Cesar Trillo | University of Florida (original) (raw)

Papers by Cesar Trillo

Research paper thumbnail of Timing of the Onset of Acute Respiratory Distress Syndrome: A Population-Based Study

BACKGROUND: Many patients with acute lung injury (ALI) and acute respiratory distress syn-drome (... more BACKGROUND: Many patients with acute lung injury (ALI) and acute respiratory distress syn-drome (ARDS) have had recent healthcare interventions prior to developing ALI/ARDS. OBJEC-TIVE: To determine the timing of ALI/ARDS onset in relation to hospital admission and other healthcare interventions. METHODS: We conducted a population-based observational cohort study with a validated electronic surveillance tool, and identified patients with possible ALI/ARDS among critically ill adults at Mayo Clinic hospitals that provide critical care services for Olmsted County, Minnesota, in 2006. Trained investigators independently reviewed electronic medical records and confirmed the presence and timing of ALI/ARDS based on the American-European consensus definition. RESULTS: Of 124 episodes of ALI in 118 patients, only 5 did not fulfill the ARDS criteria. The syndrome developed a median 30 hours (IQR 10–82 h) after hospital admission in 79 patients (67%). ARDS was present on admission in 39 pati...

Research paper thumbnail of CFTR Modulator Use in Post-Lung Transplant Recipients

TP32. TP032 EPIDEMIOLOGY, BIOMARKERS, AND THERAPY IN CF AND NON-CF BRONCHIECTASIS, 2021

Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulator therapy has previously been ... more Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulator therapy has previously been contraindicated in solid organ transplant recipients. This was due to lack of data and concern for interactions with immunosuppressive drug regimens. However, in post-lung transplant recipients, CFTR modulators may improve extrapulmonary manifestations of cystic fibrosis without impacting graft function or immunosuppressive drug levels. Herein, we present our single center experience with the use of elexacaftor/tezacaftor/ivacaftor, Trikafta, in adult post-lung transplant recipients.

Research paper thumbnail of Ustekinumab associated chronic eosinophilic pneumonia

Journal of Asthma, 2020

IntroductionUstekinumab induced eosinophilic pneumonia is rare and to our knowledge, this is the ... more IntroductionUstekinumab induced eosinophilic pneumonia is rare and to our knowledge, this is the 5th reported case of such an entity.Case StudyA 60-year-old female was admitted with worsening shortness of breath and a non-productive cough for 4 months. Her past medical history was significant for Crohn's disease and psoriatic arthritis that was previously managed with Adalimumab and switched to Ustekinumab 2 months beforesymptoms. Initial diagnostic workup showed 10% peripheral eosinophilia and a CT chest showed numerous 5 mm nodules scattered throughout the lungs along with some peripheral reticulations.Her BAL fluid analysis showed abnormally high eosinophil count (67%), greatly limiting her potential diagnoses to eosinophilic pneumonia, EGPA, and tropical pulmonary eosinophilia (TPE). AEP typically causes more severe disease with a rapid onset and there was low suspicion for TPE based on history, leaving EGPA and CEP.Based on her negative autoimmune serology, a negative biopsy of the nasal mucosa (no vasculitis/granulomata or eosinophils), and negative infectious workup, the patient was diagnosed with CEP secondary to Ustekinumab and the drug was stopped. She was started on high dose prednisone and after a prolonged taper over 5 months, her symptoms and nodules and reticulations on her CT scan resolved.DiscussionThis case exemplifies the importance of identifying drug-induced lung diseases which in many cases might not have a strong temporal association with the symptom onset. It also highlights that some drugs owing to their long elimination half-time can remain in the system for a prolonged period and continue to cause symptoms despite their cessation and require prolonged treatment and reassurance.ConclusionThe association of eosinophilic pneumonia with Ustekinumab, a drug used in the treatment of psoriasis and other autoimmune diseases, is rare and there is a paucity of literature regarding this association.

Research paper thumbnail of A rare case of disseminated Sporothrix schenckii with bone marrow involvement in a patient with idiopathic CD4 lymphocytopenia

IDCases, 2017

Sporothrix schenckii is a pathogen with a predilection for dissemination in immunocompromised ind... more Sporothrix schenckii is a pathogen with a predilection for dissemination in immunocompromised individuals, often with HIV. We report a case of disseminated sporotrichosis in an unfortunate 25 year old male (without HIV) who was originally treated for presumed pneumonia. The patient continued to worsen clinically and further work-up eventually revealed Sporothrix schenckii species with involvement of multiple organs including the skin, heart, lungs and bone marrow. Despite treatment with multiple antibacterials and antifungals, he ultimately passed away. This case illustrates the aggressive nature of this disease along with the importance of early/proper diagnosis and treatment.

