of diagnosis codes and medication use. Hospitals were grouped into quartiles based on their average volumes of immunosuppressed patients with sepsis per year. Multilevel logistic regression with clustering of patients by hospital was used to determine whether the odds of in-hospital death from sepsis owing to a suppressed immune state varied by hospital quartile. RESULTS There were 350,183 patients with sepsis at 60 hospitals in the Vizient database from 2010 to 2012. Immunosuppressed patients with sepsis at the 15 hospitals in the lowest quartile (64 to 224 immunosuppressed patients with sepsis per year) had an increased odds of in-hospital death relative to nonimmunosuppressed patients with sepsis at these hospitals (adjusted odds ratio, 1.38; 95% confidence interval, 1.27-1.50; P < 0.001). The odds of in-hospital death for immunosuppressed patients with sepsis relative to nonimmunosuppressed patients with sepsis was similar for patients at hospitals in the second, third, and fourth quartiles (225 to 1,056 immunosuppressed patients with sepsis per year). The adjusted odds of death from sepsis owing to a suppressed immune state of 1.21 (95% confidence interval, 1.18-1.25; P < 0.001) for patients at these 45 hospitals was significantly less than for patients at the 15 hospitals in the lowest quartile (P = 0.004 for difference). CONCLUSIONS The risk of death from sepsis owing to a suppressed immune state was greatest at hospitals with the lowest volume of immunosuppressed patients with sepsis. Further study is needed to determine whether this finding is related to differences in patient characteristics or in care delivery at hospitals with different amounts of exposure to immunosuppressed patients.
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Affiliation(s)
- Jared A. Greenberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Samuel F. Hohmann
- Department of Health Systems Management
- Center for Advanced Analytics, Vizient, Chicago, Illinois
| | - Bryan D. James
- Department of Internal Medicine
- Rush Alzheimer’s Disease Center, and
| | - Raj C. Shah
- Rush Alzheimer’s Disease Center, and
- Department of Family Medicine, Rush University Medical Center, Chicago, Illinois
| | - Jesse B. Hall
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois; and
| | - John P. Kress
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois; and
| | - Michael Z. David
- Division of Infectious Disease, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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20
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Greenberg JA, Hrusch CL, Jaffery MR, David MZ, Daum RS, Hall JB, Kress JP, Sperling AI, Verhoef PA. Distinct T-helper cell responses to Staphylococcus aureus bacteremia reflect immunologic comorbidities and correlate with mortality. Crit Care 2018; 22:107. [PMID: 29695270 PMCID: PMC5916828 DOI: 10.1186/s13054-018-2025-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 04/03/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The dysregulated host immune response that defines sepsis varies as a function of both the immune status of the host and the distinct nature of the pathogen. The degree to which immunocompromising comorbidities or immunosuppressive medications affect the immune response to infection is poorly understood because these patients are often excluded from studies about septic immunity. The objectives of this study were to determine the immune response to a single pathogen (Staphylococcus aureus) among a diverse case mix of patients and to determine whether comorbidities affect immune and clinical outcomes. METHODS Blood samples were drawn from 95 adult inpatients at multiple time points after the first positive S. aureus blood culture. Cox proportional hazards modeling was used to determine the associations between admission neutrophil counts, admission lymphocyte counts, cytokine levels, and 90-day mortality. A nested case-control flow cytometric analysis was conducted to determine T-helper type 1 (Th1), Th2, Th17, and regulatory T-cell (Treg) subsets among a subgroup of 28 patients. In a secondary analysis, we categorized patients as either having immunocompromising disorders (human immunodeficiency virus and hematologic malignancies), receiving immunosuppressive medications, or being not immunocompromised. RESULTS Higher neutrophil-to-lymphocyte count ratios and higher Th17 cytokine responses relative to Th1 cytokine responses early after infection were independently associated with mortality and did not depend on the immune state of the patient (HR 1.93, 95% CI 1.17-3.17, p = 0.01; and HR 1.13, 95% CI 1.01-1.27, p = 0.03, respectively). On the basis of flow cytometric analysis of CD4 T-helper subsets, an increasing Th17/Treg response over the course of the infection was most strongly associated with increased mortality (HR 4.41, 95% CI 1.69-11.5, p < 0.01). This type of immune response was most common among patients who were not immunocompromised. In contrast, among immunocompromised patients who died, a decreasing Th1/Treg response was most common. CONCLUSIONS The association of both increased Th17 responses and increased neutrophil counts relative to lymphocyte counts with mortality suggests that an overwhelming inflammatory response is detrimental. However, the differential responses of patients according to immune state suggest that immune status is an important clinical indicator that should be accounted for in the management of septic patients, as well as in the development of novel immunomodulatory therapies.
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Affiliation(s)
- Jared A Greenberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, 1725 West Harrison Street, Suite 054, Chicago, IL, 60612, USA.
| | - Cara L Hrusch
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Mohammad R Jaffery
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Michael Z David
- Division of Infectious Disease, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert S Daum
- Section of Infectious Disease and Global Health, Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Jesse B Hall
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - John P Kress
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Anne I Sperling
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.,Committee on Immunology, University of Chicago, Chicago, IL, USA
| | - Philip A Verhoef
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
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21
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Affiliation(s)
- John P Kress
- University of Chicago, Chicago, Illinois (J.P.K., J.B.H.)
| | - Jesse B Hall
- University of Chicago, Chicago, Illinois (J.P.K., J.B.H.)
