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Jevnikar WR, Almassi N, Wright A, Sreedharan R. Urology Clinical Challenge: Venous Air Embolism. Urology 2023; 178:e195-e196. [PMID: 37302760 DOI: 10.1016/j.urology.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/15/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Affiliation(s)
- William R Jevnikar
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Nima Almassi
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| | - Alexandra Wright
- Department of Intensive Care & Resuscitation, Anesthesiology & Pain Management Institute, Cleveland Clinic, Cleveland, OH
| | - Roshni Sreedharan
- Department of Intensive Care & Resuscitation, Anesthesiology & Pain Management Institute, Cleveland Clinic, Cleveland, OH
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Sreedharan R, Khanna S, Shaw A. Perioperative glycemic management in adults presenting for elective cardiac and non-cardiac surgery. Perioper Med (Lond) 2023; 12:13. [PMID: 37120562 PMCID: PMC10149003 DOI: 10.1186/s13741-023-00302-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/19/2023] [Indexed: 05/01/2023] Open
Abstract
Perioperative dysglycemia is associated with adverse outcomes in both cardiac and non-cardiac surgical patients. Hyperglycemia in the perioperative period is associated with an increased risk of postoperative infections, length of stay, and mortality. Hypoglycemia can induce neuronal damage, leading to significant cognitive deficits, as well as death. This review endeavors to summarize existing literature on perioperative dysglycemia and provides updates on pharmacotherapy and management of perioperative hyperglycemia and hypoglycemia in surgical patients.
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Affiliation(s)
- Roshni Sreedharan
- Department of Intensive Care & Resuscitation, Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of General Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sandeep Khanna
- Department of General Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH, USA.
- Department of Outcomes Research, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Andrew Shaw
- Department of Intensive Care & Resuscitation, Cleveland Clinic Foundation, Cleveland, OH, USA
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Sreedharan R, Martini A, Das G, Aftab N, Khanna S, Ruetzler K. Clinical challenges of glycemic control in the intensive care unit: A narrative review. World J Clin Cases 2022; 10:11260-11272. [PMID: 36387820 PMCID: PMC9649548 DOI: 10.12998/wjcc.v10.i31.11260] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/15/2022] [Accepted: 09/27/2022] [Indexed: 02/05/2023] Open
Abstract
Glucose control in patient admitted to the intensive care unit has been a topic of much debate over the past 20 years. The harmful effects of uncontrolled hyperglycemia and hypoglycemia in critically ill patients is well established. Although a large clinical trial in 2001 demonstrated significant mortality and morbidity benefits with tight glucose control in this patient population, the results could not be replicated by other investigators. The “Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation” trial in 2009 established that tight glucose control was not only of no benefit, but in fact harmful due to the significant risk of hypoglycemia. The current guidelines suggest a moderate approach with the initiation of intravenous insulin therapy in critically ill patients when the blood glucose level is above 180 mg/dL. The most important factor that underpins glycemic management in intensive care unit patients is the consequent prevention of hypoglycemia. Robust glucose monitoring strategies and insulin protocols need to be implemented in order to achieve this goal.
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Affiliation(s)
- Roshni Sreedharan
- Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Adriana Martini
- Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Gyan Das
- Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Nida Aftab
- Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Sandeep Khanna
- Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Kurt Ruetzler
- Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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Khanna S, Richardson R, Trombetta C, Sreedharan R. Anterolateral papillary muscle rupture in acute myocardial infarction. Colomb J Anesthesiol 2022. [DOI: 10.5554/22562087.e1052] [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: 02/05/2023] Open
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Udeh C, Perez-Protto S, Canfield CM, Sreedharan R, Factora F, Hata JS. Outcomes Associated with ICU Telemedicine and Other Risk Factors in a Multi-Hospital Critical Care System: A Retrospective, Cohort Study for 30-Day In-Hospital Mortality. Telemed J E Health 2022; 28:1395-1403. [PMID: 35294855 DOI: 10.1089/tmj.2021.0465] [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: 11/12/2022] Open
Abstract
Introduction: Intensive care unit telemedicine (ICU-TM) is expanding due to increasing demands for critical care, but impact on outcomes remains controversial. This study evaluated the association of ICU-TM and other clinical factors with 30-day, in-hospital mortality. Methods: This retrospective, cohort study included 151,780 consecutive ICU patients admitted to nine hospitals in the Cleveland Clinic Health System from 2010 to 2020. Patients were identified from an institutional datamart and Acute Physiology and Chronic Health Evaluation IV (APACHE IV) registry. Primary outcome was 30-day in-hospital mortality. Analyses included multivariate logistic regression modeling, and survival analysis. Results: Overall, unadjusted 30-day, in-hospital mortality incidence was significantly different with (5.6%) or without ICU-TM (7.2%), and risk ratio was 0.78 (95% confidence interval [CI] 0.75-0.81) (p < 0.0001). Mortality rate for ICU-TM and no ICU-TM was 2.4/1,000 versus 3.2/1,000 patient days, respectively (p < 0.0001). Multivariate logistic regression showed that ICU-TM was associated with reduced 30-day mortality (odds ratio 0.78, 95% CI 0.72-0.83). Increased risk was seen with cardiac arrest admissions, males, acute stroke, weekend admission, emergency admission, race (non-white), sepsis, APACHE IV score, ICU length of stay (LOS), and the interaction term, emergency surgical admissions. Reduced risk was associated with hospital LOS, surgical admission, and the interaction terms (weekend admissions with ICU-TM and after-hour admissions with ICU-TM). The model c-statistic was 0.77. Median ICU and hospital lengths of stay were significantly reduced with ICU-TM, with no difference in 48-h mortality or 48-h mortality rate. Conclusion: ICU telemedicine exposure appears to be one of several operational and clinical factors associated with reduced 30-day, in-hospital mortality.
