Critical Care Commons^™

Spontaneous Pneumomediastinum In Children Is Not Associated With Esophageal Perforation, Kevin Roby, Catherine Barkach, Diane Studzinsk, Nathan M. Novotny, Begum Akay, Pavan Brahmamdam

Conference Presentation Abstracts

Purpose: We hypothesized that esophageal perforation is not a common etiology for spontaneous pneumomediastinum (SPM), and that SPM is a self-limited disease not requiring routine admission. Methods: We performed a retrospective review of patients, ages 0 to 21 years, diagnosed with SPM in one hospital system (five hospitals) from 2009 – 2019. Cases were identified using ICD9 and 10 codes and confirmed through chart review. Cases were excluded for trauma, severe infections, or subsequent development of SPM after admission for a separate diagnosis. Data regarding patient characteristics, diagnostic tests, and outcomes were collected, and summary statistics were performed. Results: We …

Advancements In Left Ventricular Assist Devices To Prevent Pump Thrombosis And Blood Coagulopathy, Grainne Malone, Gerges Abdelsayed, Fianait Bligh, Fatma Al Qattan, Saifullah Syed, Prateepan Varatharajullu, Augustin Msellati, Daniela Mwipatayi, Maimoona Azhar, Saulat Hasnain Fatimi

Section of Cardiothoracic Surgery

Mechanical circulatory support (MCS) devices, such as left ventricular assist devices (LVADs) are very useful in improving outcomes in patients with advanced-stage heart failure. Despite recent advances in LVAD development, pump thrombosis is one of the most severe adverse events caused by LVADs. The contact of blood with artificial materials of LVAD pumps and cannulas triggers the coagulation cascade. Heat spots, for example, produced by mechanical bearings are often subjected to thrombus build-up when low-flow situations impair washout and thus the necessary cooling does not happen. The formation of thrombus in an LVAD may compromise its function, causing a drop …

Sitting, John Brill

Journal of Patient-Centered Research and Reviews

A family physician volunteers for a hospital shift as a patient sitter and reflects on the experience in this creative writing article. Freed from clinical responsibilities in a hospital setting, sitting and observing the patient’s interactions with health care professionals and staff reinforced the importance of human connection to recovery.

A Project Proposal: The Effects Of Standard Protocols During Cpr On Hospital-Acquired Infections Of Post-Open-Heart Surgery Patients In The Cvicu, Jessica Monahan

Symposium of Student Scholars

Abstract

A Project Proposal: The Effects of Standard Protocols during CPR on Hospital-Acquired Infections of Post-Open-Heart Surgery Patients in the CVICU

Background: Hospital-acquired infections (HAIs) are one of the most common complications post-cardiac surgeries and are associated with longer hospitalizations, elevated use of healthcare resources, and increased morbidity and mortality. The effects of HAIs after cardio-pulmonary resuscitation (CPR) in recent post-open-heart surgery patients remains largely unexplored. Therefore, the purpose of this project was to determine, in the CVICU does implementing standard protocols during CPR on recent post-open-heart surgery patients reduce HAIs?

Literature Review: HAIs during CPR can be acquired through …

Post-Intensive Care Syndrome Prevention And Detection In Covid-19 Patients, Bethany Sloane Melega

Student Scholar Showcase

COVID-19 has impacts on patient health beyond the hospital. The trauma that patients, and families of patients, can experience during an admission to an intensive care unit (ICU) can last long after discharge from the ICU and the hospital in general. The psychological and physical impacts of ICU hospitalization can cause patients to experience Post Intensive Care Syndrome (PICS). PICS is the culmination of symptoms that persist after a critical illness that involve all aspects of a patient’s physical and mental well-being and can significantly affect family life and increase recovery time. Due to the strict personal-protective equipment (PPE) usage …

Maximising Access To Timely Trauma Care Across Population Of Karachi And Its Districts: A Geospatial Approach To Develop A Trauma Care Network, Muhammad Nabeel Ashraf, Mohammad Salman Khalil, Ahwaz Akhtar, Lubna Samad, Asad Latif

