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Vanstone MG, Krewulak K, Taneja S, Swinton M, Fiest K, Burns KEA, Debigare S, Dionne JC, Guyatt G, Marshall JC, Muscedere JG, Deane AM, Finfer S, Myburgh JA, Gouskos A, Rochwerg B, Ball I, Mele T, Niven DJ, English SW, Verhovsek M, Cook DJ. Patient-important upper gastrointestinal bleeding in the ICU: A mixed-methods study of patient and family perspectives. J Crit Care 2024; 81:154761. [PMID: 38447306 DOI: 10.1016/j.jcrc.2024.154761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION The objective of this study was to create a definition of patient-important upper gastrointestinal bleeding during critical illness as an outcome for a randomized trial. DESIGN This was a sequential mixed-methods qualitative-dominant multi-center study with an instrument-building aim. In semi-structured individual interviews or focus groups we elicited views from survivors of critical illness and family members of patients in the intensive care unit (ICU) regarding which features indicate important gastrointestinal bleeding. Quantitative demographic characteristics were collected. We analyzed qualitative data using inductive content analysis to develop a definition for patient-important upper gastrointestinal bleeding. SETTING Canada and the United States. PARTICIPANTS 51 ICU survivors and family members of ICU patients. RESULTS Participants considered gastrointestinal bleeding to be important if it resulted in death, disability, or prolonged hospitalization. The following also signaled patient-important upper gastrointestinal bleeding: blood transfusion, vasopressors, endoscopy, CT-angiography, or surgery. Whether an intervention evinced concern depended on its effectiveness, side-effects, invasiveness and accessibility; contextual influences included participant familiarity and knowledge of interventions and trust in the clinical team. CONCLUSIONS Survivors of critical illness and family members described patient-important upper gastrointestinal bleeding differently than current definitions of clinically-important upper gastrointestinal bleeding.
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Affiliation(s)
- Meredith G Vanstone
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Karla Krewulak
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shipra Taneja
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marilyn Swinton
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Canada
| | - Sylvie Debigare
- Patient and Family Partnership Committee, Commission Scolaire Central Québec, Canadian Critical Care Trials Group, Canada
| | - Joanna C Dionne
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John C Marshall
- Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Canada; Department of Surgery, Unity Health Toronto, University of Toronto, Canada
| | - John G Muscedere
- Department of Critical Care Medicine, Queens University, Kingston Health Sciences Center
| | - Adam M Deane
- Department of Critical Care, University of Melbourne, Melbourne Medical School, Victoria, Australia
| | - Simon Finfer
- Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, School of Public Health, Imperial College London, London, England, United Kingdom
| | - John A Myburgh
- Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Audrey Gouskos
- Patient and Family Advisory Committee and Steering Committee representative, FAST-NAWC Trial, University of Toronto, Canada
| | - Bram Rochwerg
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ian Ball
- Department of Medicine, Western University, London, Ontario, Canada.; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Tina Mele
- Department of Critical Care Medicine, Western University, London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shane W English
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Madeleine Verhovsek
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, St. Joseph's Healthcare Hamilton.
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Dion PM, Lapierre M, Said H, Tremblay S, Tariq K, Lamb T, English SW, Kingstone M, Stratton A, Boet S, Shorr R, Lampron J. Rethinking cervical spine clearance in obtunded trauma patients: An updated systematic review and meta-analysis. Injury 2024; 55:111308. [PMID: 38266326 DOI: 10.1016/j.injury.2023.111308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Cervical spine injuries (CSI) are often challenging to diagnose in obtunded adult patients with blunt trauma and the optimal imaging modality remains uncertain. This study systematically synthesized the last decade of evidence to determine the type of imaging required to clear the c-spine in obtunded patients with blunt trauma. METHODS A systematic review with meta-analysis was conducted and reported using PRISMA 2020 guidelines. The protocol was registered on June 22, 2022 (PROSPERO CRD42022341386). MEDLINE (Ovid), EMBASE, and Cochrane Library were searched for studies published between January 1, 2012, and October 17, 2023. Studies comparing CT alone to CT combined with MRI for c-spine clearance were included. Two independent reviewers screened articles for eligibility in duplicate. Meta-analysis was conducted using a random-effect model. Risk of bias and quality assessment were performed using the ROBINS-I and QUADAS-2. The certainty of evidence was assessed using the GRADE methodology. RESULTS 744 obtunded trauma patients from six included studies were included. Among the 584 that had a negative CT scan, the pooled missed rate of clinically significant CSI using CT scans alone was 6 % (95 % CI: 0.02 to 0.17), and the pooled missed rate of CSI requiring treatment was 7 % (95 % CI: 0.02 to 0.18). High heterogeneity was observed among included studies (I² > 84 %). The overall risk of bias was moderate, and the quality of evidence was low due to the retrospective nature of the included studies and high heterogeneity. CONCLUSIONS Limited evidence published in the last decade found that CT scans alone may not be sufficient for detecting clinically significant CSI and injuries requiring treatment in obtunded adult patients with blunt trauma. IMPLICATIONS OF KEY FINDINGS Clinicians should be aware of the limitations of CT scans and consider using MRI when appropriate. Future research should focus on prospective studies with standardized outcome measures and uniform reporting.
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Affiliation(s)
- Pierre-Marc Dion
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Hussein Said
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sophie Tremblay
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Khadeeja Tariq
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tyler Lamb
- Division of General Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine (Critical Care), The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Michael Kingstone
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Alexandra Stratton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Orthopedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Risa Shorr
- Library Services, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jacinthe Lampron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of General Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
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D’Aragon F, Rousseau W, Breau R, Aminaei D, Ichai C, Boyd GJ, Burns KEA, Cardinal H, Carrier FM, Chassé M, Chaudhury P, Dhanani S, English SW, Frenette AJ, Hanna S, Knoll G, Lauzier F, Oczkowski S, Rochwerg B, Shamseddin K, Slessarev M, Treleaven D, Turgeon AF, Weiss MJ, Selzner M, Meade MO. Calcineurin Inhibition in Deceased Organ Donors: A Systematic Review and Meta-analysis of Preclinical Studies. Transplant Direct 2023; 9:e1519. [PMID: 37649790 PMCID: PMC10465100 DOI: 10.1097/txd.0000000000001519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 09/01/2023] Open
Abstract
Background Preconditioning deceased organ donors with calcineurin inhibitors (CNIs) may reduce ischemia-reperfusion injury to improve transplant outcomes. Methods We searched MEDLINE, EMBASE, Cochrane Library, and conference proceedings for animal models of organ donation and transplantation, comparing donor treatment with CNIs with either placebo or no intervention, and evaluating outcomes for organ transplantation. Reviewers independently screened and selected studies, abstracted data, and assessed the risk of bias and clinical relevance of included studies. Where possible, we pooled results using meta-analysis; otherwise, we summarized findings descriptively. Results Eighteen studies used various animals and a range of CNI agents and doses and evaluated their effects on a variety of transplant outcomes. The risk of bias and clinical applicability were poorly reported. Pooled analyses suggested benefit of CNI treatment on early graft function in renal transplants (3 studies; serum creatinine: ratio of means [RoM] 0.54; 95% confidence interval [CI], 0.34-0.86) but not for liver transplants (2 studies; serum alanine transaminase: RoM 0.61; 95% CI, 0.30-1.26; and serum aspartate aminotransferase: RoM 0.58; 95% CI, 0.26-1.31). We found no reduction in graft loss at 7 d (2 studies; risk ratio 0.54; 95% CI, 0.08-3.42). CNI treatment was associated with reduced transplant recipient levels of interleukin-6 (4 studies; RoM 0.36; 95% CI, 0.19-0.70), tumor necrosis factor-alpha (5 studies; RoM 0.36; 95% CI, 0.12-1.03), and cellular apoptosis (4 studies; RoM 0.30; 95% CI, 0.19-0.47). Conclusions Although this compendium of animal experiments suggests that donor preconditioning with CNIs may improve early kidney graft function, the limited ability to reproduce a true clinical environment in animal experiments and to assess for risk of bias in these experiments is a serious weakness that precludes current clinical application.
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Affiliation(s)
- Frédérick D’Aragon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, QC, Canada
| | - William Rousseau
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, QC, Canada
| | - Ruth Breau
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Daniel Aminaei
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Carole Ichai
- Intensive Care Unit, University Hospital of Nice, Nice, France
| | - Gordon J. Boyd
- Division of Neurology, Department of Medicine, Queen’s University, Kingston, ON, Canada
- Department of Critical Care Medicine, Queen’s University, Kingston, ON, Canada
| | - Karen E. A. Burns
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, University Health Toronto—St. Michael’s Hospital, Toronto, ON, Canada
| | - Héloïse Cardinal
- Department of Nephrology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - François-Martin Carrier
- Department of Anesthesiology, Université de Montréal, Montreal, QC, Canada
- Department of Critical Care, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Michaël Chassé
- Department of Critical Care, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Prosanto Chaudhury
- Department of Surgery and Oncology, McGill University, Montreal, QC, Canada
| | - Sonny Dhanani
- Division of Critical Care, Department of Pediatrics, Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Shane W. English
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Steven Hanna
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, QC, Canada
| | - Gregory Knoll
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - François Lauzier
- Department of Medicine, Université Laval, Quebec City, QC, Canada
- Population Health and Optimal Health Practice Research Unit, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
| | - Simon Oczkowski
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Bram Rochwerg
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Khaled Shamseddin
- Division of Nephrology, Department of Medicine, Queen’s University, Kingston, ON, Canada
| | - Marat Slessarev
- Division of Critical Care, Department of Medicine, Western University, London, ON, Canada
| | - Darin Treleaven
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alexis F. Turgeon
- Population Health and Optimal Health Practice Research Unit, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
- Departments of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Matthew J. Weiss
- Population Health and Optimal Health Practice Research Unit, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
- Transplant Québec, QC, Canada
| | - Markus Selzner
- Department of General Surgery, University of Toronto and Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Maureen O. Meade
- Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
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Terrett LA, McIntyre L, Turgeon AF, English SW. Anemia and Red Blood Cell Transfusion in Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2023; 39:91-103. [PMID: 37634181 DOI: 10.1007/s12028-023-01815-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/13/2023] [Indexed: 08/29/2023]
Abstract
Anemia is very common in aneurysmal subarachnoid hemorrhage (aSAH), with approximately half of the aSAH patient population developing moderate anemia during their hospital stay. The available evidence (both physiologic and clinical) generally supports an association of anemia with unfavorable outcomes. Although aSAH shares a number of common mechanisms of secondary insult with other forms of acute brain injury, aSAH also has specific features that make it unique: an early phase (in which early brain injury predominates) and a delayed phase (in which delayed cerebral ischemia and vasospasm predominate). The effects of both anemia and transfusion are potentially variable between these phases, which may have unique considerations and possibly different risk-benefit profiles. Data on transfusion in this population are almost exclusively limited to observational studies, which suffer from significant heterogeneity and risk of bias. Overall, the results are conflicting, with the balance of the studies suggesting that transfusion is associated with unfavorable outcomes. The transfusion targets that are well established in other critically ill populations should not be automatically applied to patients with aSAH because of the unique disease characteristics of this population and the limited representation of aSAH in the clinical trials that established these targets. There are two upcoming clinical trials evaluating transfusion in aSAH that should help clarify specific transfusion targets. Until then, it is reasonable to base transfusion decisions on the current guidelines and use an individualized approach incorporating physiologic and clinical data when available.
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Affiliation(s)
- Luke A Terrett
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Adult Critical Care, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Lauralyn McIntyre
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute (OHRI), Civic Campus Room F202, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
- Population Health and Optimal Health Practices Unit, Centre hospitalier universitaire de Québec-Université Laval Research Center, Quebec City, QC, Canada
| | - Shane W English
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, ON, Canada.
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute (OHRI), Civic Campus Room F202, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
- The Ottawa Hospital, Ottawa, ON, Canada.
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5
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Tran A, Saigle V, Manhas N, McIntyre L, Turgeon AF, Lauzier F, Chassé M, Golka C, Millington SJ, Kyeremanteng K, Ghinda D, Lesiuk H, Kanji S, Fairbairn J, Lloyd T, English SW. Association of age with death and withdrawal of life-sustaining therapy after severe traumatic brain injury. Can J Surg 2023; 66:E348-E355. [PMID: 37402559 DOI: 10.1503/cjs.013721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Compared to younger age, older age (≥ 65 yr) is associated with worse outcomes after severe traumatic brain injury (TBI). We sought to describe the association of older age with in-hospital death and aggressiveness of intervention. METHODS We conducted a retrospective cohort study of adult (age ≥ 16 yr) patients with severe TBI admitted to a single academic tertiary care neurotrauma centre between January 2014 and December 2015. We collected data through chart review as well as from our institutional administrative database. We provided descriptive statistics and used multivariable logistic regression to evaluate the independent association of age with the primary outcome, in-hospital death. The secondary outcome was early withdrawal of life-sustaining therapy. RESULTS There were 126 adult patients (median age 67 yr [Q1-Q3, 33-80 yr]) with severe TBI during the study period who met our eligibility criteria. The most common mechanism was high-velocity blunt injury (55 patients [43.6%]). The median Marshall score was 4 (Q1-Q3, 2-6), and the median Injury Severity Score was 26 (Q1-Q3, 25-35). After controlling for confounders including clinical frailty, pre-existing comorbidity, injury severity, Marshall score and neurologic examination at admission, we observed that older patients were more likely than younger patients to die in hospital (odds ratio 5.10, 95% confidence interval 1.65-15.78). Older patients were also more likely to experience early withdrawal of life-sustaining therapy and less likely to receive invasive interventions. CONCLUSION After controlling for confounding factors relevant to older patients, we observed that age was an important and independent predictor of in-hospital death and early withdrawal of life-sustaining therapy. The mechanism by which age influences clinical decision-making independent of global and neurologic injury severity, clinical frailty and comorbidities remains unclear.
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Affiliation(s)
- Alexandre Tran
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - Victoria Saigle
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - Neraj Manhas
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - Lauralyn McIntyre
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - Alexis F Turgeon
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - François Lauzier
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - Michael Chassé
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - Colleen Golka
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - Scott J Millington
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - Kwadwo Kyeremanteng
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - Diana Ghinda
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - Howard Lesiuk
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - Salmaan Kanji
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - Jennifer Fairbairn
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - Tammy Lloyd
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
| | - Shane W English
- From the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Tran, Saigle, McIntyre, Kanji, English); the Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ont. (Tran, McIntyre, Golka, Millington, Kyeremanteng, Kanji, Fairbairn, Lloyd, English); the Department of Surgery, University of Ottawa, Ottawa, Ont. (Tran, Ghinda, Lesiuk); the Department of Surgery, University of British Columbia, Vancouver, BC (Manhas); the Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, Que. (Turgeon, Lauzier); the Department of Medicine, Université Laval, Québec, Que. (Lauzier); the CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Trauma - Emergency - Critical Care Medicine, Québec, Que. (Turgeon); the Innovation Hub, Centre hospitalier de l'Université de Montréal Research Centre, Montréal, Que. (Chassé); and the Department of Pharmacy, University of Ottawa, Ottawa, Ont. (Kanji)
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6
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Kho ME, Reid J, Molloy AJ, Herridge MS, Seely AJ, Rudkowski JC, Buckingham L, Heels-Ansdell D, Karachi T, Fox-Robichaud A, Ball IM, Burns KEA, Pellizzari JR, Farley C, Berney S, Pastva AM, Rochwerg B, D'Aragon F, Lamontagne F, Duan EH, Tsang JLY, Archambault P, English SW, Muscedere J, Serri K, Tarride JE, Mehta S, Verceles AC, Reeve B, O'Grady H, Kelly L, Strong G, Hurd AH, Thabane L, Cook DJ. Critical Care C ycling to Improve Lower Extremity Strength (CYCLE): protocol for an international, multicentre randomised clinical trial of early in-bed cycling for mechanically ventilated patients. BMJ Open 2023; 13:e075685. [PMID: 37355270 PMCID: PMC10314658 DOI: 10.1136/bmjopen-2023-075685] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/26/2023] Open
Abstract
INTRODUCTION In-bed leg cycling with critically ill patients is a promising intervention aimed at minimising immobility, thus improving physical function following intensive care unit (ICU) discharge. We previously completed a pilot randomised controlled trial (RCT) which supported the feasibility of a large RCT. In this report, we describe the protocol for an international, multicentre RCT to determine the effectiveness of early in-bed cycling versus routine physiotherapy (PT) in critically ill, mechanically ventilated adults. METHODS AND ANALYSIS We report a parallel group RCT of 360 patients in 17 medical-surgical ICUs and three countries. We include adults (≥18 years old), who could ambulate independently before their critical illness (with or without a gait aid), ≤4 days of invasive mechanical ventilation and ≤7 days ICU length of stay, and an expected additional 2-day ICU stay, and who do not fulfil any of the exclusion criteria. After obtaining informed consent, patients are randomised using a web-based, centralised system to either 30 min of in-bed cycling in addition to routine PT, 5 days per week, up to 28 days maximum, or routine PT alone. The primary outcome is the Physical Function ICU Test-scored (PFIT-s) at 3 days post-ICU discharge measured by assessors blinded to treatment allocation. Participants, ICU clinicians and research coordinators are not blinded to group assignment. Our sample size estimate was based on the identification of a 1-point mean difference in PFIT-s between groups. ETHICS AND DISSEMINATION Critical Care Cycling to improve Lower Extremity (CYCLE) is approved by the Research Ethics Boards of all participating centres and Clinical Trials Ontario (Project 1345). We will disseminate trial results through publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03471247 (Full RCT); NCT02377830 (CYCLE Vanguard 46 patient internal pilot).
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Affiliation(s)
- Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Physiotherapy, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Research Institute of St. Joe's, Hamilton, Ontario, Canada
| | - Julie Reid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alexander J Molloy
- Physiotherapy, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Research Institute of St. Joe's, Hamilton, Ontario, Canada
| | - Margaret S Herridge
- University Health Network, Toronto General Research Institute, Toronto, Ontario, Canada
| | - Andrew J Seely
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jill C Rudkowski
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Medicine, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Lisa Buckingham
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Diane Heels-Ansdell
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tim Karachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Ian M Ball
- Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Karen E A Burns
- Li Sha King Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, Unity Health Toronto, Toronto, Ontario, Canada
| | - Joseph R Pellizzari
- Consultation-Liaison Psychiatry Service, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Christopher Farley
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Sue Berney
- Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amy M Pastva
- Departments of Medicine and Orthopedic Surgery, Duke University, Durham, North Carolina, USA
| | - Bram Rochwerg
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Sherbrooke, Quebec, Canada
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Francois Lamontagne
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Erick H Duan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Medicine, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Division of Critical Care Medicine, Niagara Health System, St Catharines, Ontario, Canada
| | - Jennifer L Y Tsang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care Medicine, Niagara Health System, St Catharines, Ontario, Canada
| | - Patrick Archambault
- Anesthesiology and Intensive Care, Faculty of Medicine, Université Laval, Quebec, Québec, Canada
- Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Québec, Canada
| | - Shane W English
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Karim Serri
- Critical Care Division, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
| | - Jean-Eric Tarride
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Programs for the Assessment of Technology in Health, Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | - Avelino C Verceles
- Department of Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Brenda Reeve
- Medicine, Brantford General Hospital, Brantford, Ontario, Canada
| | - Heather O'Grady
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Laurel Kelly
- Physiotherapy, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Geoff Strong
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Abby H Hurd
- Physiotherapy, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Research Institute of St. Joe's, Hamilton, Ontario, Canada
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Research Institute of St. Joe's, Hamilton, Ontario, Canada
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Medicine, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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7
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Chassé M, Fergusson DA, Tinmouth A, Acker JP, Perelman I, Tuttle A, English SW, Hawken S, Forster AJ, Shehata N, Thavorn K, Wilson K, Cober N, Maddison H, Tokessy M. Effect of Donor Sex on Recipient Mortality in Transfusion. N Engl J Med 2023; 388:1386-1395. [PMID: 37043654 DOI: 10.1056/nejmoa2211523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Conflicting observational evidence exists regarding the association between the sex of red-cell donors and mortality among transfusion recipients. Evidence to inform transfusion practice and policy is limited. METHODS In this multicenter, double-blind trial, we randomly assigned patients undergoing red-cell transfusion to receive units of red cells from either male donors or female donors. Patients maintained their trial-group assignment throughout the trial period, including during subsequent inpatient and outpatient encounters. Randomization was conducted in a 60:40 ratio (male donor group to female donor group) to match the historical allocation of red-cell units from the blood supplier. The primary outcome was survival, with the male donor group as the reference group. RESULTS A total of 8719 patients underwent randomization before undergoing transfusion; 5190 patients were assigned to the male donor group, and 3529 to the female donor group. At baseline, the mean (±SD) age of the enrolled patients was 66.8±16.4 years. The setting of the first transfusion was as an inpatient in 6969 patients (79.9%), of whom 2942 (42.2%) had been admitted under a surgical service. The baseline hemoglobin level before transfusion was 79.5±19.7 g per liter, and patients received a mean of 5.4±10.5 units of red cells in the female donor group and 5.1±8.9 units in the male donor group (difference, 0.3 units; 95% confidence interval [CI], -0.1 to 0.7). Over the duration of the trial, 1141 patients in the female donor group and 1712 patients in the male donor group died. In the primary analysis of overall survival, the adjusted hazard ratio for death was 0.98 (95% CI, 0.91 to 1.06). CONCLUSIONS This trial showed no significant difference in survival between a transfusion strategy involving red-cell units from female donors and a strategy involving red-cell units from male donors. (Funded by the Canadian Institutes of Health Research; iTADS ClinicalTrials.gov number, NCT03344887.).