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Affiliation(s)
- Chiedozie Udeh
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
| | - Silvia Perez-Protto
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
| | - Christina M Canfield
- Cleveland Clinic Foundation, Division of Medical Operations, Cleveland, Ohio, USA
| | - Roshni Sreedharan
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
| | - Faith Factora
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
| | - J Steven Hata
- Cleveland Clinic Foundation, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland, Ohio, USA
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Qiu Y, Rivas E, Tanios M, Sreedharan R, Mao G, Ince I, Salih A, Saab R, Devarajan J, Ruetzler K, Turan A. Effect of seasons on delirium in postoperative critically ill patients: a retrospective analysis. Braz J Anesthesiol 2022; 73:3-9. [PMID: 35182552 PMCID: PMC9801211 DOI: 10.1016/j.bjane.2022.02.002] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/06/2022] [Accepted: 02/06/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Postoperative delirium is common in critically ill patients and is known to have several predisposing and precipitating factors. Seasonality affects cognitive function which has a more dysfunctional pattern during winter. We, therefore, aimed to test whether seasonal variation is associated with the occurrence of delirium and hospital Length Of Stay (LOS) in critically ill non-cardiac surgical populations. METHODS We conducted a retrospective analysis of adult patients recovering from non-cardiac surgery at the Cleveland Clinic between March 2013 and March 2018 who stayed in Surgical Intensive Care Unit (SICU) for at least 48 hours and had daily Confusion Assessment Method Intensive Care Unit (CAM-ICU) assessments for delirium. The incidence of delirium and LOS were summarized by season and compared using chi-square test and non-parametric tests, respectively. A logistic regression model was used to assess the association between delirium and LOS with seasons, adjusted for potential confounding variables. RESULTS Among 2300 patients admitted to SICU after non-cardiac surgeries, 1267 (55%) had postoperative delirium. The incidence of delirium was 55% in spring, 54% in summer, 55% in fall and 57% in winter, which was not significantly different over the four seasons (p = 0.69). The median LOS was 12 days (IQR = [8, 19]) overall. There was a significant difference in LOS across the four seasons (p = 0.018). LOS during summer was 12% longer (95% CI: 1.04, 1.21; p = 0.002) than in winter. CONCLUSIONS In adult non-cardiac critically ill surgical patients, the incidence of postoperative delirium is not associated with season. Noticeably, LOS was longer in summer than in winter.
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Affiliation(s)
- Yuwei Qiu
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA,Shanghai Jiao Tong University, Shanghai Chest Hospital, Department of Anesthesiology, Shanghai, China
| | - Eva Rivas
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA,Universidad de Barcelona, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Department of Anesthesiology, Barcelona, Spain
| | - Marianne Tanios
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA
| | - Roshni Sreedharan
- Cleveland Clinic, Anesthesiology Institute, Department of Intensive Care and Resuscitation, Cleveland, USA
| | - Guangmei Mao
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA,Cleveland Clinic, Department of Quantitative Health Sciences, Cleveland, USA
| | - Ilker Ince
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA,Altinbas University, School of Medicine, Department of Anesthesiology and Reanimation, Bahcelievler Medical Park Hospital, Istanbul, Turkey
| | - Ahmed Salih
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA
| | - Remie Saab
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA
| | - Jagan Devarajan
- Medina Hospital, Cleveland Clinic, Anesthesiology Institute, Department of General Anesthesiology, Medina, USA
| | - Kurt Ruetzler
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA,Cleveland Clinic, Anesthesiology Institute, Department of General Anesthesiology, Cleveland, USA
| | - Alparslan Turan
- Cleveland Clinic, Anesthesiology Institute, Department of Outcomes Research, Cleveland, USA; Cleveland Clinic, Anesthesiology Institute, Department of General Anesthesiology, Cleveland, USA.
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Skinner C, Sreedharan R, Trombetta C, Khanna S. Melkersson Rosenthal Syndrome: anesthetic implications. Colomb J Anesthesiol 2022. [DOI: 10.5554/22562087.e1030] [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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Khanna S, Sreedharan R. Con: Sugammadex Should Not Be Used Routinely for Reversal of Neuromuscular Blockade in Patients Undergoing Thoracic Surgery. J Cardiothorac Vasc Anesth 2022; 36:1792-1797. [PMID: 35027298 DOI: 10.1053/j.jvca.2021.12.002] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/06/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Sandeep Khanna
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH.
