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Cook D, Deane A, Dionne JC, Lauzier F, Marshall JC, Arabi YM, Wilcox ME, Ostermann M, Al-Fares A, Heels-Ansdell D, Zytaruk N, Thabane L, Finfer S. Adjudication of a primary trial outcome: Results of a calibration exercise and protocol for a large international trial. Contemp Clin Trials Commun 2024; 39:101284. [PMID: 38559746 PMCID: PMC10979133 DOI: 10.1016/j.conctc.2024.101284] [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: 10/17/2023] [Revised: 01/31/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Background Ascertainment of the severity of the primary outcome of upper gastrointestinal (GI) bleeding is integral to stress ulcer prophylaxis trials. This protocol outlines the adjudication process for GI bleeding events in an international trial comparing pantoprazole to placebo in critically ill patients (REVISE: Re-Evaluating the Inhibition of Stress Erosions). The primary objective of the adjudication process is to assess episodes submitted by participating sites to determine which fulfil the definition of the primary efficacy outcome of clinically important upper GI bleeding. Secondary objectives are to categorize the bleeding severity if deemed not clinically important, and adjudicate the bleeding site, timing, investigations, and treatments. Methods Research coordinators follow patients daily for any suspected clinically important upper GI bleeding, and submit case report forms, doctors' and nurses' notes, laboratory, imaging, and procedural reports to the methods center. An international central adjudication committee reflecting diverse specialty backgrounds conducted an initial calibration exercise to delineate the scope of the adjudication process, review components of the definition, and agree on how each criterion will be considered fulfilled. Henceforth, bleeding events will be stratified by study drug, and randomly assigned to adjudicator pairs (blinded to treatment allocation, and study center). Results Crude agreement, chance-corrected agreement, or chance-independent agreement if data have a skewed distribution will be calculated. Conclusions Focusing on consistency and accuracy, central independent blinded duplicate adjudication of suspected clinically important upper GI bleeding events will determine which events fulfil the definition of the primary efficacy outcome for this stress ulcer prophylaxis trial. Registration NCT03374800 (REVISE: Re-Evaluating the Inhibition of Stress Erosions).
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Affiliation(s)
| | - Adam Deane
- University of Melbourne, Melbourne, Australia
| | | | | | | | - Yaseen M. Arabi
- King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | | | | | | | | | | | | | - for the REVISE Investigators and the Canadian Critical Care Trials Group
- McMaster University, Hamilton, Canada
- University of Melbourne, Melbourne, Australia
- Université Laval, Québec City, Canada
- University of Toronto, Toronto, Canada
- King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- University of Alberta, Edmonton, Canada
- King's College, London, United Kingdom
- Al-Amiri Hospital, Kuwait City, Kuwait
- The George Institute, Sydney, Australia
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2
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Alroqi F, Barhoumi T, Masuadi E, Nogoud M, Aljedaie M, Abu-Jaffal AS, Bokhamseen M, Saud M, Hakami M, Arabi YM, Nasr A. Durability of COVID-19 humoral immunity post infection and different SARS-COV-2 vaccines. J Infect Public Health 2024; 17:704-711. [PMID: 38479067 DOI: 10.1016/j.jiph.2024.02.016] [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: 08/02/2023] [Revised: 02/09/2024] [Accepted: 02/27/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND The global challenge posed by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has been a major concern for the healthcare sector in recent years. Healthcare workers have a relatively high risk of encountering COVID-19 patients, making protective immunity against SARS-CoV-2 is a priority for them. This study aims to evaluate the longitudinal measurement of SARS-CoV-2 IgG spike protein antibodies in healthcare workers (HCWs) after COVID-19 infection and after receiving the first and second doses of SARS-CoV-2 vaccines, including Pfizer-BioNTech (BNT162b2) and Oxford-AstraZeneca (AZD1222). METHODS This longitudinal cohort study involved 311 healthcare workers working in two tertiary hospitals in Saudi Arabia. All participants were followed between July 2020 and July 2022 after completing the study questionnaire. A total of 3 ml of the blood samples were collected at four intervals: before/after vaccination. RESULTS HCWs post-infection had lower mean SARS-CoV-2 IgG levels three months post-infection than post-vaccination. 92.2% had positive IgG levels two weeks after the first dose and reached 100% after the second dose. Over 98% had positive antibodies nine months after the second dose, regardless of vaccine type. The number of neutralizing antibodies decreased and was around 50% at nine months after the second dose. CONCLUSION The results show different antibody patterns between infected and vaccinated HCWs. A high proportion of participants had positive antibodies after vaccination, with high levels persisting nine months after the second dose. Neutralizing antibodies decreased over time, with only about 50% of participants having positive antibodies nine months after the second dose. These results contribute to our understanding of immunity in healthcare workers and highlight the need for the continuous monitoring and possible booster strategies.
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Affiliation(s)
- Fayhan Alroqi
- Department of Paediatric, King Abdullah Specialized Children's Hospital (KASCH), Ministry of the National Guard - Health Affairs, Kingdom of Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Centre (KAIMRC), Ministry of National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia
| | - Tlili Barhoumi
- King Abdullah International Medical Research Centre (KAIMRC), Ministry of National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia
| | - Emad Masuadi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Maysa Nogoud
- King Abdullah International Medical Research Centre (KAIMRC), Ministry of National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia
| | - Modhi Aljedaie
- King Abdullah International Medical Research Centre (KAIMRC), Ministry of National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia
| | - Ahmad Selah Abu-Jaffal
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Kingdom of Saudi Arabia
| | - Maha Bokhamseen
- King Abdullah International Medical Research Centre (KAIMRC), Ministry of National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia
| | - Myaad Saud
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Kingdom of Saudi Arabia
| | - Maumonah Hakami
- King Abdullah International Medical Research Centre (KAIMRC), Ministry of National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia
| | - Yaseen M Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Centre (KAIMRC), Ministry of National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia; Intensive Care Department, King Abdulaziz Medical City (KAMC), Riyadh, Kingdom of Saudi Arabia
| | - Amre Nasr
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Centre (KAIMRC), Ministry of National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia.
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3
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Phua J, Kulkarni AP, Mizota T, Hashemian SMR, Lee WY, Permpikul C, Chittawatanarat K, Nitikaroon P, Arabi YM, Fang WF, Konkayev A, Hashmi M, Palo JE, Faruq MO, Shrestha BR, KC B, Mat Nor MBB, Sann KK, Ling L, Haniffa R, Al Bahrani M, Mendsaikhan N, Chan YH. Critical care bed capacity in Asian countries and regions before and during the COVID-19 pandemic: an observational study. Lancet Reg Health West Pac 2024; 44:100982. [PMID: 38143717 PMCID: PMC10733690 DOI: 10.1016/j.lanwpc.2023.100982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of critical care. The aim of the current study was to compare the number of adult critical care beds in relation to population size in Asian countries and regions before (2017) and during (2022) the pandemic. Methods This observational study collected data closest to 2022 on critical care beds (intensive care units and intermediate care units) in 12 middle-income and 7 high-income economies (using the 2022-2023 World Bank classification), through a mix of methods including government sources, national critical care societies, personal contacts, and data extrapolation. Data were compared with a prior study from 2017 of the same countries and regions. Findings The cumulative number of critical care beds per 100,000 population increased from 3.0 in 2017 to 9.4 in 2022 (p = 0.003). The median figure for middle-income economies increased from 2.6 (interquartile range [IQR] 1.7-7.8) to 6.6 (IQR 2.2-13.3), and that for high-income economies increased from 11.4 (IQR 7.3-22.8) to 13.9 (IQR 10.7-21.7). Only 3 countries did not see a rise in bed capacity. Where data were available in 2022, 10.9% of critical care beds were in single rooms (median 5.0% in middle-income and 20.3% in high-income economies), and 5.3% had negative pressure (median 0.7% in middle-income and 18.5% in high-income economies). Interpretation Critical care bed capacity in the studied Asian countries and regions increased close to three-fold from 2017 to 2022. Much of this increase was attributed to middle-income economies, but substantial heterogeneity exists. Funding None.
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Affiliation(s)
- Jason Phua
- Fast and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore
- Division of Respiratory and Critical Care Medicine, National University Hospital, National University Health System, Singapore
| | - Atul Prabhakar Kulkarni
- Division of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Toshiyuki Mizota
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Seyed Mohammad Reza Hashemian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Won-Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chairat Permpikul
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kaweesak Chittawatanarat
- Faculty of Medicine, Department of Surgery, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand
| | - Phongsak Nitikaroon
- Health Administration Division, Ministry of Public Health, Nonthaburi, Thailand
| | - Yaseen M. Arabi
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Wen-Feng Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Aidos Konkayev
- Anaesthesiology and Intensive Care Department, Astana Medical University, Nur-Sultan, Kazakhstan
- National Science Center of Traumatology and Orthopedia Named Batpenov, Nur-Sultan, Kazakhstan
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
| | - Jose Emmanuel Palo
- Acute and Critical Care Institute, The Medical City, Pasig City, Philippines
| | - Mohammad Omar Faruq
- General Intensive Care Unit and Emergency Department, United Hospital Ltd, Dhaka, Bangladesh
| | - Babu Raja Shrestha
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Bijay KC
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | | | - Kyi Kyi Sann
- Department of Anaesthesiology and Intensive Care Unit, Yangon General Hospital, University of Medicine 1, Yangon, Myanmar
| | - Lowell Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
| | - Maher Al Bahrani
- Department of Anesthesia and Critical Care, Royal Hospital, Muscat, Oman
| | - Naranpurev Mendsaikhan
- Mongolia-Japan Hospital, Mongolian National University Medical Sciences, Ulaanbaatar, Mongolia
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Asian Critical Care Clinical Trials (ACCCT) Group
- Fast and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore
- Division of Respiratory and Critical Care Medicine, National University Hospital, National University Health System, Singapore
- Division of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Faculty of Medicine, Department of Surgery, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand
- Health Administration Division, Ministry of Public Health, Nonthaburi, Thailand
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
- Anaesthesiology and Intensive Care Department, Astana Medical University, Nur-Sultan, Kazakhstan
- National Science Center of Traumatology and Orthopedia Named Batpenov, Nur-Sultan, Kazakhstan
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
- Acute and Critical Care Institute, The Medical City, Pasig City, Philippines
- General Intensive Care Unit and Emergency Department, United Hospital Ltd, Dhaka, Bangladesh
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
- International Islamic University Malaysia Medical Centre, Kuantan, Malaysia
- Department of Anaesthesiology and Intensive Care Unit, Yangon General Hospital, University of Medicine 1, Yangon, Myanmar
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
- Department of Anesthesia and Critical Care, Royal Hospital, Muscat, Oman
- Mongolia-Japan Hospital, Mongolian National University Medical Sciences, Ulaanbaatar, Mongolia
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
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4
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Axfors C, Schmitt AM, Janiaud P, Van't Hooft J, Abd-Elsalam S, Abdo EF, Abella BS, Akram J, Amaravadi RK, Angus DC, Arabi YM, Azhar S, Baden LR, Baker AW, Belkhir L, Benfield T, Berrevoets MAH, Chen CP, Chen TC, Cheng SH, Cheng CY, Chung WS, Cohen YZ, Cowan LN, Dalgard O, de Almeida E Val FF, de Lacerda MVG, de Melo GC, Derde L, Dubee V, Elfakir A, Gordon AC, Hernandez-Cardenas CM, Hills T, Hoepelman AIM, Huang YW, Igau B, Jin R, Jurado-Camacho F, Khan KS, Kremsner PG, Kreuels B, Kuo CY, Le T, Lin YC, Lin WP, Lin TH, Lyngbakken MN, McArthur C, McVerry BJ, Meza-Meneses P, Monteiro WM, Morpeth SC, Mourad A, Mulligan MJ, Murthy S, Naggie S, Narayanasamy S, Nichol A, Novack LA, O'Brien SM, Okeke NL, Perez L, Perez-Padilla R, Perrin L, Remigio-Luna A, Rivera-Martinez NE, Rockhold FW, Rodriguez-Llamazares S, Rolfe R, Rosa R, Røsjø H, Sampaio VS, Seto TB, Shahzad M, Soliman S, Stout JE, Thirion-Romero I, Troxel AB, Tseng TY, Turner NA, Ulrich RJ, Walsh SR, Webb SA, Weehuizen JM, Velinova M, Wong HL, Wrenn R, Zampieri FG, Zhong W, Moher D, Goodman SN, Ioannidis JPA, Hemkens LG. Author Correction: Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials. Nat Commun 2024; 15:1075. [PMID: 38316844 PMCID: PMC10844287 DOI: 10.1038/s41467-024-45360-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Affiliation(s)
- Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Andreas M Schmitt
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Medical Oncology, University of Basel, Basel, Switzerland
| | - Perrine Janiaud
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Janneke Van't Hooft
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Amsterdam University Medical Center, Amsterdam University, Amsterdam, the Netherlands
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ehab F Abdo
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Benjamin S Abella
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Javed Akram
- Department of Internal Medicine, Vice Chancellor, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Ravi K Amaravadi
- Abramson Cancer Center and Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Derek C Angus
- Department of Critical Care Medicine, The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, PA, USA
- the UPMC Health System Office of Healthcare Innovation, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
| | - Yaseen M Arabi
- Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Shehnoor Azhar
- Department of Public Health, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Lindsey R Baden
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Arthur W Baker
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Leila Belkhir
- Infectious Diseases Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Benfield
- Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Marvin A H Berrevoets
- Department of Internal Medicine, Elisabeth-Tweesteden hospital, Tilburg, Netherlands
| | - Cheng-Pin Chen
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Tsung-Chia Chen
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Shu-Hsing Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chien-Yu Cheng
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | | | | | - Olav Dalgard
- Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Marcus V G de Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Instituto Leonidas e Maria Deane - ILMD, FIOCRUZ-AM, Manaus, AM, Brazil
| | - Gisely C de Melo
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | - Lennie Derde
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Intensive Care Centre, University Medical Center Utrecht, Utrecht, Netherlands
| | - Vincent Dubee
- Infectious and Tropical Diseases Department, Angers University Hospital, Angers, France
| | | | - Anthony C Gordon
- Department of Surgery and Cancer, Anaesthetics, Pain Medicine, and Intensive Care Medicine, Imperial College London and Imperial College Healthcare NHS Trust, London, UK
| | - Carmen M Hernandez-Cardenas
- Critical Care Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Thomas Hills
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | - Andy I M Hoepelman
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | - Yi-Wen Huang
- Department of Internal Medicine, Chang Hua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
| | | | - Ronghua Jin
- Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Felipe Jurado-Camacho
- Critical Care Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Khalid S Khan
- Department of Preventive Medicine & Public Health, University of Granada, Hospital Real, Avenida del Hospicio, Granada, Granada, Spain
| | - Peter G Kremsner
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- German Center for Infection Research, Partner Site Tübingen, Tübingen, Germany
| | - Benno Kreuels
- Department of Medicine, Division of Tropical Medicine and Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Cheng-Yu Kuo
- Department of Internal Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung, Taiwan
| | - Thuy Le
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Yi-Chun Lin
- Department of Infectious Diseases, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Wu-Pu Lin
- Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Tse-Hung Lin
- Department of Internal Medicine, Chang Hua Hospital, Ministry of Health and Welfare, Changhua, Taiwan
| | - Magnus Nakrem Lyngbakken
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Colin McArthur
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Auckland City Hospital, Auckland, New Zealand
- School of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Bryan J McVerry
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Wuelton M Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Universidade do Estado do Amazonas, Manaus, AM, Brazil
| | | | - Ahmad Mourad
- Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Mark J Mulligan
- Department of Microbiology, NYU Grossman School of Medicine, New York, NY, USA
- Department of Internal Medicine, Division of Infectious Diseases and Immunology, NYU Grossman School of Medicine, New York, NY, USA
| | - Srinivas Murthy
- University of British Columbia School of Medicine, Vancouver, BC, Canada
| | - Susanna Naggie
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Shanti Narayanasamy
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Alistair Nichol
- School of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care, Alfred Health, Melbourne, VIC, Australia
- Department of Anesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Lewis A Novack
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sean M O'Brien
- Department of Biostatistics and Bioinformatics, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | - Nwora Lance Okeke
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | | | - Rogelio Perez-Padilla
- Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | | | - Arantxa Remigio-Luna
- Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | | | - Frank W Rockhold
- Department of Biostatistics and Bioinformatics, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | - Sebastian Rodriguez-Llamazares
- Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Robert Rolfe
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | | | - Helge Røsjø
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Vanderson S Sampaio
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brazil
- Fundação de Vigilância em Saúde do Amazonas, Manaus, AM, Brazil
| | - Todd B Seto
- University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
- The Queen's Medical Center, Honolulu, HI, USA
| | - Muhammad Shahzad
- Department of Pharmacology, University of Health Sciences, Lahore, Punjab, Pakistan
| | - Shaimaa Soliman
- Public Health and Community Medicine, Menoufia University, Menoufia, Egypt
| | - Jason E Stout
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Ireri Thirion-Romero
- Department of Smoking and COPD, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Andrea B Troxel
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Ting-Yu Tseng
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Nicholas A Turner
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Robert J Ulrich
- Department of Medicine, Division of Infectious Diseases and Immunology, NYU Grossman School of Medicine, New York, NY, USA
| | - Stephen R Walsh
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Steve A Webb
- School of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- St. John of God Hospital, Subiaco, WA, Australia
| | - Jesper M Weehuizen
- Department of Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Hon-Lai Wong
- Department of Internal Medicine, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Rebekah Wrenn
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Fernando G Zampieri
- Research Institute, HCor-Hospital do Coração, São Paulo, Brazil
- Research Institute, BRICNet-Brazilian Research in Intensive Care Network, São Paulo, Brazil
- IDor Research Institute, São Paulo, Brazil
| | - Wu Zhong
- National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing, People's Republic of China
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Steven N Goodman
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Lars G Hemkens
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany.
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5
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Nam KH, Phua J, Du B, Ohshimo S, Kim HJ, Lim CM, Myatra SN, Adib NABN, Arabi YM, Chan MC, Faruq MO, Redjeki IS, Son DN, Nafees KMK, Priyankara D, Patjanasoontorn B, Palo JE, Konkayev A, Shrestha GS, Koh Y. Mechanical ventilation practices in Asian intensive care units: A multicenter cross-sectional study. J Crit Care 2024; 79:154452. [PMID: 37948944 DOI: 10.1016/j.jcrc.2023.154452] [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: 02/16/2023] [Revised: 07/24/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE This study investigated current practices of mechanical ventilation in Asian intensive care units, focusing on tidal volume, plateau pressure, and positive end-expiratory pressure (PEEP). MATERIALS AND METHODS In this multicenter cross-sectional study, data on mechanical ventilation and clinical outcomes were collected. Predictors of mortality were analyzed by univariate and multivariable logistic regression. A scoring system was generated to predict 28-day mortality. RESULTS A total of 1408 patients were enrolled. In 138 patients with acute respiratory distress syndrome (ARDS), 65.9% were on a tidal volume ≤ 8 ml/kg predicted body weight (PBW), and 71.3% were on sufficient PEEP. In 1270 patients without ARDS, 88.8% were on a tidal volume ≤ 10 ml/kg PBW. A plateau pressure < 30 cmH2O was measured in 92.2% of patients. Mortality rates increased from 13% to 74% as the generated predictive score increased from 5 to ≥8.5. Income classification, age, SOFA score, PaO2/FiO2 ratio, plateau pressure, number of vasopressors, and steroid use were associated with mortality. CONCLUSIONS In Asia, low tidal volume ventilation and sufficient PEEP were underused in patients with ARDS. The majority of patients without ARDS were on intermediate tidal volumes. Country income, age, and severity of illness were associated with mortality.
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Affiliation(s)
- Kyung Hun Nam
- Department of Critical Care Medicine, Seongnam Citizens Medical Center, Seongnam, South Korea
| | - Jason Phua
- FAST and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore; Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Bin Du
- State Key Laboratory of Complex, Severe, and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Beijing, China
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, ASAN Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | | | - Yaseen M Arabi
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ming-Cheng Chan
- Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; National Chung Hsing University, Taichung, Taiwan
| | - Mohammad Omar Faruq
- Critical Care Medicine and Emergency Medicine, United Medical College and United Hospital, Dhaka 1212, Bangladesh
| | - Ike Sri Redjeki
- Faculty of Medicine, Department of Anesthesiology and Intensive Care, Padjadjaran University, Dr. Hasan Sadikin National Referral Hospital Bandung, Bandung, Indonesia
| | - Do Ngoc Son
- Center for Critical Care Medicine, Bach Mai Hospital, University of Medicine and Pharmacy, Hanoi National University, Viet Nam
| | | | | | - Boonsong Patjanasoontorn
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Jose Emmanuel Palo
- Acute and Critical Care Institute, The Medical City, Pasig City, Philippines
| | - Aidos Konkayev
- Anaesthesia and ICU Department, Astana Medical University, Institution of Traumatology and Orthopedics, Nur-Sultan, Kazakhstan
| | - Gentle Sunder Shrestha
- Department of Critical Care Medicine Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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6
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Li A, Ling L, Qin H, Arabi YM, Myatra SN, Egi M, Kim JH, Nor MBM, Son DN, Fang WF, Wahyuprajitno B, Hashmi M, Faruq MO, Patjanasoontorn B, Al Bahrani MJ, Shrestha BR, Shrestha U, Nafees KMK, Sann KK, Palo JEM, Mendsaikhan N, Konkayev A, Detleuxay K, Chan YH, Du B, Divatia JV, Koh Y, Phua J. Prognostic evaluation of quick sequential organ failure assessment score in ICU patients with sepsis across different income settings. Crit Care 2024; 28:30. [PMID: 38263076 PMCID: PMC10804657 DOI: 10.1186/s13054-024-04804-7] [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: 11/05/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND There is conflicting evidence on association between quick sequential organ failure assessment (qSOFA) and sepsis mortality in ICU patients. The primary aim of this study was to determine the association between qSOFA and 28-day mortality in ICU patients admitted for sepsis. Association of qSOFA with early (3-day), medium (28-day), late (90-day) mortality was assessed in low and lower middle income (LLMIC), upper middle income (UMIC) and high income (HIC) countries/regions. METHODS This was a secondary analysis of the MOSAICS II study, an international prospective observational study on sepsis epidemiology in Asian ICUs. Associations between qSOFA at ICU admission and mortality were separately assessed in LLMIC, UMIC and HIC countries/regions. Modified Poisson regression was used to determine the adjusted relative risk (RR) of qSOFA score on mortality at 28 days with adjustments for confounders identified in the MOSAICS II study. RESULTS Among the MOSAICS II study cohort of 4980 patients, 4826 patients from 343 ICUs and 22 countries were included in this secondary analysis. Higher qSOFA was associated with increasing 28-day mortality, but this was only observed in LLMIC (p < 0.001) and UMIC (p < 0.001) and not HIC (p = 0.220) countries/regions. Similarly, higher 90-day mortality was associated with increased qSOFA in LLMIC (p < 0.001) and UMIC (p < 0.001) only. In contrast, higher 3-day mortality with increasing qSOFA score was observed across all income countries/regions (p < 0.001). Multivariate analysis showed that qSOFA remained associated with 28-day mortality (adjusted RR 1.09 (1.00-1.18), p = 0.038) even after adjustments for covariates including APACHE II, SOFA, income country/region and administration of antibiotics within 3 h. CONCLUSIONS qSOFA was independently associated with 28-day mortality in ICU patients admitted for sepsis. In LLMIC and UMIC countries/regions, qSOFA was associated with early to late mortality but only early mortality in HIC countries/regions.
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Affiliation(s)
- Andrew Li
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Lowell Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Hanyu Qin
- State Key Laboratory of Complex, Severe and Rare Disease, Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
| | - Yaseen M Arabi
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Moritoki Egi
- Department of Anesthesiology and Intensive Care, Kyoto University Hospital, Kyoto, Japan
| | - Je Hyeong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Mohd Basri Mat Nor
- International Islamic University Malaysia Medical Center, Kuantan, Malaysia
| | - Do Ngoc Son
- Center of Critical Care Medicine, Bach Mai Hospital, Hanoi Medical University, VNU University of Medicine and Pharmacy, Hanoi, Vietnam
| | - Wen-Feng Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Bambang Wahyuprajitno
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Airlangga, Intensive Care Unit, Dr Soetomo General Hospital, Surabaya, Indonesia
| | - Madiha Hashmi
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Mohammad Omar Faruq
- General Intensive Care Unity and Emergency Department, United Hospital Ltd, Dhaka, Bangladesh
| | - Boonsong Patjanasoontorn
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Babu Raja Shrestha
- Department of Anesthesia and Intensive Care, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | - Ujma Shrestha
- Department of Anesthesia and Intensive Care, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | | | - Kyi Kyi Sann
- Department of Anaesthesiology and ICU, Yangon General Hospital, University of Medicine 1, Yangon, Myanmar
| | | | - Naranpurev Mendsaikhan
- Mongolia Japan Hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Aidos Konkayev
- Anaesthesiology and Intensive Care Department, Astana Medical University, Astana, Kazakhstan
- Anaesthesiology and Intensive Care Department, National Scientific Center of Traumatology and Orthopedia Named After Academician N.D. Batpenov, Astana, Kazakhstan
| | | | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bin Du
- State Key Laboratory of Complex, Severe and Rare Disease, Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
| | - Jigeeshu Vasishtha Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jason Phua
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
- FAST and Chronic Programmed, Alexandra Hospital, National University Health System, Singapore, Singapore
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7
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Dumas G, Arabi YM, Bartz R, Ranzani O, Scheibe F, Darmon M, Helms J. Diagnosis and management of autoimmune diseases in the ICU. Intensive Care Med 2024; 50:17-35. [PMID: 38112769 DOI: 10.1007/s00134-023-07266-7] [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: 06/23/2023] [Accepted: 11/01/2023] [Indexed: 12/21/2023]
Abstract
Autoimmune diseases encompass a broad spectrum of disorders characterized by disturbed immunoregulation leading to the development of specific autoantibodies, resulting in inflammation and multiple organ involvement. A distinction should be made between connective tissue diseases (mainly systemic lupus erythematosus, systemic scleroderma, inflammatory muscle diseases, and rheumatoid arthritis) and vasculitides (mainly small-vessel vasculitis such as antineutrophil cytoplasmic antibody-associated vasculitis and immune-complex mediated vasculitis). Admission of patients with autoimmune diseases to the intensive care unit (ICU) is often triggered by disease flare-ups, infections, and organ failure and is associated with high mortality rates. Management of these patients is complex, including prompt disease identification, immunosuppressive treatment initiation, and life-sustaining therapies, and requires multi-disciplinary involvement. Data about autoimmune diseases in the ICU are limited and there is a need for multicenter, international collaboration to improve patients' diagnosis, management, and outcomes. The objective of this narrative review is to summarize the epidemiology, clinical features, and selected management of severe systemic autoimmune diseases.
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Affiliation(s)
- Guillaume Dumas
- Medical Intensive Care Unit, Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes, Université Grenoble-Alpes, INSERM, U1042-HP2, Grenoble, France.
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of the National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences Riyadh, Riyadh, Kingdom of Saudi Arabia
| | - Raquel Bartz
- Department of Anesthesia, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Otavio Ranzani
- Barcelona Institute for Global Health, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Pulmonary Division, Faculdade de Medicina, Heart Institute, InCor, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Franziska Scheibe
- Department of Neurology and Experimental Neurology, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Michaël Darmon
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical EpidemiologyUMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Université Paris Cité, Paris, France
| | - Julie Helms
- Faculté de Médecine, Service de Médecine Intensive-Réanimation, Université de Strasbourg (UNISTRA), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de L'Hôpital, Strasbourg, France
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8
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Al-Dorzi HM, Arabi YM. Early administration of high protein for critically ill patients with acute kidney injury? Crit Care 2023; 27:484. [PMID: 38062515 PMCID: PMC10704753 DOI: 10.1186/s13054-023-04764-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Hasan M Al-Dorzi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center and Intensive Care Department, Ministry of National Guard-Health Affairs, Mail Code 1425, PO Box 22490, 11426, Riyadh, Saudi Arabia
| | - Yaseen M Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center and Intensive Care Department, Ministry of National Guard-Health Affairs, Mail Code 1425, PO Box 22490, 11426, Riyadh, Saudi Arabia.