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Affiliation(s)
- Michaël Chassé
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Dean A Fergusson
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Alan Tinmouth
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Jason P Acker
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Iris Perelman
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Angie Tuttle
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Shane W English
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Steven Hawken
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Alan J Forster
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Nadine Shehata
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Kednapa Thavorn
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Kumanan Wilson
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Nancy Cober
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Heather Maddison
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Melanie Tokessy
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
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8
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Neves Briard J, Nitulescu R, Lemoine É, Titova P, McIntyre L, English SW, Knoll G, Shemie SD, Martin C, Turgeon AF, Lauzier F, Fergusson DA, Chassé M. Diagnostic accuracy of ancillary tests for death by neurologic criteria: a systematic review and meta-analysis. Can J Anaesth 2023; 70:736-748. [PMID: 37155120 PMCID: PMC10202988 DOI: 10.1007/s12630-023-02426-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 05/10/2023] Open
Abstract
PURPOSE Ancillary tests are frequently used in death determination by neurologic criteria (DNC), particularly when the clinical neurologic examination is unreliable. Nevertheless, their diagnostic accuracy has not been extensively studied. Our objective was to synthesize the sensitivity and specificity of commonly used ancillary tests for DNC. SOURCE We performed a systematic review and meta-analysis by searching MEDLINE, EMBASE, Cochrane databases, and CINAHL Ebsco from their inception to 4 February 2022. We selected cohort and case-control studies including patients with 1) clinically diagnosed death by neurologic criteria or 2) clinically suspected death by neurologic criteria who underwent ancillary testing for DNC. We excluded studies without a priori diagnostic criteria and studies conducted solely on pediatric patients. Accepted reference standards were clinical examination, four-vessel conventional angiography, and radionuclide imaging. Data were directly extracted from published reports. We assessed the methodological quality of studies with the QUADAS-2 tool and estimated ancillary test sensitivities and specificities using hierarchical Bayesian models with diffuse priors. PRINCIPAL FINDINGS Overall, 137 records met the selection criteria. One study (0.7%) had a low risk of bias in all QUADAS-2 domains. Among clinically diagnosed death by neurologic criteria patients (n = 8,891), ancillary tests had similar pooled sensitivities (range, 0.82-0.93). Sensitivity heterogeneity was greater within (σ = 0.10-0.15) than between (σ = 0.04) ancillary test types. Among clinically suspected death by neurologic criteria patients (n = 2,732), pooled ancillary test sensitivities ranged between 0.81 and 1.00 and specificities between 0.87 and 1.00. Most estimates had high statistical uncertainty. CONCLUSION Studies assessing ancillary test diagnostic accuracy have an unclear or high risk of bias. High-quality studies are required to thoroughly validate ancillary tests for DNC. STUDY REGISTRATION PROSPERO (CRD42013005907); registered 7 October 2013.
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Affiliation(s)
- Joel Neves Briard
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, H2X 3H8, Canada
| | - Roy Nitulescu
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, H2X 3H8, Canada
| | - Émile Lemoine
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada
| | - Polina Titova
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, H2X 3H8, Canada
| | - Lauralyn McIntyre
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Greg Knoll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sam D Shemie
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Claudio Martin
- Department of Medicine, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
- Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
| | - François Lauzier
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, QC, Canada
- Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
- Department of Medicine, Université Laval, Quebec City, QC, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michaël Chassé
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue Saint-Denis, Montreal, QC, H2X 3H8, Canada.
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.
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9
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McIntyre LA, Fergusson DA, McArdle T, Fox-Robichaud A, English SW, Martin C, Marshall J, Cook DJ, Graham ID, Hawken S, McCartney C, Menon K, Saginur R, Seely A, Stiell I, Thavorn K, Weijer C, Iyengar A, Muscedere J, Forster AJ, Taljaard M. FLUID trial: a hospital-wide open-label cluster cross-over pragmatic comparative effectiveness randomised pilot trial comparing normal saline to Ringer's lactate. BMJ Open 2023; 13:e067142. [PMID: 36737087 PMCID: PMC9900065 DOI: 10.1136/bmjopen-2022-067142] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Normal saline (NS) and Ringer's lactate (RL) are the most common crystalloids used for fluid therapy. Despite evidence of possible harm associated with NS (eg, hyperchloremic metabolic acidosis, impaired kidney function and death), few large multi-centre randomised trials have evaluated the effect of these fluids on clinically important outcomes. We conducted a pilot trial to explore the feasibility of a large trial powered for clinically important outcomes. DESIGN FLUID was a pragmatic pilot cluster randomised cross-over trial. SETTING Four hospitals in the province of Ontario, Canada PARTICIPANTS: All hospitalised adult and paediatric patients with an incident admission to the hospital over the course of each study period. INTERVENTIONS A hospital wide policy/strategy which stocked either NS or RL throughout the hospital for 12 weeks before crossing over to the alternate fluid for the subsequent 12 weeks. PRIMARY AND SECONDARY OUTCOME MEASURES The primary feasibility outcome was study fluid protocol adherence. Secondary feasibility outcomes included time to Research Ethics Board (REB) approval and trial initiation. Primary (composite of death or re-admission to hospital in first 90 days of index hospitalisation) and secondary clinical outcomes were analysed descriptively. RESULTS Among 24 905 included patients, mean age 59.1 (SD 20.5); 13 977 (56.1%) were female and 21 150 (85.0%) had medical or surgical admitting diagnoses. Overall, 96 821 L were administered in the NS arm, and 78 348 L in the RL arm. Study fluid adherence to NS and RL was 93.7% (site range: 91.6%-98.0%) and 79.8% (site range: 72.5%-83.9%), respectively. Time to REB approval ranged from 2 to 48 days and readiness for trial initiation from 51 to 331 days. 5544 (22.3%) patients died or required hospital re-admission in the first 90 days. CONCLUSIONS The future large trial is feasible. Anticipating and addressing logistical challenges during the planning stages will be imperative. TRIAL REGISTRATION NUMBER NCT02721485.
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Affiliation(s)
- Lauralyn Ann McIntyre
- Department of Medicine (Critical Care), Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
- Critical Care, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Tracy McArdle
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Shane W English
- Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Claudio Martin
- Medicine (Critical Care), London Health Sciences Centre, London, Ontario, Canada
| | - John Marshall
- Surgery/Critical Care Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Clinical Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Steven Hawken
- ICES @uOttawa, Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
- Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Colin McCartney
- Anesthesiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Kusum Menon
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Raphael Saginur
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Andrew Seely
- Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ian Stiell
- Department of Emergency Medicine, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Charles Weijer
- Rotman Institute of Philospohy, Western University Faculty of Science, London, Ontario, Canada
| | - Akshai Iyengar
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - John Muscedere
- Critical Care, Kingston General Hospital, Kingston, Ontario, Canada
| | - Alan J Forster
- Internal Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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10
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Andersen CR, Presseau J, Saigle V, Fitzgerald E, Lamanna M, Talbot P, Delaney A, English SW. Prioritizing outcome measures after aneurysmal subarachnoid hemorrhage: A q-sort survey of patients, health care providers and researchers. Front Neurol 2022; 13:1068499. [PMID: 36504655 PMCID: PMC9732721 DOI: 10.3389/fneur.2022.1068499] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/03/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To understand which outcome measures patients and their families, health care providers, and researchers prioritize after aneurysmal subarachnoid hemorrhage (aSAH). Methods We conducted a cross-sectional q-sort survey with participants from three key stakeholder groups. Potential outcomes were identified from interviews and focus groups. Participants were purposively sampled to achieve diversity based on stakeholder group, geography, and profession. Respondents sorted 27 outcomes in a quasi-normally distributed grid (Q-Sort) from most to least important. Principal components analysis was used to determine similarities in the way participants sorted the outcome measures resulting in distinct groupings. Overall rankings were also reported. Results 112 participants were invited. 70 responded and 64 participants from 25 different countries completed a Q-sort. Balanced stakeholder representation was achieved. Five distinct patterns were identified based on survival, pathophysiological, psychological, resource use, and functional outcome measures. Quality of life as reported by the patient was the highest ranked outcome measure followed by independence and functional measures. Survival and biomedical outcomes were ranked in the middle and cost measures last. Conclusions In this diverse sample of key stakeholders, we characterized several distinct perspectives with respect to outcome measure selection in aSAH. We did not identify a clear pattern of opinion based on stakeholder group or other participant characteristics. Patient-reported measure of quality of life was ranked the most important overall with function and independence also highly rated. These results will assist study design and inform efforts to improve outcome selection in aSAH research.
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Affiliation(s)
- Christopher R. Andersen
- Northern Clinical School, Sydney University, Sydney, NSW, Australia,The George Institute for Global Health, UNSW, Newtown, NSW, Australia,Intensive Care Department, Royal North Shore Hospital, St Leonards, NSW, Australia,*Correspondence: Christopher R. Andersen
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada,Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
| | - Victoria Saigle
- Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
| | - Emily Fitzgerald
- The George Institute for Global Health, UNSW, Newtown, NSW, Australia,Intensive Care Department, Royal North Shore Hospital, St Leonards, NSW, Australia
| | | | - Phil Talbot
- Independent Researcher, Sydney, NSW, Australia
| | - Anthony Delaney
- Northern Clinical School, Sydney University, Sydney, NSW, Australia,The George Institute for Global Health, UNSW, Newtown, NSW, Australia,Intensive Care Department, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Shane W. English
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada,Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada,Department of Medicine (Critical Care), University of Ottawa, Ottawa, ON, Canada
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11
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Andersen CR, English SW, Delaney A. Made to measure—Selecting outcomes in aneurysmal subarachnoid hemorrhage research. Front Neurol 2022; 13:1000454. [PMID: 36212648 PMCID: PMC9532574 DOI: 10.3389/fneur.2022.1000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022] Open
Abstract
There has been limited new high-level evidence generated to guide aneurysmal subarachnoid hemorrhage (aSAH) management in the past decade. The choice of outcome measures used in aSAH clinical trials may be one of the factors hindering progress. In this narrative review we consider the current process for determining “what” to measure in aSAH and identify some of the shortcomings of these approaches. A consideration of the unique clinical course of aSAH is then discussed and how this impacts on selecting the best timepoints to assess change in the chosen constructs. We also review the how to critically appraise different measurement instruments and some of the issues with how these are applied in the context of aSAH. We conclude with current initiatives to improve outcome selection in aSAH and future directions in the research agenda.
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Affiliation(s)
- Christopher R. Andersen
- Northern Clinical School, Sydney University, Sydney, NSW, Australia
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Intensive Care Department, Royal North Shore Hospital, Sydney, NSW, Australia
- *Correspondence: Christopher R. Andersen
| | - Shane W. English
- Department of Medicine (Critical Care), uOttawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
| | - Anthony Delaney
- Northern Clinical School, Sydney University, Sydney, NSW, Australia
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- Intensive Care Department, Royal North Shore Hospital, Sydney, NSW, Australia
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12
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Reid JC, Molloy A, Strong G, Kelly L, O'Grady H, Cook D, Archambault PM, Ball I, Berney S, Burns KEA, D'Aragon F, Duan E, English SW, Lamontagne F, Pastva AM, Rochwerg B, Seely AJE, Serri K, Tsang JLY, Verceles AC, Reeve B, Fox-Robichaud A, Muscedere J, Herridge M, Thabane L, Kho ME. Research interrupted: applying the CONSERVE 2021 Statement to a randomized trial of rehabilitation during critical illness affected by the COVID-19 pandemic. Trials 2022; 23:735. [PMID: 36056378 PMCID: PMC9438218 DOI: 10.1186/s13063-022-06640-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 08/06/2022] [Indexed: 11/10/2022] Open
Abstract
RATIONALE The COVID-19 pandemic disrupted non-COVID critical care trials globally as intensive care units (ICUs) prioritized patient care and COVID-specific research. The international randomized controlled trial CYCLE (Critical Care Cycling to Improve Lower Extremity Strength) was forced to halt recruitment at all sites in March 2020, creating immediate challenges. We applied the CONSERVE (CONSORT and SPIRIT Extension for RCTs Revised in Extenuating Circumstance) statement as a framework to report the impact of the pandemic on CYCLE and describe our mitigation approaches. METHODS On March 23, 2020, the CYCLE Methods Centre distributed a standardized email to determine the number of patients still in-hospital and those requiring imminent 90-day endpoint assessments. We assessed protocol fidelity by documenting attempts to provide the in-hospital randomized intervention (cycling or routine physiotherapy) and collect the primary outcome (physical function 3-days post-ICU discharge) and 90-day outcomes. We advised sites to prioritize data for the study's primary outcome. We sought feedback on pandemic barriers related to trial procedures. RESULTS Our main Methods Centre mitigation strategies included identifying patients at risk for protocol deviations, communicating early and frequently with sites, developing standardized internal tools focused on high-risk points in the protocol for monitoring patient progress, data entry, and validation, and providing guidance to conduct some research activities remotely. For study sites, our strategies included determining how institutional pandemic research policies applied to CYCLE, communicating with the Methods Centre about capacity to continue any part of the research, and developing contingency plans to ensure the protocol was delivered as intended. From 15 active sites (12 Canada, 2 US, 1 Australia), 5 patients were still receiving the study intervention in ICUs, 6 required primary outcomes, and 17 required 90-day assessments. With these mitigation strategies, we attempted 100% of ICU interventions, 83% of primary outcomes, and 100% of 90-day assessments per our protocol. CONCLUSIONS We retained all enrolled patients with minimal missing data using several time-sensitive strategies. Although CONSERVE recommends reporting only major modifications incurred by extenuating circumstances, we suggest that it also provides a helpful framework for reporting mitigation strategies with the goal of improving research transparency and trial management. TRIAL REGISTRATION NCT03471247. Registered on March 20, 2018.
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Affiliation(s)
- Julie C Reid
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. .,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
| | - Alex Molloy
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Geoff Strong
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Laurel Kelly
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Heather O'Grady
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Deborah Cook
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Patrick M Archambault
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - Ian Ball
- Department of Medicine and Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Sue Berney
- Department of Physiotherapy, Austin Health, Heidelberg, VIC, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, VIC, Australia
| | - Karen E A Burns
- Li Sha King Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Frederick D'Aragon
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Department of Anesthesiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de recherche du CHI de Sherbrooke, Sherbrooke, QC, Canada
| | - Erick Duan
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada.,Division of Critical Care Medicine, Niagara Health, St. Catharines, ON, Canada
| | - Shane W English
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - François Lamontagne
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de recherche du CHI de Sherbrooke, Sherbrooke, QC, Canada
| | - Amy M Pastva
- Departments of Medicine, Orthopedic Surgery and Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Andrew J E Seely
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Karim Serri
- Department of Medicine, Hôpital Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Jennifer L Y Tsang
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Division of Critical Care Medicine, Niagara Health, St. Catharines, ON, Canada
| | - Avelino C Verceles
- Department of Medicine, University of Maryland Medical Centre, Midtown Campus, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brenda Reeve
- Department of Medicine, Brantford General Hospital, Brantford, ON, Canada
| | | | - John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Margaret Herridge
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Research Institute of St. Joseph's, Hamilton, ON, Canada
| | - Michelle E Kho
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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13
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Chassé M, Neves Briard J, Yu M, P Carvalho L, W English S, D'Aragon F, Lauzier F, F Turgeon A, Dhanani S, McIntyre L, D Shemie S, Knoll G, Fergusson DA, Anthony SJ, Weiss MJ. Clinical evaluation and ancillary testing for the diagnosis of death by neurologic criteria: a cross-sectional survey of Canadian intensivists. Can J Anaesth 2022; 69:353-363. [PMID: 34931292 DOI: 10.1007/s12630-021-02166-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Trust in the deceased organ donation process relies on the expectation that the diagnosis of death by neurologic criteria (DNC) is accurate and reliable. The objective of this study was to assess the perceptions and approaches to DNC diagnosis among Canadian intensivists. METHODS We conducted a self-administered, online, cross-sectional survey of Canadian intensivists. Our sampling frame included all intensivists practicing in Canadian institutions. Results are reported using descriptive statistics. RESULTS Among 550 identified intensivists, 249 (45%) completed the survey. Respondents indicated they would be comfortable diagnosing DNC based on clinical criteria alone in cases where there is movement in response to stimulation (119/248; 48%); inability to evaluate upper/lower extremity responses (84/249; 34%); spontaneous peripheral movement (76/249; 31%); inability to evaluate both oculocephalic and oculo-caloric reflexes (40/249; 16%); presence of high cervical spinal cord injury (40/249; 16%); and within 24 hr of hypoxemic-ischemic brain injury (38/247; 15%). Most respondents agreed that an ancillary test should always be conducted when a complete clinical evaluation is impossible (225/241; 93%); when there is possibility of a residual sedative effect (216/242; 89%); when the mechanism for brain injury is unclear (172/241; 71%); and if isolated brainstem injury is suspected (142/242; 59%). Sixty-six percent (158/241) believed that ancillary tests are sensitive and 55% (132/241) that they are specific for DNC. Respondents considered the following ancillary tests useful for DNC: four-vessel conventional angiography (211/241; 88%), nuclear imaging (179/240; 75%), computed tomography (CT) angiography (156/240; 65%), and CT perfusion (134/240; 56%). CONCLUSION There is variability in perceptions and approaches to DNC diagnosis among Canadian intensivists, and some practices are inconsistent with national recommendations.
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Affiliation(s)
- Michaël Chassé
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue St-Denis, Montreal, QC, H2X 3H8, Canada.
