Critical Care Commons^™

Early Intervention (Mobilization Or Active Exercise) For Critically Ill Patients In The Intensive Care Unit (Protocol), Katherine Doiron, Tammy Hoffmann, Elaine Beller

Elaine Beller

No abstract provided.

Compliance With Continuous Positive Airway Pressure (Cpap) Therapy For Obstructive Sleep Apnea Among Privately Paying Patients- A Cross Sectional Study, Syed Fayyaz Hussain, Muhammad Irfan, Zeeshan Waheed, Naveen Alam, Saba Mansoor, Muhammad Islam

Section of Pulmonary & Critical Care

Background: To evaluate the compliance, benefits and side effects associated with continuous positive airway pressure (CPAP) therapy among Pakistani patients treated for obstructive sleep apnea (OSA) in private sector.Methods: Patients diagnosed to have OSA based on overnight study who were recommended for CPAP therapy, between 1998 and 2003, were evaluated by telephonic survey and review of hospital notes. Compliance, benefits and side effects associated with CPAP therapy were assessed.Results: Out of 135 patients who were prescribed CPAP therapy, 75 could be contacted. Sixty (80%) started using CPAP within one month of diagnosis and 46 (61%) continued to use it long-term …

Efficacy Of Nasal Mometasone For The Treatment Of Chronic Sinonasal Disease In Patients With Inadequately Controlled Asthma, A. E. Dixon, M. Castro, R. I. Cohen, L. B. Gerald, J. T. Holbrook, C. G. Irvin, S. Mohapatra, S. P. Peters, S. Rayapudi, E. A. Sugar, R. A. Wise

Journal Articles

BACKGROUND: Chronic sinonasal disease is common in asthmatic patients and associated with poor asthma control; however, there are no long-term trials addressing whether chronic treatment of sinonasal disease improves asthma control. OBJECTIVE: We sought to determine whether treatment of chronic sinonasal disease with nasal corticosteroids improves asthma control, as measured by the Childhood Asthma Control Test and Asthma Control Test in children and adults, respectively. METHODS: A 24-week multicenter, randomized, placebo-controlled, double-blind trial of placebo versus nasal mometasone in adults and children with inadequately controlled asthma was performed. Treatments were randomly assigned, with concealment of allocation. RESULTS: Two hundred thirty-seven …

Ulinastatin Activates Haem Oxygenase 1 Antioxidant Pathway And Attenuates Allergic Inflammation, D. M. Song, G. Song, Y. H. Niu, W. Song, J. T. Wang, L. Yu, J. W. Yang, H. Steinberg, S. F. Liu, B. S. Wang, +1 Additional Author

Journal Articles

Background and PurposeUlinastatin (UTI), a serine protease inhibitor, was recently found to have an anti-inflammatory action. However, the mechanisms mediating this anti-inflammatory effect are not well understood. This study tested the hypothesis that UTI suppresses allergic inflammation by inducing the expression of haem oxygenase 1 (HO1). Experimental ApproachControl mice and mice sensitized (on days 1, 9 and 14) and challenged (on days 21 to 27) with ovalbumin (OVA) were treated with UTI. The effects of UTI on basal expression of HO1 and that induced by OVA challenge were examined. The involvement of UTI-induced HO1 expression in anti-inflammatory and antioxidant effects …

An Obligatory Role Of Nf-Kappa B In Mediating Bone Marrow Derived Endothelial Progenitor Cell Recruitment And Proliferation Following Endotoxemic Multiple Organ Injury In Mice, S. Z. Mao, X. B. Ye, G. Liu, D. M. Song, S. F. Liu

Journal Articles

Background: Recruitment of bone marrow derived endothelial progenitor cells (BMDEPCs) alleviates multiple organ injury (MOI) and improves outcomes. However, mechanisms mediating BMDEPC recruitment following septic MOI remain largely unknown. This study characterized the kinetics of BMDEPC recruitment and proliferation and defined the role of NF-kappa B in regulating BMDEPC recruitment and proliferation. Methods and Main Findings: Chimeric mice with an intact or disrupted NF-kappa B p50 gene and BMDEPC-restricted expression of green fluorescent protein were created and injected with LPS (2 mg/kg, i.p.). BMDEPC recruitment and proliferation in multiple organs were quantified. BMDEPC recruitment and proliferation are highly organ-dependent. Lungs …