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9
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Adhikari NKJ, Hashmi M, Tirupakuzhi Vijayaraghavan BK, Haniffa R, Beane A, Webb SA, Angus DC, Gordon AC, Cook DJ, Guyatt GH, Berry LR, Lorenzi E, Mouncey PR, Au C, Pinto R, Ménard J, Sprague S, Masse MH, Huang DT, Heyland DK, Nichol AD, McArthur CJ, de Man A, Al-Beidh F, Annane D, Anstey M, Arabi YM, Battista MC, Berry S, Bhimani Z, Bonten MJM, Bradbury CA, Brant EB, Brunkhorst FM, Burrell A, Buxton M, Cecconi M, Cheng AC, Cohen D, Cove ME, Day AG, Derde LPG, Detry MA, Estcourt LJ, Fagbodun EO, Fitzgerald M, Goossens H, Green C, Higgins AM, Hills TE, Ichihara N, Jayakumar D, Kanji S, Khoso MN, Lawler PR, Lewis RJ, Litton E, Marshall JC, McAuley DF, McGlothlin A, McGuinness SP, McQuilten ZK, McVerry BJ, Murthy S, Parke RL, Parker JC, Reyes LF, Rowan KM, Saito H, Salahuddin N, Santos MS, Saunders CT, Seymour CW, Shankar-Hari M, Tolppa T, Trapani T, Turgeon AF, Turner AM, Udy AA, van de Veerdonk FL, Zarychanski R, Lamontagne F. Intravenous Vitamin C for Patients Hospitalized With COVID-19: Two Harmonized Randomized Clinical Trials. JAMA 2023; 330:1745-1759. [PMID: 37877585 PMCID: PMC10600726 DOI: 10.1001/jama.2023.21407] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
Importance The efficacy of vitamin C for hospitalized patients with COVID-19 is uncertain. Objective To determine whether vitamin C improves outcomes for patients with COVID-19. Design, Setting, and Participants Two prospectively harmonized randomized clinical trials enrolled critically ill patients receiving organ support in intensive care units (90 sites) and patients who were not critically ill (40 sites) between July 23, 2020, and July 15, 2022, on 4 continents. Interventions Patients were randomized to receive vitamin C administered intravenously or control (placebo or no vitamin C) every 6 hours for 96 hours (maximum of 16 doses). Main Outcomes and Measures The primary outcome was a composite of organ support-free days defined as days alive and free of respiratory and cardiovascular organ support in the intensive care unit up to day 21 and survival to hospital discharge. Values ranged from -1 organ support-free days for patients experiencing in-hospital death to 22 organ support-free days for those who survived without needing organ support. The primary analysis used a bayesian cumulative logistic model. An odds ratio (OR) greater than 1 represented efficacy (improved survival, more organ support-free days, or both), an OR less than 1 represented harm, and an OR less than 1.2 represented futility. Results Enrollment was terminated after statistical triggers for harm and futility were met. The trials had primary outcome data for 1568 critically ill patients (1037 in the vitamin C group and 531 in the control group; median age, 60 years [IQR, 50-70 years]; 35.9% were female) and 1022 patients who were not critically ill (456 in the vitamin C group and 566 in the control group; median age, 62 years [IQR, 51-72 years]; 39.6% were female). Among critically ill patients, the median number of organ support-free days was 7 (IQR, -1 to 17 days) for the vitamin C group vs 10 (IQR, -1 to 17 days) for the control group (adjusted proportional OR, 0.88 [95% credible interval {CrI}, 0.73 to 1.06]) and the posterior probabilities were 8.6% (efficacy), 91.4% (harm), and 99.9% (futility). Among patients who were not critically ill, the median number of organ support-free days was 22 (IQR, 18 to 22 days) for the vitamin C group vs 22 (IQR, 21 to 22 days) for the control group (adjusted proportional OR, 0.80 [95% CrI, 0.60 to 1.01]) and the posterior probabilities were 2.9% (efficacy), 97.1% (harm), and greater than 99.9% (futility). Among critically ill patients, survival to hospital discharge was 61.9% (642/1037) for the vitamin C group vs 64.6% (343/531) for the control group (adjusted OR, 0.92 [95% CrI, 0.73 to 1.17]) and the posterior probability was 24.0% for efficacy. Among patients who were not critically ill, survival to hospital discharge was 85.1% (388/456) for the vitamin C group vs 86.6% (490/566) for the control group (adjusted OR, 0.86 [95% CrI, 0.61 to 1.17]) and the posterior probability was 17.8% for efficacy. Conclusions and Relevance In hospitalized patients with COVID-19, vitamin C had low probability of improving the primary composite outcome of organ support-free days and hospital survival. Trial Registration ClinicalTrials.gov Identifiers: NCT04401150 (LOVIT-COVID) and NCT02735707 (REMAP-CAP).
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Affiliation(s)
- Neill K J Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
| | | | - Rashan Haniffa
- Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, Scotland
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Abi Beane
- Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, Scotland
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Steve A Webb
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- St John of God Health Care, Perth, Australia
| | - Derek C Angus
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anthony C Gordon
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Imperial College London, London, England
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, England
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Paul R Mouncey
- Intensive Care National Audit and Research Centre, London, England
| | - Carly Au
- Intensive Care National Audit and Research Centre, London, England
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Ménard
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sheila Sprague
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marie-Hélène Masse
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - David T Huang
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alistair D Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Australia
- University College Dublin, Dublin, Ireland
- Alfred Health, Melbourne, Australia
| | - Colin J McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Angelique de Man
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Djillali Annane
- UVSQ University Paris Saclay, Institut-Hospitalo Universitaire Prometheus, Paris, France
- Médecine Intensive-Réanimation, Hôpital Raymond-Poincaré, Garches, France
| | - Matthew Anstey
- Sir Charles Gairdner Hospital, Nedlands, Australia
- University of Western Australia, Perth
| | - Yaseen M Arabi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Marie-Claude Battista
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Zahra Bhimani
- St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- European Clinical Research Alliance on Infectious Diseases, Utrecht, the Netherlands
| | | | - Emily B Brant
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Frank M Brunkhorst
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Aidan Burrell
- Alfred Health, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Meredith Buxton
- Global Coalition for Adaptive Research, Larkspur, California
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Allen C Cheng
- Monash Infectious Disease, Monash Health and School of Clinical Sciences, Monash University, Clayton, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dian Cohen
- Bishop's University, Sherbrooke, Quebec, Canada
- Massawippi Valley Foundation, Ayer's Cliff, Quebec, Canada
| | - Matthew E Cove
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andrew G Day
- Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada
| | - Lennie P G Derde
- European Clinical Research Alliance on Infectious Diseases, Utrecht, the Netherlands
- Intensive Care Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Lise J Estcourt
- Department of Haematology, NHS Blood and Transplant, Bristol, England
- Radcliffe Department of Medicine, University of Oxford, Oxford, England
| | | | | | - Herman Goossens
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
| | - Cameron Green
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Nao Ichihara
- Department of Cardiovascular Surgery, School of Medicine, Jikei University, Tokyo, Japan
| | | | - Salmaan Kanji
- Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Patrick R Lawler
- University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Edward Litton
- Fiona Stanley Hospital, Department of Intensive Care Unit, University of Western Australia, Perth
| | - John C Marshall
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Daniel F McAuley
- Queen's University of Belfast, Belfast, Northern Ireland
- Centre for Infection and Immunity, Royal Victoria Hospital, Belfast, Northern Ireland
| | | | - Shay P McGuinness
- Medical Research Institute of New Zealand, Wellington
- Auckland City Hospital, Cardiothoracic and Vascular Intensive Care Unit, Auckland, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | | | - Bryan J McVerry
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Rachael L Parke
- Medical Research Institute of New Zealand, Wellington
- Auckland City Hospital, Cardiothoracic and Vascular Intensive Care Unit, Auckland, New Zealand
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jane C Parker
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Australia
| | - Luis Felipe Reyes
- Department of Infectious Diseases, Universidad de La Sabana, Chia, Colombia
- Department of Critical Care Medicine, Clinica Universidad de La Sabana, Chia, Colombia
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, London, England
| | - Hiroki Saito
- Department of Emergency and Critical Care Medicine, St Marianna University Yokohama Seibu Hospital, Yokohama, Japan
| | - Nawal Salahuddin
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Marlene S Santos
- Department of Critical Care, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Christopher W Seymour
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Manu Shankar-Hari
- Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, Scotland
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland
| | - Timo Tolppa
- National Intensive Care Surveillance, Colombo, Sri Lanka
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care, Université Laval, Quebec City, Quebec, Canada
- Population Health and Optimal Health Practices Research Unit, Departments of Traumatology, Emergency Medicine, and Critical Care Medicine, Université Laval Research Center, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Anne M Turner
- Medical Research Institute of New Zealand, Wellington
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, Australia
| | | | - Ryan Zarychanski
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - François Lamontagne
- Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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10
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Oreibi T, Alenezi F, Ahmed AM, Humaid FB, Sadat M, Tamim HM, Baseet FF, Naidu B, Arabi YM. Outcomes of patients admitted to the intensive care unit with community-acquired pneumonia in a tertiary care center in Riyadh, Saudi Arabia. Ann Thorac Med 2023; 18:206-210. [PMID: 38058784 PMCID: PMC10697301 DOI: 10.4103/atm.atm_49_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2003] [Revised: 05/01/2023] [Accepted: 08/01/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a leading cause of intensive care unit (ICU) morbidity and mortality. Despite extensive international epidemiological and clinical studies to improve those patients' outcomes, local statistics in Saudi Arabia are limited. The objective of this study is to describe the clinical characteristics and outcomes of patients admitted to the ICU with the diagnosis of CAP reflecting the experience of a tertiary center over an 18-year period. METHODS A retrospective cohort study included all consecutive adult ICU patients diagnosed with CAP between 1999 and 2017. Baseline demographics, patients' risk factors, and initial admission laboratory investigations were compared between survivors and nonsurvivors. A multivariate regression model was used to predict mortality. RESULTS During the study period, there were 3438 patients admitted to the ICU with CAP (median age 67 [Quartile 1, 3 (Q1, Q3) 51, 76] years) and 54.4% were males, of whom 1007 (29.2%) died. The survivors compared with nonsurvivors were younger (65 vs. 70 years), less likely to have chronic liver disease (2.4% vs. 10.5%), chronic renal failure (8.1% vs. 14.4%), and be immunocompromised (10.2% vs. 18.2%), and less frequently required mechanical ventilation or vasopressors (46.2% vs. 80.5% and 29.6% vs. 55.9%, respectively). Acute Physiology and Chronic Health Evaluation (APACHE) II score was significantly higher among nonsurvivors (median score 26 vs. 20) with a longer duration of mechanical ventilation and ICU stay. Using a multivariate regression model, age, APACHE II score, bilirubin level, vasopressors, and mechanical ventilation were significantly associated with increased mortality, while diabetes was associated with lower mortality. CONCLUSION Around one-third of patients admitted to the ICU with CAP died. Mortality was significantly associated with age, APACHE II score, vasopressor use, and mechanical ventilation. A comprehensive national registry is needed to enhance epidemiological data and to guide initiatives for improving CAP patients' outcomes.
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Affiliation(s)
- Talal Oreibi
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Farhan Alenezi
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amjad M. Ahmed
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Felwa Bin Humaid
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Musharaf Sadat
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hani Mohammed Tamim
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- American University of Beirut-Medical Center, Beirut, Lebanon
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Faisal Fouad Baseet
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Brintha Naidu
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yaseen M. Arabi
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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11
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Karthika M, Al Enezi FA, Pillai LV, Arabi YM. Rate of Change of Rapid Shallow Breathing Index and Extubation Outcome in Mechanically Ventilated Patients. Crit Care Res Pract 2023; 2023:9141441. [PMID: 37795474 PMCID: PMC10547562 DOI: 10.1155/2023/9141441] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 10/06/2023] Open
Abstract
Background Rapid shallow breathing index (RSBI) has been widely used as a predictor of extubation outcome in mechanically ventilated patients. We hypothesize that the rate of change of RSBI between the beginning and end of a 120-minute spontaneous breathing trial (SBT) could be a better predictor of extubation outcome than a single RSBI measured at the end of SBT in mechanically ventilated patients. Methodology. In this prospective observational study, we enrolled 193 patients who met the inclusion criteria, of whom 33 patients were unable to tolerate a 120-minute SBT and were excluded from the study. The study population consisted of 160 patients, categorized into three subgroups: patients with normal lung (no reported history of respiratory diseases), patients with airway disease, and patients with parenchymal disease who completed 120 minutes of SBT on low levels of pressure support ventilation. RSBI was obtained from the ventilator display at the 5th and the 120th minutes of SBT. The rate of change of RSBI (RSBI 5-120) was calculated as (RSBI 2-RSBI 1)/RSBI 1 × 100. Receiver-operating characteristic (ROC) curves were plotted for RSBI 5-120 and RSBI 120 in all patients and among the three subgroups (normal group, airway group, and parenchymal group) to compare the superiority of their best thresholds in predicting extubation failure. Results The RSBI 5-120 threshold for extubation failure in the entire patient group was 23% with an overall accuracy of 88% (AUC = 0.933, sensitivity = 91%, and specificity = 86%) and the threshold of RSBI 120 for extubation failure in the entire patient group was 70 breaths/min/L with an overall accuracy of 82% (AUC = 0.899, sensitivity = 85%, and specificity = 81%). In patients in the normal lung group, the threshold of RSBI 5-120 was 22%, with an overall accuracy of 89% (AUC = 0.892, sensitivity = 87.5%, and specificity = 90%), and the RSBI 120 threshold was 70 breaths/min/L, with an overall accuracy of 89% (AUC = 0.956, sensitivity = 88%, and specificity = 90%). The RSBI 5-120 threshold in patients with airway disease was 25% with an accuracy of 86% (AUC = 0.892, sensitivity = 85%, and specificity = 86%) and the threshold of RSBI 120 was 73 breaths/min/L with an accuracy of 83% (AUC = 0.874, sensitivity = 85%, and specificity = 82%). In patients in the parenchymal disease group, the threshold of RSBI 5-120 was 24%, with an accuracy of 90% (AUC = 0.966, sensitivity = 92%, and specificity = 89%) and RSBI 120 threshold was 71 breaths/min/L, which was 88% accurate (AUC = 0.893, sensitivity = 85%, and specificity = 89%). Conclusion The rate of change of RSBI between the 5th and 120th minutes was moderately more accurate than the single value of RSBI measured at the 120th minute in predicting extubation outcome.
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Affiliation(s)
- Manjush Karthika
- Faculty of Medical and Health Sciences, Liwa College, Abu Dhabi, UAE
- Faculty of Medical and Health Sciences, Symbiosis Centre for Research and Innovation, Symbiosis International University, Pune, India
| | - Farhan A. Al Enezi
- Intensive Care Department, King Abdulaziz Medical City, King Saud Bin Abdulaziz University of Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Lalitha V. Pillai
- Faculty of Medical and Health Sciences, Symbiosis Centre for Research and Innovation, Symbiosis International University, Pune, India
- Department of Critical Care Medicine, Aundh Institute of Medical Sciences, Pune, India
| | - Yaseen M. Arabi
- Intensive Care Department, King Abdulaziz Medical City, King Saud Bin Abdulaziz University of Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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12
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Arabi YM, Diaz J, Lamontagne F. Coronavirus disease 2019. Intensive Care Med 2023; 49:1103-1106. [PMID: 37505257 DOI: 10.1007/s00134-023-07168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Yaseen M Arabi
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, King Abdullah International Medical Research Center, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Janet Diaz
- World Health Organization, Geneva, Switzerland
| | - François Lamontagne
- Université de Sherbrooke, Centre de recherche du CHU, Sherbrooke, QC, Canada
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13
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Wetterslev M, Hylander Møller M, Granholm A, Hassager C, Haase N, Lange T, Myatra SN, Hästbacka J, Arabi YM, Shen J, Cronhjort M, Lindqvist E, Aneman A, Young PJ, Szczeklik W, Siegemund M, Koster T, Aslam TN, Bestle MH, Girkov MS, Kalvit K, Mohanty R, Mascarenhas J, Pattnaik M, Vergis S, Haranath SP, Shah M, Joshi Z, Wilkman E, Reinikainen M, Lehto P, Jalkanen V, Pulkkinen A, An Y, Wang G, Huang L, Huang B, Liu W, Gao H, Dou L, Li S, Yang W, Tegnell E, Knight A, Czuczwar M, Czarnik T, Perner A. Atrial Fibrillation (AFIB) in the ICU: Incidence, Risk Factors, and Outcomes: The International AFIB-ICU Cohort Study. Crit Care Med 2023; 51:1124-1137. [PMID: 37078722 DOI: 10.1097/ccm.0000000000005883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES To assess the incidence, risk factors, and outcomes of atrial fibrillation (AF) in the ICU and to describe current practice in the management of AF. DESIGN Multicenter, prospective, inception cohort study. SETTING Forty-four ICUs in 12 countries in four geographical regions. SUBJECTS Adult, acutely admitted ICU patients without a history of persistent/permanent AF or recent cardiac surgery were enrolled; inception periods were from October 2020 to June 2021. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We included 1,423 ICU patients and analyzed 1,415 (99.4%), among whom 221 patients had 539 episodes of AF. Most (59%) episodes were diagnosed with continuous electrocardiogram monitoring. The incidence of AF was 15.6% (95% CI, 13.8-17.6), of which newly developed AF was 13.3% (11.5-15.1). A history of arterial hypertension, paroxysmal AF, sepsis, or high disease severity at ICU admission was associated with AF. Used interventions to manage AF were fluid bolus 19% (95% CI 16-23), magnesium 16% (13-20), potassium 15% (12-19), amiodarone 51% (47-55), beta-1 selective blockers 34% (30-38), calcium channel blockers 4% (2-6), digoxin 16% (12-19), and direct current cardioversion in 4% (2-6). Patients with AF had more ischemic, thromboembolic (13.6% vs 7.9%), and severe bleeding events (5.9% vs 2.1%), and higher mortality (41.2% vs 25.2%) than those without AF. The adjusted cause-specific hazard ratio for 90-day mortality by AF was 1.38 (95% CI, 0.95-1.99). CONCLUSIONS In ICU patients, AF occurred in one of six and was associated with different conditions. AF was associated with worse outcomes while not statistically significantly associated with 90-day mortality in the adjusted analyses. We observed variations in the diagnostic and management strategies for AF.
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Affiliation(s)
- Mik Wetterslev
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Granholm
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Haase
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Theis Lange
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Sheila N Myatra
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Johanna Hästbacka
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Yaseen M Arabi
- Department of Intensive Care Medicine, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Jiawei Shen
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Maria Cronhjort
- Department of Clinical Science and Education, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Elin Lindqvist
- Department of Clinical Science and Education, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Anders Aneman
- Department of Intensive Care Medicine, Liverpool Hospital, Liverpool, NSW, Australia
- South Western Clinical School, University of New South Wales, Warwick Farm, NSW, Australia
| | - Paul J Young
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Martin Siegemund
- Intensive Care Medicine, Department of Acute Medicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Thijs Koster
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tayyba Naz Aslam
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - North Zealand, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mia S Girkov
- Department of Anaesthesia and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kushal Kalvit
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rakesh Mohanty
- Department of Anaesthesiology Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Joanne Mascarenhas
- Department of Medicine and Critical Care, Breach Candy Hospital Trust, Mumbai, India
| | - Manoranjan Pattnaik
- Department of Pulmonary Medicine, SCB Medical College & Hospital, Cuttack, India
| | - Sara Vergis
- Department of Anaesthesia and Critical Care, MOSC Medical College, Kolenchery, India
| | | | - Mehul Shah
- Department of Critical Care Medicine, Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Ziyokov Joshi
- Department of Cardiac Anaesthesiology and Critical Care, Tagore Hospital, Jalandhar, India
| | - Erika Wilkman
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Pasi Lehto
- Department of Anaesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland
| | - Ville Jalkanen
- Department of Intensive Care, Tampere University Hospital, Tampere, Finland
| | - Anni Pulkkinen
- Department of Anesthesia and Intensive Care, Central Finland Central Hospital, Central Finland Health Care District, Jyväskylä, Finland
| | - Youzhong An
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Guoxing Wang
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lei Huang
- Department of Intensive Care Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Bin Huang
- Department of Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wei Liu
- Department of Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Hengbo Gao
- Department of Critical Care Medicine, The Second Hospital, Hebei Medical University, Hebei, China
| | - Lin Dou
- Department of Intensive Care Medicine, Tianjin First Center Hospital, Tianjin, China
| | - Shuangling Li
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Wanchun Yang
- Emergency Intensive Care Unit, Xinjiang Production and Construction Crops 13 div Red Star Hospital
| | - Emily Tegnell
- Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Agnes Knight
- Department of Anaesthesia and Intensive Care, Hudiksvall Hospital, Hudiksvall, Sweden
| | - Miroslaw Czuczwar
- Second Department of Anesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Tomasz Czarnik
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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14
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Relan P, Murthy S, Marshall JC, Annane D, Chevret S, Arabi YM, Waweru-Siika W, Dominguez Rodriguez S, Convocar P, Diaz J. WHO O2CoV2: oxygen requirements and respiratory support in patients with COVID-19 in low-and-middle income countries-protocol for a multicountry, prospective, observational cohort study. BMJ Open 2023; 13:e071346. [PMID: 37591648 PMCID: PMC10441039 DOI: 10.1136/bmjopen-2022-071346] [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: 01/09/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION SARS-CoV-2 has been identified as the cause of the disease officially named COVID-19, primarily a respiratory illness. COVID-19 was characterised as a pandemic on 11 March 2020. It has been estimated that approximately 20% of people with COVID-19 require oxygen therapy. Oxygen has been listed on the WHO Model List of Essential Medicines List and Essential Medicines List for Children for almost two decades. The COVID-19 pandemic has highlighted, more than ever, the acute need for scale-up of oxygen therapy. Detailed data on the use of oxygen therapy in low-and-middle income countries at the patient and facility level are needed to target interventions better globally. METHODS AND ANALYSIS We aim to describe the requirements and use of oxygen at the facility and patient level of approximately 4500 patients with COVID-19 in 30 countries. Our objectives are specifically to characterise type and duration of different modalities of oxygen therapy delivered to patients; describe demographics and outcomes of hospitalised patients with COVID-19; and describe facility-level oxygen production and support. Primary analyses will be descriptive in nature. Respiratory support transitions will be described in Sankey plots, and Kaplan-Meier models will be used to estimate probability of each transition. A multistate model will be used to study the course of hospital stay of the study population, evaluating transitions of escalating respiratory support transitions to the absorbing states. ETHICS AND DISSEMINATION WHO Ad Hoc COVID-19 Research Ethics Review Committee (ERC) has approved this global protocol. When this protocol is adopted at specific country sites, national ERCs may make require adjustments in accordance with their respective national research ethics guidelines. Dissemination of this protocol and global findings will be open access through peer-reviewed scientific journals, study website, press and online media. TRIAL REGISTRATION NUMBER NCT04918875.
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Affiliation(s)
| | - Srinivas Murthy
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Djillali Annane
- IHU PROMETHEUS, General ICU, Raymond Poincaré Hospital, University Paris Saclay campus Versailles, APHP, Garches, France
| | - Sylvie Chevret
- UMR1153, Université Paris Cité and INSERM, Paris, France
| | - Yaseen M Arabi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | | | - Pauline Convocar
- Corazon Locsin Montelibano Memorial Medical Hospital, Manila Doctors Hospital, Southern Philippines Medical Center, Manila, Philippines
| | - Janet Diaz
- World Health Organization, Geneva, Switzerland
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15
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Arabi YM, Al-Dorzi HM, Sadat M, Muharib D, Algethamy H, Al-Hameed F, Mady A, AlGhamdi A, Almekhlafi GA, Al-Fares AA, Kharaba A, Al Bshabshe A, Maghrabi K, Al Ghamdi K, Rasool G, Chalabi J, AlHumedi HI, Sakkijha MH, Alamrey NK, Alhutail RH, Sifaoui K, Almaani M, Alqahtani R, Qureshi AS, Hejazi MM, Arishi H, AlQahtani S, Ghazi AM, Baaziz ST, Azhar AO, Alabbas SF, AlAqeely M, AlOrabi O, Al-Mutawa A, AlOtaibi M, Aldibaasi O, Jose J, Starkopf J, Preiser JC, Perner A, Al-Dawood A. Replacing protein via enteral nutrition in a stepwise approach in critically ill patients: the REPLENISH randomized clinical trial protocol. Trials 2023; 24:485. [PMID: 37518058 PMCID: PMC10388494 DOI: 10.1186/s13063-023-07507-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/11/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Protein intake is recommended in critically ill patients to mitigate the negative effects of critical illness-induced catabolism and muscle wasting. However, the optimal dose of enteral protein remains unknown. We hypothesize that supplemental enteral protein (1.2 g/kg/day) added to standard enteral nutrition formula to achieve high amount of enteral protein (range 2-2.4 g/kg/day) given from ICU day 5 until ICU discharge or ICU day 90 as compared to no supplemental enteral protein to achieve moderate amount enteral protein (0.8-1.2 g/kg/day) would reduce all-cause 90-day mortality in adult critically ill mechanically ventilated patients. METHODS The REPLENISH (Replacing Protein Via Enteral Nutrition in a Stepwise Approach in Critically Ill Patients) trial is an open-label, multicenter randomized clinical trial. Patients will be randomized to the supplemental protein group or the control group. Patients in both groups will receive the primary enteral formula as per the treating team, which includes a maximum protein 1.2 g/kg/day. The supplemental protein group will receive, in addition, supplemental protein at 1.2 g/kg/day starting the fifth ICU day. The control group will receive the primary formula without supplemental protein. The primary outcome is 90-day all-cause mortality. Other outcomes include functional and quality of life assessments at 90 days. The trial will enroll 2502 patients. DISCUSSION The study has been initiated in September 2021. Interim analysis is planned at one third and two thirds of the target sample size. The study is expected to be completed by the end of 2025. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04475666 . Registered on July 17, 2020.
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Affiliation(s)
- Yaseen M Arabi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Hasan M Al-Dorzi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Musharaf Sadat
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Dina Muharib
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Haifa Algethamy
- Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad Al-Hameed
- Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed Mady
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- College of Medicine, Tanta University, Tanta, Egypt
| | - Adnan AlGhamdi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ghaleb A Almekhlafi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman A Al-Fares
- Department of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Ayman Kharaba
- Pulmonary & Critical Care Departments, King Fahad Hospital, Medinah, Saudi Arabia
- Critical Care Units, Ministry of Health, Madinah, Saudi Arabia
| | - Ali Al Bshabshe
- Department of Critical Care Medicine, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| | - Khalid Maghrabi
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khalid Al Ghamdi
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Ghulam Rasool
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Jamal Chalabi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Abdulaziz Hospital, Ministry of National Guard Health Affairs, AlAhsa, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, AlAhsa, Saudi Arabia
| | - Haifaa Ibrahim AlHumedi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maram Hasan Sakkijha
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Norah Khalid Alamrey
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Rabeah Hamad Alhutail
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Kaouthar Sifaoui
- Pulmonary & Critical Care Departments, King Fahad Hospital, Medinah, Saudi Arabia
- Critical Care Units, Ministry of Health, Madinah, Saudi Arabia
| | - Mohammed Almaani
- Adult Critical Care Services, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Rakan Alqahtani
- Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad S Qureshi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Intensive Care Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, Madinah, Saudi Arabia
| | - Mohammed Moneer Hejazi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hatim Arishi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Samah AlQahtani
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amro Mohamed Ghazi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saleh T Baaziz
- Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abeer Othman Azhar
- Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sara Fahad Alabbas
- Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed AlAqeely
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ohoud AlOrabi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Aliaa Al-Mutawa
- Department of Nutrition, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Maha AlOtaibi
- Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Omar Aldibaasi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Jesna Jose
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Joel Starkopf
- Clinic of Anaesthesiology and Intensive Care, University of Tartu, Tartu University Hospital, Tartu, Estonia
| | | | - Anders Perner
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Abdulaziz Al-Dawood
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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16
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Grasselli G, Calfee CS, Camporota L, Poole D, Amato MBP, Antonelli M, Arabi YM, Baroncelli F, Beitler JR, Bellani G, Bellingan G, Blackwood B, Bos LDJ, Brochard L, Brodie D, Burns KEA, Combes A, D'Arrigo S, De Backer D, Demoule A, Einav S, Fan E, Ferguson ND, Frat JP, Gattinoni L, Guérin C, Herridge MS, Hodgson C, Hough CL, Jaber S, Juffermans NP, Karagiannidis C, Kesecioglu J, Kwizera A, Laffey JG, Mancebo J, Matthay MA, McAuley DF, Mercat A, Meyer NJ, Moss M, Munshi L, Myatra SN, Ng Gong M, Papazian L, Patel BK, Pellegrini M, Perner A, Pesenti A, Piquilloud L, Qiu H, Ranieri MV, Riviello E, Slutsky AS, Stapleton RD, Summers C, Thompson TB, Valente Barbas CS, Villar J, Ware LB, Weiss B, Zampieri FG, Azoulay E, Cecconi M. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med 2023; 49:727-759. [PMID: 37326646 PMCID: PMC10354163 DOI: 10.1007/s00134-023-07050-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 97.0] [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: 01/12/2023] [Accepted: 03/24/2023] [Indexed: 06/17/2023]
Abstract
The aim of these guidelines is to update the 2017 clinical practice guideline (CPG) of the European Society of Intensive Care Medicine (ESICM). The scope of this CPG is limited to adult patients and to non-pharmacological respiratory support strategies across different aspects of acute respiratory distress syndrome (ARDS), including ARDS due to coronavirus disease 2019 (COVID-19). These guidelines were formulated by an international panel of clinical experts, one methodologist and patients' representatives on behalf of the ESICM. The review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations and the quality of reporting of each study based on the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) network guidelines. The CPG addressed 21 questions and formulates 21 recommendations on the following domains: (1) definition; (2) phenotyping, and respiratory support strategies including (3) high-flow nasal cannula oxygen (HFNO); (4) non-invasive ventilation (NIV); (5) tidal volume setting; (6) positive end-expiratory pressure (PEEP) and recruitment maneuvers (RM); (7) prone positioning; (8) neuromuscular blockade, and (9) extracorporeal life support (ECLS). In addition, the CPG includes expert opinion on clinical practice and identifies the areas of future research.
