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Saha B, Drapak S, Mailman JF, Kassir S, Sy E. Evaluating service needs for veno-venous extracorporeal membrane oxygenation in patients with severe acute respiratory distress syndrome in Saskatchewan. Sci Rep 2023; 13:17627. [PMID: 37848526 PMCID: PMC10582080 DOI: 10.1038/s41598-023-45013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 10/14/2023] [Indexed: 10/19/2023] Open
Abstract
To determine the number of patients with acute respiratory distress syndrome (ARDS) who would be eligible to receive veno-venous extracorporeal membrane oxygenation (VV-ECMO). We conducted a retrospective observational study of ARDS patients admitted to Regina General Hospital Intensive Care Unit (ICU). VV-ECMO eligibility was assessed using selection criteria from the Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Syndrome trial (EOLIA), the Extracorporeal Life Support Organization (ELSO), New South Wales (NSW), Critical Care Services Ontario (CCSO) and a Regina-restrictive criteria. Of 415 patients admitted between October 16, 2018, and January 21, 2021, 103 (25%) had mild, 175 (42%) had moderate, and 64 (15%) had severe ARDS. Of the cohort, 144 (35%) had bacterial pneumonia, 86 (21%) had viral pneumonia (including COVID-19), and 72 (17%) had aspiration pneumonia. Using the EOLIA, ELSO, NSW, CCSO and Regina-restrictive criteria, 7/415 (1.7%), 6/415 (1.5%), 19/415 (4.6%), 26/415 (6.3%) and 12/415 (2.9%) were eligible for VV-ECMO, respectively. Of all ECMO-eligible patients, only one (2.4%) actually received VV-ECMO, 20/42 (48%) received prone positioning and 21/42 (50%) received neuromuscular blockade. There is potential for service expansion of VV-ECMO in Regina; however, there is still a need to improve the delivery of evidence-based ARDS therapies.
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Affiliation(s)
- Barsa Saha
- School of Public Health, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
| | - Savannah Drapak
- School of Health Sciences, Saskatchewan Polytech, 4635 Wascana Pkwy, Regina, SK, S4P 3A3, Canada
| | - Jonathan F Mailman
- Pharmacy Department, Royal Jubilee Hospital, Vancouver Island Health Authority, Victoria, BC, V8R 1J8, Canada
- College of Medicine, University of Saskatchewan, 1440-14th Avenue, Regina, SK, S4P 0W5, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Sandy Kassir
- Research Department, Saskatchewan Health Authority, Wascana Rehabilitation Centre, 2180-23 Ave, Regina, SK, S4S 0A5, Canada
| | - Eric Sy
- College of Medicine, University of Saskatchewan, 1440-14th Avenue, Regina, SK, S4P 0W5, Canada.
- Department of Critical Care, Saskatchewan Health Authority, 1440-14th Avenue, Regina, SK, S4P 0W5, Canada.
- Surgical Intensive Care Unit, Regina General Hospital, 1440-14 Avenue, Regina, SK, S4P 0W5, Canada.
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Lanigan A, Mailman JF, Kassir S, Schmidt K, Lee SB, Sy E. Treatments and Outcomes of Critically Ill Patients with Candida spp. Colonization of the Lower Respiratory Tract in Regina, Saskatchewan. Can J Hosp Pharm 2023; 76:309-313. [PMID: 37767389 PMCID: PMC10522344 DOI: 10.4212/cjhp.3408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Background Among critically ill patients receiving mechanical ventilation, Candida spp. are commonly detected in the lower respiratory tract (LRT). This is generally considered to represent colonization. Objective To evaluate the use of antifungal treatments and the clinical outcomes of patients with Candida colonization of the LRT. Methods This retrospective analysis involved consecutive patients admitted to the intensive care unit between April 2016 and May 2021with positive results on Candida spp. testing of LRT samples. Data related to antifungal treatment and clinical outcomes were analyzed descriptively, and multivariable logistic regression was performed. Results Of 200 patients initially identified, 160 (80%) died in hospital. Antifungal therapy was given to 103 (51.5%) of the patients, with treatment being more likely among those with shock and those who received parenteral nutrition. Mortality was high among patients with positive Candida results on LRT culture, regardless of treatment. Multivariable logistic regression, with adjustment for age, sex, comorbidities, and sequential organ failure assessment (SOFA) score, showed that antifungal treatment was associated with lower odds of death (odds ratio 0.39, 95% confidence interval 0.17-0.87) compared with no treatment (p = 0.021). Conclusions This study showed higher mortality rates than have been reported previously. Further investigation into the role of antifungal therapy among critically ill patients with Candida spp. colonization is required.
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Affiliation(s)
- Adam Lanigan
- MSc, is with the College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Jonathan F Mailman
- BSc(Pharm), ACRP, PharmD, CD, is with the College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan; the Department of Pharmacy Services, Island Health, Victoria, British Columbia; and the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| | - Sandy Kassir
- MSc, MPH, is with the Research Department, Saskatchewan Health Authority - Regina, Regina, Saskatchewan
| | - Kristin Schmidt
- BSP, is with the Department of Stewardship and Clinical Appropriateness, Saskatchewan Health Authority - Regina, Regina, Saskatchewan
| | - Stephen B Lee
- MD, MS, FRCPC, is with the College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, and the Department of Infectious Diseases, Saskatchewan Health Authority - Regina, Regina, Saskatchewan
| | - Eric Sy
- MD, MPH, FRCPC, is with the College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, and the Department of Critical Care, Saskatchewan Health Authority - Regina, Regina, Saskatchewan
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Daoust D, Dodin P, Sy E, Lau V, Roumeliotis N. Prevalence and Readmission Rates of Discharge Directly Home From the PICU: A Systematic Review. Pediatr Crit Care Med 2023; 24:62-71. [PMID: 36594800 DOI: 10.1097/pcc.0000000000003114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Critically ill patients are increasingly being discharged directly home from PICU as opposed to discharged home, via the ward. The objective was to assess the prevalence, safety, and satisfaction of discharge directly home from PICUs. DATA SOURCES We searched PubMed, Medline, EMBASE, PsycINFO, and CINAHL for studies published between January 1991 and June 2021. STUDY SELECTION We included observational or randomized studies, of children up to 18 years old, that reported on the prevalence, safety, or satisfaction of discharge directly home from the PICU, compared with the ward. Safety outcomes included readmission, unplanned visits to hospital, and any adverse events. We excluded case series, reviews, and studies discharging patients to other facilities. DATA EXTRACTION Two independent reviewers evaluated 88 full-text articles; five studies met eligibility (362,868 patients). Only one study had discharge directly home as a primary outcome. DATA SYNTHESIS Prevalence of discharge directly to home from the PICU ranged from less than 1% to 23% (random effects proportion 7.7 [95% CI, 1.3-18.6]). Readmissions to the PICU (only safety outcome) were significantly lower in the discharge directly home group compared with the ward group, in two of three studies (p < 0.0001). No studies reported on patient or family satisfaction. CONCLUSIONS The prevalence of discharge directly home from the PICU ranges from 1% to 23%. PICU readmission rates do not appear to increase after discharge directly home. Caution is needed in the interpretation of the results, given the significant heterogeneity of the included studies. Further high-quality studies are needed to evaluate the safety of discharge directly home from the PICU and support families in this transition.