Effects Of Pulmonary Rehabilitation On Fatigue Severity Scale In Patients With Lung Disease, A. Talwar, S. Sahni, S. John, S. Verma, J. Cardenas-Garcia, N. Kohn

Journal Articles

INTRODUCTION: Fatigue is a known symptom of advanced lung disease and impacts quality of life and psychological health. Many of these patients undergo pulmonary rehabilitation as part of their therapy. Understanding the effect of pulmonary rehabilitation on fatigue in these patients is important, as one may be able to design more focused rehabilitation programs. The aim of this study is to evaluate the effect of pulmonary rehabilitation on fatigue as measured by the Fatigue Severity Scale (FSS) in patients with advanced lung disease. MATERIAL AND METHODS: Patients were enrolled in a standardized 6 week pulmonary rehabilitation program. They were asked …

Resolution Of Severe Obstructive Sleep Apnea After Treatment Of Anti-Muscle Kinase Receptor-Positive Myasthenia Gravis Despite 60-Pound Weight Gain, M. Morgenstern, E. Singas, B. Zleik, H. Greenberg

Journal Articles

Obstructive sleep apnea (OSA) in patients with myasthenia gravis (MG) may be caused by reduced pharyngeal dilator muscle activity. We report a patient with anti-muscle kinase receptor MG with severe OSA and hypoventilation that resolved upon successful treatment of MG despite a 60-lb weight gain.

Depression In Pulmonary Arterial Hypertension And Interstitial Lung Diseases, S. Verma, J. Cardenas-Garcia, P. R. Mohapatra, A. Talwar

Journal Articles

Advanced lung diseases such as pulmonary arterial hypertension (PAH) and interstitial lung diseases (ILD) are chronic diseases that cause significantly high morbidity and mortality. As a result, patients can undergo some psychological changes leading to a poor quality of life and depression. Diagnosis of depression is often obscured because fatigue and apathy, two common symptoms of depression, frequently overlap with PAH and ILD. Healthcare providers are sometimes reluctant to ask or mistakenly believe that these symptoms are part of the ongoing disease process, rather than a serious condition like depression. Screening tools are available for physicians to be well positioned …

What Happens To Patients With Copd With Long-Term Oxygen Treatment Who Receive Mechanical Ventilation For Copd Exacerbation? A 1-Year Retrospective Follow-Up Study, N. Hajizadeh, K. Goldfeld, K. Crothers

Journal Articles

We performed a retrospective cohort study of patients with chronic obstructive lung disease (COPD) on long-term oxygen treatment (LTOT) who received invasive mechanical ventilation for COPD exacerbation. Of the 4791 patients, 23% died in the hospital, and 45% died in the subsequent 12 months. 67% of patients were readmitted at least once in the subsequent 12 months, and 26.8% were discharged to a nursing home or skilled nursing facility within 30 days. We conclude that these patients have high mortality rates, both in-hospital and in the 12 months postdischarge. If patients survive, many will be readmitted to the hospital and …

The Role Of Scavenger Receptor Class B Type I-Regulated Inducible Glucocorticoids In Sepsis, Junting Ai

Theses and Dissertations--Nutritional Sciences

Sepsis claims over 215,000 lives in the US annually. Inducible glucocorticoids (iGC) is produced during sepsis. However, the precise effects of iGC in sepsis remain unclear due to a lack of appropriate animal models. Glucocorticoid (GC) insufficiency is associated with a marked increase in mortality and occurs in 60% of severe septic patients. Yet the conclusion of GC therapy on septic patients is still controversial.