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Affiliation(s)
- Giacomo Grasselli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Carolyn S Calfee
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Daniele Poole
- Operative Unit of Anesthesia and Intensive Care, S. Martino Hospital, Belluno, Italy
| | | | - Massimo Antonelli
- Department of Anesthesiology Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of the National Guard - Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Francesca Baroncelli
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Torino, Italy
| | - Jeremy R Beitler
- Center for Acute Respiratory Failure and Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, NY, USA
| | - Giacomo Bellani
- Centre for Medical Sciences - CISMed, University of Trento, Trento, Italy
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, APSS Trento, Trento, Italy
| | - Geoff Bellingan
- Intensive Care Medicine, University College London, NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Lieuwe D J Bos
- Intensive Care, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Laurent Brochard
- Keenan Research Center, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Daniel Brodie
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Division of Critical Care, Unity Health Toronto - Saint Michael's Hospital, Toronto, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Alain Combes
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Sonia D'Arrigo
- Department of Anesthesiology Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Demoule
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France
| | - Sharon Einav
- Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Niall D Ferguson
- Department of Medicine, Division of Respirology and Critical Care, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
- Departments of Medicine and Physiology, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Jean-Pierre Frat
- CHU De Poitiers, Médecine Intensive Réanimation, Poitiers, France
- INSERM, CIC-1402, IS-ALIVE, Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France
| | - Luciano Gattinoni
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Claude Guérin
- University of Lyon, Lyon, France
- Institut Mondor de Recherches Biomédicales, INSERM 955 CNRS 7200, Créteil, France
| | - Margaret S Herridge
- Critical Care and Respiratory Medicine, University Health Network, Toronto General Research Institute, Institute of Medical Sciences, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Carol Hodgson
- The Australian and New Zealand Intensive Care Research Center, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Intensive Care, Alfred Health, Melbourne, Australia
| | - Catherine L Hough
- Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Samir Jaber
- Anesthesia and Critical Care Department (DAR-B), Saint Eloi Teaching Hospital, University of Montpellier, Research Unit: PhyMedExp, INSERM U-1046, CNRS, 34295, Montpellier, France
| | - Nicole P Juffermans
- Laboratory of Translational Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken Der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arthur Kwizera
- Makerere University College of Health Sciences, School of Medicine, Department of Anesthesia and Intensive Care, Kampala, Uganda
| | - John G Laffey
- Anesthesia and Intensive Care Medicine, School of Medicine, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
- Anesthesia and Intensive Care Medicine, Galway University Hospitals, Saolta University Hospitals Groups, Galway, Ireland
| | - Jordi Mancebo
- Intensive Care Department, Hospital Universitari de La Santa Creu I Sant Pau, Barcelona, Spain
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA, USA
| | - Daniel F McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Alain Mercat
- Département de Médecine Intensive Réanimation, CHU d'Angers, Université d'Angers, Angers, France
| | - Nuala J Meyer
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, Canada
| | - Sheila N Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Michelle Ng Gong
- Division of Pulmonary and Critical Care Medicine, Montefiore Medical Center, Bronx, New York, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Laurent Papazian
- Bastia General Hospital Intensive Care Unit, Bastia, France
- Aix-Marseille University, Faculté de Médecine, Marseille, France
| | - Bhakti K Patel
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Mariangela Pellegrini
- Anesthesia and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Antonio Pesenti
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Lise Piquilloud
- Adult Intensive Care Unit, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Marco V Ranieri
- Alma Mater Studiorum - Università di Bologna, Bologna, Italy
- Anesthesia and Intensive Care Medicine, IRCCS Policlinico di Sant'Orsola, Bologna, Italy
| | - Elisabeth Riviello
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Renee D Stapleton
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Charlotte Summers
- Department of Medicine, University of Cambridge Medical School, Cambridge, UK
| | - Taylor B Thompson
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Carmen S Valente Barbas
- University of São Paulo Medical School, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jesús Villar
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | - Lorraine B Ware
- Departments of Medicine and Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Björn Weiss
- Department of Anesthesiology and Intensive Care Medicine (CCM CVK), Charitè - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Fernando G Zampieri
- Academic Research Organization, Albert Einstein Hospital, São Paulo, Brazil
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Elie Azoulay
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris Cité University, Paris, France
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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17
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Skrifvars MB, Luethi N, Bailey M, French C, Nichol A, Trapani T, McArthur C, Arabi YM, Bendel S, Cooper DJ, Bellomo R. The effect of recombinant erythropoietin on long-term outcome after moderate-to-severe traumatic brain injury. Intensive Care Med 2023; 49:831-839. [PMID: 37405413 PMCID: PMC10353955 DOI: 10.1007/s00134-023-07141-5] [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] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE Recombinant erythropoietin (EPO) administered for traumatic brain injury (TBI) may increase short-term survival, but the long-term effect is unknown. METHODS We conducted a pre-planned long-term follow-up of patients in the multicentre erythropoietin in TBI trial (2010-2015). We invited survivors to follow-up and evaluated survival and functional outcome with the Glasgow Outcome Scale-Extended (GOSE) (categories 5-8 = good outcome), and secondly, with good outcome determined relative to baseline function (sliding scale). We used survival analysis to assess time to death and absolute risk differences (ARD) to assess favorable outcomes. We categorized TBI severity with the International Mission for Prognosis and Analysis of Clinical Trials in TBI model. Heterogeneity of treatment effects were assessed with interaction p-values based on the following a priori defined subgroups, the severity of TBI, and the presence of an intracranial mass lesion and multi-trauma in addition to TBI. RESULTS Of 603 patients in the original trial, 487 patients had survival data; 356 were included in the follow-up at a median of 6 years from injury. There was no difference between treatment groups for patient survival [EPO vs placebo hazard ratio (HR) (95% confidence interval (CI) 0.73 (0.47-1.14) p = 0.17]. Good outcome rates were 110/175 (63%) in the EPO group vs 100/181 (55%) in the placebo group (ARD 8%, 95% CI [Formula: see text] 3 to 18%, p = 0.14). When good outcome was determined relative to baseline risk, the EPO groups had better GOSE (sliding scale ARD 12%, 95% CI 2-22%, p = 0.02). When considering long-term patient survival, there was no evidence for heterogeneity of treatment effect (HTE) according to severity of TBI (p = 0.85), presence of an intracranial mass lesion (p = 0.48), or whether the patient had multi-trauma in addition to TBI (p = 0.08). Similarly, no evidence of treatment heterogeneity was seen for the effect of EPO on functional outcome. CONCLUSION EPO neither decreased overall long-term mortality nor improved functional outcome in moderate or severe TBI patients treated in the intensive care unit (ICU). The limited sample size makes it difficult to make final conclusions about the use of EPO in TBI.
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Affiliation(s)
- Markus B Skrifvars
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, PB 340, 00029 HUS, Helsinki, Finland.
| | - Nora Luethi
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Craig French
- Department of Intensive Care, Western Health, Melbourne, VIC, Australia
| | - Alistair Nichol
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Colin McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Yaseen M Arabi
- Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Stepani Bendel
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital and University of Eastern, Kuopio, Finland
| | - David J Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
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18
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Pirracchio R, Annane D, Waschka AK, Lamontagne F, Arabi YM, Bollaert PE, Billot L, Du B, Briegel J, Cohen J, Finfer S, Gordon A, Hammond N, Hyvernat H, Keh D, Li Y, Liu L, Meduri GU, Mirea L, Myburgh JA, Sprung CL, Tilouche N, Tongyoo S, Venkatesh B, Zheng R, Delaney A. Patient-Level Meta-Analysis of Low-Dose Hydrocortisone in Adults with Septic Shock. NEJM Evid 2023; 2:EVIDoa2300034. [PMID: 38320130 DOI: 10.1056/evidoa2300034] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Low-Dose Hydrocortisone and Septic ShockCorticosteroids have been evaluated as a therapy for septic shock for more than 50 years. However, uncertainty persists about their effects on mortality. Pirracchio and colleagues undertake a patient-level meta-analysis to answer this important question.
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Affiliation(s)
- Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco
| | - Djillali Annane
- General Intensive Care Unit, Raymond Poincaré Hospital (APHP), Garches, France
- School of Medicine Simone Veil, University Paris Saclay-Campus UVSQ, Paris
- FHU SEPSIS, U1173, University Paris Saclay, INSERM, Paris
| | - Andre K Waschka
- Department of Statistics, University of California Berkeley, Berkeley
- Department of Mathematics, Mercer University, Macon, Georgia
| | - François Lamontagne
- Département de médecine interne, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of the National Guard-Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Laurent Billot
- The George Institute for Global Health, University of New South Wales Sydney, Sydney
| | - Bin Du
- State Key Laboratory of Complex Severe and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Beijing
| | - Josef Briegel
- Department of Anesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Jeremy Cohen
- Intensive Care Unit, The Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales Sydney, Sydney
- School of Public Health, Imperial College London, London
| | - Anthony Gordon
- Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London
| | - Naomi Hammond
- The George Institute for Global Health, University of New South Wales Sydney, Sydney
- Newtown, NSW, Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Herve Hyvernat
- Intensive Care Unit, Hôpital ARCHET 1-CHU de Nice, Nice, France
| | - Didier Keh
- Klinik für Anästhsiologie m.S. Canpus Virchow-Klinikum, Charite University Berlin, Berlin
| | - Yi Li
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing
- Chinese Academy of Medical Science and Peking Union Medical College, Beijing
| | - Ling Liu
- Department of Critical Medicine, Zhong-Da Hospital, and School of Clinical Medicine, Southeast University, Nanjing, China
| | | | - Liliana Mirea
- Anaesthesia and Intensive Care Clinic, Clinical Emergency Hospital of Bucharest, Carol Davila University of Medicine, Bucharest, Romania
| | - John A Myburgh
- The George Institute for Global Health, University of New South Wales Sydney, Sydney
| | - Charles L Sprung
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem
| | - Neijla Tilouche
- Intensive Care Unit, University Hospital Taher Sfar Mahdia, University of Monastir, Research Laboratory, Monastir, Tunisia
| | - Surat Tongyoo
- Division of Critical Care, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Balasubramanian Venkatesh
- The George Institute for Global Health, University of New South Wales Sydney, Sydney
- Wesley Hospital, George Institute for Global Health, University of New South Wales, Sydney
| | - Ruiqiang Zheng
- Department of Critical Care Medicine, Northern Jiangsu People's Hospital; Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Anthony Delaney
- The George Institute for Global Health, University of New South Wales Sydney, Sydney
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney
- Northern Clinical School, Sydney Medical School, University of Sydney, Sydney
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19
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Young PJ, Al-Fares A, Aryal D, Arabi YM, Ashraf MS, Bagshaw SM, Beane A, de Oliveira Manoel AL, Dullawe L, Fazla F, Fujii T, Haniffa R, Hodgson CL, Hunt A, Tirupakuzhi Vijayaraghavan BK, Landoni G, Lawrence C, Maia IS, Mackle D, Mazlan MZ, Nichol AD, Olatunji S, Rashan A, Rashan S, Kasza J. Protocol and statistical analysis plan for the mega randomised registry trial comparing conservative vs. liberal oxygenation targets in adults with sepsis in the intensive care unit (Mega-ROX Sepsis). CRIT CARE RESUSC 2023; 25:106-112. [PMID: 37876605 PMCID: PMC10581255 DOI: 10.1016/j.ccrj.2023.04.008] [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: 10/26/2023]
Abstract
Background The effect of conservative vs. liberal oxygen therapy on 90-day in-hospital mortality in adults with sepsis receiving unplanned invasive mechanical ventilation in the intensive care unit (ICU) is uncertain. Objective The objective of this study was to summarise the protocol and statistical analysis plan for the Mega-ROX Sepsis trial. Design setting and participants The Mega-ROX Sepsis trial is an international randomised clinical trial that will be conducted within an overarching 40,000-patient registry-embedded clinical trial comparing conservative and liberal ICU oxygen therapy regimens. We anticipate that between 10,000 and 13,000 patients with sepsis who are receiving unplanned invasive mechanical ventilation in the ICU will be enrolled in this trial. Main outcome measures The primary outcome is in-hospital all-cause mortality up to 90 days from the date of randomisation. Secondary outcomes include duration of survival, duration of mechanical ventilation, ICU length of stay, hospital length of stay, and the proportion of patients discharged home. Results and conclusions Mega-ROX Sepsis will compare the effect of conservative vs. liberal oxygen therapy on 90-day in-hospital mortality in adults with sepsis who are receiving unplanned invasive mechanical ventilation in the ICU. The protocol and a prespecified approach to analyses are reported here to mitigate analysis bias.
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Affiliation(s)
- Paul J. Young
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Abdulrahman Al-Fares
- Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait
- Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Respiratory and Cardiac Failure, Ministry of Health, Kuwait
| | - Diptesh Aryal
- Nepal Intensive Care Research Foundation, Kathmandu, Nepal
| | - Yaseen M. Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | - Sean M. Bagshaw
- Department of Critical Care Medicine, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
| | - Abigail Beane
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
| | | | - Layoni Dullawe
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
| | - Fathima Fazla
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
| | - Tomoko Fujii
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Rashan Haniffa
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- University College Hospital, London, United Kingdom
| | - Carol L. Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- The Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Anna Hunt
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Cassie Lawrence
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Diane Mackle
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Mohd Zulfakar Mazlan
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Anaesthesiology and Intensive Care, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
| | - Alistair D. Nichol
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- The Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- School of Medicine and Medical Sciences, University College Dublin, Ireland
- Department of Anaesthesia and Intensive Care, St Vincent's Hospital, Dublin, Ireland
| | - Shaanti Olatunji
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Aasiyah Rashan
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
- University College London, Institute of Health Informatics, London, United Kingdom
| | - Sumayyah Rashan
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - for the Mega-ROX management committee
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait
- Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Respiratory and Cardiac Failure, Ministry of Health, Kuwait
- Nepal Intensive Care Research Foundation, Kathmandu, Nepal
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Anesthesia and Critical Care Unit, Lady Reading Hospital, Peshawar, Pakistan
- Department of Critical Care Medicine, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
- Department of Critical Care Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- University College Hospital, London, United Kingdom
- The Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, India
- The George Institute for Global Health, New Delhi, India
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- HCor Research Institute, São Paulo, Brazil
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Anaesthesiology and Intensive Care, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- School of Medicine and Medical Sciences, University College Dublin, Ireland
- Department of Anaesthesia and Intensive Care, St Vincent's Hospital, Dublin, Ireland
- University College London, Institute of Health Informatics, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - the Australian and New Zealand Intensive Care Society Clinical Trials Group
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait
- Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Respiratory and Cardiac Failure, Ministry of Health, Kuwait
- Nepal Intensive Care Research Foundation, Kathmandu, Nepal
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Anesthesia and Critical Care Unit, Lady Reading Hospital, Peshawar, Pakistan
- Department of Critical Care Medicine, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
- Department of Critical Care Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- University College Hospital, London, United Kingdom
- The Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, India
- The George Institute for Global Health, New Delhi, India
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- HCor Research Institute, São Paulo, Brazil
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Anaesthesiology and Intensive Care, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- School of Medicine and Medical Sciences, University College Dublin, Ireland
- Department of Anaesthesia and Intensive Care, St Vincent's Hospital, Dublin, Ireland
- University College London, Institute of Health Informatics, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - the Critical Care Asia and Africa Network
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait
- Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Respiratory and Cardiac Failure, Ministry of Health, Kuwait
- Nepal Intensive Care Research Foundation, Kathmandu, Nepal
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Anesthesia and Critical Care Unit, Lady Reading Hospital, Peshawar, Pakistan
- Department of Critical Care Medicine, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
- Department of Critical Care Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- University College Hospital, London, United Kingdom
- The Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, India
- The George Institute for Global Health, New Delhi, India
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- HCor Research Institute, São Paulo, Brazil
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Anaesthesiology and Intensive Care, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- School of Medicine and Medical Sciences, University College Dublin, Ireland
- Department of Anaesthesia and Intensive Care, St Vincent's Hospital, Dublin, Ireland
- University College London, Institute of Health Informatics, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - the Irish Critical Care-Clinical Trials Group
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait
- Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Respiratory and Cardiac Failure, Ministry of Health, Kuwait
- Nepal Intensive Care Research Foundation, Kathmandu, Nepal
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Anesthesia and Critical Care Unit, Lady Reading Hospital, Peshawar, Pakistan
- Department of Critical Care Medicine, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
- Department of Critical Care Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- University College Hospital, London, United Kingdom
- The Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, India
- The George Institute for Global Health, New Delhi, India
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- HCor Research Institute, São Paulo, Brazil
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Anaesthesiology and Intensive Care, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
- School of Medicine and Medical Sciences, University College Dublin, Ireland
- Department of Anaesthesia and Intensive Care, St Vincent's Hospital, Dublin, Ireland
- University College London, Institute of Health Informatics, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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20
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Amer M, Alshahrani MS, Arabi YM, Al-Jedai A, Alshaqaq HM, Al-Sharydah A, Al-Suwaidan FA, Aljehani H, Nouh T, Mashbari H, Tarazan N, Alqahtani S, Tashkandi W, Maghrabi K, Albugami M, Hashim S, Alsubaie NM, Alsenani M, Algethamy H, Alshammari TM, Alaklabi A, Ismail N, Altawil ES, Elhazmi A, Nahhas A, Aljuaid M, Alsadoon N, Binbraik Y, Yuan Y, Alhazzani W. Saudi Critical Care Society clinical practice guidelines on the prevention of venous thromboembolism in adults with trauma: reviewed for evidence-based integrity and endorsed by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. Ann Intensive Care 2023; 13:41. [PMID: 37165105 PMCID: PMC10172441 DOI: 10.1186/s13613-023-01135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/23/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND To develop evidence-based clinical practice guidelines on venous thromboembolism (VTE) prevention in adults with trauma in inpatient settings. METHODS The Saudi Critical Care Society (SCCS) sponsored guidelines development and included 22 multidisciplinary panel members who completed conflict-of-interest forms. The panel developed and answered structured guidelines questions. For each question, the literature was searched for relevant studies. To summarize treatment effects, meta-analyses were conducted or updated. Quality of evidence was assessed using the Grading Recommendations, Assessment, Development, and Evaluation (GRADE) approach, then the evidence-to-decision (EtD) framework was used to generate recommendations. Recommendations covered the following prioritized domains: timing of pharmacologic VTE prophylaxis initiation in non-operative blunt solid organ injuries; isolated blunt traumatic brain injury (TBI); isolated blunt spine trauma or fracture and/or spinal cord injury (SCI); type and dose of pharmacologic VTE prophylaxis; mechanical VTE prophylaxis; routine duplex ultrasonography (US) surveillance; and inferior vena cava filters (IVCFs). RESULTS The panel issued 12 clinical practice recommendations-one, a strong recommendation, 10 weak, and one with no recommendation due to insufficient evidence. The panel suggests starting early pharmacologic VTE prophylaxis for non-operative blunt solid organ injuries, isolated blunt TBIs, and SCIs. The panel suggests using low molecular weight heparin (LMWH) over unfractionated heparin (UFH) and suggests either intermediate-high dose LMWH or conventional dosing LMWH. For adults with trauma who are not pharmacologic candidates, the panel strongly recommends using mechanical VTE prophylaxis with intermittent pneumatic compression (IPC). The panel suggests using either combined VTE prophylaxis with mechanical and pharmacologic methods or pharmacologic VTE prophylaxis alone. Additionally, the panel suggests routine bilateral lower extremity US in adults with trauma with elevated risk of VTE who are ineligible for pharmacologic VTE prophylaxis and suggests against the routine placement of prophylactic IVCFs. Because of insufficient evidence, the panel did not issue any recommendation on the use of early pharmacologic VTE prophylaxis in adults with isolated blunt TBI requiring neurosurgical intervention. CONCLUSION The SCCS guidelines for VTE prevention in adults with trauma were based on the best available evidence and identified areas for further research. The framework may facilitate adaptation of recommendations by national/international guideline policymakers.
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Affiliation(s)
- Marwa Amer
- Medical/Critical Pharmacy Division, King Faisal Specialist Hospital and Research Center, Al Mathar Ash Shamali, Riyadh, 11564, Saudi Arabia.
- College of Medicine and Pharmacy, Alfaisal University, Riyadh, Saudi Arabia.
| | - Mohammed S Alshahrani
- Department of Emergency and Critical Care, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed Al-Jedai
- College of Medicine and Pharmacy, Alfaisal University, Riyadh, Saudi Arabia
- Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Hassan M Alshaqaq
- Emergency Medicine Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Al-Sharydah
- Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal A Al-Suwaidan
- Clinical Excellence Administration and King Fahad Medical City, Second Health Cluster in Riyadh, Ministry of Health, Riyadh, Saudi Arabia
| | - Hosam Aljehani
- Department of Interventional Neuroradiology, Neurosurgery, Neurocritical Care, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Thamer Nouh
- Trauma and Acute Care Surgery Unit, King Saud University, Riyadh, Saudi Arabia
| | - Hassan Mashbari
- Department of Surgery, Jazan University, Jazan, Saudi Arabia
| | - Nehal Tarazan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Saad Alqahtani
- Department of Orthopedic Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Wail Tashkandi
- Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Critical Care, Fakeeh Care Group, Jeddah, Saudi Arabia
| | - Khalid Maghrabi
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Muneerah Albugami
- Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Samaher Hashim
- Pulmonary and Critical Care Department, International Medical Center/First Clinic, Jeddah, Saudi Arabia
| | - Norah M Alsubaie
- Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Haifa Algethamy
- Department of Anesthesia and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Thamir M Alshammari
- College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ali Alaklabi
- Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Nadia Ismail
- Department of Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Esraa S Altawil
- Pharmacy Department, Clinical Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Alyaa Elhazmi
- Dr Sulaiman Al-Habib Medical Group, Critical Care Department, Riyadh, Saudi Arabia
| | - Ahmed Nahhas
- Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Maha Aljuaid
- Clinical Nursing Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Naif Alsadoon
- Alshaya International Trading Company, Riyadh, Saudi Arabia
| | - Yasser Binbraik
- Department of Medicine, McMaster University, Hamilton, Canada
- Cardiac Sciences Department, King Saud University, Riyadh, Saudi Arabia
| | - Yuhong Yuan
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Scientific Research Center, Directorate General of Armed Forces Medical Services, Riyadh, Saudi Arabia
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21
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Lawler PR, Derde LPG, van de Veerdonk FL, McVerry BJ, Huang DT, Berry LR, Lorenzi E, van Kimmenade R, Gommans F, Vaduganathan M, Leaf DE, Baron RM, Kim EY, Frankfurter C, Epelman S, Kwan Y, Grieve R, O'Neill S, Sadique Z, Puskarich M, Marshall JC, Higgins AM, Mouncey PR, Rowan KM, Al-Beidh F, Annane D, Arabi YM, Au C, Beane A, van Bentum-Puijk W, Bonten MJM, Bradbury CA, Brunkhorst FM, Burrell A, Buzgau A, Buxton M, Cecconi M, Cheng AC, Cove M, Detry MA, Estcourt LJ, Ezekowitz J, Fitzgerald M, Gattas D, Godoy LC, Goossens H, Haniffa R, Harrison DA, Hills T, Horvat CM, Ichihara N, Lamontagne F, Linstrum KM, McAuley DF, McGlothlin A, McGuinness SP, McQuilten Z, Murthy S, Nichol AD, Owen DRJ, Parke RL, Parker JC, Pollock KM, Reyes LF, Saito H, Santos MS, Saunders CT, Seymour CW, Shankar-Hari M, Singh V, Turgeon AF, Turner AM, Zarychanski R, Green C, Lewis RJ, Angus DC, Berry S, Gordon AC, McArthur CJ, Webb SA. Effect of Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Initiation on Organ Support-Free Days in Patients Hospitalized With COVID-19: A Randomized Clinical Trial. JAMA 2023; 329:1183-1196. [PMID: 37039790 PMCID: PMC10326520 DOI: 10.1001/jama.2023.4480] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/07/2023] [Indexed: 04/12/2023]
Abstract
IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non-critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support-free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support-free days among critically ill patients was 10 (-1 to 16) in the ACE inhibitor group (n = 231), 8 (-1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support-free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02735707.
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Affiliation(s)
- Patrick R Lawler
- Peter Munk Cardiac Centre at University Health Network, Toronto, Canada
- McGill University Health Centre, Montreal, QC, Canada
| | | | | | | | | | | | | | | | - Frank Gommans
- Radboud University Medical Centre, Nijmegen, Netherlands
| | | | - David E Leaf
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rebecca M Baron
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edy Y Kim
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Slava Epelman
- Peter Munk Cardiac Centre at University Health Network, Toronto, Canada
| | - Yvonne Kwan
- Peter Munk Cardiac Centre at University Health Network, Toronto, Canada
| | - Richard Grieve
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephen O'Neill
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zia Sadique
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Paul R Mouncey
- Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | - Kathryn M Rowan
- Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | | | - Djillali Annane
- Hospital Raymond Poincaré (Assistance Publique Hôpitaux de Paris), Garches, France
- Université Versailles SQY - Université Paris Saclay, Montigny-le-Bretonneux, France
| | - Yaseen M Arabi
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Carly Au
- Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | - Abi Beane
- University of Oxford, Oxford, England
| | | | | | | | | | | | | | - Meredith Buxton
- Global Coalition for Adaptive Research, Larkspur, California
| | | | | | - Matthew Cove
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | | | | | | | | | - David Gattas
- The George Institute for Global Health, Sydney, Australia
| | - Lucas C Godoy
- Peter Munk Cardiac Centre at University Health Network, Toronto, Canada
| | | | - Rashan Haniffa
- University of Oxford, Bangkok, Thailand
- National Intensive Care Surveillance (NICST), Colombo, Sri Lanka
| | - David A Harrison
- Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | - Thomas Hills
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
| | | | | | | | | | - Daniel F McAuley
- Queen's University Belfast, Belfast, Northern Ireland
- Royal Victoria Hospital, Belfast, Northern Ireland
| | | | - Shay P McGuinness
- Monash University, Melbourne, Australia
- Auckland City Hospital, Auckland, New Zealand
| | | | | | - Alistair D Nichol
- Monash University, Melbourne, Australia
- University College Dublin, Dublin, Ireland
| | - David R J Owen
- Department of Brain Sciences, Imperial College London, London, United Kingdom
- UK Dementia Research Institute of Imperial College London, London, United Kingdom
| | - Rachael L Parke
- Auckland City Hospital, Auckland, New Zealand
- University of Auckland, Auckland, New Zealand
| | | | | | - Luis Felipe Reyes
- Universidad de La Sabana, Chia, Colombia
- Clinica Universidad de La Sabana, Chia, Colombia
| | - Hiroki Saito
- St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | | | | | | | | | | | - Alexis F Turgeon
- Université Laval, Québec City, Canada
- CHU de Québec-Université Laval Research Center, Québec City, Canada
| | - Anne M Turner
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
| | | | | | - Roger J Lewis
- Berry Consultants, Austin, Texas
- Harbor-UCLA Medical Center, Torrance, California
- Statistical Editor, JAMA
| | - Derek C Angus
- University of Pittsburgh, Pittsburgh, Pennsylvania
- Senior Editor, JAMA
| | | | - Anthony C Gordon
- Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | | | - Steve A Webb
- Monash University, Melbourne, Australia
- St John of God Hospital, Subiaco, Australia
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22
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Alotaibi F, Alharbi NK, Rosen LB, Asiri AY, Assiri AM, Balkhy HH, Al Jeraisy M, Mandourah Y, AlJohani S, Al Harbi S, Jokhdar HAA, Deeb AM, Memish ZA, Jose J, Ghazal S, Al Faraj S, Al Mekhlafi GA, Sherbeeni NM, Elzein FE, AlMutairi BM, Al‐Dawood A, Abdullah ML, Barhoumi T, Alenazi MW, Almasood A, Holland SM, Arabi YM. Type I interferon autoantibodies in hospitalized patients with Middle East respiratory syndrome and association with outcomes and treatment effect of interferon beta‐1b in MIRACLE clinical trial. Influenza Other Respir Viruses 2023; 17:e13116. [PMID: 36960162 PMCID: PMC10028524 DOI: 10.1111/irv.13116] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/06/2023] [Accepted: 02/14/2023] [Indexed: 03/24/2023] Open
Abstract
Background Type I interferons (IFNs) are essential antiviral cytokines induced upon respiratory exposure to coronaviruses. Defects in type I IFN signaling can result in severe disease upon exposure to respiratory viral infection and are associated with worse clinical outcomes. Neutralizing autoantibodies (auto‐Abs) to type I IFNs were reported as a risk factor for life‐threatening COVID‐19, but their presence has not been evaluated in patients with severe Middle East respiratory syndrome (MERS). Methods We evaluated the prevalence of type I IFN auto‐Abs in a cohort of hospitalized patients with MERS who were enrolled in a placebo‐controlled clinical trial for treatment with IFN‐β1b and lopinavir‐ritonavir (MIRACLE trial). Samples were tested for type I IFN auto‐Abs using a multiplex particle‐based assay. Results Among the 62 enrolled patients, 15 (24.2%) were positive for immunoglobulin G auto‐Abs for at least one subtype of type I IFNs. Auto‐Abs positive patients were not different from auto‐Abs negative patients in age, sex, or comorbidities. However, the majority (93.3%) of patients who were auto‐Abs positive were critically ill and admitted to the ICU at the time of enrollment compared to 66% in the auto‐Abs negative patients. The effect of treatment with IFN‐β1b and lopinavir‐ritonavir did not significantly differ between the two groups. Conclusion This study demonstrates the presence of type I IFN auto‐Abs in hospitalized patients with MERS.