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Affiliation(s)
- Daphne Daoust
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Philippe Dodin
- Medical Librarian, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, QC, Canada
| | - Eric Sy
- Department of Medicine, College of Medicine, University of Saskatchewan, Regina, SK, Canada
| | - Vincent Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nadia Roumeliotis
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
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Burns KEA, Moss M, Lorens E, Jose EKA, Martin CM, Viglianti EM, Fox-Robichaud A, Mathews KS, Akgun K, Jain S, Gershengorn H, Mehta S, Han JE, Martin GS, Liebler JM, Stapleton RD, Trachuk P, Vranas KC, Chua A, Herridge MS, Tsang JLY, Biehl M, Burnham EL, Chen JT, Attia EF, Mohamed A, Harkins MS, Soriano SM, Maddux A, West JC, Badke AR, Bagshaw SM, Binnie A, Carlos WG, Çoruh B, Crothers K, D'Aragon F, Denson JL, Drover JW, Eschun G, Geagea A, Griesdale D, Hadler R, Hancock J, Hasmatali J, Kaul B, Kerlin MP, Kohn R, Kutsogiannis DJ, Matson SM, Morris PE, Paunovic B, Peltan ID, Piquette D, Pirzadeh M, Pulchan K, Schnapp LM, Sessler CN, Smith H, Sy E, Thirugnanam S, McDonald RK, McPherson KA, Kraft M, Spiegel M, Dodek PM. Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey. Crit Care Med 2022; 50:1689-1700. [PMID: 36300945 PMCID: PMC9668381 DOI: 10.1097/ccm.0000000000005674] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Few surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic. DESIGN Cross-sectional survey using four validated instruments. SETTING Sixty-two sites in Canada and the United States. SUBJECTS Attending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS We analysed 431 questionnaires (43.3% response rate) from 25 states and eight provinces. Respondents were predominantly male (229 [55.6%]) and in practice for 11.8 ± 9.8 years. Compared with prepandemic, respondents reported significant intrapandemic increases in days worked/mo, ICU bed occupancy, and self-reported moral distress (240 [56.9%]) and burnout (259 [63.8%]). Of the 10 top-ranked items that incited moral distress, most pertained to regulatory/organizational ( n = 6) or local/institutional ( n = 2) issues or both ( n = 2). Average moral distress (95.6 ± 66.9), professional fulfilment (6.5 ± 2.1), and burnout scores (3.6 ± 2.0) were moderate with 227 physicians (54.6%) meeting burnout criteria. A significant dose-response existed between COVID-19 patient volume and moral distress scores. Physicians who worked more days/mo and more scheduled in-house nightshifts, especially combined with more unscheduled in-house nightshifts, experienced significantly more moral distress. One in five physicians used at least one maladaptive coping strategy. We identified four coping profiles (active/social, avoidant, mixed/ambivalent, infrequent) that were associated with significant differences across all wellness measures. CONCLUSIONS Despite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness.
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Affiliation(s)
- Karen E A Burns
- Unity Health Toronto - St. Michaels Hospital, Toronto, ON, Canada
- Department of Medicine and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Marc Moss
- University of Colorado - Anschutz Medical Campus and Children's Hospital of Colorado, Aurora, CO
| | - Edmund Lorens
- Department of Medicine and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Claudio M Martin
- Division of Critical Care, London Health Sciences, London Health Sciences Centre, London, ON, Canada
| | - Elizabeth M Viglianti
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Alison Fox-Robichaud
- Division of Critical Care, McMaster University, Department of Medicine, Hamilton, ON, Canada
| | - Kusum S Mathews
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kathleen Akgun
- Section of Pulmonary, Critical Care & Sleep Medicine, VA Connecticut Healthcare System, West Haven, CT
| | - Snigdha Jain
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Hayley Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Sangeeta Mehta
- Department of Medicine and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Sinai Health, Toronto, ON, Canada
| | - Jenny E Han
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Gregory S Martin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Janice M Liebler
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Southern California, Los Angeles, CA
| | - Renee D Stapleton
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Polina Trachuk
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, New York University Langone Health, New York, NY
| | - Kelly C Vranas
- Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland, OR
| | | | - Margaret S Herridge
- Department of Medicine and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, University Health Network, Toronto, ON, Canada
| | | | - Michelle Biehl
- Departments of Critical Care Medicine and Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Ellen L Burnham
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Jen-Ting Chen
- Harborview Medical Center, University of Washington, Seattle, WA
| | - Engi F Attia
- Division of Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Amira Mohamed
- Division of Pulmonary, Critical Care and Sleep, Department of Internal Medicine, Montefiore Medical Center, Bronx, NY
| | - Michelle S Harkins
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of New Mexico, Albuquerque, NM
| | - Sheryll M Soriano
- OSF Medical Group Pulmonary and Critical Care Division, Order of St Francis (OSF) Healthcare, Peoria, IL
| | - Aline Maddux
- University of Colorado - Anschutz Medical Campus and Children's Hospital of Colorado, Aurora, CO
| | - Julia C West
- Department of Pediatrics, Section of Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Andrew R Badke
- Pulmonary and Critical Care, LDS Hospital, Intermountain Healthcare, Salt Lake City, UT
| | - Sean M Bagshaw
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Alexandra Binnie
- Department of Critical Care Medicine at William Osler Health System, William Osler Health System, Toronto, ON, Canada
| | - W Graham Carlos
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA
| | - Kristina Crothers
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Veterans Affairs Puget Sound Health Care, Seattle, WA
| | - Frederick D'Aragon
- Department of Anesthesia, University de Sherbrooke, Sherbrooke, QC, Canada
| | - Joshua Lee Denson
- Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, LA
| | - John W Drover
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Gregg Eschun
- Section of Critical Care, University of Manitoba, Winnipeg, MB, Canada
| | - Anna Geagea
- Division of Critical Care, Department of Medicine, North York General Hospital, Toronto, ON, Canada
| | - Donald Griesdale
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia. Vancouver, BC, Canada
| | - Rachel Hadler
- Department of Anesthesia, University of Iowa Hospital and Clinics, Iowa City, IA
| | | | - Jovan Hasmatali
- Department of Critical Care, Health Sciences Centre, Winnipeg, MB, Canada
| | - Bhavika Kaul
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA
| | - Meeta Prasad Kerlin
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Rachel Kohn
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - D James Kutsogiannis
