Critical Care Commons^™

Impact Of Rapid Response Team On In-Hospital Cardiac Arrest Events, Sara Everard Tucker, Julie Gale Bell, Stephanie Pigg, Shelby Austin, Kelsey Sawyer, Stephan Smith, Michelle Bradberry, Jonathan Ortegon, Matt Mitchell

Covenant Nurses Week 2026

No abstract provided.

Empowering Nurses In Cardioversion Management, Joel Hutcherson, Abby Gale Perez

Covenant Nurses Week 2026

No abstract provided.

When A Rare Neuromuscular Disorder Meets Covid-19: A Challenging Case Of Myotonic Dystrophy In The Intensive Care Unit, Pradeep Rajbhandari, Lawrence San Jose, Michael Waxman

MidAmerica Division GME Healthcare Symposium 2026

No abstract provided.

Implementation Of A Pressure Injury Prevention Bundle To Reduce Hospital-Acquired Pressure Injuries In The Intensive Care Unit, Xibo Lan

Doctor of Nursing Practice Final Project Abstract

Purpose

The goal of this quality improvement project was to utilize the SKINSAFE pressure injury prevention bundle during 12 weeks of implementation to increase evidence-based pressure injury prevention practices adherence and decrease risk of hospital-acquired pressure injury (HAPI) in the intensive care units (ICU).

Background

ICU patients experience high risk for hospital acquired pressure injuries (HAPIs) secondary to immobility and device related pressure. Initial adherence to SKINSAFE bundle was 55-56%. There was inconsistent use of heel offloading devices, wound photography and documentation. Prevention bundles were affected by staffing fluctuations and leadership turnovers.

Methodology

The Plan-Do-Study-Act cycle for this project included …

The Murdock Daily Reilly (M.D.R.) Scale: A Pressure Injury Risk Assessment Scale For Critical Care, Ann Murdock, Andrea Daily, Deby Reilly, Shih-Ting Chiu, Melissa Robinson

Publications 2026-present

No abstract provided.

Enhancing Skin Integrity In Medical Intensive Care Unit Patients, Chelsea Lannoo

Publications 2026-present

No abstract provided.

Comparative Assessment Of Arterial Line And Pulse Contour Derived Hemodynamics Monitoring In A Post-Cardiac Surgery Icu Patient: Pilot Observation, Chiraag Ashokkumar, Justin Gisel

South Atlantic Division GME Research Days 2026

No abstract provided.

Trimethoprim–Sulfamethoxazole–Induced Thrombotic Thrombocytopenic Purpura, Renee Morecroft, Jyoti Moorjani, Mohamed Hussam Hallak, Tathana Rivera Hernandez, Isabella Estrada, Hammad Awad, Payam Nabizadeh-Eraghi

South Atlantic Division GME Research Days 2026

No abstract provided.

Changing Practice: Optimizing Head Ct-Imaging In Pediatric Trauma Patients At A Community Level Ii Pediatric Trauma Center - A Quality Improvement Initiative, Matthew Daniel, Aaron Worthley, Sarah Johnson, Daniel Saad, Antonio Pepe, Eleah Porter

South Atlantic Division GME Research Days 2026

No abstract provided.

Implementing Daily Spontaneous Awakening And Breathing Trials In The Trauma Intensive Care Unit: A Quality Improvement Initiative, Bradley Vaughn, Lina V. Mata-Mcmurry, Eric Shaw, James Dunne

South Atlantic Division GME Research Days 2026

No abstract provided.

Masld-Induced Hyperammonemia With Atypical, Restricted Diffusion Pattern Suggesting Mixed Metabolic And Hypoxic-Anoxic Injury, Renu Thomas, Nhuchau Tiffany Nguyen, Daniel Bao, Jonathan Tang, Uzma Ali, Damon Cao

HCA Healthcare Journal of Medicine

Background

Hepatic encephalopathy is a common cause of altered mental status for patients with decompensated cirrhosis. Their conditions typically improve with high-dose laxatives; if not optimally treated, can develop neurologic sequelae like cerebral edema and herniation. In severe cases, despite normal systemic oxygenation, hyperammonemia may result in mixed restricted diffusion patterns that partially resemble those seen in hypoxic-anoxic brain injury.