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Affiliation(s)
- Faizah Alotaibi
- College of Science and Health ProfessionsKing Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Ministry of National Guard Health AffairsRiyadhSaudi Arabia
| | - Naif Khalaf Alharbi
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research CenterRiyadhSaudi Arabia
| | - Lindsey B. Rosen
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural ResearchNational Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)MDBethesdaUSA
| | - Ayed Y. Asiri
- Prince Mohammed bin Abdulaziz HospitalRiyadhSaudi Arabia
| | | | - Hanan H. Balkhy
- Antimicrobial Resistance DivisionWorld Health OrganizationGenevaSwitzerland
| | - Majed Al Jeraisy
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research CenterRiyadhSaudi Arabia
| | | | - Sameera AlJohani
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research CenterRiyadhSaudi Arabia
- Department of Pathology and Laboratory MedicineKing Abdulaziz Medical City, Ministry of National Guard Health AffairsRiyadhSaudi Arabia
| | - Shmeylan Al Harbi
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research CenterRiyadhSaudi Arabia
- Pharmaceutical Care DepartmentKing Abdulaziz Medical City, Ministry of National Guard Health AffairsRiyadhSaudi Arabia
| | | | - Ahmad M. Deeb
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research CenterRiyadhSaudi Arabia
| | - Ziad A. Memish
- Prince Mohammed bin Abdulaziz Hospital, Ministry of Health, College of MedicineAlfaisal University, Riyadh, Kingdom of Saudi Arabia, Hubert Department of Global Health, Rollins School of Public Health, Emory UniversityGeorgiaAtlantaUSA
| | - Jesna Jose
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research CenterRiyadhSaudi Arabia
| | - Sameeh Ghazal
- Prince Mohammed bin Abdulaziz HospitalRiyadhSaudi Arabia
| | | | | | | | | | - Badriah M. AlMutairi
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research CenterRiyadhSaudi Arabia
| | - Abdulaziz Al‐Dawood
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research CenterRiyadhSaudi Arabia
- Intensive Care DepartmentKing Abdulaziz Medical City, Ministry of National Guard Health AffairsRiyadhSaudi Arabia
| | - Mashan L. Abdullah
- Experimental Medicine Department, King Abdullah International Medical Research CenterKing Saud bin Abdulaziz University for Health SciencesRiyadhSaudi Arabia
| | - Tlili Barhoumi
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research CenterRiyadhSaudi Arabia
| | - Mohammed W. Alenazi
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research CenterRiyadhSaudi Arabia
| | - Abdulrahman Almasood
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research CenterRiyadhSaudi Arabia
| | - Steven M. Holland
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural ResearchNational Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)MDBethesdaUSA
| | - Yaseen M. Arabi
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research CenterRiyadhSaudi Arabia
- Intensive Care DepartmentKing Abdulaziz Medical City, Ministry of National Guard Health AffairsRiyadhSaudi Arabia
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23
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Elhazmi A, Rabie AA, Al-Omari A, Mufti HN, Sallam H, Alshahrani MS, Mady A, Alghamdi A, Altalaq A, Azzam MH, Sindi A, Kharaba A, Al-Aseri ZA, Almekhlafi GA, Tashkandi W, Alajmi SA, Faqihi F, Alharthy A, Al-Tawfiq JA, Melibari RG, Arabi YM. Tocilizumab Outcomes in Critically Ill COVID-19 Patients Admitted to the ICU and the Role of Non-Tocilizumab COVID-19-Specific Medical Therapeutics. J Clin Med 2023; 12:jcm12062301. [PMID: 36983304 PMCID: PMC10053430 DOI: 10.3390/jcm12062301] [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: 01/28/2023] [Revised: 02/15/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
Background: Tocilizumab is a monoclonal antibody proposed to manage cytokine release syndrome (CRS) associated with severe COVID-19. Previously published reports have shown that tocilizumab may improve the clinical outcomes of critically ill patients admitted to the ICU. However, no precise data about the role of other medical therapeutics concurrently used for COVID-19 on this outcome have been published. Objectives: We aimed to compare the overall outcome of critically ill COVID-19 patients admitted to the ICU who received tocilizumab with the outcome of matched patients who did not receive tocilizumab while controlling for other confounders, including medical therapeutics for critically ill patients admitted to ICUs. Methods: A prospective, observational, multicenter cohort study was conducted among critically ill COVID-19 patients admitted to the ICU of 14 hospitals in Saudi Arabia between 1 March 2020, and October 31, 2020. Propensity-score matching was utilized to compare patients who received tocilizumab to patients who did not. In addition, the log-rank test was used to compare the 28 day hospital survival of patients who received tocilizumab with those who did not. Then, a multivariate logistic regression analysis of the matched groups was performed to evaluate the impact of the remaining concurrent medical therapeutics that could not be excluded via matching 28 day hospital survival rates. The primary outcome measure was patients’ overall 28 day hospital survival, and the secondary outcomes were ICU length of stay and ICU survival to hospital discharge. Results: A total of 1470 unmatched patients were included, of whom 426 received tocilizumab. The total number of propensity-matched patients was 1278. Overall, 28 day hospital survival revealed a significant difference between the unmatched non-tocilizumab group (586; 56.1%) and the tocilizumab group (269; 63.1%) (p-value = 0.016), and this difference increased even more in the propensity-matched analysis between the non-tocilizumab group (466.7; 54.6%) and the tocilizumab group (269; 63.1%) (p-value = 0.005). The matching model successfully matched the two groups’ common medical therapeutics used to treat COVID-19. Two medical therapeutics remained significantly different, favoring the tocilizumab group. A multivariate logistic regression was performed for the 28 day hospital survival in the propensity-matched patients. It showed that neither steroids (OR: 1.07 (95% CI: 0.75–1.53)) (p = 0.697) nor favipiravir (OR: 1.08 (95% CI: 0.61–1.9)) (p = 0.799) remained as a predictor for an increase in 28 day survival. Conclusion: The tocilizumab treatment in critically ill COVID-19 patients admitted to the ICU improved the overall 28 day hospital survival, which might not be influenced by the concurrent use of other COVID-19 medical therapeutics, although further research is needed to confirm this.
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Affiliation(s)
- Alyaa Elhazmi
- Department of Critical Care, Dr. Sulaiman Al-Habib Medical Group, Riyadh 11643, Saudi Arabia
- Correspondence: or (A.E.); or (A.A.R.)
| | - Ahmed A. Rabie
- Critical Care Department, King Saud Medical City, Riyadh 11196, Saudi Arabia
- Correspondence: or (A.E.); or (A.A.R.)
| | - Awad Al-Omari
- Research Center, Dr. Sulaiman Alhabib Medical Group, Riyadh 11643, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Hani N. Mufti
- Section of Cardiac Surgery, Department of Cardiac Sciences, King Faisal Cardiac Center, King Abdulaziz Medical City, MNGHA-WR, Jeddah 21423, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 11481, Saudi Arabia
| | - Hend Sallam
- Department of Adult Critical Care Medicine, King Faisal Specialist Hospital & Research Centre, Jeddah 23431, Saudi Arabia
| | - Mohammed S. Alshahrani
- Department of Emergency and Critical Care, King Fahad Hospital of the University, Dammam University, Al Khobar 31952, Saudi Arabia
| | - Ahmed Mady
- Critical Care Department, King Saud Medical City, Riyadh 11196, Saudi Arabia
- Department of Anesthesiology and Intensive Care, Tanta University Hospital, Tanta 31527, Egypt
| | - Adnan Alghamdi
- Prince Sultan Military Medical City, Military Medical Services, Ministry of Defense, Riyadh 12233, Saudi Arabia
| | - Ali Altalaq
- Prince Sultan Military Medical City, Military Medical Services, Ministry of Defense, Riyadh 12233, Saudi Arabia
| | - Mohamed H. Azzam
- Intensive Care Department, King Abdullah Medical Complex, Jeddah 23816, Saudi Arabia
| | - Anees Sindi
- Department of Medicine, Intensive Care, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ayman Kharaba
- Department of Critical Care, King Fahad Hospital, Al Medina Al Munawara 41477, Saudi Arabia
| | - Zohair A. Al-Aseri
- Departments of Emergency Medicine and Critical Care, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
- College of Medicine, Dar Al Uloom University, Riyadh 13314, Saudi Arabia
| | - Ghaleb A. Almekhlafi
- Prince Sultan Military Medical City, Military Medical Services, Ministry of Defense, Riyadh 12233, Saudi Arabia
| | - Wail Tashkandi
- Department of Adult Critical Care, Fakeeh Care Group, Jeddah 23323, Saudi Arabia
- Department of Surgery, Intensive Care, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Saud A. Alajmi
- Prince Sultan Military Medical City, Military Medical Services, Ministry of Defense, Riyadh 12233, Saudi Arabia
| | - Fahad Faqihi
- Department of Critical Care, Dr. Sulaiman Al-Habib Medical Group, Riyadh 11643, Saudi Arabia
| | | | - Jaffar A. Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran 34464, Saudi Arabia
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Rami Ghazi Melibari
- Department of Critical Care, King Abdullah Medical City, Makah 24246, Saudi Arabia
| | - Yaseen M. Arabi
- Intensive Care Department, King Abdullah International Medical Research Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh 11426, Saudi Arabia
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24
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Al-Dorzi HM, AlQahtani S, Al-Dawood A, Al-Hameed FM, Burns KEA, Mehta S, Jose J, Alsolamy SJ, Abdukahil SAI, Afesh LY, Alshahrani MS, Mandourah Y, Almekhlafi GA, Almaani M, Al Bshabshe A, Finfer S, Arshad Z, Khalid I, Mehta Y, Gaur A, Hawa H, Buscher H, Lababidi H, Al Aithan A, Arabi YM. Association of early mobility with the incidence of deep-vein thrombosis and mortality among critically ill patients: a post hoc analysis of PREVENT trial. Crit Care 2023; 27:83. [PMID: 36869382 PMCID: PMC9985278 DOI: 10.1186/s13054-023-04333-9] [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: 11/02/2022] [Accepted: 01/24/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND This study assessed the mobility levels among critically ill patients and the association of early mobility with incident proximal lower-limb deep-vein thrombosis and 90-day mortality. METHODS This was a post hoc analysis of the multicenter PREVENT trial, which evaluated adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis with an expected ICU stay ≥ 72 h and found no effect on the primary outcome of incident proximal lower-limb deep-vein thrombosis. Mobility levels were documented daily up to day 28 in the ICU using a tool with an 8-point ordinal scale. We categorized patients according to mobility levels within the first 3 ICU days into three groups: early mobility level 4-7 (at least active standing), 1-3 (passive transfer from bed to chair or active sitting), and 0 (passive range of motion). We evaluated the association of early mobility and incident lower-limb deep-vein thrombosis and 90-day mortality by Cox proportional models adjusting for randomization and other co-variables. RESULTS Of 1708 patients, only 85 (5.0%) had early mobility level 4-7 and 356 (20.8%) level 1-3, while 1267 (74.2%) had early mobility level 0. Patients with early mobility levels 4-7 and 1-3 had less illness severity, femoral central venous catheters, and organ support compared to patients with mobility level 0. Incident proximal lower-limb deep-vein thrombosis occurred in 1/85 (1.3%) patients in the early mobility 4-7 group, 7/348 (2.0%) patients in mobility 1-3 group, and 50/1230 (4.1%) patients in mobility 0 group. Compared with early mobility group 0, mobility groups 4-7 and 1-3 were not associated with differences in incident proximal lower-limb deep-vein thrombosis (adjusted hazard ratio [aHR] 1.19, 95% confidence interval [CI] 0.16, 8.90; p = 0.87 and 0.91, 95% CI 0.39, 2.12; p = 0.83, respectively). However, early mobility groups 4-7 and 1-3 had lower 90-day mortality (aHR 0.47, 95% CI 0.22, 1.01; p = 0.052, and 0.43, 95% CI 0.30, 0.62; p < 0.0001, respectively). CONCLUSIONS Only a small proportion of critically ill patients with an expected ICU stay ≥ 72 h were mobilized early. Early mobility was associated with reduced mortality, but not with different incidence of deep-vein thrombosis. This association does not establish causality, and randomized controlled trials are required to assess whether and to what extent this association is modifiable. TRIAL REGISTRATION The PREVENT trial is registered at ClinicalTrials.gov, ID: NCT02040103 (registered on 3 November 2013) and Current controlled trials, ID: ISRCTN44653506 (registered on 30 October 2013).
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Affiliation(s)
- Hasan M Al-Dorzi
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Samah AlQahtani
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Al-Dawood
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Fahad M Al-Hameed
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Unity Health Toronto - St Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Sangeeta Mehta
- Department of Medicine, University of Toronto, Toronto, Canada.,Medical Surgical ICU, Sinai Health, Toronto, Canada
| | - Jesna Jose
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Sami J Alsolamy
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Sheryl Ann I Abdukahil
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Lara Y Afesh
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed S Alshahrani
- Department of Emergency and Critical Care Medicine, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Yasser Mandourah
- Military Medical Services, Ministry of Defense, Riyadh, Kingdom of Saudi Arabia
| | - Ghaleb A Almekhlafi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Almaani
- Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ali Al Bshabshe
- Department of Critical Care Medicine, King Khalid University, Asir Central Hospital, Abha, Kingdom of Saudi Arabia
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Zia Arshad
- Department of Anesthesiology and Critical Care, King George's Medical University, Lucknow, India
| | - Imran Khalid
- Critical Care Section, Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Yatin Mehta
- Institute of Critical Care and Anaesthesiology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Atul Gaur
- Intensive Care Department, Gosford Hospital, Gosford, NSW, Australia
| | - Hassan Hawa
- Critical Care Medicine Department, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Hergen Buscher
- Department of Intensive Care Medicine, Center for Applied Medical Research, St. Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Hani Lababidi
- Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdulsalam Al Aithan
- Intensive Care Division, Department of Medicine, King Abdulaziz Hospital, Ministry of National Guard Health Affairs, Al Ahsa, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center , Al Ahsa, Kingdom of Saudi Arabia
| | - Yaseen M Arabi
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. .,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
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25
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Arabi YM, Patel BK, Antonelli M. Helmet trials: resolving the puzzle. Intensive Care Med 2023; 49:458-461. [PMID: 36856774 PMCID: PMC9976661 DOI: 10.1007/s00134-023-07004-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/10/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Yaseen M. Arabi
- Intensive Care Department, Ministry of National Guard-Health Affairs, King Abdullah International Medical Research Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426 Saudi Arabia
| | - Bhakti K. Patel
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL USA
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy ,Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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26
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Young PJ, Al-Fares A, Aryal D, Arabi YM, Ashraf MS, Bagshaw SM, Mat-Nor MB, Beane A, Borghi G, de Oliveira Manoel AL, Dullawe L, Fazla F, Fujii T, Haniffa R, Hodgson CL, Hunt A, Lawrence C, Mackle D, Mangal K, Nichol AD, Olatunji S, Rashan A, Rashan S, Tomazini B, Kasza J. Protocol and statistical analysis plan for the mega randomised registry trial comparing conservative vs. liberal oxygenation targets in adults with nonhypoxic ischaemic acute brain injuries and conditions in the intensive care unit (Mega-ROX Brains). CRIT CARE RESUSC 2023; 25:53-59. [PMID: 37876994 PMCID: PMC10581272 DOI: 10.1016/j.ccrj.2023.04.011] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Background The effect of conservative vs. liberal oxygen therapy on 90-day in-hospital mortality in adults who have nonhypoxic ischaemic encephalopathy acute brain injuries and conditions and are receiving invasive mechanical ventilation in the intensive care unit (ICU) is uncertain. Objective The objective of this study was to summarise the protocol and statistical analysis plan for the Mega-ROX Brains trial. Design setting and participants Mega-ROX Brains is an international randomised clinical trial, which will be conducted within an overarching 40,000-participant, registry-embedded clinical trial comparing conservative and liberal ICU oxygen therapy regimens. We expect to enrol between 7500 and 9500 participants with nonhypoxic ischaemic encephalopathy acute brain injuries and conditions who are receiving unplanned invasive mechanical ventilation in the ICU. Main outcome measures The primary outcome is in-hospital all-cause mortality up to 90 d from the date of randomisation. Secondary outcomes include duration of survival, duration of mechanical ventilation, ICU length of stay, hospital length of stay, and the proportion of participants discharged home. Results and conclusions Mega-ROX Brains will compare the effect of conservative vs. liberal oxygen therapy regimens on 90-day in-hospital mortality in adults in the ICU with acute brain injuries and conditions. The protocol and planned analyses are reported here to mitigate analysis bias. Trial Registration Australian and New Zealand Clinical Trials Registry (ACTRN 12620000391976).
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Affiliation(s)
- Paul J. Young
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Abdulrahman Al-Fares
- Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait
- Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Respiratory and Cardiac Failure, Ministry of Health, Kuwait
| | - Diptesh Aryal
- Nepal Intensive Care Research Foundation, Kathmandu, Nepal
| | - Yaseen M. Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, And Intensive Care Department, King Abdulaziz Medical City, Ministry of National-Guard Health Affairs, Riyadh, Saudi Arabia
| | | | - Sean M. Bagshaw
- Department of Critical Care Medicine, University of Alberta, And the Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Mohd Basri Mat-Nor
- Department of Anaesthesiology and Intensive Care, School of Medicine, International Islamic University of Malaysia, Kuantan, Pahang, Malaysia
| | - Abigail Beane
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
| | - Giovanni Borghi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Layoni Dullawe
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
| | - Fathima Fazla
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
| | - Tomoko Fujii
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Rashan Haniffa
- Department of Anaesthesiology and Intensive Care, School of Medicine, International Islamic University of Malaysia, Kuantan, Pahang, Malaysia
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- University College Hospital, London, UK
| | - Carol L. Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- The Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Anna Hunt
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Cassie Lawrence
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Diane Mackle
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Kishore Mangal
- Department of Critical Care Medicine, Fortis Escorts Hospital, Jaipur, India
| | - Alistair D. Nichol
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- The Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- School of Medicine and Medical Sciences, University College Dublin, Ireland
- Department of Anaesthesia and Intensive Care, St Vincent's Hospital, Dublin, Ireland
| | - Shaanti Olatunji
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Aasiyah Rashan
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- University College London, Institute of Health Informatics, London, UK
| | - Sumayyah Rashan
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Bruno Tomazini
- HCor Research Institute, São Paulo, Brazil
- Brazilian Research in Intensive Care Network – BricNet, Brazil
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - for the Mega-ROX management committee
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait
- Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Respiratory and Cardiac Failure, Ministry of Health, Kuwait
- Nepal Intensive Care Research Foundation, Kathmandu, Nepal
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, And Intensive Care Department, King Abdulaziz Medical City, Ministry of National-Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Anesthesia and Critical Care Unit, Lady Reading Hospital, Peshawar, Pakistan
- Department of Critical Care Medicine, University of Alberta, And the Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Anaesthesiology and Intensive Care, School of Medicine, International Islamic University of Malaysia, Kuantan, Pahang, Malaysia
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Critical Care Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- University College Hospital, London, UK
- The Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Department of Critical Care Medicine, Fortis Escorts Hospital, Jaipur, India
- School of Medicine and Medical Sciences, University College Dublin, Ireland
- Department of Anaesthesia and Intensive Care, St Vincent's Hospital, Dublin, Ireland
- University College London, Institute of Health Informatics, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- HCor Research Institute, São Paulo, Brazil
- Brazilian Research in Intensive Care Network – BricNet, Brazil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - the Australian and New Zealand Intensive Care Society Clinical Trials Group
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait
- Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Respiratory and Cardiac Failure, Ministry of Health, Kuwait
- Nepal Intensive Care Research Foundation, Kathmandu, Nepal
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, And Intensive Care Department, King Abdulaziz Medical City, Ministry of National-Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Anesthesia and Critical Care Unit, Lady Reading Hospital, Peshawar, Pakistan
- Department of Critical Care Medicine, University of Alberta, And the Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Anaesthesiology and Intensive Care, School of Medicine, International Islamic University of Malaysia, Kuantan, Pahang, Malaysia
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Critical Care Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- University College Hospital, London, UK
- The Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Department of Critical Care Medicine, Fortis Escorts Hospital, Jaipur, India
- School of Medicine and Medical Sciences, University College Dublin, Ireland
- Department of Anaesthesia and Intensive Care, St Vincent's Hospital, Dublin, Ireland
- University College London, Institute of Health Informatics, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- HCor Research Institute, São Paulo, Brazil
- Brazilian Research in Intensive Care Network – BricNet, Brazil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - the Brazilian Research in Intensive Care Network
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait
- Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Respiratory and Cardiac Failure, Ministry of Health, Kuwait
- Nepal Intensive Care Research Foundation, Kathmandu, Nepal
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, And Intensive Care Department, King Abdulaziz Medical City, Ministry of National-Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Anesthesia and Critical Care Unit, Lady Reading Hospital, Peshawar, Pakistan
- Department of Critical Care Medicine, University of Alberta, And the Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Anaesthesiology and Intensive Care, School of Medicine, International Islamic University of Malaysia, Kuantan, Pahang, Malaysia
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Critical Care Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- University College Hospital, London, UK
- The Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Department of Critical Care Medicine, Fortis Escorts Hospital, Jaipur, India
- School of Medicine and Medical Sciences, University College Dublin, Ireland
- Department of Anaesthesia and Intensive Care, St Vincent's Hospital, Dublin, Ireland
- University College London, Institute of Health Informatics, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- HCor Research Institute, São Paulo, Brazil
- Brazilian Research in Intensive Care Network – BricNet, Brazil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - the Critical Care Asia and Africa Network
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait
- Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Respiratory and Cardiac Failure, Ministry of Health, Kuwait
- Nepal Intensive Care Research Foundation, Kathmandu, Nepal
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, And Intensive Care Department, King Abdulaziz Medical City, Ministry of National-Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Anesthesia and Critical Care Unit, Lady Reading Hospital, Peshawar, Pakistan
- Department of Critical Care Medicine, University of Alberta, And the Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Anaesthesiology and Intensive Care, School of Medicine, International Islamic University of Malaysia, Kuantan, Pahang, Malaysia
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Critical Care Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- University College Hospital, London, UK
- The Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Department of Critical Care Medicine, Fortis Escorts Hospital, Jaipur, India
- School of Medicine and Medical Sciences, University College Dublin, Ireland
- Department of Anaesthesia and Intensive Care, St Vincent's Hospital, Dublin, Ireland
- University College London, Institute of Health Informatics, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- HCor Research Institute, São Paulo, Brazil
- Brazilian Research in Intensive Care Network – BricNet, Brazil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - the Irish Critical Care-Clinical Trials Group
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait
- Kuwait Extracorporeal Life Support Program, Al-Amiri Center for Respiratory and Cardiac Failure, Ministry of Health, Kuwait
- Nepal Intensive Care Research Foundation, Kathmandu, Nepal
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, And Intensive Care Department, King Abdulaziz Medical City, Ministry of National-Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Anesthesia and Critical Care Unit, Lady Reading Hospital, Peshawar, Pakistan
- Department of Critical Care Medicine, University of Alberta, And the Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Anaesthesiology and Intensive Care, School of Medicine, International Islamic University of Malaysia, Kuantan, Pahang, Malaysia
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- National Intensive Care Surveillance - MORU (NICS-MORU), Colombo, Sri Lanka
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Critical Care Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- University College Hospital, London, UK
- The Intensive Care Unit, Alfred Health, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Department of Critical Care Medicine, Fortis Escorts Hospital, Jaipur, India
- School of Medicine and Medical Sciences, University College Dublin, Ireland
- Department of Anaesthesia and Intensive Care, St Vincent's Hospital, Dublin, Ireland
- University College London, Institute of Health Informatics, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- HCor Research Institute, São Paulo, Brazil
- Brazilian Research in Intensive Care Network – BricNet, Brazil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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27
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Arishi H, AlQahtani S, Sadat M, Arabi YM. Author reply: Combination of norepinephrine with phenylephrine versus norepinephrine with vasopressin in critically ill patients with septic shock: A retrospective study. J Crit Care 2023; 73:154176. [PMID: 36266194 DOI: 10.1016/j.jcrc.2022.154176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Hatim Arishi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Samah AlQahtani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Musharaf Sadat
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Yaseen M Arabi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
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28
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Myatra SN, Alhazzani W, Belley-Cote E, Møller MH, Arabi YM, Chawla R, Chew MS, Einav S, Ergan B, Kjaer MBN, McGloughlin S, Nasa P, Parhar KKS, Patel A, Piquilloud L, Pisani L, Scala R, Tripathy S, Weatherald J, Oczkowski S. Awake proning in patients with COVID-19-related hypoxemic acute respiratory failure: A rapid practice guideline. Acta Anaesthesiol Scand 2023; 67:569-575. [PMID: 36691710 DOI: 10.1111/aas.14205] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 12/21/2022] [Revised: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 01/25/2023]
Abstract
This rapid practice guideline provides evidence-based recommendations for the use of awake proning in adult patients with acute hypoxemic respiratory failure due to COVID-19. The panel included 20 experts from 12 countries, including one patient representative, and used a strict conflict of interest policy for potential financial and intellectual conflicts of interest. Methodological support was provided by the guidelines in intensive care, development, and evaluation (GUIDE) group. Based on an updated systematic review, and the grading of recommendations, assessment, development, and evaluation (GRADE) method we evaluated the certainty of evidence and developed recommendations using the Evidence-to-Decision framework. We conducted an electronic vote, requiring >80% agreement amongst the panel for a recommendation to be adopted. The panel made a strong recommendation for a trial of awake proning in adult patients with COVID-19 related hypoxemic acute respiratory failure who are not invasively ventilated. Awake proning appears to reduce the risk of tracheal intubation, although it may not reduce mortality. The panel judged that most patients would want a trial of awake proning, although this may not be feasible in some patients and some patients may not tolerate it. However, given the high risk of clinical deterioration amongst these patients, awake proning should be conducted in an area where patients can be monitored by staff experienced in rapidly detecting and managing clinical deterioration. This RPG panel recommends a trial of awake prone positioning in patients with acute hypoxemic respiratory failure due to COVID-19.
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Affiliation(s)
- Sheila Nainan Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Emilie Belley-Cote
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton, Ontario, Canada
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Yaseen M Arabi
- Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Rajesh Chawla
- Department of Respiratory and Critical Care Medicine, Indraprastha Apollo Hospital, New Delhi, India
| | - Michelle S Chew
- Department of Anaesthesia and Intensive Care Medicine, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sharon Einav
- Intensive Care Unit, Shaare Zedek Medical Centre, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Begum Ergan
- Department of Pulmonary and Critical Care, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | | | - Steve McGloughlin
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Prashant Nasa
- Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates.,Department of Internal Medicine, College of Medicine and Health Sciences, Al Ain, United Arab Emirates
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, Canada
| | - Anil Patel
- Department of Anaesthesia, Royal National ENT & Eastman Dental Hospital, University College London Hospitals, London, UK
| | - Lise Piquilloud
- Adult Intensive Care Unit, University Hospital and Lausanne University, Lausanne, Switzerland
| | - Lara Pisani
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
| | - Raffaele Scala
- Cardio-thoraco-neurovascular Department, Pulmonology and Respiratory Intensive Care Unit, S Donato Hospital, Arezzo, Italy
| | - Swagata Tripathy
- Department of Anaesthesia & Critical Care, AIIMS, Bhubaneswar, India
| | - Jason Weatherald
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Simon Oczkowski
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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29
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Dionne JC, Johnstone J, Heels-Ansdell D, Duan E, Lauzier F, Arabi YM, Adhikari NKJ, Sligl W, Dodek P, Rochwerg B, Marshall JC, Niven DJ, Williamson DR, Reynolds S, Zytaruk N, Cook D. Clostridioides difficile infection in mechanically ventilated critically ill patients: A nested cohort study. J Crit Care 2023; 75:154254. [PMID: 36682909 DOI: 10.1016/j.jcrc.2023.154254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Clostridioides difficile infection (CDI) is a serious complication of critical illness. The objective of the study was to determine its incidence, prevalence, timing, severity, predictors, and outcomes. METHODS We performed a prospective nested cohort study of CDI within a randomized trial comparing Lactobacillus rhamnosus GG to placebo. We adjudicated cases of CDI using standardized definitions, assessed timing (pre-ICU, in ICU, post-ICU) and severity. We analyzed risk factors and outcomes. RESULTS Of 2650 patients, 86 were diagnosed with CDI during 90,833 hospital-days (0.95/1000 hospital-days); CDI prevalence was 3.2%. CDI incidence varied in timing; 0.3% patients had CDI pre-ICU, 2.2% in the ICU; an 0.8% developed CDI post-ICU. Relapse or recurrence of CDI was documented in 9.3% patients. Infections were mild/moderate in severity. Complications included septic shock (26.7%), organ failure (16.3%), and toxic megacolon requiring colectomy (1.2%). No risk factors for CDI were identified. CDI was not associated with hospital mortality. The duration of hospital stay was longer for those who had CDI compared those who did not, CONCLUSION: CDI was uncommon, severity was mild to moderate and not associated with mortality however CDI was associated with a longer hospital stay.
