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8. Early Post-Hospitalization Hemoglobin Recovery and Clinical Outcomes in Survivors of Critical Illness: A Population-Based Cohort Study.

Author

Warner, Matthew, Hanson, Andrew, Schulte, Phillip, Storlie, Curt, Demuth, Gabriel, Gajic, Ognjen, Kor, Daryl, and Roubinian, Nareg

Subjects
anemia, critical illness, hemoglobin, intensive care, readmission, transfusion, Adult, Aged, Aged, 80 and over, Anemia, Cohort Studies, Critical Illness, Female, Hemoglobins, Hospitalization, Humans, Male, Middle Aged, Survivors, United States
Abstract

Anemia is common during critical illness, is associated with adverse clinical outcomes, and often persists after hospitalization. The goal of this investigation is to assess the relationships between post-hospitalization hemoglobin recovery and clinical outcomes after survival of critical illness. This is a population-based observational study of adults (≥18 years) surviving hospitalization for critical illness between January 1, 2010 and December 31, 2016 in Olmsted County, Minnesota, United States with hemoglobin concentrations and clinical outcomes assessed through one-year post-hospitalization. Multi-state proportional hazards models were utilized to assess the relationships between 1-month post-hospitalization hemoglobin recovery and hospital readmission or death through one-year after discharge. Among 6460 patients that survived hospitalization for critical illness during the study period, 2736 (42%) were alive, not hospitalized, and had available hemoglobin concentrations assessed at 1-month post-index hospitalization. Median (interquartile range) age was 69 (56, 80) years with 54% of male gender. Overall, 86% of patients had anemia at the time of hospital discharge, with median discharge hemoglobin concentrations of 10.2 (9.1, 11.6) g/dL. In adjusted analyses, each 1 g/dL increase in 1-month hemoglobin recovery was associated with decreased instantaneous hazard for hospital readmission (HR 0.87 [95% CI 0.84-0.90]; p

Published
2022

9. The Association of Asthma and Metabolic Dysfunction With Outcomes of Hospitalized Patients With COVID-19

Author

Vukoja, Marija, Tekin, Aysun, Parada, Nereida A., Gray, JaVaughn C., Mallouhi, Alan, Roddy, Tiana, Cartin-Ceba, Rodrigo, Perkins, Nicholas E., Belden, Katherine A., Cheruku, Sreekanth, Kaufman, Margit, Lee Armaignac, Donna, Christie, Amy B., Lal, Amos, Zu, Yuanhao, Kumar, Vishakha, Walkey, Allen, Gajic, Ognjen, Kashyap, Rahul, and Denson, Joshua L.

Published
2024
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11. Pneumomediastinum and pneumothorax in coronavirus disease-2019: Description of a case series and a matched cohort study

Author

Tekin, Aysun, Devarajan, Anusha, Sakata, Kenneth K., Qamar, Shahraz, Sharma, Mayank, Valencia Morales, Diana J., Malinchoc, Michael, Talaei, Fahimeh, Welle, Stephanie, Taji, Jamil, Khosa, Sandeep, Sharma, Nikhil, Brown, Meghan, Lal, Amos, Bansal, Vikas, Khan, Syed Anjum, La Nou, Abigail T., Sanghavi, Devang, Cartin-Ceba, Rodrigo, Kashyap, Rahul, Gajic, Ognjen, Domecq, Juan P., and Azadeh, Natalya

Published
2024
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14. Hospital Variation in Management and Outcomes of Acute Respiratory Distress Syndrome Due to COVID-19.

Author

Johnson, Shelsey W, Garcia, Michael A, Sisson, Emily KQ, Sheldrick, Christopher R, Kumar, Vishakha K, Boman, Karen, Bolesta, Scott, Bansal, Vikas, Lal, Amos, Domecq, JP, Melamed, Roman R, Christie, Amy B, Husain, Abdurrahman, Yus, Santiago, Gajic, Ognjen, Kashyap, Rahul, and Walkey, Allan J