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22
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Patel BK, Wolfe KS, Hall JB, Kress JP. A Word of Caution Regarding Patient Self-inflicted Lung Injury and Prophylactic Intubation. Am J Respir Crit Care Med 2017; 196:936. [PMID: 28460177 DOI: 10.1164/rccm.201702-0410le] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Kasimanickam RK, Hall JB, Estill CT, Kastelic JP, Joseph C, Abdel Aziz RL, Nak D. Flunixin meglumine improves pregnancy rate in embryo recipient beef cows with an excitable temperament. Theriogenology 2017; 107:70-77. [PMID: 29132037 DOI: 10.1016/j.theriogenology.2017.10.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 08/30/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 11/18/2022]
Abstract
Objectives were to determine effects of: 1) handling temperament and administration of flunixin meglumine, an inhibitor of prostaglandin F2a (PGF2a) synthesis, given at the time of embryo transfer, on pregnancy rates in beef cattle embryo transfer recipients; 2) handling temperament and flunixin meglumine on peripheral concentrations of progesterone, cortisol, substance-P, prostaglandin F metabolites (PGFM, (13,14-dihydro-15-keto-PGF2a) and isoprostane 8-epi PGF2a; and 3) flunixin meglumine treatment on proportion of non-pregnant recipient cows returning to estrus within an expected interval. Angus cross beef cows (n = 710) at 7 locations were assigned a body condition score (BCS: 1, emaciated; 9, obese) and a temperament score [0, calm, slow chute exit; walk (n = 352), 1, excited, fast chute exit; jump, trot or run (n = 358)] and were synchronized with Select-Synch with a controlled internal drug release (CIDR) protocol. Estrus detection aids were applied at CIDR removal and cows were observed thrice daily for estrus until 72 h. Recipient cows that expressed estrus and had a corpus luteum received a frozen-thawed embryo on Day 7 after estrus. At the time of transfer, recipient cows were randomly allocated to receive 10 mL of flunixin meglumine im, immediately after transfer (n = 365) or served as an untreated control (n = 345). In a subset of cows (n = 80), ovarian ultrasonography was performed on the day of embryo transfer to determine corpus luteum volume and blood samples were collected twice, at the time of embryo transfer and 7 d later. All cows received estrus detection aids again on Day 14 (7 d after embryo transfer) and were observed for estrus twice daily until Day 24. Accounting for treatment (P > 0.1), embryo transfer difficulty score (P < 0.1), temperament by treatment interaction (P < 0.05), recipient cows with calm temperament had a higher pregnancy rate compared to those with an excited temperament [59.4 (209/352) vs 51.7% (185/358)]. The pregnancy rate for excitable cows without flunixin meglumine was lower (46.3% 81/175) compared to excitable cows that did received flunixin meglumine [56.8% (104/183)], and calm cows that did [59.3% (108/182)] or did not [59.4% (104/170)] receive flunixin meglumine. Proportions of non-pregnant recipient cows returning to estrus on Days 18-24 were not different between flunixin meglumine and control groups, 87.6% (134/153) and 84.0% (137/163), respectively (P > 0.1). At the time of embryo transfer and 7 d later, there were moderate to strong correlations among circulating concentrations of progesterone, cortisol, substance-P, PGFM and isoprostane 8-epi PGF2a. Among excitable cows, progesterone concentrations were lower and cortisol, substance-P, PGFM and isoprostane 8-epi PGF2a concentrations were greater for cows in the control group compared to cows that received flunixin meglumine. In conclusion, administration of flunixin meglumine improved pregnancy rates in excitable recipient cows following embryo transfer without affecting the proportion of non-pregnant cows returning to estrus.
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Affiliation(s)
- R K Kasimanickam
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, WA, USA.
| | - J B Hall
- Nancy M. Cummings Research, Extension and Education Center, University of Idaho, Carmen, ID, USA
| | - C T Estill
- Department of Clinical Sciences, Oregon State University, Corvallis, OR, USA
| | - J P Kastelic
- Department of Production Animal Health, University of Calgary, Calgary, AB, Canada
| | - C Joseph
- Department of Clinics, Tamil Nadu Veterinary and Animal Sciences University, Vepery, Chennai, India
| | - R L Abdel Aziz
- Department of Theriogenology, Beni-Suef University, Beni-Suef, Egypt
| | - D Nak
- Department of Obstetrics and Gynecology, Uludag University Veterinary Faculty, Bursa, Turkey
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Affiliation(s)
- Jesse B Hall
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois
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Thomas JM, Locke JWC, Vishwanath R, Hall JB, Ellersieck MR, Smith MF, Patterson DJ. Effective use of SexedULTRA™ sex-sorted semen for timed artificial insemination of beef heifers. Theriogenology 2017; 98:88-93. [PMID: 28601161 DOI: 10.1016/j.theriogenology.2017.03.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 11/30/2016] [Revised: 03/17/2017] [Accepted: 03/20/2017] [Indexed: 11/17/2022]
Abstract
An experiment was designed to evaluate the relative fertility of SexedULTRATM sex-sorted semen compared to conventional, non-sex-sorted semen when used among beef heifers in conjunction with split-time AI following the 14-d CIDR-PG protocol. Units of conventional semen were generated with 25.0 × 106 live cells per 0.5 ml straw prior to freezing, and units of sex-sorted semen were generated using the SexedULTRATM Genesis III sorting technology with 4.0 × 106 live cells per 0.25 ml straw prior to freezing. Sex-sorted units were sorted to contain X chromosome-bearing sperm cells at an accuracy level of >90%. Estrus was synchronized in 851 heifers at four locations using the 14-d CIDR-PG protocol: controlled internal drug release (CIDR) insert (1.38 g progesterone) on Day 0, CIDR removal on Day 14, and administration of prostaglandin F2α (PG; 25 mg im) on Day 30. Estrus detection aids were applied at PG on Day 30 to evaluate estrous response rate, and split-time AI was performed based on estrous response. At 66 h after PG (Day 33), heifers having expressed estrus received timed AI. Heifers failing to express estrus by 66 h received timed AI 24 h later (90 h after PGF2α on Day 34). Heifers failing to express estrus by 90 h were administered gonadotropin-releasing hormone (GnRH; 100 μg im) concurrent with AI. Heifers were preassigned to treatment (insemination with either conventional or SexedULTRATM sex-sorted semen), and treatments were balanced within each location based on source, reproductive tract score, and weight. Heifers were exposed for natural service beginning 14 d after AI for the remainder of a 60 d breeding season. Pregnancy rates to AI across locations tended to be higher (P = 0.09) for heifers inseminated with conventional semen (60%; 257/429) compared to sex-sorted semen (52%; 218/422). Higher pregnancy rates to AI (P < 0.0001) were obtained among heifers that expressed estrus prior to AI than among heifers that failed to express estrus prior to AI at 90 h. Total pregnancy rates at the end of the 60 d breeding season did not differ between heifers that received sex-sorted semen at AI (89%; 376/422) and heifers that received conventional semen at AI (89%; 382/429). In summary, the pregnancy rates observed suggest that SexedULTRATM sex-sorted semen can be used effectively for timed AI of beef heifers when split-time AI is performed following the 14-d CIDR-PG protocol.