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Affiliation(s)
- Joanna C Dionne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Farncombe Family Digestive Health Research Institute, McMaster University Hamilton, Ontario, Canada; Department of Health Research Methods, Evaluation and Impact, McMaster University, Canada.
| | - Jennie Johnstone
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evaluation and Impact, McMaster University, Canada
| | - Erick Duan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Francois Lauzier
- Department of Critical Care Medicine, Universite Laval, Quebec City, Quebec, Canada
| | - Yaseen M Arabi
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Neill K J Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada
| | - Wendy Sligl
- Departments of Critical Care Medicine and Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Dodek
- Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evaluation and Impact, McMaster University, Canada
| | - John C Marshall
- Department of Surgery, Keenan Research Centre for Biomedical Research, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Niven
- Departments of Critical Care Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David R Williamson
- Pharmacy Department, Hôpital du Sacré-Cœur de Montréal, Montréal, Quebec, Canada; Research Centre, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Faculté de Pharmacie, Université de Montréal, Canada
| | - Steven Reynolds
- Division of Critical Care Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Zytaruk
- Department of Health Research Methods, Evaluation and Impact, McMaster University, Canada
| | - Deborah Cook
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evaluation and Impact, McMaster University, Canada
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30
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Higgins AM, Berry LR, Lorenzi E, Murthy S, McQuilten Z, Mouncey PR, Al-Beidh F, Annane D, Arabi YM, Beane A, van Bentum-Puijk W, Bhimani Z, Bonten MJM, Bradbury CA, Brunkhorst FM, Burrell A, Buzgau A, Buxton M, Charles WN, Cove M, Detry MA, Estcourt LJ, Fagbodun EO, Fitzgerald M, Girard TD, Goligher EC, Goossens H, Haniffa R, Hills T, Horvat CM, Huang DT, Ichihara N, Lamontagne F, Marshall JC, McAuley DF, McGlothlin A, McGuinness SP, McVerry BJ, Neal MD, Nichol AD, Parke RL, Parker JC, Parry-Billings K, Peters SEC, Reyes LF, Rowan KM, Saito H, Santos MS, Saunders CT, Serpa-Neto A, Seymour CW, Shankar-Hari M, Stronach LM, Turgeon AF, Turner AM, van de Veerdonk FL, Zarychanski R, Green C, Lewis RJ, Angus DC, McArthur CJ, Berry S, Derde LPG, Gordon AC, Webb SA, Lawler PR. Long-term (180-Day) Outcomes in Critically Ill Patients With COVID-19 in the REMAP-CAP Randomized Clinical Trial. JAMA 2023; 329:39-51. [PMID: 36525245 PMCID: PMC9857594 DOI: 10.1001/jama.2022.23257] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
Importance The longer-term effects of therapies for the treatment of critically ill patients with COVID-19 are unknown. Objective To determine the effect of multiple interventions for critically ill adults with COVID-19 on longer-term outcomes. Design, Setting, and Participants Prespecified secondary analysis of an ongoing adaptive platform trial (REMAP-CAP) testing interventions within multiple therapeutic domains in which 4869 critically ill adult patients with COVID-19 were enrolled between March 9, 2020, and June 22, 2021, from 197 sites in 14 countries. The final 180-day follow-up was completed on March 2, 2022. Interventions Patients were randomized to receive 1 or more interventions within 6 treatment domains: immune modulators (n = 2274), convalescent plasma (n = 2011), antiplatelet therapy (n = 1557), anticoagulation (n = 1033), antivirals (n = 726), and corticosteroids (n = 401). Main Outcomes and Measures The main outcome was survival through day 180, analyzed using a bayesian piecewise exponential model. A hazard ratio (HR) less than 1 represented improved survival (superiority), while an HR greater than 1 represented worsened survival (harm); futility was represented by a relative improvement less than 20% in outcome, shown by an HR greater than 0.83. Results Among 4869 randomized patients (mean age, 59.3 years; 1537 [32.1%] women), 4107 (84.3%) had known vital status and 2590 (63.1%) were alive at day 180. IL-6 receptor antagonists had a greater than 99.9% probability of improving 6-month survival (adjusted HR, 0.74 [95% credible interval {CrI}, 0.61-0.90]) and antiplatelet agents had a 95% probability of improving 6-month survival (adjusted HR, 0.85 [95% CrI, 0.71-1.03]) compared with the control, while the probability of trial-defined statistical futility (HR >0.83) was high for therapeutic anticoagulation (99.9%; HR, 1.13 [95% CrI, 0.93-1.42]), convalescent plasma (99.2%; HR, 0.99 [95% CrI, 0.86-1.14]), and lopinavir-ritonavir (96.6%; HR, 1.06 [95% CrI, 0.82-1.38]) and the probabilities of harm from hydroxychloroquine (96.9%; HR, 1.51 [95% CrI, 0.98-2.29]) and the combination of lopinavir-ritonavir and hydroxychloroquine (96.8%; HR, 1.61 [95% CrI, 0.97-2.67]) were high. The corticosteroid domain was stopped early prior to reaching a predefined statistical trigger; there was a 57.1% to 61.6% probability of improving 6-month survival across varying hydrocortisone dosing strategies. Conclusions and Relevance Among critically ill patients with COVID-19 randomized to receive 1 or more therapeutic interventions, treatment with an IL-6 receptor antagonist had a greater than 99.9% probability of improved 180-day mortality compared with patients randomized to the control, and treatment with an antiplatelet had a 95.0% probability of improved 180-day mortality compared with patients randomized to the control. Overall, when considered with previously reported short-term results, the findings indicate that initial in-hospital treatment effects were consistent for most therapies through 6 months.
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Affiliation(s)
| | | | | | - Srinivas Murthy
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Zoe McQuilten
- Monash University, Melbourne, Victoria, Australia
- Monash Health, Melbourne, Victoria, Australia
| | - Paul R Mouncey
- Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | | | - Djillali Annane
- Hospital Raymond Poincaré (Assistance Publique Hôpitaux de Paris), Garches, France
- Université Versailles SQY - Université Paris Saclay, Montigny-le-Bretonneux, France
| | - Yaseen M Arabi
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Abi Beane
- University of Oxford, Oxford, United Kingdom
| | | | - Zahra Bhimani
- St Michael's Hospital Unity Health, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Walton N Charles
- Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | - Matthew Cove
- Yong Loo Lin Scholle of Medicine, National University Singapore, Singapore
| | | | | | | | | | | | - Ewan C Goligher
- Peter Munk Cardiac Centre at University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Rashan Haniffa
- University of Oxford, Bangkok, Thailand
- National Intensive Care Surveillance (NICST), Colombo, Sri Lanka
| | - Thomas Hills
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
| | | | | | | | | | - John C Marshall
- St Michael's Hospital Unity Health, Toronto, Ontario, Canada
| | - Daniel F McAuley
- Queen's University Belfast, Belfast, Northern Ireland
- Royal Victoria Hospital, Belfast, Northern Ireland
| | | | - Shay P McGuinness
- Monash University, Melbourne, Victoria, Australia
- Auckland City Hospital, Auckland, New Zealand
| | | | | | - Alistair D Nichol
- Monash University, Melbourne, Victoria, Australia
- University College Dublin, Dublin, Ireland
| | - Rachael L Parke
- Auckland City Hospital, Auckland, New Zealand
- University of Auckland, Auckland, New Zealand
| | | | - Karen Parry-Billings
- Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | - Sam E C Peters
- Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | - Luis F Reyes
- Universidad de La Sabana, Chia, Colombia
- Clinica Universidad de La Sabana, Chia, Colombia
| | - Kathryn M Rowan
- Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom
| | - Hiroki Saito
- St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | | | | | - Ary Serpa-Neto
- Monash University, Melbourne, Victoria, Australia
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Manu Shankar-Hari
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Alexis F Turgeon
- Université Laval, Québec City, Québec, Canada
- CHU de Québec-Université Laval Research Center, Québec City, Canada
| | - Anne M Turner
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
| | | | | | | | - Roger J Lewis
- Berry Consultants, Austin, Texas
- Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | - Anthony C Gordon
- Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom
| | - Steve A Webb
- Monash University, Melbourne, Victoria, Australia
- St John of God Hospital, Subiaco, Australia
| | - Patrick R Lawler
- Peter Munk Cardiac Centre at University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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Arabi YM, Al Aseri Z, Alsaawi A, Al Khathaami AM, Al Qasim E, Alzahrani AA, Al Qarni M, Abdukahil SAI, Al-Dorzi HM, Alattasi A, Mandourah Y, Alaama TY, Alabdulaali MK, Alqahtani A, Shuaibi A, Al Qarni A, Alkatheri M, Al Hazme RH, Vishwakarma RK, Aldibasi O, Alshahrani MS, Attia A, Alharthy A, Mady A, Abdelrahman BA, Mhawish HA, Abdallah HA, Al-Hameed F, Alghamdi K, Alghamdi A, Almekhlafi GA, Qasim SAH, Al Haji HA, Al Mutairi M, Tashkandi N, Alabbasi SO, Al Shehri T, Moftah E, Kalantan B, Matroud A, Naidu B, Al Zayer S, Burrows V, Said Z, Soomro NA, Yousef MH, Fattouh AA, Tahoon MA, Muhammad M, Alruwili AM, Al Hanafi HA, Dandekar PB, Ibrahim K, AlHomsi M, Al Harbi AR, Saleem A, Masih E, Al Rashidi NM, Amanatullah AK, Al Mubarak J, Al Radwan AAA, Al Hassan A, Al Muoalad S, Alzahrani AA, Chalabi J, Qureshi A, Al Ansari M, Sallam H, Elhazmi A, Alkhaldi F, Malibary A, Ababtain A, Latif A, Berenholtz SM. Impact of a national collaborative project to improve the care of mechanically ventilated patients. PLoS One 2023; 18:e0280744. [PMID: 36716310 PMCID: PMC9886257 DOI: 10.1371/journal.pone.0280744] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/19/2022] [Indexed: 02/01/2023] Open
Abstract
This prospective quasi-experimental study from the NASAM (National Approach to Standardize and Improve Mechanical Ventilation) collaborative assessed the impact of evidence-based practices including subglottic suctioning, daily assessment for spontaneous awakening trial (SAT), spontaneous breathing trial (SBT), head of bed elevation, and avoidance of neuromuscular blockers unless otherwise indicated. The study outcomes included VAE (primary) and intensive care unit (ICU) mortality. Changes in daily care process measures and outcomes were evaluated using repeated measures mixed modeling. The results were reported as incident rate ratio (IRR) for each additional month with 95% confidence interval (CI). A comprehensive program that included education on evidence-based practices for optimal care of mechanically ventilated patients with real-time benchmarking of daily care process measures to drive improvement in forty-two ICUs from 26 hospitals in Saudi Arabia (>27,000 days of observation). Compliance with subglottic suctioning, SAT and SBT increased monthly during the project by 3.5%, 2.1% and 1.9%, respectively (IRR 1.035, 95%CI 1.007-1.064, p = 0.0148; 1.021, 95% CI 1.010-1.032, p = 0.0003; and 1.019, 95%CI 1.009-1.029, p = 0.0001, respectively). The use of neuromuscular blockers decreased monthly by 2.5% (IRR 0.975, 95%CI 0.953-0.998, p = 0.0341). The compliance with head of bed elevation was high at baseline and did not change over time. Based on data for 83153 ventilator days, VAE rate was 15.2/1000 ventilator day (95%CI 12.6-18.1) at baseline and did not change during the project (IRR 1.019, 95%CI 0.985-1.053, p = 0.2812). Based on data for 8523 patients; the mortality was 30.4% (95%CI 27.4-33.6) at baseline, and decreased monthly during the project by 1.6% (IRR 0.984, 95%CI 0.973-0.996, p = 0.0067). A national quality improvement collaborative was associated with improvements in daily care processes. These changes were associated with a reduction in mortality but not VAEs. Registration The study is registered in clinicaltrials.gov (NCT03790150).
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Affiliation(s)
- Yaseen M. Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- * E-mail:
| | - Zohair Al Aseri
- Department of Emergency, Department of Intensive Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmohsen Alsaawi
- Department of Medical Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ali M. Al Khathaami
- Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Eman Al Qasim
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah A. Alzahrani
- Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Al Qarni
- Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sheryl Ann I. Abdukahil
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hasan M. Al-Dorzi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaleem Alattasi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Yasser Mandourah
- Department of Military Medical Services, Ministry of Defense, Riyadh, Saudi Arabia
| | - Tareef Y. Alaama
- Deputyship of Curative Services, Ministry of Health, Riyadh, Saudi Arabia
| | | | - Abdulrahman Alqahtani
- Executive Director of Medical Affairs Department, Ministry of Health, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmad Shuaibi
- Department of Medical Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Dammam, Saudi Arabia
| | - Ali Al Qarni
- Department of Medicine, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Mufareh Alkatheri
- Quality and Patient Safety Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Raed H. Al Hazme
- Department of Health Informatics, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Biomedical Informatics, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Ramesh Kumar Vishwakarma
- Department of Bioinformatics and Biostatistics, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Statistics Department, European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Omar Aldibasi
- Department of Bioinformatics and Biostatistics, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Saeed Alshahrani
- Department of Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Ashraf Attia
- Department of Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | | | - Ahmed Mady
- Department of Intensive Care, King Saud Medical City, Riyadh, Saudi Arabia
- Department of Anesthesiology and Intensive Care, Tanta University Hospital, Tanta, Egypt
| | | | - Huda Ahmad Mhawish
- Department of Intensive Care, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Fahad Al-Hameed
- Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Khalid Alghamdi
- Department of Intensive Care, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Adnan Alghamdi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ghaleb A. Almekhlafi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Saleh Abdorabo Haider Qasim
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hussain Ali Al Haji
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammed Al Mutairi
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nabiha Tashkandi
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shatha Othman Alabbasi
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Tariq Al Shehri
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Emad Moftah
- Rehabilitation Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Basim Kalantan
- Rehabilitation Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amal Matroud
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Brintha Naidu
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Salha Al Zayer
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Victoria Burrows
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Zayneb Said
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | | | | | | | - Majdi Muhammad
- Department of Intensive Care, Gurayat General Hospital, AlGurayat, Saudi Arabia
| | | | | | | | - Kamel Ibrahim
- Department of Intensive Care, King Khalid General Hospital, Majmaah, Saudi Arabia
| | - Mwafaq AlHomsi
- Department of Intensive Care, Buraydah Central Hospital, AlQassim, Saudi Arabia
| | - Asma Rayan Al Harbi
- Department of Intensive Care, King Fahad Specialist Hospital, AlQassim, Saudi Arabia
| | - Adel Saleem
- Department of Intensive Care, King Faisal Hospital, Makkah, Saudi Arabia
| | - Ejaz Masih
- Department of Intensive Care, King Khaled Hospital, Tabuk, Saudi Arabia
| | | | | | - Jaffar Al Mubarak
- Respiratory Services, King Khalid General Hospital, Hafer Al Batin, Saudi Arabia
| | | | - Ali Al Hassan
- Department of Intensive Care, King Khalid Hospital, Najran, Saudi Arabia
| | - Sadiyah Al Muoalad
- Nursing Services, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ammar Abdullah Alzahrani
- Respiratory Services Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Jamal Chalabi
- Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia
| | - Ahmad Qureshi
- Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Madinah, Saudi Arabia
| | - Maryam Al Ansari
- Department of Intensive Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Dammam, Saudi Arabia
| | - Hend Sallam
- Department of Intensive Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Alyaa Elhazmi
- Department of Intensive Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Fawziah Alkhaldi
- Nursing Services, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulrauf Malibary
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Ababtain
- Respiratory Services, Royal Commission Health Services Program, Jubayl, Saudi Arabia
| | - Asad Latif
- Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sean M. Berenholtz
- Department of Anesthesiology and Critical Care Medicine, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Weatherald J, Parhar KKS, Al Duhailib Z, Chu DK, Granholm A, Solverson K, Lewis K, Møller MH, Alshahrani M, Belley-Cote E, Loroff N, Qian ET, Gatto CL, Rice TW, Niven D, Stelfox HT, Fiest K, Cook D, Arabi YM, Alhazzani W. Efficacy of awake prone positioning in patients with covid-19 related hypoxemic respiratory failure: systematic review and meta-analysis of randomized trials. BMJ 2022; 379:e071966. [PMID: 36740866 PMCID: PMC9727649 DOI: 10.1136/bmj-2022-071966] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of awake prone positioning versus usual care in non-intubated adults with hypoxemic respiratory failure due to covid-19. DESIGN Systematic review with frequentist and bayesian meta-analyses. STUDY ELIGIBILITY Randomized trials comparing awake prone positioning versus usual care in adults with covid-19 related hypoxemic respiratory failure. Information sources were Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to 4 March 2022. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and assessed risk of bias. Random effects meta-analyses were performed for the primary and secondary outcomes. Bayesian meta-analyses were performed for endotracheal intubation and mortality outcomes. GRADE certainty of evidence was assessed for outcomes. MAIN OUTCOME MEASURES The primary outcome was endotracheal intubation. Secondary outcomes were mortality, ventilator-free days, intensive care unit (ICU) and hospital length of stay, escalation of oxygen modality, change in oxygenation and respiratory rate, and adverse events. RESULTS 17 trials (2931 patients) met the eligibility criteria. 12 trials were at low risk of bias, three had some concerns, and two were at high risk. Awake prone positioning reduced the risk of endotracheal intubation compared with usual care (crude average 24.2% v 29.8%, relative risk 0.83, 95% confidence interval 0.73 to 0.94; high certainty). This translates to 55 fewer intubations per 1000 patients (95% confidence interval 87 to 19 fewer intubations). Awake prone positioning did not significantly affect secondary outcomes, including mortality (15.6% v 17.2%, relative risk 0.90, 0.76 to 1.07; high certainty), ventilator-free days (mean difference 0.97 days, 95% confidence interval -0.5 to 3.4; low certainty), ICU length of stay (-2.1 days, -4.5 to 0.4; low certainty), hospital length of stay (-0.09 days, -0.69 to 0.51; moderate certainty), and escalation of oxygen modality (21.4% v 23.0%, relative risk 1.04, 0.74 to 1.44; low certainty). Adverse events related to awake prone positioning were uncommon. Bayesian meta-analysis showed a high probability of benefit with awake prone positioning for endotracheal intubation (non-informative prior, mean relative risk 0.83, 95% credible interval 0.70 to 0.97; posterior probability for relative risk <0.95=96%) but lower probability for mortality (0.90, 0.73 to 1.13; <0.95=68%). CONCLUSIONS Awake prone positioning compared with usual care reduces the risk of endotracheal intubation in adults with hypoxemic respiratory failure due to covid-19 but probably has little to no effect on mortality or other outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022314856.
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Affiliation(s)
- Jason Weatherald
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
- Contributed equally
| | - Ken Kuljit S Parhar
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 5A1, Canada
- O'Brien Institute for Public Health, Calgary, AB, Canada
- Contributed equally
| | - Zainab Al Duhailib
- Critical Care Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Derek K Chu
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
| | - Anders Granholm
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Kevin Solverson
- Department of Medicine, Division of Respirology, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 5A1, Canada
| | - Kimberley Lewis
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Mohammed Alshahrani
- Department of Emergency and Critical Care, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Emilie Belley-Cote
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Nicole Loroff
- Knowledge Resource Service, Alberta Health Services, Edmonton, AB, Canada
| | - Edward T Qian
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cheryl L Gatto
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd W Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dan Niven
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 5A1, Canada
- O'Brien Institute for Public Health, Calgary, AB, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 5A1, Canada
- O'Brien Institute for Public Health, Calgary, AB, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 5A1, Canada
- O'Brien Institute for Public Health, Calgary, AB, Canada
| | - Deborah Cook
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Yaseen M Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- The Research Institute of St Joe's Hamilton, Hamilton, ON, Canada
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Arishi H, AlQahtani S, Tamim H, Sadat M, Alenezi FZ, Bin Humaid F, AlWehaibi W, Arabi YM. Combination of norepinephrine with phenylephrine versus norepinephrine with vasopressin in critically ill patients with septic shock: A retrospective study. J Crit Care 2022; 72:154121. [PMID: 35908329 DOI: 10.1016/j.jcrc.2022.154121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 04/18/2022] [Revised: 06/27/2022] [Accepted: 07/21/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the outcomes of patients with septic shock treated with a combination of norepinephrine with phenylephrine compared to norepinephrine with vasopressin. MATERIALS AND METHODS This was a retrospective cohort study including adults admitted between 2002 and 2017 with septic shock according to the Sepsis 3 criteria. We compared outcomes of patients treated with norepinephrine with phenylephrine to those treated with norepinephrine with vasopressin. Multivariate analysis was carried out to evaluate the association of norepinephrine with phenylephrine compared to norepinephrine with vasopressin with in-hospital mortality. RESULTS During the study period, 158 patients with septic shock were treated with norepinephrine with phenylephrine and 129 with norepinephrine with vasopressin. Crude in-hospital mortality was not different between the two groups [91/158 (57.6%) versus 80/129 (62.5%), p = 0.40]. There was also no difference in ICU length of stay or hospital length of stay. Multivariate analysis demonstrated no significant association of norepinephrine with phenylephrine with in-hospital mortality compared to norepinephrine with vasopressin (OR 0.62 (95% confidence interval 0.31, 1.23, p = 0.17). CONCLUSION Phenylephrine used as a second-line vasoactive agent combined with norepinephrine may be a reasonable option compared to vasopressin. However, this finding needs to be validated in a randomized controlled trial.
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Affiliation(s)
- Hatim Arishi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
| | - Samah AlQahtani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hani Tamim
- American University of Beirut Medical Center, Clinical Research Institute, Beirut, Lebanon; AlFaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - Musharaf Sadat
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
| | - Farhan Zayed Alenezi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Felwa Bin Humaid
- King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Wedyan AlWehaibi
- King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Yaseen M Arabi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
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34
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Lau VI, Xie F, Fowler RA, Rochwerg B, Johnstone J, Lauzier F, Marshall JC, Basmaji J, Henderson W, Khwaja K, Loubani O, Niven DJ, Zarychanski R, Arabi YM, Cartin-Ceba R, Thabane L, Heels-Ansdell D, Cook DJ. Health economic evaluation alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (E-PROSPECT): a cost-effectiveness analysis. Can J Anaesth 2022; 69:1515-1526. [PMID: 36289153 DOI: 10.1007/s12630-022-02335-9] [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: 04/27/2022] [Revised: 06/06/2022] [Accepted: 06/21/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We sought to compare the cost-effectiveness of probiotics and usual care with usual care without probiotics in mechanically ventilated, intensive care unit patients alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT). METHODS We conducted a health economic evaluation alongside the PROSPECT randomized control trial (October 2013-March 2019). We adopted a public healthcare payer's perspective. Forty-four intensive care units in three countries (Canada/USA/Saudi Arabia) with adult critically ill, mechanically ventilated patients (N = 2,650) were included. Interventions were probiotics (Lactobacillus rhamnosus GG) vs placebo administered enterally twice daily. We collected healthcare resource use and estimated unit costs in 2019 United States dollars (USD) over a time horizon from randomization to hospital discharge/death. We calculated incremental cost-effectiveness ratios (ICERs) comparing probiotics vs usual care. The primary outcome was incremental cost per ventilator-associated pneumonia (VAP) event averted; secondary outcomes were costs per Clostridioides difficile-associated diarrhea (CDAD), antibiotic-associated diarrhea (AAD), and mortality averted. Uncertainty was investigated using nonparametric bootstrapping and sensitivity analyses. RESULTS Mean (standard deviation [SD]) cost per patient was USD 66,914 (91,098) for patients randomized to probiotics, with a median [interquartile range (IQR)] of USD 42,947 [22,239 to 76,205]. By comparison, for those not receiving probiotics, mean (SD) cost per patient was USD 62,701 (78,676) (median [IQR], USD 41,102 [23,170 to 75,140]; incremental cost, USD 4,213; 95% confidence interval [CI], -2,269 to 10,708). Incremental cost-effectiveness ratios for VAP or AAD events averted, probiotics were dominated by usual care (more expensive, with similar effectiveness). The ICERs were USD 1,473,400 per CDAD event averted (95% CI, undefined) and USD 396,764 per death averted (95% CI, undefined). Cost-effectiveness acceptability curves reveal that probiotics were not cost-effective across wide ranges of plausible willingness-to-pay thresholds. Sensitivity analyses did not change the conclusions. CONCLUSIONS Probiotics for VAP prevention among critically ill patients were not cost-effective. Study registration data www. CLINICALTRIALS gov (NCT01782755); registered 4 February 2013.
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Affiliation(s)
- Vincent I Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. .,Department of Critical Care, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 Street, Edmonton, AB, Canada.
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Programs for Health Economics and Outcomes Measures, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jennie Johnstone
- Department of Infection Prevention and Control, Sinai Health, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - François Lauzier
- Departments of Medicine, Anesthesiology & Critical Care, Université Laval, Quebec, QC, Canada
| | - John C Marshall
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - John Basmaji
- Division of Critical Care Medicine, Department of Medicine, Western University, London, ON, Canada
| | - William Henderson
- Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kosar Khwaja
- Departments of Surgery and Critical Care Medicine, McGill University, Montreal, QC, Canada
| | - Osama Loubani
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ryan Zarychanski
- Sections of Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Yaseen M Arabi
- Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Rodrigo Cartin-Ceba
- Division of Pulmonary Medicine and Critical Care, Department of Critical Care, Mayo Clinic, Phoenix, AZ, USA
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Deborah J Cook
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
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35
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Butler-Laporte G, Povysil G, Kosmicki JA, Cirulli ET, Drivas T, Furini S, Saad C, Schmidt A, Olszewski P, Korotko U, Quinodoz M, Çelik E, Kundu K, Walter K, Jung J, Stockwell AD, Sloofman LG, Jordan DM, Thompson RC, Del Valle D, Simons N, Cheng E, Sebra R, Schadt EE, Kim-Schulze S, Gnjatic S, Merad M, Buxbaum JD, Beckmann ND, Charney AW, Przychodzen B, Chang T, Pottinger TD, Shang N, Brand F, Fava F, Mari F, Chwialkowska K, Niemira M, Pula S, Baillie JK, Stuckey A, Salas A, Bello X, Pardo-Seco J, Gómez-Carballa A, Rivero-Calle I, Martinón-Torres F, Ganna A, Karczewski KJ, Veerapen K, Bourgey M, Bourque G, Eveleigh RJM, Forgetta V, Morrison D, Langlais D, Lathrop M, Mooser V, Nakanishi T, Frithiof R, Hultström M, Lipcsey M, Marincevic-Zuniga Y, Nordlund J, Schiabor Barrett KM, Lee W, Bolze A, White S, Riffle S, Tanudjaja F, Sandoval E, Neveux I, Dabe S, Casadei N, Motameny S, Alaamery M, Massadeh S, Aljawini N, Almutairi MS, Arabi YM, Alqahtani SA, Al Harthi FS, Almutairi A, Alqubaishi F, Alotaibi S, Binowayn A, Alsolm EA, El Bardisy H, Fawzy M, Cai F, Soranzo N, Butterworth A, Geschwind DH, Arteaga S, Stephens A, Butte MJ, Boutros PC, Yamaguchi TN, Tao S, Eng S, Sanders T, Tung PJ, Broudy ME, Pan Y, Gonzalez A, Chavan N, Johnson R, Pasaniuc B, Yaspan B, Smieszek S, Rivolta C, Bibert S, Bochud PY, Dabrowski M, Zawadzki P, Sypniewski M, Kaja E, Chariyavilaskul P, Nilaratanakul V, Hirankarn N, Shotelersuk V, Pongpanich M, Phokaew C, Chetruengchai W, Tokunaga K, Sugiyama M, Kawai Y, Hasegawa T, Naito T, Namkoong H, Edahiro R, Kimura A, Ogawa S, Kanai T, Fukunaga K, Okada Y, Imoto S, Miyano S, Mangul S, Abedalthagafi MS, Zeberg H, Grzymski JJ, Washington NL, Ossowski S, Ludwig KU, Schulte EC, Riess O, Moniuszko M, Kwasniewski M, Mbarek H, Ismail SI, Verma A, Goldstein DB, Kiryluk K, Renieri A, Ferreira MAR, Richards JB. Exome-wide association study to identify rare variants influencing COVID-19 outcomes: Results from the Host Genetics Initiative. PLoS Genet 2022; 18:e1010367. [PMID: 36327219 PMCID: PMC9632827 DOI: 10.1371/journal.pgen.1010367] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/29/2022] [Indexed: 11/05/2022] Open
Abstract
Host genetics is a key determinant of COVID-19 outcomes. Previously, the COVID-19 Host Genetics Initiative genome-wide association study used common variants to identify multiple loci associated with COVID-19 outcomes. However, variants with the largest impact on COVID-19 outcomes are expected to be rare in the population. Hence, studying rare variants may provide additional insights into disease susceptibility and pathogenesis, thereby informing therapeutics development. Here, we combined whole-exome and whole-genome sequencing from 21 cohorts across 12 countries and performed rare variant exome-wide burden analyses for COVID-19 outcomes. In an analysis of 5,085 severe disease cases and 571,737 controls, we observed that carrying a rare deleterious variant in the SARS-CoV-2 sensor toll-like receptor TLR7 (on chromosome X) was associated with a 5.3-fold increase in severe disease (95% CI: 2.75-10.05, p = 5.41x10-7). This association was consistent across sexes. These results further support TLR7 as a genetic determinant of severe disease and suggest that larger studies on rare variants influencing COVID-19 outcomes could provide additional insights.