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Scott M Matson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Peter E Morris
- University of Kentucky College of Medicine, Lexington, KY
| | - Bojan Paunovic
- Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ithan D Peltan
- Division of Pulmonary/Critical Care Medicine, Department of Medicine, Intermountain Healthcare, Salt Lake City, UT
| | - Dominique Piquette
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mina Pirzadeh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Krishna Pulchan
- Division of Critical Care Medicine, Horizon Health Network, Fredericton, NB, Canada
| | - Lynn M Schnapp
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Curtis N Sessler
- Department of Medicine, Section of Critical Care, Virginia Commonwealth University Health System, Richmond, VA
| | | | - Eric Sy
- Regina General Hospital, Regina, SK, Canada
| | | | | | - Katie A McPherson
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Monica Kraft
- University of Arizona College of Medicine, Tucson, AZ
| | - Michelle Spiegel
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, SC
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Sy E, Zacharias S, Lee JS. Neck Swelling in a Critically Ill Patient With COVID-19-Related Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation: Consider the Differential. Cureus 2022; 14:e30877. [DOI: 10.7759/cureus.30877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
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Zhao M, Elshoni H, O'Brien J, Barbour-Tuck E, Walker ME, Dyck H, Vasquez A, Sy E, Baerwald A, Michaels C, Kamrul R, Reis O, Schuster B, Beaurivage B, Clay A, Lees M, Gamble J. Patient and provider experiences with virtual care during the COVID-19 pandemic: A mixed methods study. Patient Experience Journal 2022. [DOI: 10.35680/2372-0247.1674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Singh J, Bhagaloo L, Sy E, Lavoie AJ, Dehghani P, Bardutz HA, Mang CS, Buttigieg J, Neary JP. Cardiac impairments in postacute COVID-19 with sustained symptoms: A review of the literature and proof of concept. Physiol Rep 2022; 10:e15430. [PMID: 35993433 PMCID: PMC9393908 DOI: 10.14814/phy2.15430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022] Open
Abstract
Although acute COVID-19 is known to cause cardiac damage in some cases, there is still much to learn about the duration and relative permanence of the damage that may occur. Long COVID is a condition that can occur when COVID-19 symptoms remain in the postviral acute period. Varying accounts of long COVID have been described across the literature, however, cardiac impairments are sustained in many individuals and cardiovascular assessment is now considered to be an expected follow-up examination. The purpose of this review and proof of concept is to summarize the current research related to the assessment of cardiac function, including echocardiography and blood biomarker data, during the follow-up period in patients who recovered from COVID-19. Following a literature review, it was found that right ventricular dysfunction along with global longitudinal strain and diastolic dysfunction are common findings. Finally, more severe acute myocardial injury during the index hospitalization appears to exacerbate cardiac function. The available literature implies that cardiac function must be monitored in patients recovered from COVID-19 who remain symptomatic and that the impairments and severity vary from person-to-person. The proof-of-concept analysis of patients with cardiac disease and respiratory disease in comparison to those with sustained symptoms from COVID-19 suggests elevated systolic time interval in those with sustained symptoms from COVID-19, thus reducing heart performance indices. Future research must consider the details of cardiac complications during the acute infection period and relate this to the cardiac function in patients with long COVID during mid- and long-term follow-up.
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Affiliation(s)
- Jyotpal Singh
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
- Department of CardiologyPrairie Vascular Research Inc, Saskatchewan Health AuthorityReginaSaskatchewanCanada
| | - Lanishen Bhagaloo
- Gateway Alliance MedicalReginaSaskatchewanCanada
- College of MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
- Department of Family MedicineSaskatchewan Health AuthorityReginaSaskatchewanCanada
| | - Eric Sy
- Department of Critical CareSaskatchewan Health AuthorityReginaSaskatchewanCanada
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
- College of Graduate and Postdoctoral StudiesUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Andrea J. Lavoie
- Department of CardiologyPrairie Vascular Research Inc, Saskatchewan Health AuthorityReginaSaskatchewanCanada
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
| | - Payam Dehghani
- Department of CardiologyPrairie Vascular Research Inc, Saskatchewan Health AuthorityReginaSaskatchewanCanada
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
| | - Holly A. Bardutz
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
| | - Cameron S. Mang
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
| | - Josef Buttigieg
- Faculty of Science, Department of BiologyUniversity of ReginaReginaSaskatchewanCanada
| | - J. Patrick Neary
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
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Sy E, Gupta C, Shahab Z, Fortin N, Kassir S, Mailman JF, Lau VI. Long-term Safety of Directly Discharging Patients Home from the ICU Compared to Ward Transfer. J Intensive Care Med 2022; 37:1344-1352. [PMID: 35350921 DOI: 10.1177/08850666221090459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the long-term safety of directly discharging intensive care unit (ICU) survivors to their home. Methods: A retrospective observational cohort of 341 ICU survivors who were directly discharged home from the ICU ("direct discharge") or discharged home ≤72 hours after ICU transfer to the ward ("ward transfer") was conducted in Regina, Saskatchewan ICUs between September 1, 2016 and September 30, 2018. The primary outcome was 90-day hospital readmission. Secondary outcomes included 30-day, 90-day, and 365-day emergency department (ED) visits, 30-day and 365-day hospital readmissions, and 365-day mortality. All outcomes were evaluated by multivariable Cox regression after adjustment for demographic and clinical characteristics. Results: Of 341 survivors (25.5% of total ICU visits), 148 (43.4%) patients were direct discharges and 193 (56.6%) were ward transfers. The median age was 46 years (interquartile range, 34-62), 38.4% were female, and 61.8% resided in Regina. Compared to the ward transfer cohort, more patients in the direct discharge cohort had at least one 90-day hospital readmission (30.4% versus 17.1% of patients, adjusted hazard ratio 2.09, 95% confidence interval 1.28-3.40, P = .003), after adjustment. Additionally, there were more 90-day ED visits (P = .045), and 30-day (P = .049) and 365-day hospital readmissions (P = .03), after adjustment. Conclusions: In Saskatchewan, direct discharge compared to ward transfer was associated with an increase in 90-day hospital readmissions, and potentially other clinical outcomes. Further study is necessary.