Case Presentation

A 61-year-old woman with cirrhosis secondary to metabolic dysfunction-associated steatotic liver disease, scleroderma, and rheumatoid arthritis presented to the emergency room with altered mental status. She was admitted to the intensive care unit (ICU) and was intubated due …

External Multicenter Validation Of The Esah Score For Predicting Outcomes After Subarachnoid Hemorrhage, Natália Vasconcellos De Oliveira Souza, Rohan Sharma, Otavio Frederico De Toledo, Ingrid Pereira Marques, Salvador F. Gutierrez-Aguirre, Lara-Velazquez Montserrat, Eric Sauvageau, Naval Neeraj, Amin Aghaebrahim, Feres Chaddad Neto, Ricardo A. Hanel, Gisele Sampaio Silva, William David Freeman

Jefferson Hospital Staff Papers and Presentations

Reliable assessment of prognosis after aneurysmal subarachnoid hemorrhage (SAH) is essential to inform clinical decision-making and prevent premature assumptions of poor outcome. The enhanced SAH (eSAH) score combines three routinely available variables-age, Glasgow Coma Scale (GCS), and subarachnoid hemorrhage blood volume (SAHV)-to provide an objective framework for early outcome stratification. SAHV is estimated using the ABC/2-derived ellipsoid method applied across five major cisternal compartments on non-contrast CT. While the eSAH score has shown promise in initial derivation studies, its external performance and calibration have not yet been validated across diverse healthcare settings. We conducted a retrospective cohort study using consecutive …

Documenting Death: Maternal Mortality And The Ethics Of Care In Tanzania (Adrienne E. Strong 2020), Luluk Oktavia, Megawati Sukarno

Paradigma: Jurnal Kajian Budaya

In recent decades, global efforts to reduce maternal mortality have become a primary focus in health development agendas. However, challenges in providing quality healthcare remain complex, especially in resource-limited countries. Adrienne E. Strong’s book, Documenting Death: Maternal Mortality and the Ethics of Care in Tanzania, offers an ethnographic perspective on the relationship between bureaucratic structures, resource constraints, and healthcare practices in Tanzania. This review examines Strong’s key concepts, such as good enough care, documented care, and fierce care, which highlight the ethical dilemmas faced by healthcare workers in delivering care under administrative pressures and limited facilities. The critique of the …

Vasoactive Drug Use In Children With Community Acquired Septic Shock In Australia And New Zealand, Elliot Long, Stephen Hearps, Amanda Williams, Ben Gelbart, Warwick Butt, Thomas Rozen, Sarah Mcnab, Meredith Borland, Simon Erickson, Shefali Jani, Marino Festa, Eunicia Tan, Natalie Phillips, Sainath Raman, Amit Kochar, Subodh Ganu, Simon Craig, Anna Lithgow, Arjun Rao, Emma Whyte, Stuart Dalziel, Shane George, Fran Balamuth, Scott Weiss, Nathan Kuppermann, Franz Babl

Department of Medicine Faculty Papers

BACKGROUND: Vasoactive agents are a critical supportive therapy for children with sepsis. We describe the choice and use patterns of vasoactive agents in children with sepsis.

METHODS: Prospective observational study conducted in 11 hospitals in Australia and New Zealand through the Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network from April 2021 to December 2023. Children aged 0-< 18 years with suspected sepsis were included. Children admitted to hospital and treated with parenteral antibiotics and either 1) a provisional diagnosis of sepsis, and/or 2) treatment for suspected sepsis (fluid bolus to treat poor perfusion). The frequency and sequence of use of vasoactive agents, and contributors to the choice of initial vasoactive were collected.

FINDINGS: 6232 children with suspected sepsis were included; median age of 2.1 years (IQR 0.3-7.1 years), in-hospital mortality of 60 (1.0%), in whom a subset of 306 (4.9%) met Phoenix sepsis criteria. Vasoactive agents were used in 179 (2.9%) children overall …

Distinguishing Acute Cardiac Events From Chronic Troponin Elevation: Integrating High-Sensitivity Troponin Trends With Objective Ischemic Evidence Under The 4th Udmi Across Diverse Renal Function Profiles, Aidan Fernandez, Amanda Green, Silvija Milanovic, Eric Han, Asia Elbooz, Michael Petrauskis, Justin Nippert, Michael Marchick, Nicholas Maldonado, Mohammed Ruzieh, Elizabeth Warren, Matthew Shaw, Lars Beattie, Brandon Allen

Florida Journal of Emergency Medicine (FJEM)

The Fourth (4th) Universal Definition of Myocardial Infarction (UDMI) provides a standardized framework to enhance diagnostic accuracy and clinical decision-making. However, challenges can arise due to the use of subjective clinical assessment in diagnostic criteria or in the presence of impaired renal clearance. This study modifies the 4th UDMI by requiring objective ischemic evidence to improve consistency in myocardial infarction (MI) classification and applies it across diverse patient populations.

