Critical Care Commons^™

Leveraging Administrative Health Data To Capture Rare Adverse Drug Reactions: Identifying Pediatric Patients With Trimethoprim-Sulfamethoxazole Acute Respiratory Distress Syndrome., Keith Feldman, Jenna Miller, Katherine Doane, Laura Loftis, James W. Antoon, Kevin J. Downes, Jennifer Goldman

Manuscripts, Articles, Book Chapters and Other Papers

Rare adverse drug reactions (ADRs) are underrecognized and underreported in the electronic medical record (EMR). These events often require clinical review, making systematic identification challenging. The study aim was to develop an approach to prioritize identification and validation of a rare ADR to trimethoprim-sulfamethoxazole causing acute respiratory distress syndrome (TMP-SMX ARDS) across medical institutions. We developed a clinical phenotype based on 2 local TMP-SMX ARDS cases mapped to standardized elements of a national comparative healthcare database (PHIS). We validated identification of TMP-SMX ARDS at scale across medical institutions. A set of scoring criteria was created to prioritize cases and generate …

Extracorporeal Rescue In Massive Pulmonary Embolism: A Case Of Chronic Thromboembolic Pulmonary Hypertension Unveiled, Kenzo Ramos, Kari Gorder

Journal of Shock and Hemodynamics

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare yet curable cause of pulmonary hypertension from unresolved pulmonary emboli. We present the case of a 48-year-old man with progressive dyspnea and leg swelling, who was found to have bilateral pulmonary emboli with right heart strain. He developed cardiac arrest during thrombectomy, requiring emergent veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Further evaluation revealed acute emboli superimposed on CTEPH. After incomplete thrombectomy and persistent instability, he underwent successful pulmonary endarterectomy with ECMO decannulation, leading to recovery of right ventricular function and discharge in stable condition. This case illustrates that previously unrecognized CTEPH may …

State And Regional Variation In Access To Pediatric Extracorporeal Membrane Oxygenation., Allan M. Joseph, Andrew J. Lautz, Carlie N. Myers, Ranjit S. Chima, Juan P. Gurria, Shafee Salloum, Wendy Hasson, Matthew P. Malone, Jenna Miller, Reanna Smith, Maya L. Dewan

Manuscripts, Articles, Book Chapters and Other Papers

Extracorporeal membrane oxygenation (ECMO) is only available in specialized medical centers. We conducted a geospatial analysis and found state- and region-level variation in the supply of ECMO centers, and the number of children who had access to ECMO. These findings may help target areas for the development of new ECMO programs.

Assessing Clinician Preference For Redirection Of Care In Neonatal Tracheostomies, Gabriella Destefano, Alla Kushnir, Perri Donenfeld

Cooper Rowan Medical Journal

A spectrum of indications exists for the implementation of neonatal tracheostomies, ranging from short-term airway control to congenital airway anomalies. The decision to initiate long-term mechanical ventilation is multifaceted and can be influenced by factors such as physician preferences, caregivers’ attitudes, and comorbidities. It is important to have an ethical framework in place to guide the treatment of preterm neonates who may require long term mechanical ventilation. This study examines physician perspectives on the ethics of neonatal tracheostomy, focusing on the treatment of infants with bronchopulmonary dysplasia. A mixed methods study, consisting of demographic information and 5 clinical vignettes centering …

Exploring Moral Distress In Pediatric Residents: Impact Of Structured Debriefing And Insights From Qualitative Interviews, Aashish Shah, Sarah Fleishaker, Danielle Key, Linda Tewksbury, Ami Shah, Kelley Groves

Journal of Wellness

No abstract provided.

Nurses’ Knowledge Regarding Ventilator-Associated Pneumonia Prevention Bundle In Adult Cardiac Care Units, Marwa Abdo

Nursing

Ventilator-associated pneumonia (VAP) is among the most common ICU infections for ventilated patients, associated with increased mortality (20-50%), morbidity, and health care costs. Nurses' knowledge of VAP prevention bundles is vital to reducing its incidence in critical care areas. Aim: To assess Nurses’ knowledge regarding the ventilator-associated pneumonia prevention bundle in Adult Cardiac Care Units. Study design: A cross-sectional study design was used. Setting: This study was conducted in both the adult cardiac intensive care unit and the cardiac care unit at Aswan Heart Centre–Magdy Yacoub Foundation, Egypt. Subject: A convenience sample of 67 nurses was selected. Data collection tool: …