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Affiliation(s)
- Eric Sy
- Department of Critical Care, 7234Saskatchewan Health Authority, Regina General Hospital, Regina, Saskatchewan, Canada.,College of Medicine, 12371University of Saskatchewan, Regina General Hospital, Regina, Saskatchewan, Canada
| | - Chiraag Gupta
- College of Medicine, 12371University of Saskatchewan, Regina General Hospital, Regina, Saskatchewan, Canada.,Research Department, 7234Saskatchewan Health Authority, Wascana Rehabilitation Centre, Regina, Saskatchewan, Canada
| | - Zunaira Shahab
- College of Medicine, 12371University of Saskatchewan, Regina General Hospital, Regina, Saskatchewan, Canada.,Department of Medicine, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nathan Fortin
- College of Medicine, 12371University of Saskatchewan, Regina General Hospital, Regina, Saskatchewan, Canada
| | - Sandy Kassir
- Research Department, 7234Saskatchewan Health Authority, Wascana Rehabilitation Centre, Regina, Saskatchewan, Canada
| | - Jonathan F Mailman
- Department of Critical Care, 7234Saskatchewan Health Authority, Regina General Hospital, Regina, Saskatchewan, Canada.,College of Medicine, 12371University of Saskatchewan, Regina General Hospital, Regina, Saskatchewan, Canada.,Department of Pharmacy Services, 7234Saskatchewan Health Authority, Regina General Hospital, Regina, Saskatchewan, Canada
| | - Vincent I Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3C1.12 Walter C Mackenzie Centre, Edmonton, Alberta, Canada
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Sy E, Ross T. Transport par ambulance aérienne. CMAJ 2021; 193:E1791-E1792. [PMID: 34810169 PMCID: PMC8608456 DOI: 10.1503/cmaj.210354-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Eric Sy
- Collège de médecine (Sy et Ross), Université de la Saskatchewan; Département de médecine intensive (Sy), Autorité sanitaire de la Saskatchewan; Shock Trauma Air Rescue Service (STARS) (Sy et Ross); Département de médecine d'urgence (Ross), Autorité sanitaire de la Saskatchewan, Regina, Sask.
| | - Terrance Ross
- Collège de médecine (Sy et Ross), Université de la Saskatchewan; Département de médecine intensive (Sy), Autorité sanitaire de la Saskatchewan; Shock Trauma Air Rescue Service (STARS) (Sy et Ross); Département de médecine d'urgence (Ross), Autorité sanitaire de la Saskatchewan, Regina, Sask
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10
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Ho K, Bare I, Sy E, Singh J, Opotowsky AR, Dehghani P. Trends in Patient Characteristic, Cost, and Mortality Among Mechanically Ventilated Adult Patients With Congenital Heart Disease in the United States. CJC Open 2021; 4:197-205. [PMID: 35198937 PMCID: PMC8843989 DOI: 10.1016/j.cjco.2021.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/21/2021] [Indexed: 12/20/2022] Open
Abstract
Background There is an increasing number of adults with congenital heart disease (ACHD), but critically ill patients with ACHD remain understudied. The objective of this study was to evaluate patient characteristics and trends in mortality of mechanically ventilated patients with ACHD. Methods We evaluated ACHD with an ICD-9 procedure code for mechanical ventilation using the National Inpatient Sample (NIS), a public all-payer inpatient United States database, from 2005 to 2014. Primary and secondary outcomes were evaluated using multivariable logistic regression. Results There were 10,962 of 77,334,704 discharges, representing 52,876 (0.6%) hospitalizations that were for patients with ACHD who required mechanical ventilation (MV). Mean age was 59 years (interquartile range: 45-71); 45.3% were female patients. The number of patients with ACHD requiring MV increased over the years (2342 to 7775, P < 0.001). Age and comorbidities of this cohort also increased (55 to 59, P < 0.001; 1 to 2, P < 0.001). Case-fatality ratio remained stable over the years (0.254 to 0.259, P = 0.42). Median cost of hospital stay was USD $49,583 and remained stable over the study period (P = 0.42), whereas total cost increased from $115 million to $564 million (P < 0.001). Conclusions The number of mechanically ventilated ACHD has increased over the years. Remarkably, despite an increase in the age and comorbidity burden in this cohort, case-fatality ratio of these patients and the cost per patient remained stable. Nonetheless, there is a growing need for health care resources in the management of this cohort of patients. Further studies will need to be conducted to evaluate the underlying physiological impact and prognosis of MV in specific subsets of ACHD.
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Affiliation(s)
- Karen Ho
- Division of Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- College of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Idris Bare
- Division of Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- College of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Eric Sy
- College of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
- Department of Critical Care, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Jyoptal Singh
- Department of Cardiology, Prairie Vascular Research Inc, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Alexander R. Opotowsky
- Adult Congenital Heart Disease Program, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Payam Dehghani
- College of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
- Department of Cardiology, Prairie Vascular Research Inc, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
- Corresponding author: Dr Payam Dehghani, Department of Cardioneurosciences, Regina General Hospital, 3rd floor,1440 14th Avenue, Regina, Saskatchewan S4P 0W5, Canada. Tel.: +1-306-596-9799.
