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3 results on '"Michael J. Frazer"'

1. Impact of COVID-19 on inpatient clinical emergencies: A single-center experience

Author

Oscar J.L. Mitchell, Stacie Neefe, Jennifer C. Ginestra, Cameron M. Baston, Michael J. Frazer, Steven Gudowski, Jeff Min, Nahreen H. Ahmed, Jose L. Pascual, William D. Schweickert, Brian J. Anderson, George L. Anesi, Scott A. Falk, and Michael G.S. Shashaty

Subjects
Coronavirus, COVID-19, Rapid response team, Medical emergency response team, Clinical emergencies, Patient safety, Specialties of internal medicine, RC581-951
Abstract

Aim: Determine changes in rapid response team (RRT) activations and describe institutional adaptations made during a surge in hospitalizations for coronavirus disease 2019 (COVID-19). Methods: Using prospectively collected data, we compared characteristics of RRT calls at our academic hospital from March 7 through May 31, 2020 (COVID-19 era) versus those from January 1 through March 6, 2020 (pre-COVID-19 era). We used negative binomial regression to test differences in RRT activation rates normalized to floor (non-ICU) inpatient census between pre-COVID-19 and COVID-19 eras, including the sub-era of rapid COVID-19 census surge and plateau (March 28 through May 2, 2020). Results: RRT activations for respiratory distress rose substantially during the rapid COVID-19 surge and plateau (2.38 (95% CI 1.39–3.36) activations per 1000 floor patient-days v. 1.27 (0.82–1.71) during the pre-COVID-19 era; p = 0.02); all-cause RRT rates were not significantly different (5.40 (95% CI 3.94–6.85) v. 4.83 (3.86–5.80) activations per 1000 floor patient-days, respectively; p = 0.52). Throughout the COVID-19 era, respiratory distress accounted for a higher percentage of RRT activations in COVID-19 versus non-COVID-19 patients (57% vs. 28%, respectively; p = 0.001). During the surge, we adapted RRT guidelines to reduce in-room personnel and standardize personal protective equipment based on COVID-19 status and risk to providers, created decision-support pathways for respiratory emergencies that accounted for COVID-19 status uncertainty, and expanded critical care consultative support to floor teams. Conclusion: Increased frequency and complexity of RRT activations for respiratory distress during the COVID-19 surge prompted the creation of clinical tools and strategies that could be applied to other hospitals.

Published
2021
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2. Early Clinical Experience in Using Helmet Continuous Positive Airway Pressure and High-Flow Nasal Cannula in Overweight and Obese Patients With Acute Hypoxemic Respiratory Failure From Coronavirus Disease 2019

Author

Barry D. Fuchs, Timothy G. Gaulton, Michael J. Frazer, Giacomo Bellani, Maurizio Cereda, Giuseppe Foti, Gaulton, T, Bellani, G, Foti, G, Frazer, M, Fuchs, B, and Cereda, M

Subjects
2019-20 coronavirus outbreak, Acute hypoxemic respiratory failure, Coronavirus disease 2019 (COVID-19), business.industry, medicine.medical_treatment, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), acute hypoxemic respiratory failure, noninvasive respiratory support, General Medicine, Overweight, medicine.disease_cause, coronavirus disease 2019, Anesthesia, medicine, Continuous positive airway pressure, medicine.symptom, High flow, business, Nasal cannula, Letter to the Editor
Published
2020

3. Efficacy of Oscillation and Lung Expansion in Reducing Postoperative Pulmonary Complication

Author

Timothy Liesching, Toan T. Huynh, Michael R. Nahouraii, Michael J. Frazer, Yuxiu Lei, Maurizio Cereda, and Gregory B. Diette

Subjects
Lung Diseases, Male, medicine.medical_specialty, medicine.medical_treatment, law.invention, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, law, Internal medicine, medicine, Humans, Hospital Mortality, Prospective Studies, Continuous positive airway pressure, Chest wall oscillation, Prospective cohort study, Aged, Retrospective Studies, Lung, Continuous Positive Airway Pressure, business.industry, Pulmonary Complication, Retrospective cohort study, Length of Stay, Middle Aged, medicine.disease, Intensive care unit, Chest Wall Oscillation, Pneumonia, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Surgery, business
Abstract

Postoperative pulmonary complications (PPCs) cause high morbidity and mortality. Targeted treatment for patients at risk for PPCs can improve outcomes. This multicenter prospective trial examined the impact of oscillation and lung expansion (OLE) therapy, using continuous high-frequency oscillation and continuous positive expiratory pressure on PPCs in high-risk patients.In stage I, CPT and ICD codes were queried for patients (n = 210) undergoing thoracic, upper abdominal, or aortic open procedures at 3 institutions from December 2014 to April 2016. Patients were selected randomly. Age, comorbidities, American Society of Anesthesiologists physical status classification scores, and PPC rates were determined. In stage II, 209 subjects were enrolled prospectively from October 2016 to July 2017 using the same criteria. Stage II subjects received OLE treatment and standard respiratory care. The PPCs rate (prolonged ventilation, high-level respiratory support, pneumonia, ICU readmission) were compared. We also compared ICU length of stay (LOS), hospital LOS, and mortality using t-tests and analysis of covariance. Data are mean ± SD.There were 419 subjects. Stage II patients were older (61.1 ± 13.7 years vs 57.4 ± 15.5 years; p0.05) and had higher American Society of Anesthesiologists scores. Treatment with OLE decreased PPCs from 22.9% (stage I) to 15.8% (stage II) (p0.01 adjusted for age, American Society of Anesthesiologists score, and operation time). Similarly, OLE treatment reduced ventilator time (23.7 ± 107.5 hours to 8.5 ± 27.5 hours; p0.05) and hospital LOS (8.4 ± 7.9 days to 6.8 ± 5.0 days; p0.05). No differences in ICU LOS, pneumonia, or mortality were observed.Aggressive treatment with OLE reduces PPCs and resource use in high-risk surgical patients.

Published
2019
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