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Affiliation(s)
- J M Thomas
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States
| | - J W C Locke
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States; College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, United States
| | - R Vishwanath
- Sexing Technologies, Navasota, TX 77868, United States
| | - J B Hall
- Department of Animal and Veterinary Science, Nancy M. Cummings Research Extension and Education Center, University of Idaho, Carmen, ID 83462, United States
| | - M R Ellersieck
- Agriculture Experiment Station Statistician, University of Missouri, Columbia, MO 65211, United States
| | - M F Smith
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States
| | - D J Patterson
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, United States.
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Kasimanickam RK, Hall JB, Whittier WD. Fertility of Angus cross beef heifers after GnRH treatment on day 23 and timing of insemination in 14-day CIDR protocol. Reprod Domest Anim 2016; 52:122-129. [DOI: 10.1111/rda.12866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/10/2016] [Indexed: 11/26/2022]
Affiliation(s)
- RK Kasimanickam
- Department of Veterinary Clinical Sciences; Washington State University; Pullman WA USA
| | - JB Hall
- Nancy M. Cummings Nancy M Cummins Research Extension and Education Center; University of Idaho; Carmen ID USA
| | - WD Whittier
- Department of Large Animal Clinical sciences; Virginia Polytechnic Institute and State University; Blacksburg VA USA
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Affiliation(s)
- Bhakti K Patel
- Section of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois
| | - Jesse B Hall
- Section of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois
| | - John P Kress
- Section of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois
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Greenberg JA, David MZ, Churpek MM, Pitrak DL, Hall JB, Kress JP. Sequential Organ Failure Assessment Score Modified for Recent Infection in Patients With Hematologic Malignant Tumors and Severe Sepsis. Am J Crit Care 2016; 25:409-17. [PMID: 27587420 DOI: 10.4037/ajcc2016281] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Baseline health status influences outcomes of severe sepsis. OBJECTIVE To determine if recent infection is a marker of poor health in patients with hematologic malignant tumors and severe sepsis by modifying the Sequential Organ Failure Assessment (SOFA) score to account for infection. METHODS Medical records of the first 50 patients with hematologic malignant tumors and severe sepsis admitted from September 1, 2009 to September 1, 2014, were reviewed to derive a modified SOFA score. The predictive accuracy of the modified score was compared with that of the unmodified score and the Acute Physiology and Chronic Health Evaluation (APACHE) II score for the 196 subsequent patients. RESULTS The area under the receiver operator characteristic curve was 0.73 (95% CI, 0.66-0.80) for the modified score, 0.68 (95% CI, 0.61-0.76) for the unmodified score, and 0.65 (95% CI, 0.58-0.73) for the APACHE II score. The modified score was better for discriminating survivors from nonsurvivors than the unmodified score (P = .005) and the APACHE II score (P = .04). After adjustments for the modified score and age, only increased days from hospital to intensive care unit admission was significantly associated with 30-day mortality. CONCLUSION Modifying the SOFA score to account for infections before admission to the intensive care unit improved the prognostic usefulness of the scores for patients with hematologic malignant tumors and severe sepsis.
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Affiliation(s)
- Jared A Greenberg
- Jared A. Greenberg is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, Illinois. Matthew M. Churpek is an assistant professor, Jesse B. Hall is a professor, and John P. Kress is a professor, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois. Michael Z. David is an assistant professor and David L. Pitrak is a professor, Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago.
| | - Michael Z David
- Jared A. Greenberg is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, Illinois. Matthew M. Churpek is an assistant professor, Jesse B. Hall is a professor, and John P. Kress is a professor, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois. Michael Z. David is an assistant professor and David L. Pitrak is a professor, Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago
| | - Matthew M Churpek
- Jared A. Greenberg is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, Illinois. Matthew M. Churpek is an assistant professor, Jesse B. Hall is a professor, and John P. Kress is a professor, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois. Michael Z. David is an assistant professor and David L. Pitrak is a professor, Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago
| | - David L Pitrak
- Jared A. Greenberg is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, Illinois. Matthew M. Churpek is an assistant professor, Jesse B. Hall is a professor, and John P. Kress is a professor, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois. Michael Z. David is an assistant professor and David L. Pitrak is a professor, Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago
| | - Jesse B Hall
- Jared A. Greenberg is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, Illinois. Matthew M. Churpek is an assistant professor, Jesse B. Hall is a professor, and John P. Kress is a professor, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois. Michael Z. David is an assistant professor and David L. Pitrak is a professor, Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago
| | - John P Kress
- Jared A. Greenberg is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rush University Medical Center, Chicago, Illinois. Matthew M. Churpek is an assistant professor, Jesse B. Hall is a professor, and John P. Kress is a professor, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois. Michael Z. David is an assistant professor and David L. Pitrak is a professor, Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago
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Patel BK, Wolfe KS, Pohlman AS, Hall JB, Kress JP. Effect of Noninvasive Ventilation Delivered by Helmet vs Face Mask on the Rate of Endotracheal Intubation in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA 2016; 315:2435-41. [PMID: 27179847 PMCID: PMC4967560 DOI: 10.1001/jama.2016.6338] [Citation(s) in RCA: 333] [Impact Index Per Article: 41.6] [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: 01/01/2023]
Abstract
IMPORTANCE Noninvasive ventilation (NIV) with a face mask is relatively ineffective at preventing endotracheal intubation in patients with acute respiratory distress syndrome (ARDS). Delivery of NIV with a helmet may be a superior strategy for these patients. OBJECTIVE To determine whether NIV delivered by helmet improves intubation rate among patients with ARDS. DESIGN, SETTING, AND PARTICIPANTS Single-center randomized clinical trial of 83 patients with ARDS requiring NIV delivered by face mask for at least 8 hours while in the medical intensive care unit at the University of Chicago between October 3, 2012, through September 21, 2015. INTERVENTIONS Patients were randomly assigned to continue face mask NIV or switch to a helmet for NIV support for a planned enrollment of 206 patients (103 patients per group). The helmet is a transparent hood that covers the entire head of the patient and has a rubber collar neck seal. Early trial termination resulted in 44 patients randomized to the helmet group and 39 to the face mask group. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients who required endotracheal intubation. Secondary outcomes included 28-day invasive ventilator-free days (ie, days alive without mechanical ventilation), duration of ICU and hospital length of stay, and hospital and 90-day mortality. RESULTS Eighty-three patients (45% women; median age, 59 years; median Acute Physiology and Chronic Health Evaluation [APACHE] II score, 26) were included in the analysis after the trial was stopped early based on predefined criteria for efficacy. The intubation rate was 61.5% (n = 24) for the face mask group and 18.2% (n = 8) for the helmet group (absolute difference, -43.3%; 95% CI, -62.4% to -24.3%; P < .001). The number of ventilator-free days was significantly higher in the helmet group (28 vs 12.5, P < .001). At 90 days, 15 patients (34.1%) in the helmet group died compared with 22 patients (56.4%) in the face mask group (absolute difference, -22.3%; 95% CI, -43.3 to -1.4; P = .02). Adverse events included 3 interface-related skin ulcers for each group (ie, 7.6% in the face mask group had nose ulcers and 6.8% in the helmet group had neck ulcers). CONCLUSIONS AND RELEVANCE Among patients with ARDS, treatment with helmet NIV resulted in a significant reduction of intubation rates. There was also a statistically significant reduction in 90-day mortality with helmet NIV. Multicenter studies are needed to replicate these findings. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01680783.