- Medicine, Université de Montréal, Montreal, QC, Canada.
| | - Joel Neves Briard
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue St-Denis, Montreal, QC, H2X 3H8, Canada
- Neuroscience, Université de Montréal, Montreal, QC, Canada
| | - Michael Yu
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue St-Denis, Montreal, QC, H2X 3H8, Canada
| | - Livia P Carvalho
- Centre de recherche du Centre hospitalier de l'Université de Montréal, 900 rue St-Denis, Montreal, QC, H2X 3H8, Canada
| | - Shane W English
- Critical Care, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Frédérick D'Aragon
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - François Lauzier
- CHU de Québec Research Center, Université Laval, Quebec City, QC, Canada
- Critical Care, Université Laval, Quebec City, QC, Canada
| | - Alexis F Turgeon
- CHU de Québec Research Center, Université Laval, Quebec City, QC, Canada
- Critical Care, Université Laval, Quebec City, QC, Canada
| | - Sonny Dhanani
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lauralyn McIntyre
- Critical Care, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sam D Shemie
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
- Critical Care, Montreal Children's Hospital, Montreal, QC, Canada
- McGill University Health Centre and Research Institute, Montreal, QC, Canada
| | - Gregory Knoll
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Critical Care, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Dean A Fergusson
- Critical Care, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Samantha J Anthony
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Matthew J Weiss
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- CHU de Québec Research Center, Université Laval, Quebec City, QC, Canada
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
- Transplant Québec, Montreal, QC, Canada
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14
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Tran A, Fernando SM, Carrier M, Siegal DM, Inaba K, Vogt K, Engels PT, English SW, Kanji S, Kyeremanteng K, Lampron J, Kim D, Rochwerg B. Efficacy and Safety of Low Molecular Weight Heparin Versus Unfractionated Heparin for Prevention of Venous Thromboembolism in Trauma Patients: A Systematic Review and Meta-analysis. Ann Surg 2022; 275:19-28. [PMID: 34387202 DOI: 10.1097/sla.0000000000005157] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 11/26/2022]
Abstract
PURPOSE Trauma patients are at high risk of VTE. We summarize the efficacy and safety of LMWH versus UFH for the prevention of VTE in trauma patients. METHODS We searched 6 databases from inception through March 12, 2021. We included randomized controlled trials (RCTs) or observational studies comparing LMWH versus UFH for thromboprophylaxis in adult trauma patients. We pooled effect estimates across RCTs and observational studies separately, using random-effects model and inverse variance weighting. We assessed risk of bias using the Cochrane tool for RCTs and the Risk of Bias in Non-Randomized Studies (ROBINS)-I tool for observational studies and assessed certainty of findings using Grading of Recommendations, Assessment, Development and Evaluations methodology. RESULTS We included 4 RCTs (879 patients) and 8 observational studies (306,747 patients). Based on pooled RCT data, compared to UFH, LMWH reduces deep vein thrombosis (RR 0.67, 95% CI 0.50 to 0.88, moderate certainty) and VTE (RR 0.68, 95% CI 0.51 to 0.90, moderate certainty). As compared to UFH, LMWH may reduce pulmonary embolism [adjusted odds ratio from pooled observational studies 0.56 (95% CI 0.50 to 0.62)] and mortality (adjusted odds ratio from pooled observational studies 0.54, 95% CI 0.45 to 0.65), though based on low certainty evidence. There was an uncertain effect on adverse events (RR from pooled RCTs 0.80, 95% CI 0.48 to 1.33, very low certainty) and heparin induced thrombocytopenia [RR from pooled RCTs 0.26 (95% CI 0.03 to 2.38, very low certainty)]. CONCLUSIONS Among adult trauma patients, LMWH is superior to UFH for deep vein thrombosis and VTE prevention and may additionally reduce pulmonary embolism and mortality. The impact on adverse events and heparin induced thrombocytopenia is uncertain.
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Affiliation(s)
- Alexandre Tran
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Marc Carrier
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Deborah M Siegal
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kenji Inaba
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles
| | - Kelly Vogt
- Division of General Surgery, Department of Surgery, Western University, London, Canada
| | - Paul T Engels
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Canada
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada
| | - Shane W English
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Salmaan Kanji
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jacinthe Lampron
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Canada
| | - Dennis Kim
- Department of Surgery, University of California Los Angeles, Los Angeles, California
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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15
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Tran A, Fernando SM, Rochwerg B, Cook DJ, Crowther MA, Fowler RA, Alhazzani W, Siegal DM, Castellucci LA, Zarychanski R, English SW, Kyeremanteng K, Carrier M. Prognostic Factors Associated With Development of Venous Thromboembolism in Critically Ill Patients-A Systematic Review and Meta-Analysis. Crit Care Med 2021; 50:e370-e381. [PMID: 34636806 DOI: 10.1097/ccm.0000000000005382] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify prognostic factors for the development of venous thromboembolism in the ICU. DATA SOURCES We searched MEDLINE, EMBASE, and Cochrane CENTRAL from inception to March 1, 2021. STUDY SELECTION We included English-language studies describing prognostic factors associated with the development of venous thromboembolism among critically ill patients. DATA EXTRACTION Two authors performed data extraction and risk-of-bias assessment. We pooled adjusted odds ratios and adjusted hazard ratios for prognostic factors using random-effects model. We assessed risk of bias using the Quality in Prognosis Studies tool and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach. DATA SYNTHESIS We included 39 observational cohort studies involving 729,477 patients. Patient factors with high or moderate certainty of association with increased odds of venous thromboembolism include older age (adjusted odds ratio, 1.15; 95% CI, 1.02-1.29 per 10 yr), obesity (adjusted odds ratio, 1.25; 95% CI, 1.18-1.32), active malignancy (adjusted odds ratio, 1.70; 95% CI, 1.18-2.44), history of venous thromboembolism (adjusted odds ratio, 4.77; 95% CI, 3.42-6.65), and history of recent surgery (adjusted odds ratio, 1.77; 95% CI, 1.26-2.47). ICU-specific factors with high or moderate certainty of association with increased risk of venous thromboembolism include sepsis (adjusted odds ratio, 1.41; 95% CI, 1.12-1.78), lack of pharmacologic venous thromboembolism prophylaxis (adjusted odds ratio, 1.80; 95% CI, 1.14-2.84), central venous catheter (adjusted odds ratio, 2.93; 95% CI, 1.98-4.34), invasive mechanical ventilation (adjusted odds ratio, 1.74; 95% CI, 1.36-2.24), and use of vasoactive medication (adjusted odds ratio, 1.86; 95% CI, 1.23-2.81). CONCLUSIONS This meta-analysis provides quantitative summaries of the association between patient-specific and ICU-related prognostic factors and the risk of venous thromboembolism in the ICU. These findings provide the foundation for the development of a venous thromboembolism risk stratification tool for critically ill patients.
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Affiliation(s)
- Alexandre Tran
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. Department of Medicine, McMaster University, Hamilton, ON, Canada. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. Department of Medicine, University of Manitoba, Winnipeg, MB, Canada. Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada. Center of Health Care Innovation, Winnipeg, MB, Canada
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16
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Fernando SM, Tran A, Cheng W, Sadeghirad B, Arabi YM, Cook DJ, Møller MH, Mehta S, Fowler RA, Burns KEA, Wells PS, Carrier M, Crowther MA, Scales DC, English SW, Kyeremanteng K, Kanji S, Kho ME, Rochwerg B. Venous Thromboembolism Prophylaxis in Critically Ill Adults: A Systematic Review and Network Meta-analysis. Chest 2021; 161:418-428. [PMID: 34419428 DOI: 10.1016/j.chest.2021.08.050] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Critically ill adults are at increased risk of VTE, including DVT, and pulmonary embolism. Various agents exist for venous thromboprophylaxis in this population. RESEARCH QUESTION What is the comparative efficacy and safety of prophylaxis agents for prevention of VTE in critically ill adults? STUDY DESIGN AND METHODS Systematic review and network meta-analysis of randomized clinical trials (RCTs) evaluating efficacy of thromboprophylaxis agents among critically ill patients. We searched six databases (including PubMed, EMBASE, and Medline) from inception through January 2021 for RCTs of patients in the ICU receiving pharmacologic, mechanical, or combination therapy (pharmacologic agents and mechanical devices) for thromboprophylaxis. Two reviewers performed screening, full-text review, and extraction. We used the Grading of Recommendations Assessment, Development, and Evaluation to rate certainty of effect estimates. RESULTS We included 13 RCTs (9,619 patients). Compared with control treatment (a composite of no prophylaxis, placebo, or compression stockings only), low-molecular-weight heparin (LMWH) reduced the incidence of DVT (OR, 0.59 [95% credible interval [CrI], 0.33-0.90]; high certainty) and unfractionated heparin (UFH) may reduce the incidence of DVT (OR, 0.82 [95% CrI, 0.47-1.37]; low certainty). LMWH probably reduces DVT compared with UFH (OR, 0.72 [95% CrI, 0.46-0.98]; moderate certainty). Compressive devices may reduce risk of DVT compared with control treatments; however, this is based on low-certainty evidence (OR, 0.85 [95% CrI, 0.50-1.50]). Combination therapy showed unclear effect on DVT compared with either therapy alone (very low certainty). INTERPRETATION Among critically ill adults, compared with control treatment, LMWH reduces incidence of DVT, whereas UFH and mechanical compressive devices may reduce the risk of DVT. LMWH is probably more effective than UFH in reducing incidence of DVT and should be considered the primary pharmacologic agent for thromboprophylaxis. The efficacy and safety of combination pharmacologic therapy and mechanical compressive devices were unclear. TRIAL REGISTRY Open Science Framework; URL: https://osf.io/694aj.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Alexandre Tran
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Wei Cheng
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Yaseen M Arabi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Deborah J Cook
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital Righospitalet, Copenhagen, Denmark
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Karen E A Burns
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Philip S Wells
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marc Carrier
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mark A Crowther
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Damon C Scales
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Shane W English
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Salmaan Kanji
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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17
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Fernando SM, Qureshi D, Talarico R, Dowlatshahi D, Sood MM, Smith EE, Hill MD, McCredie VA, Scales DC, English SW, Rochwerg B, Tanuseputro P, Kyeremanteng K. Short- and Long-term Health Care Resource Utilization and Costs Following Intracerebral Hemorrhage. Neurology 2021; 97:e608-e618. [PMID: 34108269 DOI: 10.1212/wnl.0000000000012355] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/03/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We sought to evaluate the short- and long-term resource use and costs associated with intracerebral hemorrhage (ICH) taken from an entire population. We in addition sought to evaluate the association of oral anticoagulation (OAC) and health care costs. METHODS This was a retrospective cohort study of adult patients (≥18 years) with ICH in the entire population of Ontario, Canada (2009-2017). We captured outcomes through linkage to health administrative databases. We used generalized linear models to identify factors associated with total cost. Analysis of OAC use was limited to patients ≥66 years of age. The primary outcome was total 1-year direct health care costs in 2020 US dollars. RESULTS Among 16,248 individuals with ICH (mean age 71.2 years, male 52.3%), 1-year mortality was 46.0%, and 24.2% required mechanical ventilation. The median total 1-year cost was $26,886 (interquartile range [IQR] $9,641-$62,907) with costs for those who died in hospital of $7,268 (IQR $4,031-$14,966) vs $44,969 (IQR $20,264-$82,414, p < 0.001) for survivors to discharge. OAC use (analysis limited to individuals ≥66 years old) was associated with higher total 1-year costs (cost ratio 1.06 [95% confidence interval 1.01-1.11]). Total 1-year costs for the entire cohort exceeded $120 million per year over the study period. CONCLUSIONS ICH is associated with significant health care costs, and the median cost of a patient with ICH is roughly 10 times the median inpatient cost in Ontario. Costs were higher among survivors than deceased patients. OAC use is independently associated with increased costs. To maximize cost-effectiveness, future therapies for ICH must aim to reduce disability, not only improve mortality.
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Affiliation(s)
- Shannon M Fernando
- From the Division of Critical Care (S.M.F., S.W.E., K.K.), Department of Medicine, and Department of Emergency Medicine (S.M.F.), University of Ottawa; ICES (D.Q., R.T., M.M.S., D.C.S., P.T.), Toronto; Clinical Epidemiology Program (D.Q., R.T., D.D., M.M.S., S.W.E., P.T., K.K.), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (D.Q., D.D., M.M.S., S.W.E., P.T.), University of Ottawa; Bruyère Research Institute (D.Q., P.T.); Division of Palliative Care (D.Q., P.T., K.K.), Department of Medicine, Division of Neurology (D.D.), Department of Medicine, and Division of Nephrology (M.M.S.), Department of Medicine, University of Ottawa, Ontario; Calgary Stroke Program (E.E.S., M.D.H.), Hotchkiss Brain Institute, and Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, Alberta; Interdepartmental Division of Critical Care Medicine (V.A.M., D.C.S.), University of Toronto; Krembil Research Institute (V.A.M.), Toronto Western Hospital, University Health Network; Department of Critical Care Medicine (V.A.M., D.C.S.), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (D.C.S.), St. Michael's Hospital, Toronto; Department of Medicine (B.R.), Division of Critical Care and Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton; and Institut du Savoir Montfort (K.K.), Ottawa, Ontario, Canada.
| | - Danial Qureshi
- From the Division of Critical Care (S.M.F., S.W.E., K.K.), Department of Medicine, and Department of Emergency Medicine (S.M.F.), University of Ottawa; ICES (D.Q., R.T., M.M.S., D.C.S., P.T.), Toronto; Clinical Epidemiology Program (D.Q., R.T., D.D., M.M.S., S.W.E., P.T., K.K.), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (D.Q., D.D., M.M.S., S.W.E., P.T.), University of Ottawa; Bruyère Research Institute (D.Q., P.T.); Division of Palliative Care (D.Q., P.T., K.K.), Department of Medicine, Division of Neurology (D.D.), Department of Medicine, and Division of Nephrology (M.M.S.), Department of Medicine, University of Ottawa, Ontario; Calgary Stroke Program (E.E.S., M.D.H.), Hotchkiss Brain Institute, and Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, Alberta; Interdepartmental Division of Critical Care Medicine (V.A.M., D.C.S.), University of Toronto; Krembil Research Institute (V.A.M.), Toronto Western Hospital, University Health Network; Department of Critical Care Medicine (V.A.M., D.C.S.), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (D.C.S.), St. Michael's Hospital, Toronto; Department of Medicine (B.R.), Division of Critical Care and Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton; and Institut du Savoir Montfort (K.K.), Ottawa, Ontario, Canada
| | - Robert Talarico
- From the Division of Critical Care (S.M.F., S.W.E., K.K.), Department of Medicine, and Department of Emergency Medicine (S.M.F.), University of Ottawa; ICES (D.Q., R.T., M.M.S., D.C.S., P.T.), Toronto; Clinical Epidemiology Program (D.Q., R.T., D.D., M.M.S., S.W.E., P.T., K.K.), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (D.Q., D.D., M.M.S., S.W.E., P.T.), University of Ottawa; Bruyère Research Institute (D.Q., P.T.); Division of Palliative Care (D.Q., P.T., K.K.), Department of Medicine, Division of Neurology (D.D.), Department of Medicine, and Division of Nephrology (M.M.S.), Department of Medicine, University of Ottawa, Ontario; Calgary Stroke Program (E.E.S., M.D.H.), Hotchkiss Brain Institute, and Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, Alberta; Interdepartmental Division of Critical Care Medicine (V.A.M., D.C.S.), University of Toronto; Krembil Research Institute (V.A.M.), Toronto Western Hospital, University Health Network; Department of Critical Care Medicine (V.A.M., D.C.S.), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (D.C.S.), St. Michael's Hospital, Toronto; Department of Medicine (B.R.), Division of Critical Care and Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton; and Institut du Savoir Montfort (K.K.), Ottawa, Ontario, Canada
| | - Dar Dowlatshahi
- From the Division of Critical Care (S.M.F., S.W.E., K.K.), Department of Medicine, and Department of Emergency Medicine (S.M.F.), University of Ottawa; ICES (D.Q., R.T., M.M.S., D.C.S., P.T.), Toronto; Clinical Epidemiology Program (D.Q., R.T., D.D., M.M.S., S.W.E., P.T., K.K.), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (D.Q., D.D., M.M.S., S.W.E., P.T.), University of Ottawa; Bruyère Research Institute (D.Q., P.T.); Division of Palliative Care (D.Q., P.T., K.K.), Department of Medicine, Division of Neurology (D.D.), Department of Medicine, and Division of Nephrology (M.M.S.), Department of Medicine, University of Ottawa, Ontario; Calgary Stroke Program (E.E.S., M.D.H.), Hotchkiss Brain Institute, and Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, Alberta; Interdepartmental Division of Critical Care Medicine (V.A.M., D.C.S.), University of Toronto; Krembil Research Institute (V.A.M.), Toronto Western Hospital, University Health Network; Department of Critical Care Medicine (V.A.M., D.C.S.), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (D.C.S.), St. Michael's Hospital, Toronto; Department of Medicine (B.R.), Division of Critical Care and Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton; and Institut du Savoir Montfort (K.K.), Ottawa, Ontario, Canada
| | - Manish M Sood
- From the Division of Critical Care (S.M.F., S.W.E., K.K.), Department of Medicine, and Department of Emergency Medicine (S.M.F.), University of Ottawa; ICES (D.Q., R.T., M.M.S., D.C.S., P.T.), Toronto; Clinical Epidemiology Program (D.Q., R.T., D.D., M.M.S., S.W.E., P.T., K.K.), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (D.Q., D.D., M.M.S., S.W.E., P.T.), University of Ottawa; Bruyère Research Institute (D.Q., P.T.); Division of Palliative Care (D.Q., P.T., K.K.), Department of Medicine, Division of Neurology (D.D.), Department of Medicine, and Division of Nephrology (M.M.S.), Department of Medicine, University of Ottawa, Ontario; Calgary Stroke Program (E.E.S., M.D.H.), Hotchkiss Brain Institute, and Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, Alberta; Interdepartmental Division of Critical Care Medicine (V.A.M., D.C.S.), University of Toronto; Krembil Research Institute (V.A.M.), Toronto Western Hospital, University Health Network; Department of Critical Care Medicine (V.A.M., D.C.S.), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (D.C.S.), St. Michael's Hospital, Toronto; Department of Medicine (B.R.), Division of Critical Care and Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton; and Institut du Savoir Montfort (K.K.), Ottawa, Ontario, Canada
| | - Eric E Smith
- From the Division of Critical Care (S.M.F., S.W.E., K.K.), Department of Medicine, and Department of Emergency Medicine (S.M.F.), University of Ottawa; ICES (D.Q., R.T., M.M.S., D.C.S., P.T.), Toronto; Clinical Epidemiology Program (D.Q., R.T., D.D., M.M.S., S.W.E., P.T., K.K.), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (D.Q., D.D., M.M.S., S.W.E., P.T.), University of Ottawa; Bruyère Research Institute (D.Q., P.T.); Division of Palliative Care (D.Q., P.T., K.K.), Department of Medicine, Division of Neurology (D.D.), Department of Medicine, and Division of Nephrology (M.M.S.), Department of Medicine, University of Ottawa, Ontario; Calgary Stroke Program (E.E.S., M.D.H.), Hotchkiss Brain Institute, and Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, Alberta; Interdepartmental Division of Critical Care Medicine (V.A.M., D.C.S.), University of Toronto; Krembil Research Institute (V.A.M.), Toronto Western Hospital, University Health Network; Department of Critical Care Medicine (V.A.M., D.C.S.), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (D.C.S.), St. Michael's Hospital, Toronto; Department of Medicine (B.R.), Division of Critical Care and Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton; and Institut du Savoir Montfort (K.K.), Ottawa, Ontario, Canada
| | - Michael D Hill
- From the Division of Critical Care (S.M.F., S.W.E., K.K.), Department of Medicine, and Department of Emergency Medicine (S.M.F.), University of Ottawa; ICES (D.Q., R.T., M.M.S., D.C.S., P.T.), Toronto; Clinical Epidemiology Program (D.Q., R.T., D.D., M.M.S., S.W.E., P.T., K.K.), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (D.Q., D.D., M.M.S., S.W.E., P.T.), University of Ottawa; Bruyère Research Institute (D.Q., P.T.); Division of Palliative Care (D.Q., P.T., K.K.), Department of Medicine, Division of Neurology (D.D.), Department of Medicine, and Division of Nephrology (M.M.S.), Department of Medicine, University of Ottawa, Ontario; Calgary Stroke Program (E.E.S., M.D.H.), Hotchkiss Brain Institute, and Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, Alberta; Interdepartmental Division of Critical Care Medicine (V.A.M., D.C.S.), University of Toronto; Krembil Research Institute (V.A.M.), Toronto Western Hospital, University Health Network; Department of Critical Care Medicine (V.A.M., D.C.S.), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (D.C.S.), St. Michael's Hospital, Toronto; Department of Medicine (B.R.), Division of Critical Care and Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton; and Institut du Savoir Montfort (K.K.), Ottawa, Ontario, Canada
| | - Victoria A McCredie
