7 research outputs found
Effect of pressure support ventilation and positive end expiratory pressure on the rapid shallow breathing index in intensive care unit patients
No full textObjective: We compared rapid shallow breathing index (RSBI) values under various ventilatory support settings prior to extubation. Design and setting: Prospective study in the intensive care unit at a university hospital. Patients: Thirty six patients ready for extubation. Interventions: Patients were enrolled when receiving pressure support ventilation (PSV) of 5 cmH2O, PEEP of 5 cmH2O, and FIO2 of 40percent (PS). Subsequently each patient received a trial of PSV of 0 cmH2O, PEEP of 5 cmH 2O, and FIO2 of 40percent (CPAP), a trial of PSV of 0 cmH 2O, PEEP of 5 cmH2O and FIO2 of 21percent (CPAP-R-A), and a 1-minute spontaneously breathing room air trial off the ventilator (T-piece). Trials were carried out in random order. Measurements and results: Respiratory frequency (f) and tidal volume (VT) were measured during PS, CPAP, CPAP-R-A, and T-piece in all patients. RSBI (f-VT) was determined for each patient under all experimental conditions, and the average RSBI was compared duringPS, CPAP, CPAP-R-A, and T-piece. RSBI was significantly smaller during PS (46 ± 8bpm-l), CPAP (63 ± 13bpm-l) and CPAP-R-A (67 ± 14bpm-l) vs. T-piece (100 ± 23bpm-l). There was no significant difference in RSBI between CPAP and CPAP-R-A. RSBI during CPAP and CPAP-R-A were significantly smaller than RSBI during T-piece. In all patients RSBI values were less than 105 bpm-l during PS, CPAP, and CPAP-R-A. However, during T-piece the RSBI increased to greater than 105 bpm-l in 13 of 36 patients. Conclusions: In the same patient the use of PSV and-or PEEP as low as 5 cmH2O can influence the RSBI. In contrast, changes in FIO 2 may have no effect on the RSBI. © 2007 Springer-Verlag.Acosta P, 2007, CRIT CARE CLIN, V23, P251, DOI 10.1016-j.ccc.2006.12.012; BROCHARD L, 1994, AM J RESP CRIT CARE, V150, P896; Calzia E, 2004, CRIT CARE, V8, P308, DOI 10.1186-cc2914; Chao DC, 2007, RESPIR CARE, V52, P159; Cohen JD, 2006, CRIT CARE MED, V34, P682, DOI 10.1097-01.CCM.0000201888.32663.6A; El-Khatib MF, 2002, CHEST, V121, P475, DOI 10.1378-chest.121.2.475; EPSTEIN SK, 1995, AM J RESP CRIT CARE, V152, P545; Eskandar N, 2007, CRIT CARE CLIN, V23, P263, DOI 10.1016-j.ccc.2006.12.002; HABERTHUR C, 2005, CRIT CARE, V9, P407; Hoo GWS, 2002, CHEST, V121, P1947; Johannigman JA, 1997, SURGERY, V122, P737, DOI 10.1016-S0039-6060(97)90081-7; Khamiees Mohammad, 2002, Respir Care, V47, P150; Krieger BP, 1997, CHEST, V112, P1029, DOI 10.1378-chest.112.4.1029; Kuo PH, 2006, J FORMOS MED ASSOC, V105, P390; MacIntyre NR, 2001, CHEST, V120, p375S, DOI 10.1378-chest.120.6_suppl.375S; PESENTI A, 1993, CHEST, V103, P1185, DOI 10.1378-chest.103.4.1185; Petrini Marcy F., 1998, Biomedical Instrumentation and Technology, V32, P273; Saura Pilar, 2002, Respir Care, V47, P279; SYDOW M, 1995, INTENS CARE MED, V21, P887, DOI 10.1007-BF01712329; Tehrani Fleur, 2002, J Clin Monit Comput, V17, P367, DOI 10.1023-A:1024261021473; Tobin MJ, 2006, INTENS CARE MED, V32, P2002, DOI 10.1007-s00134-006-0439-4; Toth I, 2007, CRIT CARE MED, V35, P787, DOI 10.1097-01.CCM.0000257330.54882.BE; Vitacca M, 2004, CHEST, V126, P851, DOI 10.1378-chest.126.3.851; YANG KL, 1991, NEW ENGL J MED, V324, P1445, DOI 10.1056-NEJM19910523324210121211
Critical care clinicians' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia
No full textBackground Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different initiatives for the prevention of ventilator-associated pneumonia have been developed and recommended. Objective To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-based guidelines for preventing ventilator-associated pneumonia. Methods Ten physicians, 41 nurses, and 18 respiratory therapists working in the intensive care unit of a major tertiary care university hospital center completed an anonymous questionnaire on 9 nonpharmacological guidelines for prevention of ventilator-associated pneumonia. Results The mean (SD) total