A5006241042- Sepsis Diagnosis and Treatment
- Hemodynamic Monitoring and Therapy
- Clinical Reasoning and Diagnostic Skills
- Cardiac, Anesthesia and Surgical Outcomes
- Intensive Care Unit Cognitive Disorders
- Emergency and Acute Care Studies
- Respiratory Support and Mechanisms
- Cardiac Arrest and Resuscitation
- Ultrasound in Clinical Applications
- Nosocomial Infections in ICU
- Renal function and acid-base balance
- COVID-19 Clinical Research Studies
- Acute Kidney Injury Research
- Simulation-Based Education in Healthcare
- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Bacterial Identification and Susceptibility Testing
- Heart Failure Treatment and Management
- Bipolar Disorder and Treatment
- Thermal Regulation in Medicine
- Vitamin C and Antioxidants Research
- Airway Management and Intubation Techniques
- Chronic Kidney Disease and Diabetes
- Vitamin D Research Studies
- Health Systems, Economic Evaluations, Quality of Life
- Blood Pressure and Hypertension Studies
Loma Linda University
2014-2025
Loma Linda University Medical Center
2006-2025
AbbVie (United States)
2023
Loma Linda University Children's Hospital
2018-2022
Queen Elizabeth Hospital
2021
University of Toledo
2015
Virginia Commonwealth University
2011
Henry Ford Health System
1999-2011
University of Pennsylvania
2011
Duke Medical Center
2011
Objective: Serial lactate concentrations can be used to examine disease severity in the intensive care unit. This study examines clinical utility of clearance before unit admission (during most proximal period presentation) as an indicator outcome severe sepsis and septic shock. We hypothesize that a high 6 hrs is associated with decreased mortality rate. Design: Prospective observational study. Setting: An urban emergency department over 1-yr period. Patients: A convenience cohort patients...
The purpose of this study was to examine the outcome implications implementing a severe sepsis bundle in an emergency department as quality indicator set with feedback modify physician behavior related early management and septic shock.Two-year prospective observational cohort.Academic tertiary care facility.Patients were 330 patients presenting who met criteria for or shock.Five indicators comprised department: a) initiate central venous pressure (CVP)/central oxygen saturation (Scvo2)...
Rationale: We recently reported two novel biomarkers for acute kidney injury (AKI), tissue inhibitor of metalloproteinases (TIMP)-2 and insulin-like growth factor binding protein 7 (IGFBP7), both related to G1 cell cycle arrest.Objectives: now validate a clinical test urinary [TIMP-2]·[IGFBP7] at high-sensitivity cutoff greater than 0.3 AKI risk stratification in diverse population critically ill patients.Methods: conducted prospective multicenter study 420 patients. The primary analysis was...
Significance Statement Although AKI is an important sequela of coronavirus disease 2019 (COVID-19), data on treated with RRT (AKI-RRT) in patients COVID-19 are limited. In a multicenter cohort study 3099 critically ill adults admitted to intensive care units (ICUs) at 67 hospitals across the United States, one five developed AKI-RRT, 63% whom died during hospitalization. Among who survived hospital discharge, three remained dependent and six 60 days after ICU admission. The identified...
Previous studies have shown that high concentrations of ethanol (≥40%) cause functional damage the gastrointestinal epithelial barrier by direct cytotoxic effect on cells. The effects lower noncytotoxic doses function are unknown. A major cells is to provide a against hostile substances in lumen. apicolaterally located tight junctions (TJs) form paracellular seal between lateral membranes adjacent and act as barrier. In this study, we investigated intestinal TJ using filter-grown Caco-2...
To define a biomarker panel to predict organ dysfunction, shock, and in-hospital mortality in emergency department (ED) patients with suspected sepsis.Prospective observational study.EDs of ten academic medical centers.There were 971 enrolled.1) ED age > 18; 2) infection or serum lactate level 2.5 mmol/L; 3) two more systemic inflammatory response syndrome criteria.pregnancy, do-not-resuscitate status, cardiac arrest.Nine biomarkers assayed from blood draws obtained on presentation....