- From the Division of Critical Care (S.M.F., S.W.E., K.K.), Department of Medicine, and Department of Emergency Medicine (S.M.F.), University of Ottawa; ICES (D.Q., R.T., M.M.S., D.C.S., P.T.), Toronto; Clinical Epidemiology Program (D.Q., R.T., D.D., M.M.S., S.W.E., P.T., K.K.), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (D.Q., D.D., M.M.S., S.W.E., P.T.), University of Ottawa; Bruyère Research Institute (D.Q., P.T.); Division of Palliative Care (D.Q., P.T., K.K.), Department of Medicine, Division of Neurology (D.D.), Department of Medicine, and Division of Nephrology (M.M.S.), Department of Medicine, University of Ottawa, Ontario; Calgary Stroke Program (E.E.S., M.D.H.), Hotchkiss Brain Institute, and Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, Alberta; Interdepartmental Division of Critical Care Medicine (V.A.M., D.C.S.), University of Toronto; Krembil Research Institute (V.A.M.), Toronto Western Hospital, University Health Network; Department of Critical Care Medicine (V.A.M., D.C.S.), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (D.C.S.), St. Michael's Hospital, Toronto; Department of Medicine (B.R.), Division of Critical Care and Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton; and Institut du Savoir Montfort (K.K.), Ottawa, Ontario, Canada
| | - Damon C Scales
- From the Division of Critical Care (S.M.F., S.W.E., K.K.), Department of Medicine, and Department of Emergency Medicine (S.M.F.), University of Ottawa; ICES (D.Q., R.T., M.M.S., D.C.S., P.T.), Toronto; Clinical Epidemiology Program (D.Q., R.T., D.D., M.M.S., S.W.E., P.T., K.K.), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (D.Q., D.D., M.M.S., S.W.E., P.T.), University of Ottawa; Bruyère Research Institute (D.Q., P.T.); Division of Palliative Care (D.Q., P.T., K.K.), Department of Medicine, Division of Neurology (D.D.), Department of Medicine, and Division of Nephrology (M.M.S.), Department of Medicine, University of Ottawa, Ontario; Calgary Stroke Program (E.E.S., M.D.H.), Hotchkiss Brain Institute, and Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, Alberta; Interdepartmental Division of Critical Care Medicine (V.A.M., D.C.S.), University of Toronto; Krembil Research Institute (V.A.M.), Toronto Western Hospital, University Health Network; Department of Critical Care Medicine (V.A.M., D.C.S.), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (D.C.S.), St. Michael's Hospital, Toronto; Department of Medicine (B.R.), Division of Critical Care and Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton; and Institut du Savoir Montfort (K.K.), Ottawa, Ontario, Canada
| | - Shane W English
- From the Division of Critical Care (S.M.F., S.W.E., K.K.), Department of Medicine, and Department of Emergency Medicine (S.M.F.), University of Ottawa; ICES (D.Q., R.T., M.M.S., D.C.S., P.T.), Toronto; Clinical Epidemiology Program (D.Q., R.T., D.D., M.M.S., S.W.E., P.T., K.K.), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (D.Q., D.D., M.M.S., S.W.E., P.T.), University of Ottawa; Bruyère Research Institute (D.Q., P.T.); Division of Palliative Care (D.Q., P.T., K.K.), Department of Medicine, Division of Neurology (D.D.), Department of Medicine, and Division of Nephrology (M.M.S.), Department of Medicine, University of Ottawa, Ontario; Calgary Stroke Program (E.E.S., M.D.H.), Hotchkiss Brain Institute, and Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, Alberta; Interdepartmental Division of Critical Care Medicine (V.A.M., D.C.S.), University of Toronto; Krembil Research Institute (V.A.M.), Toronto Western Hospital, University Health Network; Department of Critical Care Medicine (V.A.M., D.C.S.), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (D.C.S.), St. Michael's Hospital, Toronto; Department of Medicine (B.R.), Division of Critical Care and Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton; and Institut du Savoir Montfort (K.K.), Ottawa, Ontario, Canada
| | - Bram Rochwerg
- From the Division of Critical Care (S.M.F., S.W.E., K.K.), Department of Medicine, and Department of Emergency Medicine (S.M.F.), University of Ottawa; ICES (D.Q., R.T., M.M.S., D.C.S., P.T.), Toronto; Clinical Epidemiology Program (D.Q., R.T., D.D., M.M.S., S.W.E., P.T., K.K.), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (D.Q., D.D., M.M.S., S.W.E., P.T.), University of Ottawa; Bruyère Research Institute (D.Q., P.T.); Division of Palliative Care (D.Q., P.T., K.K.), Department of Medicine, Division of Neurology (D.D.), Department of Medicine, and Division of Nephrology (M.M.S.), Department of Medicine, University of Ottawa, Ontario; Calgary Stroke Program (E.E.S., M.D.H.), Hotchkiss Brain Institute, and Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, Alberta; Interdepartmental Division of Critical Care Medicine (V.A.M., D.C.S.), University of Toronto; Krembil Research Institute (V.A.M.), Toronto Western Hospital, University Health Network; Department of Critical Care Medicine (V.A.M., D.C.S.), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (D.C.S.), St. Michael's Hospital, Toronto; Department of Medicine (B.R.), Division of Critical Care and Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton; and Institut du Savoir Montfort (K.K.), Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- From the Division of Critical Care (S.M.F., S.W.E., K.K.), Department of Medicine, and Department of Emergency Medicine (S.M.F.), University of Ottawa; ICES (D.Q., R.T., M.M.S., D.C.S., P.T.), Toronto; Clinical Epidemiology Program (D.Q., R.T., D.D., M.M.S., S.W.E., P.T., K.K.), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (D.Q., D.D., M.M.S., S.W.E., P.T.), University of Ottawa; Bruyère Research Institute (D.Q., P.T.); Division of Palliative Care (D.Q., P.T., K.K.), Department of Medicine, Division of Neurology (D.D.), Department of Medicine, and Division of Nephrology (M.M.S.), Department of Medicine, University of Ottawa, Ontario; Calgary Stroke Program (E.E.S., M.D.H.), Hotchkiss Brain Institute, and Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, Alberta; Interdepartmental Division of Critical Care Medicine (V.A.M., D.C.S.), University of Toronto; Krembil Research Institute (V.A.M.), Toronto Western Hospital, University Health Network; Department of Critical Care Medicine (V.A.M., D.C.S.), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (D.C.S.), St. Michael's Hospital, Toronto; Department of Medicine (B.R.), Division of Critical Care and Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton; and Institut du Savoir Montfort (K.K.), Ottawa, Ontario, Canada
| | - Kwadwo Kyeremanteng
- From the Division of Critical Care (S.M.F., S.W.E., K.K.), Department of Medicine, and Department of Emergency Medicine (S.M.F.), University of Ottawa; ICES (D.Q., R.T., M.M.S., D.C.S., P.T.), Toronto; Clinical Epidemiology Program (D.Q., R.T., D.D., M.M.S., S.W.E., P.T., K.K.), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (D.Q., D.D., M.M.S., S.W.E., P.T.), University of Ottawa; Bruyère Research Institute (D.Q., P.T.); Division of Palliative Care (D.Q., P.T., K.K.), Department of Medicine, Division of Neurology (D.D.), Department of Medicine, and Division of Nephrology (M.M.S.), Department of Medicine, University of Ottawa, Ontario; Calgary Stroke Program (E.E.S., M.D.H.), Hotchkiss Brain Institute, and Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, Alberta; Interdepartmental Division of Critical Care Medicine (V.A.M., D.C.S.), University of Toronto; Krembil Research Institute (V.A.M.), Toronto Western Hospital, University Health Network; Department of Critical Care Medicine (V.A.M., D.C.S.), Sunnybrook Health Sciences Centre; Li Ka Shing Knowledge Institute (D.C.S.), St. Michael's Hospital, Toronto; Department of Medicine (B.R.), Division of Critical Care and Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton; and Institut du Savoir Montfort (K.K.), Ottawa, Ontario, Canada
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Fernando SM, Qureshi D, Talarico R, Tanuseputro P, Dowlatshahi D, Sood MM, Smith EE, Hill MD, McCredie VA, Scales DC, English SW, Rochwerg B, Kyeremanteng K. Intracerebral Hemorrhage Incidence, Mortality, and Association With Oral Anticoagulation Use: A Population Study. Stroke 2021; 52:1673-1681. [PMID: 33685222 DOI: 10.1161/strokeaha.120.032550] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke associated with significant morbidity and mortality. Recent epidemiological data on incidence, mortality, and association with oral anticoagulation are needed. METHODS Retrospective cohort study of adult patients (≥18 years) with ICH in the entire population of Ontario, Canada (April 1, 2009-March 30, 2019). We captured outcome data using linked health administrative databases. The primary outcome was mortality during hospitalization, as well as at 1 year following ICH. RESULTS We included 20 738 patients with ICH. Mean (SD) age was 71.3 (15.1) years, and 52.6% of patients were male. Overall incidence of ICH throughout the study period was 19.1/100 000 person-years and did not markedly change over the study period. In-hospital and 1-year mortality were high (32.4% and 45.4%, respectively). Mortality at 2 years was 49.5%. Only 14.5% of patients were discharged home independently. Over the study period, both in-hospital and 1-year mortality reduced by 10.4% (37.5% to 27.1%, P<0.001) and 7.6% (50.0% to 42.4%, P<0.001), respectively. Use of oral anticoagulation was associated with both in-hospital mortality (adjusted odds ratio 1.37 [95% CI, 1.26-1.49]) and 1-year mortality (hazard ratio, 1.18 [95% CI, 1.12-1.25]) following ICH. CONCLUSIONS Both short- and long-term mortality have decreased in the past decade. Most survivors from ICH are likely to be discharged to long-term care. Oral anticoagulation is associated with both short- and long-term mortality following ICH. These findings highlight the devastating nature of ICH, but also identify significant improvement in outcomes over time.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine (S.M.F., S.W.E., K.K.), University of Ottawa, ON, Canada.,Department of Emergency Medicine (S.M.F.), University of Ottawa, ON, Canada
| | - Danial Qureshi
- School of Epidemiology and Public Health (D.Q., P.T., D.D., M.M.S., S.W.E.), University of Ottawa, ON, Canada.,ICES, Toronto, ON, Canada (D.Q., R.T., P.T., M.M.S., P.T.).,Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.).,Bruyère Research Institute, Ottawa, ON, Canada (D.Q., P.T.)
| | - Robert Talarico
- ICES, Toronto, ON, Canada (D.Q., R.T., P.T., M.M.S., P.T.).,Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.)
| | - Peter Tanuseputro
- School of Epidemiology and Public Health (D.Q., P.T., D.D., M.M.S., S.W.E.), University of Ottawa, ON, Canada.,Division of Palliative Care, Department of Medicine (P.T., K.K.), University of Ottawa, ON, Canada.,ICES, Toronto, ON, Canada (D.Q., R.T., P.T., M.M.S., P.T.).,Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.).,Bruyère Research Institute, Ottawa, ON, Canada (D.Q., P.T.)
| | - Dar Dowlatshahi
- School of Epidemiology and Public Health (D.Q., P.T., D.D., M.M.S., S.W.E.), University of Ottawa, ON, Canada.,Division of Neurology, Department of Medicine (D.D.), University of Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.)
| | - Manish M Sood
- School of Epidemiology and Public Health (D.Q., P.T., D.D., M.M.S., S.W.E.), University of Ottawa, ON, Canada.,Division of Nephrology, Department of Medicine (M.M.S.), University of Ottawa, ON, Canada.,ICES, Toronto, ON, Canada (D.Q., R.T., P.T., M.M.S., P.T.).,Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.)
| | - Eric E Smith
- Calgary Stroke Program, Hotchkiss Brain Institute (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada.,Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Michael D Hill
- Calgary Stroke Program, Hotchkiss Brain Institute (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada.,Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Victoria A McCredie
- Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada (V.A.M., D.C.S.).,Krembil Research Institute, Toronto Western Hospital, University Health Network, ON, Canada (V.A.M.).,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada (V.A.M., D.C.S.)
| | - Damon C Scales
- Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada (V.A.M., D.C.S.).,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada (V.A.M., D.C.S.).,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada (D.C.S.)
| | - Shane W English
- Division of Critical Care, Department of Medicine (S.M.F., S.W.E., K.K.), University of Ottawa, ON, Canada.,School of Epidemiology and Public Health (D.Q., P.T., D.D., M.M.S., S.W.E.), University of Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.)
| | - Bram Rochwerg
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada (V.A.M., D.C.S.).,Department of Medicine, Division of Critical Care (B.R.), McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine (S.M.F., S.W.E., K.K.), University of Ottawa, ON, Canada.,Division of Palliative Care, Department of Medicine (P.T., K.K.), University of Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.).,Institut du Savoir Montfort, Ottawa, ON, Canada (K.K.)
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19
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Shoamanesh A, Patrice Lindsay M, Castellucci LA, Cayley A, Crowther M, de Wit K, English SW, Hoosein S, Huynh T, Kelly M, O'Kelly CJ, Teitelbaum J, Yip S, Dowlatshahi D, Smith EE, Foley N, Pikula A, Mountain A, Gubitz G, Gioia LC. Canadian stroke best practice recommendations: Management of Spontaneous Intracerebral Hemorrhage, 7th Edition Update 2020. Int J Stroke 2020; 16:321-341. [PMID: 33174815 DOI: 10.1177/1747493020968424] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [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: 01/13/2023]
Abstract
Spontaneous intracerebral hemorrhage is a particularly devastating type of stroke with greater morbidity and mortality compared with ischemic stroke and can account for half or more of all deaths from stroke. The seventh update of the Canadian Stroke Best Practice Recommendations includes a new stand-alone module on intracerebral hemorrhage, with a focus on elements of care that are unique or affect persons disproportionately relative to ischemic stroke. Prior to this edition, intracerebral hemorrhage was included in the Acute Stroke Management module and was limited to its management during the first 12 h. With the growing evidence on intracerebral hemorrhage, a separate module focused on this topic across the care continuum was added. In addition to topics related to initial clinical management, neuroimaging, blood pressure management, and surgical management, new sections have been introduced addressing topics surrounding inpatient complications such as venous thromboembolism, seizure management, and increased intracranial pressure, rehabilitation as well as issues related to secondary management including lifestyle management, maintaining a normal blood pressure and antithrombotic therapy, are addressed. The Canadian Stroke Best Practice Recommendations (CSBPR) are intended to provide up-to-date evidence-based guidelines for the prevention and management of stroke and to promote optimal recovery and reintegration for people who have experienced stroke, including patients, families, and informal caregivers.
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Affiliation(s)
- Ashkan Shoamanesh
- Faculty of Medicine (Neurology), McMaster University, Hamilton, Canada.,Hamilton Health Sciences, Division of Neurology, Hamilton, Canada
| | | | - Lana A Castellucci
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Department of Medicine, Divisions of Hematology and General Internal Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Anne Cayley
- Toronto West Regional Stroke Program, University Health Network, Toronto, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Kerstin de Wit
- Department of Medicine (Emergency Medicine), McMaster University, Hamilton, Canada.,Hamilton Health Sciences, Divisions of Emergency Medicine and Thrombosis, Hamilton, Canada
| | - Shane W English
- Ottawa Hospital Research Institute (Clinical Epidemiology Program), Ottawa, Canada.,University of Ottawa, Department of Medicine (Critical Care) and School of Epidemiology and Public Health, Ottawa, Canada
| | - Sharon Hoosein
- Trillium Health Partners Stroke Program, Mississauga, Canada
| | - Thien Huynh
- Department of Diagnostic and Interventional Neuroradiology, Queen Elizabeth II Health Sciences Centre, Halifax, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Michael Kelly
- Department of Neurosurgery, University of Saskatchewan, Saskatoon, Canada
| | - Cian J O'Kelly
- Department of Neurological Surgery, University of Alberta, Edmonton, Canada
| | - Jeanne Teitelbaum
- Department of Neurology, Universite de Montreal, Montreal, Canada.,Department of Neurocritical Care, Montreal Neurological Institute MUHC, Montreal, Canada
| | - Samuel Yip
- Faculty of Medicine (Neurology), University of British Columbia, Vancouver, Canada
| | | | - Eric E Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Aleksandra Pikula
- Toronto West Regional Stroke Program, University Health Network, Toronto, Canada
| | - Anita Mountain
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Canada.,Queen Elizabeth II Health Sciences Centre, Nova Scotia Rehabilitation Centre Site, Halifax, Canada
| | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Stroke Program, Halifax, Canada
| | - Laura C Gioia
- Department of Neurology, Universite de Montreal, Montreal, Canada.,CHUM-Centre Hospitalier de l'Université de Montréal, Stroke Program, Montréal, Canada
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Bensaidane MR, Turgeon AF, Lauzier F, English SW, Leblanc G, Francoeur CL. Neuromonitoring with near-infrared spectroscopy (NIRS) in aneurysmal subarachnoid haemorrhage: a systematic review protocol. BMJ Open 2020; 10:e043300. [PMID: 33172952 PMCID: PMC7656947 DOI: 10.1136/bmjopen-2020-043300] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/22/2020] [Accepted: 10/06/2020] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating disease associated with high mortality and morbidity. The main threat to patients is delayed cerebral ischaemia (DCI). Near-infrared spectroscopy (NIRS) is a recent technology allowing continuous, non-invasive cerebral oximetry that could permit timely detection of impending DCI and appropriate intervention to improve outcomes. However, the ability of regional oxygen saturation to detect DCI, its association to the outcome, or benefits of any interventions based on NIRS data, are lacking. Our aims are to evaluate NIRS technology both as a therapeutic tool to improve outcomes in aSAH patients and as a diagnostic tool for DCI. METHODS AND ANALYSIS MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews will be searched from their inception and without language restriction. Our search strategy will cover the themes of subarachnoid haemorrhage and cerebral oximetry, without limitations regarding studied outcomes. We will identify all observational and interventional human studies of adult patients hospitalised after aSAH that were monitored using NIRS. Functional outcome measures, including the modified Rankin Scale, the Glasgow Outcome Scale and the Barthel Index, will constitute the primary outcome. The Cochrane Risk of Bias tool will be used for randomised controlled trials, the ROBINS-I tool to assess non-randomised studies of interventions and the Newcastle-Ottawa Scale for cohort or case-control studies. The Quality Assessment of Diagnostic Accuracy Studies-2 will be applied to studies evaluating NIRS diagnostic accuracy for DCI. We will evaluate the quality of the evidence of the effect based on the Grading of Recommendations Assessment, Development and Evaluation methodology. ETHICS AND DISSEMINATION Dissemination will proceed through submission for journal publication, trial registry completion and abstract presentation. Ethics approval is not required. PROSPERO REGISTRATION NUMBER CRD42020077522.
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Affiliation(s)
- Mohamed Reda Bensaidane
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Quebec City, Quebec, Canada
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Quebec City, Quebec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada
| | - François Lauzier
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Quebec City, Quebec, Canada
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Guillaume Leblanc
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Quebec City, Quebec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Charles L Francoeur
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Quebec City, Quebec, Canada
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada
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Weiss MJ, English SW, D'Aragon F, Lauzier F, Turgeon AF, Dhanani S, McIntyre L, Carvalho LP, Yu M, Shemie SD, Knoll G, Fergusson DA, Anthony SJ, Haj-Moustafa A, Hartell D, Mohr J, Chassé M. Survey of Canadian critical care physicians' knowledge and attitudes towards legislative aspects of the deceased organ donation system. Can J Anaesth 2020; 67:1349-1358. [PMID: 32696225 DOI: 10.1007/s12630-020-01756-8] [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] [Received: 02/26/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE We surveyed Canadian critical care physicians who may care for patients who are potential organ donors to understand their attitudes and knowledge of legislation governing the deceased organ donation system. METHODS We used a web-based, self-administered survey that included questions related to opt-out consent and mandatory referral legislation. Potential participants were identified through membership lists of professional societies and manual searches. We designed our survey using standardized methods and administered it in February and March 2018. RESULTS Fifty percent (263/529) of potential participants completed the questionnaire. A majority (61%; 144/235) supported a change towards an opt-out consent model, and 77% (181/235) stated they believe it would increase donation rates. Asked if opt-out consent would change their practices, 71% (166/235) stated an opt-out model would not change how or if they approach families to discuss donation. Fifty-six percent (139/249) supported mandatory referral laws, while only 42% (93/219) of those working in provinces with mandatory referral correctly stated that such laws exist in their province. Respondents gave variable responses on who should be accountable when patients are not referred, and 16% (40/249) believed no one should be held accountable. CONCLUSIONS While a majority of critical care physicians supported opt-out consent and mandatory referral, many were neutral or against it. Many were unaware of existing laws and had variable opinions on how to ensure accountability. Efforts to increase understanding of how legislative models influence practice are required for any law to achieve its desired effect.
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Affiliation(s)
- Matthew J Weiss
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada.
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada.
- Transplant Québec, Montréal, QC, Canada.