scores of physicians, nurses, and respiratory therapists were 80.2percent (11.4percent), 78.1percent (10.6percent), and 80.5percent (6percent), respectively, with no significant differences between them. Furthermore, within each category of health care professionals, the scores of professionals with less than 5 years of intensive care experience did not differ significantly from the scores of professionals with more than 5 years of intensive care experience. Conclusions A health care delivery model that includes physicians, nurses, and respiratory therapists in the intensive care unit can result in an adequate level of knowledge on evidence-based nonpharmacological guidelines for the prevention of ventilator-associated pneumonia. © 2009 American Association of Critical-Care Nurses.Biancofiore G, 2007, MINERVA ANESTESIOL, V73, P129; Blot SI, 2007, INTENS CARE MED, V33, P1463, DOI 10.1007-s00134-007-0705-0; CHASTER J, 2002, AM J RESP CRIT CARE, V65, P867; Depuydt P, 2006, CURR OPIN PULM MED, V12, P192; Heyland DK, 2002, J CRIT CARE, V17, P161, DOI 10.1053-jcrc.2002.35814; Kaynar AM, 2007, RESP CARE, V52, P1687; Labeau S, 2007, AM J CRIT CARE, V16, P371; Muscedere J, 2008, J CRIT CARE, V23, P126, DOI 10.1016-j.jcrc.2007.11.014; Rello J, 2002, CHEST, V122, P2115, DOI 10.1378-chest.122.6.2115; Ricart M, 2003, CRIT CARE MED, V31, P2693, DOI 10.1097-01.CCM.0000094226.05094.AA; Safdar N, 2005, CRIT CARE MED, V33, P2184, DOI 10.1097-01.CCM.0000181731.53912.D9; Sierra R, 2005, CHEST, V128, P1667, DOI 10.1378-chest.128.3.1667; Sinuff T, 2008, J CRIT CARE, V23, P118, DOI 10.1016-j.jcrc.2007.11.013; Tolentino-DelosReyes AF, 2007, AM J CRIT CARE, V16, P20149
Metabolic and respiratory variables during pressure support versus synchronized intermittent mandatory ventilation
No full textBackground: Mechanically ventilated patients interact and respond differently to different modes of ventilatory support. Objectives: To assess changes in metabolic and respiratory variables during equivalent changes with either pressure support ventilation (PSV) or volume-cycled synchronized intermittent mandatory ventilation (SIMV) in non-tracheostomized patients without known obstructive pulmonary disease receiving short-term mechanical ventilation in the intensive care unit. Methods: Fourteen patients receiving volume-cycled SIMV at 12 breaths-min (SIMV100percent) were included in the study. The PSV level (PSV100percent) resulting in a minute volume and respiratory rate equivalent to that during SIMV100percent was determined for each patient. Then each patient underwent trials at 66percent and 33percent of initial ventilator support with volume-cycled SIMV (SIMV66percent and SIMV 33percent) and PSV (PSV66percent and PSV33percent) in random order. At the end of each trial, oxygen consumption (V̇O2), carbon dioxide production (V̇CO2), measured energy expenditures (MEE), peak inspiratory flow, total respiratory frequency, tidal volume, minute ventilation, occlusion pressure (P0.1) and inspiratory duty cycle (Ti-Ttot) were measured. Results: There were smaller changes in V̇O2, V̇CO2 and MEE when equivalent changes were applied with PSV (15.7 ± 4.4; 12.5 ± 2.2 and 15 ± 3.5percent) compared with volume-cycled SIMV (32.7 ± 7.7; 23 ± 5.2 and 30.7 ± 6.8percent; p andlt; 0.05). P0.1 and T i-Ttot were significantly smaller during PSV (2.64 ± 0.28 and 0.38 ± 0.03 cm H2O) than volume-cycled SIMV (4.01 ± 0.21 and 0.43 ± 0.02 cm H2O; p andlt; 0.05). Conclusions: Changes in the level of PSV resulted in smaller changes in metabolic and respiratory variables compared with equivalent changes in the level of volume-cycled SIMV support. PSV may be more suitable for progressive respiratory muscle reloading. Copyright © 2008 S. Karger AG.BROCHARD L, 1994, AM J RESP CRIT CARE, V150, P896; BROCHARD L, 1989, AM REV RESPIR DIS, V139, P513; Corne S, 1997, AM J RESP CRIT CARE, V156, P304; ESTEBAN A, 1995, NEW ENGL J MED, V332, P345, DOI 10.1056-NEJM199502093320601; Esteban A, 2002, JAMA-J AM MED ASSOC, V287, P345, DOI 10.1001-jama.287.3.345; GIULIANI R, 1995, AM J RESP CRIT