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11
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Sy E, Parvez S, Kassir S, Donnelly R, Gupta C, Mailman JF, Lau VI. Canadian healthcare provider perceptions of discharging patients directly home from the intensive care unit. Can J Anaesth 2021; 68:1840-1842. [PMID: 34553307 DOI: 10.1007/s12630-021-02107-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/23/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Eric Sy
- Department of Critical Care, Saskatchewan Health Authority, Regina General Hospital, Regina, SK, Canada. .,College of Medicine, University of Saskatchewan, Regina General Hospital, Regina, SK, Canada.
| | - Sehar Parvez
- College of Medicine, University of Saskatchewan, Regina General Hospital, Regina, SK, Canada
| | - Sandy Kassir
- Research Department, Saskatchewan Health Authority, Wascana Rehabilitation Centre, Regina, SK, Canada
| | - Ryan Donnelly
- College of Medicine, University of Saskatchewan, Regina General Hospital, Regina, SK, Canada
| | - Chiraag Gupta
- College of Medicine, University of Saskatchewan, Regina General Hospital, Regina, SK, Canada.,Research Department, Saskatchewan Health Authority, Wascana Rehabilitation Centre, Regina, SK, Canada
| | - Jonathan F Mailman
- College of Medicine, University of Saskatchewan, Regina General Hospital, Regina, SK, Canada.,Department of Pharmacy Services, Saskatchewan Health Authority, Regina General Hospital, Regina, SK, Canada
| | - Vincent I Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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12
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Affiliation(s)
- Eric Sy
- College of Medicine (Sy, Ross), University of Saskatchewan; Department of Critical Care (Sy), Saskatchewan Health Authority; Shock Trauma Air Rescue Service (STARS) (Sy, Ross); Department of Emergency Medicine (Ross), Saskatchewan Health Authority, Regina, Sask.
| | - Terrance Ross
- College of Medicine (Sy, Ross), University of Saskatchewan; Department of Critical Care (Sy), Saskatchewan Health Authority; Shock Trauma Air Rescue Service (STARS) (Sy, Ross); Department of Emergency Medicine (Ross), Saskatchewan Health Authority, Regina, Sask
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13
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Singh J, Bhagaloo L, Sy E, Lavoie AJ, Dehghani P, Neary P. Novel effects of acute COVID-19 on cardiac mechanical function: Two case studies. Physiol Rep 2021; 9:e14998. [PMID: 34448551 PMCID: PMC8391984 DOI: 10.14814/phy2.14998] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022] Open
Abstract
The spread of the novel coronavirus 2019 (COVID-19) has caused a global pandemic. The disease has spread rapidly, and research shows that COVID-19 can induce long-lasting cardiac damage. COVID-19 can result in elevated cardiac biomarkers indicative of acute cardiac injury, and research utilizing echocardiography has shown that there is mechanical dysfunction in these patients as well, especially when observing the isovolumic, systolic, and diastolic portions of the cardiac cycle. The purpose of this study was to present two case studies on COVID-19 positive patients who had their cardiac mechanical function assessed every day during the acute period to show that cardiac function in these patients was altered, and the damage occurring can change from day-to-day. Participant 1 showed compromised cardiac function in the systolic time, diastolic time, isovolumic time, and the calculated heart performance index (HPI), and these impairments were sustained even 23 days post-symptom onset. Furthermore, Participant 1 showed prolonged systolic periods that lasted longer than the diastolic periods, indicative of elevated pulmonary artery pressure. Participant 2 showed decreases in systole and consequently, increases in HPI during the 3 days post-symptom onset, and these changes returned to normal after day 4. These results showed that daily observation of cardiac function can provide detailed information about the overall mechanism by which cardiac dysfunction is occurring and that COVID-19 can induce cardiac damage in unique patterns and thus can be studied on a case-by-case basis, day-to-day during infection. This could allow us to move toward more personalized cardiovascular medical treatment.
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Affiliation(s)
- Jyotpal Singh
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
| | - Lanishen Bhagaloo
- Gateway Alliance Medical ClinicReginaSaskatchewanCanada
- Faculty of MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Eric Sy
- Department of Critical CareSaskatchewan Health AuthorityReginaSaskatchewanCanada
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
| | - Andrea J. Lavoie
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
- Department of CardiologyPrairie Vascular Research IncSaskatchewan Health AuthorityReginaSaskatchewanCanada
| | - Payam Dehghani
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
- Department of CardiologyPrairie Vascular Research IncSaskatchewan Health AuthorityReginaSaskatchewanCanada
| | - Patrick Neary
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
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14
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Lee B, Clay A, Sy E. Evaluation of extracorporeal cardiopulmonary resuscitation eligibility criteria for out-of-hospital cardiac arrest patients. BMC Res Notes 2021; 14:139. [PMID: 33858479 PMCID: PMC8051044 DOI: 10.1186/s13104-021-05564-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/09/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives To evaluate the number of out-of-hospital cardiac arrest (OHCA) patients eligible for extracorporeal cardiopulmonary resuscitation (ECPR) in Saskatchewan and their clinical outcomes, including survival and neurological outcomes at discharge. ECPR eligibility was assessed, using clinical criteria from the University of British Columbia (UBC, Canada), University of Michigan (UM, United States), University of California (UC, United States) and a restrictive ECPR criteria. Results We performed a retrospective cohort study of 200 OHCA patients (August 1, 2017-May 31, 2019) in Regina, Saskatchewan. Sixty-one (30%) were female, the median age was 64 years (interquartile range [IQR], 52–78), the median CPR duration was 30 min (IQR 12–47), and 20% survived to discharge. Two (1%) patients received ECPR but did not meet any ECPR criteria. Nineteen (10%), thirty (15%), twenty-two (11%), and seven (4%) patients were ECPR-eligible, using the UBC, UM, UC, and restrictive criteria. However, none of these patients had received ECPR. Only two (11%), two (7%), two (9%), and one (14%) of these patient(s) survived to discharge, respectively. Neurological outcomes were unfavourable among all ECPR-eligible patients. Future study at our centre will be necessary on how to implement ECPR program to further improve these outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05564-1.
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Affiliation(s)
- Brendan Lee
- College of Medicine, University of Saskatchewan, Regina General Hospital, 1440 - 14th Avenue, Regina, SK, S4P 0W5, Canada
| | - Adam Clay
- Research Department, Saskatchewan Health Authority, Wascana Rehabilitation Centre, 2180 - 23 Ave, Regina, SK, S4S 0A5, Canada.,Department of Academic Family Medicine, University of Saskatchewan, 1621 Albert St #172, Regina, SK, S4P 2S5, Canada
| | - Eric Sy
- College of Medicine, University of Saskatchewan, Regina General Hospital, 1440 - 14th Avenue, Regina, SK, S4P 0W5, Canada. .,Department of Critical Care, Regina General Hospital, 1440-14th Avenue, Regina, SK, S4P 0W5, Canada.
