16 results on '"Cortes-Puch I"'
Search Results
2. Adult Respiratory Distress Syndrome Intervention Dashboard - Using Informatics to Track Evidence-based Metrics and Design Future QI Initiatives
- Author
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Blount, J., primary, Cortes-Puch, I., additional, Liu, A., additional, Fazio, S.A., additional, Myers, S., additional, Sebat, C.M., additional, and Adams, J.Y., additional
- Published
- 2024
- Full Text
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3. Antimicrobial Resistance
- Author
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Taylor, N., Cortés Puch, I., Silvestri, L., Zandstra, D. F., van Saene, H. K. F., van Saene, Hendrick K.F., editor, Silvestri, Luciano, editor, de la Cal, Miguel A., editor, and Gullo, Antonino, editor
- Published
- 2012
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4. ICU Patients Following Transplantation
- Author
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Martinez-Pellus, A., Cortés Puch, I., van Saene, Hendrick K.F., editor, Silvestri, Luciano, editor, de la Cal, Miguel A., editor, and Gullo, Antonino, editor
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- 2012
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5. Development and Results of an EHR-Based Algorithm to Quantify Out-of-Bed ICU Early Mobility Events Over 3-Years at an Academic Medical Center
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Fazio, S.A., primary, Cortes-Puch, I., additional, Taylor, S., additional, Liu, A., additional, Black, H., additional, and Adams, J.Y., additional
- Published
- 2020
- Full Text
- View/download PDF
6. A Machine Learning Classifier for Early Detection of ARDS Using Raw Ventilator Waveform Data
- Author
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Adams, J.Y., primary, Rehm, G.B., additional, Cortes-Puch, I., additional, Kuhn, B.T., additional, Nguyen, J.I., additional, Anderson, N.R., additional, and Chuah, C.-N., additional
- Published
- 2019
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7. Conflicts of interest in the new consensus based definition of sepsis and septic shock (sepsis-3)
- Author
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Barea-Mendoza, J.A., Cortés-Puch, I., and Chico-Fernández, M.
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- 2017
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8. Using the ROX Index to Predict Treatment Outcome for High-Flow Nasal Cannula and/or Noninvasive Ventilation in Patients With COPD Exacerbations.
- Author
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Schaeffer BZ, Fazio SA, Stocking JC, Adams JY, Liu A, Black HB, Harper RW, Cortes-Puch I, Albertson TE, and Kuhn BT
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- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Disease Progression, Intubation, Intratracheal, Oxygen Saturation, Respiration, Artificial, Respiratory Rate, Retrospective Studies, ROC Curve, Treatment Outcome, Cannula, Noninvasive Ventilation methods, Oxygen Inhalation Therapy methods, Predictive Value of Tests, Pulmonary Disease, Chronic Obstructive therapy, Pulmonary Disease, Chronic Obstructive complications, Pulmonary Disease, Chronic Obstructive mortality, Respiratory Insufficiency therapy, Respiratory Insufficiency etiology, Respiratory Insufficiency mortality
- Abstract
Background: The ratio of oxygen saturation index (ROX index; or S
pO /F2 IO /breathing frequency) has been shown to predict risk of intubation after high-flow nasal cannula (HFNC) support among adults with acute hypoxemic respiratory failure primarily due to pneumonia. However, its predictive value for other subtypes of respiratory failure is unknown. This study investigated whether the ROX index predicts liberation from HFNC or noninvasive ventilation (NIV), intubation with mechanical ventilation, or death in adults admitted for respiratory failure due to an exacerbation of COPD., Methods: We performed a retrospective study of 260 adults hospitalized with a COPD exacerbation and treated with HFNC and/or NIV (continuous or bi-level). ROX index scores were collected at treatment initiation and predefined time intervals throughout HFNC and/or NIV treatment or until the subject was intubated or died. A ROX index score of ≥ 4.88 was applied to the cohort to determine if the same score would perform similarly in this different cohort. Accuracy of the ROX index was determined by calculating the area under the receiver operator curve., Results: A total of 47 subjects (18%) required invasive mechanical ventilation or died while on HFNC/NIV. The ROX index at treatment initiation, 1 h, and 6 h demonstrated the best prediction accuracy for avoidance of invasive mechanical ventilation or death (area under the receiver operator curve 0.73 [95% CI 0.66-0.80], 0.72 [95% CI 0.65-0.79], and 0.72 [95% CI 0.63-0.82], respectively). The optimal cutoff value for sensitivity (Sn) and specificity (Sp) was a ROX index score > 6.88 (sensitivity 62%, specificity 57%)., Conclusions: The ROX index applied to adults with COPD exacerbations treated with HFNC and/or NIV required higher scores to achieve similar prediction of low risk of treatment failure when compared to subjects with hypoxemic respiratory failure/pneumonia. ROX scores < 4.88 did not accurately predict intubation or death., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2024 by Daedalus Enterprises.)2 - Published
- 2024
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9. Risks of Restrictive Versus Liberal Red Blood Cell Transfusion Strategies in Patients With Cardiovascular Disease: An Updated Meta-Analysis.
