1
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Wang MC, Zhou KJ, Shay SL, Herlihy JP, Siddique MA, Trevino Castillo S, Lasco TM, Barrett M, Al Mohajer M. The impact of a blood-culture diagnostic stewardship intervention on utilization rates and antimicrobial stewardship. Infect Control Hosp Epidemiol 2024; 45:670-673. [PMID: 38088164 DOI: 10.1017/ice.2023.265] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Blood-culture overutilization is associated with increased cost and excessive antimicrobial use. We implemented an intervention in the adult intensive care unit (ICU), combining education based on the DISTRIBUTE algorithm and restriction to infectious diseases and ICU providers. Our intervention led to reduced blood-culture utilization without affecting safety metrics.
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Affiliation(s)
- Melinda C Wang
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Kelvin J Zhou
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Sabra L Shay
- Premier Inc, Department of Clinical Intelligence, Charlotte, North Carolina
| | - James P Herlihy
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Baylor St Luke's Medical Center, Houston, Texas
| | - Muhammad A Siddique
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Baylor St Luke's Medical Center, Houston, Texas
| | - Sergio Trevino Castillo
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Baylor St Luke's Medical Center, Houston, Texas
| | - Todd M Lasco
- Baylor St Luke's Medical Center, Houston, Texas
- Department of Pathology, Baylor College of Medicine, Houston, Texas
| | | | - Mayar Al Mohajer
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Baylor St Luke's Medical Center, Houston, Texas
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2
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Gladstone DE, D'Alessio F, Howard C, Lyu MA, Mock JR, Gibbs KW, Abrams D, Huang M, Zeng K, Herlihy JP, Castillo ST, Bassett R, Sadeghi T, Parmar S, Flowers CR, Mukherjee S, Schoenfeld D, Thall PF, Slutsky AS. Randomized, double-blinded, placebo-controlled trial of allogeneic cord blood T-regulatory cells for treatment of COVID-19 ARDS. Blood Adv 2023; 7:3075-3079. [PMID: 36961352 PMCID: PMC10043947 DOI: 10.1182/bloodadvances.2022009619] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Affiliation(s)
- Douglas E Gladstone
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY
| | - Franco D'Alessio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Mi-Ae Lyu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason R. Mock
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kevin W. Gibbs
- Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, and Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY
| | - Meixian Huang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ke Zeng
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Roland Bassett
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | | | - Simrit Parmar
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher R. Flowers
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Siddhartha Mukherjee
- Division of Hematology/ Oncology, Department of Medicine, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | | | - Peter F. Thall
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Arthur S. Slutsky
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto and University of Toronto, Toronto, Canada
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3
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Zulbaran-Rojas A, Mishra R, Rodriguez N, Bara RO, Lee M, Bagheri AB, Herlihy JP, Siddique M, Najafi B. Safety and efficacy of electrical stimulation for lower-extremity muscle weakness in intensive care unit 2019 Novel Coronavirus patients: A phase I double-blinded randomized controlled trial. Front Med (Lausanne) 2022; 9:1017371. [PMID: 36561714 PMCID: PMC9763311 DOI: 10.3389/fmed.2022.1017371] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Background Intensive care unit (ICU) prolonged immobilization may lead to lower-extremity muscle deconditioning among critically ill patients, particularly more accentuated in those with 2019 Novel Coronavirus (COVID-19) infection. Electrical stimulation (E-Stim) is known to improve musculoskeletal outcomes. This phase I double-blinded randomized controlled trial examined the safety and efficacy of lower-extremity E-Stim to prevent muscle deconditioning. Methods Critically ill COVID-19 patients admitted to the ICU were randomly assigned to control (CG) or intervention (IG) groups. Both groups received daily E-Stim (1 h) for up to 14 days on both gastrocnemius muscles (GNMs). The device was functional in the IG and non-functional in the CG. Primary outcomes included ankle strength (Ankles) measured by an ankle-dynamometer, and GNM endurance (GNMe) in response to E-Stim assessed with surface electromyography (sEMG). Outcomes were measured at baseline, 3 and 9 days. Results Thirty-two (IG = 16, CG = 16) lower extremities in 16 patients were independently assessed. The mean time between ICU admission and E-Stim therapy delivery was 1.8 ± 1.9 days (p = 0.29). At 3 days, the IG showed an improvement compared to the CG with medium effect sizes for Ankles (p = 0.06, Cohen's d = 0.77) and GNMe (p = 0.06, d = 0.69). At 9 days, the IG GNMe was significantly higher than the CG (p = 0.04, d = 0.97) with a 6.3% improvement from baseline (p = 0.029). E-Stim did not alter vital signs (i.e., heart/respiratory rate, blood saturation of oxygen), showed no adverse events (i.e., pain, skin damage, discomfort), nor interfere with ICU standard of care procedures (i.e., mechanical ventilation, prone rotation). Conclusion This study supports the safety and efficacy of early E-Stim therapy to potentially prevent deterioration of lower-extremity muscle conditions in critically ill COVID-19 patients recently admitted to the ICU. If confirmed in a larger sample, E-Stim may be used as a practical adjunctive therapy. Clinical trial registration [https://clinicaltrials.gov/], identifier [NCT04685213].