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15
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Cheung K, Mailman JF, Crawford JJ, Karvellas CJ, Sy E. Trends and outcomes of mechanically ventilated cirrhotic patients in the United States from 2005–2014. J Intensive Care Soc 2021; 23:139-149. [DOI: 10.1177/1751143720985293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose Cirrhotic patients in organ failure are frequently admitted to intensive care units (ICUs) to receive invasive mechanical ventilation (IMV). We evaluated the trends of hospitalizations, in-hospital mortality, hospital costs, and hospital length of stay (LOS) of IMV patients with cirrhosis. Methods We analyzed the United States National Inpatient Sample from 2005–2014. We selected discharges of IMV adult (≥18 years) patients with cirrhosis using the International Classification of Diseases, 9th Edition , Clinical Modification codes. Trends were assessed using linear regression and joinpoint regression. Results Between 2005 and 2014, there were approximately 9,441,605 hospitalizations of IMV adult patients, of which 4.7% had cirrhosis. There was an increasing trend in the total number of IMV cirrhotic patient hospitalizations (annual percent change [APC] 7.0%, 95% confidence interval [CI] 6.4%; 7.6%, Ptrend < 0.001). The in-hospital case-fatality ratio declined between 2005–2011 (APC –2.9%, 95% CI, –3.4%; –2.4%, Ptrend < 0.001); however, it remained similar between 2011–2014 ( Ptrend = 0.58). The total annual hospital costs of all IMV cirrhotic patients increased from approximately $1.2 billion USD in 2005 to $2.7 billion USD in 2014 ( Ptrend < 0.001). The mean hospital costs per patient and mean LOS declined between 2005 and 2014 ( Ptrend < 0.001 and Ptrend = 0.01 respectively). Conclusions The total number of hospitalizations and total annual costs of IMV patients with cirrhosis have been increasing over time. However, past hesitancy around admitting cirrhotic patients to the ICU may need to be tempered by the improving mortality trends in this patient population.
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Affiliation(s)
- Kyle Cheung
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jonathan F Mailman
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Department of Critical Care, Regina General Hospital, Regina, Saskatchewan, Canada
- Department of Pharmacy Services, Regina General Hospital, Regina, Saskatchewan, Canada
| | | | - Constantine J Karvellas
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Sy
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Department of Critical Care, Regina General Hospital, Regina, Saskatchewan, Canada
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16
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Sy E, Sy S, Gupta C, Kassir S, Mailman J. 468: Hospital Readmissions Among Mechanically Ventilated Elderly Patients: A US Nationwide Analysis. Crit Care Med 2021. [DOI: 10.1097/01.ccm.0000727760.81640.fa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
High volume plasmapheresis (HVP) is defined as an exchange of 8-12 L or 15% of ideal body weight with fresh-frozen plasma. It has been reported that HVP can improve outcomes in patients with acute liver failure (ALF) and/or acute-on-chronic liver failure (ACLF). Here, we present a case of a 34-year-old man presenting with ALF that led to multi-organ failure who received HVP in the intensive care unit that improved his biochemical parameters, volume status, and hemodynamics. However, despite objective clinical and biochemical improvements, the patient had developed signs of potential brain injury, and subsequently the family withdrew care. This case and the associated literature review highlight the potential value of HVP in facilities who do not have access to liver transplantation or other means of extracorporeal liver support systems.
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Affiliation(s)
- Landon Tam
- Internal Medicine, University of Saskatchewan, Regina, CAN
| | | | - Eric Sy
- Critical Care Medicine, University of Saskatchewan, Regina, CAN
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18
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Fralick M, Sy E, Karsies T. Absolute Risk Estimates of the Association Between Concussion and Suicide-Reply. JAMA Neurol 2020; 76:871-872. [PMID: 31180471 DOI: 10.1001/jamaneurol.2019.1452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael Fralick
- Clinician Scientist Training Program, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eric Sy
- College of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada.,Department of Critical Care, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Todd Karsies
- Division of Critical Care, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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19
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Fralick M, Sy E, Hassan A, Burke MJ, Mostofsky E, Karsies T. Association of Concussion With the Risk of Suicide: A Systematic Review and Meta-analysis. JAMA Neurol 2019; 76:144-151. [PMID: 30419085 DOI: 10.1001/jamaneurol.2018.3487] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Concussion is the most common form of traumatic brain injury (TBI). While most patients fully recover within 1 week of injury, a subset of patients might be at a higher risk of suicide. Objective To assess the risk of suicide after concussion. Data Sources We performed a systematic search of Medline (PubMed), Embase, PsycINFO, and Published International Literature on Traumatic Stress (PILOTS) from 1963 to May 1, 2017. We also searched Google Scholar and conference proceedings and contacted experts in the field to seek additional studies. Study Selection Studies that quantified the risk of suicide, suicide attempt, or suicidal ideation after a concussion and/or mild TBI were included. Studies that included children and adults, including military and nonmilitary personnel, were included. Two authors independently reviewed all titles and abstracts to determine study eligibility. Data Extraction and Synthesis Study characteristics were extracted independently by 2 trained investigators. Study quality was assessed using the Newcastle-Ottawa Scale. Study data were pooled using random-effects meta-analysis. Main Outcomes and Measures The primary exposure was concussion and/or mild TBI, and the primary outcome was suicide. Secondary outcomes were suicide attempt and suicidal ideation. Results Data were extracted from 10 cohort studies (n = 713 706 individuals diagnosed and 6 236 010 individuals not diagnosed with concussion and/or mild TBI), 5 cross-sectional studies (n = 4420 individuals diagnosed and 11 275 individuals not diagnosed with concussion and/or mild TBI), and 2 case-control studies (n = 446 individuals diagnosed and 8267 individuals not diagnosed with concussion and/or mild TBI). Experiencing concussion and/or mild TBI was associated with a 2-fold higher risk of suicide (relative risk, 2.03 [95% CI, 1.47-2.80]; I2 = 96%; P < .001). In 2 studies that provided estimates with a median follow-up of approximately 4 years, 1664 of 333 118 individuals (0.50%) and 750 of 126 114 individuals (0.59%) diagnosed with concussion and/or mild TBI died by suicide. Concussion was also associated with a higher risk of suicide attempt and suicide ideation. The heightened risk of suicide outcomes after concussion was evident in studies with and without military personnel. Conclusions and Relevance Experiencing concussion and/or mild TBI was associated with a higher risk of suicide. Future studies are needed to identify and develop strategies to decrease this risk.