In this retrospective study, patients who presented to the emergency department (ED) with 99th percentile high sensitivity cardiac troponin (hs-cTn) values were classified using the modified 4th UDMI into the categories …

Point Of Care Ultrasound For Rapid Identification Of Central Retinal Artery Occlusion And Subsequent Vision Rescue Utilizing Intravenous Alteplase, Joseph Pepe, Karl Kasischke, Calen Hart

Florida Journal of Emergency Medicine (FJEM)

Central retinal artery occlusion (CRAO) is a rare but critical diagnosis to make in patients with acute vision loss. Cases of central retinal artery occlusion historically have a poor prognosis due to delayed presentation, lack of early identification, and limited effective treatment options. Due to these challenges, patients are often left with permanent loss of vision.

We present a case of a male patient in his late 70s with sudden onset of loss of vision to the right eye. Identification of CRAO was made utilizing point of care ultrasound (POCUS). After discussion with neurology, the patient was treated with alteplase …

Issue 16: Pulmonary & Critical Care Insider, Bharat Bajantri Md, Sarah Ellsworth Mls

Critical Care & Pulmonary

Pulmonary & Critical Care Insider Issue 16

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:

EVERDAC Trial: Do All Shock Patients Need Arterial Lines?

Beyond MAP: Redefining Perfusion Pressure in Septic Shock

ECG Findings You Cannot Miss in Acute Pulmonary Embolism

Food for Thought: When Private Equity Buys Hospitals, Who Pays …

Advancing Anesthesia Provider Proficiency In Airway Assessment Using Point-Of-Care Ultrasound: An Osce-Based Educational Initiative, Austin Fike, Trevor Jordan, Sam Sherrill Iii

Doctoral Projects

Airway management is one of the fundamental pillars of anesthesia. Traditionally, tools such as the Mallampati classification and the thyromental distance are used for airway assessment in the perioperative area. However, often, these methods fail to reliably predict difficult intubations. The use of point-of-care ultrasound (POCUS) has emerged as a valuable adjunct in airway assessment. However, a knowledge deficit exists among anesthesia providers regarding its application in airway assessments for perioperative adult patients. This doctoral project addressed the knowledge deficit in POCUS airway assessment among Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) through the development and …

Frequency, Duration, And Cost Of Pulmonary Exacerbations Among Patients With Bronchiectasis, Maitreyee Mohanty, Claudia Leiras, Haiyan Sun, Reina Rau, John Fastenau, Joseph Feliciano, Sunjay R Devarajan

Faculty, Staff and Students Publications

Background: In administrative claims database studies of bronchiectasis, pulmonary exacerbations are usually defined using a fixed period for their start and end, which prevents assessment of exacerbation duration and thereby limits assessment of exacerbation characteristics. Here, we applied a novel cost-based algorithm to characterize exacerbations.

Methods: This cohort study used the Merative MarketScan Commercial Claims and Encounters database, 1-Jan-2016 to 31-Dec-2022. Patients ≥18 years with bronchiectasis (≥2 outpatient or ≥1 inpatient claim with bronchiectasis; no cystic fibrosis) had 12 months of continuous enrollment before (baseline) and ≥12 months after (follow-up) index (first bronchiectasis claim). Cost-based exacerbations were identified by compound …

Perioperative Nutrition In Pediatric Patients With Congenital Heart Disease And Heart Failure., Jaime Silva-Gburek, Kelsey May, Bailey Walvoord, Catalina Lozano, Jorge A. Coss-Bu

Manuscripts, Articles, Book Chapters and Other Papers

Optimal nutritional therapy is important for infants and children with perioperative congenital heart disease and heart failure. Medical providers face physiological and metabolic challenges when administering enteral and parenteral nutrition to these patients. Complications related to enteral nutrition can increase morbidity and mortality, although outcomes are improved in those cases in which caloric and nutrient administration can be achieved. Consensus regarding feeding strategies and timing of nutritive care is lacking. This narrative review aims to summarize, analyze and discuss the most recent literature on nutritional therapy in perioperative congenital heart disease, heart failure and pediatric patients requiring mechanical circulatory support …