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada.
| | - Shane W English
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Frederick D'Aragon
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - François Lauzier
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, QC, Canada
- Department of Medicine, Université Laval, Québec, QC, Canada
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, QC, Canada
| | - Sonny Dhanani
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Division of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lauralyn McIntyre
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Livia P Carvalho
- Carrefour de l'innovation, Centre de Recherche du CHUM, Montréal, QC, Canada
| | - Michael Yu
- Carrefour de l'innovation, Centre de Recherche du CHUM, Montréal, QC, Canada
| | - Sam D Shemie
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
- Division of Critical Care, Montréal Children's Hospital, Montréal, QC, Canada
- McGill University Health Centre and Research Institute, Montréal, QC, Canada
| | - Gregory Knoll
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Dean A Fergusson
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Samantha J Anthony
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Adnan Haj-Moustafa
- Carrefour de l'innovation, Centre de Recherche du CHUM, Montréal, QC, Canada
| | - David Hartell
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
| | - Jim Mohr
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Michaël Chassé
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Carrefour de l'innovation, Centre de Recherche du CHUM, Montréal, QC, Canada
- Division of Critical Care, Department of Medicine, Centre Hospitalier de L'Université de Montréal, Montréal, QC, Canada
- Department of Medicine, Université de Montréal, Montréal, QC, Canada
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Affiliation(s)
- Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada. .,Department of Medicine (Critical Care), University of Ottawa, Ottawa, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
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English SW, Saigle V, McIntyre L, Chassé M, Fergusson D, Turgeon AF, Lauzier F, Griesdale D, Garland A, Zarychanski R, Algird A, Wiens EJ, Hu V, Dutta P, Boun V, van Walraven C. External validation demonstrated the Ottawa SAH prediction models can identify pSAH using health administrative data. J Clin Epidemiol 2020; 126:122-130. [PMID: 32619751 DOI: 10.1016/j.jclinepi.2020.06.024] [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: 01/30/2020] [Revised: 05/22/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of the study is to externally validate three primary subarachnoid hemorrhage (pSAH) identification models. STUDY DESIGN AND SETTING We evaluated three models that identify pSAH using recursive partitioning (A), logistic regression (B), and a prevalence-adjusted logistic regression(C), respectively. Blinded chart review and/or linkage to existing registries determined pSAH status. We included all patients aged ≥18 in four participating center registries or whose discharge abstracts contained ≥1 administrative codes of interest between January 1, 2012 and December 31, 2013. RESULTS A total of 3,262 of 193,190 admissions underwent chart review (n = 2,493) or registry linkage (n = 769). A total of 657 had pSAH confirmed (20·1% sample, 0·34% admissions). The sensitivity, specificity, and positive predictive value (PPV) were as follows: i) model A: 98·3% (97·0-99·2), 53·5% (51·5-55·4), and 34·8% (32·6-37·0); ii) model B (score ≥6): 98·0% (96·6-98·9), 47·4% (45·5-49·4), and 32·0% (30·0-34·1); and iii) model C (score ≥2): 95·7% (93·9-97·2), 85·5% (84·0-86·8), and 62·3 (59·3-65·3), respectively. Model C scores of 0, 1, 2, 3, or 4 had probabilities of 0·5% (0·2-1·5), 1·5% (1·0-2·2), 24·8% (21·0-29·0), 90·0% (86·8-92·0), and 97·8% (88·7-99·6), without significant difference between centers (P = 0·86). The PPV of the International Classification of Diseases code (I60) was 63·0% (95% confidence interval: 60·0-66·0). CONCLUSIONS All three models were highly sensitive for pSAH. Model C could be used to adjust for misclassification bias.
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Affiliation(s)
- Shane W English
- Department of Medicine (Critical Care), uOttawa, Civic Campus Room F202, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute (OHRI), Civic Campus Room F202, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada.
| | - Victoria Saigle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Lauralyn McIntyre
- Department of Medicine (Critical Care), uOttawa, Civic Campus Room F202, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Michaël Chassé
- Division of Critical Care, Department of Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 St Denis Street, Montreal, Quebec H2X 0A9, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Department of Medicine (Clinical Epidemiology), uOttawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Alexis F Turgeon
- Centre de recherche du CHU de Québec - Université Laval, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), 1050 Chemin Sainte-Foy, Local K0-03, Québec, Québec G1S 4L8, Canada; Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, 2325 Rue de l'Université, Québec, Québec G1V 0A6, Canada
| | - François Lauzier
- Centre de recherche du Centre Hospitalier de l'Université de Québec, Université Laval, Québec City, Québec, Canada; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, and Department of Medicine, Université Laval, 2325 Rue de l'Université, Québec, Québec G1V 0A6, Canada
| | - Donald Griesdale
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Allan Garland
- Sections of Critical Care and Respirology, Department of Internal Medicine, University of Manitoba, Health Sciences Centre, University of Manitoba, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Sections of Critical Care and Hematology/Medical Oncology, University of Manitoba, Health Sciences Centre, University of Manitoba, 820 Sherbrook Street, Winnipeg Manitoba R3A 1R9, Canada
| | - Almunder Algird
- Department of Neurosurgery, McMaster University, Hamilton Health Sciences, 1200 Main St W, Hamilton, Ontario L8N 3Z5, Canada
| | - Evan J Wiens
- Department of Internal Medicine, University of Manitoba, Health Sciences Centre, University of Manitoba, 820 Sherbrook Street, Winnipeg Manitoba R3A 1R9, Canada
| | - Vivien Hu
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Pallavi Dutta
- Faculty of Health Sciences, McMaster University, 1200 Main St W, Hamilton, Ontario L8N 3Z5, Canada
| | - Vincent Boun
- Centre de recherche du CHU de Québec - Université Laval, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), 1050 Chemin Sainte-Foy, Local K0-03, Québec, Québec G1S 4L8, Canada
| | - Carl van Walraven
- Department of Medicine (Clinical Epidemiology), uOttawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue Building, 1st Floor, Ottawa, Ontario K1Y 4E9, Canada; ICES-uOttawa, Administrative Services, 1053 Carling Avenue Building, 1st Floor, Ottawa, Ontario K1Y 4E9, Canada
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24
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Andersen CR, Presseau J, Saigle V, Etminan N, Vergouwen MDI, English SW. Core outcomes for subarachnoid haemorrhage. Lancet Neurol 2020; 18:1075-1076. [PMID: 31701889 DOI: 10.1016/s1474-4422(19)30412-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/16/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Christopher R Andersen
- Kadoorie Centre for Critical Care Research, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK; The George Institute for Global Health, Newtown, NSW, Australia.
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Victoria Saigle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Nima Etminan
- Department of Neurosurgery, Mannheim University Hospital, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Kobewka DM, Mulpuru S, Chassé M, Thavorn K, Lavallée LT, English SW, Neilipovitz B, Neilipovitz J, Forster AJ, McIsaac DI. Predicting the need for supportive services after discharged from hospital: a systematic review. BMC Health Serv Res 2020; 20:161. [PMID: 32131817 PMCID: PMC7057581 DOI: 10.1186/s12913-020-4972-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 02/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some patients admitted to acute care hospital require supportive services after discharge. The objective of our review was to identify models and variables that predict the need for supportive services after discharge from acute care hospital. METHODS We performed a systematic review searching the MEDLINE, CINAHL, EMBASE, and COCHRANE databases from inception to May 1st 2017. We selected studies that derived and validated a prediction model for the need for supportive services after hospital discharge for patients admitted non-electively to a medical ward. We extracted cohort characteristics, model characteristics and variables screened and included in final predictive models. Risk of bias was assessed using the Quality in Prognostic Studies tool. RESULTS Our search identified 3362 unique references. Full text review identified 6 models. Models had good discrimination in derivation (c-statistics > 0.75) and validation (c-statistics > 0.70) cohorts. There was high quality evidence that age, impaired physical function, disabilities in performing activities of daily living, absence of an informal care giver and frailty predict the need for supportive services after discharge. Stroke was the only unique diagnosis with at least moderate evidence of an independent effect on the outcome. No models were externally validated, and all were at moderate or higher risk of bias. CONCLUSIONS Deficits in physical function and activities of daily living, age, absence of an informal care giver and frailty have the strongest evidence as determinants of the need for support services after hospital discharge. TRIAL REGISTRATION This review was registered with PROSPERO #CRD42016037144.
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Affiliation(s)
- Daniel M Kobewka
- Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, ON K1Y 4E9, Canada. .,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Sunita Mulpuru
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michaël Chassé
- Department of Medicine (Critical Care), University of Montreal Hospital, Montreal, Quebec, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Shane W English
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin Neilipovitz
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jonathan Neilipovitz
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alan J Forster
- Department of Medicine, Division of General Internal Medicine, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, Ontario, ON K1Y 4E9, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Performance Measurement, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Departments of Anesthesiology & Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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26
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Weiss MJ, English SW, D'Aragon F, Lauzier F, Turgeon AF, Dhanani S, McIntyre L, Shemie SD, Knoll G, Fergusson DA, Anthony SJ, Haj-Moustafa A, Hartell D, Mohr J, Chassé M. Survey of Canadian intensivists on physician non-referral and family override of deceased organ donation. Can J Anaesth 2020; 67:313-323. [PMID: 31768789 DOI: 10.1007/s12630-019-01538-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/08/2019] [Accepted: 09/04/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Intensive care physicians play an important role in the identification and referral of potential organ donors in Canada. Nevertheless, little is known about intensivists' attitudes or behaviours in situations where families override previously expressed consent to donate; nor why physicians elect not to refer patients who are potential donors to provincial organ donation organizations (physician non-referral). METHODS We integrated questions regarding family override and physician non-referral into an online, self-administered survey of Canadian intensivists. We report results descriptively. RESULTS Fifty percent of targeted respondents (n = 550) participated. Fifty-five percent reported having witnessed family override situations and 44% reported having personally not referred patients who were potential donors. Fifty-six percent of respondents stated they would not pursue donation in the face of family override; 2% stated they would continue with the donation process. Fear of loss of trust in the donation system (81%) and obligation to respect the grief and desires of surrogate decision makers (71%) were frequently reported reasons to respect family override requests. Respondents who chose not to refer patients often did so based on organ dysfunction they assumed would preclude donation (59%), or a perception that the family was too distressed to consider donation (42%). No respondents reported that personally held beliefs against organ donation influenced their decision. CONCLUSION Physicians caring for patients who are potential organ donors commonly encounter both family override and physician non-referral situations. Knowledge translation of optimal practices in identification and referral could help ensure that physician practices align with legal requirements and practice recommendations.
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Affiliation(s)
- Matthew J Weiss
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada.
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada.
- Transplant Québec, Montréal, QC, Canada.
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada.
| | - Shane W English
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Frederick D'Aragon
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - François Lauzier
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, QC, Canada
- Department of Medicine, Université Laval, Québec, QC, Canada
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, QC, Canada
| | - Sonny Dhanani
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Division of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lauralyn McIntyre
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sam D Shemie
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
- Division of Critical Care, Montréal Children's Hospital, McGill University Health Centre and Research Institute, Montreal, QC, Canada
- McGill University, Montréal, QC, Canada
| | - Gregory Knoll
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Dean A Fergusson
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Samantha J Anthony
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Adnan Haj-Moustafa
- Carrefour de l'Innovation, Centre de Recherche du CHUM, Montréal, QC, Canada
| | - David Hartell
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
| | - Jim Mohr
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Michaël Chassé
- Canadian Donation and Transplant Research Program, Ottawa, ON, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
- Carrefour de l'Innovation, Centre de Recherche du CHUM, Montréal, QC, Canada
- Division of Critical Care, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Department of Medicine, University of Montréal, Montréal, QC, Canada
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Bellomo R, Wunderink RG, Szerlip H, English SW, Busse LW, Deane AM, Khanna AK, McCurdy MT, Ostermann M, Young PJ, Handisides DR, Chawla LS, Tidmarsh GF, Albertson TE. Angiotensin I and angiotensin II concentrations and their ratio in catecholamine-resistant vasodilatory shock. Crit Care 2020; 24:43. [PMID: 32028998 PMCID: PMC7006163 DOI: 10.1186/s13054-020-2733-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [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: 09/11/2019] [Accepted: 01/10/2020] [Indexed: 12/12/2022]
Abstract
Background In patients with vasodilatory shock, plasma concentrations of angiotensin I (ANG I) and II (ANG II) and their ratio may reflect differences in the response to severe vasodilation, provide novel insights into its biology, and predict clinical outcomes. The objective of these protocol prespecified and subsequent post hoc analyses was to assess the epidemiology and outcome associations of plasma ANG I and ANG II levels and their ratio in patients with catecholamine-resistant vasodilatory shock (CRVS) enrolled in the Angiotensin II for the Treatment of High-Output Shock (ATHOS-3) study. Methods We measured ANG I and ANG II levels at baseline, calculated their ratio, and compared these results to values from healthy volunteers (controls). We dichotomized patients according to the median ANG I/II ratio (1.63) and compared demographics, clinical characteristics, and clinical outcomes. We constructed a Cox proportional hazards model to test the independent association of ANG I, ANG II, and their ratio with clinical outcomes. Results Median baseline ANG I level (253 pg/mL [interquartile range (IQR) 72.30–676.00 pg/mL] vs 42 pg/mL [IQR 30.46–87.34 pg/mL] in controls; P < 0.0001) and median ANG I/II ratio (1.63 [IQR 0.98–5.25] vs 0.4 [IQR 0.28–0.64] in controls; P < 0.0001) were elevated, whereas median ANG II levels were similar (84 pg/mL [IQR 23.85–299.50 pg/mL] vs 97 pg/mL [IQR 35.27–181.01 pg/mL] in controls; P = 0.9895). At baseline, patients with a ratio above the median (≥1.63) had higher ANG I levels (P < 0.0001), lower ANG II levels (P < 0.0001), higher albumin concentrations (P = 0.007), and greater incidence of recent (within 1 week) exposure to angiotensin-converting enzyme inhibitors (P < 0.00001), and they received a higher norepinephrine-equivalent dose (P = 0.003). In the placebo group, a baseline ANG I/II ratio <1.63 was associated with improved survival (hazard ratio 0.56; 95% confidence interval 0.36–0.88; P = 0.01) on unadjusted analyses. Conclusions Patients with CRVS have elevated ANG I levels and ANG I/II ratios compared with healthy controls. In such patients, a high ANG I/II ratio is associated with greater norepinephrine requirements and is an independent predictor of mortality, thus providing a biological rationale for interventions aimed at its correction. Trial registration ClinicalTrials.gov identifier NCT02338843. Registered 14 January 2015.
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Affiliation(s)
- Rinaldo Bellomo
- Centre for Integrated Critical Care, Department of Medicine & Radiology, The University of Melbourne, Melbourne, Australia. .,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Richard G Wunderink
- Department of Medicine, Pulmonary and Critical Care Division, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Harold Szerlip
- Department of Medicine, Division of Nephrology, Baylor University Medical Center, Dallas, TX, USA
| | - Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Laurence W Busse
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, USA
| | - Adam M Deane
- Department of Medicine and Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne Medical School, Parkville, Australia
| | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.,Outcomes Research Consortium, Cleveland, OH, USA
| | - Michael T McCurdy
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK
| | - Paul J Young
- Medical Research Institute of New Zealand, Wellington, New Zealand.,Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
| | | | | | | | - Timothy E Albertson
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, CA, USA.,Department of Veterans Affairs, Northern California Health System, Mather, CA, USA
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Thompson M, Mei SH, Wolfe D, Champagne J, Fergusson D, Stewart DJ, Sullivan KJ, Doxtator E, Lalu M, English SW, Granton J, Hutton B, Marshall J, Maybee A, Walley KR, Santos CD, Winston B, McIntyre L. Cell therapy with intravascular administration of mesenchymal stromal cells continues to appear safe: An updated systematic review and meta-analysis. EClinicalMedicine 2020; 19:100249. [PMID: 31989101 PMCID: PMC6970160 DOI: 10.1016/j.eclinm.2019.100249] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/04/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Characterization of the mesenchymal stromal cell (MSC) safety profile is important as this novel therapy continues to be evaluated in clinical trials for various inflammatory conditions. Due to an increase in published randomized controlled trials (RCTs) from 2012-2019, we performed an updated systematic review to further characterize the MSC safety profile. METHODS MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science (to May 2018) were searched. RCTs that compared intravascular delivery of MSCs to controls in adult populations were included. Pre-specified adverse events were grouped according to: (1) immediate, (2) infection, (3) thrombotic/embolic, and (4) longer-term events (mortality, malignancy). Adverse events were pooled and meta-analyzed by fitting inverse-variance binary random effects models. Primary and secondary clinical efficacy endpoints were summarized descriptively. FINDINGS 7473 citations were reviewed and 55 studies met inclusion criteria (n = 2696 patients). MSCs as compared to controls were associated with an increased risk of fever (Relative Risk (RR) = 2·48, 95% Confidence Interval (CI) = 1·27-4·86; I2 = 0%), but not non-fever acute infusional toxicity, infection, thrombotic/embolic events, death, or malignancy (RR = 1·16, 0·99, 1·14, 0·78, 0·93; 95% CI = 0·70-1·91, 0·81-1·21, 0·67-1·95, 0·65-0·94, 0·60-1·45; I2 = 0%, 0%, 0%, 0%, 0%). No included trials were ended prematurely due to safety concerns. INTERPRETATIONS MSC therapy continues to exhibit a favourable safety profile. Future trials should continue to strengthen study rigor, reporting of MSC characterization, and adverse events. FUNDING Stem Cell Network, Ontario Institute for Regenerative Medicine and Ontario Research Fund.
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Affiliation(s)
- Mary Thompson
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shirley H.J. Mei
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dianna Wolfe
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Josée Champagne
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Duncan J. Stewart
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Katrina J. Sullivan
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Emily Doxtator
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Manoj Lalu
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Shane W. English
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - John Granton
- Department of Medicine (Critical Care), University of Toronto, Toronto, Ontario, Canada
| | - Brian Hutton
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - John Marshall
- Department of Surgery (Critical Care), University of Toronto, Toronto, Ontario, Canada
| | - Alies Maybee
- Patient Advisors Network, Toronto, Ontario, Canada
| | - Keith R. Walley
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claudia Dos Santos
- Department of Surgery (Critical Care), University of Toronto, Toronto, Ontario, Canada
| | - Brent Winston
- Department of Critical Care, Medicine, and Biochemistry and Microbiology, University of Calgary, Calgary, Alberta, Canada
| | - Lauralyn McIntyre
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Gris T, Laplante P, Thebault P, Cayrol R, Najjar A, Joannette-Pilon B, Brillant-Marquis F, Magro E, English SW, Lapointe R, Bojanowski M, Francoeur CL, Cailhier JF. Innate immunity activation in the early brain injury period following subarachnoid hemorrhage. J Neuroinflammation 2019; 16:253. [PMID: 31801576 PMCID: PMC6894125 DOI: 10.1186/s12974-019-1629-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/31/2019] [Indexed: 01/01/2023] Open
Abstract
Background Aneurysmal subarachnoid hemorrhage (SAH) is a catastrophic disease with devastating consequences, including a high mortality rate and severe disabilities among survivors. Inflammation is induced following SAH, but the exact role and phenotype of innate immune cells remain poorly characterized. We investigated the inflammatory components of the early brain injury in an animal model and in SAH patients. Method SAH was induced through injection of blood in the subarachnoid space of C57Bl/6 J wild-type mice. Prospective blood collections were obtained at 12 h, days 1, 2, and 7 to evaluate the systemic inflammatory consequences of SAH by flow cytometry and enzyme-linked immunosorbent-assay (ELISA). Brains were collected, enzymatically digested, or fixed to characterize infiltrating inflammatory cells and neuronal death using flow cytometry and immunofluorescence. Phenotypic evaluation was performed at day 7 using the holding time and footprint tests. We then compared the identified inflammatory proteins to the profiles obtained from the plasma of 13 human SAH patients. Results Following SAH, systemic IL-6 levels increased rapidly, whereas IL-10 levels were reduced. Neutrophils were increased both in the brain and in the blood reflecting local and peripheral inflammation following SAH. More intracerebral pro-inflammatory monocytes were found at early time points. Astrocyte and microglia activation were also increased, and mice had severe motor deficits, which were associated with an increase in the percentage of caspase-3-positive apoptotic neurons. Similarly, we found that IL-6 levels in patients were rapidly increased following SAH. ICAM-1, bFGF, IL-7, IL-12p40, and MCP-4 variations over time were different between SAH patients with good versus bad outcomes. Moreover, high levels of Flt-1 and VEGF at admission were associated with worse outcomes. Conclusion SAH induces an early intracerebral infiltration and peripheral activation of innate immune cells. Furthermore, microglia and astrocytic activation are present at later time points. Our human and mouse data illustrate that SAH is a systemic inflammatory disease and that immune cells represent potential therapeutic targets to help this population of patients in need of new treatments.
