Critical Care Commons^™

Endogenous But Not Sensory-Driven Activity Controls Migration, Morphogenesis And Survival Of Adult-Born Juxtaglomerular Neurons In The Mouse Olfactory Bulb, Kaizhen Li, Katherine Figarella, Xin Su, Yury Kovalchuk, Jessika Gorzolka, Jonas J Neher, Nima Mojtahedi, Nicolas Casadei, Ulrike B S Hedrich, Olga Garaschuk

Faculty, Staff and Student Publications

The development and survival of adult-born neurons are believed to be driven by sensory signaling. Here, in vivo analyses of motility, morphology and Ca²⁺ signaling, as well as transcriptome analyses of adult-born juxtaglomerular cells with reduced endogenous excitability (via cell-specific overexpression of either Kv1.2 or Kir2.1 K⁺ channels), revealed a pronounced impairment of migration, morphogenesis, survival, and functional integration of these cells into the mouse olfactory bulb, accompanied by a reduction in cytosolic Ca²⁺ fluctuations, phosphorylation of CREB and pCREB-mediated gene expression. Moreover, K⁺ channel overexpression strongly downregulated genes involved in neuronal migration, differentiation, and morphogenesis …

Association Of Symptoms And Mode Of Transportation To Emergency Department In Patients With Acute Coronary Syndrome, Leslie L. Davis, Thomas P. Mccoy, Barbara Riegel, Sharon Mckinley, Lynn V. Doering, Debra K. Moser

UK CARES Faculty Publications

Background: Patients with acute coronary syndrome (ACS) with symptoms matching their expectations of a heart attack are more likely to use emergency medical services (EMS) than not.

Objective: To determine whether presenting symptom clusters are associated with EMS use in ACS patients and if EMS use or symptom clusters are associated with prehospital delay.

Methods: This secondary analysis used data from the PROMOTION trial, a randomized clinical trial that enrolled 3522 subjects with a history of or at risk for ACS from 5 sites in the United States, Australia, and New Zealand. Subjects were randomized to usual care or an …

Medical Device-Related Pressure Injury (Mdrpi) Prevention In The Intensive Care Unit (Icu): An Evidence Based Practice Quality Improvement Project, Sana Shah

DNP Projects

Introduction: All intensive care unit (ICU) patients utilize various medical devices for care and treatment, placing them at high-risk for medical device-related pressure injuries (MDRPIs), which can lead to life-threatening infections, wounds/scars, and consumption of additional time and products to rectify these issues. Lack of appropriate decompression measures and improper bedside handoff report was recognized in the ICU at a hospital in Connecticut (CT).

Method: A literature search using CINAHL, MEDLINE, and the Cochrane Database of Systematic Reviews was conducted, restricting the search to the period between 2018-2022. The keywords searched were: “pressure injuries,” “adult patients,” “intensive care …

Asthma And Cardiovascular Disease: A Bidirectional Association?, Muhammad Adrish, Nicola A Hanania

Faculty, Staff and Students Publications

No abstract provided.

Mortality Patterns Associated With Central Sleep Apnea Among Veterans: A Large, Retrospective, Longitudinal Report, Ritwick Agrawal, Amir Sharafkhaneh, Daniel J Gottlieb, Sara Nowakowski, Javad Razjouyan

Faculty, Staff and Students Publications

Rationale

Central sleep apnea (CSA) is associated with high mortality. Current knowledge stems from studies with limited sample size (fewer than 100 subjects) and in homogeneous populations such as heart failure (HF).

Objectives

To address this knowledge gap, we compared the mortality pattern and time to death between the CSA and obstructive sleep apnea (OSA) patients in the large Veterans Health Administration patient population using the big data analytic approach.

Methods

This is a retrospective study using national Veterans Health Administration electronic medical records from October 1, 1999, through September 30, 2020. We grouped the patients with underlying sleep disorders …

Electrical Stimulation To Regain Lower Extremity Muscle Perfusion And Endurance In Patients With Post-Acute Sequelae Of Sars Cov-2: A Randomized Controlled Trial, Alejandro Zulbaran-Rojas, Myeounggon Lee, Rasha O Bara, Areli Flores-Camargo, Gil Spitz, M G Finco, Amir Behzad Bagheri, Dipaben Modi, Fidaa Shaib, Bijan Najafi