Ultra-Low-Field Portable Magnetic Resonance Imaging Feasibility And Safety In Pediatric And Neonatal Extracorporeal Membrane Oxygenation: A Single-Center Year-Long Experience., Jessica S. Wallisch, Asdis Finnsdottir Wagner, John M. Daniel Iv, Allison Taber, Maura Sien, Sarah Foster, Nathan S. Artz, Timothy Zinkus, Hung-Wen Yeh, Jose A. Pineda, Patrick M. Kochanek, Sherwin S. Chan

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Despite improving outcomes, extracorporeal membrane oxygenation (ECMO) remains associated with high rates of acute brain injury, impacting survival and outcomes. Clinical imaging modalities, including computed tomography and standard-field magnetic resonance imaging (≥1.5 Tesla), have either limited early detection of ischemic-type injuries or are incompatible with ECMO, causing diagnostic delays. A Food and Drug Administration-cleared ultra-low-field portable magnetic resonance imaging (pMRI; 0.064 Tesla) has shown promise in acute brain injury detection and use with MRI-unsafe equipment, but pediatric ECMO data are limited.

METHODS: This institutional review board-approved, single-center study was conducted at a quaternary children's hospital. Neonatal and pediatric patients …

Development Of A Longitudinal, Small-Group Pocus Curriculum For Internal Medicine Residents, Shah N. Mahmud Do, Ammar W. Bhatti Do, Ariq Rahman Md, Omar Al Qassab Md, Fraser Mackay Md

The Lahey Journal

Development of a Longitudinal, Small-Group POCUS Curriculum for Internal Medicine Residents

Introduction

Point-of-Care Ultrasound (POCUS) is integral for clinicians to enhance their diagnostic and procedural skills. Unlike Emergency Medicine or Anesthesia training programs, Internal Medicine programs often lack a structured and standardized curriculum. We thus developed a longitudinal and multi-pronged POCUS curriculum aimed at building trainee competency when utilizing ultrasound for diagnostic and procedural work-up.

Methods

The curriculum encompasses the following: basics of ultrasound, ultrasound-guided procedures, thoracic ultrasound/Bed Lung Ultrasound in Emergency (BLUE), and cardiac ultrasound/Focus-Assessed Transthoracic Echocardiography (FATE). These modules were integrated into the residents’ clinic blocks. We utilized …

Global Trends And Forecast Of Cardiovascular Diseases, Cancer, And Shared Risk Factors: Insights From The Gbd 2021, Chieh Y Koo, Bryan Chong, Jayanth Jayabaskaran, Srinithy Nagarajan, Silingga M Jauhari, Yiming Chen, Li L Tan, Anurag Mehta, Muhammad S Khan, Mark Muthiah, Derek Hausenloy, A M Richards, Dennis T Ko, Christian D Mallen, Eric A Secemsky, Mark Y Chan, Paaladinesh Thavendiranathan, Nicholas W S Chew, Mamas A Mamas

Faculty, Staff and Students Publications

Background: Cardiovascular disease (CVD) and cancer share multiple risk factors and are the leading causes of morbidity and death worldwide. This study aims to examine historical and projected trends of the combined CVD-cancer global estimates and their shared risk factors.

Methods: Death and disability-adjusted life years (DALYs) associated with CVDs, cancers, and their risk factors were obtained from the GBD (Global Burden of Disease) 2021 study. Historical estimates from 1990 to 2021 and forecast data from 2025 to 2050 were examined across age groups, regions, sociodemographic index, and sex.

Results: In 2021, CVD-cancer resulted in age-standardized DALY rates of 8009 …

Centrally Inserted Central Catheter Placement Using A Novel, Handheld, Image-Guided, Robotic Device: Results Of Initial Feasibility Trial In Patients, James P Herlihy, William E Cohn, Adrian Ebner

Faculty, Staff and Students Publications

Background: Central venous access devices (CVADs) are an essential and widely used tool for the treatment of the critically ill, patients undergoing major surgery, and for many patients requiring hemodialysis. Automation of centrally inserted central catheters (CICCs) could potentially make CVAD placement safer, more effective, and more accessible. A new device that uses ultrasound image-guided, robotic needle placement, in addition to traditional Seldinger technique, to place a CICC is described.

Objective: The device was used in a small, first-in-human, trial for placing non-tunneled hemodialysis catheters (NTHDCs), in order to determine feasibility of clinical use.

Methods: Consecutive patients requiring a NTHDC, …

Assessing The Efficacy Of The Cam-Icu Scale In Reducing Length Of Stay In The Icu: A Scoping Review, James Ray Davis Mph, Bsn, Rn, Donna Lynch-Smith Dnp, Aprn, Acnp-Bc, Ne-Bc, Cnl

Doctor of Nursing Practice Projects

No abstract provided.