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Affiliation(s)
- Bhakti K Patel
- University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, Chicago, Illinois
| | - Krysta S Wolfe
- University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, Chicago, Illinois
| | - Anne S Pohlman
- University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, Chicago, Illinois
| | - Jesse B Hall
- University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, Chicago, Illinois
| | - John P Kress
- University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, Chicago, Illinois
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McGee M, Welch CM, Ramirez JA, Carstens GE, Price WJ, Hall JB, Hill RA. Relationships of feeding behaviors with average daily gain, dry matter intake, and residual feed intake in Red Angus-sired cattle. J Anim Sci 2015; 92:5214-21. [PMID: 25349363 DOI: 10.2527/jas.2014-8036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 11/13/2022] Open
Abstract
Feeding behavior has the potential to enhance prediction of feed intake and to improve understanding of the relationships between behavior, DMI, ADG, and residual feed intake (RFI) in beef cattle. Two cohorts, born in 2009 and 2010, the progeny of Red Angus bulls (n = 58 heifers and n = 53 steers), were evaluated during the growing phase, and the latter group of steers was also evaluated during the finishing phase. All behavior analyses were based on 7 feeding behavior traits (bunk visit frequency, bunk visit duration [BVDUR], feed bout frequency, feed bout duration, meal frequency, meal duration, and average meal intake) and their relationships with ADG, DMI, and RFI. During the growing phase, feeding duration traits were most indicative of DMI with positive correlations between BVDUR and DMI for cohort 1 steers, growing phase (n = 28, r = 0.52, P = 0.00); cohort 2 steers, growing phase (n = 25, r = 0.44, P = 0.01); and cohort 2 heifers, growing phase (n = 29, r = 0.28 P = 0.05). There were similar trends toward correlation of BVDUR and RFI for both steer groups and cohort 1 heifers, growing phase (C1HG; n = 29; r = 0.27, P = 0.06; r = 0.30, P = 0.07; and r = 0.26, P = 0.08, respectively). Feed bout frequency was correlated with ADG in C1HG and in cohort 2 steers, finishing phase (r = -0.31, P = 0.04, and r = 0.43, P = 0.01, respectively). Feed bout duration was correlated with ADG in heifer groups (r = 0.29 and r = 0.28, P = 0.05 for both groups) and DMI for all growing phase animals (r = 0.29 to 0.55, P ≤ 0.05 for all groups). Evaluation of growing vs. finishing phase steer groups suggests that all behaviors, RFI, and DMI, but not ADG, are correlated through the growing and finishing phases (P ≤ 0.01 for all variables excluding ADG), implying that feeding behaviors determined during the growing phase are strong predictors of DMI in either life stage. Sire maintenance energy EPD effects (measured as high or low groups) on progeny feeding behaviors revealed a difference in meal duration with a tendency to differ in average meal intake (P = 0.01 and P = 0.07, respectively). Feeding behavior duration traits may be useful predictors of DMI in Red Angus cattle.
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Affiliation(s)
- M McGee
- Department of Animal and Veterinary Science, University of Idaho, Moscow 83844
| | - C M Welch
- Department of Animal and Veterinary Science, University of Idaho, Moscow 83844
| | - J A Ramirez
- Department of Animal Science, Texas A&M University, College Station 77843
| | - G E Carstens
- Department of Animal Science, Texas A&M University, College Station 77843
| | - W J Price
- Statistical Programs, University of Idaho, Moscow 83844
| | - J B Hall
- University of Idaho Nancy M. Cummings Research, Education, and Extension Center, Carmen 83467
| | - R A Hill
- Department of Animal and Veterinary Science, University of Idaho, Moscow 83844
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Morgan SE, Mosakowski S, Solano P, Hall JB, Tung A. High-Flow Nasal Cannula and Aerosolized β Agonists for Rescue Therapy in Children With Bronchiolitis: A Case Series. Respir Care 2015; 60:e161-5. [PMID: 26106204 DOI: 10.4187/respcare.03996] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Asthma and bronchiolitis are episodic obstructive pulmonary diseases characterized by bronchoconstriction, airway wall inflammation, increased mucus production, and air-flow obstruction. We present the cases of 5 infants treated for acute bronchiolitis with respiratory distress using a combination of high-flow nasal cannula oxygen (HFNC) and an Aerogen nebulizer to deliver aerosolized β-agonist therapy. In all infants, we found that HFNC resulted in a greater heart rate increase than delivery via a facemask. We also found that patients tolerated inhaled therapy better with HFNC than a facemask.