| | - Roshni Sreedharan
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH; Department of Intensive Care Resuscitation, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH
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Khanna S, Sreedharan R, Trombettaa C. Iatrogenic tracheal wall injury. Colomb J Anesthesiol 2021. [DOI: 10.5554/22562087.e1003] [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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10
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Khanna S, Sreedharan R, Trombettaa C, Bustamante S. Inverted P waves: harmless or harbinger of doom? Colomb J Anesthesiol 2021. [DOI: 10.5554/22562087.e1002] [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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Avidan A, Sprung CL, Schefold JC, Ricou B, Hartog CS, Nates JL, Jaschinski U, Lobo SM, Joynt GM, Lesieur O, Weiss M, Antonelli M, Bülow HH, Bocci MG, Robertsen A, Anstey MH, Estébanez-Montiel B, Lautrette A, Gruber A, Estella A, Mullick S, Sreedharan R, Michalsen A, Feldman C, Tisljar K, Posch M, Ovu S, Tamowicz B, Demoule A, DeKeyser Ganz F, Pargger H, Noto A, Metnitz P, Zubek L, de la Guardia V, Danbury CM, Szűcs O, Protti A, Filipe M, Simpson SQ, Green C, Giannini AM, Soliman IW, Piras C, Caser EB, Hache-Marliere M, Mentzelopoulos SD. Variations in end-of-life practices in intensive care units worldwide (Ethicus-2): a prospective observational study. Lancet Respir Med 2021; 9:1101-1110. [PMID: 34364537 DOI: 10.1016/s2213-2600(21)00261-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND End-of-life practices vary among intensive care units (ICUs) worldwide. Differences can result in variable use of disproportionate or non-beneficial life-sustaining interventions across diverse world regions. This study investigated global disparities in end-of-life practices. METHODS In this prospective, multinational, observational study, consecutive adult ICU patients who died or had a limitation of life-sustaining treatment (withholding or withdrawing life-sustaining therapy and active shortening of the dying process) during a 6-month period between Sept 1, 2015, and Sept 30, 2016, were recruited from 199 ICUs in 36 countries. The primary outcome was the end-of-life practice as defined by the end-of-life categories: withholding or withdrawing life-sustaining therapy, active shortening of the dying process, or failed cardiopulmonary resuscitation (CPR). Patients with brain death were included in a separate predefined end-of-life category. Data collection included patient characteristics, diagnoses, end-of-life decisions and their timing related to admission and discharge, or death, with comparisons across different regions. Patients were studied until death or 2 months from the first limitation decision. FINDINGS Of 87 951 patients admitted to ICU, 12 850 (14·6%) were included in the study population. The number of patients categorised into each of the different end-of-life categories were significantly different for each region (p<0·001). Limitation of life-sustaining treatment occurred in 10 401 patients (11·8% of 87 951 ICU admissions and 80·9% of 12 850 in the study population). The most common limitation was withholding life-sustaining treatment (5661 [44·1%]), followed by withdrawing life-sustaining treatment (4680 [36·4%]). More treatment withdrawing was observed in Northern Europe (1217 [52·8%] of 2305) and Australia/New Zealand (247 [45·7%] of 541) than in Latin America (33 [5·8%] of 571) and Africa (21 [13·0%] of 162). Shortening of the dying process was uncommon across all regions (60 [0·5%]). One in five patients with treatment limitations survived hospitalisation. Death due to failed CPR occurred in 1799 (14%) of the study population, and brain death occurred in 650 (5·1%). Failure of CPR occurred less frequently in Northern Europe (85 [3·7%] of 2305), Australia/New Zealand (23 [4·3%] of 541), and North America (78 [8·5%] of 918) than in Africa (106 [65·4%] of 162), Latin America (160 [28·0%] of 571), and Southern Europe (590 [22·5%] of 2622). Factors associated with treatment limitations were region, age, and diagnoses (acute and chronic), and country end-of-life legislation. INTERPRETATION Limitation of life-sustaining therapies is common worldwide with regional variability. Withholding treatment is more common than withdrawing treatment. Variations in type, frequency, and timing of end-of-life decisions were observed. Recognising regional differences and the reasons behind these differences might help improve end-of-life care worldwide. FUNDING None.
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Affiliation(s)
- Alexander Avidan
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Charles L Sprung
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Joerg C Schefold
- Inselspital, Department of Intensive Care Medicine, University of Bern, Bern, Switzerland
| | - Bara Ricou
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Geneva, Switzerland
| | - Christiane S Hartog
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany, and Klinik Bavaria, Kreischa, Germany
| | - Joseph L Nates
- Critical Care Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ulrich Jaschinski
- Department of Anesthesiology and Critical Care Medicine, University Hospital Augsburg, Augsburg, Germany
| | - Suzana M Lobo
- Intensive Care Division, São José do Rio Preto School of Medicine, São Jose do Rio Preto, São Paulo, Brazil
| | - Gavin M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong
| | - Olivier Lesieur
- Intensive Care Unit, Saint Louis General Hospital, La Rochelle, France
| | - Manfred Weiss
- Clinic of Anaesthesiology and Intensive Care Medicine, University Hospital Medical School, Ulm, Germany
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Hans-Henrik Bülow
- Department of Anesthesiology and Intensive Care, Holbaek University Hospital, Zealand Region, Denmark
| | - Maria G Bocci
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Annette Robertsen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | | | | | - Alexandre Lautrette
- Medical Intensive Care Unit, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Anastasiia Gruber
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Angel Estella
- Intensive Care Department, University Hospital SAS of Jerez, Jerez de la Frontera, Spain
| | | | - Roshni Sreedharan
