Critical Care Commons^™

Utility Of Peripheral Protein Biomarkers For The Prediction Of Incident Interstitial Features: A Multicentre Retrospective Cohort Study, Samuel Ash, Tracy J Doyle, Bina Choi, Ruben San Jose Estepar, Victor Castro, Nicholas Enzer, Ravi Kalhan, Gabrielle Liu, Russell Bowler, David O Wilson, Raul San Jose Estepar, Ivan O Rosas, George R Washko

Faculty, Staff and Students Publications

INTRODUCTION/RATIONALE: Protein biomarkers may help enable the prediction of incident interstitial features on chest CT.

METHODS: We identified which protein biomarkers in a cohort of smokers (COPDGene) differed between those with and without objectively measured interstitial features at baseline using a univariate screen (t-test false discovery rate, FDR p

RESULTS: In COPDGene, 1305 biomarkers were available and 20 differed between those with and without interstitial features at baseline. Of these, 11 were associated with feature progression over a mean of 5.5 years of follow-up, and of these 4 were available in PLuSS, (angiopoietin-2, matrix metalloproteinase 7, macrophage inflammatory protein 1 …

Effectiveness Of The Introduction To Critical Care In Emergency Medicine Curriculum's Implementation Among Trainees Interested In Intensive Care, Matthew M.T. Carvey

Researchers, Instructors, & Staff Scholarship

Background: Emergency physicians and trainees provide the initial care for critically ill patients. In times of emergency department boarding, this care may extend beyond the first few hours. To meet the needs of this population, a standardized novel critical care curriculum targeting third- and fourth-year medical students was developed. Objectives: We hypothesized that the institution of such a curriculum is feasible and will provide an increased understanding of the underlying critical care principles within this learner population. Methods: We developed a 2-month-long critical care curriculum (February–April) and carried out the course twice from 2022–2023. Our pilot study deployed this curriculum …

A True Bloody Emergency: An Unusual Case Of Thrombotic Thrombocytopenic Purpura, Joshua M. Ninan

Research Symposium

Background: Thrombotic thrombocytopenic purpura (TTP) is a primary thrombotic microangiopathy that is classically characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA). Although rare with an annual incidence of 3.7 cases per one million adults, it is considered a true hematological emergency due to its fatality rate of almost 100% if appropriate treatment is not initiated immediately. This makes it vitally important to identify and treat patients with TTP, a task that becomes unusually challenging in the absence of the disorder’s other characteristically diagnostic clinical features such as mucosal bleeding, fever, or presence of schistocytes.

Case Presentation: A 30-year-old gentleman with …

Painting A Landscape Of Acute Care Nurse Scientist Work, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

Background: Hospitals are increasingly hiring nurse scientists, motivated in part by nursing excellence designations such as Magnet. Magnet designation requires at least three, nurse-led, Institutional Review Board-approved research studies to be conducted in the hospital every four years and for nurses to be actively implementing evidence-based practice (EBP) projects using research evidence. However, clinical nurses often lack the specialized knowledge and training necessary to engage in well-designed research or EBP. Nurse scientists are PhD-prepared individuals with expertise to mentor clinical nurses to navigate the rigor and complexity of creating, implementing, analyzing, and disseminating research and EBP projects. Yet, due …

Acute Care Staff Interactions With Chaplains To Discuss Team Or Personal, Non-Work-Related Stressors, Gary Weisbrich, Sarah Sumner, Teresa Rangel

Providence Nursing Research Conference 2023 – Present

Background: Healthcare staff experience stress from the workplace when providing complex patient care and often may lean on specially trained spiritual support caregivers, or chaplains, for support navigating patient-related stressors. Yet, healthcare staff can also suffer from team-related or personal stressors that, if unresolved, could negatively impact care delivery. Little is known about whether, how often, and which staff may interact with chaplains for emotional support when experiencing non-patient-related stressors originating from work or personal lives.

Purpose: To describe the proportion of individuals who report discussing team-related or personal stressors with chaplains in the past 12 months, and to …

The Long-Term Economic Implications Of Burn Injury For Burn Survivors, Jacob M. Dougherty Bs, Hannan A. Maqsood Mbbs, Zhaohui Fan Md Mph, Stewart C. Wang Md Phd, Mark R. Hemmila Md, Naveen F. Sangji Md Mph

Medical Student Research Symposium

Introduction: The long-term economic implications of burn injury on patients and payors has not been well described. Burn injury can be costly due to prolonged intensive care, wound care, rehabilitation, psychological care, and reconstructive surgery that may be required well after the initial injury. We investigated index and post-acute payor and out-of-pocket (OOP) costs related to burn injury for in-patient care at 30 days, and up to 36 months post-discharge to understand the long-term economic implications for burn survivors.