CARE, V151, P1; IMSAND C, 1994, ANESTHESIOLOGY, V80, P13, DOI 10.1097-00000542-199401000-00006; Leung P, 1997, AM J RESP CRIT CARE, V155, P1940; MACINTYRE NR, 1991, CHEST, V99, P134, DOI 10.1378-chest.99.1.134; PUDDY A, 1992, AM REV RESPIR DIS, V146, P787; Putensen Christian, 2002, Curr Opin Crit Care, V8, P51, DOI 10.1097-00075198-200202000-00009; Tejeda M, 1997, CHEST, V111, P1322, DOI 10.1378-chest.111.5.1322; TISSOT S, 1995, INTENS CARE MED, V21, P149, DOI 10.1007-BF01726538; Tobin MJ, 2001, AM J RESP CRIT CARE, V163, P1059; VANDEGRAAFF WB, 1991, CHEST, V100, P1082, DOI 10.1378-chest.100.4.1082; WARD ME, 1988, ANESTHESIOLOGY, V69, P29, DOI 10.1097-00000542-198807000-0000554
The mediating role of residents' wellbeing between program leadership and quality of care: A cross-sectional study
No full textBackground Research has shown that organizational leadership and support affect organizational outcomes in several sectors, including healthcare. However, less is known about how organizational leadership might influence the wellbeing of clinical trainees as well as the quality of their patient care practices. Objectives This study examined the mediating effects of burnout and engagement between program director-resident relationship quality and residents' reported quality of care, and the moderating effect of perceived departmental support. Methods The authors conducted a cross-sectional study in September 2020, using a 41-item questionnaire, among 20 residency programs in an academic medical center in Lebanon. Measures included program director-resident relationship quality, perceived departmental support, burnout subcomponents, engagement, and self-reported quality of care. Ordinary least squares regression was used to conduct parallel mediation and moderated mediation analyses using SPSS macro-PROCESS, to assess the strength and direction of each of the proposed associations. Results A total of 95/332 (28.6%) residents responded. Results revealed that program director-resident relationship quality had a significant indirect effect on residents' suboptimal patient care practices and attitudes towards patients, through at least one of the wellbeing dimensions (p < .05). Perceived departmental support did not play a dominant role over program director-resident relationship quality, and thus did not influence any of the mediated relationships. Conclusion Our study adds a new dimension to the body of literature suggesting that program directorresident relationship quality plays an important role in promoting residents' wellbeing and achieving important clinical health outcomes. Such findings imply that the quality of program director-resident relationship could be an important component of residents' wellbeing and patient safety. If further research confirms these associations, it will become imperative to determine what interventions might improve the quality of relationships between program directors and residents. © 2021 Msheik-El Khoury et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Smoking and the risk of mortality and vascular and respiratory events in patients undergoing major surgery
No full textIMPORTANCE: The effects of smoking on postoperative outcomes in patients undergoing major surgery are not fully established. The association between smoking and adverse postoperative outcomes has been confirmed. Whether the associations are dose dependent or restricted to patients with smoking-related disease remains to be determined. OBJECTIVE: To evaluate the association between current and past smoking on the risk of postoperative mortality and vascular and respiratory events in patients undergoing major surgery. DESIGN: Cohort study using the American College of Surgeons National Surgical Quality Improvement Program database.We obtained data on smoking history, perioperative risk factors, and 30-day postoperative outcomes.We assessed the effects of current and past smoking (1 year prior) on postoperative outcomes after adjustment for potential confounders and effect mediators (eg, cardiovascular disease, chronic