Department of Anaesthesia

Objectives: To develop and propose a cost-effective trauma care network for Karachi, Pakistan, by calculating maximum timely trauma care (TTC) coverage achieved with the addition of potential designated private and public level 1 and level 2 trauma centres (TCs).
Setting: A lower middle-income country metropolis, Karachi is Pakistan's largest city with a population of 16 million and a total of 56 hospitals as per government registry data.
Participants: 41 potential TCs selected using a two-level, contextually-relevant TC designation criteria adapted from various international guidelines.
Primary and secondary outcome measures: Maximum TTC coverage achievable with the addition of potential TCs. Proposed …

Communicating Comfort In Crisis: A Literature Review On Overcoming The Emergency Room Environment To Foster The Nurse-Patient Relationship, Faith G. Davenport

Senior Honors Theses

The average emergency room patient is not receiving the compassionate nurse-patient communication that patients experience on other hospital floors. Fewer positive nurse-patient interactions prompt patients to state that they feel uncomforted and dissatisfied on hospital exit surveys, inciting hospital management to investigate how to reverse this trend to retain their federal funding. Emergency room nurses cite multiple barriers inherent in their work environment that prevent them from building rapport with their patients, including a layout not conducive to private conversations, strict time constraints, and a fluctuating workload. Working for a prolonged period under these conditions is driving many nurses to …

Identifying Predictive Factors For Patients Transferred From Floor To Picu Within 24 Hours Of Admission By A Pediatric Critical Care Transport Team, Gina Patel, Lisa Carney, Brian S. Olsen, Jennifer Flint

Posters

Abstract Objectives: Appropriate triage and disposition during transport can reduce the need for unplanned transfers to the pediatric intensive care unit (PICU) within 24 hours of admission. The pediatric early warning score (PEWS) is utilized to monitor for inpatient clinical deterioration and acuity during transport at our hospital. We sought to determine predictive factors of patients admitted to the inpatient ward who required PICU transfer within 24 hours following transport by Children’s Mercy Critical Care Transport (CMCCT) team. We hypothesized patients with respiratory illness and PEWS > 4 during interfacility transport are at higher risk of PICU transfer within 24 hours …

The Impact Of Early Goal Directed Sepsis Bundle Sets In The Emergency Department And The Impact Of Sep-1 Compliance Rates, Christie L. Ferrari

DNP Scholarly Projects

Sepsis is a medical emergency that is prevalent throughout hospitals everywhere. Due to the growing crisis, the Centers for Medicare and Medicaid Services (CMS) in collaboration with the Surviving Sepsis Campaign (SSC) adopted core measures for sepsis (SEP-1) which aim at improving overall compliance of evidence-based treatment standards for sepsis. The purpose of this Doctor of Nursing Practice (DNP) project was to determine if incorporating early goal directed sepsis bundles in a rural Midwestern ED was effective in increasing compliance with SEP-1 rates. The secondary purpose evaluated how nursing knowledge, awareness, and compliance with sepsis bundles affects SEP-1 compliance rates. …

Association Of Trauma Center Designation With Postdischarge Survival Among Older Adults With Injuries, Molly P. Jarman, Ginger Jin, Joel S. Weissman, Arlene S. Ash, Jennifer Tjia, Ali Salim, Adil Haider, Zara Cooper

Section of General Surgery

Importance: Trauma centers improve outcomes for young patients with serious injuries. However, most injury-related hospital admissions and deaths occur in older adults, and it is not clear whether trauma center care provides the same benefit in this population.
Objective: To examine whether 30- and 365-day mortality of injured older adults is associated with the treating hospital's trauma center level.
Design, setting, and participants: This prospective, population-based cohort study used Medicare claims data from January 1, 2013, to December 31, 2016, for all fee-for-service Medicare beneficiaries 66 years or older with inpatient admission for traumatic injury in 2014 to 2015. Data …

Residual Symptoms And The Quality Of Life In Individuals Recovered From Covid-19 Infection: A Survey From Pakistan, Mohammad Aadil Qamar, Russell Seth Martins, Rubaid Azhar Dhillon, Areeba Tharwani, Omar Irfan, Qosain Fatima Suriya, Wajiha Rizwan, Javaid Ahmed Khan, Ali Bin Sarwar Zubairi