Methods: An observational cohort study was conducted using a commercial claims database from IBM Watson Health® Marketscan. Patients age ≤ …

Racial Disparities In Palliative Care Utilization In The Covid-19 Pandemic, Margaret S. Bove, Benjamin Huber, Myles Hardeman, Daniel Harris, Areeba Jawed, Amber Comer

Medical Student Research Symposium

BACKGROUND

Palliative care is a vital resource for the critically or terminally ill. It has myriad benefits such as improved quality of life, reduced depressive symptoms, and decreased scarce resource utilization. Self-identified Black/African patients, however, are less likely to utilize advanced care directives or engage in hospice/comfort care measures and are more likely to prefer intensive treatment at the end of life. There is no research, however, on how the COVID-19 pandemic may have affected these trends.

METHODS

A retrospective cohort study of patients who experienced in hospital mortality or in hospital hospice due to COVID-19 between March 2020 – …

An Educational Intervention Differentiating Pressure Injuries From End-Of-Life Wounds, Alicia Perez Varela, Annette Callis

Providence Nursing Research Conference 2023 – Present

Background

End-of-life (EOL) wounds are identified in the literature as Kennedy Terminal Ulcers (KTU), Skin Failure (SF), Trombley-Brennan Terminal Tissue Injury (TB-TTI), and SCALE (Skin Changes at Life’s End). EOL wounds have a similar appearance to pressure injuries (PIs) with a fundamentally different etiology. The misclassification of EOL wounds as PIs results in increased Hospital Acquired Pressure Injuries (HAPI), hospital fines, and less-than-optimal EOL wound management.

Purpose

To examine the effectiveness of an educational intervention on EOL wounds in increasing nurse confidence in providing End-of-Life Care (EOLC) and differentiating PIs from EOL wounds.

Methods

This quasi-experimental study used the 28-item …

Management Of Sepsis With The Quick Sequential Organ Failure Assessment, Jeanna Adams

Providence Nursing Research Conference 2023 – Present

Abstract

Background:

Sepsis can be a source of morbidity and mortality particularly when there are delays in treatment. Early identification may improve time to antimicrobial administration. The quick Sequential Organ Failure Assessment (qSOFA) is an evidence-based practice screening tool that, when in used in conjunction with the Systemic Inflammatory Response Syndrome (SIRS) criteria can enhance recognition and treatment of sepsis. On a suburban Southern California hospital Neurological/Telemetry Unit the qSOFA is automatically calculated in the electronic medical record (EMR) but the bedside nurses were unaware of its availability and value. In addition, sepsis was not being identified in a timely …

An Evidence-Based Skin Management Improvement Project In The Intensive Care Unit, Chelsea Lannoo

Providence Nursing Research Conference 2023 – Present

Background:

Pressure injuries have detrimental effects on patients healing and outcomes and are costly to organizations due to payment programs. Pressure injuries are largely preventable if appropriate interventions are implemented early. In our ICU, post-pandemic monitoring showed increases in hospital-acquired pressure injuries (HAPIs) and consults for medical device HAPIs were increasing. Rounds with wound care department indicated lack of staff compliance with recommended preventive practices. Some issues reported were the use of diapers and excessive linens, failure to use scheduled turning for patients, lack of prevention related to medical devices

Purpose:

The goal of this skin-care management project is …

The Utility Of Interventional Anesthesia, Kylie Daguio, Kiley Jackson, Samantha Boever, Andrew Chang, James Keane, Leonard B. Goldstein

SOMA Faculty Publications

no abstract

Issue 7: Pulmonary & Critical Care Insider, Bharat Bajantri Md, Sarah Ellsworth-Hoffman Mls, Srinivasan Devanathan Md, Manuel Martinez Md

Critical Care & Pulmonary

Pulmonary & Critical Care Insider Issue 7

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. The content resides within critical care and pulmonary related topics and this information is compiled into four main formats.