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Affiliation(s)
- Alejandro Zulbaran-Rojas
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Ramkinker Mishra
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Naima Rodriguez
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Rasha O. Bara
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Myeounggon Lee
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Amir Behzad Bagheri
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - James P. Herlihy
- Department of Pulmonary Critical Care, Baylor College of Medicine, Houston, TX, United States
| | - Muhammad Siddique
- Department of Pulmonary Critical Care, Baylor College of Medicine, Houston, TX, United States
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States,*Correspondence: Bijan Najafi,
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4
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Grouls A, Nwogu-Onyemkpa E, Guffey D, Chatterjee S, Herlihy JP, Naik AD. Palliative Care Impact on COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation. J Pain Symptom Manage 2022; 64:e181-e187. [PMID: 35764199 PMCID: PMC9233556 DOI: 10.1016/j.jpainsymman.2022.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 12/05/2022]
Abstract
CONTEXT Patients with severe respiratory failure from COVID-19 refractory to conventional therapies may be treated with extracorporeal membrane oxygenation (ECMO). ECMO requirement is associated with high mortality and prolonged hospital course. ECMO is a high-resource intervention with significant burdens placed on caregivers and families with limited data on the integration of palliative care consultation (PCC). OBJECTIVES To explore the role of standard vs. automatic PCC in the management of COVID patients on ECMO. METHODS Retrospective chart review of all COVID patients on ECMO admitted from March 2020 to May 2021 at a large volume academic medical center with subsequent analysis. RESULTS Forty-eight patients were included in the analysis. Twenty-six (54.2%) received PCC of which 42% of consults were automatically initiated. PCC at any point in admission was associated with longer duration on ECMO (24.5 vs. 37 days; P < 0.05). Automatic PCC resulted in more family meetings than standard PCC (0 vs. 3; P < 0.05) and appears to trend with reduced time on ECMO, shorter length of stay, and higher DNAR rates at death, though results were not significant. Decedents not receiving PCC had higher rates of no de-escalation of interventions at time of death (31% vs. 11%), indicating full intensive care measures continued through death. CONCLUSIONS Among patients with COVID-19 receiving ECMO, PCC may be associated with a shift to DNAR status particularly with automatic PCC. There may be a further impact on length of stay, duration of time on ECMO and care plan at end of life.
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Affiliation(s)
- Astrid Grouls
- Department of Medicine (A.G., E.N.O.), Section of Geriatrics and Palliative Medicine, Baylor College of Medicine, Houston, Texas, USA.