obstructive pulmonary disease, and cancer).We also determined whether the effects are dose dependent through analysis of pack-year quintiles. SETTING AND PARTICIPANTS: A total of 607 558 adult patients undergoing major surgery in non-Veterans Affairs hospitals across the United States, Canada, Lebanon, and the United Arab Emirates during 2008 and 2009. MAIN OUTCOMES AND MEASURES: The primary outcome measurewas 30-day postoperative mortality; secondary outcome measures included arterial events (myocardial infarction or cerebrovascular accident), venous events (deep vein thrombosis or pulmonary embolism), and respiratory events (pneumonia, unplanned intubation, or ventilator requirement 48 hours). RESULTS: The sample included 125 192 current (20.6percent) and 78 763 past (13.0percent) smokers. Increased odds of postoperative mortality were noted in current smokers only (odds ratio, 1.17 [95percentCI, 1.10-1.24]). When we compared current and past smokers, the adjusted odds ratios were higher in the former for arterial events (1.65 [95percentCI, 1.51-1.81] vs 1.20 [1.09-1.31], respectively) and respiratory events (1.45 [1.40-1.51] vs 1.13 [1.08-1.18], respectively). No effects on venous events were observed. The effects of smoking mediated through smoking-related disease were minimal. The increased adjusted odds of mortality in current smokers were evident from a smoking history of less than 10 pack-years, whereas the effects of smoking on arterial and respiratory events were incremental with increased pack-years. CONCLUSIONS AND RELEVANCE: Smoking cessation at least 1 year before major surgery abolishes the increased risk of postoperative mortality and decreases the risk of arterial and respiratory events evident in current smokers. These findings should be carried forward to evaluate the value and cost-effectiveness of intervention in this setting. Our study should increase awareness of the detrimental effects of smoking - and the benefits of its cessation - on morbidity and mortality in the surgical setting.Al-Sarraf N, 2008, THORAC CARDIOV SURG, V56, P449, DOI 10.1055-s-2008-1038693; Al-Sarraf N, 2008, ANN THORAC SURG, V86, P517, DOI 10.1016-j.athoracsur.2008.03.070; American College of Surgeons, 2009, ACS NSQIP US GUID 20; Arabaci U, 2003, JPN HEART J, V44, P61, DOI 10.1536-jhj.44.61; Caponnetto P, 2011, EUR J CLIN INVEST, V41, P616, DOI 10.1111-j.1365-2362.2010.02449.x; Celermajer DS, 1996, NEW ENGL J MED, V334, P150, DOI 10.1056-NEJM199601183340303; Delgado-Rodriguez M, 2003, INFECT CONT HOSP EP, V24, P37; Dhillon NK, 2009, TOXICOL APPL PHARM, V237, P22, DOI 10.1016-j.taap.2009.02.021; Drannik AG, 2004, AM J RESP CRIT CARE, V170, P1164, DOI 10.1164-rccm.200311-1521OC; Finan KR, 2005, AM J SURG, V190, P676, DOI 10.1016-j.amjsurg.2005.06.041; Fink AS, 2002, ANN SURG, V236, P344, DOI 10.1097-01.SLA.0000027082.79556.55; Fiore MC, 2012, NEW ENGL J MED, V366, P1172, DOI 10.1056-NEJMp1115176; Garey KW, 2004, CHEST, V125, P22, DOI 10.1378-chest.125.1.22; Godtfredsen NS, 2011, CLIN RESPIR J, V5, P187, DOI 10.1111-j.1752-699X.2011.00262.x; Hawn MT, 2011, ANN SURG, V254, P914, DOI 10.1097-SLA.0b013e31822d7f81; HOLLENBERG M, 1992, JAMA-J AM MED ASSOC, V268, P205, DOI 10.1001-jama.268.2.205; Johnson HM, 2010, J AM COLL CARDIOL, V55, P1988, DOI 10.1016-j.jacc.2010.03.002; Johnson RG, 2007, J AM COLL SURGEONS, V204, P1188, DOI 10.1016-j.jamcollsurg.2007.02.070; Khuri SF, 2007, J AM COLL SURGEONS, V204, P1089, DOI 10.1016-j.jamcollsurg.2007.03.028; Kuri M, 2005, ANESTHESIOLOGY, V102, P892, DOI 10.1097-00000542-200505000-00005; Lindstrom D, 2008, ANN SURG, V248, P739, DOI 10.1097-SLA.0b013e3181889d0d; Livingston EH, 2006, J AM COLL SURGEONS, V203, P625, DOI 10.1016-j.jamcollsurg.2006.07.006; Mason DP, 2009, ANN THORAC SURG, V88, P362, DOI 10.1016-j.athoracsur.2009.04.035; Mastracci TM, 2011, J AM COLL SURGEONS, V212, P1094, DOI 10.1016-j.jamcollsurg.2011.03.015; Mattison Sue, 2006, Intensive Crit Care Nurs, V22, P329, DOI 10.1016-j.iccn.2006.03.003; Moller AM, 2002, LANCET, V359, P114, DOI 10.1016-S0140-6736(02)07369-5; Musallam