- Department of General Anesthesiology, Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrej Michalsen
- Department of Anesthesiology and Critical Care, Medizin Campus Bodensee-Tettnang Hospital, Tettnang, Germany
| | - Charles Feldman
- Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kai Tisljar
- Intensive Care Unit, University Hospital and University of Basel, Basel, Switzerland
| | - Martin Posch
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Steven Ovu
- Critical Care Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barbara Tamowicz
- Faculty of Health Sciences, Poznan University of Medical Sciences, Poznań, Poland
| | - Alexandre Demoule
- Service de Médecine intensive- Réanimation, AP-HP Sorbonne Université, Site Pitié-Salpêtrière, and UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
| | - Freda DeKeyser Ganz
- Hadassah Hebrew University School of Nursing and Jerusalem College of Technology, Faculty of Life and Health Sciences, Jerusalem, Israel
| | - Hans Pargger
- Intensive Care Unit, University Hospital and University of Basel, Basel, Switzerland
| | - Alberto Noto
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Intensive Care, University of Messina, Messina, Italy
| | - Philipp Metnitz
- Department of General Anaesthesiology, Emergency and Intensive Care Medicine, LKH-University Hospital of Graz, Graz, Austria
| | - Laszlo Zubek
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Veronica de la Guardia
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Orsolya Szűcs
- 1st Department of Surgery and Interventional Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Alessandro Protti
- Department of Anesthesia, Intensive Care, and Emergency Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Filipe
- Department of Anesthesiology and Critical Care Medicine, DPC Hospital Budapest, Semmelweis University, Budapest, Hungary
| | - Steven Q Simpson
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas, Kansas City, KS, USA
| | - Cameron Green
- Department of Intensive Care, Peninsula Health, Melbourne, VIC, Australia
| | - Alberto M Giannini
- Division of Pediatric Anesthesia and Intensive Care, ASST-Spedali Civili, Brescia, Italy
| | - Ivo W Soliman
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Eliana B Caser
- Department of Internal Medicine, University Federal do Espírito Santo, Espírito Santo, Brazil
| | - Manuel Hache-Marliere
- Department of Critical Care Medicine, CEDIMAT, Santo Domingo, Dominican Republic, and Department of Internal Medicine, Jacobi Medical Center-AECOM, Bronx, NY, USA
| | - Spyros D Mentzelopoulos
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelsimos General Hospital, Athens, Greece
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Khanna S, Sreedharan R, Trombetta C. Spontaneous rupture of hepatocellular carcinoma. Colomb J Anesthesiol 2021. [DOI: 10.5554/22562087.e961] [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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13
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Sreedharan R, Factora F, Trombetta C, Khanna S. Hypercoagulability resulting in adrenal hemorrhage in COVID-19. Colomb J Anesthesiol 2021. [DOI: 10.5554/22562087.e992] [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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14
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Siddiqui S, Bartels K, Schaefer MS, Novack L, Sreedharan R, Ben-Jacob TK, Khanna AK, Nunnally ME, Souter M, Simmons ST, Williams G. Critical Care Medicine Practice: A Pilot Survey of US Anesthesia Critical Care Medicine-Trained Physicians. Anesth Analg 2021; 132:761-769. [PMID: 32665465 DOI: 10.1213/ane.0000000000005030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND This survey assessed satisfaction with the practice environment among physicians who have completed fellowship training in critical care medicine (CCM) as recognized by the American Board of Anesthesiology (and are members of the American Society of Anesthesiology) and evaluated the perceived effectiveness of training programs in preparing fellows for critical care practice. METHODS A cross-sectional online survey composed of 39 multiple choice and open-ended questions was administered between August and December 2018 to all members of the American Society of Anesthesiologists (ASA) who self-identified as being CCM trained. The survey instrument was developed and revised in an iterative fashion by ASA committee on CCM and the Society for Education in Anesthesia (SEA). Survey results were analyzed using a mixed-method approach. RESULTS Three hundred fifty-three of the 1400 anesthesiologists who self-identified to the ASA as having CCM training (25.2%) completed the survey. Most were men (72.3%), board certified in CCM (98.7%), and had practiced a median of 5 years. Half of the respondents rated their training as "excellent." A total of 70.6% described currently working in academic centers with 53.6% providing care in open surgical intensive care units (ICUs). Most anesthesiologist intensivists (75%) spend at least 25% of their clinical time providing ICU care (versus clinical anesthesia). A total of 89% of the respondents were involved in educational activities, 60% reported being in administrative leadership roles, and 37% engaged in scholarly activity. Areas of dissatisfaction included fatigue, lack of collegiality or respect, lack of research training, decreased job satisfaction, and burnout. Analysis suggested moderate levels of job satisfaction (49%), work-life balance (52%), and high levels of burnout (74%). A significant contributor to burnout was with a perception of lack of respect (P = .005) in the work environment. Burnout was not significantly associated with gender or duration of practice. Qualitative analysis of the open-ended responses also identified these 3 variables as major themes. CONCLUSIONS This survey of CCM-trained anesthesiologists described a high rate of board certification, practice in academic settings, and participation in resident education. Areas of dissatisfaction with an anesthesia/critical care practice included burnout, work/life balance, and lack of respect. These results may increase recruitment of anesthesiologists into critical care and inform strategies to improve satisfaction with anesthesia critical care practice, fellowship training.