Subjects
COVID-19, Viral Infection and Respiratory Illness Universal Study, acute respiratory distress syndrome, low-tidal-volume ventilation, prone ventilation, severe acute respiratory syndrome coronavirus-2, Rare Diseases, Clinical Research, Lung, Acute Respiratory Distress Syndrome, Management of diseases and conditions, 7.1 Individual care needs, Infection, Good Health and Well Being
Abstract

ObjectivesTo describe hospital variation in use of "guideline-based care" for acute respiratory distress syndrome (ARDS) due to COVID-19.DesignRetrospective, observational study.SettingThe Society of Critical Care Medicine's Discovery Viral Infection and RESPIRATORY ILLNESS UNIVERSAL STUDY COVID-19 REGISTRY.PatientsAdult patients with ARDS due to COVID-19 between February 15, 2020, and April 12, 2021.InterventionsHospital-level use of "guideline-based care" for ARDS including low-tidal-volume ventilation, plateau pressure less than 30 cm H2O, and prone ventilation for a Pao2/Fio2 ratio less than 100.Measurements and main resultsAmong 1,495 adults with COVID-19 ARDS receiving care across 42 hospitals, 50.4% ever received care consistent with ARDS clinical practice guidelines. After adjusting for patient demographics and severity of illness, hospital characteristics, and pandemic timing, hospital of admission contributed to 14% of the risk-adjusted variation in "guideline-based care." A patient treated at a randomly selected hospital with higher use of guideline-based care had a median odds ratio of 2.0 (95% CI, 1.1-3.4) for receipt of "guideline-based care" compared with a patient receiving treatment at a randomly selected hospital with low use of recommended therapies. Median-adjusted inhospital mortality was 53% (interquartile range, 47-62%), with a nonsignificantly decreased risk of mortality for patients admitted to hospitals in the highest use "guideline-based care" quartile (49%) compared with the lowest use quartile (60%) (odds ratio, 0.7; 95% CI, 0.3-1.9; p = 0.49).ConclusionsDuring the first year of the COVID-19 pandemic, only half of patients received "guideline-based care" for ARDS management, with wide practice variation across hospitals. Strategies that improve adherence to recommended ARDS management strategies are needed.