KM, 2011, LANCET, V378, P1396, DOI 10.1016-S0140-6736(11)61381-0; Myles PS, 2002, ANESTHESIOLOGY, V97, P842, DOI 10.1097-00000542-200210000-00015; Pomp ER, 2008, AM J HEMATOL, V83, P97, DOI 10.1002-ajh.21059; Rock Peter, 2003, Curr Opin Anaesthesiol, V16, P123, DOI 10.1097-00001503-200304000-00004; Saetta M, 2000, AM J RESP CRIT CARE, V161, P1016; Shi Y, 2010, ANESTHESIOLOGY, V112, P102, DOI 10.1097-ALN.0b013e3181c61cf9; Sorensen LT, 2003, ANN SURG, V238, P1, DOI 10.1097-01.SLA.0000074980.39700.31; Sørensen L T, 2007, Hernia, V11, P327, DOI 10.1007-s10029-007-0229-0; Sørensen Lars Tue, 2003, Colorectal Dis, V5, P347, DOI 10.1046-j.1463-1318.2003.00450.x; Tapson Victor F, 2005, Proc Am Thorac Soc, V2, P71, DOI 10.1513-pats.200407-038MS; Thomsen T, 2010, COCHRANE DB SYST REV, DOI 10.1002-14651858.CD002294.pub3; Turan A, 2011, ANESTHESIOLOGY, V114, P837, DOI 10.1097-ALN.0b013e318210f560; Utley JR, 1996, J CARDIAC SURG, V11, P377, DOI 10.1111-j.1540-8191.1996.tb00067.x; Varela-Carver Anabel, 2010, Curr Pharm Des, V16, P255168
Structure and evaluation of a residency research program in a university hospital
No full textBackground: Most academic medical institutions lack a structured program that provides residents with an in-depth research training. The objectives of this paper are to describe a comprehensive residency research program at a university hospital, and to assess the pre- post-self-assessment of research capabilities of resident for the evaluation of the program. Methods: The residency research program (RRP) was implemented in 2011 as an essential component of the residency program at the American University of Beirut Medical Center. Categorical residents are required to carry out a research project and go through all the steps of the research process from identifying a topic to writing a manuscript. As for evaluating the program, data were collected from residents who graduated between 2014 and 2016 using a questionnaire, which included the overall evaluation of the program, self-assessment on research-related tasks pre- and post- joining the program, as well as general recommendations. The mean scores on the five-point Likert scale were transformed into percentages (0-100%). The average was calculated and the difference in the means was reported. Results: Overall, 103 residents from the different clinical departments were included in this study. Residents' self-assessment showed a 19.3% improvement in research-related tasks before and after completion of the RRP (P < 0.0001). Most of the residents have either published or are in the process of publishing their projects (34 and 55.3%, respectively). Time management was the most reported challenge. Generally, the program was evaluated positively. Conclusion: The RRP is a unique, well-structured program, encompassing residents from various clinical departments, which enhances residents' research capabilities. © 2019 The Author(s)
Integrative Transcriptome Analyses Empower the Anti-COVID-19 Drug Arsenal
No full textThe beginning of the 21st century has been marked by three distinct waves of zoonotic coronavirus outbreaks into the human population. The COVID-19 (coronavirus disease 2019) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and emerged as a global threat endangering the livelihoods of millions worldwide. Currently, and despite collaborative efforts, diverse therapeutic strategies from ongoing clinical trials are still debated. To address the need for such an immediate call of action, we leveraged the largest dataset of drug-induced transcriptomic perturbations, public SARS-CoV-2 transcriptomic datasets, and expression profiles from normal lung transcriptomes. Most importantly, our unbiased systems biology approach prioritized more than 50 repurposable drug candidates (e.g., corticosteroids, Janus kinase and Bruton kinase inhibitors). Further clinical investigation of these FDA-approved candidates as monotherapy or in combination with an antiviral regimen (e.g., remdesivir) could lead to promising outcomes in patients with COVID-19. © 2020 The Author