| | - Eberechi Nwogu-Onyemkpa
- Department of Medicine (A.G., E.N.O.), Section of Geriatrics and Palliative Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Danielle Guffey
- Institute for Clinical and Translational Research (D.G.), Baylor College of Medicine, Houston, Texas, USA
| | - Subhasis Chatterjee
- Divisions of General and Cardiothoracic Surgery (S.C.), Michael E. DeBakey Department of Surgery, Baylor College Medicine, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA
| | - James P Herlihy
- Department of Medicine (J.P.H.), Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Aanand D Naik
- Department of Management, Policy, and Community Health (MPACH) (A.D.N.), University of Texas School of Public Health, UTHealth Consortium on Aging; and VA Center of Innovations, DeBakey VA Medical Center, Houston, Texas USA
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5
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Howard C, Amspoker AB, Morgan CK, Kuo D, Esquivel A, Rosen T, Razjouyan J, Siddique MA, Herlihy JP, Naik AD. Implementation of automated early warning decision support to detect acute decompensation in the emergency department improves hospital mortality. BMJ Open Qual 2022; 11:bmjoq-2021-001653. [PMID: 35396254 PMCID: PMC8996043 DOI: 10.1136/bmjoq-2021-001653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/06/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Amber B Amspoker
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas, USA
| | | | - Dick Kuo
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Adol Esquivel
- Baylor St Luke's Medical Center (BSLMC), Houston, Texas, USA
| | - Tracey Rosen
- Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas, USA
| | - Javad Razjouyan
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas, USA
| | | | - James P Herlihy
- Baylor St Luke's Medical Center (BSLMC), Houston, Texas, USA
| | - Aanand D Naik
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas, USA.,Management, Policy, and Community Health, University of Texas School of Public Health, Houston, Texas, USA
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6
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Mankidy B, Howard C, Morgan CK, Valluri KA, Giacomino B, Marfil E, Voore P, Ababio Y, Razjouyan J, Naik AD, Herlihy JP. Reduction of in-hospital cardiac arrest with sequential deployment of rapid response team and medical emergency team to the emergency department and acute care wards. PLoS One 2020; 15:e0241816. [PMID: 33259488 PMCID: PMC7707602 DOI: 10.1371/journal.pone.0241816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose This study aimed to determine if sequential deployment of a nurse-led Rapid Response Team (RRT) and an intensivist-led Medical Emergency Team (MET) for critically ill patients in the Emergency Department (ED) and acute care wards improved hospital-wide cardiac arrest rates. Methods In this single-center, retrospective observational cohort study, we compared the cardiac arrest rates per 1000 patient-days during two time periods. Our hospital instituted a nurse-led RRT in 2012 and added an intensivist-led MET in 2014. We compared the cardiac arrest rates during the nurse-led RRT period and the combined RRT-MET period. With the sequential approach, nurse-led RRT evaluated and managed rapid response calls in acute care wards and if required escalated care and co-managed with an intensivist-led MET. We specifically compared the rates of pulseless electrical activity (PEA) in the two periods. We also looked at the cardiac arrest rates in the ED as RRT-MET co-managed patients with the ED team. Results Hospital-wide cardiac arrests decreased from 2.2 events per 1000 patient-days in the nurse-led RRT period to 0.8 events per 1000 patient-days in the combined RRT and MET period (p-value = 0.001). Hospital-wide PEA arrests and shockable rhythms both decreased significantly. PEA rhythms significantly decreased in acute care wards and the ED. Conclusion Implementing an intensivist-led MET-RRT significantly decreased the overall cardiac arrest rate relative to the rate under a nurse-led RRT model. Additional MET capabilities and early initiation of advanced, time-sensitive therapies likely had the most impact.