Faculty, Staff and Students Publications

Muscle deconditioning and impaired vascular function in the lower extremities (LE) are among the long‐term symptoms experienced by COVID‐19 patients with a history of severe illness. These symptoms are part of the post‐acute sequelae of Sars‐CoV‐2 (PASC) and currently lack evidence‐based treatment. To investigate the efficacy of lower extremity electrical stimulation (E‐Stim) in addressing PASC‐related muscle deconditioning, we conducted a double‐blinded randomized controlled trial. Eighteen (n = 18) patients with LE muscle deconditioning were randomly assigned to either the intervention (IG) or the control (CG) group, resulting in 36 LE being assessed. Both groups received daily 1 h E‐Stim …

Association Of Glucose-6-Phosphate Dehydrogenase Deficiency With Outcomes In Us Veterans With Covid-19, Sarah H Elsea, Javad Razjouyan, Kyung Min Lee, Julie A Lynch, Sharyl Martini, Lavannya M Pandit

Faculty, Staff and Students Publications

IMPORTANCE: The underlying biological risk factors for severe outcome due to SAR-CoV-2 infection are not well defined.

OBJECTIVE: To determine the association between glucose-6-phosphate dehydrogenase (G6PD) deficiency and severity of COVID-19.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included analysis of 24 700 veterans with G6PD enzyme testing prior to January 1, 2020, obtained through the US Veterans Health Administration national databases. These veterans were cross-referenced with the Veterans Administration COVID-19 Shared Data Resource for SARS-CoV-2 testing from February 15, 2020, to January 1, 2021. The final study population consisted of 4811 veterans who tested positive for SARS-CoV-2. Statistical …

Linoleic Acid Improves Piezo2 Dysfunction In A Mouse Model Of Angelman Syndrome, Luis O Romero, Rebeca Caires, A Kaitlyn Victor, Juanma Ramirez, Francisco J Sierra-Valdez, Patrick Walsh, Vincent Truong, Jungsoo Lee, Ugo Mayor, Lawrence T Reiter, Valeria Vásquez, Julio F Cordero-Morales

Faculty, Staff and Student Publications

Angelman syndrome (AS) is a neurogenetic disorder characterized by intellectual disability and atypical behaviors. AS results from loss of expression of the E3 ubiquitin-protein ligase UBE3A from the maternal allele in neurons. Individuals with AS display impaired coordination, poor balance, and gait ataxia. PIEZO2 is a mechanosensitive ion channel essential for coordination and balance. Here, we report that PIEZO2 activity is reduced in Ube3a deficient male and female mouse sensory neurons, a human Merkel cell carcinoma cell line and female human iPSC-derived sensory neurons with UBE3A knock-down, and de-identified stem cell-derived neurons from individuals with AS. We find that loss …

Direct Costs Of Second Aqueous Shunt Implant Versus Transscleral Cyclophotocoagulation (The Assists Trial), Jack X Ma, Alice Z Chuang, Robert M Feldman, Steve L Mansberger, Angelo P Tanna, Lauren S Blieden, Daniel Shoham, Nicholas P Bell, Ronald L Gross, Louis R Pasquale, David S Greenfield, Jeffrey M Liebmann, Robert N Weinreb

Faculty, Staff and Student Publications

PRCIS: The cost of cyclophotocoagulation is less than the cost of a second glaucoma drainage device.

PURPOSE: To compare the total direct costs of implantation of a second glaucoma drainage device (SGDD) with transscleral cyclophotocoagulation (CPC) for patients with inadequately controlled intraocular pressure (IOP) reduction, despite the presence of a preexisting glaucoma drainage device in the ASSISTS clinical trial.

METHODS: We compared the total direct cost per patient, including the initial study procedure, medications, additional procedures, and clinic visits during the study period. The relative costs for each procedure during the 90-day global period and the entire study period were …

Urine Complement Factor Ba Is Associated With Aki In Critically Ill Children, Erin K Stenson, Charles L Edelstein, Zhiying You, Shinobu Miyazaki-Anzai, Joshua M Thurman, Bradley P Dixon, Michael Zappitelli, Stuart L Goldstein, Ayse Akcan Arikan, Jessica Kendrick

Faculty, Staff and Students Publications

KEY POINTS: Complement activation, specifically factor B, is implicated in AKI pathogenesis in animal models. Urine Ba (an activation fragment of factor B) was significantly higher in critically ill children with stage 3 AKI and sepsis-AKI. If larger studies show similar association between urine Ba and AKI severity, clinical trials of factor B inhibition are warranted.