Medical College Documents

Background: There remains scarcity of literature regarding the patient's health status post-COVID-19 infection. This study analyzes the prevalence of residual symptoms and quality of life (QoL) after COVID-19.
Methods: An anonymous online survey was administrated in Pakistan from November 2020 to April 2021 in COVID-19 survivors. The questionnaire used the 12-Item Short Form Health Survey (SF-12) to assess mental and physical QoL. Multivariate linear regression was used to explore factors associated with mental and physical QoL scores.
Results: A total of 331 COVID-19 survivors participated in our survey. Around 42.0% of the cohort reported within 1-3 months of diagnosis of …

The Unspoken Grief Of Multiple Stillbirths In Rural Pakistan: An Interpretative Phenomenological Study, Muhammad Asim, Sehrish Karim, Hajra Khwaja, Waqas Hameed, Sarah Saleem

Community Health Sciences

Background: Pakistan has the highest rate of stillbirth (30.6 stillbirths per 1000 total births) as compared to other South Asian countries. The psychological impact of stillbirths on bereaved women is well documented; however, there is a dearth of literature on lived experiences of women with multiple stillbirths in Pakistan.
Objective: The purpose of this research is to understand the lived experiences of women who had multiple stillbirths in Thatta, Pakistan.
Methods: An interpretative phenomenological study was conducted in district Thatta with eight women who experienced more than one stillbirth. A semi-structured in-depth interview guide was used for data collection. The …

What After Bcg Fails In Non-Muscle Invasive Bladder Cancer?, M Hammad Ather

Section of Urology

No abstract provided.

Multicenter Retrospective Review Of Ketamine Use In The Icu., Christine M Groth, Christopher A Droege, Kathryn A Connor, Kimberly Kaukeinen, Nicole M Acquisto, Sai Ho J Chui, Michaelia D Cucci, Deepali Dixit, Alexander H Flannery, Kyle A Gustafson, Nina E Glass, Helen Horng, Mojdeh S Heavner, Justin Kinney, Rachel M Kruer, William J Peppard, Preeyaporn Sarangarm, Andrea Sikora, Velliyur Viswesh, Brian L Erstad, Parkview Health

Pharmacy

This publication is included in our collection because several Parkview pharmacists were involved in the data collection part and acknowledged for the assistance they provided to the overall article. See Comment.

The response of ICU patients to continuously infused ketamine when it is used for analgesia and/or sedation remains poorly established.

OBJECTIVES: To describe continuous infusion (CI) ketamine use in critically ill patients, including indications, dose and duration, adverse effects, patient outcomes, time in goal pain/sedation score range, exposure to analgesics/sedatives, and delirium.

DESIGN SETTING AND PARTICIPANTS: Multicenter, retrospective, observational study from twenty-five diverse institutions in the United States. Patients …

Perceived Risk And Distress Related To Covid-19 In Healthcare Versus Non-Healthcare Workers Of Pakistan: A Cross-Sectional Study, Adeel Abid, Hania Shahzad, Hyder Ali Khan, Suneel Piryani, Areeba Raza Khan, Fauziah Rabbani

Medical College Documents

Background:
Healthcare workers (HCWs) have found themselves and their families more susceptible to contracting COVID-19. This puts them at a higher risk of psychological distress, which may compromise patient care. In this study, we aim to explore the risk perceptions and psychological distress between HCWs and non-healthcare workers (NHCWs) in Pakistan.
Methods:
A cross-sectional study was conducted using an online self-administered questionnaire. Psychological distress was assessed through The Hospital Anxiety and Depression Scale (HADS). Comparisons were made between HCWs (front/backend, students/graduates) and NHCWs related to risk perceptions and stress levels related to COVID19. Following tests for normality (Shapiro–Wilk test), variables …

Simulation-Based System Analysis: Testing Preparedness For Extracorporeal Membrane Oxygenation Cannulation In Pediatric Covid-19 Patients., Alyssa Stoner, Robert Schremmer, Mikaela A. Miller, Kari L. Davidson, Rachael L. Pedigo, Jamie S. Parson, Christopher S. Kennedy, Eugenia K. Pallotto, Jenna Miller

Manuscripts, Articles, Book Chapters and Other Papers

Introduction: Coronavirus Disease-2019 presents risk to both patients and medical teams. Staff-intensive, complex procedures such as extracorporeal membrane oxygenation (ECMO) or extracorporeal cardiopulmonary resuscitation (eCPR) may increase chances of exposure and spread. This investigation aimed to rapidly deploy an in situ Simulation-based Clinical Systems Testing (SbCST) framework to identify Latent Safety Threats (LSTs) related to ECMO/eCPR initiation during a pandemic.