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Affiliation(s)
- Michael Fralick
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Now with Eliot Phillipson Clinician Scientist Training Program, Department of Medicine, University of Toronto, Ontario, Canada
| | - Eric Sy
- College of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada.,Department of Critical Care, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Adiba Hassan
- Antiviral Research Center, Department of Medicine, University of California, San Diego
| | - Matthew J Burke
- Cognitive Neurology Unit, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Mostofsky
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Todd Karsies
- Division of Critical Care, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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20
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Cardoso FS, Abraldes JG, Sy E, Ronco JJ, Bagulho L, Mcphail MJ, Karvellas CJ. Lactate and number of organ failures predict intensive care unit mortality in patients with acute-on-chronic liver failure. Liver Int 2019; 39:1271-1280. [PMID: 30825255 DOI: 10.1111/liv.14083] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/20/2019] [Accepted: 02/21/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Patients with acute-on-chronic liver failure (ACLF) have high mortality rates. Most prognostic scores were not developed for the intensive care unit (ICU) setting. We aimed to improve risk stratification for patients with ACLF in the ICU. METHODS A training set with 240 patients with cirrhosis and organ failures (Chronic Liver Failure Sequential Organ Failure Assessment score [CLIF-SOFA]) from Curry Cabral Hospital (Portugal) and University of Alberta Hospital (Canada) in 2010-2016 was used to derive a prognostic model for ICU mortality. A validation set with 237 patients with cirrhosis and organ failures from Vancouver General Hospital (Canada) in 2000-2011 was used to evaluate its performance. RESULTS Amongst patients in the training set, ICU and hospital mortality rates were 39.2% and 54.6% respectively. Median lactate (4.4 vs 2.5 mmol/L) and number of organ failures (3 vs 2) on admission to ICU were associated with higher likelihood of ICU mortality (P < 0.001 for both). The lactate and organ failures predictive model (LacOF) was derived to predict ICU mortality: -2.420 + 0.072 × lactate + 0.569 × number of organ failures (area under-the-curve [AUC], 0.76). In the validation set, the LacOF model discriminative ability (AUC, 0.85) outperformed the CLIF-SOFA (AUC, 0.79), Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (AUC, 0.73), Model for End-stage Liver Disease score (AUC, 0.78) and Acute Physiology and Chronic Health Evaluation II scores (AUC, 0.74; P < 0.05 for all). The LacOF model calibration was good up to the 25% likelihood of ICU mortality. CONCLUSIONS In patients with ACLF, lactate and number of organ failures on admission to ICU are useful to predict ICU mortality. This early prognostic evaluation may help to better stratify the risk of ICU mortality and thus optimize organ support strategies.
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Affiliation(s)
- Filipe S Cardoso
- Gastroenterology and Intensive Care Divisions, Central Lisbon Hospital Center, Curry Cabral Hospital, Lisbon, Portugal
| | - Juan G Abraldes
- Gastroenterology Division (Liver Unit), University of Alberta Hospital, Edmonton, AB, Canada
| | - Eric Sy
- Critical Care Division, Vancouver General Hospital, Vancouver, BC, Canada
| | - Juan J Ronco
- Critical Care Division, Vancouver General Hospital, Vancouver, BC, Canada
| | - Luís Bagulho
- Intensive Care Division, Central Lisbon Hospital Center, Curry Cabral Hospital, Lisbon, Portugal
| | - Mark J Mcphail
- Liver Intensive Therapy Unit, King's College Hospital, London, UK
| | - Constantine J Karvellas
- Gastroenterology Division (Liver Unit), University of Alberta Hospital, Edmonton, AB, Canada.,Critical Care Department, University of Alberta Hospital, Edmonton, AB, Canada
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Sy E, Ronco JJ, Searle R, Karvellas CJ. Prognostication of critically ill patients with acute-on-chronic liver failure using the Chronic Liver Failure-Sequential Organ Failure Assessment: A Canadian retrospective study. J Crit Care 2016; 36:234-239. [PMID: 27569253 DOI: 10.1016/j.jcrc.2016.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/31/2016] [Accepted: 08/04/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE We evaluated the Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) score to predict survival in a Canadian critically ill cohort with acute-on-chronic liver failure. METHODS We retrospectively examined 274 acute-on-chronic liver failure patients admitted to a quaternary level intensive care unit (ICU) between April 1, 2000, and April 30, 2011. We evaluated severity of illness scores, including the Acute Physiology and Chronic Health Evaluation (APACHE) II, model for end-stage liver disease (MELD), Child-Turcotte-Pugh (CTP), SOFA, and CLIF-SOFA. RESULTS On ICU admission, patients had the following median (interquartile range): APACHE II, 23 (19-28); MELD, 26 (19-35); CTP, 12 (10-13); SOFA, 15 (11-18); and CLIF-SOFA, 17 (13-21). In-hospital survival was 40%. There were no significant differences in survival for cirrhosis etiology, reason, or year of admission. The CLIF-SOFA score had the greatest area under receiver operating curve of 0.865 (95% confidence interval, 0.820-0.909) and outperformed the CTP, MELD, SOFA, and APACHE II scores. Sequential Organ Failure Assessment score performance improved on the third day of ICU admission (area under receiver operating curve, 0.935; 95% confidence interval, 0.895-0.975). CONCLUSIONS The CLIF-SOFA and SOFA scores during the first 3 days of ICU admission appear to be highly predictive of in-hospital mortality.