BACKGROUND:: Critically ill children with AKI have high morbidity and mortality rates and lack treatment options. Complement activation is implicated in AKI pathogenesis, which could be treated with complement-targeted therapeutics. We assessed for an association between urine Ba, an activation fragment of the alternative …

Systemic Inflammatory Markers And Eeg Features Of Children With Fires Receiving Anakinra, Yi-Chen Lai, Gabriella Abou-El-Kheir, Thao Nguyen, Margo Hanerhoff, James J Riviello, Eyal Muscal

Faculty, Staff and Students Publications

In a retrospective case series of 10 children with cryptogenic FIRES, we sought to describe the early clinical course and potential biomarkers following anakinra initiation. Six children achieved anesthetic withdrawal within 3 weeks of therapy and one in week four. Of the available cEEG (six children), CRP (10 children), and serum cytokine (six children) studies, there were temporal changes in highly epileptiform bursts (observed in three children), CRP, IL-6, and IL-10 levels that might parallel clinical progression. These observations may represent candidate biomarkers for monitoring clinical progression and therapeutic interventions including anakinra, which merits further investigation in future studies.

Community-Onset Bacterial Coinfection In Children Critically Ill With Severe Acute Respiratory Syndrome Coronavirus 2 Infection, Kristin L Moffitt, Mari M Nakamura, Cameron C Young, Margaret M Newhams, Natasha B Halasa, J Nelson Reed, Julie C Fitzgerald, Philip C Spinella, Vijaya L Soma, Tracie C Walker, Laura L Loftis, Aline B Maddux, Michele Kong, Courtney M Rowan, Charlotte V Hobbs, Jennifer E Schuster, Becky J Riggs, Gwenn E Mclaughlin, Kelly N Michelson, Mark W Hall, Christopher J Babbitt, Natalie Z Cvijanovich, Matt S Zinter, Mia Maamari, Adam J Schwarz, Aalok R Singh, Heidi R Flori, Shira J Gertz, Mary A Staat, John S Giuliano, Saul R Hymes, Katharine N Clouser, John Mcguire, Christopher L Carroll, Neal J Thomas, Emily R Levy, Adrienne G Randolph

Faculty, Staff and Students Publications

BACKGROUND: Community-onset bacterial coinfection in adults hospitalized with coronavirus disease 2019 (COVID-19) is reportedly uncommon, though empiric antibiotic use has been high. However, data regarding empiric antibiotic use and bacterial coinfection in children with critical illness from COVID-19 are scarce.

METHODS: We evaluated children and adolescents agedadmission, we adjudicated whether patients had community-onset bacterial coinfection. We compared demographic and clinical characteristics of those who did and did not (1) receive antibiotics and (2) have bacterial coinfection early in admission. Using Poisson regression models, we assessed factors associated with these outcomes.

RESULTS: Of the 532 patients, 63.3% received empiric antibiotics, but …

Complications Of Cardiopulmonary Bypass From An Anesthesia Perspective: A Clinical Review, Alex Roberts, Elizabeth C. Duncan, Paul Hargrave, David Redding Kingery, Josh Barnes, Derek L. Horstemeyer, Russell F. Stahl

HCA Healthcare Journal of Medicine

Cardiopulmonary bypass (CPB) is frequently used for open heart surgery and other procedures that utilize temporary substitution or support of heart and lung function. While it is widely accepted as the predominant method to carry out these procedures, it is not without possible complications. CPB can be seen as the ultimate “team sport” as it includes and is dependent on contributions from multiple professionals including anesthesiologists, cardiothoracic surgeons, and perfusion technicians. In this clinical review paper, we examine possible complications of CPB, primarily from the perspective of the anesthesiologist, and how to troubleshoot them if they arise, which often requires …

Reducing Inequities In Maternal And Child Health In Rural Guatemala Through The Cbio+ Approach Of Curamericas: 2. Study Site, Design, And Methods, Henry B. Perry, Mario Valdez, Stanley Blanco, Ramiro Llanque, Shayanne Martin, Jason Lambden, Corey Gregg, Kaitlin Leach, Elijah Olivas, Barbara Muffoletto, Jacqueline Wallace, Nina Modanlo, Erin Pfeiffer, Carey C. Westgate, Breanne Lesnar, Ira Stollak