Scavenger receptor class B type I (SR-BI) in the adrenal mediates the selective uptake of cholesteryl ester from lipoproteins for GC synthesis. SR-BI-/- mice completely lack iGC during sepsis and are highly susceptible to septic …

Handoffs And Transitions In Critical Care (Hatricc): Protocol For A Mixed Methods Study Of Operating Room To Intensive Care Unit Handoffs, Meghan B. Lane-Fall, Rinad S. Beidas, Jose L. Pascual, Meredith L. Collard, Hannah G. Peifer, Tyler J. Chavez, Mark E. Barry, Jacob Gutsche, Scott D. Halpern, Lee A. Fleisher, Frances K. Barg

Departmental Papers (Psychiatry)

Background: Operating room to intensive care unit handoffs are high-risk events for critically ill patients. Studies in selected patient populations show that standardizing operating room to intensive care unit handoffs improves information exchange and decreases errors. To adapt these findings to mixed surgical populations, we propose to study the implementation of a standardized operating room to intensive care unit handoff process in two intensive care units currently without an existing standard process.

Methods/Design: The Handoffs and Transitions in Critical Care (HATRICC) study is a hybrid effectiveness- implementation trial of operating room to intensive care unit handoffs. We will use mixed …

A Review Of “An Ethical Market In Human Organs,” By Charles A. Erin And John Harris, And A Proposed Solution To The Current Organ Shortage, Rachel Rattenni Fcrh '14

The Fordham Undergraduate Research Journal

In 2005, an Israeli man named Nick Rosen answered an ad in his local Tel Aviv newspaper searching for someone interested in selling a kidney. Through funding from the broker who placed the ad, Rosen was flown to New York and set up with a dialysis patient from Brooklyn. After Rosen and the dialysis patient passed a simple procedure for the screening of illegal organ sales by saying the two were old friends, the successful transplant surgery was performed at the esteemed Mount Sinai Medical Center in New York. The Brooklyn resident walked away never again needing to go on …

You Can't Do This To Me! I Have Rights! Refusal Of Care In A Critical Setting, Edward Norris

Edward R Norris MD, FAPA, FAPM

No abstract provided.

A Rare Aetiology Of Respiratory Failure In A 10-Year-Old Boy: Inflammatory Myofibroblastic Tumour., Ali Khawaja, Prem Kumar Maheshwar, Anwarul Haque, Ali Bin Sarwar Zubairi

Department of Medicine

Primary neoplasms of the respiratory tract are rarely encountered in the paediatric population. Inflammatory myofibroblastic tumour (IMT) is a rare soft tissue mesenchymal tumour but a distinct disease entity accounting for less than 1% of all primary lung tumours. We report a case of a 10-year-old boy who presented with respiratory failure and left lung collapse. On flexible fiberoptic bronchoscopy, a pedunculated mass in the lower part of the trachea originating from the left main stem bronchus was identified. The patient subsequently underwent a left-sided pneumonectomy with complete resection of the mass. The histopathological analysis was consistent with IMT. Two …

Pulmonary Embolism After Stroke, Gustavo Saposnik

Gustavo Saposnik

BACKGROUND: Limited information is available on the frequency of pulmonary embolism (PE) in patients with an acute ischemic stroke (AIS). We evaluated clinical characteristics, predisposing factors, and outcomes in AIS patients with PE.

METHODS AND RESULTS: We included all AIS patients admitted to participating institutions in the Registry of the Canadian Stroke Network. Clinically PE was documented by a physician and confirmed by computed tomography pulmonary angiography within 30 days of the stroke case index. The primary outcome was death or disability at discharge. Secondary outcomes included disposition, length of hospital stay, mortality at 3 months and 1 year. Among …

Six-Minute Walk Test Performance In Healthy Adult Pakistani Volunteers, Nisar Ahmed Rao, Muhammad Irfan, Ahmed Suleman Haque, Ali Bin Sarwar Zubairi, Safia Awan

Section of Pulmonary & Critical Care

Objective: To determine the six-minute walking distance (6MWD) for healthy Pakistanis, identify factors affecting 6MWD, compare published equations with the local data and derive an equation. Study Design: Cross-sectional study. Place and Duration of Study: Two medical institutes of Karachi, from January to May 2011. Methodology: Subjects between 15 and 65 years were prospectively enrolled after screening. A standardized 6MWT was administered. SpO2, HR, BP and dyspnoea scores were determined pre- and post-test. Results: Two hundred and eleven (71%) men and 85 (29%) women participated. Mean 6MWD was 469.88 ± 101.24 m: men walked 502.35 ± 92.21 m and women …