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Affiliation(s)
- Shahla Siddiqui
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Karsten Bartels
- Department of Anesthesiology, University of Colorado, Aurora, Colorado
| | - Maximilian S Schaefer
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Department of Anaesthesiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Lena Novack
- From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Biostatistics and Epidemiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roshni Sreedharan
- Department of Intensive Care & Resuscitation and Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Talia K Ben-Jacob
- Department of Anesthesiology, Cooper Medical School of Rowan University, Camden, New Jersey.,Department of Anesthesiology, Cooper University Hospital, Camden, New Jersey
| | - Ashish K Khanna
- Section on Critical Care Medicine, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Outcomes Research Consortium, Cleveland, Ohio.,ASA committee on Critical Care Medicine, Schaumburg, Illinois
| | - Mark E Nunnally
- Departments of Anesthesiology, Perioperative Care and Pain Medicine, Neurology, Surgery and Medicine, Adult Critical Care Services, New York University (NYU) Langone Health, New York, New York
| | - Michael Souter
- Department of Anesthesiology & Pain Medicine, Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Shawn T Simmons
- Department of Anesthesia, University of Iowa, Iowa City, Iowa
| | - George Williams
- ASA committee on Critical Care Medicine, Schaumburg, Illinois.,Department of Anesthesiology, University of Texas, Houston, Texas
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15
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Verdiner RE, Choukalas CG, Siddiqui S, Stahl DL, Galvagno SM, Jabaley CS, Bartz RR, Lane-Fall M, Goff K, Sreedharan R, Bennett S, Williams GW, Khanna A. COVID-Activated Emergency Scaling of Anesthesiology Responsibilities Intensive Care Unit. Anesth Analg 2020; 131:365-377. [PMID: 32398432 PMCID: PMC7219847 DOI: 10.1213/ane.0000000000004957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Accepted: 05/06/2020] [Indexed: 02/06/2023]
Abstract
In response to the rapidly evolving coronavirus disease 2019 (COVID-19) pandemic and the potential need for physicians to provide critical care services, the American Society of Anesthesiologists (ASA) has collaborated with the Society of Critical Care Anesthesiologists (SOCCA), the Society of Critical Care Medicine (SCCM), and the Anesthesia Patient Safety Foundation (APSF) to develop the COVID-Activated Emergency Scaling of Anesthesiology Responsibilities (CAESAR) Intensive Care Unit (ICU) workgroup. CAESAR-ICU is designed and written for the practicing general anesthesiologist and should serve as a primer to enable an anesthesiologist to provide limited bedside critical care services.
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Affiliation(s)
| | | | - Shahla Siddiqui
- Department of Anesthesiology, Pain, and Intensive Care, Beth Israel Deaconess Medical Center, Harvard Medical School
| | | | - Samuel M. Galvagno
- Multi Trauma Critical Care Unit, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine
| | | | - Raquel R. Bartz
- Departments of Anesthesia and Medicine, Duke University School of Medicine
| | - Meghan Lane-Fall
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania
| | - Kristina Goff
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center
| | - Roshni Sreedharan
- Center for Excellence in Healthcare Communication, Anesthesiology Institute, Cleveland Clinic
| | - Suzanne Bennett
- Department of Anesthesiology, University of Cincinnati College of Medicine
| | - George W. Williams
- Department of Anesthesiology, UT Health McGovern Medical School at Houston
| | - Ashish Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine
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16
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Hilton EJ, Lunardi N, Sreedharan R, Goff KL, Batakji M, Rosenberger DS. Two Sides of the Same Coin: Addressing Racial and Gender Disparities Among Physicians and the Impact on the Community They Serve. Anesthesiol Clin 2020; 38:369-377. [PMID: 32336390 DOI: 10.1016/j.anclin.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/24/2022]
Abstract
The influence of historical cultural norms is evident when analyzing the physician demographics in the United States. To this day, there exists a paucity in diversity as it pertains to gender balance and ethnicity. This phenomenon is particularly concerning when studies support the notion that race and gender concordance are associated with improved outcomes. The literature presented in this article identifies potential targets for interventions on how to attract, train, and retain minority physicians.
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Affiliation(s)
- Ebony J Hilton
- University of Virginia Health System, PO Box 800710, Charlottesville, VA 22908, USA.
| | - Nadia Lunardi
- University of Virginia Health System, PO Box 800710, Charlottesville, VA 22908, USA
| | - Roshni Sreedharan
- Case Western Reserve University School of Medicine, 9500 Euclid Avenue, Mail code G-58, Cleveland, OH 44195, USA
| | - Kristina L Goff
- University of Texas Southwestern Medical Center, 3851 Beutel Court, Dallas, TX 75229, USA
| | - Mariam Batakji
- University of Virginia Health System, PO Box 800710, Charlottesville, VA 22908, USA
| | - Dorothea S Rosenberger
- University of Utah School of Medicine, 30 North 1900 East, Room 3C444 SOM, Salt Lake City, UT 84132, USA
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17
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Hilton EJ, Goff KL, Sreedharan R, Lunardi N, Batakji M, Rosenberger DS. The Flaw of Medicine: Addressing Racial and Gender Disparities in Critical Care. Anesthesiol Clin 2020; 38:357-368. [PMID: 32336389 DOI: 10.1016/j.anclin.2020.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/14/2022]
Abstract
The age of modern medicine has ushered in remarkable advances and with them increased longevity of life. The questions are, however: Has everyone benefited from these developments equally? and Do all lives truly matter? The presence of gender and racial health disparities indicates that there is work still left to be done. The first target of intervention may well be the medical establishment itself. The literature presented in this article identifies potential targets for interventions and future areas of exploration.