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Affiliation(s)
- Babith Mankidy
- Department of Medicine, Baylor College of Medicine, Baylor St Luke’s Medical Center, Houston, Texas, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail:
| | - Christopher Howard
- Department of Medicine, Baylor College of Medicine, Baylor St Luke’s Medical Center, Houston, Texas, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Christopher K. Morgan
- Department of Medicine, Baylor College of Medicine, Baylor St Luke’s Medical Center, Houston, Texas, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Kartik A. Valluri
- Department of Medicine, Baylor College of Medicine, Baylor St Luke’s Medical Center, Houston, Texas, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Bria Giacomino
- Department of Medicine, Baylor College of Medicine, Baylor St Luke’s Medical Center, Houston, Texas, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Eddie Marfil
- Department of Medicine, Baylor College of Medicine, Baylor St Luke’s Medical Center, Houston, Texas, United States of America
| | - Prakruthi Voore
- Department of Medicine, Baylor College of Medicine, Baylor St Luke’s Medical Center, Houston, Texas, United States of America
| | - Yao Ababio
- Department of Medicine, Baylor College of Medicine, Baylor St Luke’s Medical Center, Houston, Texas, United States of America
| | - Javad Razjouyan
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Veterans Affairs Health Services Research & Development, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
| | - Aanand D. Naik
- Department of Medicine, Baylor College of Medicine, Baylor St Luke’s Medical Center, Houston, Texas, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Veterans Affairs Health Services Research & Development, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
| | - James P. Herlihy
- Department of Medicine, Baylor College of Medicine, Baylor St Luke’s Medical Center, Houston, Texas, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
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Abstract
Introduction Noninvasive positive pressure ventilation (NIPPV) plays an important role in the management of respiratory failure. However, since the emergence of the COVID-19 pandemic, utilization of traditional face mask NIPPV has been curtailed in part due to risk of aerosolization of respiratory particles and subsequent health care worker exposure. A randomized clinical trial in 2016 reported that an alternative interface, helmet NIPPV, may be more effective than traditional NIPPV at preventing intubation and improving mortality. The helmet NIPPV interface provides positive airway pressure, while also theoretically minimizing aerosolization, making it a feasible modality in management of respiratory failure in COVID-19 patients. Case and outcomes This report describes a single-center experience of a series of three COVID-19 patients with hypoxemic respiratory failure managed with helmet NIPPV. One patient was able to avoid intubation while a second patient was successfully extubated to NIPPV. Ultimately, the third patient was unable to avoid intubation with helmet NIPPV, although the application of the device was late in the progression of the disease. Discussion NIPPV is an important modality in the management of respiratory failure and has been shown to reduce the need for immediate endotracheal intubation in select populations. For patients unable to tolerate facemask NIPPV, the helmet provides an alternate interface. In COVID-19 patients, the helmet interface may reduce the risk of virus exposure to health care workers from aerosolization. Based on this experience, we recommend that helmet NIPPV can be considered as a feasible option for the management of patients with COVID-19, whether the goal is to prevent immediate intubation or avoid post-extubation respiratory failure. Randomized studies are needed to definitively validate the use of helmet NIPPV in this population. Conclusion Helmet NIPPV is a feasible therapy to manage COVID-19 patients.
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Affiliation(s)
- Aniket S Rali
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Christopher Howard
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Rachel Miller
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Christopher K Morgan
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Dennis Mejia
- Department of Respiratory Care, Baylor St. Luke's Medical Center, Houston, TX, USA
| | - John Sabo
- Department of Respiratory Care, Baylor St. Luke's Medical Center, Houston, TX, USA
| | - James P Herlihy
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sunjay R Devarajan
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
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8
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Yang Y, Rali AS, Inchaustegui C, Alakbarli J, Chatterjee S, Herlihy JP, George J, Shafii A, Nair A, Simpson L. Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019-associated Acute Respiratory Distress Syndrome: An Initial US Experience at a High-volume Centre. Card Fail Rev 2020; 6:e17. [PMID: 32670617 PMCID: PMC7341259 DOI: 10.15420/cfr.2020.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
- Yang Yang
- Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
| | - Aniket S Rali
- Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
| | | | - Javid Alakbarli
- Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
| | - Subhasis Chatterjee
- Michael E DeBakey Department of Surgery, Baylor College Medicine Houston, TX, US.,Department of Cardiovascular Surgery, Texas Heart Institute Houston, TX, US
| | - James P Herlihy
- Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
| | - Joggy George