Published
2022

17. Variation in Sedative and Analgesic Use During the COVID-19 Pandemic and Associated Outcomes

Author

Mesland, Jean-Baptiste, Henin, Pierre, Petre, Hélène, Buelens, Isabelle, Gerard, Anne-Catherine, Markotić, Dragana, Bošnjak, Ivana, Garza, Ruben, Chu, Eric, Chan, Victoria, Gavidia, Oscar Y., Pachon, Felipe, El Kassas, Mohamed, Tawheed, Ahmed, Matsuda, Wataru, Itagaki, Yuki, Kodate, Akira, Suzuki, Reina, Takahashi, Yuki, Moriki, Koyo, Amer, Marwa Ridha, Bawazeer, Mohammed Abdullah, Dahhan, Talal I., Kseibi, Eiad, Butt, Abid Shahzad, Khurshid, Syed Moazzum, Rabee, Muath, Abujazar, Mohammed, Alghunaim, Razan, Abualkhair, Maal, AlFirm, Abeer Turki, Almazyad, Mohammed A., Alarifi, Mohammed I., Macarambon, Jara M., Bukhari, Ahmad Abdullah, Albahrani, Hussain A., Asfina, Kazi N., Aldossary, Kaltham M., Bojicic, Jovana, Kovacevic, Bojan, Predrag, Stevanovic, Stojakov, Dejan S., Ignjatovic, Duska K., Bojic, Suzana C., Bobos, Marina M., Nenadic, Irina B., Zaric, Milica S., Djuric, Marko D., Djukic, Vladimir R., Teruel, Santiago Y., Martin, Belen C., Kharbanda, Anmol, Jhajhria, Sunil, Fyffe, Zachary, Capizzi, Stephen, Alicie, Bethany, Green, Martha, Crockarell, Lori, Drennan, Amelia, Dubuque, Kathleen, Fambrough, Tonya, Gasaway, Nikole, Krantz, Briana, Nebi, Peiman, Orga, Jan, Serfass, Margaret, Simion, Alina, Warren, Kimberly, Wheeler, Cassie, Woolman, C.J., Christie, Amy B., Ashley, Dennis W., Adiga, Rajani, Newsome, Andrea Sikora, Forehand, Christy C., Bruning, Rebecca, Jones, Timothy W., Walkey, Allan J., Waikar, Sushrut S., Garcia, Michael A., Colona, Mia, Kibbelaar, Zoe, Leong, Michael, Wallman, Daniel, Soni, Kanupriya, Maccarone, Jennifer, Gilman, Joshua, Devis, Ycar, Chung, Joseph, Paracha, Munizay, Lumelsky, David N., DiLorenzo, Madeline, Abdurrahman, Najla, Johnson, Shelsey, Tirupathi, Raghavendra, Tang, Alymer, Safi, Arshad, Green, Cindy, Newell, Jackie, Ramani, Naga, Ganti, Bhavani Harika, Daugherty, Steven K., Atkinson, Sam, Shrimpton, Kelly, Smalls, Norma, Reilkoff, Ronald A., Heneghan, Julia A., Eichen, Sarah, Goertzen, Lexie, Rajala, Scott, Feussom, Ghislaine, Tang, Ben, Cartin-Ceba, Rodrigo, Sen, Ayan, Talaei, Fahimeh, Kashyap, Rahul, Domecq, Juan Pablo, Gajic, Ognjen, Bansal, Vikas, Tekin, Aysun, Lal, Amos, O'Horo, John C., Deo, Neha N., Sharma, Mayank, Qamar, Shahraz, Singh, Romil, Valencia Morales, Diana J., Sharma, Nikhil, Khan, Syed Anjum, Jain, Nitesh Kumar, Koritala, Thoyaja, Khedr, Anwar M., Mushtaq, Hisham A., Jama, Abbas B., Venkata, Chakradhar, Engemann, Miriam, Mantese, Annamarie, Aulakh, Bhagat S., Tripathi, Sandeep, Bandy, Jennifer A., Kreps, Lisa M., Bollinger, Dawn R., Stienecker, Roger Scott, Melendez, Andre G., Brunner, Tressa A., Budzon, Sue M., Heffernan, Jessica L., Souder, Janelle M., Miller, Tracy L., Maisonneuve, Andrea G., Vilella, Antonia L., Kutner, Sara B., Clark, Kacie, Moore, Danielle, Zaren, Howard A., Smith, Stephanie J., Lewis, Grant C., Seames, Lauren, Farlow, Cheryl, Miller, Judy, Broadstreet, Gloria, Martinez, Anthony, Allison, Micheal, Mittal, Aniket, Ruiz, Rafael, Skaanland, Aleta, Ross, Robert, Bernstein, Michael A., Goff, Ian K., Naftilan, Matthew, Mathew, Amal, Williams, Deborah, Murdock, Sue, Ducey, Maryanne, Nelson, Kerianne, Gupta, Neha, Jones, Tracy L., Ayers, Shonda C., Harrell, Amy B., Brown, Brent R., Malone, Kassidy, Sinko, Lauren A., Settle, Lisa M., Sears, Taylor J., McGonagill, Patrick W., Galet, Colette, Hubbard, Janice, Wang, David, Allan, Lauren, Badheka, Aditya, Chegondi, Madhuradhar, Stapleton, Renee D., Dixon, Anne E., Johnson, Olivia, Ardren, Sara S., Burns, Stephanie, Raymond, Anna, Gonyaw, Erika, Hodgdon, Kevin, Housenger, Chloe, Lin, Benjamin, McQuesten, Karen, Pecott-Grimm, Heidi, Sweet, Julie, Ventrone, Sebastian, Khanna, Ashish K., Harris, Lynnette, Cusson, Bruce, Reeves, Brandon, Fanelli, Jessica, Disher, Nataya, Samant, Anusha, DeGroot, Chritian, Youshock, Evan, Ligon, R. Miller, McCartney, Katherine, Garcia, Julio, Iloabachie, Chidi, Flores, Kelsey, VanEenenaam, David, Sands, Lauren, Robinson, Samuel, Sweatt, Nia, Fowler, Jacob, Fram, Madeline, Howard, Easton, Johnson, Kathleen, Udoh, Imoh, Nosow, Lillian, Howard, Lucy Winesett, Minh Pham, Quan Duc, Irfanullah, Aman, Ong, Tiffany, Enwezor, Chukwunyelu Henry, Dabagian, Hannah, Mendoza, Rafael, Rucci, Justin M., Law, Anica C., Bolesta, Scott, Quinn, Emily K., Boman, Karen, Yus, Santiago, Goodspeed, Valerie M., and Kumar, Vishakha