Heat Stroke Encephalopathy Without The Presence Of Distinct Imaging Findings: Case Report And Review Of Literature, Ryan Sholes, David J. Walz, Julia S. Evans, Tessa Connelly, Joseph Rigotti

Abington Jefferson Health Papers

Heat stroke is a life-threatening emergency characterized by severe hyperthermia and acute central nervous system (CNS) dysfunction. We describe a 72-year-old man who was found unresponsive in his vehicle on a day with ambient temperatures exceeding 90°F. On arrival, his core temperature was 105.8°F, and Glasgow Coma Scale (GCS) score was 5. Despite prompt initiation of active cooling and supportive care with normalization of body temperature, the patient developed persistent and fluctuating encephalopathy. Extensive metabolic, infectious, and toxicologic evaluations were unrevealing. Thyroid-stimulating hormone was normal, arterial blood gases showed no acid-base derangements, ammonia and liver function tests were within normal …

Enhancing Lactation Support In The Icu Via Interdisciplinary Collaboration, Lexxi Ellis, Aretha Miller

All Poster Presentations

No abstract provided.

Richmond Agitation-Sedation Scoring Implementation In A Critical Access Hospital, Jasmine A. Hobbs

Doctor of Nursing Practice Posters and Presentations

Mechanically ventilated patients who are boarding in rural emergency departments face an increased risk of inconsistent sedation management due to the lack of standardized protocols and the extended transfer times to higher levels of care. The variability in sedation practices can lead to both under- and over-sedation, which negatively affects patient comfort, safety, and clinical outcomes. Research suggests that sedation protocols incorporating the Richmond Agitation-Sedation Scale (RASS) can shorten mechanical ventilation duration and improve clinical outcomes. The purpose of this project was to evaluate the effectiveness of a targeted educational intervention on improving nursing knowledge and comfort with the RASS …

Richmond Agitation-Sedation Scoring Implementation In A Critical Access Hospital, Jasmine A. Hobbs

Doctor of Nursing Practice Scholarly Projects

Mechanically ventilated patients who are boarding in rural emergency departments face an increased risk of inconsistent sedation management due to the lack of standardized protocols and the extended transfer times to higher levels of care. The variability in sedation practices can lead to both under- and over-sedation, which negatively affects patient comfort, safety, and clinical outcomes. Research suggests that sedation protocols incorporating the Richmond Agitation-Sedation Scale (RASS) can shorten mechanical ventilation duration and improve clinical outcomes. The purpose of this project was to evaluate the effectiveness of a targeted educational intervention on improving nursing knowledge and comfort with the RASS …

From Learners To Leaders: A Peer-Led Simulation Program For Anesthesia Procedural Skills Training In Medical Students, Noah S. Kos, Ryan Beyers, Chloe Sutlick, Benjamin Sun, Tochi Mbagwu, Dr. John D. Mitchell Md

Medical Student Research Symposium

Title: From Learners to Leaders: A Peer-Led Simulation Program for Anesthesia Procedural Skills Training in Medical Students

Authors: Noah Kos, Ryan Beyers, Chloe Sutlick, Benjamin Sun, Tochi Mbagwu, John D. Mitchell, M.D.

Background: Procedural skill competency is vital in medical education, but limited faculty availability poses challenges. We implemented a peer-led simulation program teaching peripheral IV insertion (PIV) and endotracheal intubation, with a focus on student leadership.

Methods: Sixteen peer educators, trained by attendings, conducted monthly workshops from July-October 2025. Students practiced at PIV and intubation stations, assessed via validated rubrics (17 items for PIV, 21 for intubation; 5-point scale). …

Safety And Efficacy Of Outpatient Thoracentesis: A Retrospective Analysis, Brooke Ruane, Msn, Crnp, Brian Schonewald, Md, Christine S. Shusted, Mph, Christopher Mcgrath, Md, Frances Mae West, Md, Prarthna Chandar, Md

Division of Pulmonary, Allergy, and Critical Care Medicine Posters

Objectives

• To examine the patient population, procedural indications, and clinical outcomes associated with a clinic-based outpatient thoracentesis program.
• To evaluate the safety, feasibility, and cost implications of an advanced practice provider (APP)-driven model for pleural effusion management.