1. Original Study Summaries: New research publications are read, reviewed, then concisely summarized for clinical interpretation with professional …

Spontaneous Coronary Artery Dissection With Cardiogenic Shock In The United States, Chayakrit Krittanawong, Dhrubajyoti Bandyopadhyay, Neelkumar Patel, Yusuf Kamran Qadeer, Neil Sagar Maitra, Zhen Wang, Mahboob Alam, Samin Sharma, Hani Jneid

Faculty, Staff and Students Publications

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is defined as a non-traumatic separation of the epicardial coronary artery walls that creates a false lumen. SCAD poses a difficult challenge in management, as decisions regarding revascularization and medical management seem to be tailored to the individual patient. We evaluated and compared outcomes based on cardiogenic shock in patients with SCAD utilizing Nationwide Readmissions Database (NRD) between January 1, 2016, to December 30, 2020.

METHODS: We utilized the NRD 2016-2019 to carry out this study. We evaluated demographics (e.g., age, gender), conventional risk factors, comorbidities present on the index admission, and in-hospital outcomes …

Advances And Challenges In Conventional And Modern Techniques For Halal Food Authentication: A Review, Ifrah Usman, Saima Sana, Muhammad Afzaal, Ali Imran, Farhan Saeed, Aftab Ahmed, Yasir Abbas Shah, Muniba Munir, Huda Ateeq, Atka Afzal, Iqra Azam, Afaf Ejaz, Gulzar Ahmad Nayik, Mahbubar Rahman Khan

Faculty, Staff and Student Publications

Food is one of the most necessary needs since human civilization. For Muslims, it is mandatory to consume halal food. From a halal authentication perspective, adulteration of food products is an emerging challenge worldwide. The demand for halal food consumption has resulted in an ever-increasing need for halal product validity. In the market, there are several food products in which actual ingredients and their source are not mentioned on the label and cannot be observed by the naked eye. Commonly nonhalal items include pig derivatives like lard, pork, and gelatin derivatives, dead meats, alcohol, blood, and prohibited animals. Purposely, various …

Airway Management In The Paediatric Difficult Intubation Registry: A Propensity Score Matched Analysis Of Outcomes Over Time, Mary Lyn Stein, Lina Andrea Sarmiento Argüello, Steven J Staffa, Julia Heunis, Chinyere Egbuta, Stephen G Flynn, Sabina A Khan, Stefano Sabato, Brad M Taicher, Franklin Chiao, Adrian Bosenberg, Angela C Lee, H Daniel Adams, Britta S Von Ungern-Sternberg, Raymond S Park, James M Peyton, Patrick N Olomu, Agnes I Hunyady, Annery Garcia-Marcinkiewicz, John E Fiadjoe, Pete G Kovatsis

Faculty, Staff and Student Publications

BACKGROUND: The Paediatric Difficult Intubation Collaborative identified multiple attempts and persistence with direct laryngoscopy as risk factors for complications in children with difficult tracheal intubations and subsequently engaged in initiatives to reduce repeated attempts and persistence with direct laryngoscopy in children. We hypothesised these efforts would lead to fewer attempts, fewer direct laryngoscopy attempts and decrease complications.

METHODS: Paediatric patients less than 18 years of age with difficult direct laryngoscopy were enrolled in the Paediatric Difficult Intubation Registry. We define patients with difficult direct laryngoscopy as those in whom (1) an attending or consultant obtained a Cormack Lehane Grade 3 …

Channel Gating In Kalium Channelrhodopsin Slow Mutants, Oleg A Sineshchekov, Elena G Govorunova, Hai Li, Yumei Wang, John L Spudich

Faculty, Staff and Student Publications

Kalium channelrhodopsin 1 from Hyphochytrium catenoides (HcKCR1) is the first discovered natural light-gated ion channel that shows higher selectivity to K+ than to Na+ and therefore is used to silence neurons with light (optogenetics). Replacement of the conserved cysteine residue in the transmembrane helix 3 (Cys110) with alanine or threonine results in a >1,000-fold decrease in the channel closing rate. The phenotype of the corresponding mutants in channelrhodopsin 2 is attributed to breaking of a specific interhelical hydrogen bond (the “DC gate”). Unlike CrChR2 and other ChRs with long distance “DC gates”, the HcKCR1 structure does …