Vest Chest Physiotherapy Airway Clearance Is Associated With Nitric Oxide Metabolism., Joseph H. Sisson, Todd A. Wyatt, Jacqueline A. Pavlik, Pawanjit S. Sarna, Peter J. Murphy

Journal Articles: Pulmonary & Critical Care Med

Background. Vest chest physiotherapy (VCPT) enhances airway clearance in cystic fibrosis (CF) by an unknown mechanism. Because cilia are sensitive to nitric oxide (NO), we hypothesized that VCPT enhances clearance by changing NO metabolism. Methods. Both normal subjects and stable CF subjects had pre- and post-VCPT airway clearance assessed using nasal saccharin transit time (NSTT) followed by a collection of exhaled breath condensate (EBC) analyzed for NO metabolites (NO x ). Results. VCPT shorted NSTT by 35% in normal and stable CF subjects with no difference observed between the groups. EBC NO x concentrations decreased 68% in control subjects after …

Asymmetric Dimethylarginine Blocks Nitric Oxide-Mediated Alcohol-Stimulated Cilia Beating., Todd A. Wyatt, S . M. Wells, Z . A. Alsaidi, Jane M. Devasure, E. B. Klein, Kristina L. Bailey, Joseph H. Sisson

Journal Articles: Pulmonary & Critical Care Med

The airway epithelium is exposed to alcohol during drinking through direct exhalation of volatized ethanol from the bronchial circulation. Alcohol exposure leads to a rapid increase in the cilia beat frequency (CBF) of bronchial epithelial cells followed by a chronic desensitization of cilia stimulatory responses. This effect is governed in part by the nitric oxide regulation of cyclic guanosine and adenosine monophosphate-dependent protein kinases (PKG and PKA) and is not fully understood. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, is implicated in the pathogenesis of several pulmonary disorders. We hypothesized that the inhibition of nitric oxide synthase …

National Estimates Of Emergency Department Visits For Pediatric Severe Sepsis In The United States, Sara Singhal, Mathias W. Allen, John-Ryan Mcannally, Kenneth S. Smith, John P. Donnelly, Henry E. Wang

Emergency Medicine Faculty Publications

Objective. We sought to determine the characteristics of children presenting to United States (US) Emergency Departments (ED) with severe sepsis.

Study design. Cross-sectional analysis using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Using triage vital signs and ED diagnoses (defined by the International Classification of Diseases, Ninth Revision codes), we identified children(triage fever or ICD-9 infection) and organ dysfunction (triage hypotension or ICD-9 organ dysfunction).

Results. Of 28.2 million pediatric patients presenting to US EDs each year, severe sepsis was present in 95,055 (0.34%; 95% CI: 0.29-0.39%). Fever and respiratory infection were the most common indicators of …

Maresin-1 Reduces The Pro-Inflammatory Response Of Bronchial Epithelial Cells To Organic Dust., Tara M. Nordgren, Art J. Heires, Todd A. Wyatt, Jill A. Poole, Tricia D. Levan, D. Roselyn Cerutis, Debra J. Romberger

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Exposure to organic dust causes detrimental airway inflammation. Current preventative and therapeutic measures do not adequately treat resulting disease, necessitating novel therapeutic interventions. Recently identified mediators derived from polyunsaturated fatty acids exhibit anti-inflammatory and pro-resolving actions. We tested the potential of one of these mediators, maresin-1 (MaR1), in reducing organic dust-associated airway inflammation.

METHODS: As bronchial epithelial cells (BECs) are pivotal in initiating organic dust-induced inflammation, we investigated the in vitro effects of MaR1 on a human BEC cell line (BEAS-2B). Cells were pretreated for 1 hour with 0-200 nM MaR1, followed by 1-24 hour treatment with 5% hog …