Published
2024
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19. Challenges, obstacles, and unknowns in implementing principles of modern intensive care medicine in low-resource settings: an insider's perspective

Author

Kovacevic, Pedja, Meyer, F. Joachim, and Gajic, Ognjen

Subjects
Evidence-based medicine
Abstract

Author(s): Pedja Kovacevic [sup.1] [sup.2], F. Joachim Meyer [sup.3], Ognjen Gajic [sup.4] Author Affiliations: (1) grid.461884.7, Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, , dvanaest [...]

Published
2024
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21. Variation in Early Management Practices in Moderate-to-Severe ARDS in the United States The Severe ARDS: Generating Evidence Study

Author

Qadir, Nida, Bartz, Raquel R, Cooter, Mary L, Hough, Catherine L, Lanspa, Michael J, Banner-Goodspeed, Valerie M, Chen, Jen-Ting, Giovanni, Shewit, Gomaa, Dina, Sjoding, Michael W, Hajizadeh, Negin, Komisarow, Jordan, Duggal, Abhijit, Khanna, Ashish K, Kashyap, Rahul, Khan, Akram, Chang, Steven Y, Tonna, Joseph E, Anderson, Harry L, Liebler, Janice M, Mosier, Jarrod M, Morris, Peter E, Genthon, Alissa, Louh, Irene K, Tidswell, Mark, Stephens, R Scott, Esper, Annette M, Dries, David J, Martinez, Anthony, Schreyer, Kraftin E, Bender, William, Tiwari, Anupama, Guru, Pramod K, Hanna, Sinan, Gong, Michelle N, Park, Pauline K, Investigators, the Severe ARDS Generating Evidence Study, Steingrub, Jay S, Brierley, Kristin, Larson, Julia L, Mueller, Ariel, Pinkhasova, Tereza, Talmor, Daniel, Aisiku, Imoigele, Baron, Rebecca, Fredenburgh, Lauren, Hou, Peter, Massaro, Anthony, Seethala, Raghu, Hite, Duncan, Brodie, Daniel, Short, Briana, Bartz, Raquel, Komisarow, Jordan C, Blum, James, Esper, Annette, Martin, Greg S, Bulger, Eileen, Ungar, Anna, Brown, Samuel M, Grissom, Colin K, Hirshberg, Eliotte L, Peltan, Ithan D, Brower, Roy G, Sahetya, Sarina K, Bohman, John K, Coville, Hongchuan, Gajic, Ognjen, O’Horo, John C, Ataucuri-Vargas, Jorge-Bleik, Mastroianni, Fiore, Hirsch, Jamie, Qui, Michael, Stewart, Molly, Haq, Ebaad, Kamel, Makrina, Krol, Olivia, Lerner, Kimberly, Marini, John, and Amaral, Valentina Chiara Bistolfi

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Patient Safety, Rare Diseases, Acute Respiratory Distress Syndrome, Lung, Good Health and Well Being, Adult, Aged, Cohort Studies, Early Medical Intervention, Extracorporeal Membrane Oxygenation, Female, Glucocorticoids, Guideline Adherence, Hospital Mortality, Humans, Male, Middle Aged, Neuromuscular Blockade, Patient Positioning, Positive-Pressure Respiration, Practice Guidelines as Topic, Practice Patterns, Physicians', Prone Position, Quality of Health Care, Respiration, Artificial, Respiratory Distress Syndrome, Severity of Illness Index, United States, Vasodilator Agents, Ventilator-Induced Lung Injury, ARDS, corticosteroids, extracorporeal membrane oxygenation, mechanical ventilation, neuromuscular blockade, prone positioning, Severe ARDS: Generating Evidence (SAGE) Study Investigators, Society of Critical Care Medicine's Discovery Network, Respiratory System, Cardiovascular medicine and haematology, Clinical sciences
Abstract

