A5061802591- Airway Management and Intubation Techniques
- Respiratory Support and Mechanisms
- Cardiac Arrest and Resuscitation
- Tracheal and airway disorders
- Emergency and Acute Care Studies
- Neonatal Respiratory Health Research
- Innovations in Medical Education
- Family and Patient Care in Intensive Care Units
- Electronic Health Records Systems
- Infant Development and Preterm Care
- Cardiac, Anesthesia and Surgical Outcomes
- Mechanical Circulatory Support Devices
- Evaluation and Performance Assessment
- Child and Adolescent Health
- Simulation-Based Education in Healthcare
- Long-Term Effects of COVID-19
- Sepsis Diagnosis and Treatment
- Intensive Care Unit Cognitive Disorders
- Epilepsy research and treatment
- Healthcare professionals’ stress and burnout
- Cardiac Arrhythmias and Treatments
- Global Health Workforce Issues
- Medical Education and Admissions
- Anesthesia and Sedative Agents
- Clinical Reasoning and Diagnostic Skills
Penn State Milton S. Hershey Medical Center
2016-2025
Hershey (United States)
2024
Pennsylvania State University
2003-2022
Dartmouth–Hitchcock Medical Center
2017
Children's Hospital of Philadelphia
2017
Background/Objectives Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be associated febrile seizures, but the overall frequency and outcomes are unknown. The objectives of this study to (1) determine pediatric subjects diagnosed seizures COVID-19, (2) evaluate patient characteristics, (3) describe treatments (medications need for invasive mechanical ventilation) applied. Methods This was a retrospective utilizing TriNetX electronic health record data. We...
Determine if apneic oxygenation (AO) delivered via nasal cannula during the phase of tracheal intubation (TI), reduces adverse TI-associated events (TIAEs) in children. AO was implemented across 14 pediatric intensive care units as a quality improvement intervention 2016-2020. Implementation consisted an safety checklist, leadership endorsement, local champion, and data feedback to frontline clinicians. Standardized oxygen flow for follows: 5 L/min infants (< 1 year), 10 young children (1-7...
Objectives: Oxygen desaturation during tracheal intubation is known to be associated with adverse ICU outcomes in critically ill children. We aimed determine the occurrence and severity of intubations association hemodynamic intubation–associated events. Design: Retrospective cohort study as a part National Emergency Airway Registry for Children Network’s quality improvement project from January 2012 December 2014. Setting: International PICUs. Patients: Critically children younger than 18...
The objective of this study was to compare the systemic inflammatory response and hemolytic characteristics a conventional roller pump (HL20-NP) an alternative diagonal with nonpulsatile (DP3-NP) pulsatile mode (DP3-P) in simulated neonatal extracorporeal life support (ECLS) systems. experimental ECLS circuits consist Jostra HL20 or Medos DP3 pump, Hilite 800 LT hollow-fiber oxygenator diffusion membrane. Eighteen sterile were primed freshly donated whole blood divided into three groups:...
Video (indirect) laryngoscopy is used as a primary tracheal intubation device for difficult airways in emergency departments and adult ICUs. The use outcomes of video compared with direct has not been quantified PICUs or cardiac
Objectives: Tracheal intubation (TI) is a critical skill for PICU attending physicians to maintain. We hypothesize that attendings perform fewer TIs and have lower success rate in programs with Pediatric Critical Care Medicine (PCCM) fellowship. Design: Retrospective study using the National Emergency Airway Registry Children (NEAR4KIDS) from July 2016 June 2020. Exposures were presence of PCCM fellowship TI maintenance program (SMP). The primary outcome was attending’s first attempt...
Objectives: Tracheal intubation in critically ill children with shock poses a risk of hemodynamic compromise. Ketamine has been considered the drug choice for induction these patients, but limited data exist. We investigated whether administration ketamine tracheal or without was associated fewer adverse events compared other agents. also if there dose dependence any association between use and events. Design: performed retrospective analysis using prospectively collected observational from...
Coronavirus disease 2019 (COVID-19) is associated with pulmonary embolism in adults, but the clinical circumstances surrounding its presence are unknown children. The objectives of this study to determine prevalence pediatric subjects COVID-19, evaluate patient characteristics, and describe treatments applied.We performed a retrospective cohort using TriNetX electronic health record data aged <18 years who were diagnosed COVID-19 infection (International Classification Diseases, 10th...
Objectives: To evaluate the effect of a tracheal intubation safety bundle on adverse intubation-associated events across 15 PICUs. Design: Multicenter time-series study. Setting: PICUs in United States. Patients: All patients received intubations ICUs. Interventions: We implemented as quality-improvement intervention that includes: 1) quarterly site benchmark performance report and 2) airway checklists (preprocedure risk factor, approach, role planning, preprocedure bedside “time-out,”...
Abstract Background Tracheal intubation (TI) practice across pediatric emergency departments (EDs) has not been comprehensively reported. We aim to describe TI and outcomes in EDs contrast those intensive care units (ICUs) use the data identify quality improvement targets. [Correction added on 30 April 2022, after first online publication: The sentence modified.] Methods Consecutive encounters from ICUs National Emergency Airway Registry for Children (NEAR4KIDS) database 2015 2018 were...