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Grants
- 409511 CIHR
- RG/13/13/30194 British Heart Foundation
- C18281/A29019 Cancer Research UK
- 100558 CIHR
- MC_PC_20004 Medical Research Council
- 365825 CIHR
- UL1 TR001873 NCATS NIH HHS
- RG/18/13/33946 British Heart Foundation
- CH/12/2/29428 British Heart Foundation
- CanCOGeN HostSeq
- Fonds de Recherche Québec Santé (FRQS)
- Génome Québec
- Public Health Agency of Canada
- Canadian Institutes of Health Research (CIHR)
- Lady Davis Institute of the Jewish General Hospital
- Canadian Foundation for Innovation
- NIH Foundation
- McGill Interdisciplinary Initiative in Infection and Immunity (MI4)
- Jewish General Hospital Foundation
- McGill University
- Calcul Québec and Compute Canada
- Compute Canada
- Vagelos College of Physicians & Surgeons Office for Research
- Biomedical Informatics Resource of the Columbia University Irving Institute for Clinical and Translational Research (CTSA)
- National Center for Advancing Translational Sciences, National Institutes of Health
- German Research Foundation
- NGS Competence Center Tübingen
- West German Genome Center
- Stiftung Universitätsmedizin Essen
- Technical University of Munich
- BONFOR program of the Medical Faculty, University of Bonn
- Emmy-Noether programm of the German Research Foundation
- State of Saarland
- Dr. Rolf M. Schwiete Foundation
- Munich Clinician Scientist Programm
- Netzwerk-Universitaetsmedizin-COVIM
- Federal Ministry of Education and Research
- Swiss National Science Foundation
- Leenaards Foundation
- Santos-Suarez Foundation
- Carigest
- MIUR project “Dipartimenti di Eccellenza 2018-2020”
- Bando Ricerca COVID-19 Toscana
- charity fund 2020 from Intesa San Paolo
- Italian Ministry of University and Research
- Istituto Buddista Italiano Soka Gakkai
- Instituto de Salud Carlos III
- GePEM
- DIAVIR
- Resvi-Omics
- ReSVinext
- Enterogen
- Agencia Gallega para la Gestión del Conocimiento en Salud
- BI-BACVIR
- CovidPhy
- Agencia Gallega de Innovación (GAIN):
- GEN-COVID
- Framework Partnership Agreement between the Consellería de Sanidad de la XUNTA de Galicia
- GENVIP-IDIS
- consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
- F. Hoffmann-La Roche Ltd
- U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, and Biomedical Advanced Research and Development Authority
- Nevada Governor's Office of Economic Development
- Renown Health and the Renown Health Foundation
- Ratchadapiseksompotch Fund, Faculty of Medicine, Chulalongkorn University
- Healthcare-associated Infection Research Group STAR (Special Task Force for Activating Research)
- Grant for Development of New Faculty Staff, Ratchadaphiseksomphot Endowment Fund
- e-ASIA Joint Research Program (National Science and Technology Development Agency)
- Health Systems Research Institute, TSRI Fund
- Thailand Research Fund
- Ratchadapiseksompotch Fund
- Ratchadapiseksompotch Fund, Faculty of Medicine,Chulalongkorn University, Bangkok, Thailand
- Health Systems Research Institute
- Ratchadapisek Sompoch Endowment Fund, Chulalongkorn University
- NHS Blood and Transplant
- National Institute for Health Research
- UK Medical Research Council
- Japan Agency for Medical Research and Development
- Japan Science and Technology Agency
- National Center for Global Health and Medicine
- Agency for Medical Research and Development
- Polish National Science Centre
- Medical Research Agency
- Perelman School of Medicine at University of Pennsylvania
- Smilow family
- National Center for Advancing Translational Sciences of the National Institutes of Health
- Polish Medical Research Agency
- Qatar Foundation for Education, Science and Community Development
- Saudi Ministry of Health
- King Abdulaziz City for Science and Technology
- European Union’s Horizon 2020 research and innovation program
- Science for Life Laboratory
- Swedish Research Council
- Knut and Alice Wallenberg Foundation
- OCRC
- Microsoft COVID Compute Funding
- Illumina
- UCLA David Geffen School of Medicine - Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research Award Program
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Affiliation(s)
- Guillaume Butler-Laporte
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Gundula Povysil
- Institute for Genomic Medicine, Columbia University, New York city, New York, United States of America
| | - Jack A. Kosmicki
- Regeneron Genetics Center, Tarrytown, New York, United States of America
| | | | - Theodore Drivas
- Division of Human Genetics, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Simone Furini
- Department of Medical Biotechnologies, Med Biotech Hub and Competence Center, University of Siena, Siena, Italy
| | - Chadi Saad
- Qatar Genome Program, Qatar Foundation Research, Development and Innovation, Qatar Foundation, Doha, Qatar
| | - Axel Schmidt
- Institute of Human Genetics, School of Medicine and University Hospital Bonn, University of Bonn, Bonn, Germany
| | | | - Urszula Korotko
- IMAGENE.ME SA, Bialystok, Poland
- Centre for Bioinformatics and Data Analysis, Medical University of Bialystok, Bialystok, Poland
| | - Mathieu Quinodoz
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Elifnaz Çelik
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Kousik Kundu
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - Klaudia Walter
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - Junghyun Jung
- Department of Clinical Pharmacy, School of Pharmacy, University of Southern California, Los Angeles, California, United States of America
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Amy D. Stockwell
- Genentech Inc, South San Francisco, California, United States of America
| | - Laura G. Sloofman
- Seaver Autism Center for Research and Treatment, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York city, New York, United States of America
| | - Daniel M. Jordan
- Mount Sinai Clnical Intelligence Center, Charles Bronfman Institute for Personalized Medicine, Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York city, New York, United States of America
| | - Ryan C. Thompson
- Icahn Institute of Data Science and Genomics Technology, New York city, New York, United States of America
| | - Diane Del Valle
- Icahn School of Medicine at Mount Sinai, New York city, New York, United States of America
| | - Nicole Simons
- Icahn School of Medicine at Mount Sinai, New York city, New York, United States of America
| | - Esther Cheng
- Icahn School of Medicine at Mount Sinai, New York city, New York, United States of America
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York city,New York, United States of America
| | - Eric E. Schadt
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York city,New York, United States of America
| | - Seunghee Kim-Schulze
- Department of Oncological Science, Human Immune Monitoring Center, Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York city, New York, United States of America
| | - Sacha Gnjatic
- Icahn School of Medicine at Mount Sinai, New York city, New York, United States of America
| | - Miriam Merad
- Precision Immunology Institute, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York city, New York, United States of America
| | - Joseph D. Buxbaum
- Seaver Autism Center for Research and Treatment, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York city, New York, United States of America
| | - Noam D. Beckmann
- Precision Immunology Institute, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York city, New York, United States of America
| | - Alexander W. Charney
- Mount Sinai Clinical Intelligence Center; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York city, New York, United States of America
| | | | - Timothy Chang
- Department of Neurology, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Tess D. Pottinger
- Institute for Genomic Medicine, Columbia University, New York city, New York, United States of America
| | - Ning Shang
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York city, New York, United States of America
| | - Fabian Brand
- Institute of Genomic Statistics and Bioinformatics, School of Medicine and University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Francesca Fava
- Department of Medical Biotechnologies, Med Biotech Hub and Competence Center, University of Siena, Siena, Italy
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
- Medical Genetics, University of Siena, Siena, Italy
| | - Francesca Mari
- Department of Medical Biotechnologies, Med Biotech Hub and Competence Center, University of Siena, Siena, Italy
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
- Medical Genetics, University of Siena, Siena, Italy
| | - Karolina Chwialkowska
- IMAGENE.ME SA, Bialystok, Poland
- Centre for Bioinformatics and Data Analysis, Medical University of Bialystok, Bialystok, Poland
| | - Magdalena Niemira
- Centre for Clinical Research, Medical University of Bialystok, Bialystok, Poland
| | | | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
- Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- Intensive Care Unit, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | | | - Antonio Salas
- Unidade de Xenética, Instituto de Ciencias Forenses (INCIFOR), Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, Instituto de Investigaciones Sanitarias, Hospital Clínico Universitario de Santiago (SERGAS), Santiago de Compostela, Galicia, Spain
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain
| | - Xabier Bello
- Unidade de Xenética, Instituto de Ciencias Forenses (INCIFOR), Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, Instituto de Investigaciones Sanitarias, Hospital Clínico Universitario de Santiago (SERGAS), Santiago de Compostela, Galicia, Spain
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain
| | - Jacobo Pardo-Seco
- Unidade de Xenética, Instituto de Ciencias Forenses (INCIFOR), Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, Instituto de Investigaciones Sanitarias, Hospital Clínico Universitario de Santiago (SERGAS), Santiago de Compostela, Galicia, Spain
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain
| | - Alberto Gómez-Carballa
- Unidade de Xenética, Instituto de Ciencias Forenses (INCIFOR), Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, Instituto de Investigaciones Sanitarias, Hospital Clínico Universitario de Santiago (SERGAS), Santiago de Compostela, Galicia, Spain
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain
| | - Irene Rivero-Calle
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Federico Martinón-Torres
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Andrea Ganna
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachussets, United States of America
| | - Konrad J. Karczewski
- Stanley Center for Psychiatric Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Kumar Veerapen
- Stanley Center for Psychiatric Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Mathieu Bourgey
- Canadian Centre for Computational Genomics, McGill University, Montréal, Québec, Canada
- McGill Genome Center, McGill University, Montréal, Québec, Canada
| | - Guillaume Bourque
- Canadian Centre for Computational Genomics, McGill University, Montréal, Québec, Canada
- McGill Genome Center, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
| | - Robert JM Eveleigh
- Canadian Centre for Computational Genomics, McGill University, Montréal, Québec, Canada
- McGill Genome Center, McGill University, Montréal, Québec, Canada
| | - Vincenzo Forgetta
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - David Morrison
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - David Langlais
- McGill Genome Center, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
| | - Mark Lathrop
- McGill Genome Center, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
| | - Vincent Mooser
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
| | - Tomoko Nakanishi
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
- Kyoto-McGill International Collaborative School in Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Research Fellow, Japan Society for the Promotion of Science, Tokyo, Japan
| | - Robert Frithiof
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Michael Hultström
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Integrative Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Hedenstierna Laboratory, CIRRUS, Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Yanara Marincevic-Zuniga
- Department of Medical Sciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Jessica Nordlund
- Department of Medical Sciences, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - William Lee
- Helix, San Mateo, California, United States of America
| | | | - Simon White
- Helix, San Mateo, California, United States of America
| | | | | | | | - Iva Neveux
- Center for Genomic Medicine, Desert Research Institute, Reno, Nevada United States of America
| | - Shaun Dabe
- Renown Health, Reno, Nevada, United States of America
| | - Nicolas Casadei
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
- NGS Competence Center Tuebingen, Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Susanne Motameny
- West German Genome Center, site Cologne, University of Cologne, Cologne, Germany
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Manal Alaamery
- Developmental Medicine Department, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Saudi Human Genome Project at King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Salam Massadeh
- Developmental Medicine Department, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Saudi Human Genome Project at King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Nora Aljawini
- Developmental Medicine Department, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Saudi Human Genome Project at King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Mansour S. Almutairi
- Developmental Medicine Department, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Saudi Human Genome Project at King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Yaseen M. Arabi
- Ministry of the National Guard Health Affairs, King Abdullah International Medical Research Center and King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saleh A. Alqahtani
- Liver Transplant Unit, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Fawz S. Al Harthi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Amal Almutairi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Fatima Alqubaishi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Sarah Alotaibi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Albandari Binowayn
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Ebtehal A. Alsolm
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Hadeel El Bardisy
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Mohammad Fawzy
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Fang Cai
- Genentech Inc, South San Francisco, California, United States of America
| | - Nicole Soranzo
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - Adam Butterworth
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, United Kingdom
| | | | | | | | | | | | | | | | | | - Daniel H. Geschwind
- Department of Neurology, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Stephanie Arteaga
- Department of Neurology, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Alexis Stephens
- Department of Pediatrics, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Manish J. Butte
- Department of Pediatrics, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
- Department of Microbiology, Immunology, and Molecular Genetics (MIMG), David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Paul C. Boutros
- Department of Human Genetics, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Takafumi N. Yamaguchi
- Department of Human Genetics, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Shu Tao
- Department of Human Genetics, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Stefan Eng
- Department of Human Genetics, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Timothy Sanders
- Office of Health Informatics and Analytics, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Paul J. Tung
- Office of Health Informatics and Analytics, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Michael E. Broudy
- Office of Health Informatics and Analytics, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Yu Pan
- Office of Health Informatics and Analytics, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Alfredo Gonzalez
- Department of Human Genetics, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Nikhil Chavan
- Office of Health Informatics and Analytics, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Ruth Johnson
- Department of Computer Science, McGill University, Montréal, Québec, Canada
| | - Bogdan Pasaniuc
- Department of Human Genetics, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
- Department of Computational Medicine, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
- Department of Pathology, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, California, United States of America
| | - Brian Yaspan
- Genentech Inc, South San Francisco, California, United States of America
| | - Sandra Smieszek
- Vanda Pharmaceuticals, Washington, District of Columbia, United States of America
| | - Carlo Rivolta
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Stephanie Bibert
- Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre-Yves Bochud
- Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Maciej Dabrowski
- MNM Bioscience Inc., Cambridge, Massachusetts, United States of America
| | - Pawel Zawadzki
- MNM Bioscience Inc., Cambridge, Massachusetts, United States of America
- Faculty of Physics, Adam Mickiewicz University, Poznan, Poland
| | | | - Elżbieta Kaja
- MNM Bioscience Inc., Cambridge, Massachusetts, United States of America
- Department of Medical Chemistry and Laboratory Medicine, Poznań University of Medical Sciences, Poznań, Poland
| | - Pajaree Chariyavilaskul
- Clinical Pharmacokinetics and Pharmacogenomics Research Unit, Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Voraphoj Nilaratanakul
- Healthcare-associated Infection Research Group STAR (Special Task Force for Activating Research) and Division of Infectious Diseases, Department of Medicine,Chulalongkorn University, Bangkok, Thailand
| | - Nattiya Hirankarn
- Center of Excellence in Immunology and Immune-mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, and Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Monnat Pongpanich
- Department of Mathematics and Computer Science, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | - Chureerat Phokaew
- Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wanna Chetruengchai
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Katsushi Tokunaga
- Genome Medical Science Project, Research Institute, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masaya Sugiyama
- Genome Medical Science Project, Research Institute, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yosuke Kawai
- Genome Medical Science Project, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Takanori Hasegawa
- M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuhiko Naito
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Ryuya Edahiro
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akinori Kimura
- Institute of Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institute, Stockholm, Sweden
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
- Center for Infectious Disease Education and Research (CiDER), Osaka University, Suita, Japan
| | - Seiya Imoto
- Division of Health Medical Intelligence, Human Genome Center, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
| | - Satoru Miyano
- M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Serghei Mangul
- Department of Clinical Pharmacy, School of Pharmacy, University of Southern California, Los Angeles, California, United States of America
| | - Malak S. Abedalthagafi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Hugo Zeberg
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Joseph J. Grzymski
- Center for Genomic Medicine, Desert Research Institute, Reno, Nevada United States of America
| | | | - Stephan Ossowski
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
- NGS Competence Center Tuebingen, Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Kerstin U. Ludwig
- Institute of Human Genetics, School of Medicine and University Hospital Bonn, University of Bonn, Bonn, Germany
- West German Genome Center, site Bonn, University of Bonn, Bonn, Germany
| | - Eva C. Schulte
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Institute of Virology, Technical University Munich/Helmholtz Zentrum München, Munich, Germany
| | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
- NGS Competence Center Tuebingen, Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Marcin Moniuszko
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystok, Poland
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Miroslaw Kwasniewski
- IMAGENE.ME SA, Bialystok, Poland
- Centre for Bioinformatics and Data Analysis, Medical University of Bialystok, Bialystok, Poland
| | - Hamdi Mbarek
- Qatar Genome Program, Qatar Foundation Research, Development and Innovation, Qatar Foundation, Doha, Qatar
| | - Said I. Ismail
- Qatar Genome Program, Qatar Foundation Research, Development and Innovation, Qatar Foundation, Doha, Qatar
| | - Anurag Verma
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
| | - David B. Goldstein
- Institute for Genomic Medicine, Columbia University, New York city, New York, United States of America
- Department of Genetics & Development, Columbia University, New York city, New York, United States of America
| | - Krzysztof Kiryluk
- Institute for Genomic Medicine, Columbia University, New York city, New York, United States of America
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York city, New York, United States of America
| | - Alessandra Renieri
- Department of Medical Biotechnologies, Med Biotech Hub and Competence Center, University of Siena, Siena, Italy
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
- Medical Genetics, University of Siena, Siena, Italy
| | | | - J Brent Richards
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada
- Department of Human Genetics, McGill University, Montréal, Québec, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
- Department of Twin Research, King’s College London, London, United Kingdom
- 5 Prime Sciences Inc, Montreal, Quebec, Canada
- * E-mail:
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36
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Li A, Ling L, Qin H, Arabi YM, Myatra SN, Egi M, Kim JH, Mat Nor MB, Son DN, Fang WF, Wahyuprajitno B, Hashmi M, Faruq MO, Patjanasoontorn B, Al Bahrani MJ, Shrestha BR, Shrestha U, Nafees KMK, Sann KK, Palo JEM, Mendsaikhan N, Konkayev A, Detleuxay K, Chan YH, Du B, Divatia JV, Koh Y, Gomersall CD, Phua J. Epidemiology, Management, and Outcomes of Sepsis in ICUs among Countries of Differing National Wealth across Asia. Am J Respir Crit Care Med 2022; 206:1107-1116. [PMID: 35763381 DOI: 10.1164/rccm.202112-2743oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 12/11/2021] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Rationale: Directly comparative data on sepsis epidemiology and sepsis bundle implementation in countries of differing national wealth remain sparse. Objectives: To evaluate across countries/regions of differing income status in Asia 1) the prevalence, causes, and outcomes of sepsis as a reason for ICU admission and 2) sepsis bundle (antibiotic administration, blood culture, and lactate measurement) compliance and its association with hospital mortality. Methods: A prospective point prevalence study was conducted among 386 adult ICUs from 22 Asian countries/regions. Adult ICU participants admitted for sepsis on four separate days (representing the seasons of 2019) were recruited. Measurements and Main Results: The overall prevalence of sepsis in ICUs was 22.4% (20.9%, 24.5%, and 21.3% in low-income countries/regions [LICs]/lower middle-income countries/regions [LMICs], upper middle-income countries/regions, and high-income countries/regions [HICs], respectively; P < 0.001). Patients were younger and had lower severity of illness in LICs/LMICs. Hospital mortality was 32.6% and marginally significantly higher in LICs/LMICs than HICs on multivariable generalized mixed model analysis (adjusted odds ratio, 1.84; 95% confidence interval, 1.00-3.37; P = 0.049). Sepsis bundle compliance was 21.5% at 1 hour (26.0%, 22.1%, and 16.2% in LICs/LMICs, upper middle-income countries/regions, and HICs, respectively; P < 0.001) and 36.6% at 3 hours (39.3%, 32.8%, and 38.5%, respectively; P = 0.001). Delaying antibiotic administration beyond 3 hours was the only element independently associated with increased mortality (adjusted odds ratio, 2.53; 95% confidence interval, 2.07-3.08; P < 0.001). Conclusions: Sepsis is a common cause of admission to Asian ICUs. Mortality remains high and is higher in LICs/LMICs after controlling for confounders. Sepsis bundle compliance remains low. Delaying antibiotic administration beyond 3 hours from diagnosis is associated with increased mortality. Clinical trial registered with www.ctri.nic.in (CTRI/2019/01/016898).
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Affiliation(s)
- Andrew Li
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
- Department of Intensive Care Medicine, Woodlands Health, Singapore, Singapore
| | - Lowell Ling
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Hanyu Qin
- State Key Laboratory of Complex, Severe and Rare Disease, Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
| | - Yaseen M Arabi
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Sheila Nainan Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Moritoki Egi
- Department of Anesthesiology and Intensive Care Medicine, Kobe University Hospital, Kobe, Japan
| | - Je Hyeong Kim
- Department of Critical Care Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - Mohd Basri Mat Nor
- International Islamic University Malaysia Medical Centre, Kuantan, Malaysia
| | - Do Ngoc Son
- Critical Care Unit, Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
| | - Wen-Feng Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Bambang Wahyuprajitno
- Department of Anesthesiology and Reanimation, Faculty of Medicine - University of Airlangga, Intensive Care Unit, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Madiha Hashmi
- Department of Anaesthesiology, Aga Khan University, Karachi, Pakistan
| | - Mohammad Omar Faruq
- General Intensive Care Unit and Emergency Department, United Hospital Ltd., Dhaka, Bangladesh
| | - Boonsong Patjanasoontorn
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Babu Raja Shrestha
- Department of Anesthesia and Intensive Care, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | - Ujma Shrestha
- Department of Anesthesia and Intensive Care, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | | | - Kyi Kyi Sann
- Department of Anaesthesiology and Intensive Care Unit, Yangon General Hospital, University of Medicine 1, Yangon, Myanmar
| | | | - Naranpurev Mendsaikhan
- Anaesthesia and Critical Care Department, Mongolian National University of Health Science, Ulaanbaatar, Mongolia
| | - Aidos Konkayev
- Anaesthesiology and Intensive Care Department, Astana Medical University, Nur-Sultan, Kazakhstan
- Anaesthesia and Intensive Care Unit Department, Institution of Traumatology and Orthopedics, Nur-Sultan, Kazakhstan
| | - Khamsay Detleuxay
- Adult Intensive Care Unit, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bin Du
- State Key Laboratory of Complex, Severe and Rare Disease, Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
| | - Jigeeshu Vasishtha Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; and
| | - Charles D Gomersall
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason Phua
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
- FAST and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore, Singapore
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Arabi YM, Asiri AY, Assiri AM, Abdullah ML, Aljami HA, Balkhy HH, Al Jeraisy M, Mandourah Y, AlJohani S, Al Harbi S, Jokhdar HAA, Deeb AM, Memish ZA, Jose J, Ghazal S, Al Faraj S, Al Mekhlafi GA, Sherbeeni NM, Elzein FE, Hayden FG, Fowler RA, AlMutairi BM, Al-Dawood A, Alharbi NK. Heterogeneity of treatment effect of interferon-β1b and lopinavir-ritonavir in patients with Middle East respiratory syndrome by cytokine levels. Sci Rep 2022; 12:18186. [PMID: 36307462 PMCID: PMC9616407 DOI: 10.1038/s41598-022-22742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/19/2022] [Indexed: 12/31/2022] Open
Abstract
Animal and human data indicate variable effects of interferons in treating coronavirus infections according to inflammatory status and timing of therapy. In this sub-study of the MIRACLE trial (MERS-CoV Infection Treated with a Combination of Lopinavir-Ritonavir and Interferon β-1b), we evaluated the heterogeneity of treatment effect of interferon-β1b and lopinavir-ritonavir versus placebo among hospitalized patients with MERS on 90-day mortality, according to cytokine levels and timing of therapy. We measured plasma levels of 17 cytokines at enrollment and tested the treatment effect on 90-day mortality according to cytokine levels (higher versus lower levels using the upper tertile (67%) as a cutoff point) and time to treatment (≤ 7 days versus > 7 days of symptom onset) using interaction tests. Among 70 included patients, 32 received interferon-β1b and lopinavir-ritonavir and 38 received placebo. Interferon-β1b and lopinavir-ritonavir reduced mortality in patients with lower IL-2, IL-8 and IL-13 plasma concentrations but not in patients with higher levels (p-value for interaction = 0.09, 0.07, and 0.05, respectively) and with early but not late therapy (p = 0.002). There was no statistically significant heterogeneity of treatment effect according to other cytokine levels. Further work is needed to evaluate whether the assessment of inflammatory status can help in identifying patients with MERS who may benefit from interferon-β1b and lopinavir-ritonavir. Trial registration: This is a sub-study of the MIRACLE trial (ClinicalTrials.gov number, NCT02845843).
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Affiliation(s)
- Yaseen M. Arabi
- grid.412149.b0000 0004 0608 0662Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia ,grid.415254.30000 0004 1790 7311Intensive Care Department, King Abdulaziz Medical City, ICU 1425, P.O. Box 22490, Riyadh, 11426 Kingdom of Saudi Arabia
| | - Ayed Y. Asiri
- grid.440269.dIntensive Care Department, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Abdullah M. Assiri
- grid.415696.90000 0004 0573 9824Infection Prevention and Control, Preventive Health, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Mashan L. Abdullah
- grid.412149.b0000 0004 0608 0662Experimental Medicine Department, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Haya A. Aljami
- grid.412149.b0000 0004 0608 0662King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hanan H. Balkhy
- grid.3575.40000000121633745Antimicrobial Resistance, World Health Organization, Geneva, Switzerland
| | - Majed Al Jeraisy
- grid.415254.30000 0004 1790 7311College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Pharmaceutical Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Yasser Mandourah
- grid.415989.80000 0000 9759 8141Military Medical Services, Ministry of Defense, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Sameera AlJohani
- grid.412149.b0000 0004 0608 0662Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Shmeylan Al Harbi
- grid.415254.30000 0004 1790 7311College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Pharmaceutical Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Hani A. Aziz Jokhdar
- grid.415696.90000 0004 0573 9824Deputyship for Public Health, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad M. Deeb
- grid.412149.b0000 0004 0608 0662King Abdulaziz Medical City, Ministry of National Guard Health Affairs, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Ziad A. Memish
- grid.411335.10000 0004 1758 7207Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia ,grid.189967.80000 0001 0941 6502Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Jesna Jose
- grid.412149.b0000 0004 0608 0662Department Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Sameeh Ghazal
- grid.440269.dPrince Mohammed Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Sarah Al Faraj
- grid.440269.dPrince Mohammed Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Ghaleb A. Al Mekhlafi
- Intensive Care Department, King Salman bin Abdulaziz Medical City, Madinah, Kingdom of Saudi Arabia
| | - Nisreen Murad Sherbeeni
- grid.415989.80000 0000 9759 8141Infectious Diseases Division, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Fatehi Elnour Elzein
- grid.415989.80000 0000 9759 8141Infectious Diseases Division, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Frederick G. Hayden
- grid.27755.320000 0000 9136 933XDivision of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA USA
| | - Robert A. Fowler
- grid.416745.5Institute of Health Policy Management and Evaluation, University of Toronto, Department of Critical Care Medicine and Department of Medicine, Sunnybrook Hospital, Toronto, Canada
| | - Badriah M. AlMutairi
- grid.412149.b0000 0004 0608 0662King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Al-Dawood
- grid.412149.b0000 0004 0608 0662Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Naif Khalaf Alharbi
- grid.412149.b0000 0004 0608 0662King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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Shehabi Y, Serpa Neto A, Bellomo R, Howe BD, Arabi YM, Bailey M, Bass FE, Bin Kadiman S, McArthur CJ, Reade MC, Seppelt IM, Takala J, Wise MP, Webb SA. Dexmedetomidine and Propofol Sedation in Critically Ill Patients and Dose Associated 90-day Mortality: A Secondary Cohort Analysis of a Randomized Controlled Trial (SPICE-III). Am J Respir Crit Care Med 2022; 207:876-886. [PMID: 36215171 DOI: 10.1164/rccm.202206-1208oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Sedation Practice in Intensive Care Evaluation (SPICE-III) trial reported significant heterogeneity in mortality with dexmedetomidine treatment. Supplemental propofol was commonly used to achieve desirable sedation. OBJECTIVES to quantify the association of different infusion rates of dexmedetomidine or propofol, given in combination, with mortality and if this is modified by age. METHODS AND MEASUREMENTS We included 1177 patients randomized in SPICE-III to receive dexmedetomidine and given supplemental propofol, stratified by age (>65 or ≤65 years). We used double stratification analysis to produce quartiles of steady infusion rates of dexmedetomidine, while escalating propofol dose and vice versa. We used Cox proportional hazard and multivariable regression, adjusted for relevant clinical variable to evaluate the association of sedative dose with 90-day mortality. MAIN RESULTS Younger patients 598/1177(50.8%) received a significantly higher dose of both sedatives compared with older patients, to achieve comparable sedation depth. On double stratification analysis, escalating infusion rates of propofol to 1.27 mg/kg/h at a steady dexmedetomidine infusion rate (0.54 mcg/kg/h) was associated with reduced adjusted mortality in younger, but not older patients. This was consistent with multivariable regression modelling [hazard ratio: 0.59(95% Confidence Interval 0.43-0.78),P<0.0001], adjusted for baseline risk and interaction with dexmedetomidine dose. In contrast, among younger patients using multivariable regression, escalating dexmedetomidine infusion rate was associated with increased adjusted mortality [HR:1.30(95%CI 1.03-1.65), P=0.029]. CONCLUSION In patients ≤ 65 years sedated with dexmedetomidine and propofol combination, preferentially increasing the dose of propofol was associated with decreased adjusted 90-day mortality. Conversely, increasing dexmedetomidine may be associated with increased mortality. Clinical trial registration available at www. CLINICALTRIALS gov, ID: NCT01728558.