Adrenal Crisis Induced-Seizures: A Case Report And Literature Review, Israel Umoh, Elizabeth Mikhail, Narjis Batool, Nosheen Hajra, Ibrahim Al-Sanouri

Journal of Community Hospital Internal Medicine Perspectives

This case report underscores the critical interplay between adrenal crisis and seizure activity, emphasizing the importance of rapid recognition and management of this life-threatening condition. Adrenal crisis, characterized by severe hypotension and electrolyte disturbances, often manifests with nonspecific symptoms such as fatigue, nausea, and altered consciousness, which can obscure diagnosis, especially in pediatric and young adult populations. The report details a 21-year-old female with a complex endocrinologic background who developed seizures precipitated by an adrenal crisis triggered by gastroenteritis and compounded by medication noncompliance. Clinical findings included profound dehydration, electrolyte abnormalities, refractory hypotension, and low cortisol levels, which responded favorably …

Evaluation Of The Effectiveness Of Antihypertensive Therapy Chosen Through Maternal Hemodynamic Profile Analysis, Margaret Weimer

Poster Presentations

In treatment of emergent hypertension, the American College of Obstetricians and Gynecologists (ACOG) recommends both oral labetalol and nifedipine, with no preference shown between the two. These medications have different mechanisms of action. Studies have suggested that consideration of hemodynamic profile may be an effective way to determine medication, but have not considered the Rule of 55, a simple calculation to predict hemodynamic profile.

Goals: 1. Determine if tailoring the antihypertensive to patient’s hemodynamic profile is associated with better control of blood pressure. 2. Determine if the Rule of 55 is an accurate method to determine hemodynamic profile.

Navigating The Nicu Without Words: A Case Study Of A Spanish-Speaking Mother’S Healthcare Experience, Emma Norris

Poster Presentations

Research on NICU experiences largely focuses on majority-language families; non-English-speaking families are understudied (Cleveland, 2008). The Family Integrated Care model promotes parent-infant connection and shared decision-making to improve outcomes (Wreesmann et al., 2020). Language barriers impede parent-provider communication, increasing miscommunication and parental anxiety (Kynoe et al., 2020; Ardal et al., 2011). The purpose of this research is to explore communication experiences and barriers between English-speaking and bilingual NICU nurses and a Spanish-speaking NICU mother.

Adhesion Of Antibiotic-Resistant Bacteria To Thermoplastic Materials Used In Fabricating Medical Devices: Patient Consequences, Dev V. Mehta

Poster Presentations

Burn injury patients wear supportive orthoses made by heat-forming sheets of thermoplastic material (Figs. 1 & 2). Bacteria cause severe soft tissue infections in patients wearing contaminated orthoses. Thermoplastic medical devices can develop biofilms that include antibiotic-resistant (AR) bacteria, which significantly reduces the number of available treatment options. A biofilm is a community of microorganisms that share resources allowing them to exist in a nutrient-limited environment. Biofilm microbes secrete extracellular polymeric substance (EPS) that attaches them firmly to a substrate surface while protecting them from harmful substances, including antibiotics. Bacteria living within biofilms on inanimate surfaces can survive for extended …

Rethinking Mixed Dka-Hhs: An Extreme Presentation Of Hyperosmolar Hyperglycemic State, Sajith Silva, Umair Malik, Amin Pasha, Sujata Kambhatla

Conference Presentation Abstracts

Introduction: The American Diabetes Association (ADA) recognizes diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) as life-threatening hyperglycemic emergencies that can overlap clinically; approximately 10% of presentations are described as mixed DKA–HHS. Because current guidelines do not define a single “mixed” category, overlap is best understood as concurrent fulfillment of key elements of both syndromes: DKA-type anion-gap metabolic acidosis with ketonemia or ketonuria, together with HHS-type severe hyperglycemia, hyperosmolality, and dehydration. We report an extreme HHS presentation (glucose >2,100 mg/dL) with limited DKA overlap. Case Description: A 34-year-old woman with longstanding type 1 diabetes mellitus managed with an insulin pump, …

A Rare Price Of Pain Control: Methemoglobinemia From A Lidocaine Patch, Sushmita Mantravadi, Kesava Mankikanta Achuta, Aaron Goyal, Amin Pasha, Abed L. Dabaja

Conference Presentation Abstracts

Introduction The overall prevalence of methemoglobinemia is around 0.035%. Methemoglobinemia is a rare but potentially life-threatening complication of local anesthetic use. While all patients are at risk, those with cardiac or pulmonary compromise are more susceptible to developing clinical manifestations. We report a case of acquired methemoglobinemia following topical lidocaine patch application for post-operative pain management in an elderly patient. Case Presentation 84-year-old male with a past medical history of aortic stenosis status post Transcatheter aortic valve replacement, Coronary artery disease, gastrointestinal bleed due to colon polyps, obstructive sleep apnea, chronic kidney disease, trigeminal neuralgia, obesity, essential hypertension, chronic atrial …