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Affiliation(s)
- Typhaine Gris
- Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,CRCHUM and Montreal Cancer Institute, 900 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Patrick Laplante
- Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,CRCHUM and Montreal Cancer Institute, 900 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Paméla Thebault
- Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,CRCHUM and Montreal Cancer Institute, 900 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Romain Cayrol
- Department of Pathology and Cellular Biology, Faculty of Medicine, Université de Montréal, Pavillon Roger-Gaudry, 5e étage, 2900, Boulevard Édouard-Montpetit, Montreal, Quebec, Canada
| | - Ahmed Najjar
- Department of Surgery, Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), 850 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Benjamin Joannette-Pilon
- Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,CRCHUM and Montreal Cancer Institute, 900 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Frédéric Brillant-Marquis
- Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,CRCHUM and Montreal Cancer Institute, 900 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Elsa Magro
- Neurosurgery Service of CHU Cavale Blanche, INSERM, Boulevard Tanguy Prigent, Finistère, 29200, Brest, Bretagne, France
| | - Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.,Departments of Medicine (Critical Care) and School of Epidemiology and Public Health, Division of Critical Care, The Ottawa Hospital, University of Ottawa, Civic Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Réjean Lapointe
- Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,CRCHUM and Montreal Cancer Institute, 900 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Michel Bojanowski
- Department of Surgery, Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), 850 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Charles L Francoeur
- Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine) and Department of Anesthesiology and Critical Care, CHU de Québec-Université Laval, (Hôpital de l'Enfant-Jésus), 1401, 18e rue, Room Z-204, Québec, G1J 1Z4, Canada
| | - Jean-François Cailhier
- Research Centre of Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada. .,CRCHUM and Montreal Cancer Institute, 900 rue St-Denis, Montreal, Quebec, H2X 0A9, Canada. .,Nephrology Division, CHUM and Department of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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Fernando SM, Mok G, Rochwerg B, English SW, Thavorn K, McCredie VA, Dowlatshahi D, Perry JJ, Wijdicks EFM, Reardon PM, Tanuseputro P, Kyeremanteng K. Preadmission Antiplatelet Use and Associated Outcomes and Costs Among ICU Patients With Intracranial Hemorrhage. J Intensive Care Med 2019; 36:70-79. [PMID: 31741418 DOI: 10.1177/0885066619885347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/17/2022]
Abstract
INTRODUCTION Patients with intracranial hemorrhage (including intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic hemorrhage) are commonly admitted to the intensive care unit (ICU). Although indications for oral antiplatelet agents are increasing, the impact of preadmission use on outcomes in patients with intracranial hemorrhage admitted to the ICU is unknown. We sought to evaluate the association between preadmission oral antiplatelet use, in-hospital mortality, resource utilization, and costs among ICU patients with intracranial hemorrhage. METHODS We retrospectively analyzed a prospectively collected registry (2011-2016) and included consecutive adult patients from 2 hospitals admitted to ICU with intracranial hemorrhage. Patients were categorized on the basis of preadmission oral antiplatelet use. We excluded patients with preadmission anticoagulant use. The primary outcome was in-hospital mortality and was analyzed using a multivariable logistic regression model. Contributors to total hospital cost were analyzed using a generalized linear model with log link and gamma distribution. RESULTS Of 720 included patients with intracranial hemorrhage, 107 (14.9%) had been using an oral antiplatelet agent at the time of ICU admission. Oral antiplatelet use was not associated with in-hospital mortality (adjusted odds ratio: 1.31 [95% confidence interval [CI]: 0.93-2.22]). Evaluation of total costs also revealed no association with oral antiplatelet use (adjusted ratio of means [aROM]: 0.92 [95% CI: 0.82-1.02, P = .10]). Total cost among patients with intracranial hemorrhage was driven by illness severity (aROM: 1.96 [95% CI: 1.94-1.98], P < .001), increasing ICU length of stay (aROM: 1.05 [95% CI: 1.05-1.06], P < .001), and use of invasive mechanical ventilation (aROM: 1.76 [95% CI: 1.68-1.86], P < .001). CONCLUSIONS Among ICU patients admitted with intracranial hemorrhage, preadmission oral antiplatelet use was not associated with increased in-hospital mortality or hospital costs. These findings have important prognostic implications for clinicians who care for patients with intracranial hemorrhage.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada.,Department of Emergency Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Garrick Mok
- Department of Emergency Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Bram Rochwerg
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shane W English
- Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, 6363University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- School of Epidemiology and Public Health, 6363University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Victoria A McCredie
- Interdepartmental Division of Critical Care Medicine, 7938University of Toronto, Toronto, Ontario, Canada.,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Dar Dowlatshahi
- School of Epidemiology and Public Health, 6363University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Neurology, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, 6363University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Eelco F M Wijdicks
- Division of Neurocritical Care and Hospital Neurology, Department of Neurology, 6915Mayo Clinic, Rochester, MN, USA
| | - Peter M Reardon
- Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada.,Department of Emergency Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- School of Epidemiology and Public Health, 6363University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Palliative Care, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
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Tsampalieros A, Fergusson D, Dixon S, English SW, Manuel D, Van Walraven C, Taljaard M, Knoll GA. The Effect of Transplant Volume and Patient Case Mix on Center Variation in Kidney Transplantation Outcomes. Can J Kidney Health Dis 2019; 6:2054358119875462. [PMID: 31565233 PMCID: PMC6755637 DOI: 10.1177/2054358119875462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/26/2019] [Indexed: 01/06/2023] Open
Abstract
Background Kidney transplantation is the optimal treatment for patients with end-stage renal disease; however, long-term outcomes remain suboptimal. Objective The objectives of our study were to examine the variation in survival rates and determine whether center volume and case mix are associated with transplant outcomes and explain the variation across kidney transplant centers in Ontario, Canada. Design This was a population-based cohort study using health care administrative databases. Setting A total of 5 transplant centers across Ontario, Canada. Patients We included adults (≥18 years) undergoing primary, solitary kidney transplantation between January 1, 2000 to December 31, 2013. Measurements The co-primary outcomes were death-censored graft loss and total mortality. Methods Multivariable Cox proportional hazards regression was used to assess potential associations and describe variation, using hazard ratios (HRs) with 95% confidence intervals (CIs) for each center relative to the average across all centers. Results The study cohort included 5037 patients followed for a median of 5.3 years, interquartile range (2.7-8.6). In multivariable models, recipient age, body mass index, Charlson Index, time on dialysis, donor type, and age were found to be significantly associated with death-censored graft loss, and recipient age and sex, Charlson Index, time on dialysis, donor age, and time era of transplant were associated with total mortality. There was statistically significant variation across centers observed for death-censored graft loss (P = .04) with HRs ranging from 0.72 to 1.22. However, neither adjusting for case mix nor center volume meaningfully changed the HRs reflecting each center-specific effect. There was a tendency toward reduced risk of graft loss (HR, per additional 25 patients, 0.90 [95% CI, 0.78-1.04]) in centers with higher volumes. For total mortality, there was statistically significant variation across centers with HRs ranging from 0.82 to 1.13 (P = .04); however, neither adjusting for case mix or center volume meaningfully changed the HRs. Center volume was not significantly associated with total mortality (HR, per additional 25 patients, 1.04 [95% CI, 0.90-1.20]). Limitations This study was limited by the small number of centers included. Conclusions Outcomes differ across the 5 transplant centers in Ontario. We did not find any strong support for our hypotheses that case mix or center volume is responsible for these differences.
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Affiliation(s)
- Anne Tsampalieros
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada.,Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada
| | - Stephanie Dixon
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,Institute for Clinical Evaluative Sciences, London, ON, Canada
| | - Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada.,Department of Medicine (Critical Care), University of Ottawa, ON, Canada
| | - Douglas Manuel
- Department of Family Medicine, University of Ottawa, ON, Canada
| | - Carl Van Walraven
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada.,Department of Medicine, University of Ottawa, ON, Canada.,Institute for Evaluative Sciences, Toronto, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, ON, Canada
| | - Greg A Knoll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada.,Division of Nephrology, Kidney Research Center, Department of Medicine, University of Ottawa, ON, Canada
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Reardon PM, Hickey M, English SW, Hibbert B, Simard T, Hendin A, Yadav K. Optimizing the Early Resuscitation After Out-of-Hospital Cardiac Arrest. J Intensive Care Med 2019; 35:1556-1563. [PMID: 31512559 DOI: 10.1177/0885066619873318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/17/2022]
Abstract
Resuscitation after out-of-hospital cardiac arrest can be one of the most challenging scenarios in acute-care medicine. The devastating effects of postcardiac arrest syndrome carry a substantial morbidity and mortality that persist long after return of spontaneous circulation. Management of these patients requires the clinician to simultaneously address multiple emergent priorities including the resuscitation of the patient and the efficient diagnosis and management of the underlying etiology. This review provides a concise evidence-based overview of the core concepts involved in the early postcardiac arrest resuscitation. It will highlight the components of an effective management strategy including addressing hemodynamic, oxygenation, and ventilation goals as well as carefully considering cardiac catheterization and targeted temperature management. An organized approach is paramount to providing effective care to patients in this vulnerable time period.
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Affiliation(s)
- Peter M Reardon
- Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada.,Department of Emergency Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Hickey
- Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada.,Department of Emergency Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Shane W English
- Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, 6363University of Ottawa, Ottawa Ontario Canada
| | - Benjamin Hibbert
- Division of Cardiology, 27339University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor Simard
- Division of Cardiology, 27339University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Ariel Hendin
- Division of Critical Care, Department of Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada.,Department of Emergency Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
| | - Krishan Yadav
- Department of Emergency Medicine, 6363University of Ottawa, Ottawa, Ontario, Canada
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Gershkovich B, English SW, Doyle MA, Menon K, McIntyre L. Choice of crystalloid fluid in the treatment of hyperglycemic emergencies: a systematic review protocol. Syst Rev 2019; 8:228. [PMID: 31481108 PMCID: PMC6720374 DOI: 10.1186/s13643-019-1130-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 08/13/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are life-threatening complications of diabetes mellitus which require prompt treatment with large volume crystalloid fluid administration. A variety of crystalloid fluids is currently available for use and differs in their composition and ion concentrations. While there are potential pros and cons for different crystalloid fluids, it remains unknown if any particular fluid confers a clinical outcome benefit over others in the treatment of hyperglycemic emergencies. METHODS A systematic search of MEDLINE, Embase, and the Cochrane Library of Systematic Reviews will be conducted to identify eligible studies, which will include observational and interventional studies involving adult and pediatric patients admitted to the hospital with either DKA or HHS. The interventions will include intravenous treatment with 0.9% saline versus other buffered (Ringer's lactate, Hartmann's, etc.), and non-buffered (0.45% saline) crystalloid fluids. The primary outcome is mortality at the latest follow-up time point. Secondary outcomes will include mortality at specific time points, length of hospital stay, development of acute kidney injury, requirement for renal replacement therapy, altered level of consciousness, and the time to normalization of several serum biochemical parameters. Where appropriate, meta-analyses will be performed for the outcomes and conducted separately for adult and pediatric patient populations. DISCUSSION DKA and HHS are dangerous complications of diabetes mellitus and account for significant morbidity and mortality. Given the importance of crystalloid fluid administration in the management of these conditions, a systematic synthesis of the existing evidence base will identify potential evidence gaps and may help guide future clinical practice.
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Affiliation(s)
- Benjamin Gershkovich
- Department of Medicine, University of Ottawa, 401 Smyth Road, Ottawa, Ontario K1H 5B2 Canada
| | - Shane W. English
- Department of Medicine, University of Ottawa, 401 Smyth Road, Ottawa, Ontario K1H 5B2 Canada
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, 401 Smyth Road, Ottawa, Ontario K1H 5B2 Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada
| | - Mary-Anne Doyle
- Department of Medicine, University of Ottawa, 401 Smyth Road, Ottawa, Ontario K1H 5B2 Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Kusum Menon
- CHEO Research Institute, Ottawa, Ontario Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario Canada
| | - Lauralyn McIntyre
- Department of Medicine, University of Ottawa, 401 Smyth Road, Ottawa, Ontario K1H 5B2 Canada
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, 401 Smyth Road, Ottawa, Ontario K1H 5B2 Canada
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Fernando SM, Tran A, Cheng W, Rochwerg B, Taljaard M, Kyeremanteng K, English SW, Sekhon MS, Griesdale DEG, Dowlatshahi D, McCredie VA, Wijdicks EFM, Almenawer SA, Inaba K, Rajajee V, Perry JJ. Diagnosis of elevated intracranial pressure in critically ill adults: systematic review and meta-analysis. BMJ 2019; 366:l4225. [PMID: 31340932 PMCID: PMC6651068 DOI: 10.1136/bmj.l4225] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To summarise and compare the accuracy of physical examination, computed tomography (CT), sonography of the optic nerve sheath diameter (ONSD), and transcranial Doppler pulsatility index (TCD-PI) for the diagnosis of elevated intracranial pressure (ICP) in critically ill patients. DESIGN Systematic review and meta-analysis. DATA SOURCES Six databases, including Medline, EMBASE, and PubMed, from inception to 1 September 2018. STUDY SELECTION CRITERIA English language studies investigating accuracy of physical examination, imaging, or non-invasive tests among critically ill patients. The reference standard was ICP of 20 mm Hg or more using invasive ICP monitoring, or intraoperative diagnosis of raised ICP. DATA EXTRACTION Two reviewers independently extracted data and assessed study quality using the quality assessment of diagnostic accuracy studies tool. Summary estimates were generated using a hierarchical summary receiver operating characteristic (ROC) model. RESULTS 40 studies (n=5123) were included. Of physical examination signs, pooled sensitivity and specificity for increased ICP were 28.2% (95% confidence interval 16.0% to 44.8%) and 85.9% (74.9% to 92.5%) for pupillary dilation, respectively; 54.3% (36.6% to 71.0%) and 63.6% (46.5% to 77.8%) for posturing; and 75.8% (62.4% to 85.5%) and 39.9% (26.9% to 54.5%) for Glasgow coma scale of 8 or less. Among CT findings, sensitivity and specificity were 85.9% (58.0% to 96.4%) and 61.0% (29.1% to 85.6%) for compression of basal cisterns, respectively; 80.9% (64.3% to 90.9%) and 42.7% (24.0% to 63.7%) for any midline shift; and 20.7% (13.0% to 31.3%) and 89.2% (77.5% to 95.2%) for midline shift of at least 10 mm. The pooled area under the ROC (AUROC) curve for ONSD sonography was 0.94 (0.91 to 0.96). Patient level data from studies using TCD-PI showed poor performance for detecting raised ICP (AUROC for individual studies ranging from 0.55 to 0.72). CONCLUSIONS Absence of any one physical examination feature is not sufficient to rule out elevated ICP. Substantial midline shift could suggest elevated ICP, but the absence of shift cannot rule it out. ONSD sonography might have use, but further studies are needed. Suspicion of elevated ICP could necessitate treatment and transfer, regardless of individual non-invasive tests. REGISTRATION PROSPERO CRD42018105642.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alexandre Tran
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Wei Cheng
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Shane W English
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mypinder S Sekhon
- Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Donald E G Griesdale
- Department of Medicine, Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Dar Dowlatshahi
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Divison of Neurology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Victoria A McCredie
- Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Eelco F M Wijdicks
- Division of Neurocritical Care and Hospital Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Saleh A Almenawer
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Kenji Inaba
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Venkatakrishna Rajajee
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Wood MD, Khan J, Lee KFH, Maslove DM, Muscedere J, Hunt M, Scott SH, Day A, Jacobson JA, Ball I, Slessarev M, O'Regan N, English SW, McCredie V, Chasse M, Griesdale D, Boyd JG. Assessing the relationship between near-infrared spectroscopy-derived regional cerebral oxygenation and neurological dysfunction in critically ill adults: a prospective observational multicentre protocol, on behalf of the Canadian Critical Care Trials Group. BMJ Open 2019; 9:e029189. [PMID: 31243036 PMCID: PMC6597627 DOI: 10.1136/bmjopen-2019-029189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Survivors of critical illness frequently exhibit acute and chronic neurological complications. The underlying aetiology of this dysfunction remains unknown but may be associated with cerebral ischaemia. This study will use near-infrared spectroscopy to non-invasively quantify regional cerebral oxygenation (rSO2) to assess the association between poor rSO2 during the first 72 hours of critical illness with delirium severity, as well as long-term sensorimotor and cognitive impairment among intensive care unit (ICU) survivors. Further, the physiological determinants of rSO2 will be examined. METHODS AND ANALYSIS This multicentre prospective observational study will consider adult patients (≥18 years old) eligible for enrolment if within 24 hours of ICU admission, they require mechanical ventilation and/or vasopressor support. For 72 hours, rSO2 will be continuously recorded, while vital signs (eg, heart rate) and peripheral oxygenation saturation will be concurrently captured with data monitoring software. Arterial and central venous gases will be sampled every 12 hours for the 72 hours recording period and will include: pH, PaO2, PaCO2, and haemoglobin concentration. Participants will be screened daily for delirium with the confusion assessment method (CAM)-ICU, whereas the brief-CAM will be used on the ward. At 3 and 12 months post-ICU discharge, neurological function will be assessed with the Repeatable Battery for the Assessment of Neuropsychological Status and KINARM sensorimotor and cognitive robot-based behavioural tasks. ETHICS AND DISSEMINATION The study protocol has been approved in Ontario by a central research ethics board (Clinical Trials Ontario); non-Ontario sites will obtain local ethics approval. The study will be conducted under the guidance of the Canadian Critical Care Trials Group (CCCTG) and the results of this study will be presented at national meetings of the CCCTG for internal peer review. Results will also be presented at national/international scientific conferences. On completion, the study findings will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03141619.
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Affiliation(s)
- Michael D Wood
- Centre For Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Jasmine Khan
- Centre For Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Kevin F H Lee
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - David M Maslove
- Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - John Muscedere
- Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| | - Miranda Hunt
- Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Stephen H Scott
- Centre For Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Andrew Day
- Department of Community Health and Epidemiology and CERU, Queen's University, Kingston, Ontario, Canada
| | | | - Ian Ball
- Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Marat Slessarev
- Medicine, Division of Geriatric Medicine, Western University, London, Ontario, Canada
| | - Niamh O'Regan
- Medicine, Division of Geriatric Medicine, Western University, London, Ontario, Canada
| | - Shane W English
- Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Victoria McCredie
- Medicine; Critical Care, University of Toronto; Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Michaël Chasse
- Medicine (Critical Care), Centre Hospitalier de L'Universite de Montreal, Montréal, Quebec, Canada
| | - Donald Griesdale
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Gordon Boyd
- Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada
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Saigle V, Asad S, Presseau J, Chassé M, McIntyre L, English SW. Do patient-reported outcome measures for SAH include patient, family, and caregiver priorities? A scoping review. Neurology 2019; 92:281-295. [PMID: 30626652 DOI: 10.1212/wnl.0000000000006883] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/03/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To systematically describe literature that identified patient/family/caregiver priorities for subarachnoid hemorrhage (SAH)-specific patient-reported outcome measures (PROMs), developed novel SAH PROMs by incorporating patient/family/caregiver perspectives, or involved patient/family/caregiver perspectives in evaluating existing SAH PROMs. METHODS We conducted a scoping review using Embase and Ovid MEDLINE from inception to February 6, 2018. Study eligibility and data extraction was performed independently and in duplicate. For each eligible citation, we abstracted information about study population, design, type of patient involvement, and outcome measures. We planned a descriptive summary of all included studies. RESULTS Our search yielded 4,961 citations, of which 15 met our eligibility criteria. Four of these included duplicate data, so our final sample consisted of 12 articles. There were 879 patients with SAH and 241 carers from the 11/12 articles that reported these data. One additional study involved 70 individuals but did not specify the number of carers or patients. We did not find any studies where SAH survivors or their families were directly involved in the full continuum of PROM outcome conceptualization from development to evaluation. We found 41 measures identified by patients with SAH. We identified only 2 PROMs developed with patients and only one that was a post hoc evaluation by patients. These 3 PROMs are subarachnoid hemorrhage outcome tool, Wessex Patient Carer Questionnaire, and Functional Status Examination, respectively. CONCLUSION We identified 3 PROMs that have involved patients in some way, but the extent to which they reflect patient priorities remains unclear. More work is needed to ensure SAH research is not overlooking outcomes that are important to patients.