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Affiliation(s)
- Yahya Shehabi
- Monash University, School of Clinical Sciences , Clayton, Victoria, Australia.,Monash Health, Intensive Care Services, Clayton, Victoria, Australia.,University of New South Wales - Kensington Campus, Intensive Care - School of Clinical Medicine , Sydney, New South Wales, Australia;
| | - Ary Serpa Neto
- Monash University Faculty of Medicine Nursing and Health Sciences, ANZIC-RC, Prahran, Victoria, Australia
| | | | - Belinda D Howe
- Monash University, ANZIC-RC, Prahran, Victoria, Australia
| | - Yaseen M Arabi
- King Saud bin Abdulaziz Medical City for Science and Technology, Intensive Care Medicine, Riyadh, Saudi Arabia
| | - Michael Bailey
- ANZIC-RC, School of Public Health and Preventive Medicine , Melbourne, Victoria, Australia
| | - Frances E Bass
- Royal North Shore Hospital, Intensive Care , St Leonards, New South Wales, Australia
| | - Suhaini Bin Kadiman
- National Heart Institute University of Technology Malaysia Cardiovascular Engineering Centre, Johor Bahru, Johor, Malaysia
| | | | - Michael C Reade
- University of Queensland, Burns, Trauma and Critical Care Research Centre, Brisbane, Queensland, Australia.,Australian Defence Force, Joint Health Command, Brisbane, Queensland, Australia
| | - Ian M Seppelt
- University of Sydney Nepean Clinical School Intensive Care Medicine, Kingswood, New South Wales, Australia
| | - Jukka Takala
- Inselspital University Hospital Bern, Bern, Switzerland
| | - Matt P Wise
- University Hospital of Wales, Adult Critical Care, Cardiff, United Kingdom of Great Britain and Northern Ireland
| | - Steve A Webb
- University of Western Australia, Perth, Australia.,Royal Perth Hospital, Perth, Australia.,St John of God Health Care Inc, Intensive Care , Subiaco , Australia
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Alhazzani W, Weatherald J, Arabi YM. Effect of Awake Prone Positioning on Patients With COVID-19 and Acute Respiratory Failure-Reply. JAMA 2022; 328:1354-1355. [PMID: 36194221 DOI: 10.1001/jama.2022.13994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Jason Weatherald
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Canada
| | - Yaseen M Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Arabi YM, Aldekhyl S, Al Qahtani S, Al-Dorzi HM, Abdukahil SA, Al Harbi MK, Al Qasim E, Kharaba A, Albrahim T, Alshahrani MS, Al-Fares AA, Al Bshabshe A, Mady A, Al Duhailib Z, Algethamy H, Jose J, Al Mutairi M, Al Zumai O, Al Haji H, Alaqeily A, Al Aseri Z, Al-Omari A, Al-Dawood A, Tlayjeh H. Effect of Helmet Noninvasive Ventilation vs Usual Respiratory Support on Mortality Among Patients With Acute Hypoxemic Respiratory Failure Due to COVID-19: The HELMET-COVID Randomized Clinical Trial. JAMA 2022; 328:1063-1072. [PMID: 36125473 PMCID: PMC9490511 DOI: 10.1001/jama.2022.15599] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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: 11/14/2022]
Abstract
IMPORTANCE Helmet noninvasive ventilation has been used in patients with COVID-19 with the premise that helmet interface is more effective than mask interface in delivering prolonged treatments with high positive airway pressure, but data about its effectiveness are limited. OBJECTIVE To evaluate whether helmet noninvasive ventilation compared with usual respiratory support reduces mortality in patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia. DESIGN, SETTING, AND PARTICIPANTS This was a multicenter, pragmatic, randomized clinical trial that was conducted in 8 sites in Saudi Arabia and Kuwait between February 8, 2021, and November 16, 2021. Adult patients with acute hypoxemic respiratory failure (n = 320) due to suspected or confirmed COVID-19 were included. The final follow-up date for the primary outcome was December 14, 2021. INTERVENTIONS Patients were randomized to receive helmet noninvasive ventilation (n = 159) or usual respiratory support (n = 161), which included mask noninvasive ventilation, high-flow nasal oxygen, and standard oxygen. MAIN OUTCOMES AND MEASURES The primary outcome was 28-day all-cause mortality. There were 12 prespecified secondary outcomes, including endotracheal intubation, barotrauma, skin pressure injury, and serious adverse events. RESULTS Among 322 patients who were randomized, 320 were included in the primary analysis, all of whom completed the trial. Median age was 58 years, and 187 were men (58.4%). Within 28 days, 43 of 159 patients (27.0%) died in the helmet noninvasive ventilation group compared with 42 of 161 (26.1%) in the usual respiratory support group (risk difference, 1.0% [95% CI, -8.7% to 10.6%]; relative risk, 1.04 [95% CI, 0.72-1.49]; P = .85). Within 28 days, 75 of 159 patients (47.2%) required endotracheal intubation in the helmet noninvasive ventilation group compared with 81 of 161 (50.3%) in the usual respiratory support group (risk difference, -3.1% [95% CI, -14.1% to 7.8%]; relative risk, 0.94 [95% CI, 0.75-1.17]). There were no significant differences between the 2 groups in any of the prespecified secondary end points. Barotrauma occurred in 30 of 159 patients (18.9%) in the helmet noninvasive ventilation group and 25 of 161 (15.5%) in the usual respiratory support group. Skin pressure injury occurred in 5 of 159 patients (3.1%) in the helmet noninvasive ventilation group and 10 of 161 (6.2%) in the usual respiratory support group. There were 2 serious adverse events in the helmet noninvasive ventilation group and 1 in the usual respiratory support group. CONCLUSIONS AND RELEVANCE Results of this study suggest that helmet noninvasive ventilation did not significantly reduce 28-day mortality compared with usual respiratory support among patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia. However, interpretation of the findings is limited by imprecision in the effect estimate, which does not exclude potentially clinically important benefit or harm. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04477668.
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Affiliation(s)
- Yaseen M. Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Sara Aldekhyl
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Saad Al Qahtani
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Hasan M. Al-Dorzi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Sheryl Ann Abdukahil
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Khulaif Al Harbi
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Department of Anesthesia, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Eman Al Qasim
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Ayman Kharaba
- Pulmonary and Critical Care Departments, King Fahad Hospital, Madinah, Kingdom of Saudi Arabia
| | - Talal Albrahim
- Department of Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Kingdom of Saudi Arabia
| | - Mohammed S. Alshahrani
- Department of Emergency and Critical Care, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar, Kingdom of Saudi Arabia
| | - Abdulrahman A. Al-Fares
- Department of Anesthesia, Critical Care Medicine and Pain Medicine, Al-Amiri Hospital, Ministry of Health, Kuwait, Kuwait
| | - Ali Al Bshabshe
- Department of Critical Care Medicine, King Khalid University, Aseer Central Hospital, Abha, Kingdom of Saudi Arabia
| | - Ahmed Mady
- Intensive Care Department, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
- College of Medicine, Tanta University, Tanta, Egypt
| | - Zainab Al Duhailib
- Adult Critical Care Medicine Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Haifa Algethamy
- Department of Anesthesia and Critical Care, King Abdulaziz University, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Jesna Jose
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Department of Bioinformatics and Biostatistics, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Al Mutairi
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Omar Al Zumai
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Hussain Al Haji
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Alaqeily
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Respiratory Services Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Zohair Al Aseri
- Emergency and Intensive Care Departments, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Awad Al-Omari
- Alfaisal University, Critical Care and Infectious Disease and Infection Control Departments, Dr Sulaiman Al Habib Medical Group, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Al-Dawood
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Haytham Tlayjeh
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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Alshamrani MM, El-Saed A, Arabi YM, Zunitan MA, Farahat FM, Bonnie HB, Matalqa M, Othman F, Almohrij S. Risk of COVID-19 in healthcare workers working in intensive care setting. Am J Infect Control 2022; 50:988-993. [PMID: 35081425 PMCID: PMC8783836 DOI: 10.1016/j.ajic.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND The higher risk of COVID-19 in health care workers (HCWs) is well-known. However, the risk within HCWs is not fully understood. The objective was to compare the COVID-19 risk in intensive care unit (ICU) vs non-ICU locations. METHODS A prospective surveillance study was conducted among HCWs at a large tertiary care facility in Riyadh between March 1st to November 30th, 2020. HCWs included both clinical (provide direct patient care) and nonclinical positions (do not provide direct patient care). RESULTS A total 1,594 HCWs with COVID-19 were included; 103 (6.5%) working in ICU and 1,491 (93.5%) working in non-ICU locations. Compared with non-ICU locations, ICU had more nurses (54.4% vs 22.1%, P < .001) and less support staff (2.9% vs 53.1%, P < .001). COVID-19 infection was similar in ICU and non-ICU locations (9.0% vs 9.8%, P = .374). However, it was significantly higher in ICU nurses (12.3% vs 6.5%, P < .001). Support staff had higher risk than other HCWs, irrespective of ICU working status (15.1% vs 7.2%, P < 0.001). The crude relative risk of COVID-19 in ICU vs non-ICU locations was 0.92, 95% confidence interval ( was 0.76-1.11 (P = .374). However, relative risk adjusted for professional category was significantly increased to 1.23, 95% confidence interval 1.01-1.50 (P = .036). CONCLUSIONS ICU had a significantly higher risk of COVID-19 infection only after adjusting for the distribution and risk of different professional categories. The latter is probably determined by both exposure level and protection practices. The finding underscores the importance of strict implementation of preventive measures among all HCWs, including those performing nonclinical services.
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Affiliation(s)
- Majid M. Alshamrani
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia,King Saud bin Abdulaziz University for Health Sciences, Riyadh Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia,Address correspondence to Majid M. Alshamrani, MD, Infection Prevention and Control, King Abdualziz Medical city, Adult Infectious Disease, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 22490, Riyadh, 11426, Saudi Arabia
| | - Aiman El-Saed
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia,King Saud bin Abdulaziz University for Health Sciences, Riyadh Saudi Arabia,Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yaseen M Arabi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh Saudi Arabia,Department of Critical Care Medicine, KAMC, MNGHA, Riyadh, Saudi Arabia
| | - Mohammed Al Zunitan
- Infection Prevention and Control Department, King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia
| | - Fayssal M Farahat
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia,King Saud bin Abdulaziz University for Health Sciences, Riyadh Saudi Arabia
| | - Henry Baffoe Bonnie
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Muayed Matalqa
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Fatmah Othman
- King Saud bin Abdulaziz University for Health Sciences, Riyadh Saudi Arabia
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Pathak GA, Karjalainen J, Stevens C, Neale BM, Daly M, Ganna A, Andrews SJ, Kanai M, Cordioli M, Polimanti R, Harerimana N, Pirinen M, Liao RG, Chwialkowska K, Trankiem A, Balaconis MK, Nguyen H, Solomonson M, Veerapen K, Wolford B, Roberts G, Park D, Ball CA, Coignet M, McCurdy S, Knight S, Partha R, Rhead B, Zhang M, Berkowitz N, Gaddis M, Noto K, Ruiz L, Pavlovic M, Hong EL, Rand K, Girshick A, Guturu H, Baltzell AH, Niemi MEK, Rahmouni S, Guntz J, Beguin Y, Cordioli M, Pigazzini S, Nkambule L, Georges M, Moutschen M, Misset B, Darcis G, Guiot J, Azarzar S, Gofflot S, Claassen S, Malaise O, Huynen P, Meuris C, Thys M, Jacques J, Léonard P, Frippiat F, Giot JB, Sauvage AS, Frenckell CV, Belhaj Y, Lambermont B, Nakanishi T, Morrison DR, Mooser V, Richards JB, Butler-Laporte G, Forgetta V, Li R, Ghosh B, Laurent L, Belisle A, Henry D, Abdullah T, Adeleye O, Mamlouk N, Kimchi N, Afrasiabi Z, Rezk N, Vulesevic B, Bouab M, Guzman C, Petitjean L, Tselios C, Xue X, Afilalo J, Afilalo M, Oliveira M, Brenner B, Brassard N, Durand M, Schurr E, Lepage P, Ragoussis J, Auld D, Chassé M, Kaufmann DE, Lathrop GM, Adra D, Hayward C, Glessner JT, Shaw DM, Campbell A, Morris M, Hakonarson H, Porteous DJ, Below J, Richmond A, Chang X, Polikowski H, Lauren PE, Chen HH, Wanying Z, Fawns-Ritchie C, North K, McCormick JB, Chang X, Glessner JR, Hakonarson H, Gignoux CR, Wicks SJ, Crooks K, Barnes KC, Daya M, Shortt J, Rafaels N, Chavan S, Timmers PRHJ, Wilson JF, Tenesa A, Kerr SM, D’Mellow K, Shahin D, El-Sherbiny YM, von Hohenstaufen KA, Sobh A, Eltoukhy MM, Nkambul L, Elhadidy TA, Abd Elghafar MS, El-Jawhari JJ, Mohamed AAS, Elnagdy MH, Samir A, Abdel-Aziz M, Khafaga WT, El-Lawaty WM, Torky MS, El-shanshory MR, Yassen AM, Hegazy MAF, Okasha K, Eid MA, Moahmed HS, Medina-Gomez C, Ikram MA, Uitterlinden AG, Mägi R, Milani L, Metspalu A, Laisk T, Läll K, Lepamets M, Esko T, Reimann E, Naaber P, Laane E, Pesukova J, Peterson P, Kisand K, Tabri J, Allos R, Hensen K, Starkopf J, Ringmets I, Tamm A, Kallaste A, Alavere H, Metsalu K, Puusepp M, Batini C, Tobin MD, Venn LD, Lee PH, Shrine N, Williams AT, Guyatt AL, John C, Packer RJ, Ali A, Free RC, Wang X, Wain LV, Hollox EJ, Bee CE, Adams EL, Palotie A, Ripatti S, Ruotsalainen S, Kristiansson K, Koskelainen S, Perola M, Donner K, Kivinen K, Palotie A, Kaunisto M, Rivolta C, Bochud PY, Bibert S, Boillat N, Nussle SG, Albrich W, Quinodoz M, Kamdar D, Suh N, Neofytos D, Erard V, Voide C, Bochud PY, Rivolta C, Bibert S, Quinodoz M, Kamdar D, Neofytos D, Erard V, Voide C, Friolet R, Vollenweider P, Pagani JL, Oddo M, zu Bentrup FM, Conen A, Clerc O, Marchetti O, Guillet A, Guyat-Jacques C, Foucras S, Rime M, Chassot J, Jaquet M, Viollet RM, Lannepoudenx Y, Portopena L, Bochud PY, Vollenweider P, Pagani JL, Desgranges F, Filippidis P, Guéry B, Haefliger D, Kampouri EE, Manuel O, Munting A, Papadimitriou-Olivgeris M, Regina J, Rochat-Stettler L, Suttels V, Tadini E, Tschopp J, Van Singer M, Viala B, Boillat-Blanco N, Brahier T, Hügli O, Meuwly JY, Pantet O, Gonseth Nussle S, Bochud M, D’Acremont V, Estoppey Younes S, Albrich WC, Suh N, Cerny A, O’Mahony L, von Mering C, Bochud PY, Frischknecht M, Kleger GR, Filipovic M, Kahlert CR, Wozniak H, Negro TR, Pugin J, Bouras K, Knapp C, Egger T, Perret A, Montillier P, di Bartolomeo C, Barda B, de Cid R, Carreras A, Moreno V, Kogevinas M, Galván-Femenía I, Blay N, Farré X, Sumoy L, Cortés B, Mercader JM, Guindo-Martinez M, Torrents D, Garcia-Aymerich J, Castaño-Vinyals G, Dobaño C, Gori M, Renieri A, Mari F, Mondelli MU, Castelli F, Vaghi M, Rusconi S, Montagnani F, Bargagli E, Franchi F, Mazzei MA, Cantarini L, Tacconi D, Feri M, Scala R, Spargi G, Nencioni C, Bandini M, Caldarelli GP, Canaccini A, Ognibene A, D’Arminio Monforte A, Girardis M, Antinori A, Francisci D, Schiaroli E, Scotton PG, Panese S, Scaggiante R, Monica MD, Capasso M, Fiorentino G, Castori M, Aucella F, Biagio AD, Masucci L, Valente S, Mandalà M, Zucchi P, Giannattasio F, Coviello DA, Mussini C, Tavecchia L, Crotti L, Rizzi M, Rovere MTL, Sarzi-Braga S, Bussotti M, Ravaglia S, Artuso R, Perrella A, Romani D, Bergomi P, Catena E, Vincenti A, Ferri C, Grassi D, Pessina G, Tumbarello M, Pietro MD, Sabrina R, Luchi S, Furini S, Dei S, Benetti E, Picchiotti N, Sanarico M, Ceri S, Pinoli P, Raimondi F, Biscarini F, Stella A, Zguro K, Capitani K, Nkambule L, Tanfoni M, Fallerini C, Daga S, Baldassarri M, Fava F, Frullanti E, Valentino F, Doddato G, Giliberti A, Tita R, Amitrano S, Bruttini M, Croci S, Meloni I, Mencarelli MA, Rizzo CL, Pinto AM, Beligni G, Tommasi A, Sarno LD, Palmieri M, Carriero ML, Alaverdian D, Busani S, Bruno R, Vecchia M, Belli MA, Mantovani S, Ludovisi S, Quiros-Roldan E, Antoni MD, Zanella I, Siano M, Emiliozzi A, Fabbiani M, Rossetti B, Bergantini L, D’Alessandro M, Cameli P, Bennett D, Anedda F, Marcantonio S, Scolletta S, Guerrini S, Conticini E, Frediani B, Spertilli C, Donati A, Guidelli L, Corridi M, Croci L, Piacentini P, Desanctis E, Cappelli S, Verzuri A, Anemoli V, Pancrazzi A, Lorubbio M, Miraglia FG, Venturelli S, Cossarizza A, Vergori A, Gabrieli A, Riva A, Paciosi F, Andretta F, Gatti F, Parisi SG, Baratti S, Piscopo C, Russo R, Andolfo I, Iolascon A, Carella M, Merla G, Squeo GM, Raggi P, Marciano C, Perna R, Bassetti M, Sanguinetti M, Giorli A, Salerni L, Parravicini P, Menatti E, Trotta T, Coiro G, Lena F, Martinelli E, Mancarella S, Gabbi C, Maggiolo F, Ripamonti D, Bachetti T, Suardi C, Parati G, Bottà G, Domenico PD, Rancan I, Bianchi F, Colombo R, Barbieri C, Acquilini D, Andreucci E, Segala FV, Tiseo G, Falcone M, Lista M, Poscente M, Vivo OD, Petrocelli P, Guarnaccia A, Baroni S, Hayward C, Porteous DJ, Fawns-Ritchie C, Richmond A, Campbell A, van Heel DA, Hunt KA, Trembath RC, Huang QQ, Martin HC, Mason D, Trivedi B, Wright J, Finer S, Akhtar S, Anwar M, Arciero E, Ashraf S, Breen G, Chung R, Curtis CJ, Chowdhury M, Colligan G, Deloukas P, Durham C, Finer S, Griffiths C, Huang QQ, Hurles M, Hunt KA, Hussain S, Islam K, Khan A, Khan A, Lavery C, Lee SH, Lerner R, MacArthur D, MacLaughlin B, Martin H, Mason D, Miah S, Newman B, Safa N, Tahmasebi F, Trembath RC, Trivedi B, van Heel DA, Wright J, Griffiths CJ, Smith AV, Boughton AP, Li KW, LeFaive J, Annis A, Niavarani A, Aliannejad R, Sharififard B, Amirsavadkouhi A, Naderpour Z, Tadi HA, Aleagha AE, Ahmadi S, Moghaddam SBM, Adamsara A, Saeedi M, Abdollahi H, Hosseini A, Chariyavilaskul P, Jantarabenjakul W, Hirankarn N, Chamnanphon M, Suttichet TB, Shotelersuk V, Pongpanich M, Phokaew C, Chetruengchai W, Putchareon O, Torvorapanit P, Puthanakit T, Suchartlikitwong P, Nilaratanakul V, Sodsai P, Brumpton BM, Hveem K, Willer C, Wolford B, Zhou W, Rogne T, Solligard E, Åsvold BO, Franke L, Boezen M, Deelen P, Claringbould A, Lopera E, Warmerdam R, Vonk JM, van Blokland I, Lanting P, Ori APS, Feng YCA, Mercader J, Weiss ST, Karlson EW, Smoller JW, Murphy SN, Meigs JB, Woolley AE, Green RC, Perez EF, Wolford B, Zöllner S, Wang J, Beck A, Sloofman 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A first update on mapping the human genetic architecture of COVID-19. Nature 2022; 608:E1-E10. [PMID: 35922517 PMCID: PMC9352569 DOI: 10.1038/s41586-022-04826-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/29/2022] [Indexed: 01/04/2023]
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Lamontagne F, Masse MH, Menard J, Sprague S, Pinto R, Heyland DK, Cook DJ, Battista MC, Day AG, Guyatt GH, Kanji S, Parke R, McGuinness SP, Tirupakuzhi Vijayaraghavan BK, Annane D, Cohen D, Arabi YM, Bolduc B, Marinoff N, Rochwerg B, Millen T, Meade MO, Hand L, Watpool I, Porteous R, Young PJ, D'Aragon F, Belley-Cote EP, Carbonneau E, Clarke F, Maslove DM, Hunt M, Chassé M, Lebrasseur M, Lauzier F, Mehta S, Quiroz-Martinez H, Rewa OG, Charbonney E, Seely AJE, Kutsogiannis DJ, LeBlanc R, Mekontso-Dessap A, Mele TS, Turgeon AF, Wood G, Kohli SS, Shahin J, Twardowski P, Adhikari NKJ. Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. N Engl J Med 2022; 386:2387-2398. [PMID: 35704292 DOI: 10.1056/nejmoa2200644] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [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 Studies that have evaluated the use of intravenous vitamin C in adults with sepsis who were receiving vasopressor therapy in the intensive care unit (ICU) have shown mixed results with respect to the risk of death and organ dysfunction. METHODS In this randomized, placebo-controlled trial, we assigned adults who had been in the ICU for no longer than 24 hours, who had proven or suspected infection as the main diagnosis, and who were receiving a vasopressor to receive an infusion of either vitamin C (at a dose of 50 mg per kilogram of body weight) or matched placebo administered every 6 hours for up to 96 hours. The primary outcome was a composite of death or persistent organ dysfunction (defined by the use of vasopressors, invasive mechanical ventilation, or new renal-replacement therapy) on day 28. RESULTS A total of 872 patients underwent randomization (435 to the vitamin C group and 437 to the control group). The primary outcome occurred in 191 of 429 patients (44.5%) in the vitamin C group and in 167 of 434 patients (38.5%) in the control group (risk ratio, 1.21; 95% confidence interval [CI], 1.04 to 1.40; P = 0.01). At 28 days, death had occurred in 152 of 429 patients (35.4%) in the vitamin C group and in 137 of 434 patients (31.6%) in the placebo group (risk ratio, 1.17; 95% CI, 0.98 to 1.40) and persistent organ dysfunction in 39 of 429 patients (9.1%) and 30 of 434 patients (6.9%), respectively (risk ratio, 1.30; 95% CI, 0.83 to 2.05). Findings were similar in the two groups regarding organ-dysfunction scores, biomarkers, 6-month survival, health-related quality of life, stage 3 acute kidney injury, and hypoglycemic episodes. In the vitamin C group, one patient had a severe hypoglycemic episode and another had a serious anaphylaxis event. CONCLUSIONS In adults with sepsis receiving vasopressor therapy in the ICU, those who received intravenous vitamin C had a higher risk of death or persistent organ dysfunction at 28 days than those who received placebo. (Funded by the Lotte and John Hecht Memorial Foundation; LOVIT ClinicalTrials.gov number, NCT03680274.).
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Affiliation(s)
- François Lamontagne
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Marie-Hélène Masse
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Julie Menard
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Sheila Sprague
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Ruxandra Pinto
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Daren K Heyland
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Deborah J Cook
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Marie-Claude Battista
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Andrew G Day
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Gordon H Guyatt
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Salmaan Kanji
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Rachael Parke
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Shay P McGuinness
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Bharath-Kumar Tirupakuzhi Vijayaraghavan
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Djillali Annane
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Dian Cohen
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Yaseen M Arabi
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Brigitte Bolduc
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Nicole Marinoff
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Bram Rochwerg
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Tina Millen
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Maureen O Meade
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Lori Hand
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Irene Watpool
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Rebecca Porteous
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Paul J Young
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Frederick D'Aragon
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Emilie P Belley-Cote
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Elaine Carbonneau
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - France Clarke
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - David M Maslove
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Miranda Hunt
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Michaël Chassé
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Martine Lebrasseur
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - François Lauzier
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Sangeeta Mehta
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Hector Quiroz-Martinez
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Oleksa G Rewa
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Emmanuel Charbonney
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Andrew J E Seely
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Demetrios J Kutsogiannis
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Remi LeBlanc
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Armand Mekontso-Dessap
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Tina S Mele
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Alexis F Turgeon
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Gordon Wood
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Sandeep S Kohli
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Jason Shahin
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Pawel Twardowski
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
| | - Neill K J Adhikari
- From the Departments of Medicine (F. Lamontagne, M.-C.B., H.Q.M.) and Anesthesiology (F.D.), Université de Sherbrooke, the Department of Pharmacy (B.B.), Centre de Recherche du CHU de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke (F. Lamontagne, M.-H.M., J.M., F.D., E. Carbonneau), and Bishop's University (D.C.), Sherbrooke, QC, the Division of Orthopaedic Surgery, Department of Surgery (S.S.), the Department of Medicine (D.J.C., G.H.G., B.R., T.M., M.O.M., E.P.B.-C., S.S.K.), the Department of Health Research Methods, Evidence, and Impact (D.J.C., G.H.G., B.R., M.O.M., L.H., E.P.B.-C., F.C.), and the Population Health Research Institute (E.P.B.-C.), McMaster University, the Department of Critical Care, St. Joseph's Healthcare Hamilton (D.J.C.), the Intensive Care Unit, Juravinski Hospital (T.M.), and Respiratory Therapy, Hamilton Health Sciences (L.H.), Hamilton, ON, the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre (R. Pinto, N.M., N.K.J.A.), the Interdepartmental Division of Critical Care Medicine, University of Toronto (S.M., N.K.J.A.), and Sinai Health System (S.M.), Toronto, the Departments of Critical Care Medicine (D.K.H., D.M.M., M.H.), Public Health Sciences (A.G.D.), and Medicine (D.M.M.), Queen's University, and Kingston Health Sciences Centre (A.G.D., D.M.M.), Kingston, ON, the Department of Pharmacy, Ottawa Hospital (S.K.), Ottawa Hospital Research Institute (S.K., I.W., R. Porteous), and the Department of Surgery, University of Ottawa (A.J.E.S.), Ottawa, ON, the Massawippi Valley Foundation, Ayer's Cliff, QC (D.C.), the Department of Medicine, Université de Montréal (M.C.), the Centre Hospitalier de l'Université de Montréal (M.C., M.L., E. Charbonney), the Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal (E. Charbonney), and the Departments of Medicine and Critical Care, McGill University Health Centre (J.S.), Montreal, QC, the Department of Medicine (F. Lauzier) and the Division of Critical Care Medicine, Department of Anesthesiology and Critical Care (F. Lauzier, A.F.T.), Université Laval, the Critical Care Medicine Service (F. Lauzier, A.F.T.), and the Research Center (F. Lauzier, A.F.T.), CHU de Québec-Université Laval, Quebec, QC, the Department of Critical Care Medicine, University of Alberta, Edmonton (O.G.R., D.J.K.), the Division of Intensive Care, Department of Medicine, CHU Dr. Georges L. Dumont, Moncton, NB (R.L.), the Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON (T.S.M.), the Division of Intensive Care Medicine, Island Health Authority, Victoria, BC (G.W.), and the Department of Medicine, Halton Healthcare, Oakville, ON (S.S.K.) - all in Canada; the Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital (R. Parke, S.P.M.), and the School of Nursing, University of Auckland (R. Parke), Auckland, the Medical Research Institute of New Zealand, Newtown (R. Parke, S.P.M., P.J.Y.), the Intensive Care Unit, Wellington Hospital, Wellington (P.J.Y.), and the Department of Surgical Sciences, University of Otago, Dunedin (P.T.) - all in New Zealand; the Department of Critical Care Medicine, Apollo Hospitals, Chennai, and George Institute for Global Health, New Delhi - both in India (B.K.T.V.); the Department of Intensive Care Medicine, Raymond-Poincaré Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), and Fédération Hospitalo-Universitaire SEPSIS, Garches (D.A.), Institut National de la Santé et de la Recherche Médicale, University Paris-Saclay Campus UVSQ, Versailles (D.A.), and Service de Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Groupe de Recherche Clinique CARMAS, and Institut Mondor de Recherche Biomédicale, Université Paris Est Créteil, Créteil (A.M.-D.) - all in France; the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, and the Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs - all in Riyadh, Saudi Arabia (Y.M.A.); and the Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (R. Parke, S.P.M., P.J.Y.)
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Elhazmi A, Al-Omari A, Sallam H, Mufti HN, Rabie AA, Alshahrani M, Mady A, Alghamdi A, Altalaq A, Azzam MH, Sindi A, Kharaba A, Al-Aseri ZA, Almekhlafi GA, Tashkandi W, Alajmi SA, Faqihi F, Alharthy A, Al-Tawfiq JA, Melibari RG, Al-Hazzani W, Arabi YM. Machine learning decision tree algorithm role for predicting mortality in critically ill adult COVID-19 patients admitted to the ICU. J Infect Public Health 2022; 15:826-834. [PMID: 35759808 PMCID: PMC9212964 DOI: 10.1016/j.jiph.2022.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/02/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Coronavirus disease-19 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is currently a major cause of intensive care unit (ICU) admissions globally. The role of machine learning in the ICU is evolving but currently limited to diagnostic and prognostic values. A decision tree (DT) algorithm is a simple and intuitive machine learning method that provides sequential nonlinear analysis of variables. It is simple and might be a valuable tool for bedside physicians during COVID-19 to predict ICU outcomes and help in critical decision-making like end-of-life decisions and bed allocation in the event of limited ICU bed capacities. Herein, we utilized a machine learning DT algorithm to describe the association of a predefined set of variables and 28-day ICU outcome in adult COVID-19 patients admitted to the ICU. We highlight the value of utilizing a machine learning DT algorithm in the ICU at the time of a COVID-19 pandemic. Methods This was a prospective and multicenter cohort study involving 14 hospitals in Saudi Arabia. We included critically ill COVID-19 patients admitted to the ICU between March 1, 2020, and October 31, 2020. The predictors of 28-day ICU mortality were identified using two predictive models: conventional logistic regression and DT analyses. Results There were 1468 critically ill COVID-19 patients included in the study. The 28-day ICU mortality was 540 (36.8 %), and the 90-day mortality was 600 (40.9 %). The DT algorithm identified five variables that were integrated into the algorithm to predict 28-day ICU outcomes: need for intubation, need for vasopressors, age, gender, and PaO2/FiO2 ratio. Conclusion DT is a simple tool that might be utilized in the ICU to identify critically ill COVID-19 patients who are at high risk of 28-day ICU mortality. However, further studies and external validation are still required.