- Department of Cardiology, Texas Heart Institute Houston, TX, US
| | - Alexis Shafii
- Michael E DeBakey Department of Surgery, Baylor College Medicine Houston, TX, US.,Department of Cardiovascular Surgery, Texas Heart Institute Houston, TX, US
| | - Ajith Nair
- Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
| | - Leo Simpson
- Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
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9
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Rali AS, Trevino S, Yang E, Herlihy JP, Diaz-Gomez J. Cardiopulmonary Ultrasonography for Severe Coronavirus Disease 2019 Patients in Prone Position. Card Fail Rev 2020; 6:e12. [PMID: 32514381 PMCID: PMC7265100 DOI: 10.15420/cfr.2020.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/03/2020] [Indexed: 01/19/2023] Open
Affiliation(s)
- Aniket S Rali
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
| | - Sergio Trevino
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
| | - Edward Yang
- Department of Anesthesiology, Baylor College of Medicine Houston, TX, US
| | - James P Herlihy
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
| | - Jose Diaz-Gomez
- Department of Anesthesiology, Baylor College of Medicine Houston, TX, US
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10
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Affiliation(s)
- Aniket S Rali
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor College of Medicine Houston, Texas, US
| | - Krishidhar R Nunna
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor College of Medicine Houston, Texas, US
| | - Christopher Howard
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor College of Medicine Houston, Texas, US
| | - James P Herlihy
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor College of Medicine Houston, Texas, US
| | - Kalpalatha K Guntupalli
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Baylor College of Medicine Houston, Texas, US
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11
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Berger DH, Howard C, Holcomb JB, Herlihy JP. Improved Survival in Critically Ill Patients after Implementing a Visual Clinical Decision Support System. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.09.013] [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: 10/28/2022]
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12
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Herlihy JP, Loyalka P, Gnananandh J, Gregoric ID, Dahlberg CGW, Kar B, Delgado RM. PleurX catheter for the management of refractory pleural effusions in congestive heart failure. Tex Heart Inst J 2009; 36:38-43. [PMID: 19436784 PMCID: PMC2676536] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Pleural effusions that are caused by congestive heart failure and refractory to medical management are rare, and the options for treating them are few and sometimes ineffective. We report here our experience, over a 2-year period, with a novel device, the Denver Biomedical PleurX pleural catheter, in treating a series of 5 patients who had chronic, refractory, heart-failure-associated pleural effusions. The PleurX catheter is a small-bore chest tube designed to remain in place for prolonged periods, through which drainage of pleural fluid can be performed easily on a daily or less frequent outpatient basis. Placement of the catheter, in our series, was associated with no complications. In all patients, the catheter effectively drained the pleural space initially, thereby controlling the effusions and alleviating New York Heart Association functional class IV symptoms. The catheters remained in place for a period of 1 to 15 months. In 2 of the patients, the catheter was associated with no complications during the time that it remained in place. One of these patients had the catheter removed at heart transplantation, and 1 retained the catheter until death from underlying heart disease. For 1 patient, the catheter resulted in a partially loculated pleural space, and it was removed. In 2 patients, after prolonged use, it was associated with empyema, for which it was removed. We conclude that the PleurX catheter can effectively control refractory congestive-heart-failure-associated pleural effusions temporarily, but that its prolonged use can cause significant complications, most importantly empyema.
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Affiliation(s)
- James P Herlihy
- Department of Pulmonary and Critical Care Medicine, Baylor College of Medicine, 6624 Fannin St., Houston, TX 77030, USA.
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13
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Herlihy JP, Loyalka P, Jayaraman G, Kar B, Gregoric ID. Extracorporeal membrane oxygenation using the TandemHeart System's catheters. Tex Heart Inst J 2009; 36:337-341. [PMID: 19693311 PMCID: PMC2720287] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We describe the initial--and successful--use of the TandemHeart System's catheters to provide extracorporeal membrane oxygenation (ECMO), in 2 patients. In 1 patient, who was experiencing severe primary respiratory failure, the catheters provided a standard venovenous ECMO circuit. In the other patient, who had severe, acute pulmonary hypertension and right-heart failure, the catheters enabled a novel right atrial-to-left atrial circuit for ECMO. We discuss the potential of the TandemHeart System's catheters to provide novel and possibly superior vascular routes for the delivery of ECMO in different types of cardiopulmonary failure.
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Affiliation(s)
- James P Herlihy
- Department of Pulmonary & Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA.