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Affiliation(s)
- Victoria Saigle
- From the Clinical Epidemiology Program (Centre for Transfusion Research) (V.S., S.A., L.M., S.W.E.), Ottawa Hospital Research Institute (J.P.); School of Epidemiology and Public Health (J.P., S.W.E.) and Department of Medicine (Critical Care) (S.W.E., L.M.), University of Ottawa; and Department of Medicine (Critical Care) (M.C.), University of Montreal Hospital, Canada
| | - Sarah Asad
- From the Clinical Epidemiology Program (Centre for Transfusion Research) (V.S., S.A., L.M., S.W.E.), Ottawa Hospital Research Institute (J.P.); School of Epidemiology and Public Health (J.P., S.W.E.) and Department of Medicine (Critical Care) (S.W.E., L.M.), University of Ottawa; and Department of Medicine (Critical Care) (M.C.), University of Montreal Hospital, Canada
| | - Justin Presseau
- From the Clinical Epidemiology Program (Centre for Transfusion Research) (V.S., S.A., L.M., S.W.E.), Ottawa Hospital Research Institute (J.P.); School of Epidemiology and Public Health (J.P., S.W.E.) and Department of Medicine (Critical Care) (S.W.E., L.M.), University of Ottawa; and Department of Medicine (Critical Care) (M.C.), University of Montreal Hospital, Canada
| | - Michaël Chassé
- From the Clinical Epidemiology Program (Centre for Transfusion Research) (V.S., S.A., L.M., S.W.E.), Ottawa Hospital Research Institute (J.P.); School of Epidemiology and Public Health (J.P., S.W.E.) and Department of Medicine (Critical Care) (S.W.E., L.M.), University of Ottawa; and Department of Medicine (Critical Care) (M.C.), University of Montreal Hospital, Canada
| | - Lauralyn McIntyre
- From the Clinical Epidemiology Program (Centre for Transfusion Research) (V.S., S.A., L.M., S.W.E.), Ottawa Hospital Research Institute (J.P.); School of Epidemiology and Public Health (J.P., S.W.E.) and Department of Medicine (Critical Care) (S.W.E., L.M.), University of Ottawa; and Department of Medicine (Critical Care) (M.C.), University of Montreal Hospital, Canada
| | - Shane W English
- From the Clinical Epidemiology Program (Centre for Transfusion Research) (V.S., S.A., L.M., S.W.E.), Ottawa Hospital Research Institute (J.P.); School of Epidemiology and Public Health (J.P., S.W.E.) and Department of Medicine (Critical Care) (S.W.E., L.M.), University of Ottawa; and Department of Medicine (Critical Care) (M.C.), University of Montreal Hospital, Canada.
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van Gaal SC, English SW, Bourque PRJ, Zwicker JC. Pulmonary Function Testing in Elderly Patients Treated for a Myasthenia Gravis Exacerbation. Neurohospitalist 2018; 9:79-84. [PMID: 30915185 DOI: 10.1177/1941874418811249] [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: 11/15/2022] Open
Abstract
Background and Purpose Pulmonary function testing is a standard part of care for patients admitted to hospital with a myasthenia gravis exacerbation. It may inform clinicians' decisions to intubate patients. It is known that pulmonary function declines with age in healthy adults. We studied the effect of age on pulmonary function and serious respiratory events, including intubation, in patients admitted to hospital for a myasthenia gravis exacerbation. Methods Single center, retrospective cohort of consecutive patients treated for a myasthenia gravis exacerbation. Demographics, pulmonary function tests (PFTs), and respiratory events requiring intubation or emergency respiratory therapy were recorded for each encounter. Relationship of PFTs to age was analyzed using age as a continuous and as a dichotomous (cut-value 70 years) variable. Results Forty-nine encounters from 39 patients were included. Slow vital capacity (SVC) was negatively correlated with age (R 0.46, P value .002). Maximum inspiratory pressure (MIP) and SVC were significantly reduced in elderly versus nonelderly patients (MIP-20.0 vs -30.0 cm H2O, P value .004; SVC 16.5 vs 23.4 mL/kg, P value .013). The incidence of respiratory events did not significantly differ between elderly and nonelderly patients (χ2 P value .08). Conclusions In patients treated for a myasthenia gravis exacerbation, pulmonary function values are significantly reduced in elderly patients compared to nonelderly patients. Despite very low SVC and MIP values most elderly patients do not require intubation however they do require intensive monitoring for serious respiratory complications.
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Affiliation(s)
- Stephen C van Gaal
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shane W English
- Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pierre R J Bourque
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
| | - Jocelyn C Zwicker
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
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English SW, McIntyre L, Saigle V, Chassé M, Fergusson DA, Turgeon AF, Lauzier F, Griesdale D, Garland A, Zarychanski R, Algird A, van Walraven C. The Ottawa SAH search algorithms: protocol for a multi- centre validation study of primary subarachnoid hemorrhage prediction models using health administrative data (the SAHepi prediction study protocol). BMC Med Res Methodol 2018; 18:94. [PMID: 30219029 PMCID: PMC6139177 DOI: 10.1186/s12874-018-0553-3] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 08/31/2018] [Indexed: 01/07/2023] Open
Abstract
Background Conducting prospective epidemiological studies of hospitalized patients with rare diseases like primary subarachnoid hemorrhage (pSAH) are difficult due to time and budgetary constraints. Routinely collected administrative data could remove these barriers. We derived and validated 3 algorithms to identify hospitalized patients with a high probability of pSAH using administrative data. We aim to externally validate their performance in four hospitals across Canada. Methods Eligible patients include those ≥18 years of age admitted to these centres from January 1, 2012 to December 31, 2013. We will include patients whose discharge abstracts contain predictive variables identified in the models (ICD-10-CA diagnostic codes I60** (subarachnoid hemorrhage), I61** (intracranial hemorrhage), 162** (other nontrauma intracranial hemorrhage), I67** (other cerebrovascular disease), S06** (intracranial injury), G97 (other postprocedural nervous system disorder) and CCI procedural codes 1JW51 (occlusion of intracranial vessels), 1JE51 (carotid artery inclusion), 3JW10 (intracranial vessel imaging), 3FY20 (CT scan (soft tissue of neck)), and 3OT20 (CT scan (abdominal cavity)). The algorithms will be applied to each patient and the diagnosis confirmed via chart review. We will assess each model’s sensitivity, specificity, negative and positive predictive value across the sites. Discussion Validating the Ottawa SAH Prediction Algorithms will provide a way to accurately identify large SAH cohorts, thereby furthering research and altering care.
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Affiliation(s)
- S W English
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, ON, K1Y 4E9, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - L McIntyre
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, ON, K1Y 4E9, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - V Saigle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Chassé
- Department of Medicine, Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - D A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - A F Turgeon
- Centre de recherche du CHU de Québec, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Québec City, QC, Canada.,Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, QC, Canada
| | - F Lauzier
- Centre de recherche du CHU de Québec, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Québec City, QC, Canada.,Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, QC, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Québec, Université Laval, Québec City, QC, Canada
| | - D Griesdale
- Deparment of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
| | - A Garland
- Department of Internal Medicine, Sections of Critical Care and Respirology, University of Manitoba, Winnipeg, MB, Canada
| | - R Zarychanski
- Department of Internal Medicine, Sections of Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - A Algird
- Department of Neurosurgy, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
| | - C van Walraven
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
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McIntyre L, Taljaard M, McArdle T, Fox-Robichaud A, English SW, Martin C, Marshall J, Menon K, Muscedere J, Cook DJ, Weijer C, Saginur R, Maybee A, Iyengar A, Forster A, Graham ID, Hawken S, McCartney C, Seely AJE, Stiell IG, Thavorn K, Fergusson DA. FLUID trial: a protocol for a hospital-wide open-label cluster crossover pragmatic comparative effectiveness randomised pilot trial. BMJ Open 2018; 8:e022780. [PMID: 30139908 PMCID: PMC6112401 DOI: 10.1136/bmjopen-2018-022780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION 0.9% saline and Ringer's lactate are the two most common resuscitation crystalloid fluids. 0.9% saline may lead to hyperchloraemic metabolic acidosis and may be associated with impaired kidney function and death. Few large multicentre randomised trials have been conducted to evaluate the effect of these two fluids on clinically important outcomes. METHODS FLUID is a pragmatic pilot cluster randomised crossover trial in which four hospitals will be randomised to normal saline or Ringer's lactate for 14 weeks, then crossover to the alternative fluid for the subsequent 14 weeks after 1 to 3 week transition. With waiver of informed consent, all adult and paediatric patients admitted to participating sites will be included in the FLUID trial except for neonates. Primary feasibility outcome is study fluid protocol adherence (target:≥80%). Secondary feasibility outcomes include time to research ethics board (REB) approval and readiness to trial initiation (≤3 months from REB submission and approval). Primary (composite of death or re-admission to hospital in first 90 days of index hospitalisation) and secondary clinical outcomes for the future large FLUID trial will be described. Protocol adherence will be collected by site at specified time points. All clinical data will be obtained at patient level through provincial health administrative data held at the Institute for Clinical Evaluative Sciences (ICES). Event rates for the primary and secondary outcomes will be described using frequencies and proportions with 95% CIs. Intracluster and interperiod correlation coefficients will be calculated from population-level data available at ICES. ETHICS AND DISSEMINATION The study protocol has been approved by the Ottawa Health Science Research Ethics Board. The FLUID pilot will determine feasibility, and ICES data across all potential sites in Ontario will allow calculation of sample size parameter estimates to inform the design and implementation of the large trial. TRIAL REGISTRATION NUMBER NCT02721485; Pre-results.
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Affiliation(s)
- Lauralyn McIntyre
- Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Tracy McArdle
- Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alison Fox-Robichaud
- Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Shane W English
- Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Claudio Martin
- Division of Critical Care Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - John Marshall
- Department of Surgery, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kusum Menon
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - John Muscedere
- Department of Critical Care Medicine, Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada
| | - Deborah J Cook
- Departments of Medicine, Clinical Epidemiology and Biostatistics, St Joseph’s Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - Charles Weijer
- Rotman Institute of Philosophy, Western University, London, Ontario, Canada
| | - Raphael Saginur
- Department of Medicine, The Ottawa Hospital (Infectious Diseases), University of Ottawa, Ottawa, Ontario, Canada
| | - Alies Maybee
- Patient Engagement Advisory Board, Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Akshai Iyengar
- The Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | - Alan Forster
- Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ian D Graham
- Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Steven Hawken
- Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Colin McCartney
- Department of Anesthesiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Andrew JE Seely
- Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ian G Stiell
- Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Thompson M, McIntyre L, Hutton B, Tran A, Wolfe D, Hutchison J, Fergusson D, Turgeon AF, English SW. Comparison of crystalloid resuscitation fluids for treatment of acute brain injury: a clinical and pre-clinical systematic review and network meta-analysis protocol. Syst Rev 2018; 7:125. [PMID: 30115113 PMCID: PMC6097326 DOI: 10.1186/s13643-018-0790-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/23/2018] [Accepted: 07/30/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Current guidelines identify the choice of fluid resuscitation as important in minimizing the incidence of secondary brain injury from cerebral edema. It is widely accepted that isotonic crystalloid resuscitation fluids, specifically normal saline (NS), are optimal for resuscitation and that other relatively hypotonic fluids, such as Ringer's lactate (RL), should be avoided in this patient population. The aim of this review is to systematically compare the use of relatively hypotonic versus isotonic crystalloid resuscitation fluids in clinical and pre-clinical models of acute brain injury and their effect on outcomes. In recognition of the potential need for a network meta-analysis (NMA), we have also included all other relevant crystalloid resuscitation fluids as interventions of relevance to potentially inform indirect comparisons. METHODS Systematic searches of MEDLINE, Embase, and Web of Science BIOSIS Previews® will be used to identify eligible clinical and pre-clinical studies, which included studies examining acute brain injury (human and in vivo animal brain injury models) within the first 7 days of therapy. The intervention of interest is the intravenous use of relatively hypotonic crystalloid resuscitation fluids (e.g., Ringer's lactate, Hartmann's or Plasma Lyte® fluids). The main comparator of interest is an isotonic crystalloid resuscitation fluid, specifically normal saline (0.9%). Other crystalloid resuscitation fluids (e.g., hypertonic saline (3-23.4%)) will also be included as an additional intervention of interest. The primary outcome measures of interest are intracranial pressure (ICP) and cerebral perfusion pressure (CPP). Secondary outcomes include the effect of resuscitation on cerebral edema, brain and serum osmolarity, and electrolyte concentrations and clinical outcomes including modified Rankin Scale (mRS), (extended) Glasgow Outcome Scale (GOS/eGOS), and mortality. Separate meta-analyses will be conducted to quantify the effects of the different fluid resuscitation on acute brain injury outcomes in clinical and pre-clinical populations. Network meta-analyses to compare interventions will also be performed to compare the effects of different interventions. DISCUSSION This systematic review will comprehensively summarize the difference in treatment efficacy of various crystalloid resuscitation fluids in acute brain injury. This review is essential to underscore the evidence, or lack thereof, present in the literature to date to support current preference-driven practice and to direct future study. SYSTEMATIC REVIEW REGISTRATION PROSPERO #CRD42016042960.
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Affiliation(s)
- Mary Thompson
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Lauralyn McIntyre
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- Department of Medicine (Critical Care), University of Ottawa, CPCR Building, 501 Smyth Rd, CPCR Box 201B, Ottawa, Ontario K1H 8L6 Canada
| | - Brian Hutton
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada
| | - Alexandre Tran
- Department of General Surgery, University of Ottawa, Ottawa, Ontario Canada
| | - Dianna Wolfe
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Jamie Hutchison
- Department of Critical Care, Sick Kids Hospital, Toronto, Ontario Canada
| | - Dean Fergusson
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Alexis F. Turgeon
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, Quebec Canada
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec, Université Laval (Hôpital de L’Enfant-Jésus), Quebec City, Quebec Canada
| | - Shane W. English
- Clinical Epidemiology Program (CEP), Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- Department of Medicine (Critical Care), University of Ottawa, CPCR Building, 501 Smyth Rd, CPCR Box 201B, Ottawa, Ontario K1H 8L6 Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada
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English SW, Chassé M, Turgeon AF, Lauzier F, Griesdale D, Garland A, Fergusson D, Zarychanski R, van Walraven C, Montroy K, Ziegler J, Dupont-Chouinard R, Carignan R, Dhaliwal A, Mallick R, Sinclair J, Boutin A, Pagliarello G, Tinmouth A, McIntyre L. Anemia prevalence and incidence and red blood cell transfusion practices in aneurysmal subarachnoid hemorrhage: results of a multicenter cohort study. Crit Care 2018; 22:169. [PMID: 29973245 PMCID: PMC6031110 DOI: 10.1186/s13054-018-2089-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 01/15/2018] [Accepted: 06/07/2018] [Indexed: 11/16/2022]
Abstract
Background Whether a restrictive strategy for red blood cell (RBC) transfusion is applied to patients with aneurysmal subarachnoid hemorrhage (aSAH) is unclear. To inform the design and conduct of a future clinical trial, we sought to describe transfusion practices, hemoglobin (Hb) triggers, and predictors of RBC transfusion in patients with aSAH. Methods This is a retrospective cohort study of all consecutively admitted adult patients with aSAH at four tertiary care centers from January 1, 2012, to December 31, 2013. Patients were identified from hospital administrative discharge records and existing local aSAH databases. Data collection by trained abstractors included demographic data, aSAH characteristics, Hb and transfusion data, other major aSAH cointerventions, and outcomes using a pretested case report form with standardized procedures. Descriptive statistics were used to summarize data, and regression models were used to identify associations between anemia, transfusion, and other relevant predictors and outcome. Results A total of 527 patients met inclusion eligibility. Mean (±SD) age was 57 ± 13 years, and 357 patients (67.7%) were female. The median modified Fisher grade was 4 (IQR 3–4). Mean nadir Hb was 98 ± 20 g/L and occurred on median admission day 4 (IQR 2–11). RBC transfusion occurred in 100 patients (19.0%). Transfusion rates varied across centers (12.1–27.4%, p = 0.02). Patients received a median of 1 RBC unit (IQR 1–2) per transfusion episode and a median total of 2 units (IQR 1–4). Median pretransfusion Hb for first transfusion was 79 g/L (IQR 74–93) and did not vary substantially across centers (78–82 g/L, p = 0.37). Of patients with nadir Hb < 80 g/L, 66.3% received a transfusion compared with 2.0% with Hb nadir ≥ 100 g/L (p < 0.0001). Predictors of transfusion were history of oral anticoagulant use, anterior circulation aneurysm, neurosurgical clipping, and lower Hb. Controlling for numerous potential confounders, transfusion was not independently associated with poor outcome. Conclusions We observed that moderate anemia remains very common early in admission following SAH. Only one-fifth of patients with SAH received RBC transfusions, mostly in cases of significant anemia (Hb < 80 g/L), and this did not appear to be associated with outcome. Electronic supplementary material The online version of this article (10.1186/s13054-018-2089-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shane W English
- Department of Medicine (Critical Care), The Ottawa Hospital, Civic Campus Room F202, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada. .,Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Michaël Chassé
- Department of Medicine, University of Montreal, Montreal, QC, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology & Critical Care, Université Laval, Quebec City, QC, Canada
| | - François Lauzier
- Department of Anesthesiology & Critical Care, Université Laval, Quebec City, QC, Canada.,Department of Medicine, Université Laval, Quebec City, QC, Canada
| | - Donald Griesdale
- Deparment of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Allan Garland
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ryan Zarychanski
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Kaitlyn Montroy
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jennifer Ziegler
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Raphaëlle Carignan
- Department of Anesthesiology & Critical Care, Université Laval, Quebec City, QC, Canada
| | - Andy Dhaliwal
- Department of Medicine, University of Saskatchewan, Regina, SK, Canada
| | - Ranjeeta Mallick
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - John Sinclair
- Department of Surgery (Neurosurgery), University of Ottawa, Ottawa, ON, Canada
| | - Amélie Boutin
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, Canada
| | | | - Alan Tinmouth
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Lauralyn McIntyre
- Department of Medicine (Critical Care), The Ottawa Hospital, Civic Campus Room F202, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.,Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Lee H, Perry JJ, English SW, Alkherayf F, Joseph J, Nobile S, Zhou LL, Lesiuk H, Moulton R, Agbi C, Sinclair J, Dowlatshahi D. Clinical prediction of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage. J Neurosurg 2018; 130:1-8. [PMID: 29882700 DOI: 10.3171/2018.1.jns172715] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/10/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe aim of this study was to derive a clinically applicable decision rule using clinical, radiological, and laboratory data to predict the development of delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH) patients.METHODSPatients presenting over a consecutive 9-year period with subarachnoid hemorrhage (SAH) and at least 1 angiographically evident aneurysm were included. Variables significantly associated with DCI in univariate analysis underwent multivariable logistic regression. Using the beta coefficients, points were assigned to each predictor to establish a scoring system with estimated risks. DCI was defined as neurological deterioration attributable to arterial narrowing detected by transcranial Doppler ultrasonography, CT angiography, MR angiography, or catheter angiography, after exclusion of competing diagnoses.RESULTSOf 463 patients, 58% experienced angiographic vasospasm with an overall DCI incidence of 21%. Age, modified Fisher grade, and ruptured aneurysm location were significantly associated with DCI. This combination of predictors had a greater area under the receiver operating characteristic curve than the modified Fisher grade alone (0.73 [95% CI 0.67-0.78] vs 0.66 [95% CI 0.60-0.71]). Patients 70 years or older with modified Fisher grade 0 or 1 SAH and a posterior circulation aneurysm had the lowest risk of DCI at 1.2% (0 points). The highest estimated risk was 38% (17 points) in patients 40-59 years old with modified Fisher grade 4 SAH following rupture of an anterior circulation aneurysm.CONCLUSIONSAmong patients presenting with aSAH, this score-based clinical prediction tool exhibits increased accuracy over the modified Fisher grade alone and may serve as a useful tool to individualize DCI risk.