Research paper thumbnail of Cryptococcal Meningitis in a Patient with Liver Cirrhosis. Case Report and Review of the Literature

Research paper thumbnail of Comparison of International Classification of Disease-Ninth Revision (ICD-9) Coding with Retrospective Case Review for the Diagnosis of Septic Shock

C56. SEPSIS: FROM BENCH TO THE BEDSIDE, 2009

Research paper thumbnail of Derivation of a Lung Injury Prediction Score (LIPS) To Identify Patients at High Risk of ARDS at the Time of Hospital Admission

C54. ALI/ARDS: DIAGNOSIS AND OUTCOMES, 2009

Research paper thumbnail of Mapping physicians' admission diagnoses to structured concepts towards fully automatic calculation of Acute Physiology and Chronic Health Evaluation score

BMJ Open, 2011

Objective: Acute Physiology and Chronic Health Evaluation (APACHE) is most widely used as a morta... more Objective: Acute Physiology and Chronic Health Evaluation (APACHE) is most widely used as a mortality prediction score in US intensive care units (ICUs), but its calculation is onerous. The authors aimed to develop and validate automatic mapping of physicians' admission diagnoses to structured concepts for automated APACHE IV calculation. Methods: This retrospective study was conducted in medical ICUs of a tertiary healthcare and academic centre. Boolean-logic text searches were used to map admission diagnoses, and these were compared with conventional APACHE database entry by bedside nurses and a gold-standard physician chart review. The primary outcome was APACHE IV predicted hospital mortality. The tool was developed in a larger cohort of ICU patients. Results: In a derivation cohort of 192 consecutive critically ill patients, the diagnosis coefficient coded by three different methods had a positive correlation, highest between manual and gold standard (r 2 ¼0.95; mean square error (MSE)¼0.040) and least between manual and automatic tool (r 2 ¼0.88; MSE¼0.066). The automatic tool had an area under the curve (95% CI) value of 0.82 (0.74 to 0.90) which was similar to the physician gold standard, 0.83 (0.75 to 0.91) and standard manual entry, 0.81 (0.73 to 0.89). The HosmereLemeshow goodness-of-fit test demonstrated good calibration of automatically calculated APACHE IV score (c 2 ¼6.46; p¼0.6). The automatic tool demonstrated excellent discrimination with an area under the curve value of 0.87 (95% CI 0.83 to 0.92) and good calibration (p¼0.58) in the validation cohort of 593 patients. Conclusion: A Boolean-logic text search is an efficient alternative to manual database entry for mapping of ICU admission diagnosis to structured APACHE IV concepts.

Research paper thumbnail of Timing of the Onset of Acute Respiratory Distress Syndrome: A Population-Based Study

Respiratory Care, 2011

BACKGROUND: Many patients with acute lung injury (ALI) and acute respiratory distress syndrome (A... more BACKGROUND: Many patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) have had recent healthcare interventions prior to developing ALI/ARDS. OBJECTIVE: To determine the timing of ALI/ARDS onset in relation to hospital admission and other healthcare interventions. METHODS: We conducted a population-based observational cohort study with a validated electronic surveillance tool, and identified patients with possible ALI/ARDS among critically ill adults at Mayo Clinic hospitals that provide critical care services for Olmsted County, Minnesota, in 2006. Trained investigators independently reviewed electronic medical records and confirmed the presence and timing of ALI/ARDS based on the American-European consensus definition. RESULTS: Of 124 episodes of ALI in 118 patients, only 5 did not fulfill the ARDS criteria. The syndrome developed a median 30 hours (IQR 10-82 h) after hospital admission in 79 patients (67%). ARDS was present on admission in 39 patients (33%), of whom 14 had recent hospitalization, 6 were transferred from nursing homes, and 3 had recent outpatient contact (1 antibiotic prescription, 1 surgical intervention, and 1 chemotherapy). Only 16 ARDS patients (14%) did not have known recent contact with a healthcare system. Compared to ARDS on admission, hospital-acquired ARDS was more likely to occur in surgery patients (54% vs 15%, P < .001), and had longer adjusted hospital stay (mean difference 8.9 d, 95% CI 0.3-17.4, P ‫؍‬ .04). CONCLUSIONS: ARDS in the community most often develops either during hospitalization or in patients who recently had contact with a healthcare system. These findings have important implications for potential preventive strategies.