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Affiliation(s)
| | | | | | - Jesse B Hall
- Section of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Avery Tung
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
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Bosslet GT, Pope TM, Rubenfeld GD, Lo B, Truog RD, Rushton CH, Curtis JR, Ford DW, Osborne M, Misak C, Au DH, Azoulay E, Brody B, Fahy BG, Hall JB, Kesecioglu J, Kon AA, Lindell KO, White DB. An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units. Am J Respir Crit Care Med 2015; 191:1318-30. [DOI: 10.1164/rccm.201505-0924st] [Citation(s) in RCA: 341] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Patel BK, Pohlman AS, Hall JB, Kress JP. Impact of early mobilization on glycemic control and ICU-acquired weakness in critically ill patients who are mechanically ventilated. Chest 2015; 146:583-589. [PMID: 25180722 DOI: 10.1378/chest.13-2046] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND ICU-acquired weakness (ICU-AW) has immediate and long-term consequences for critically ill patients. Strategies for the prevention of weakness include modification of known risk factors, such as hyperglycemia and immobility. Intensive insulin therapy (IIT) has been proposed to prevent critical illness polyneuropathy. However, the effect of insulin and early mobilization on clinically apparent weakness is not well known. METHODS This is a secondary analysis of all patients with mechanical ventilation (N = 104) previously enrolled in a randomized controlled trial of early occupational and physical therapy vs conventional therapy, which evaluated the end point of functional independence. Every patient had IIT and blinded muscle strength testing on hospital discharge to determine the incidence of clinically apparent weakness. The effects of insulin dose and early mobilization on the incidence of ICU-AW were assessed. RESULTS On logistic regression analyses, early mobilization and increasing insulin dose prevented the incidence of ICU-AW (OR, 0.18, P = .001; OR, 0.001, P = .011; respectively) independent of known risk factors for weakness. Early mobilization also significantly reduced insulin requirements to achieve similar glycemic goals as compared with control patients (0.07 units/kg/d vs 0.2 units/kg/d, P < .001). CONCLUSIONS The duel effect of early mobilization in reducing clinically relevant ICU-AW and promoting euglycemia suggests its potential usefulness as an alternative to IIT.
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Affiliation(s)
- Bhakti K Patel
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Anne S Pohlman
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Jesse B Hall
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - John P Kress
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
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Angus DC, Deutschman CS, Hall JB, Wilson KC, Munro CL, Hill NS. Choosing wisely(®) in critical care: maximizing value in the intensive care unit. Am J Crit Care 2014; 23:444-6. [PMID: 25362666 DOI: 10.4037/ajcc2014481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Derek C Angus
- Derek C. Angus is with the University of Pittsburgh Schools of the Health Sciences, Pittsburgh, Pennsylvania. Clifford S. Deutschman is with the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania and the Society of Critical Care Medicine, Mount Prospect, Illinois. Jesse B. Hall is with the University of Chicago School of Medicine, Chicago, Illinois and the American College of Chest Physicians, Glenview, Illinois. Kevin C. Wilson is with the Boston University School of Medicine, Boston, Massachusetts. Cindy L. Munro is with the University of South Florida College of Nursing, Tampa, Florida and the American Association of Critical-Care Nurses, Aliso Viejo, California. Nicholas S. Hill is with the Tufts University School of Medicine, Boston, Massachusetts and the American Thoracic Society, New York, New York
| | - Clifford S Deutschman
- Derek C. Angus is with the University of Pittsburgh Schools of the Health Sciences, Pittsburgh, Pennsylvania. Clifford S. Deutschman is with the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania and the Society of Critical Care Medicine, Mount Prospect, Illinois. Jesse B. Hall is with the University of Chicago School of Medicine, Chicago, Illinois and the American College of Chest Physicians, Glenview, Illinois. Kevin C. Wilson is with the Boston University School of Medicine, Boston, Massachusetts. Cindy L. Munro is with the University of South Florida College of Nursing, Tampa, Florida and the American Association of Critical-Care Nurses, Aliso Viejo, California. Nicholas S. Hill is with the Tufts University School of Medicine, Boston, Massachusetts and the American Thoracic Society, New York, New York
| | - Jesse B Hall
- Derek C. Angus is with the University of Pittsburgh Schools of the Health Sciences, Pittsburgh, Pennsylvania. Clifford S. Deutschman is with the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania and the Society of Critical Care Medicine, Mount Prospect, Illinois. Jesse B. Hall is with the University of Chicago School of Medicine, Chicago, Illinois and the American College of Chest Physicians, Glenview, Illinois. Kevin C. Wilson is with the Boston University School of Medicine, Boston, Massachusetts. Cindy L. Munro is with the University of South Florida College of Nursing, Tampa, Florida and the American Association of Critical-Care Nurses, Aliso Viejo, California. Nicholas S. Hill is with the Tufts University School of Medicine, Boston, Massachusetts and the American Thoracic Society, New York, New York
| | - Kevin C Wilson
- Derek C. Angus is with the University of Pittsburgh Schools of the Health Sciences, Pittsburgh, Pennsylvania. Clifford S. Deutschman is with the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania and the Society of Critical Care Medicine, Mount Prospect, Illinois. Jesse B. Hall is with the University of Chicago School of Medicine, Chicago, Illinois and the American College of Chest Physicians, Glenview, Illinois. Kevin C. Wilson is with the Boston University School of Medicine, Boston, Massachusetts. Cindy L. Munro is with the University of South Florida College of Nursing, Tampa, Florida and the American Association of Critical-Care Nurses, Aliso Viejo, California. Nicholas S. Hill is with the Tufts University School of Medicine, Boston, Massachusetts and the American Thoracic Society, New York, New York.