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Applefeld WN, Ford VJ, Cortes-Puch I, Wang J, Sun J, Shields TC, Danner RL, Eichacker PQ, Solomon MA, Klein HG, and Natanson C
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- Humans, Risk Factors, Risk Assessment, Treatment Outcome, Hemorrhage therapy, Clinical Decision-Making, Cardiovascular Diseases diagnosis, Cardiovascular Diseases therapy, Erythrocyte Transfusion adverse effects
- Abstract
Competing Interests: Disclosures None.
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- 2024
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10. Endobronchial Phenylephrine in Airway Bleeding During Bronchoscopy Does not Cause Hypertension: A Retrospective Observational Study.
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Kim J, Phan C, Adams J, Cortes-Puch I, Stocking JC, Liu A, Ren Y, Taylor S, and Yoneda KY
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- Humans, Retrospective Studies, Male, Female, Middle Aged, Aged, Hypertension drug therapy, Blood Pressure drug effects, Phenylephrine administration & dosage, Phenylephrine adverse effects, Bronchoscopy adverse effects, Bronchoscopy methods, Vasoconstrictor Agents administration & dosage, Vasoconstrictor Agents adverse effects
- Abstract
Background: Bleeding is a known complication during bronchoscopy, with increased incidence in patients undergoing a more invasive procedure. Phenylephrine is a potent vasoconstrictor that can control airway bleeding when applied topically and has been used as an alternative to epinephrine. The clinical effects of endobronchial phenylephrine on systemic vasoconstriction have not been clearly evaluated. Here, we compared the effects of endobronchial phenylephrine versus cold saline on systemic blood pressure., Methods: In all, 160 patients who underwent bronchoscopy and received either endobronchial phenylephrine or cold saline from July 1, 2017 to June 30, 2022 were included in this retrospective observational study. Intra-procedural blood pressure absolute and percent changes were measured and compared between the 2 groups., Results: There were no observed statistical differences in blood pressure changes between groups. The median absolute change between the median and the maximum intra-procedural systolic blood pressure in the cold saline group was 29 mm Hg (IQR 19 to 41) compared with 31.8 mm Hg (IQR 18 to 45.5) in the phenylephrine group. The corresponding median percent changes in SBP were 33.6 % (IQR 18.8 to 39.4) and 28% (IQR 16.8 to 43.5) for the cold saline and phenylephrine groups, respectively. Similarly, there were no statistically significant differences in diastolic and mean arterial blood pressure changes between both groups., Conclusions: We found no significant differences in median intra-procedural systemic blood pressure changes comparing patients who received endobronchial cold saline to those receiving phenylephrine. Overall, this argues for the vascular and systemic safety of phenylephrine for airway bleeding as a reasonable alternative to epinephrine., Competing Interests: Disclosure: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
- Full Text
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11. Controls, comparator arms, and designs for critical care comparative effectiveness research: It's complicated.
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Ford VJ, Klein HG, Danner RL, Applefeld WN, Wang J, Cortes-Puch I, Eichacker PQ, and Natanson C
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- Humans, Informed Consent, Research Subjects, Critical Care, Comparative Effectiveness Research, Arm
- Abstract
Background: Comparative effectiveness research is meant to determine which commonly employed medical interventions are most beneficial, least harmful, and/or most costly in a real-world setting. While the objectives for comparative effectiveness research are clear, the field has failed to develop either a uniform definition of comparative effectiveness research or an appropriate set of recommendations to provide standards for the design of critical care comparative effectiveness research trials, spurring controversy in recent years. The insertion of non-representative control and/or comparator arm subjects into critical care comparative effectiveness research trials can threaten trial subjects' safety. Nonetheless, the broader scientific community does not always appreciate the importance of defining and maintaining critical care practices during a trial, especially when vulnerable, critically ill populations are studied. Consequently, critical care comparative effectiveness research trials sometimes lack properly constructed control or active comparator arms altogether and/or suffer from the inclusion of "unusual critical care" that may adversely affect groups enrolled in one or more arms. This oversight has led to critical care comparative effectiveness research trial designs that impair informed consent, confound interpretation of trial results, and increase the risk of harm for trial participants., Methods/examples: We propose a novel approach to performing critical care comparative effectiveness research trials that mandates the documentation of critical care practices prior to trial initiation. We also classify the most common types of critical care comparative effectiveness research trials, as well as the most frequent errors in trial design. We present examples of these design flaws drawn from past and recently published trials as well as examples of trials that avoided those errors. Finally, we summarize strategies employed successfully in well-designed trials, in hopes of suggesting a comprehensive standard for the field., Conclusion: Flawed critical care comparative effectiveness research trial designs can lead to unsound trial conclusions, compromise informed consent, and increase risks to research subjects, undermining the major goal of comparative effectiveness research: to inform current practice. Well-constructed control and comparator arms comprise indispensable elements of critical care comparative effectiveness research trials, key to improving the trials' safety and to generating trial results likely to improve patient outcomes in clinical practice., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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12. Plasma Linoleate Diols Are Potential Biomarkers for Severe COVID-19 Infections.