Methods: The adapted SbCST framework tested systems related to ECMO/eCPR initiation in the Neonatal and Pediatric Intensive Care Units. Systems were evaluated in six domains (Resources, Processes/Systems, Facilities, Clinical Performance, Infection Control, and Communication). We conducted three high-fidelity simulations with …

The Effect Of Ivermectin On Non-Severe And Severe Covid-19 Disease And Gender-Based Difference Of Its Effectiveness, Syed Muhammad Zubair, Muhammad Waleed Chaudhry, Ali Bin Sarwar Zubairi, Talha Shahzad, Aqusa Zahid, Ibrahim Ali Khan, Javaid Ahmed Khan, Muhammad Irfan

Section of Pulmonary & Critical Care

The COVID-19 pandemic has led to mortality and morbidity since December 2019. Many possible treatment options have been advised till date. The role of ivermectin in the treatment of COVID-19 disease remains controversial. The aim of our study was to evaluate the effect of ivermectin in hospitalized patients with non-severe and severe COVID-19 disease. We conducted a retrospective cohort study that compared outcomes in 2 groups of COVID-19 patients hospitalized at the largest tertiary care center of Pakistan. The study group was given ivermectin along with standard treatment of covid-19 disease; the comparison group was not. Data on mortality, inflammatory …

Still Birth Classification: Application Of Relevant Condition At Death (Recode) Classification System In A Tertiary Care Hospital Of Pakistan, Urooj Kashif, Shelina Bhamani, Asma Patel, Zaheena Shamsul Islam

Department of Obstetrics & Gynaecology

Objectives: To determine the cause of stillbirth after application of relevant condition at death (ReCoDe) classification system.
Methods: This was a retrospective cross sectional study of 207 women diagnosed with stillbirth after 24 completed weeks of pregnancy at the Aga Khan University Hospital (AKUH), Karachi between 1st January 2015 and 31st December 2019. The primary objective was to find the cause of stillbirth according to the new classification of relevant condition at death (ReCoDe).
Results: There were a total of 32413 live births and 207 stillbirths during the study period thus stillbirth rate of 6 per 1000 live births. In …

Identifying Novel Subphenotypes In Covid-19 Using Protein Biomarkers, A Spicer, P A. Verhoef, C Lopez-Espina, A Bhargava, L Schmalz, M Sims, A V. Palagiri, K V. Iyer, M J. Crisp, A Halalau, N Maddens, A Espinosa

Conference Presentation Abstracts

RATIONALE: COVID-19 is widely heterogeneous in presentation, even across patients with similar demographics and medical history. Identification of subphenotypes based on host immune responses that are biologically discrete and predict outcomes may enable personalized COVID-19 therapies. Accordingly, using a composite of electronic health record (EHR) data and 36 research biomarkers, we sought to compare COVID-19 immune responses across patients of varying disease severity, identify subphenotypes within hospitalized COVID-19 patients, and test for heterogeneity of treatment effect (HTE) to intravenous corticosteroids across these subphenotypes. METHODS: In this multicenter retrospective analysis of prospectively collected data, patients presenting to three medical centers from …

Pulmonary Cement Emboli: An Underreported Phenomenon Or Rare Kyphoplasty Complication, A Cimino, A Alchakaki

Conference Presentation Abstracts

Kyphoplasty is an intervention to treat and stabilize painful vertebral compression fractures by injecting Polymethymethacrylate (PMMA) cement in the vertebral cavity. It has become increasingly important procedure in pathologic compression fracture treatment. Pulmonary cement embolism (PCE) happens by leakage of cement through the venous plexus or retrograde migration in the arterial vessels to aorta. It was reported as a rare complication of this procedure (3.5%) but others have suggested that because of paucity in symptoms, PCE is often overlooked and can happen in up to 28.6% of kyphoplasty patients. PCE cause a wide spectrum of symptoms ranging from asymptomatic to …