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Affiliation(s)
- Alyaa Elhazmi
- Department of Critical Care, Dr. Sulaiman Al-Habib Medical Group, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Awad Al-Omari
- Research Center, Dr. Sulaiman Alhabib Medical Group, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Hend Sallam
- Department of Adult Critical Care Medicine, King Faisal Specialist Hospital & Research Centre, Saudi Arabia
| | - Hani N Mufti
- Section of Cardiac Surgery, Department of Cardiac Sciences, King Faisal Cardiac Center, King Abdulaziz Medical City, MNGHA-WR, Jeddah, Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia. King Abdullah International Medical Research Center, Jeddah, Saudi Arabia Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed A Rabie
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Mohammed Alshahrani
- Emergency and Critical Care Department, King Fahad Hospital of The University, Imam Abdul Rahman ben Faisal University, Dammam, Saudi Arabia
| | - Ahmed Mady
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia; Department of Anesthesiology and Intensive Care, Tanta University Hospitals, Tanta, Egypt
| | - Adnan Alghamdi
- Prince Sultan Military Medical City, Military Medical Services, Ministry of Defence, Riyadh, Saudi Arabia
| | - Ali Altalaq
- Prince Sultan Military Medical City, Military Medical Services, Ministry of Defence, Riyadh, Saudi Arabia
| | - Mohamed H Azzam
- Intensive Care Department, King Abdullah Medical Complex, Jeddah, Saudi Arabia
| | - Anees Sindi
- Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ayman Kharaba
- Department of Critical Care, King Fahad Hospital, Al Medina Al Monawarah, Saudi Arabia
| | - Zohair A Al-Aseri
- Departments Of Emergency Medicine and Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia; College Of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Ghaleb A Almekhlafi
- Prince Sultan Military Medical City, Military Medical Services, Ministry of Defence, Riyadh, Saudi Arabia
| | - Wail Tashkandi
- Department of Critical Care, Fakeeh Care Group, Jeddah, Saudi Arabia; Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saud A Alajmi
- Prince Sultan Military Medical City, Military Medical Services, Ministry of Defence, Riyadh, Saudi Arabia
| | - Fahad Faqihi
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia. Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rami Ghazi Melibari
- Department of Critical Care, King Abdullah Medical City, Makah, Saudi Arabia
| | - Waleed Al-Hazzani
- Department of Medicine, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Yaseen M Arabi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Alhazzani W, Parhar KKS, Weatherald J, Al Duhailib Z, Alshahrani M, Al-Fares A, Buabbas S, Cherian SV, Munshi L, Fan E, Al-Hameed F, Chalabi J, Rahmatullah AA, Duan E, Tsang JLY, Lewis K, Lauzier F, Centofanti J, Rochwerg B, Culgin S, Nelson K, Abdukahil SA, Fiest KM, Stelfox HT, Tlayjeh H, Meade MO, Perri D, Solverson K, Niven DJ, Lim R, Møller MH, Belley-Cote E, Thabane L, Tamim H, Cook DJ, Arabi YM. Effect of Awake Prone Positioning on Endotracheal Intubation in Patients With COVID-19 and Acute Respiratory Failure: A Randomized Clinical Trial. JAMA 2022; 327:2104-2113. [PMID: 35569448 PMCID: PMC9108999 DOI: 10.1001/jama.2022.7993] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE The efficacy and safety of prone positioning is unclear in nonintubated patients with acute hypoxemia and COVID-19. OBJECTIVE To evaluate the efficacy and adverse events of prone positioning in nonintubated adult patients with acute hypoxemia and COVID-19. DESIGN, SETTING, AND PARTICIPANTS Pragmatic, unblinded randomized clinical trial conducted at 21 hospitals in Canada, Kuwait, Saudi Arabia, and the US. Eligible adult patients with COVID-19 were not intubated and required oxygen (≥40%) or noninvasive ventilation. A total of 400 patients were enrolled between May 19, 2020, and May 18, 2021, and final follow-up was completed in July 2021. INTERVENTION Patients were randomized to awake prone positioning (n = 205) or usual care without prone positioning (control; n = 195). MAIN OUTCOMES AND MEASURES The primary outcome was endotracheal intubation within 30 days of randomization. The secondary outcomes included mortality at 60 days, days free from invasive mechanical ventilation or noninvasive ventilation at 30 days, days free from the intensive care unit or hospital at 60 days, adverse events, and serious adverse events. RESULTS Among the 400 patients who were randomized (mean age, 57.6 years [SD, 12.83 years]; 117 [29.3%] were women), all (100%) completed the trial. In the first 4 days after randomization, the median duration of prone positioning was 4.8 h/d (IQR, 1.8 to 8.0 h/d) in the awake prone positioning group vs 0 h/d (IQR, 0 to 0 h/d) in the control group. By day 30, 70 of 205 patients (34.1%) in the prone positioning group were intubated vs 79 of 195 patients (40.5%) in the control group (hazard ratio, 0.81 [95% CI, 0.59 to 1.12], P = .20; absolute difference, -6.37% [95% CI, -15.83% to 3.10%]). Prone positioning did not significantly reduce mortality at 60 days (hazard ratio, 0.93 [95% CI, 0.62 to 1.40], P = .54; absolute difference, -1.15% [95% CI, -9.40% to 7.10%]) and had no significant effect on days free from invasive mechanical ventilation or noninvasive ventilation at 30 days or on days free from the intensive care unit or hospital at 60 days. There were no serious adverse events in either group. In the awake prone positioning group, 21 patients (10%) experienced adverse events and the most frequently reported were musculoskeletal pain or discomfort from prone positioning (13 of 205 patients [6.34%]) and desaturation (2 of 205 patients [0.98%]). There were no reported adverse events in the control group. CONCLUSIONS AND RELEVANCE In patients with acute hypoxemic respiratory failure from COVID-19, prone positioning, compared with usual care without prone positioning, did not significantly reduce endotracheal intubation at 30 days. However, the effect size for the primary study outcome was imprecise and does not exclude a clinically important benefit. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04350723.
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Affiliation(s)
- Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Research Institute of St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Ken Kuljit S. Parhar
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Jason Weatherald
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Zainab Al Duhailib
- Critical Care Medicine Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohammed Alshahrani
- Department of Emergency and Critical Care, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulrahman Al-Fares
- Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Al Amiri Hospital, Kuwait City, Kuwait
| | - Sarah Buabbas
- Department of Anesthesia, Critical Care Medicine, and Pain Medicine, Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, Kuwait
| | - Sujith V. Cherian
- Department of Internal Medicine, Divisions of Critical Care, Pulmonary, and Sleep Medicine, University of Texas Health-McGovern Medical School, Houston
| | - Laveena Munshi
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Fahad Al-Hameed
- Department of Intensive Care, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Jamal Chalabi
- Intensive Care Department, Ministry of National Guard Health Affairs, Al Ahsa, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
| | - Amera A. Rahmatullah
- Critical Care Medicine Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Erick Duan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Research Institute of St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- Division of Critical Care, Niagara Health, St Catharines, Ontario, Canada
| | - Jennifer L. Y. Tsang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care, Niagara Health, St Catharines, Ontario, Canada
| | - Kimberley Lewis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Research Institute of St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - François Lauzier
- Department of Medicine, Université Laval, Québec City, Québec, Canada
- Department of Anesthesiology and Critical Care, Division of Critical Care, Université Laval, Québec City, Québec, Canada
| | - John Centofanti
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Culgin
- Research Institute of St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Katlynne Nelson
- Research Institute of St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Sheryl Ann Abdukahil
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Kirsten M. Fiest
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, Canada
- Department of Community Health Sciences and O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, Canada
- Department of Community Health Sciences and O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Haytham Tlayjeh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Maureen O. Meade
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dan Perri
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Research Institute of St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Kevin Solverson
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, Canada
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J. Niven
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, Canada
| | - Rachel Lim
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Emilie Belley-Cote
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Research Institute of St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Hani Tamim
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Deborah J. Cook
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Research Institute of St Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Yaseen M. Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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46
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Young PJ, Arabi YM, Bagshaw SM, Bellomo R, Fujii T, Haniffa R, Hodgson CL, Vijayaraghavan BKT, Litton E, Mackle D, Nichol AD, Kasza J. Protocol and statistical analysis plan for the mega randomised registry trial research program comparing conservative versus liberal oxygenation targets in adults receiving unplanned invasive mechanical ventilation in the ICU (Mega-ROX). CRIT CARE RESUSC 2022; 24:137-149. [PMID: 38045600 PMCID: PMC10692627 DOI: 10.51893/2022.2.oa4] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The effect of conservative versus liberal oxygen therapy on 90-day in-hospital mortality in patients who require unplanned invasive mechanical ventilation in an intensive care unit (ICU) is uncertain and will be evaluated in the mega randomised registry trial research program (Mega-ROX). Objective: To summarise the protocol and statistical analysis plan for Mega-ROX. Design, setting and participants: Mega-ROX is a 40 000-patient parallel-group, registry-embedded clinical trial in which adults who require unplanned invasive mechanical ventilation in an ICU will be randomly assigned to conservative or liberal oxygen therapy. Within this overarching trial research program, three nested parallel randomised controlled trials will be conducted. These will include patients with suspected hypoxic ischaemic encephalopathy (HIE) following resuscitation from a cardiac arrest, patients with sepsis, and patients with non-HIE acute brain injuries or conditions. Main outcome measures: The primary outcome is in-hospital allcause mortality up to 90 days from the date of randomisation. Secondary outcomes include duration of survival, duration of mechanical ventilation, ICU length of stay, hospital length of stay, and proportion of patients discharged home. Results and conclusions: Mega-ROX will compare the effect of conservative versus liberal oxygen therapy on 90-day in-hospital mortality in critically ill adults who receive unplanned invasive mechanical ventilation in an ICU. The protocol and a pre-specified approach to analyses are reported here to mitigate analysis bias. Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTRN 12620000391976).
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Affiliation(s)
- Paul J. Young
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Yaseen M. Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Sean M. Bagshaw
- Department of Critical Care Medicine, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Tomoko Fujii
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto University, Kyoto, Japan
| | - Rashan Haniffa
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- National Intensive Care Surveillance, Mahidol–Oxford Tropical Medicine Research Unit (NICS-MORU), Colombo, Sri Lanka
- University College Hospital, London, UK
| | - Carol L. Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Alfred Health, Melbourne, VIC, Australia
- George Institute for Global Health, Sydney, NSW, Australia
| | | | - Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Diane Mackle
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Alistair D. Nichol
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Intensive Care Unit, Alfred Health, Melbourne, VIC, Australia
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent’s University Hospital, Dublin, Ireland
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - For the Mega-ROX Management Committee
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Critical Care Medicine, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto University, Kyoto, Japan
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- National Intensive Care Surveillance, Mahidol–Oxford Tropical Medicine Research Unit (NICS-MORU), Colombo, Sri Lanka
- University College Hospital, London, UK
- Intensive Care Unit, Alfred Health, Melbourne, VIC, Australia
- George Institute for Global Health, Sydney, NSW, Australia
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
- George Institute for Global Health, New Delhi, Delhi, India
- Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent’s University Hospital, Dublin, Ireland
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - the Australian and New Zealand Intensive Care Society Clinical Trials Group
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Critical Care Medicine, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto University, Kyoto, Japan
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- National Intensive Care Surveillance, Mahidol–Oxford Tropical Medicine Research Unit (NICS-MORU), Colombo, Sri Lanka
- University College Hospital, London, UK
- Intensive Care Unit, Alfred Health, Melbourne, VIC, Australia
- George Institute for Global Health, Sydney, NSW, Australia
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
- George Institute for Global Health, New Delhi, Delhi, India
- Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent’s University Hospital, Dublin, Ireland
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - the Crit Care Asia and Africa Network
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Critical Care Medicine, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto University, Kyoto, Japan
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- National Intensive Care Surveillance, Mahidol–Oxford Tropical Medicine Research Unit (NICS-MORU), Colombo, Sri Lanka
- University College Hospital, London, UK
- Intensive Care Unit, Alfred Health, Melbourne, VIC, Australia
- George Institute for Global Health, Sydney, NSW, Australia
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
- George Institute for Global Health, New Delhi, Delhi, India
- Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent’s University Hospital, Dublin, Ireland
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - the Irish Critical Care Clinical Trials Group
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Critical Care Medicine, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto University, Kyoto, Japan
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- National Intensive Care Surveillance, Mahidol–Oxford Tropical Medicine Research Unit (NICS-MORU), Colombo, Sri Lanka
- University College Hospital, London, UK
- Intensive Care Unit, Alfred Health, Melbourne, VIC, Australia
- George Institute for Global Health, Sydney, NSW, Australia
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
- George Institute for Global Health, New Delhi, Delhi, India
- Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent’s University Hospital, Dublin, Ireland
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - the Alberta Health Services Critical Care Strategic Clinical Network
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Critical Care Medicine, University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto University, Kyoto, Japan
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- National Intensive Care Surveillance, Mahidol–Oxford Tropical Medicine Research Unit (NICS-MORU), Colombo, Sri Lanka
- University College Hospital, London, UK
- Intensive Care Unit, Alfred Health, Melbourne, VIC, Australia
- George Institute for Global Health, Sydney, NSW, Australia
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
- George Institute for Global Health, New Delhi, Delhi, India
- Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia
- Medical School, University of Western Australia, Perth, WA, Australia
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent’s University Hospital, Dublin, Ireland
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Kharaba A, Algethamy H, Hussein MA, Al-Hameed FM, Alghamdi A, Hamdan A, Fatani J, Elhazmi A, Alkhalaf H, Albshabshi A, Al-Dorzi HM, Arabi YM. Predictors of survival from Acinetobacter in Saudi Arabian intensive care units: A prospective, one-year, six-city, ten-center cohort study. J Infect Public Health 2022; 15:677-684. [PMID: 35623242 DOI: 10.1016/j.jiph.2022.05.007] [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: 01/14/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Antibiotic-resistant Acinetobacter baumannii is a continuously-emerging worldwide health crisis, with mortality rates approaching 50% in intensive care unit (ICU) patients. The objective of this study was to evaluate regional, patient-related, and organism-related predictors of survival among critically-ill patients with confirmed Acinetobacter infection. METHODS This prospective cohort study was conducted within ten ICUs across six geographically- and climatologically-distinct cities across Saudi Arabia over 13 months. RESULTS Of 169 patients with confirmed Acinetobacter infection enrolled in the study, 80 (47.6%) died. Survivors were statistically younger, predominantly male, more likely to be admitted for trauma, less likely to have hypertension, diabetes, or have undergone hemodialysis, and more likely to have been treated with antibiotics prior to having a positive culture for Acinetobacter, but less likely to have received an aminoglycoside. Survivors also had lower baseline APACHE II and SOFA scores and were infected with stains of Acinetobacter that had less meropenem- or colistin-resistance. Multivariate analysis identified the following independent predictors of survival: younger age, lower ICU-day#1 APACHE-II and ICU-day#3 SOFA scores, being admitted for trauma, and having no history of hemodialysis. CONCLUSIONS Patient-related factors outweigh regional and hospital-related factors as predictors of survival among critically-ill patients with Acinetobacter infection.
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Affiliation(s)
- Ayman Kharaba
- Department of Critical Care, King Fahad Hospital, Al Madinah Al Monawarah, Saudi Arabia.
| | - Haifa Algethamy
- Department of Anaesthesia and Critical Care, King Abdulaziz University, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mohamed A Hussein
- Department of Critical Care, King Fahad Hospital, Al Madinah Al Monawarah, Saudi Arabia
| | - Fahad M Al-Hameed
- Department of Intensive Care, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Adnan Alghamdi
- Prince Sultan Military Medical City, Military Medical Services, Ministry of Defense, Riyadh, Saudi Arabia
| | - Ammar Hamdan
- Department of Critical Care, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Jehan Fatani
- Department of Critical Care, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Alyaa Elhazmi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hassan Alkhalaf
- Department of Critical Care, Ohud Hospital, Al Madinah Al Monawarah, Saudi Arabia
| | - Ali Albshabshi
- Department of Medicine and Intensive Care, College of Medicine, King Khalid University, Assir Central Hospital, Abha, Saudi Arabia
| | - Hasan M Al-Dorzi
- Ministry of the National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yaseen M Arabi
- Ministry of the National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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48
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Adhikari NK, Pinto R, Day AG, Masse MH, Ménard J, Sprague S, Annane D, Arabi YM, Battista MC, Cohen D, Cook DJ, Guyatt GH, Heyland DK, Kanji S, McGuinness SP, Parke RL, Kumar Tirupakuzhi Vijayaraghavan B, Charbonney E, Chassé M, Del Sorbo L, Kutsogiannis DJ, Lauzier F, Leblanc R, Maslove DM, Mehta S, Mekontso Dessap A, Mele TS, Rochwerg B, Rewa OG, Shahin J, Twardowski P, Young PJ, Lamontagne F. Lessening Organ dysfunction with VITamin C (LOVIT): statistical analysis plan. JMIR Res Protoc 2022; 11:e36261. [PMID: 35420994 PMCID: PMC9166642 DOI: 10.2196/36261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/24/2022] [Accepted: 04/14/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Lessening Organ Dysfunction with VITamin C (LOVIT) is a blinded multicentre randomized clinical trial that compared high-dose intravenous vitamin C to placebo in patients admitted to the intensive care unit with proven or suspected infection as the main diagnosis and receiving a vasopressor. OBJECTIVE To describe a pre-specified statistical analysis plan (SAP) for LOVIT, written prior to unblinding and locking of the trial database. METHODS The SAP was designed by the LOVIT principal investigators and statisticians and approved by the steering committee and coinvestigators. The SAP defines the primary and secondary outcomes and describes the planned primary, secondary, and subgroup analyses. RESULTS The SAP includes a draft participant flow diagram, tables, and planned figures. The primary outcome is a composite of mortality and persistent organ dysfunction (receipt of mechanical ventilation, vasopressors or new renal replacement therapy) at 28 days, where day 1 is the day of randomization. All analyses will use a frequentist statistical framework. The analysis of the primary outcome will estimate the risk ratio and 95% confidence interval in a generalized linear mixed model with binomial distribution and log link and considering site as a random effect. We will perform a secondary analysis adjusting for pre-specified baseline clinical variables. Subgroup analyses will include age, sex, frailty, severity of illness, Sepsis-3 definition of septic shock, baseline ascorbic acid level, and COVID-19 status. CONCLUSIONS We have developed a SAP for the LOVIT trial and will adhere to it in the analysis phase. CLINICALTRIAL ClinicalTrials.gov identifier: NCT03680274 (21 September 2018).
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Affiliation(s)
- Neill Kj Adhikari
- Sunnybrook Health Sciences Centre, 2075 Bayview AveRoom D1 08, Toronto, CA
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, CA
| | | | - Marie-Hélène Masse
- Research Centre of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, CA
| | - Julie Ménard
- Research Centre of the Centre hospitalier universitaire de Sherbrooke, Sherbrooke, CA
| | - Sheila Sprague
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, CA.,St-Joseph's Healthcare, Hamilton, CA
| | | | - Yaseen M Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SA.,King Abdullah International Medical Research Center, Riyadh, SA.,Intensive Care Department, King Abdulaziz Medical City, Riyadh, SA
| | | | - Dian Cohen
- This author is a patient partner, North Hatley, CA
| | | | | | - Daren K Heyland
- Department of Critical Care Medicine, School of Medicine, Queen's University, Kingston, CA.,Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, CA.,Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, CA
| | - Salmaan Kanji
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, CA.,Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, CA
| | - Shay P McGuinness
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, NZ
| | - Rachael L Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, NZ.,Wellington Hospital, Wellington, NZ.,School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, NZ
| | | | | | - Michael Chassé
- Centre hospitalier de l'Université de Montréal, Montreal, CA
| | | | | | - Francois Lauzier
- CHU de Québec-Université Laval, Hôpital de l'Enfant-Jésus, Quebec, CA
| | | | | | | | | | | | | | | | | | | | | | - François Lamontagne
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, CA
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49
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Bradbury CA, Lawler PR, Stanworth SJ, McVerry BJ, McQuilten Z, Higgins AM, Mouncey PR, Al-Beidh F, Rowan KM, Berry LR, Lorenzi E, Zarychanski R, Arabi YM, Annane D, Beane A, van Bentum-Puijk W, Bhimani Z, Bihari S, Bonten MJM, Brunkhorst FM, Buzgau A, Buxton M, Carrier M, Cheng AC, Cove M, Detry MA, Estcourt LJ, Fitzgerald M, Girard TD, Goligher EC, Goossens H, Haniffa R, Hills T, Huang DT, Horvat CM, Hunt BJ, Ichihara N, Lamontagne F, Leavis HL, Linstrum KM, Litton E, Marshall JC, McAuley DF, McGlothlin A, McGuinness SP, Middeldorp S, Montgomery SK, Morpeth SC, Murthy S, Neal MD, Nichol AD, Parke RL, Parker JC, Reyes LF, Saito H, Santos MS, Saunders CT, Serpa-Neto A, Seymour CW, Shankar-Hari M, Singh V, Tolppa T, Turgeon AF, Turner AM, van de Veerdonk FL, Green C, Lewis RJ, Angus DC, McArthur CJ, Berry S, Derde LPG, Webb SA, Gordon AC. Effect of Antiplatelet Therapy on Survival and Organ Support-Free Days in Critically Ill Patients With COVID-19: A Randomized Clinical Trial. JAMA 2022; 327:1247-1259. [PMID: 35315874 PMCID: PMC8941448 DOI: 10.1001/jama.2022.2910] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance The efficacy of antiplatelet therapy in critically ill patients with COVID-19 is uncertain. Objective To determine whether antiplatelet therapy improves outcomes for critically ill adults with COVID-19. Design, Setting, and Participants In an ongoing adaptive platform trial (REMAP-CAP) testing multiple interventions within multiple therapeutic domains, 1557 critically ill adult patients with COVID-19 were enrolled between October 30, 2020, and June 23, 2021, from 105 sites in 8 countries and followed up for 90 days (final follow-up date: July 26, 2021). Interventions Patients were randomized to receive either open-label aspirin (n = 565), a P2Y12 inhibitor (n = 455), or no antiplatelet therapy (control; n = 529). Interventions were continued in the hospital for a maximum of 14 days and were in addition to anticoagulation thromboprophylaxis. Main Outcomes and Measures The primary end point was organ support-free days (days alive and free of intensive care unit-based respiratory or cardiovascular organ support) within 21 days, ranging from -1 for any death in hospital (censored at 90 days) to 22 for survivors with no organ support. There were 13 secondary outcomes, including survival to discharge and major bleeding to 14 days. The primary analysis was a bayesian cumulative logistic model. An odds ratio (OR) greater than 1 represented improved survival, more organ support-free days, or both. Efficacy was defined as greater than 99% posterior probability of an OR greater than 1. Futility was defined as greater than 95% posterior probability of an OR less than 1.2 vs control. Intervention equivalence was defined as greater than 90% probability that the OR (compared with each other) was between 1/1.2 and 1.2 for 2 noncontrol interventions. Results The aspirin and P2Y12 inhibitor groups met the predefined criteria for equivalence at an adaptive analysis and were statistically pooled for further analysis. Enrollment was discontinued after the prespecified criterion for futility was met for the pooled antiplatelet group compared with control. Among the 1557 critically ill patients randomized, 8 patients withdrew consent and 1549 completed the trial (median age, 57 years; 521 [33.6%] female). The median for organ support-free days was 7 (IQR, -1 to 16) in both the antiplatelet and control groups (median-adjusted OR, 1.02 [95% credible interval {CrI}, 0.86-1.23]; 95.7% posterior probability of futility). The proportions of patients surviving to hospital discharge were 71.5% (723/1011) and 67.9% (354/521) in the antiplatelet and control groups, respectively (median-adjusted OR, 1.27 [95% CrI, 0.99-1.62]; adjusted absolute difference, 5% [95% CrI, -0.2% to 9.5%]; 97% posterior probability of efficacy). Among survivors, the median for organ support-free days was 14 in both groups. Major bleeding occurred in 2.1% and 0.4% of patients in the antiplatelet and control groups (adjusted OR, 2.97 [95% CrI, 1.23-8.28]; adjusted absolute risk increase, 0.8% [95% CrI, 0.1%-2.7%]; 99.4% probability of harm). Conclusions and Relevance Among critically ill patients with COVID-19, treatment with an antiplatelet agent, compared with no antiplatelet agent, had a low likelihood of providing improvement in the number of organ support-free days within 21 days. Trial Registration ClinicalTrials.gov Identifier: NCT02735707.
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Affiliation(s)
| | - Patrick R Lawler
- Peter Munk Cardiac Centre at University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Simon J Stanworth
- University of Oxford, Oxford, England
- NHS Blood and Transplant, Oxford, England
| | | | - Zoe McQuilten
- Monash University, Melbourne, Victoria, Australia
- Monash Health, Melbourne, Victoria, Australia
| | | | - Paul R Mouncey
- Intensive Care National Audit and Research Centre (ICNARC), London, England
| | | | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre (ICNARC), London, England
| | | | | | | | - Yaseen M Arabi
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Djillali Annane
- Hospital Raymond Poincaré (Assistance Publique Hôpitaux de Paris), Garches, France
- Université Versailles SQY-Université Paris Saclay, Montigny-le-Bretonneux, France
| | - Abi Beane
- University of Oxford, Oxford, England
| | | | - Zahra Bhimani
- St Michael's Hospital Unity Health, Toronto, Ontario, Canada
| | - Shailesh Bihari
- Flinders University, Bedford Park, South Australia, Australia
| | | | | | | | - Meredith Buxton
- Global Coalition for Adaptive Research, Los Angeles, California
| | - Marc Carrier
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Allen C Cheng
- Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Matthew Cove
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | | | - Ewan C Goligher
- Peter Munk Cardiac Centre at University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Rashan Haniffa
- University of Oxford, Bangkok, Thailand
- National Intensive Care Surveillance (NICST), Colombo, Sri Lanka
| | - Thomas Hills
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
| | | | | | | | | | | | - Helen L Leavis
- University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Edward Litton
- Fiona Stanley Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Australia
| | - John C Marshall
- St Michael's Hospital Unity Health, Toronto, Ontario, Canada
| | - Daniel F McAuley
- Queen's University Belfast, Belfast, Northern Ireland
- Royal Victoria Hospital, Belfast, Northern Ireland
| | | | - Shay P McGuinness
- Monash University, Melbourne, Victoria, Australia
- Auckland City Hospital, Auckland, New Zealand
| | | | | | | | | | | | - Alistair D Nichol
- Monash University, Melbourne, Victoria, Australia
- University College Dublin, Dublin, Ireland
| | - Rachael L Parke
- Auckland City Hospital, Auckland, New Zealand
- University of Auckland, Auckland, New Zealand
| | | | - Luis F Reyes
- Universidad de La Sabana, Chia, Colombia
- Clinica Universidad de La Sabana, Chia, Colombia
| | - Hiroki Saito
- St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | | | | | - Ary Serpa-Neto
- Monash University, Melbourne, Victoria, Australia
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Manu Shankar-Hari
- King's College London, London, England
- Guy's and St Thomas' NHS Foundation Trust, London, England
| | | | - Timo Tolppa
- National Intensive Care Surveillance (NICST), Colombo, Sri Lanka
| | - Alexis F Turgeon
- Université Laval, Québec City, Québec, Canada
- CHU de Québec-Université Laval Research Center, Québec City, Québec, Canada
| | - Anne M Turner
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
| | | | | | - Roger J Lewis
- Berry Consultants, Austin, Texas
- Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | - Steve A Webb
- Monash University, Melbourne, Victoria, Australia
- St John of God Hospital, Subiaco, Western Australia, Australia
| | - Anthony C Gordon
- Imperial College London, London, England
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, England
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Arabi YM, Al Ghamdi AA, Al-Moamary M, Al Mutrafy A, AlHazme RH, Al Knawy BA. Electronic medical record implementation in a large healthcare system from a leadership perspective. BMC Med Inform Decis Mak 2022; 22:66. [PMID: 35292008 PMCID: PMC8922058 DOI: 10.1186/s12911-022-01801-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Information on the use of change management models to guide electronic medical records (EMR) implementation is limited. This case study describes the leadership aspects of a large-scale EMR implementation using Kotter’s change management model.
Methods This case study presents the experience in implementing a new EMR system from the leadership perspective at King Abdulaziz Medical City, a large tertiary care hospital in Riyadh, Kingdom of Saudi Arabia. We described the process of implementation and outlined the challenges and opportunities, throughout the journey from the pre-implementation to the post-implementation phases.
Results We described the corresponding actions to the eight domains of Kotter’s change management model: creating a sense of urgency, building the guiding team, developing a change vision and strategy, understanding and buy-in, removing obstacles, creating short-term wins, building on the change and anchoring the changes in corporate culture. Conclusions The case study highlights that EMR implementation is not a pure information technology project but rather is a technical-based complex social adaptive project that requires a specific set of leadership competencies that are central to its success. It demonstrates that change management models might be useful for large-scale EMR implementation.
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Affiliation(s)
- Yaseen M Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. .,Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
| | - Abdullah Ali Al Ghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Clinical Affairs, Family Medicine and Primary Healthcare, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohamed Al-Moamary
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Development and Quality Management, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Al Mutrafy
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia.,Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Raed H AlHazme
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Information Technology Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Bandar Abdulmohsen Al Knawy
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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