Icu Decision Tool Impact On Rebound Hyperglycemia, Daniel J. Donovan, Emily Highsmith, Sonya Khan, Michelle Horng

Advances in Cancer Education and Quality Improvement

Hyperglycemia, defined as a blood glucose level ≥180 mg/dL in the hospitalized patient, is linked to negative outcomes including longer hospital stays, increased infection risk, and higher morbidity and mortality rates. In addition to critically ill patients with diabetes, hyperglycemia can develop in individuals without diabetes due to factors such as steroid use, continuous tube feedings, and an elevated stress response. Patients who have uncontrolled hyperglycemia are often placed on continuous insulin infusions (CII), but rebound hyperglycemia frequently occurs after CII discontinuation if the maintenance insulin regimen (MIR) is insufficient. Implementation of a MIR decision support tool integrated within an …

Outcome And Clinical Characteristics Of Diaphragm Dysfunction After Pediatric Cardiac Surgery: From Detection To Plication, Muhammad Shahzad, Muhammad Bokir, Haifa Almuhanna, Abdulaziz Alanazi, Zehra Alabbas, Reem Beheri, Yasser Abdulrhman Alheraish, Khaled Alarwan

Journal of the Saudi Heart Association

Background:

Diaphragm paralysis (DP) due to phrenic nerve injury is a rare but serious complication of pediatric cardiac surgery (0.3–5% of cases). It presents as an extubation failure or difficulty weaning from ventilation. Early recognition and management are essential.

Objectives:

This study aimed to evaluate the incidence, clinical characteristic and outcome of diaphragm paralysis after heart surgery in children.

Methods:

A retrospective single-center review (2019–2024) was conducted of ultrasound-confirmed DP case. Demographics, surgical details, ventilatory course, interventions, and outcomes were analyzed. Partial and complete DP were compared using multivariate logistic regression to identify predictors.

Results:

Out of 2,280 surgeries, 108 …

Trends And Demographic Disparities In Septicemia-Associated Cardiac Arrest Mortality In The United States, 1999–2023, Muhammad Owais, Maham Mehfooz, Hamza Nazir, Preeti Advani, Roha Riaz, Khanij Arya, Javeria Nawaz, Syed Hadi Raza Rizvi, Murtaza Aslam, Usman Nazeer, Jairo Melo, Bravein Amalakuhan

Central & West Texas and San Antonio GME Research Day 2026

No abstract provided.

Clinical And Non-Clinical Factors Associated With Early Discharge In Pediatric Non-Trauma Patients Transported By Rotor Wing, Jordon Mitzelfelt, Lisa Pruitt, Amy Papa, Ashley K. Sherman, David Juang, Sarah Brunner, Asdis Finnsdottir Wagner, Jennifer Flint

Posters

Objective: Helicopter emergency medical services (HEMS) are crucial for transporting critically ill children to definitive care, however, rising costs and relative risks of this type of transportation necessitate careful evaluation of potential over-utilization. Current literature primarily focuses on pediatric trauma patients, leaving a significant gap in data regarding non-trauma pediatric HEMS transports and the influence of non-clinical factors such as referral hospital distance, resources, and capabilities on transport decisions. This study aims to address these gaps by examining non-trauma pediatric HEMS patients and identifying associated clinical and non-clinical factors related to early hospital discharge (< 24 hours). Methods: This retrospective, single-center study includes pediatric patients with medical and non-trauma surgical diagnoses transported by HEMS between April 1, 2021 and March 31, 2024. Clinical data were extracted from transport team records and the hospital’s electronic health records. Analyses were performed to identify factors associated with discharge within 24 hours of admission. To identify predictors of early discharge, we analyzed clinical factors including chief complaint, pre-transport vascular access, transport crew interventions (medication administration and procedures), respiratory assistance, and Pediatric Age-Adjusted Shock Index (SIPA) scores. Additionally, we examined the impact of the initial admit unit, and medical support required within the first 24 hours of hospitalization. Non-clinical predictors included the referring hospital’s status (critical access and/or rural designation) and the time of transport. Results: A total of 568 patients were transported by HEMS, of whom 88 (15%) were discharged within 24 hours. Patients in the early discharge group were more likely to present with neurologic chief complaints (40%), whereas those remaining hospitalized beyond 24 hours more frequently presented with respiratory complaints (40%). Normal SIPA scores both prior to and at the conclusion of transport were significantly associated with early discharge (p=0.012 and p=0.011, respectively). Furthermore, patients requiring no medications or respiratory assistance during transport, or no respiratory support within the first 24 hours of admission, were significantly more likely to be discharged early (p< 0.001). Notably, all patients with central access prior to transport remained admitted for more than 24 hours (p=0.004). Regarding non-clinical factors, patients transported from designated rural hospitals were more likely to experience early discharge (p< 0.001). Conclusion: These results characterize the pediatric non-trauma HEMS population and identify key predictors of early hospital discharge. This data is essential for developing standardized dispatch criteria to mitigate over-utilization and ensure high-acuity transport is reserved for the most appropriate patients.