BackgroundAlthough specific interventions previously demonstrated benefit in patients with ARDS, use of these interventions is inconsistent, and patient mortality remains high. The impact of variability in center management practices on ARDS mortality rates remains unknown.Research questionWhat is the impact of treatment variability on mortality in patients with moderate to severe ARDS in the United States?Study design and methodsWe conducted a multicenter, observational cohort study of mechanically ventilated adults with ARDS and Pao2 to Fio2 ratio of ≤ 150 with positive end-expiratory pressure of ≥ 5 cm H2O, who were admitted to 29 US centers between October 1, 2016, and April 30, 2017. The primary outcome was 28-day in-hospital mortality. Center variation in ventilator management, adjunctive therapy use, and mortality also were assessed.ResultsA total of 2,466 patients were enrolled. Median baseline Pao2 to Fio2 ratio was 105 (interquartile range, 78.0-129.0). In-hospital 28-day mortality was 40.7%. Initial adherence to lung protective ventilation (LPV; tidal volume, ≤ 6.5 mL/kg predicted body weight; plateau pressure, or when unavailable, peak inspiratory pressure, ≤ 30 mm H2O) was 31.4% and varied between centers (0%-65%), as did rates of adjunctive therapy use (27.1%-96.4%), methods used (neuromuscular blockade, prone positioning, systemic steroids, pulmonary vasodilators, and extracorporeal support), and mortality (16.7%-73.3%). Center standardized mortality ratios (SMRs), calculated using baseline patient-level characteristics to derive expected mortality rate, ranged from 0.33 to 1.98. Of the treatment-level factors explored, only center adherence to early LPV was correlated with SMR.InterpretationSubstantial center-to-center variability exists in ARDS management, suggesting that further opportunities for improving ARDS outcomes exist. Early adherence to LPV was associated with lower center mortality and may be a surrogate for overall quality of care processes. Future collaboration is needed to identify additional treatment-level factors influencing center-level outcomes.Trial registryClinicalTrials.gov; No.: NCT03021824; URL: www.clinicaltrials.gov.

Published
2021

30. Development and Validation of an Acute Respiratory Distress Syndrome Prediction Model in Coronavirus Disease 2019: Updated Lung Injury Prediction Score

Author

Tekin, Aysun, Qamar, Shahraz, Sharma, Mayank, Singh, Romil, Malinchoc, Michael, Bansal, Vikas, Deo, Neha, Bogojevic, Marija, Valencia-Morales, Diana J., Zec, Simon, Zorko-Garbajs, Nika, Sharma, Nikhil, Lal, Amos, Sanghavi, Devang K., Cartin-Ceba, Rodrigo, Khan, Syed A., La Nou, Abigail T., Cherian, Anusha, Zabolotskikh, Igor B., Kumar, Vishakha K., Kashyap, Rahul, Walkey, Allan J., Domecq, Juan P., Yadav, Hemang, Gajic, Ognjen, and Odeyemi, Yewande E.

Published
2023
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35. Pre-hospital Aspirin Use and Patient Outcomes in COVID-19: Results from the International Viral Infection and Respiratory Illness Universal Study (VIRUS)

Author

Lal, Amos, Garces, Juan Pablo Domecq, Bansal, Vikas, Tekin, Aysun, Zec, Simon, Khanna, Ashish K., Warner, Matthew A., Christie, Amy B., Cartin-Ceba, Rodrigo, Banner-Goodspeed, Valerie M., Armaignac, Donna Lee, Cheruku, Sreekanth R., Raju, Umamaheswara, Tarabichi, Yasir, Denson, Joshua L., Kumar, Vishakha, Walkey, Allan, Boman, Karen, Deo, Neha, Kashyap, Rahul, and Gajic, Ognjen

Published
2022
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36. Admission Code Status and End-of-life Care for Hospitalized Patients With COVID-19