| | - Cindy L Munro
- Derek C. Angus is with the University of Pittsburgh Schools of the Health Sciences, Pittsburgh, Pennsylvania. Clifford S. Deutschman is with the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania and the Society of Critical Care Medicine, Mount Prospect, Illinois. Jesse B. Hall is with the University of Chicago School of Medicine, Chicago, Illinois and the American College of Chest Physicians, Glenview, Illinois. Kevin C. Wilson is with the Boston University School of Medicine, Boston, Massachusetts. Cindy L. Munro is with the University of South Florida College of Nursing, Tampa, Florida and the American Association of Critical-Care Nurses, Aliso Viejo, California. Nicholas S. Hill is with the Tufts University School of Medicine, Boston, Massachusetts and the American Thoracic Society, New York, New York
| | - Nicholas S Hill
- Derek C. Angus is with the University of Pittsburgh Schools of the Health Sciences, Pittsburgh, Pennsylvania. Clifford S. Deutschman is with the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania and the Society of Critical Care Medicine, Mount Prospect, Illinois. Jesse B. Hall is with the University of Chicago School of Medicine, Chicago, Illinois and the American College of Chest Physicians, Glenview, Illinois. Kevin C. Wilson is with the Boston University School of Medicine, Boston, Massachusetts. Cindy L. Munro is with the University of South Florida College of Nursing, Tampa, Florida and the American Association of Critical-Care Nurses, Aliso Viejo, California. Nicholas S. Hill is with the Tufts University School of Medicine, Boston, Massachusetts and the American Thoracic Society, New York, New York
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Kasimanickam R, Asay M, Schroeder S, Kasimanickam V, Gay JM, Kastelic JP, Hall JB, Whittier WD. Calm temperament improves reproductive performance of beef cows. Reprod Domest Anim 2014; 49:1063-7. [PMID: 25293406 DOI: 10.1111/rda.12436] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/07/2014] [Indexed: 11/29/2022]
Abstract
Profitability of a beef operation is determined by the proportion of cows attaining pregnancy early in the breeding season and those that are pregnant at the end of breeding season. Many factors, including temperament, contribute to those reproductive parameters. The objective of this study was to evaluate effects of temperament on reproductive performance of beef cows. In Experiment 1, Angus and Angus-cross beef cows (n = 1546) from eight locations were assigned a body condition score (BCS; 1 = emaciated; 9 = obese) and chute exit and gait score (1 = slow exit, walk; calm temperament; 2 = jump, trot or run; excitable temperament). Cows were grouped with bulls (1 : 25 to 1 : 30; with satisfactory breeding potential and free of venereal disease) for an 85-day breeding season. Pregnancy status and stage of gestation were determined (transrectal palpation) 35 days after the end of the breeding season. Controlling for BCS (p < 0.01) and handling facility (p < 0.0001) and handling facility by temperament score interaction (p < 0.001), breeding season pregnancy rate was lower in excited versus calm cows [88.6% (798/901) vs 94.1% (607/645); p < 0.001]. Cows with an excitable temperament took 24 more days to become pregnant compared to calm cows (median days to pregnancy, 35 vs 59 days; p < 0.0001). In Experiment 2, Angus and Angus-cross beef cows (n = 1407) from 8 locations were assigned scores for body condition and chute exit and gait (as described in Experiment 1) and assigned to bulls (breeding sound and free of venereal disease; 1 : 25 to 1 : 30) for 85 days. Pregnancy status was determined by transrectal palpation at 2 and 6 months after the onset of the breeding season. Controlling for BCS (p < 0.05), pregnancy loss was higher in excited versus calm cows [5.5% (36/651) vs 3.2% (20/623), p < 0.0001]. In conclusion, beef cows with an excitable temperament had significantly lower reproductive performance than calmer cows. The modified two-point chute exit-gait scoring method was repeatable and identified cattle with an excitable temperament.
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Affiliation(s)
- R Kasimanickam
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, WA, USA
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Hall JB. Giants in chest medicine: Lawrence D. H. Wood, MD, PhD. Chest 2014; 146:13-15. [PMID: 25010958 DOI: 10.1378/chest.14-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Morgan SE, Vukin K, Mosakowski S, Solano P, Stanton L, Lester L, Lavani R, Hall JB, Tung A. Use of heliox delivered via high-flow nasal cannula to treat an infant with coronavirus-related respiratory infection and severe acute air-flow obstruction. Respir Care 2014; 59:e166-70. [PMID: 25118308 DOI: 10.4187/respcare.02728] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Heliox, a helium-oxygen gas mixture, has been used for many decades to treat obstructive pulmonary disease. The lower density and higher viscosity of heliox relative to nitrogen-oxygen mixtures can significantly reduce airway resistance when an anatomic upper air-flow obstruction is present and gas flow is turbulent. Clinically, heliox can decrease airway resistance in acute asthma in adults and children and in COPD. Heliox may also enhance the bronchodilating effects of β-agonist administration for acute asthma. Respiratory syndromes caused by coronavirus infections in humans range in severity from the common cold to severe acute respiratory syndrome associated with human coronavirus OC43 and other viral strains. In infants, coronavirus infection can cause bronchitis, bronchiolitis, and pneumonia in variable combinations and can produce enough air-flow obstruction to cause respiratory failure. We describe a case of coronavirus OC43 infection in an infant with severe acute respiratory distress treated with heliox inhalation to avoid intubation.
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Affiliation(s)
| | - Kirissa Vukin
- Department of Pediatric Critical Care Nursing, Comer Children's Hospital
| | | | | | | | - Lucille Lester
- Department of Pediatric Pulmonary Medicine, Comer Children's Hospital, The University of Chicago, Chicago, Illinois
| | | | | | - Avery Tung
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, Illinois
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Chanques G, Pohlman A, Kress JP, Molinari N, de Jong A, Jaber S, Hall JB. Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report. Crit Care 2014; 18:R160. [PMID: 25063269 PMCID: PMC4220092 DOI: 10.1186/cc14000] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/19/2014] [Indexed: 01/02/2023]
Abstract
Introduction Pain assessment is associated with important outcomes in ICU patients but remains challenging, particularly in non-communicative patients. Use of a reliable tool is paramount to allow any implementation of sedation/analgesia protocols in a multidisciplinary team. This study compared psychometric properties (inter-rater agreement primarily; validity, responsiveness and feasibility secondarily) of three pain scales: Behavioural Pain Scale (BPS/BPS-NI, that is BPS for Non-Intubated patients), Critical Care Pain Observation Tool (CPOT) and Non-verbal Pain Scale (NVPS), the pain tool routinely used in this 16-bed medical ICU. Methods Pain was assessed by at least one of four investigators and one of the 20 bedside nurses before, during and 10 minutes after routine care procedures in non-comatose patients (Richmond Agitation Sedation Scale ≥ -3) who were unable to self-report their pain intensity. The Confusion Assessment Method for the ICU was used to assess delirium. Non-parametric tests were used for statistical analysis. Quantitative data are presented as median (25th to 75th). Results A total of 258 paired assessments of pain were performed in 30 patients (43% lightly sedated, 57% with delirium, 63% mechanically ventilated). All three scales demonstrated good psychometric properties. However, BPS and CPOT exhibited the best inter-rater reliability (weighted-κ 0.81 for BPS and CPOT) and the best internal consistency (Cronbach-α 0.80 for BPS, 0.81 for CPOT), which were higher than for NVPS (weighted-κ 0.71, P <0.05; Cronbach-α 0.76, P <0.01). Responsiveness was significantly higher for BPS compared to CPOT and for CPOT compared to NVPS. For feasibility, BPS was rated as the easiest scale to remember but there was no significant difference in regards to users’ preference. Conclusions BPS and CPOT demonstrate similar psychometric properties in non-communicative intubated and non-intubated ICU patients. Electronic supplementary material The online version of this article (doi:10.1186/cc14000) contains supplementary material, which is available to authorized users.