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Affiliation(s)
- Ebony J Hilton
- University of Virginia Health System, PO Box 800710, Charlottesville, VA 22908, USA.
| | - Kristina L Goff
- University of Texas Southwestern Medical Center, 3851 Beutel Court, Dallas, TX 75229, USA
| | - Roshni Sreedharan
- Case Western Reserve University School of Medicine, 9500 Euclid Avenue, Mail Code G-58, Cleveland, OH 44195, USA
| | - Nadia Lunardi
- University of Virginia Health System, PO Box 800710, Charlottesville, VA 22908, USA
| | - Mariam Batakji
- University of Virginia Health System, PO Box 800710, Charlottesville, VA 22908, USA
| | - Dorothea S Rosenberger
- University of Utah School of Medicine, 30 North 1900 East, Room 3C444 SOM, Salt Lake City, UT 84132, USA
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18
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Affiliation(s)
- Sandeep Khanna
- From the Departments of General Anesthesiology (S.K., R.S., K.R.) Outomes Research (S.K., K.R.) Critical Care Medicine (R.S.) Cardiothoracic Anesthesiology (C.T.), Cleveland Clinic Foundation, Cleveland, Ohio
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19
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Sprung CL, Ricou B, Hartog CS, Maia P, Mentzelopoulos SD, Weiss M, Levin PD, Galarza L, de la Guardia V, Schefold JC, Baras M, Joynt GM, Bülow HH, Nakos G, Cerny V, Marsch S, Girbes AR, Ingels C, Miskolci O, Ledoux D, Mullick S, Bocci MG, Gjedsted J, Estébanez B, Nates JL, Lesieur O, Sreedharan R, Giannini AM, Fuciños LC, Danbury CM, Michalsen A, Soliman IW, Estella A, Avidan A. Changes in End-of-Life Practices in European Intensive Care Units From 1999 to 2016. JAMA 2019; 322:1692-1704. [PMID: 31577037 PMCID: PMC6777263 DOI: 10.1001/jama.2019.14608] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE End-of-life decisions occur daily in intensive care units (ICUs) around the world, and these practices could change over time. OBJECTIVE To determine the changes in end-of-life practices in European ICUs after 16 years. DESIGN, SETTING, AND PARTICIPANTS Ethicus-2 was a prospective observational study of 22 European ICUs previously included in the Ethicus-1 study (1999-2000). During a self-selected continuous 6-month period at each ICU, consecutive patients who died or had any limitation of life-sustaining therapy from September 2015 until October 2016 were included. Patients were followed up until death or until 2 months after the first treatment limitation decision. EXPOSURES Comparison between the 1999-2000 cohort vs 2015-2016 cohort. MAIN OUTCOMES AND MEASURES End-of-life outcomes were classified into 5 mutually exclusive categories (withholding of life-prolonging therapy, withdrawing of life-prolonging therapy, active shortening of the dying process, failed cardiopulmonary resuscitation [CPR], brain death). The primary outcome was whether patients received any treatment limitations (withholding or withdrawing of life-prolonging therapy or shortening of the dying process). Outcomes were determined by senior intensivists. RESULTS Of 13 625 patients admitted to participating ICUs during the 2015-2016 study period, 1785 (13.1%) died or had limitations of life-prolonging therapies and were included in the study. Compared with the patients included in the 1999-2000 cohort (n = 2807), the patients in 2015-2016 cohort were significantly older (median age, 70 years [interquartile range {IQR}, 59-79] vs 67 years [IQR, 54-75]; P < .001) and the proportion of female patients was similar (39.6% vs 38.7%; P = .58). Significantly more treatment limitations occurred in the 2015-2016 cohort compared with the 1999-2000 cohort (1601 [89.7%] vs 1918 [68.3%]; difference, 21.4% [95% CI, 19.2% to 23.6%]; P < .001), with more withholding of life-prolonging therapy (892 [50.0%] vs 1143 [40.7%]; difference, 9.3% [95% CI, 6.4% to 12.3%]; P < .001), more withdrawing of life-prolonging therapy (692 [38.8%] vs 695 [24.8%]; difference, 14.0% [95% CI, 11.2% to 16.8%]; P < .001), less failed CPR (110 [6.2%] vs 628 [22.4%]; difference, -16.2% [95% CI, -18.1% to -14.3%]; P < .001), less brain death (74 [4.1%] vs 261 [9.3%]; difference, -5.2% [95% CI, -6.6% to -3.8%]; P < .001) and less active shortening of the dying process (17 [1.0%] vs 80 [2.9%]; difference, -1.9% [95% CI, -2.7% to -1.1%]; P < .001). CONCLUSIONS AND RELEVANCE Among patients who had treatment limitations or died in 22 European ICUs in 2015-2016, compared with data reported from the same ICUs in 1999-2000, limitations in life-prolonging therapies occurred significantly more frequently and death without limitations in life-prolonging therapies occurred significantly less frequently. These findings suggest a shift in end-of-life practices in European ICUs, but the study is limited in that it excluded patients who survived ICU hospitalization without treatment limitations.