Author

Kiker, Whitney A, Cheng, Si, Pollack, Lauren R, Creutzfeldt, Claire J, Kross, Erin K, Curtis, J Randall, Belden, Katherine A, Melamed, Roman, Armaignac, Donna Lee, Heavner, Smith F, Christie, Amy B, Banner-Goodspeed, Valerie M, Khanna, Ashish K, Sili, Uluhan, Anderson, Harry L, III, Kumar, Vishakha, Walkey, Allan, Kashyap, Rahul, Gajic, Ognjen, Domecq, Juan Pablo, and Khandelwal, Nita

Published
2022
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40. Implementation of a Virtual Interprofessional ICU Learning Collaborative: Successes, Challenges, and Initial Reactions From the Structured Team-Based Optimal Patient-Centered Care for Virus COVID-19 Collaborators

Author

Zec, Simon, Zorko Garbajs, Nika, Dong, Yue, Gajic, Ognjen, Kordik, Christina, Harmon, Lori, Bogojevic, Marija, Singh, Romil, Sun, Yuqiang, Bansal, Vikas, Vu, Linh, Cawcutt, Kelly, Litell, John M., Redmond, Sarah, Fitzpatrick, Eleanor, Kooda, Kirstin J., Biehl, Michelle, Dangayach, Neha S., Kaul, Viren, Chae, June M., Leppin, Aaron, Siuba, Mathew, Kashyap, Rahul, Walkey, Allan J., Niven, Alexander S., Martinez, Anthony, Meadows, Dean, Stinnett, Helen, Allison, Michael, Adeyemi, Olubukola, Herbert, Terry, Weinhouse, Gerald L., Patil, Namrata, Hacobian, Gaspar, Rangelov, Kamen, Parker, Jillian, Smith, Michael P., Smith, Rachel, Deery, Eliza, Harper, Andrea, Davis, Emily, Arteaga, Grace M., Fleegel, Jennifer L., Duncan, Julie M., Graner, Kevin K., Schultz, Tammy J., Giri, Abhishek, Gill, Ashley, Mielke, Catherine L., Sanghavi, Devang, Clark, Jonathan K., Shimp, Julie, Marshall, Lisa, Spiros, Michael, Kaur, Nirmaljot, Kiley, Sean P., Yarrarapu, Siva Naga, Keister, Teresa, Stroope, Gage, Stark, Jackie, Poehler, Jessica, Pablo, Juan, Garces, Domecq, Jain, Nitesh Kumar, Khan, Syed Anjum, Koritala, Thoyaja, La Nou, Abigail, Hall, Christina, Christensen, Cindy, Holbrook, Kirsten, Toufar, Sara, Normand, Sarah, Spitzner, Amy, Quinn, Carissa, Xia, Christina, Behrns, Holly D., Barreto, Erin, Elmer, Jennifer, Chalmers, Sarah, Cooper, Macy, Harthan, Aaron, Martinez, Edmundo A., Bandy, Jennifer A., Sanford, John, Guiliani, Jackie A., Kupferschmid, Megan, Pariyadath, Anand, Vitielliss, Brandy, Temas, Daniel, Heavner, Smith F., Frary, Amanda, Akhter, Murtaza, Rahman, Rania, Mulrow, Mary, Cooper, Tracy, Litell, John M., Chae, June Mee, Cawcutt, Kelly, Kooda, Kirstin J., Biehl, Michelle, Dangayach, Neha S., Redmond, Sarah, Kaul, Viren, Siuba, Matthew, Holley, Aaron B., Kon, Alexander A., Avadhani, Amita, Dzierba, Amy L., Kalil, Andre C., Cawcutt, Kelly, DePriest, Ashley D., Peters, Bradley, Pun, Brenda T., Bennett, Courtney E., Kriner, Eric, DeMartino, Erin S., Strong, Erin, Netzer, Giora, Martin, Greg S., Zimmerman, Jerry J., Taylor, Julia, Korzick, Karen A., Fischkoff, Katherine, Kaplan, Lewis J., Ostermann, Marlies, Gaeta, Mary Susan, Marshall, Mary Faith, Ahmed, Nahreen, Nyquist, Paul Alan, Nawathe, Pooja A., John, Preeti R., and Syed, Uzma

Published
2023
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42. SARS-CoV-2 infection increases risk of acute kidney injury in a bimodal age distribution