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McGee M, Ramirez JA, Carstens GE, Price WJ, Hall JB, Hill RA. Relationships of feeding behaviors with efficiency in RFI-divergent Japanese Black cattle. J Anim Sci 2014; 92:3580-90. [PMID: 24948647 DOI: 10.2527/jas.2013-7360] [Citation(s) in RCA: 10] [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] [Indexed: 11/13/2022] Open
Abstract
New approaches to limit expenses associated with input, without compromising profit, are needed in the beef industry. Residual feed intake (RFI) is an efficiency trait that measures variation in feed intake beyond maintenance, growth, and body composition. The addition of feeding behavior analysis to standard RFI tests may provide an approach to more readily identify feed-efficient cattle. The current study analyzes 7 feeding behaviors (BVFREQ: bunk visit frequency, BVDUR: bunk visit duration, FBFREQ: feed bout frequency, FBDUR: feed bout duration, MFREQ: meal frequency, MDUR: meal duration, and AMINT: average meal intake) and their relationships with RFI, ADG, and DMI in Japanese Black (Wagyu) cattle. Three cohorts of yearling Wagyu animals were studied using a standard 70-d RFI test, and data from divergent ( ± 0.5 SD from population RFI mean) subsets of animals were analyzed for feeding behaviors [n = 58, bulls on high-concentrate diet (C1); n = 36, bulls on a lower-concentrate diet (C2); n = 34, heifers on a lower-concentrate diet (C3)]. The following behaviors were correlated with ADG: BVFREQ (r = 0.32, P = 0.01; C1 bulls), BVDUR (r = 0.42, P = 0.01, C2 bulls), FBFREQ (r = 0.37, P < 0.01; C1 bulls), FBDUR (r = 0.46, P < 0.01, C1 bulls), and MFREQ (r = 0.42, P < 0.01, C2 bulls). Behaviors were trending or significantly correlated with DMI for all cases except for MFREQ for C3 and AMINT for C2. Residual feed intake was positively correlated with MDUR across all cohorts (r = 0.31, P = 0.02; r = 0.38, P = 0.02; r = 0.54, P ≥ 0.01, respectively). For C2 bulls and C3 heifers, RFI was positively correlated with behavior frequency categories (BVFREQ; r = 0.44, P = 0.01; r = 0.60, P ≤ 0.01, respectively, and FBFREQ r = 0.46, P ≤ 0.01; r = 0.60, P ≤ 0.01, respectively). Bunk visit frequency and FBFREQ were highly correlated with RFI status (high or low) in C2 bulls and C3 heifers. Behavior duration categories (BVDUR, FBDUR, and MDUR) were most correlated with efficiency status in C1 bulls. However, behavior frequency categories (BVFREQ and FBFREQ), as well as MDUR, were most correlated with efficiency status in C2 bulls and C3 heifers. Inclusion of meal duration measurements when evaluating RFI provides an additional tool in understanding the drivers of variation in this important trait in Wagyu cattle. The present study provides new insights into feed intake patterns of a beef breed for which there are few reports of feeding behavior.
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Affiliation(s)
- M McGee
- Department of Animal and Veterinary Science, University of Idaho, Moscow 83844
| | - J A Ramirez
- Department of Animal Science, Texas A&M University, College Station 77843
| | - G E Carstens
- Department of Animal Science, Texas A&M University, College Station 77843
| | - W J Price
- Statistical Programs, University of Idaho, Moscow 83844
| | - J B Hall
- Nancy M. Cummings Research, Education, and Extension Center, University of Idaho, Carmen 83467
| | - R A Hill
- Department of Animal and Veterinary Science, University of Idaho, Moscow 83844
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Kress JP, Patel SB, Hall JB. Reply: The Importance of Determining the Reason for Intensive Care Unit Delirium. Am J Respir Crit Care Med 2014; 189:1444-5. [DOI: 10.1164/rccm.201404-0637le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Greenberg JA, David MZ, Pitrak DL, Hall JB, Kress JP. Prior infections are associated with increased mortality from subsequent blood-stream infections among patients with hematological malignancies. Eur J Clin Microbiol Infect Dis 2014; 33:1615-21. [PMID: 24791952 DOI: 10.1007/s10096-014-2114-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 04/07/2014] [Indexed: 01/14/2023]
Abstract
Many patients who are evaluated and treated for sepsis have histories of recent infections. The prognostic implications of surviving an infectious process are not well understood. We undertook this study to determine the clinical impact of prior infections among patients with hematological malignancies, a population at high risk for developing and dying from sepsis. The medical records of 203 patients with hematological malignancies and blood-stream infections admitted over a 3-year period to an urban teaching hospital were retrospectively reviewed. The 30-day mortality after blood-stream infection in these high-risk patients was 24 %. There were 46 patients (23 %) who had inpatient infections in the 90 days prior to the index blood-stream infection. History of recent infection portended worse prognosis from blood-stream infection under multivariable analysis [odds ratio (OR) 2.60, p = 0.04, 95 % confidence interval (CI) 1.04-6.47]. There were 86 patients (42 %) who had subsequent infections in the first 90 days after the index blood-stream infection. Patients with subsequent infections had greater mortality during days 91-365 than patients without subsequent infections [hazard ratio (HR) 1.97, p = 0.02, 95 % CI 1.13-3.44]. Recent infections prognosticate worse outcomes from subsequent blood-stream infections for this high-risk population. Further research into the clinical and biochemical reasons for this observation may lead to targets for intervention, and, ultimately, improvements in long-term mortality from sepsis.