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Herlihy JP, Koch SM, Jackson R, Nora H. Course of weaning from prolonged mechanical ventilation after cardiac surgery. Tex Heart Inst J 2006; 33:122-9. [PMID: 16878611 PMCID: PMC1524720] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In order to determine the temporal pattern of weaning from mechanical ventilation for patients undergoing prolonged mechanical ventilation after cardiac surgery, we performed a retrospective review of 21 patients' weaning courses at our long-term acute care hospital. Using multiple regression analysis of an estimate of individual patients' percentage of mechanical ventilator support per day (%MVSD), we determined that 14 of 21 patients (67%) showed a statistically significant quadratic or cubic relationship between time and % MVSD. These patients showed little or no improvement in their ventilator dependence until a point in time when, abruptly, they began to make rapid progress (a "wean turning point"), after which they progressed to discontinuation of mechanical ventilation in a relatively short period of time. The other 7 patients appeared to have a similar weaning pattern, although the data were not statistically significant. Most patients in the study group weaned from the ventilator through a specific temporal pattern that is newly described herein. Data analysis suggested that the mechanism for the development of a wean turning point was improvement of pulmonary mechanics rather than improvement in gas exchange or respiratory load. Although these observations need to be confirmed by a prospective trial, they may have implications for weaning cardiac surgery patients from prolonged mechanical ventilation, and possibly for weaning a broader group of patients who require prolonged mechanical ventilation.
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Kerawala R, Reul R, Herlihy JP. PROLONGED ENTRAPMENT OF FOREIGN BODY IN THE AIRWAY. Chest 2005. [DOI: 10.1378/chest.128.4_meetingabstracts.470s-a] [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: 11/01/2022] Open
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Abstract
A 57-year-old man who had received an automatic implantable cardioverter defibrillator and subsequent orthotopic heart transplant presented to medical attention for hemoptysis. The hemoptysis was caused by the migration of the left ventricular patch of the automatic implantable cardioverter defibrillator, which had been left in place at the time of orthotopic heart transplant. The patch had eroded into the left lung. We recommend that implantable cardioverter defibrillators be removed completely at the time of heart transplantation to prevent subsequent complications.
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Affiliation(s)
- S Chilukuri
- Pulmonary Medicine and Critical Care, St. Luke's Episcopal Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
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Abstract
Polymorphonuclear leukocytes (PMN) are recruited to the lungs to defend against injury and infection. However, PMN undergo apoptosis, thereby losing functional ability within hours, and die with lysis soon thereafter unless they receive specific signals preventing this phenomenon. We hypothesized that alveolar macrophages (AM) could provide these signals. Therefore AM, obtained through bronchoalveolar lavage of healthy volunteers (n = 9), were cultured for 24 h, after which the AM conditioned media (AM-CM) were removed. Freshly isolated PMN, which showed no apoptosis, were suspended in AM-CM, as well as in unconditioned media (UM), and followed over 48 h for apoptosis and survival. In eight of nine patients, AM-CM contained tumor necrosis factor (TNF), which modestly delayed AM apoptosis so that the percentage of PMN apoptotic at 24 h was 77 +/- 6% in AM-CM compared with 91 +/- 2% in UM (P < 0.05). In one patient, urticaria developed early in the lavage, and this subject's AM-CM profoundly prevented apoptosis of PMN (to 10% at 24 h). PMN survival in this patient was similarly enhanced, so that at 48 h of culture it was 60%, compared with 45 +/- 8% in AM-CM and 30 +/- 6% in UM (P < 0.05 UM vs. AM-CM). Granulocyte/macrophage colony-stimulating factor (GM-CSF), in addition to TNF-alpha, partly accounted for this medium's activity. Thus AM can delay apoptosis in PMN through production of TNF-alpha and in some cases by GM-CSF. When activated in vivo by conditions such as an allergic reaction, AM can rapidly and profoundly suppress PMN apoptosis.