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Affiliation(s)
- Charles L. Sprung
- Department of Anesthesiology, Critical Care Medicine, and Pain Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Bara Ricou
- Department of Anesthesiology, Pharmacology, and Intensive Care, University Hospital of Geneva, Geneva, Switzerland
| | - Christiane S. Hartog
- Department of Anesthesiology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin and Klinik Bavaria, Kreischa, Germany
| | - Paulo Maia
- Intensive Care Department, Hospital S. Antonio, Centro Hospitalar do Porto, Porto, Portugal
| | - Spyros D. Mentzelopoulos
- First Department of Intensive Care Medicine, University of Athens Medical School, Evaggelsimos General Hospital, Athens, Greece
| | - Manfred Weiss
- Clinic of Anaesthesiology, University Hospital Medical School, Ulm, Germany
| | - Phillip D. Levin
- General Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Laura Galarza
- Intensive Care Unit, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Veronica de la Guardia
- Department of Anesthesiology, Critical Care Medicine, and Pain Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joerg C. Schefold
- Inselspital, Department of Intensive Care Medicine, University of Bern, Switzerland
| | - Mario Baras
- The Hebrew University—Hadassah School of Public Health, Jerusalem, Israel
| | - Gavin M. Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Hans-Henrik Bülow
- Department of Anesthesiology and Intensive Care, Holbaek University Hospital, Zealand Region, Denmark
| | - Georgios Nakos
- Department of Intensive Care Medicine, University of Ioannina, Ioannina, Greece
| | - Vladimir Cerny
- Department of Anesthesiology, Perioperative Medicine, and Intensive Care, J.E. Purkinje University, Masaryk Hospital Usti nad Labem, Czech Republic
| | - Stephan Marsch
- Medical Intensive Care, University of Basel Hospital, Basel, Switzerland
| | - Armand R. Girbes
- Department of Intensive Care Medicine, VU Medical Center, Amsterdam, the Netherlands
| | - Catherine Ingels
- Intensive Care Medicine, University Hospitals K.U. Leuven, Leuven Belgium
| | - Orsolya Miskolci
- Mater Misericordiae University Hospital, Intensive Care Unit, Dublin, Ireland
| | - Didier Ledoux
- Department of Anesthesiology and Intensive Care Medicine, University of Liege, Liege, Belgium
| | | | - Maria G. Bocci
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jakob Gjedsted
- Department of Anesthesia and Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Belén Estébanez
- Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Joseph L. Nates
- Critical Care Department, The University of Texas MD Anderson Cancer Center, Houston
| | - Olivier Lesieur
- Intensive Care Unit, Saint Louis General Hospital, La Rochelle, France
| | - Roshni Sreedharan
- Department of General Anesthesiology, Center for Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Alberto M. Giannini
- Division of Pediatric Anesthesia and Intensive Care, ASST Spedali Civili, Brescia, Italy
| | | | | | - Andrej Michalsen
- Department of Anesthesiology and Critical Care, Medizin Campus Bodensee-Tettnang Hospital, Tettnang, Germany
| | - Ivo W. Soliman
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Angel Estella
- Intensive Care Department, University Hospital SAS of Jerez, Jerez de la Frontera, Spain
| | - Alexander Avidan
- Department of Anesthesiology, Critical Care Medicine, and Pain Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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20
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De La Rocque S, Caya F, El Idrissi AH, Mumford L, Belot G, Carron M, Sreedharan R, Suryantoro L, Stelter R, Copper F, Isla N, Mayigane LN, Bell A, Huda Q, Stratton J, Di Giacinto A, Corning S, Pinto J, Ormel HJ, Chungong S. One Health operations: a critical component in the International Health Regulations Monitoring and Evaluation Framework. REV SCI TECH OIE 2019; 38:303-314. [PMID: 31564720 DOI: 10.20506/rst.38.1.2962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Under the International Health Regulations (IHR, 2005), a legally binding document adopted by 196 States Parties, countries are required to develop their capacity to rapidly detect, assess, notify and respond to unusual health events of potential international concern. To support countries in monitoring and enhancing their capacities and complying with the IHR (2005), the World Health Organization (WHO) developed the IHR Monitoring and Evaluation Framework (IHR MEF). This framework comprises four complementary components: the State Party Annual Report, the Joint External Evaluation, after-action reviews and simulation exercises. The first two are used to review capacities and the second two to help to explore their functionality. The contribution of different disciplines, sectors, and areas of work, joining forces through a One Health approach, is essential for the implementation of the IHR (2005). Therefore, WHO, in partnership with the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE), and other international and national partners, has actively worked on facilitating the inclusion of the relevant sectors, in particular the animal health sector, in each of the four components of the IHR MEF. Other tools complement the IHR MEF, such as the WHO/OIE IHR-PVS [Performance of Veterinary Services] National Bridging Workshops, which facilitate the optimal use of the results of the IHR MEF and the OIE Performance of Veterinary Services Pathway and create an opportunity for stakeholders from animal health and human health services to work on the coordination of their efforts. The results of these various tools are used in countries' planning processes and are incorporated in their National Action Plan for Health Security to accelerate the implementation of IHR core capacities. The present article describes how One Health is incorporated in all components of the IHR MEF.
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21
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Sreedharan R, Argalious MY. Critical Cases in Electrocardiography. Anesth Analg 2019. [DOI: 10.1213/ane.0000000000004218] [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]
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22
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Abstract
Diabetes is an important cause of morbidity in the adult population resulting in blindness, renal dysfunction, cardiovascular events, and amputation. Such morbidities may have an impact on perioperative anesthetic care and outcomes. In this review, the authors discuss the preoperative considerations in managing patients with diabetes as well as those without diabetes albeit hyperglycemic. They propose a plan for managing preoperative diabetes pharmacotherapy, including the use of a subcutaneous insulin pump to avoid both hypoglycemia and hyperglycemia. The authors also discuss the decision whether to proceed or cancel surgery for a given hemoglobin A1c percentage or blood glucose concentration.