Risk Of 30-Day All-Cause Readmission In Interstitial Lung Disease Patients After Covid-19: National-Level Data, Ali Vaeli Zadeh, Roshan Dinparastisaleh, Atefeh Vaezi, Debabrata Bandyopadhyay, Israel Rubinstein, Hassan Z Baig, Rafael Calderon-Candelario, Abdolrazagh Hashemi Shahraki, Takeshi Kawasaki, Jesper M Magnusson, Lars-Olof Larsson, Amir Sharafkhaneh, Jose D Herazo-Maya, Augustine S Lee, Mehdi Mirsaeidi

Faculty, Staff and Students Publications

Rationale

Hospital readmission within 30 days poses challenges for healthcare providers, policymakers, and patients because of its impact on care quality, costs, and outcomes. Patients with interstitial lung disease (ILD) are particularly affected by readmission, which is associated with increased morbidity and mortality and reduced quality of life. Because small sample sizes have hindered previous studies, this study seeks to address this gap in knowledge by examining a large-scale dataset.

Objective: To determine the rate and probability of 30-day all-cause readmission and secondary outcomes in patients with coronavirus disease (COVID-19) or ILD admitted to the hospital.

Methods

This study is …

Programs And Processes For Advancing Pediatric Acute Kidney Support Therapy In Hospitalized And Critically Ill Children: A Report From The 26th Acute Disease Quality Initiative (Adqi) Consensus Conference, Tara M Neumayr, Benan Bayrakci, Rahul Chanchlani, Akash Deep, Jolyn Morgan, Ayse Akcan Arikan, Rajit K Basu, Stuart L Goldstein, David J Askenazi

Faculty, Staff and Students Publications

Pediatric acute kidney support therapy (paKST) programs aim to reliably provide safe, effective, and timely extracorporeal supportive care for acutely and critically ill pediatric patients with acute kidney injury (AKI), fluid and electrolyte derangements, and/or toxin accumulation with a goal of improving both hospital-based and lifelong outcomes. Little is known about optimal ways to configure paKST teams and programs, pediatric-specific aspects of delivering high-quality paKST, strategies for transitioning from acute continuous modes of paKST to facilitate rehabilitation, or providing effective short- and long-term follow-up. As part of the 26th Acute Disease Quality Initiative Conference, the first to focus on a …

Fluid Assessment, Fluid Balance, And Fluid Overload In Sick Children: A Report From The Pediatric Acute Disease Quality Initiative (Adqi) Conference, David T Selewski, Matthew F Barhight, Erica C Bjornstad, Zaccaria Ricci, Marcelo De Sousa Tavares, Ayse Akcan-Arikan, Stuart L Goldstein, Rajit Basu, Sean M Bagshaw

Faculty, Staff and Students Publications

BACKGROUND: The impact of disorders of fluid balance, including the pathologic state of fluid overload in sick children has become increasingly apparent. With this understanding, there has been a shift from application of absolute thresholds of fluid accumulation to an appreciation of the intricacies of fluid balance, including the impact of timing, trajectory, and disease pathophysiology.

METHODS: The 26th Acute Disease Quality Initiative was the first to be exclusively dedicated to pediatric and neonatal acute kidney injury (pADQI). As part of the consensus panel, a multidisciplinary working group dedicated to fluid balance, fluid accumulation, and fluid overload was created. Through …

Preoperative Hemodynamics Impact The Benefit Of Fenestration On Fontan Postoperative Length Of Stay, Garick D Hill, Danny T Y Wu, M Eric Ferguson, Saul Flores, Salil Ginde, Kevin D Hill, Michael Johansen, Jane W Newburger, Zhiqian Gao, James F Cnota

Faculty, Staff and Students Publications

BACKGROUND: Utilization of Fontan fenestration varies considerably by center.

OBJECTIVES: Using a multicenter Pediatric Heart Network dataset linking surgical and preoperative hemodynamic variables, the authors evaluated factors associated with use of Fontan fenestration and the impact of fenestration on post-Fontan length of stay (LOS).

METHODS: Patients 2 to 6 years old at Fontan surgery from 2010 to 2020 with catheterizationeffect.

RESULTS: Fenestration was used in 465 of 702 patients (66.2%). Placement of a fenestration was associated with center (range 27%-93% use,

CONCLUSIONS: There is wide center variability in use of Fontan fenestration that is not explained by preoperative hemodynamics. Fenestration …