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McReynolds CB, Cortes-Puch I, Ravindran R, Khan IH, Hammock BG, Shih PB, Hammock BD, and Yang J
- Abstract
Polyunsaturated fatty acids are metabolized into regulatory lipids important for initiating inflammatory responses in the event of disease or injury and for signaling the resolution of inflammation and return to homeostasis. The epoxides of linoleic acid (leukotoxins) regulate skin barrier function, perivascular and alveolar permeability and have been associated with poor outcomes in burn patients and in sepsis. It was later reported that blocking metabolism of leukotoxins into the vicinal diols ameliorated the deleterious effects of leukotoxins, suggesting that the leukotoxin diols are contributing to the toxicity. During quantitative profiling of fatty acid chemical mediators (eicosanoids) in COVID-19 patients, we found increases in the regioisomeric leukotoxin diols in plasma samples of hospitalized patients suffering from severe pulmonary involvement. In rodents these leukotoxin diols cause dramatic vascular permeability and are associated with acute adult respiratory like symptoms. Thus, pathways involved in the biosynthesis and degradation of these regulatory lipids should be investigated in larger biomarker studies to determine their significance in COVID-19 disease. In addition, incorporating diols in plasma multi-omics of patients could illuminate the COVID-19 pathological signature along with other lipid mediators and blood chemistry., Competing Interests: BDH, CM, IC-P, and JY are partly employed by EicOsis, which is developing a potent soluble epoxide hydrolase inhibitor for pain relief. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 McReynolds, Cortes-Puch, Ravindran, Khan, Hammock, Shih, Hammock and Yang.)
- Published
- 2021
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13. Movement to the Clinic of Soluble Epoxide Hydrolase Inhibitor EC5026 as an Analgesic for Neuropathic Pain and for Use as a Nonaddictive Opioid Alternative.
- Author
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Hammock BD, McReynolds CB, Wagner K, Buckpitt A, Cortes-Puch I, Croston G, Lee KSS, Yang J, Schmidt WK, and Hwang SH
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- Analgesics chemistry, Animals, Clinical Trials, Phase I as Topic, Dogs, Endoplasmic Reticulum Stress drug effects, Enzyme Inhibitors chemistry, Horses, Humans, Inflammation drug therapy, Male, Molecular Structure, Phenylurea Compounds chemistry, Rats, Sprague-Dawley, Structure-Activity Relationship, Rats, Analgesics therapeutic use, Enzyme Inhibitors therapeutic use, Epoxide Hydrolases antagonists & inhibitors, Neuralgia drug therapy, Phenylurea Compounds therapeutic use
- Abstract
This report describes the development of an orally active analgesic that resolves inflammation and neuropathic pain without the addictive potential of opioids. EC5026 acts on the cytochrome P450 branch of the arachidonate cascade to stabilize epoxides of polyunsaturated fatty acids (EpFA), which are natural mediators that reduce pain, resolve inflammation, and maintain normal blood pressure. EC5026 is a slow-tight binding transition-state mimic that inhibits the soluble epoxide hydrolase (sEH) at picomolar concentrations. The sEH rapidly degrades EpFA; thus, inhibiting sEH increases EpFA in vivo and confers beneficial effects. This mechanism addresses disease states by shifting endoplasmic reticulum stress from promoting cellular senescence and inflammation toward cell survival and homeostasis. We describe the synthesis and optimization of EC5026 and its development through human Phase 1a trials with no drug-related adverse events. Additionally, we outline fundamental work leading to discovery of the analgesic and inflammation-resolving CYP450 branch of the arachidonate cascade.
- Published
- 2021
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14. Leveraging IoTs and Machine Learning for Patient Diagnosis and Ventilation Management in the Intensive Care Unit.