Author

Bjornstad, Erica C., Cutter, Gary, Guru, Pramod, Menon, Shina, Aldana, Isabella, House, Scott, M. Tofil, Nancy, St. Hill, Catherine A., Tarabichi, Yasir, Banner-Goodspeed, Valerie M., Christie, Amy B., Mohan, Surapaneni Krishna, Sanghavi, Devang, Mosier, Jarrod M., Vadgaonkar, Girish, Walkey, Allan J., Kashyap, Rahul, Kumar, Vishakha K., Bansal, Vikas, Boman, Karen, Sharma, Mayank, Bogojevic, Marija, Deo, Neha, Retford, Lynn, Gajic, Ognjen, and Gist, Katja M.

Published
2022
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47. Variation in Early Management Practices in Moderate-to-Severe ARDS in the United States: The Severe ARDS: Generating Evidence Study

Author

Steingrub, Jay S., Tidswell, Mark, Banner-Goodspeed, Valerie M., Brierley, Kristin, Larson, Julia L., Mueller, Ariel, Pinkhasova, Tereza, Talmor, Daniel, Aisiku, Imoigele, Baron, Rebecca, Fredenburgh, Lauren, Genthon, Alissa, Hou, Peter, Massaro, Anthony, Seethala, Raghu, Duggal, Abhijit, Hite, Duncan, Khanna, Ashish K., Brodie, Daniel, Louh, Irene K., Short, Briana, Bartz, Raquel, Cooter, Mary L., Komisarow, Jordan C., Tiwari, Anupama, Bender, William, Blum, James, Esper, Annette, Martin, Greg S., Bulger, Eileen, Hough, Catherine L., Ungar, Anna, Brown, Samuel M., Grissom, Colin K., Hirshberg, Eliotte L., Lanspa, Michael J., Peltan, Ithan D., Brower, Roy G., Sahetya, Sarina K., Stephens, R Scott, Guru, Pramod K., Bohman, John K., Coville, Hongchuan, Gajic, Ognjen, Kashyap, Rahul, O’Horo, John C., Ataucuri-Vargas, Jorge-Bleik, Chen, Jen-Ting, Gong, Michelle N., Mastroianni, Fiore, Hajizadeh, Negin, Hirsch, Jamie, Qui, Michael, Stewart, Molly, Khan, Akram, Haq, Ebaad, Kamel, Makrina, Krol, Olivia, Lerner, Kimberly, Dries, David J., Marini, John, Bistolfi Amaral, Valentina Chiara, Martinez, Anthony, Anderson, Harry L., III, Brown, Jill, Brozik, Michael, Kemmer, Heidi, Obear, Janet, Gentile, Nina, Shreyer, Kraftin E., Cairns, Charles, Hypes, Cameron, Malo, Josh, Mosier, Jarrod, Natt, Bhupinder, Chang, Steven Y., Hu, Scott, Mehta, Ishan, Qadir, Nida, Branson, Richard, Gomaa, Dina, Tsuei, Betty, Dhar, Sanjay, Montgomery-Yates, Ashley, Morris, Peter, Chen, Tina, Hanna, Sinan, Park, Pauline K., Sjoding, Michael W., Chang, Alfredo Lee, Cobb, Perren, Liebler, Janice M., Harris, Estelle, Hatton, Nate, Lewis, Gia, McKellar, Stephen, Raman, Sanjeev, Tonna, Joseph, Caldwell, Ellen, Dean, Sarah, Giovanni, Shewit, Bartz, Raquel R., Komisarow, Jordan, Tonna, Joseph E., Mosier, Jarrod M., Morris, Peter E., Stephens, R. Scott, Esper, Annette M., and Schreyer, Kraftin E.