Lactate clearance, a surrogate for the magnitude and duration of global tissue hypoxia, is used diagnostically, therapeutically prognostically. This study examined association early lactate clearance with selected inflammatory, coagulation, apoptosis response biomarkers organ dysfunction scores in severe sepsis septic shock.Measurements serum arterial lactate, (interleukin-1 receptor antagonist, interleukin-6, interleukin-8, interleukin-10, tumor necrosis factor-alpha, intercellular adhesion...
To examine the performance of urinary biomarker panel tissue inhibitor metalloproteinase-2 and insulin-like growth factor-binding protein 7 in patients with sepsis at ICU admission. investigate effect nonrenal organ dysfunction on this population.In ancillary analysis, we included who were enrolled either two trials including 39 ICUs across Europe North America. The primary endpoint was moderate-severe acute kidney injury (equivalent to Kidney Disease Improving Global Outcome stage 2-3)...
The use of novel sepsis biomarkers has increased in recent years. However, their prognostic value with respect to illness severity not been explored. In this work, we examined the ability mid-regional proadrenomedullin (MR-proADM) predicting mortality patients different degrees organ failure, compared that procalcitonin, C-reactive protein and lactate. This was a two-centre prospective observational cohort, enrolling severe or septic shock admitted ICU. Plasma were measured during first 12 h...
Abstract. Objectives: The changing landscape of health care in this country has seen an increase the delivery to critically ill patients emergency department (ED). However, methodologies assess and outcomes similar those used intensive unit (ICU) are currently lacking setting. This study examined impact ED intervention on morbidity mortality using Acute Physiology Chronic Health Evaluation (APACHE II), Simplified Score (SAPS Multiple Organ Dysfunction (MODS). Methods: was a prospective,...
Recent studies have reported decreased overall severe sepsis mortality, but associations with organism trends not yet been investigated. This study explored organism-specific mortality from 1999 to 2008 in a large hospital-based administrative database.Secondary data analysis using the Nationwide Inpatient Sample.United States hospitals sampled Sample dataset.This sample approximates stratified 20% of all nonfederal, short-term, general, and specialty serving adults United States. Severe...
In this study, we aim to describe the post-sepsis syndrome from perspective of sepsis survivors. The study is a prospective, observational online international survey. Sepsis survivors enrolled via social media 13 September 2014 2016. None. Physiologic, physical and psychological function post-sepsis; patient satisfaction with sepsis-centered care. 1731 completed surveys 41 countries were analyzed, 79.9% female respondents, age 47.6 ± 14.4 years. majority respondents (47.8%) had within last...
Rationale: Variation in hospital mortality has been described for coronavirus disease (COVID-19), but the factors that explain these differences remain unclear. Objective: Our objective was to use a large, nationally representative data set of critically ill adults with COVID-19 determine which variability. Methods: In this multicenter cohort study, we examined hospitalized ICUs at 70 U.S. hospitals between March and June 2020. The primary outcome 28-day mortality. We patient-level...
BackgroundUS hospitals have reported compliance with the SEP-1 quality measure to Medicare since 2015. Finding an association between and outcomes is essential gauge effectiveness.Research QuestionWhat 30-day mortality among beneficiaries?Study Design And MethodsStudying patient-level data by 3,241 from October 1, 2015, March 31, 2017, we used propensity score matching a hierarchical general linear model (HGLM) estimate treatment effects associated SEP-1. Compliance was defined as completion...
Patients who present to the emergency department (ED) with return of spontaneous circulation after cardiac arrest generally have poor outcomes. Guidelines for treatment can be complicated and difficult implement. This study examined feasibility implementing a care bundle including therapeutic hypothermia (TH) early hemodynamic optimization comatose patients out-of-hospital arrest. The included over 2-year period in ED intensive unit an academic tertiary-care medical center. first year...
In sepsis, the vitamin D active metabolite 1,25-dihydroxyvitamin (1,25(OH)2D) may play a crucial role by its action to produce cathelicidin and improve endothelial barrier function, such that deficiency in 1,25(OH)2D is associated with poor outcome. To test our hypothesis, we performed analysis of stored plasma samples from prospective observational study 91 patients age 59.1+/−2.0 years, 52.7% females, 11.0% deaths at 30 days. Vitamin status, including 25-hydroxyvitamin (25(OH)D),...