Extracorporeal Membrane Oxygenation In Trauma Before And After Covid-19: Associations Of Utilization, Timing, And Outcomes, Ryan Mancoll, William Rice, Theodore Chin, Grayson Mast M.D, Samantha Olafson M.D.

Knowledge and Creativity Expo

Objectives:

The COVID-19 pandemic expanded and altered general ECMO utilization and provider experience; however, any impact on trauma-specific ECMO practice following this shift remains unclear. We hypothesize that trauma ECMO utilization patterns, timing of initiation, and outcomes have differed following COVID-19.

Methods:

We conducted a retrospective cohort study of trauma patients receiving ECMO (2017-2024) using the American College of Surgeons Trauma Quality Improvement Program (TQIP) Participant Use Files. The primary exposure was the COVID era (2017-2019 vs. 2021-2024). Primary outcomes included ECMO utilization, time to initiation, and in-hospital mortality; secondary outcomes included discharge disposition, major complications, and length of stay …

Sepsis-Triggered Proteolysis Of Profibrinolytic Annexin A2 Associated With Microvasculopathy-Related Organ Dysfunction, Hana I. Lim, Michael Bender, Huigen Chen, Frances M. West, Julio Lanfranco, Dena Almeida, Katherine A. Hajjar

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

Sepsis is a systemic inflammatory disorder marked by dysregulated inflammation and coagulopathy. Annexin A2 (A2), a profibrinolytic protein, assembles plasminogen and tissue plasminogen activator on cell surfaces, thereby maintaining vascular patency. However, its role in human sepsis has remained poorly defined. We investigated whether A2 undergoes qualitative or quantitative modification during human sepsis with associated end-organ dysfunction. Peripheral blood mononuclear cells and plasma were collected from 65 patients with sepsis and 27 healthy controls. A2 expression and integrity were evaluated with cell surface plasmin generation using immunoblot and fluorometric assays. Both A2 integrity and plasmin generation were significantly reduced in …

Improving Door To Ekg Time In The Emergency Department, Juleene J Mcgowan

Providence Nursing Research Conference 2023 – Present

References:

Yiadom, M. Y., Gong, W., Patterson, B., et al. 2022.

Fallacy of Median Door-to-ECG Time: Hidden Opportunities for STEMI Screening Involvement.

Journal of American Heart Association. Https://doi.org/10.11161/JAHA.121.024067

Yiadom, M. Y., Gong W., Bloos S., et al. 2024.

Shorter Door-to-ECG Time is Associated with Improved Mortality in STEMI Patients.

Journal of Clinical Medicine. 2024, 13, 2650. https://doi.org/10.3390/jcm13092650

Resuscitating Rapid Response And Code Blue Education, Danielle Fogel

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Critical Care Certification: Developing A Culture Of Excellence, Karis Pickett

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Evaluating The Impact Of Early Mobilization Education On Nurse Confidence And Length Of Stay In An Intensive Care Unit, Kimberly Melendez, Crystal Solis, Karis Pickett, Lillie Chung

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Participation In Ethics Consultation And Moral Resilience In Icu Nursing: Findings From An Exploratory Secondary Analysis, Sarah Sumner

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Issue 17: Pulmonary & Critical Care Insider, Bharat Bajantri Md, Sarah Ellsworth Mls, Stephanie Subart Pharmd

Critical Care & Pulmonary

Pulmonary & Critical Care Insider Issue 17

Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.

The Pulmonary & Critical Care Insider newsletter was created by Dr. Bharat Bajantri, MD and Sarah Ellsworth, MLS in 2023 as a form of current awareness for current practice at our hospital, Parkview Health.

Topics: 

• Management of Uncomplicated Gram-Negative Bacteremia
• Complicated Urinary Tract Infection Guidelines Update
• Ketamine vs Etomidate for RSI
• STORM-PE 
• Lung Ultrasound–Guided Weaning
•  D-Dimer for Pulmonary Embolism
• Extubation Failure
•  A Multimodal, physiology-Driven approach to pleural effusions
• Dexmedetomidine for Hyperactive …