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Affiliation(s)
- J A Greenberg
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA,
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Affiliation(s)
- John P Kress
- From the Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago
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Patel SB, Poston JT, Pohlman A, Hall JB, Kress JP. Rapidly Reversible, Sedation-related Delirium versus Persistent Delirium in the Intensive Care Unit. Am J Respir Crit Care Med 2014; 189:658-65. [DOI: 10.1164/rccm.201310-1815oc] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Greenberg JA, David MZ, Hall JB, Kress JP. Immune dysfunction prior to Staphylococcus aureus bacteremia is a determinant of long-term mortality. PLoS One 2014; 9:e88197. [PMID: 24505428 PMCID: PMC3914899 DOI: 10.1371/journal.pone.0088197] [Citation(s) in RCA: 7] [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: 10/31/2013] [Accepted: 01/05/2014] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The clinical implications for patients who survive serious infections are not well understood. It has been hypothesized that the excess mortality for survivors of sepsis observed in epidemiological studies is due to increased vulnerability to subsequent infections. We undertook this study to identify characteristics of patients who are at high risk for death after surviving a common type of blood-stream infection. MATERIALS AND METHODS At a single academic medical center, 237 patients with Staphylococcus aureus bacteremia admitted during a three-year period were retrospectively identified. The primary outcomes were 30-day and 31 to 90-day mortality after the first positive blood culture. The primary predictor variable of interest was clinical immune dysfunction prior to bacteremia. RESULTS The 30-day mortality was not significantly different for patients with and without prior immune dysfunction. However, during days 31 to 90, 11 patients (20%) with prior immune dysfunction compared to 10 patients (8.6%) without prior immune dysfunction died (OR 2.59, 95% CI 1.03-6.53, p = 0.04). In a Cox-proportional hazard model controlling for age, there was a significant association between prior immune dysfunction and greater 31 to 90 day mortality (HR 2.44, 95% CI 1.01-5.90, p = 0.05) and a non-significant trend towards occurrence of subsequent infections and greater 31 to 90 day mortality (HR 2.12, 95% CI 0.89-5.07, p = 0.09). CONCLUSIONS Patients with prior immune dysfunction are at high risk for death 31 to 90 days, but not <30 days, after S. aureus bacteremia. Further investigation is needed to determine if this finding is due to poor prognosis of chronic disease or increased vulnerability to subsequent infections.
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Affiliation(s)
- Jared A. Greenberg
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Michael Z. David
- Section of Infectious Disease and Global Health, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Jesse B. Hall
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - John P. Kress
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
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Gutierrez K, Kasimanickam R, Tibary A, Gay JM, Kastelic JP, Hall JB, Whittier WD. Effect of reproductive tract scoring on reproductive efficiency in beef heifers bred by timed insemination and natural service versus only natural service. Theriogenology 2014; 81:918-24. [PMID: 24560451 DOI: 10.1016/j.theriogenology.2014.01.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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: 04/28/2013] [Revised: 01/03/2014] [Accepted: 01/13/2014] [Indexed: 12/01/2022]
Abstract
The objective was to determine the effects of reproductive tract score (RTS) on reproductive performance in beef heifers bred by timed artificial insemination followed by natural service (AI-NS) or by natural service only (NSO). Angus cross beef heifers (n = 2660) in the AI-NS group were artificially inseminated at a fixed time (5- or 7-day CO-Synch + controlled internal drug release protocol) once, then exposed to bulls 2 weeks later (bull-to-heifer ratio = 1:40-1:50) for the reminder of the 85-day breeding season. Angus cross beef heifers (n = 1381) in NSO group were submitted to bulls (bull-to-heifer ratio = 1:20-1:25) for the entire 85-day breeding season. Heifers were reproductive tract scored from 1 (prepubertal) to 5 (cyclic) 4 weeks before, and were body condition scored (BCS) from 1 (emaciated) to 9 (obese) at the beginning of breeding season. Pregnancy diagnosis was performed 70 days after AI for AI-NS group and 2 months after the end of breeding season for both groups. Heifers in both groups were well managed and of similar age (14.9 ± 0.4 [AI-NS] and 14.7 ± 0.8 [NSO] months). Pregnancy rates (PRs) and number of days to become pregnant were calculated using PROC GLIMMIX and PROC LIFETEST procedures of SAS. Adjusting for BCS (P = 0.07), expressed estrus (P < 0.05), year (P < 0.05), and BCS by year interaction (P < 0.05), the AI-PR was greater for heifers in AI-NS group with higher RTS (P < 0.0001; 40.7%, 48.3%, 57.6%, and 64.6% for RTS of 2 or less, 3, 4, and 5, respectively). Controlling for BCS (P < 0.05), year (P < 0.05) and the breeding season pregnancy rates (BS-PRs) were greater for heifers in the AI-NS group with higher RTS (P < 0.01; 81.2%, 86.5%, 90.4%, and 95.2% for RTS of 2 or less, 3, 4, and 5, respectively). Similarly, adjusting for BCS, year (P < 0.05), the BS-PR was greater for heifers in NSO group with higher RTS (P < 0.01; 79.7%, 84.3%, 88.4%, and 90.2% for RTS of 2 or less, 3, 4, and 5, respectively). Heifers with higher RTS in both groups became pregnant earlier in the breeding season compared with heifers with lower RTS (log-rank statistics: P < 0.0001). Heifers in the AI-NS group become pregnant at a faster rate compared with those in the NSO group (P < 0.01). The BS-PR for heifers with RTS 5 was different between AI-NS and NSO groups (P < 0.0001). In conclusion, the RTS influenced both the number of beef heifers that became pregnant during the breeding season and the time at which they become pregnant. Furthermore, irrespective of RTS, heifers bred by NSO required more time to become pregnant than their counterparts in herds that used timed AI. The application of RTS system is reliant on the use of synchronization protocol. The application of RTS for selection may plausibly remove precocious females with lower RTS. On the contrary, application of RTS would help select heifers that will become pregnant earlier in breeding season.
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Affiliation(s)
- K Gutierrez
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington, USA
| | - R Kasimanickam
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington, USA.
| | - A Tibary
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington, USA
| | - J M Gay
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington, USA
| | - J P Kastelic
- Department of Production Animal Health, University of Calgary, Calgary, Alberta, Canada
| | - J B Hall
- Nancy M Cummings Research, Extension and Education Center, University of Idaho, Carmen, Idaho, USA
| | - W D Whittier
- Department of Large Animal Clinical Sciences, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
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Affiliation(s)
- Jesse B Hall
- Department of Anesthesia & Critical Care and Section of Pulmonary and Critical Care Medicine, Pritzker School of Medicine, The University of Chicago, Chicago, IL.
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Hall JB. Rebuttal from Dr Hall. Chest 2014; 144:1445-1446. [PMID: 24189856 DOI: 10.1378/chest.13-1461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jesse B Hall
- Department of Anesthesia & Critical Care and Section of Pulmonary and Critical Care Medicine, Pritzker School of Medicine, The University of Chicago, Chicago, IL.
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