Published
2021
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48. Timing of ARDS Resolution (TARU): A Pragmatic Clinical Assessment of ARDS Resolution in the ICU

Author

Chalmers, Sarah J., Lal, Amos, Gajic, Ognjen, and Kashyap, Rahul

Subjects
Medical research -- Health aspects, Medicine, Experimental -- Health aspects, Mortality -- Minnesota -- United Kingdom, Medical records -- Health aspects, Electronic records -- Health aspects, Blood gases -- Analysis, Health
Abstract

Purpose Lack of a pragmatic outcome measures for acute respiratory distress syndrome (ARDS) resolution is a barrier to meaningful interventional trials of novel treatments. We evaluated a pragmatic, electronic health record (EHR)-based approach toward the clinical assessment of a novel outcome measure: ICU ARDS resolution. Methods We conducted a retrospective observational cohort study evaluating adult patients with moderate-severe ARDS admitted to the medical intensive care unit (ICU) at Mayo Clinic in Rochester, MN, from January 2001 through December 2010. We compared the association of ICU ARDS resolution vs non-resolution with mortality. ICU ARDS resolution was defined as improvement in P/F > 200 for at least 48 h or (if arterial blood gas unavailable) SpO.sub.2:FiO.sub.2 (S/F) > 235, or discharge prior to 48 h from first P/F > 200 without subsequent decline in P/F, as documented in EHR. Results Of the 254 patients included, ICU ARDS resolution was achieved in 179 (70%). Hospital mortality was lower in patients who met ICU ARDS resolution criteria as compared to those who did not (23% vs. 41%, p < 0.01). After adjusting for age, gender, and illness severity, the patients who met ICU ARDS resolution criteria had lower odds of hospital mortality [odds ratio 0.47, 95% CI 0.25-0.86; p = 0.015]. Conclusion The electronic health record-based pragmatic measure of ICU ARDS resolution is associated with patient outcomes and may serve as an intermediate outcome assessing novel mechanistic treatments., Author(s): Sarah J. Chalmers [sup.1] [sup.2] [sup.4], Amos Lal [sup.1] [sup.2], Ognjen Gajic [sup.1] [sup.2], Rahul Kashyap [sup.1] [sup.3] Author Affiliations: (1) grid.66875.3a, 0000 0004 0459 167X, Multidisciplinary Epidemiology and [...]

Published
2021
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49. Differentiating pulmonary transfusion reactions using recipient and transfusion factors.

Author

Roubinian, Nareg H, Looney, Mark R, Keating, Sheila, Kor, Daryl J, Lowell, Clifford A, Gajic, Ognjen, Hubmayr, Rolf, Gropper, Michael, Koenigsberg, Monique, Wilson, Gregory A, A Matthay, Michael, Toy, Pearl, Murphy, Edward L, and TRALI Study Group

Subjects
TRALI Study Group, Humans, Natriuretic Peptide, Brain, Logistic Models, Adult, Aged, Middle Aged, Female, Male, Acute Lung Injury, Transfusion Reaction, Rare Diseases, Lung, Acute Respiratory Distress Syndrome, Clinical Research, Prevention, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Immunology, Cardiovascular System & Hematology
Abstract

BackgroundIt is increasingly recognized that recipient risk factors play a prominent role in possible transfusion-related acute lung injury (pTRALI) and transfusion-associated circulatory overload (TACO). We hypothesized that both transfusion and recipient factors including natriuretic peptides could be used to distinguish TRALI from TACO and pTRALI.Study design and methodsWe performed a post hoc analysis of a case-control study of pulmonary transfusion reactions conducted at the University of California at San Francisco and Mayo Clinic, Rochester. We evaluated clinical data and brain natriuretic peptides (BNP) levels drawn after transfusion in patients with TRALI (n = 21), pTRALI (n = 26), TACO (n = 22), and controls (n = 24). Logistic regression and receiver operating characteristics curve analyses were used to determine the accuracy of clinical and biomarker predictors in differentiating TRALI from TACO and pTRALI.ResultsWe found that pTRALI and TACO were associated with older age, higher fluid balance, and elevated BNP levels relative to those of controls and TRALI. The following variables were useful in distinguishing cases of pTRALI and TACO from TRALI: age more than 70 years, BNP levels more than 1000 pg/mL, 24-hour fluid balance of more than 3 L, and a lower number of transfused blood components. Using the above variables, our logistic model had a 91% negative predictive value in the differential diagnosis of TRALI.ConclusionsModels incorporating readily available clinical and biomarker data can be used to differentiate transfusion-related respiratory complications. Additional studies examining recipient risk factors and the likelihood of TRALI may be useful in decision making regarding donor white blood cell antibody testing.

Published
2017

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