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Affiliation(s)
- Hubert Lee
- 1Division of Neurosurgery, The Ottawa Hospital, Ottawa
| | - Jeffrey J Perry
- 2Department of Emergency Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa
| | | | | | | | | | | | - Howard Lesiuk
- 1Division of Neurosurgery, The Ottawa Hospital, Ottawa
| | | | - Charles Agbi
- 1Division of Neurosurgery, The Ottawa Hospital, Ottawa
| | - John Sinclair
- 1Division of Neurosurgery, The Ottawa Hospital, Ottawa
| | - Dar Dowlatshahi
- 5Division of Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
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Taran S, Trivedi V, Singh JM, English SW, McCredie VA. The use of standardized management protocols for critically ill patients with non-traumatic subarachnoid hemorrhage: a protocol of a systematic review and meta-analysis. Syst Rev 2018; 7:53. [PMID: 29609651 PMCID: PMC5880023 DOI: 10.1186/s13643-018-0716-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 03/20/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Caring for patients with subarachnoid hemorrhage (SAH) presents unique challenges, due in part to the severity of the underlying insult, competing systemic injuries, and unpredictable clinical course. Even when management occurs in dedicated critical care settings, treatment uncertainty often persists, and morbidity and mortality from the condition remain high. Complex decisions in SAH care may be simplified with the use of standardized management protocols (SMPs). SMPs incorporate evidence-based guidelines into a practical framework for decision-making, thereby providing clinicians with an algorithm for organizing treatments. But despite these potential advantages, it is currently unknown whether SMPs may improve outcomes in the critical care of patients with SAH. METHODS We will conduct a systematic review of cohort studies and randomized control trials of adult patients with non-traumatic SAH who received care according to a standardized management protocol. Comprehensive search strategies will be developed for MEDLINE, EMBASE, WoS, CINAHL, and CENTRAL, to identify studies for review. The gray literature will be scanned for further eligible studies. Two reviewers will independently screen the material generated by the search to identify studies for inclusion. A standardized data extraction form will be used to collect information on study design, baseline characteristics, details of the management protocol employed, and primary and secondary outcomes. Where possible, meta-analyses with random-effects models will be used to calculate pooled estimates of effect sizes. Statistical heterogeneity will be evaluated with the I2 statistics, and risk of bias and reporting quality will be assessed independently and in duplicate with standardized scales. DISCUSSION We anticipate a significant degree of clinical heterogeneity in our review, as protocols will likely vary in their content, implementation, and ICU setting. We will aim to summarize the current literature in this domain to understand if SMPs, as a low-cost process-targeted intervention, improve outcomes for critically ill patients with SAH. Our review will additionally inform future research endeavors to improve the processes of care for this patient population. SYSTEMATIC REVIEW REGISTRATION CRD42017069173.
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Affiliation(s)
- Shaurya Taran
- Division of Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON Canada
- Department of Medicine, University Health Network, 200 Elizabeth Street, Eaton Building 14-217, Toronto, ON M5G 2C4 Canada
| | - Vatsal Trivedi
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON Canada
| | - Jeffrey M. Singh
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON Canada
- Division of Critical Care Medicine, Department of Medicine, University Health Network, Toronto, ON Canada
| | - Shane W. English
- Department of Medicine (Critical Care), The Ottawa Hospital, Ottawa, ON Canada
| | - Victoria A. McCredie
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON Canada
- Division of Critical Care Medicine, Department of Medicine, University Health Network, Toronto, ON Canada
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Khanna A, English SW, Wang XS, Ham K, Tumlin J, Szerlip H, Busse LW, Altaweel L, Albertson TE, Mackey C, McCurdy MT, Boldt DW, Chock S, Young PJ, Krell K, Wunderink RG, Ostermann M, Murugan R, Gong MN, Panwar R, Hästbacka J, Favory R, Venkatesh B, Thompson BT, Bellomo R, Jensen J, Kroll S, Chawla LS, Tidmarsh GF, Deane AM. Angiotensin II for the Treatment of Vasodilatory Shock. N Engl J Med 2017; 377:419-430. [PMID: 28528561 DOI: 10.1056/nejmoa1704154] [Citation(s) in RCA: 488] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vasodilatory shock that does not respond to high-dose vasopressors is associated with high mortality. We investigated the effectiveness of angiotensin II for the treatment of patients with this condition. METHODS We randomly assigned patients with vasodilatory shock who were receiving more than 0.2 μg of norepinephrine per kilogram of body weight per minute or the equivalent dose of another vasopressor to receive infusions of either angiotensin II or placebo. The primary end point was a response with respect to mean arterial pressure at hour 3 after the start of infusion, with response defined as an increase from baseline of at least 10 mm Hg or an increase to at least 75 mm Hg, without an increase in the dose of background vasopressors. RESULTS A total of 344 patients were assigned to one of the two regimens; 321 received a study intervention (163 received angiotensin II, and 158 received placebo) and were included in the analysis. The primary end point was reached by more patients in the angiotensin II group (114 of 163 patients, 69.9%) than in the placebo group (37 of 158 patients, 23.4%) (odds ratio, 7.95; 95% confidence interval [CI], 4.76 to 13.3; P<0.001). At 48 hours, the mean improvement in the cardiovascular Sequential Organ Failure Assessment (SOFA) score (scores range from 0 to 4, with higher scores indicating more severe dysfunction) was greater in the angiotensin II group than in the placebo group (-1.75 vs. -1.28, P=0.01). Serious adverse events were reported in 60.7% of the patients in the angiotensin II group and in 67.1% in the placebo group. Death by day 28 occurred in 75 of 163 patients (46%) in the angiotensin II group and in 85 of 158 patients (54%) in the placebo group (hazard ratio, 0.78; 95% CI, 0.57 to 1.07; P=0.12). CONCLUSIONS Angiotensin II effectively increased blood pressure in patients with vasodilatory shock that did not respond to high doses of conventional vasopressors. (Funded by La Jolla Pharmaceutical Company; ATHOS-3 ClinicalTrials.gov number, NCT02338843 .).
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Affiliation(s)
- Ashish Khanna
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Shane W English
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Xueyuan S Wang
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Kealy Ham
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - James Tumlin
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Harold Szerlip
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Laurence W Busse
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Laith Altaweel
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Timothy E Albertson
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Caleb Mackey
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Michael T McCurdy
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - David W Boldt
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Stefan Chock
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Paul J Young
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Kenneth Krell
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Richard G Wunderink
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Marlies Ostermann
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Raghavan Murugan
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Michelle N Gong
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Rakshit Panwar
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Johanna Hästbacka
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Raphael Favory
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Balasubramanian Venkatesh
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - B Taylor Thompson
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Rinaldo Bellomo
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Jeffrey Jensen
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Stew Kroll
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Lakhmir S Chawla
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - George F Tidmarsh
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
| | - Adam M Deane
- From Anesthesiology Institute, Center for Critical Care and Department of Outcomes Research, Cleveland Clinic, Cleveland (A.K.); the Department of Medicine (Critical Care), University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa (S.W.E.); Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC (X.S.W.); Regions Hospital, St. Paul, MN (K.H.); University of Tennessee College of Medicine, Chattanooga (J.T.); the Division of Nephrology, Baylor University Medical Center, Dallas (H.S.); the Department of Medicine, Emory University School of Medicine, Atlanta (L.W.B.); Inova Medical Center, Falls Church, VA (L.A.); the Department of Internal Medicine, University of California Davis School of Medicine, Sacramento (T.E.A.), the Division of Critical Care, Department of Anesthesiology, University of California Los Angeles, Los Angeles (D.W.B.), and La Jolla Pharmaceutical Company, San Diego (J.J., S.K., L.S.C., G.F.T.) - all in California; the Department of Pulmonary and Critical Care Medicine, Riverside Methodist Hospital, Columbus, OH (C.M.); the Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore (M.T.M.); the Department of Surgery, Sunrise Hospital, Las Vegas (S.C.); Intensive Care Unit, Wellington Hospital, and Medical Research Institute of New Zealand, Wellington, New Zealand (P.J.Y.); the Division of Critical Care, Department of Medicine, Eastern Idaho Regional Medical Center, Idaho Falls (K.K.); the Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago (R.G.W.); the Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London (M.O.); the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh (R.M.); the Department of Medicine, Albert Einstein College of Medicine, and the Division of Critical Care Medicine, Montefiore Medical Center, Bronx, NY (M.N.G.); John Hunter Hospital, New Lambton Heights, and School of Medicine and Public Health, University of Newcastle, Callaghan, NSW (R.P.), the Department of Intensive Care, Wesley Hospital and Princess Alexandra Hospital, University of Queensland, St Lucia (B.V.), and School of Medicine, University of Melbourne, Parkville (R.B.), and the Intensive Care Unit, the Royal Melbourne Hospital, University of Melbourne (A.M.D.), Melbourne, VIC - all in Australia; the Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki (J.H.); INSERM UMR 995 LIRIC (Lille Inflammation Research Center), Centre Hospitalier Universitaire Lille, Critical Care Center and University of Lille School of Medicine, Lille, France (R.F.); and the Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (B.T.T.)
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Tran A, Blinder H, Hutton B, English SW. A Systematic Review of Alpha-2 Agonists for Sedation in Mechanically Ventilated Neurocritical Care Patients. Neurocrit Care 2017; 28:12-25. [DOI: 10.1007/s12028-017-0388-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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English SW, Fergusson D, Chassé M, Turgeon AF, Lauzier F, Griesdale D, Algird A, Kramer A, Tinmouth A, Lum C, Sinclair J, Marshall S, Dowlatshahi D, Boutin A, Pagliarello G, McIntyre LA. Aneurysmal SubArachnoid Hemorrhage-Red Blood Cell Transfusion And Outcome (SAHaRA): a pilot randomised controlled trial protocol. BMJ Open 2016; 6:e012623. [PMID: 27927658 PMCID: PMC5168610 DOI: 10.1136/bmjopen-2016-012623] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Anaemia is common in aneurysmal subarachnoid haemorrhage (aSAH) and is a potential critical modifiable factor affecting secondary injury. Despite physiological evidence and management guidelines that support maintaining a higher haemoglobin level in patients with aSAH, current practice is one of a more restrictive approach to transfusion. The goal of this multicentre pilot trial is to determine the feasibility of successfully conducting a red blood cell (RBC) transfusion trial in adult patients with acute aSAH and anaemia (Hb ≤100 g/L), comparing a liberal transfusion strategy (Hb ≤100 g/L) with a restrictive strategy (Hb ≤80 g/L) on the combined rate of death and severe disability at 12 months. METHODS Design This is a multicentre open-label randomised controlled pilot trial at 5 academic tertiary care centres. Population We are targeting adult aSAH patients within 14 days of their initial bleed and with anaemia (Hb ≤110 g/L). Randomisation Central computer-generated randomisation, stratified by centre, will be undertaken from the host centre. Randomisation into 1 of the 2 treatment arms will occur when the haemoglobin levels of eligible patients fall to ≤100 g/L. Intervention Patients will be randomly assigned to either a liberal (threshold: Hb ≤100 g/L) or a restrictive transfusion strategy (threshold: Hb ≤80 g/L). Outcome Primary: Centre randomisation rate over the study period. Secondary: (1) transfusion threshold adherence; (2) study RBC transfusion protocol adherence; and (3) outcome assessment including vital status at hospital discharge, modified Rankin Score at 6 and 12 months and Functional Independence Measure and EuroQOL Quality of Life Scale scores at 12 months. Outcome measures will be reported in aggregate. ETHICS AND DISSEMINATION The study protocol has been approved by the host centre (OHSN-REB 20150433-01H). This study will determine the feasibility of conducting the large pragmatic RCT comparing 2 RBC transfusion strategies examining the effect of a liberal strategy on 12-month outcome following aSAH. TRIAL REGISTRATION NUMBER NCT02483351; Pre-results.
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Affiliation(s)
- Shane W English
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - D Fergusson
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - M Chassé
- Centre Hospitalier de l'Université de Montréal (CHUM) Research Center, Evaluation, Care Systems and Services Theme, Montréal, Québec, Canada
- Department of Medicine (Critical Care), Université de Montréal, Montréal, Québec, Canada
| | - A F Turgeon
- Department of Anesthesiology and Critical Care, Division of Critical Care Medicine, Université Laval, Québec City, Quebec, Canada
- Population Health and Optimal Health Practices Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec—Université Laval Research Center, Québec City, Quebec, Canada
| | - F Lauzier
- Department of Anesthesiology and Critical Care, Division of Critical Care Medicine, Université Laval, Québec City, Quebec, Canada
- Population Health and Optimal Health Practices Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec—Université Laval Research Center, Québec City, Quebec, Canada
- Department of Medicine, Université Laval, Québec City, Quebec, Canada
| | - D Griesdale
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Algird
- Department of Surgery (Neurosurgery), McMaster University, Hamilton, Ontario, Canada
| | - A Kramer
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, The Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - A Tinmouth
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - C Lum
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - J Sinclair
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - S Marshall
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - D Dowlatshahi
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - A Boutin
- Population Health and Optimal Health Practices Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec—Université Laval Research Center, Québec City, Quebec, Canada
| | - G Pagliarello
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - L A McIntyre
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program (Centre for Transfusion Research), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Alhazzani W, Guyatt G, Marshall JC, Hall R, Muscedere J, Lauzier F, Thabane L, Alshahrani M, English SW, Arabi YM, Deane AM, Karachi T, Rochwerg B, Finfer S, Daneman N, Zytaruk N, Heel-Ansdell D, Cook D, Of OB. Re-evaluating the Inhibition of Stress Erosions (REVISE): a protocol for pilot randomized controlled trial. Ann Saudi Med 2016; 36:427-433. [PMID: 27920416 PMCID: PMC6074211 DOI: 10.5144/0256-4947.2016.427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Clinicians routinely administer stress ulcer prophylaxis to mechanically ventilated patients in the intensive care unit (ICU), most commonly prescribing proton pump inhibitors (PPIs). However, the incidence of gastrointestinal (GI) bleeding from stress ulceration is low and recent observational studies suggest these agents may increase infections. Therefore, a large randomized clinical trial (RCT) is needed to inform modern practice. The aim of this multicenter pilot trial is to determine the feasibility of performing a large RCT to investigate the efficacy and safety of withholding intravenous pantoprazole. METHODS AND ANALYSIS We will include adult critically ill patients who have an anticipated duration of ventilation of >=48 hours. We will exclude patients with acute or recent GI bleeding, pregnancy, dual antiplatelet therapy, poor prognosis or intent to withdraw life support, or previous enrolment in this or a confounding trial. Following informed consent, patients will be randomized to receive the intervention of placebo (0.9% NaCl) or intravenous pantoprazole 40 mg daily. Patients, families, clinicians, data collectors, adjudicators of outcome and statisticians will be blind to allocation. The three primary feasibility outcomes are the informed consent rate, recruitment rate, and protocol adherence. Clinical outcomes include clinically important upper GI bleeding, ventilator-associated pneumonia (VAP), Clostridium difficile infection, length of stay and mortality in ICU and hospital. ETHICS AND APPROVAL This study has been approved by Health Canada, and research ethics board (REB) at each of the participating centers. TRIAL REGISTRATION NUMBER This trial was registered on 31 October 2014. The trial registration number is NCT02290327. FUNDING REVISE Pilot Trial is funded by Research Grant awarded by Physicians Services Incorporated, Dammam University Research Funds, Capital Health Authority Research Award Halifax, and Royal Adelaide Hospital Project Committee Grant.
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Affiliation(s)
- Waleed Alhazzani
- Dr. Waleed Alhazzani, Critical Care Medicine, McMaster University,, 50 Charlton Avenue East,, Hamilton, Ontario,, L8N 4A6, Canada, T: +1905-522-1155 ext 32800, F: +1905-521-6068 , ORCID: http://orcid.org/0000-0001-8076-9626
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English SW, McIntyre L, Fergusson D, Turgeon A, Dos Santos MP, Lum C, Chassé M, Sinclair J, Forster A, van Walraven C. Subarachnoid hemorrhage admissions retrospectively identified using a prediction model. Neurology 2016; 87:1557-1564. [PMID: 27629096 PMCID: PMC5067543 DOI: 10.1212/wnl.0000000000003204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/29/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To create an accurate prediction model using variables collected in widely available health administrative data records to identify hospitalizations for primary subarachnoid hemorrhage (SAH). METHODS A previously established complete cohort of consecutive primary SAH patients was combined with a random sample of control hospitalizations. Chi-square recursive partitioning was used to derive and internally validate a model to predict the probability that a patient had primary SAH (due to aneurysm or arteriovenous malformation) using health administrative data. RESULTS A total of 10,322 hospitalizations with 631 having primary SAH (6.1%) were included in the study (5,122 derivation, 5,200 validation). In the validation patients, our recursive partitioning algorithm had a sensitivity of 96.5% (95% confidence interval [CI] 93.9-98.0), a specificity of 99.8% (95% CI 99.6-99.9), and a positive likelihood ratio of 483 (95% CI 254-879). In this population, patients meeting criteria for the algorithm had a probability of 45% of truly having primary SAH. CONCLUSIONS Routinely collected health administrative data can be used to accurately identify hospitalized patients with a high probability of having a primary SAH. This algorithm may allow, upon validation, an easy and accurate method to create validated cohorts of primary SAH from either ruptured aneurysm or arteriovenous malformation.
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Affiliation(s)
- Shane W English
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada.
| | - Lauralyn McIntyre
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - Dean Fergusson
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - Alexis Turgeon
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - Marlise P Dos Santos
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - Cheemun Lum
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - Michaël Chassé
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - John Sinclair
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - Alan Forster
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
| | - Carl van Walraven
- From the Department of Medicine (Critical Care) (S.W.E., L.M.), Clinical Epidemiology Program (S.W.E, L.M., D.F., A.F., C.v.W.), Ottawa Hospital Research Institute/The Ottawa Hospital; Department of Anesthesia (Critical Care) (A.T., M.C.), Hôpital de L'Enfant-Jésus, Quebec; and Departments of Medical Imaging (M.P.d.S., C.L.), Surgery (Neuro-Surgery) (J.S.), and Medicine (C.v.W, A.F.), The Ottawa Hospital, Canada
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Chassé M, Tinmouth A, English SW, Acker JP, Wilson K, Knoll G, Shehata N, van Walraven C, Forster AJ, Ramsay T, McIntyre LA, Fergusson DA. Association of Blood Donor Age and Sex With Recipient Survival After Red Blood Cell Transfusion. JAMA Intern Med 2016; 176:1307-14. [PMID: 27398639 DOI: 10.1001/jamainternmed.2016.3324] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [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: 11/14/2022]
Abstract
IMPORTANCE While red blood cells (RBCs) are administered to improve oxygen delivery and patient outcomes, they also have been associated with potential harm. Unlike solid organ transplantation, the clinical consequences of donor characteristics on recipients have not been evaluated in transfusion medicine. OBJECTIVE To analyze the association of RBC donor age and sex with the survival of transfusion recipients. DESIGN, SETTING, AND PARTICIPANTS We established a longitudinal cohort by linking data from a blood collection agency with clinical and administrative data at 4 academic hospitals. MAIN OUTCOMES AND MEASURES Cox proportional hazards regression models were fitted to evaluate the risk of donor age and sex on transfusion recipient survival. RESULTS Between October 25, 2006, and December 31, 2013, a total of 30 503 RBC transfusion recipients received 187 960 RBC transfusions from 80 755 unique blood donors. For recipients receiving an RBC unit from younger donors, the risk of death was increased compared with recipients receiving an RBC unit from a donor 40 to 49.9 years old (adjusted hazard ratio, 1.08; 95% CI, 1.06-1.10; P < .001 for donor age range 17-19.9 years and 1.06; 95% CI, 1.04-1.09; P < .001 for donor age range 20-29.9 years). Receiving an RBC transfusion from a female donor was associated with an 8% statistically significant increased risk of death compared with receiving an RBC transfusion from a male donor (adjusted hazard ratio, 1.08; 95% CI, 1.06-1.09; P < .001). CONCLUSIONS AND RELEVANCE Red blood cell transfusions from younger donors and from female donors were statistically significantly associated with increased mortality. These findings suggest that donor characteristics may affect RBC transfusion outcomes.
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Affiliation(s)
- Michaël Chassé
- Department of Anesthesiology and Critical Care, Université Laval, Quebec, Quebec, Canada
| | - Alan Tinmouth
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada3Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada3Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason P Acker
- Centre for Innovation, Canadian Blood Services, Edmonton, Alberta
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada3Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Greg Knoll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada3Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nadine Shehata
- Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Carl van Walraven
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alan J Forster
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada3Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Timothy Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lauralyn A McIntyre
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada3Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada3Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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50
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Shears M, Alhazzani W, Marshall JC, Muscedere J, Hall R, English SW, Dodek PM, Lauzier F, Kanji S, Duffett M, Barletta J, Alshahrani M, Arabi Y, Deane A, Cook DJ. Stress ulcer prophylaxis in critical illness: a Canadian survey. Can J Anaesth 2016; 63:718-24. [DOI: 10.1007/s12630-016-0612-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 01/18/2016] [Accepted: 02/04/2016] [Indexed: 01/31/2023] Open
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