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Affiliation(s)
- J P Herlihy
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, USA
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Abstract
The high incidence of both bacterial pneumonia and the adult respiratory distress syndrome (ARDS) associated with smoke inhalation injury (SII) may result, at least in part, from smoke-induced injury to the alveolar macrophage (AM). Specifically, we hypothesized that AM antimicrobial function, ability to phagocytose apoptotic PMNs, and capacity to prevent apoptosis in PMNs are impaired by smoke. To test these hypotheses, AMs were harvested by bronchoalveolar lavage from sheep before and after the animal was exposed to cotton smoke. The two populations of AMs were incubated with Pseudomonas aeruginosa (PSA) in vitro. Normal AMs (NAMs) phagocytosed a mean of 99 +/- 11% of the PSA placed in their wells, whereas smoke-exposed AMs (SAMs) ingested only 60 +/- 8%. NAMs killed 80 +/- 8% of PSA ingested, whereas SAMs killed only 56 +/- 16% (P < 0.05). When sheep PMNs, allowed to undergo apoptosis, were incubated with the two AM populations, 66 +/- 3% of the NAMs and 40 +/- 6% of the SAMs demonstrated phagocytosis of these apoptotic PMNs (P < 0.05). Fresh sheep PMNs were incubated in unconditioned media, NAM and SAM-conditioned media, and followed over 48 hr for the development of apoptosis and maintenance of viability. The NAM-conditioned media markedly prevented apoptosis and augmented PMN survival relative to the unconditioned and SAM-conditioned media (P < 0.05). The poor antimicrobial function known to be characteristic of apoptotic PMNs, together with the directly impaired antimicrobial function of AMs, may contribute to the infectious complications of SII. If the PMNs recruited to the lung in SII are not properly supported by the AMs following smoke injury, large numbers may undergo apoptosis. If not properly disposed of by these SAMs, the apoptotic PMNs could eventually lyse, releasing tissue toxins, resulting in escalation of lung injury and leading to ARDS.
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Affiliation(s)
- J P Herlihy
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston 02174
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Herlihy JP, Venegas JG, Systrom DM, Greene RE, McKusick KA, Wain JC, Ginns LC. Expiratory flow pattern following single-lung transplantation in emphysema. Am J Respir Crit Care Med 1994; 150:1684-9. [PMID: 7952633 DOI: 10.1164/ajrccm.150.6.7952633] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In single lung transplantation (SLT) recipients, a "plateau" of the maximal expiratory flow volume curve (MEFV) and a "biphasic" MEFV have been reported to reflect anastomosis pathology. A plateau is defined as constant airflow over a large expired volume early in the MEFV. A biphasic MEFV has an initial period of high flow followed by a terminal low flow phase. Models of expiratory flow limitation by wave speed, however, predict that the MEFV of SLT recipients with emphysema should both be biphasic and demonstrate a plateau even without anastomosis pathology. Review of the spirometries and clinical courses of our first ten patients receiving SLT for emphysema demonstrated a biphasic MEFV, and a plateau of the MEFV in all patients. No patient showed evidence of anastomosis pathology. Independent lung spirometries, generated by a novel technique, revealed that the initial high flow phase of the MEFV came from the transplanted lung and the terminal low flow from the native emphysematous lung. The location of the flow limitation was demonstrated to be immediately downstream from the anastomosis. Therefore, the MEFV of SLT recipients with emphysema routinely demonstrates both a biphasic pattern and a plateau, neither of which necessarily reflect anastomosis pathology.
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Affiliation(s)
- J P Herlihy
- Lung Transplantation Program, Massachusetts General Hospital, Boston 02114
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Abstract
After irradiation of the neck for a squamous cell carcinoma of the tonsillar pillar and vocal cord, a 71-year-old man presented with a rapidly progressive sleep apnea syndrome. Previous reports describe the condition of patients with obstructive sleep apnea that developed after neck irradiation and secondary to supraglottic edema. Our patient had an obstructive component to his apnea similar to that described in previous cases, but, in addition, he had hypothyroidism. Myxedema is a well-described cause of both obstructive and central apnea. We believe both contributed to his condition. He was successfully treated by placement of a tracheostomy and by thyroid supplementation. In patients who present with sleep apnea after neck irradiation, especially with acute or severe symptoms, the differential diagnosis should include both a central cause from hypothyroidism as well as a peripheral obstructive cause from laryngeal edema.
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Affiliation(s)
- J P Herlihy
- Pulmonary Disease Service, Letterman Army Medical Center, Presidio of San Francisco, CA 94129-6700
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