School of Medicine Faculty Publications

Background The Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, included implementation research designed to assess the effectiveness of an approach referred to as CBIO+ , composed of: (1) the Census- Based, Impact-Oriented (CBIO) Approach, (2) the Care Group Approach, and (3) the Community Birthing Center Approach. This is the second paper in a supplement of 10 articles describing the implementation research and its findings. Paper 1 describes CBIO+ , the Project Area, and how the Project was implemented. Objective This paper describes the implementation research design and details of how it was carried out. Methods We reviewed the original implementation …

Heart Rate Variability (Hrv) Loss And Other Ekg Changes Prior To A Cardiopulmonary Event In Children Admitted To The Icu At A Tertiary Care Children’S Hospital, Sabrina R. Orta, Shreya Chandran, Utpal Bhalala

MEDI 9331 Scholarly Activities Clinical Years

Introduction: HRV and EKG changes prior to cardiopulmonary events (CPEs) occurring in children in intensive care unit (ICU) settings is not well documented. We assess if substantial losses of HRV and/or other EKG changes, if any, may be detectable prior to a CPE occurring in children admitted to the ICU.

Methods: A prospective observational cohort study was conducted in the ICU from January to February of 2023 at Driscoll Children’s Hospital. A “CPE” was defined as a change in the clinical status of a child warranting a cardiopulmonary intervention. Demographic and clinical data from each patient was collected, …

Development Of A Rn Clinical Coach Program To Improve Retention Of Icu Residents And Fellows, Megan Jones, Sarah Sumner, Kristen Mayberry

Providence Nursing Research Conference 2023 – Present

Development of a RN Clinical Coach program to improve retention of ICU residents and fellows

Background:
The COVID-19 pandemic caused contributed to significant increases in ICU nurse turnover. To restore the ICU nursing workforce and rebuild a healthy work environment, evidence-based strategies are needed to provide social support and ongoing clinical skills development for large cohorts of ICU residents and fellows.

Purpose:
The purpose of the Clinical Coach program was to increase retention of ICU residents and fellows and foster a healthy work environment at a ministry in Southern California.

Methods:
In September 2021 the ICU manager at Providence Saint …

Comprehensive And Multidisciplinary Approach To Icu Liberation, Frederliza (Deng) M. Flores, Jason Kurian

Providence Nursing Research Conference 2023 – Present

No abstract provided.

The Impact Of Procalcitonin In Assessing Outcomes In Pediatrics Severe Trauma Cases: A Three-Year Experience From A Tertiary Hospital, Waleed H. Albuali

BioMedicine

Background Although procalcitonin levels are raised in patients with systemic inflammation, its usage in pediatric patients, particularly those in the intensive care unit who are most susceptible to sepsis. Methods It is a retrospective research study that included pediatric patients aged more than two weeks who were brought to the King Fahd Hospital of the University's PICU owing to serious trauma or post-acute postoperative occurrences from January 2017 to December 2019. At 24 hours after admission, data such as age, gender, comorbidities, trauma severity as measured by the Injury Severity Score, and PRISM III score were collected. Results Following a …

Journal Of Shock And Hemodynamics, Vol. I, Iss. 2 (Print Version)

Journal of Shock and Hemodynamics

The print version of Volume I, Issue 2 of the Journal of Shock and Hemodynamics was published in February 2023. The PDF of the print version is downloadable here.

Variance In Management Of Extracorporeal Membrane Oxygenation-Associated Fibrin Sheaths At A Single Institution, Alexandra Tedesco Md, Monica Majumdar Md, Jamel P. Ortoleva Md, Christine Nayar Md, Masashi Kawabori Md, Payam Salehi Md, Ali Irshad Md

Abington Jefferson Health Papers

Objective: Extracorporeal membrane oxygenation (ECMO) support for patients with cardiac or respiratory failure has been increasingly used by advanced critical care practitioners. The thromboembolic complications of ECMO have been extensively discussed and researched; however, research and discussion on the development, risks, and management of cannulae-associated fibrin sheaths are lacking.

Methods: Institutional review board approval was not required. We have presented three cases detailing the identifi- cation and individualized management of ECMO-associated fibrin sheaths at our institution. The three patients provided written informed consent for the report of their case details and imaging studies.

Results: Of our three patients with ECMO-associated …