As of July 2013, pediatric resident trainee guidelines in the United States no longer require proficiency nonneonatal tracheal intubation. We hypothesized that laryngoscopy by residents has decreased over time, with a more pronounced decrease after this guideline change.Prospective cohort study.Twenty-five PICUs at various children's hospitals across States.Tracheal intubations performed from 2010 to June 2016 multicenter intubation database (National Emergency Airway Registry for...
<h3>BACKGROUND:</h3> Timely ventilator liberation is crucial in the pediatric ICU. In many ICUs, decision to initiate weaning driven by physician, which may lead delays liberation. The objectives of this quality improvement project were develop and implement a respiratory therapist (RT)–led protocol for screening spontaneous breathing trial (SBT) readiness, test feasibility, evaluate its impact on SBT timing. <h3>METHODS:</h3> A retrospective chart review was performed all intubated patients...
Objectives: Bag-mask ventilation is commonly used prior to tracheal intubation; however, the epidemiology, risk factors, and clinical implications of difficult bag-mask among critically ill children are not well studied. This study aims describe prevalence factors for pediatric as its association with adverse intubation–associated events oxygen desaturation in PICU patients. Design: A retrospective review prospectively collected observational data from a multicenter intubation database...
The Medos Deltastream DP3 system is made up of a novel diagonal pump and hollow-membrane oxygenator that provides nonpulsatile pulsatile flows for extracorporeal life support (ECLS). objectives this study are to (i) evaluate the efficacy hemodynamic energy provided by in mode (ii) under different frequencies. experimental ECLS circuit was used study, primed with Ringer's lactate packed red blood cells (hematocrit 35%). All trials were conducted at flow rates 500, 1000, 1500, 2000 mL/min...
Abstract Introduction Children with CHD and acquired heart disease have unique, high-risk physiology. They may a higher risk of adverse tracheal-intubation-associated events, as compared children non-cardiac disease. Materials methods We sought to evaluate the occurrence events in cardiac A retrospective analysis tracheal intubations from 38 international paediatric ICUs was performed using National Emergency Airway Registry for (NEAR4KIDS) quality improvement registry. The primary outcome...
Tracheal intubation carries a high risk of adverse events. The current literature is unclear regarding the "New Trainee Effect" on tracheal safety in PICU. We evaluated effect timing PICU fellow academic cycle associated hypothesize 1) PICUs with pediatric critical care medicine fellowship programs have more events during first quarter (July-September) year compared rest and 2) event rates attempt success performed by fellows improve through 3-year clinical fellowship. Retrospective cohort...
Background and Purposes The coronavirus 2019 (COVID-19) pandemic was associated with catastrophic consequences increased psychological distress. However, it is unknown if the impacted frequency of functional seizures (FS), a well known manifestation psychiatric disease. study objectives are to evaluate FS diagnostic code before during COVID-19 therapies applied. We hypothesized that would be higher pandemic, but applied similar between two time periods. Methods This retrospective...
Background and objective Acute kidney injury (AKI) is a common complication in hospitalized pediatric patients. Previous studies focused on adults found that proteinuria detected during an admission urinalysis fit to serve as indicator for AKI associated clinical outcomes. The of this study evaluate if the first day hospital services children with AKI, need renal replacement therapy, shock and/or antibiotic use, critical care services, all-cause mortality at 30 days, hypothesizing it these...
Abstract Introduction Supraventricular tachycardia (SVT) can occur during treatment of an acute asthma exacerbation. There are, however, no data on the long‐term outcomes children who are diagnosed with both and SVT. This study aims to analyze impact SVT in asthmatic mortality and/or cardiac arrest, hypothesizing subjects have increased arrest compared subject no‐SVT. Methods was a retrospective cohort study, utilizing TriNetX© electronic health record (EHR) database that included 2–18 years...
Background: Methemoglobinemia requires early identification and treatment, but limited knowledge exists regarding the current therapeutic approach taken by clinicians as well outcomes that occur in children. Objectives: To determine prevalence of this rare disease pediatric population, evaluate impact methemoglobin functional hemoglobin levels, assess how is approached clinicians. We hypothesize methemoglobinemia low more methylene blue use would be observed subjects with levels less than 7...
Waveform capnography use has been incorporated into guidelines for the confirmation of tracheal intubation. We aim to describe trend in waveform emergency departments and PICUs assess association between adverse intubation-associated events.A multicenter retrospective cohort study.Thirty-four hospitals (34 ICUs nine departments) National Emergency Airway Registry Children quality improvement initiative.Primary intubation children younger than 18 years.None.Patient, provider, practice data...
Evaluate differences in tracheal intubation-associated events and process variances (i.e., multiple intubation attempts oxygen desaturation) between pediatric cardiac ICUs noncardiac PICUs children with underlying disease. Retrospective cohort study using a multicenter quality improvement database (National Emergency Airway Registry for Children). Thirty-six (five ICUs, 31 ICUs) from July 2012 to March 2016. Children medical or surgical disease who underwent an ICU. None. Our primary outcome...
Introduction The coronavirus disease 2019 (COVID-19) pandemic has resulted in the suspension of our pediatric clerkship, which may result medical student skill erosion due to lack patient contact. Our clerkship developed and assessed feasibility implementing a video-recorded oral presentation assignment formative assessment centered on virtual case-based modules. Methods This retrospective study examined providing remote third-year submissions modules over one-week time period after (March...