- Author
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Rehm GB, Woo SH, Chen XL, Kuhn BT, Cortes-Puch I, Anderson NR, Adams JY, and Chuah CN
- Abstract
Future healthcare systems will rely heavily on clinical decision support systems (CDSS) to improve the decision-making processes of clinicians. To explore the design of future CDSS, we developed a research-focused CDSS for the management of patients in the intensive care unit that leverages Internet of Things (IoT) devices capable of collecting streaming physiologic data from ventilators and other medical devices. We then created machine learning (ML) models that could analyze the collected physiologic data to determine if the ventilator was delivering potentially harmful therapy and if a deadly respiratory condition, acute respiratory distress syndrome (ARDS), was present. We also present work to aggregate these models into a mobile application that can provide responsive, real-time alerts of changes in ventilation to providers. As illustrated in the recent COVID-19 pandemic, being able to accurately predict ARDS in newly infected patients can assist in prioritizing care. We show that CDSS may be used to analyze physiologic data for clinical event recognition and automated diagnosis, and we also highlight future research avenues for hospital CDSS.
- Published
- 2020
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15. Catheterization of the carotid artery and jugular vein to perform hemodynamic measures, infusions and blood sampling in a conscious rat model.
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Feng J, Fitz Y, Li Y, Fernandez M, Cortes Puch I, Wang D, Pazniokas S, Bucher B, Cui X, and Solomon SB
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- Animals, Catheterization, Central Venous methods, Hemodynamics, Rats, Blood Specimen Collection methods, Carotid Arteries, Catheterization methods, Jugular Veins
- Abstract
The success of a small animal model to study critical illness is, in part, dependent on the ability of the model to simulate the human condition. Intra-tracheal inoculation of a known amount of bacteria has been successfully used to reproduce the pathogenesis of pneumonia which then develops into sepsis. Monitoring hemodynamic parameters and providing standard clinical treatment including infusion of antibiotics, fluids and drugs to maintain blood pressure is critical to simulate routine supportive care in this model but to do so requires both arterial and venous vascular access. The video details the surgical technique for implanting carotid artery and common jugular vein catheters in an anesthetized rat. Following a 72 hr recovery period, the animals will be re-anesthetized and connected to a tether and swivel setup attached to the rodent housing which connects the implanted catheters to the hemodynamic monitoring system. This setup allows free movement of the rat during the study while continuously monitoring pressures, infusing fluids and drugs (antibiotics, vasopressors) and performing blood sampling.
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- 2015
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16. In vivo reduction of cell-free methemoglobin to oxyhemoglobin results in vasoconstriction in canines.
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Wang D, Piknova B, Solomon SB, Cortes-Puch I, Kern SJ, Sun J, Kanias T, Gladwin MT, Helms C, Kim-Shapiro DB, Schechter AN, and Natanson C
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- Albumins pharmacology, Animals, Blood Pressure drug effects, Dogs, Methemoglobin metabolism, Nitric Oxide metabolism, Oxyhemoglobins metabolism, Random Allocation, Methemoglobin pharmacology, Oxyhemoglobins pharmacology, Vasoconstriction drug effects
- Abstract
Background: Cell-free hemoglobin (Hb) in the vasculature leads to vasoconstriction and injury. Proposed mechanisms have been based on nitric oxide (NO) scavenging by oxyhemoglobin (oxyHb) or processes mediated by oxidative reactions of methemoglobin (metHb). To clarify this, we tested the vascular effect and fate of oxyHb or metHb infusions., Study Design and Methods: Twenty beagles were challenged with 1-hour similar infusions of (200 μmol/L) metHb (n = 5), oxyHb (n = 5), albumin (n = 5), or saline (n = 5). Measurements were taken over 3 hours., Results: Infusions of the two pure Hb species resulted in increases in mean arterial blood pressure (MAP), systemic vascular resistance index, and NO consumption capacity of plasma (all p < 0.05) with the effects of oxyHb being greater than that from metHb (MAP; increase 0 to 3 hr; 27 ± 6% vs. 7 ± 2%, respectively; all p < 0.05). The significant vasoconstrictive response of metHb (vs. albumin and saline controls) was related to in vivo autoreduction of metHb to oxyHb, and the vasoactive Hb species that significantly correlated with MAP was always oxyHb, either from direct infusion or after in vivo reduction from metHb. Clearance of total Hb from plasma was faster after metHb than oxyHb infusion (p < 0.0001)., Conclusion: These findings indicate that greater NO consumption capacity makes oxyHb more vasoactive than metHb. Additionally, metHb is reduced to oxyHb after infusion and cleared faster or is less stable than oxyHb. Although we found no direct evidence that metHb itself is involved in acute vascular effects, in aggregate, these studies suggest that metHb is not inert and its mechanism of vasoconstriction is due to its delayed conversion to oxyHb by plasma-reducing agents., (© 2013 American Association of Blood Banks.)
- Published
- 2013
- Full Text
- View/download PDF
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