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Affiliation(s)
- Eric Sy
- Department of Critical Care, Regina General Hospital, Regina, Saskatchewan, Canada; Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Juan J Ronco
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rowan Searle
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Constantine J Karvellas
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Liver Transplant Program, Alberta Health Services, Edmonton, Alberta, Canada
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22
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Sy E, Luong M, Quon M, Kim Y, Sharifi S, Norena M, Wong H, Ayas N, Leipsic J, Dodek P. Implementation of a quality improvement initiative to reduce daily chest radiographs in the intensive care unit. BMJ Qual Saf 2015; 25:379-85. [PMID: 26350068 DOI: 10.1136/bmjqs-2015-004151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/17/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To reduce the number of routine chest radiographs (CXRs) done in a tertiary care intensive care unit (ICU). METHODS Using a quality improvement approach, we measured the number of CXRs done per patient-day before (15 June 2010-15 June 2011) and after (15 June 2011-15 June 2012) a multipronged intervention in a 15-bed medical-surgical ICU in a 350-bed tertiary care teaching hospital. We studied a total of 1492 patients who were admitted to this ICU-738 patients during the preintervention period and 754 patients during the postintervention period. Interventions were education for the ICU house staff, developing indications for routine CXRs on the computer order-entry system, and visual posters/signage to remind ICU staff that there were no indications for routine, daily CXRs. The primary outcome was the number of CXRs per patient-day, but we also measured CTs of the chest, mechanical ventilator days, length of ICU stay and ICU and hospital mortality. RESULTS There were 0.73 CXRs per patient-day done during the preintervention period and 0.54 CXRs per patient-day done during the postintervention period, a 26% reduction. There were no differences between the periods in age, sex or severity of illness (Acute Physiology and Chronic Health Evaluation (APACHE) II score) of the patients, number of chest CTs, mechanical ventilator days, length of ICU stay and ICU or hospital mortality. CONCLUSIONS A quality improvement that includes education, reminders of appropriate indications and computerised decision support can decrease the number of routine CXRs in an ICU.
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Affiliation(s)
- Eric Sy
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Luong
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Quon
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Young Kim
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sadra Sharifi
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Monica Norena
- Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Hubert Wong
- Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Najib Ayas
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Dodek
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Sow PS, Gueye TSN, Sy E, Toure L, Ba C, Badiane M. Drugs in the parallel market for the treatment of urethral discharge in Dakar: epidemiologic investigation and physicochemical tests. Int J Infect Dis 2002; 6:108-12. [PMID: 12121597 DOI: 10.1016/s1201-9712(02)90070-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Sexually transmitted diseases (STDs) constitute a major public health concern in developing countries. Their interest lies mainly in their diagnosis and their early treatment. Owing to lack of health education and poor living conditions inherent in underdevelopment, self-medication is common practice in these Third World countries. Therefore, the illegal sale of drugs is an important phenomenon in Africa and Asia. METHODS An investigation, with a view to evaluating the importance of drug sales in the parallel market for the treatment of urethral discharge in Dakar, was carried out in 50 different locations in the working-class districts of the capital from 13 February to 6 March 1997. These drugs, obtained from vendors in the illegal market, were tested and analyzed using the standard physicochemical methods. RESULTS The most frequently proposed drugs to treat male urethritis are: ampicillin 250-mg capsules (44%); oxytetracyline 250-mg capsules (24%); and cotrimoxazole 450-mg tablets (12%). In most cases (88%), these drugs were sold unpackaged; 12% were sold in blisters. Furthermore, in 90% of cases, the expiry date was not indicated. The dosage and duration of treatment were correct in only 6% of cases. The physicochemical analysis was based on the external appearance, the identification, and the dosage of the active principle. Of these drugs offered by street vendors, 53.1% had an unusual appearance; they were mainly ampicillin 250 mg (21 of 22 samples) and oxytetracycline 250 mg (6 of 12 samples). Furthermore, all active principles were identified as positive, with the exception of ampicillin 250 mg, for which only one sample of the 22 was positive; the others appeared to be flour, with no trace of the active principle. CONCLUSION Given the extent of these illegal sales of drug and their harmful consequences for the health of the population, adequate measures should be taken to eradicate this blight. For this mission to succeed, public authorities, health professionals and populations should combine their efforts.
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Affiliation(s)
- P S Sow
- Department of Infectious Diseases, University Teaching Hospital Fann, Dakar, Senegal. saifsow.sentoo.sn
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Abstract
Cerebral hemorrhage is the most dreaded complication of coronary thrombolysis. Significant bleeding has also been described from catheter-entry sites, the retroperitoneum, and the gastrointestinal and genitourinary tracts. However, hemoptysis induced by thrombolysis has rarely been described in the literature. We present a 66-year-old male who received front-loaded tissue plasminogen activator (tPA) for acute transmural anterior wall myocardial infarction and developed massive hemoptysis from preexisting cavitary lung disease. The patient died within 5 hours. We believe this is the first case report of fatal hemoptysis induced by coronary thrombolysis. A history of cavitary lung disease may be a risk factor for life-threatening hemoptysis in patients receiving thrombolytic therapy.
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Affiliation(s)
- AW Basher
- Division of Cardiology and Pulmonary Medicine, Bronx-Lebanon Hospital Center, Bronx, New York; Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, New York and Department of Pathology, Bronx-Lebanon Hospital Center, Bronx, New York
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Sow P, N'Gueye T, Sy E, Toure L, Ba C, Badiane M. Les médicaments du marché parallèle pour le traitement de l'écoulement urétral à Dakar: Enquête épidémiologique et contrôle physicochimique. Med Mal Infect 1999. [DOI: 10.1016/s0399-077x(99)80099-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cheer AY, Dwyer HA, Barakat AI, Sy E, Bice M. Computational study of the effect of geometric and flow parameters on the steady flow field at the rabbit aorto-celiac bifurcation. Biorheology 1998; 35:415-35. [PMID: 10656050 DOI: 10.1016/s0006-355x(99)80020-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Arterial hemodynamic forces may play a role in the localization of early atherosclerotic lesions. We have been developing numerical techniques based on overset or "Chimera" type formulations to solve the Navier-Stokes equations in complex geometries simulating arterial bifurcations. This paper presents three-dimensional steady flow computations in a model of the rabbit aorto-celiac bifurcation. The computational methods were validated by comparing the numerical results to previously-obtained flow visualization data. Once validated, the numerical algorithms were used to investigate the sensitivity of the computed flow field and resulting wall shear stress distribution to various geometric and hemodynamic parameters. The results demonstrated that a decrease in the extent of aortic taper downstream of the celiac artery induced looping fluid motion along the lateral walls of the aorta and shifted the peak wall shear stress from downstream of the celiac artery to upstream. Increasing the flow Reynolds number led to a sharp increase in spatial gradients of wall shear stress. The flow field was highly sensitive to the flow division ratio, i.e., the fraction of total flow rate that enters the celiac artery, with larger values of this ratio leading to the occurrence of flow separation along the dorsal wall of the aorta. Finally, skewness of the inlet velocity profile had a profound impact on the wall shear stress distribution near the celiac artery. While not physiological due to the assumption of steady flow, these results provide valuable insight into the fluid physics at geometries simulating arterial bifurcations.
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Affiliation(s)
- A Y Cheer
- Department of Mathematics, University of California, Davis 95616, USA
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