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Affiliation(s)
- Roshni Sreedharan
- Department of General Anesthesiology, Center for Critical Care, Anesthesiology Institute, Cleveland Clinic, E-31 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Basem Abdelmalak
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, E-31 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, E-31 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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23
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Sreedharan R, Bhalala U, Khanna A, Goodman D, Tisherman S, Lee S, Hunt E, Nadkarni V. 658. Crit Care Med 2015. [DOI: 10.1097/01.ccm.0000474486.68497.d6] [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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24
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Sreedharan R, Riordan M, Thullin G, Van Why S, Siegel NJ, Kashgarian M. The maximal cytoprotective function of the heat shock protein 27 is dependent on heat shock protein 70. Biochim Biophys Acta 2010; 1813:129-35. [PMID: 20934464 DOI: 10.1016/j.bbamcr.2010.08.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 08/12/2010] [Accepted: 08/26/2010] [Indexed: 12/31/2022]
Abstract
Endogenous heat shock proteins (HSPs) 70 and 25/27 are induced in renal cells by injury from energy depletion. Transfected over-expression of HSPs 70 or 27 (human analogue of HSP25), provide protection against renal cell injury from ATP deprivation. This study examines whether over-expressed HSP27 depends on induction of endogenous HSPs, in particular HSP70, to afford protection against cell injury. LLC-PK1 cells transfected with HSP27 (27OE cells) were injured by ATP depletion for 2h and recovered for 4h in the presence of HSF decoy, HSP70 specific siRNA (siRNA-70) and their respective controls. Injury in the presence of HSF decoy, a synthetic oligonucleotide identical to the heat shock element, the nuclear binding site of HSF, decreased HSP70 induction by 80% without affecting the over-expression of transfected HSP27. The HSP70 stress response was completely ablated in the presence of siRNA-70. Protection against injury, provided by over-expression of HSP27, was reduced by treatment with HSF decoy and abolished by treatment with siRNA-70. Immunoprecipitation studies demonstrated association of HSP27 with actin that was not affected by either treatment with HSF decoy or siRNA. Therefore, HSP27 is dependent on HSP70 to provide its maximal cytoprotective effect, but not for its interaction with actin. This study suggests that, while it has specific action on the cytoskeleton, HSP 25/27 must have coordinated activity with other HSP classes, especially HSP70, to provide the full extent of resistance to injury from energy depletion.
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Affiliation(s)
- R Sreedharan
- Medical College of Wisconsin, Wauwatosa, WI, USA.
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25
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Somanadhan B, Varughese G, Palpu P, Sreedharan R, Gudiksen L, Smitt UW, Nyman U. An ethnopharmacological survey for potential angiotensin converting enzyme inhibitors from Indian medicinal plants. J Ethnopharmacol 1999; 65:103-112. [PMID: 10465650 DOI: 10.1016/s0378-8741(98)00201-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Plants used in different traditional systems of Indian medicine and some relatives/substitutes have been investigated for their angiotensin converting enzyme (ACE) inhibitory activity. They were selected on the basis of their usage as cardiotonics, diuretics and other uses related to the symptoms of hypertension. Out of the 73 species investigated, 22 showed more than 50% ACE inhibitory activity.
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Affiliation(s)
- B Somanadhan
- Tropical Botanic Garden and Research Institute, Pacha-Palode, Thiruvananthapuram, Kerala, India
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26
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Nampoory MR, Das DK, Johny KV, Halim MM, al-Mohannadi S, Sreedharan R, Costandy JN, Gupta RK, al-Muzeiri IA. Comparative study of ultrasonogram, renogram, and fine needle aspiration cytology in the diagnosis of acute allograft rejection. Transplant Proc 1997; 29:2807-11. [PMID: 9365572 DOI: 10.1016/s0041-1345(97)00688-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- M R Nampoory
- Department of Medicine, Mubarak Al-Kabeer Hospital, Safat, Kuwait
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27
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Nampoory MR, Halim MM, Sreedharan R, al-Sweih NA, Gupta RK, Constandi JN, Johny KV. Liver abscess and disseminated intravascular coagulation in tuberculosis. Postgrad Med J 1995; 71:490-2. [PMID: 7567759 PMCID: PMC2398195 DOI: 10.1136/pgmj.71.838.490] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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: 01/26/2023]
Abstract
We report the case of a 55-year-old man with chronic renal failure, and a history of prolonged fever and jaundice. Radiological studies revealed a multiloculated irregular liver abscess. Mycobacterium tuberculosis was isolated from the abscess on smear and culture of aspirated pus. Haematological studies revealed the presence of disseminated intravascular coagulation. A detailed search failed to identify any reason for this other than the tuberculous infection. The treatment of tuberculous liver abscess and pathogenesis of disseminated intravascular coagulation in tuberculosis are discussed.
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Affiliation(s)
- M R Nampoory
- Department of Medicine, Radiology and Microbiology, Mubarak Al-Kabeer Hospital, Ministry of Public Health, Kuwait
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