Compromised Pressure-Generating Capacity Of Diaphragmatic Muscle And Its Interaction With The Lower Rib Cage At High Lung Volume During Airway Occlusion, Aladin M Boriek, Noralis Rodriguez-Santiago, Sanghyun Kim, Aubri Ford, Shari Wynd, Rolf D Hubmayr

Faculty, Staff and Students Publications

The pressure generating capacity of the diaphragm is generally thought to be compromised at high lung volume either due to loss of curvature or loss of its membrane tension. At a state of hyperinflation during airway occlusion at total lung capacity, the diaphragmatic muscle is forced to contract from an initial shorter length, the zone of apposition narrows, insertional force on the chest wall is reduced and abdominal compliance falls. We hypothesize that these altered mechanical conditions at high lung volume lead to a loss of the pressure generating capacity that is mediated by excessive muscle shortening rather than loss …

Utilization Of Critical Care U/S Imaging Tools For Assessment Of Cardio-Pulmonary Complications In Extracorporeal Circulatory Support In Patients Post Cardiac Surgery And Ecmo, Mohamed Abdelghany Mohamed Ragab, Suzi Fawazy Mikhael, Amr Elsayed Elhadidy, Ihab Ahmed Abdelmoneim, Khalid Abdulraheem Alfariady, Abdulrahman Ibrahim Alhusil, Mohsen Salah Abdelazeem Mahmoud, Abdelraouf Fahmy, Sarah Hassan Yacoub, Fathia Adel Samter

Journal of the Saudi Heart Association

Background

Extracorporeal life support (ECLS), including extracorporeal membrane oxygenation (ECMO), is increasingly used in patients post-cardiac surgery. However, cardiopulmonary complications and delayed weaning remain common.

Objectives

This study aims to investigate the clinical course of post-cardiac surgery and extracorporeal membrane oxygenation patients using lung ultrasound and echocardiography.

Patient and methods:

This prospective multicenter observational study was conducted in the intensive care units of King Fahd Military Medical Complex, Saudi Arabia, and Cairo University, Egypt. A total of 103 adult patients requiring ECMO or post-cardiac surgery with cardiopulmonary bypass were enrolled.

Result

Postoperative echocardiographic assessment showed significant reductions in EF, TAPSE, …

Erector Spinae Plane Block For Preserving Pulmonary Function In Patients With Traumatic Rib Fractures, Dakoda Farrington

Lynchburg Journal of Medical Science

Rib fractures are frequently seen in trauma patients and are associated with increased mortality, primarily due to pulmonary complications. This study investigates the efficacy of erector spinae plane block (ESPB) in preserving pulmonary function in patients with traumatic rib fractures. A search was conducted in PubMed using the terms "erector spinae plane" AND ("rib fracture" OR "rib fractures") AND trauma. The results were filtered to include studies within the past five years, available full-text articles, and relevancy to this research question. Ultimately, five studies were isolated and included in this review. The methodology for measuring pulmonary function varied between the …

Issue 15: Pulmonary & Critical Care Insider, Bharat Bajantri Md, Sarah Ellsworth-Hoffman Mls, Kristin Lytal Pharmd, Mspgx, Stephanie Subart Pharmd

Critical Care & Pulmonary

Pulmonary & Critical Care Insider Issue 15

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:

2025 Guidelines for ANCA Vasculitis

Airway Scaffolds for Emphysema: Six-Month BREATHE TRIAL Results

Tackling Emphysema-Related Hyperinflation: Scaffolds, Valves, or Vapor? How They Work?

Bactericidal vs. Bacteriostatic Antibiotics in Critically Ill Patients

Modified Cuff Leak Test (CLT) …

Leading Change: Clinical Coaching In The Icu, Megan Jones, Kristen Mayberry

Articles, Abstracts, and Reports

Purpose (What): This project aims to describe how transformational leadership by an ICU nurse leader led to the creation of the clinical coach program. This program supports and retains newly graduated nurses and experienced nurses transitioning into the ICU through collaboration with experienced preceptors.

Relevance/Significance (Why): In 2022, hospital leadership charged the ICU nurse manager with stabilizing the ICU workforce by reducing the reliance on costly temporary travel staff, a priority due to turnover during the COVID pandemic. The nurse manager, concerned about the impact of hiring many novice ICU nurses on patient safety, collaborated with experienced preceptors to develop …