Research paper thumbnail of Long-Term Survival in Patients With Tracheostomy and Prolonged Mechanical Ventilation in Olmsted County, Minnesota

Respiratory Care, 2011

BACKGROUND: An increasing number of patients require prolonged mechanical ventilation (PMV), whic... more BACKGROUND: An increasing number of patients require prolonged mechanical ventilation (PMV), which is associated with high morbidity and poor long-term survival, but there are few data regarding the incidence and outcome of PMV patients from a community perspective. METHODS: We retrospectively reviewed the electronic medical records of adult Olmsted county, Minnesota, residents admitted to the intensive care units at the 2 Mayo Clinic Rochester hospitals from January 1, 2003, to December 31, 2007, who underwent tracheostomy for PMV. RESULTS: Sixtyfive patients, median age 68 years (interquartile range [IQR] 49-80 y), 39 male, underwent tracheostomy for PMV, resulting in an age-adjusted incidence of 13 (95% CI 10-17) per 100,000 patient-years at risk. The median number of days on mechanical ventilation was 24 days (IQR 18-37 d). Forty-six patients (71%) survived to hospital discharge, and 36 (55%) were alive at 1-year follow-up. After adjusting for age and baseline severity of illness, the presence of COPD was independently associated with 1-year mortality (hazard ratio 3.4, 95% CI 1.4-8.2%). CONCLUSIONS: There was a considerable incidence of tracheostomy for PMV. The presence of COPD was an independent predictor of 1-year mortality.

Research paper thumbnail of Alcohol Consumption and Development of Acute Respiratory Distress Syndrome: A Population-Based Study

International Journal of Environmental Research and Public Health, 2009

This retrospective population-based study evaluated the effects of alcohol consumption on the dev... more This retrospective population-based study evaluated the effects of alcohol consumption on the development of acute respiratory distress syndrome (ARDS). Alcohol consumption was quantified based on patient and/or family provided information at the time of hospital admission. ARDS was defined according to American-European consensus conference (AECC). From 1,422 critically ill Olmsted county residents, 1,357 had information about alcohol use in their medical records, 77 (6%) of whom developed ARDS. A history of significant alcohol consumption (more than two drinks per day) was reported in 97 (7%) of patients. When adjusted for underlying ARDS risk factors (aspiration, chemotherapy, high-risk surgery, pancreatitis, sepsis, shock), smoking, cirrhosis and gender, history of significant alcohol consumption was associated with increased risk of ARDS development (odds ratio 2.9, 95% CI 1.3-6.2). This population-based study confirmed that excessive alcohol consumption is associated with higher risk of ARDS.

Research paper thumbnail of Evaluation of “Loss” and “End stage renal disease” after acute kidney injury defined by the Risk, Injury, Failure, Loss and ESRD classification in critically ill patients

Intensive Care Medicine, 2009

The Risk, Injury, Failure, Loss and ESRD (RIFLE) classification has been widely accepted for the ... more The Risk, Injury, Failure, Loss and ESRD (RIFLE) classification has been widely accepted for the definition of acute kidney injury (AKI); however, no study has described in detail the last two stages of the classification: ''Loss'' and ''ESRD''. We aim to describe and evaluate the development of ''Loss'' and ''ESRD'' in a group of critically ill patients. Methods: We conducted a retrospective analysis of cases prospectively collected from the Acute Physiology and Chronic Health Assessment (APACHE III) database. Subjects were consecutive critically ill patients [18 years of age admitted to three ICUs of two tertiary care academic hospitals, from January 2003 through August 2006, excluding those who denied research authorization, chronic hemodialysis therapy, kidney transplant recipients, readmissions, and admissions for less than 12 h for low risk monitoring. Results: 11,644 patients were included in the study. The median age was 66 (interquartile range, 52-76), 90% were Caucasians and 54% of the patients were male. Half of the patients developed AKI, and most of the patients were in the Risk and Injury stages. From the patients that developed AKI, a total of 1,065 (19%) patients required renal replacement therapy (RRT), 415 (39%) underwent continuous renal replacement therapy (CRRT) and 650 (61%) underwent intermittent hemodialysis. A total of 281 patients on RRT did not survive hospital discharge, 97 patients progressed to ''Loss'', and 282 patients progressed to ''ESRD''. After multivariable adjustment, the progression to ''ESRD'' was associated with higher baseline creatinine, odds ratio (OR) 1.19 per every increase in creatinine of 0.1 mg/dl (95% CI, 1.11-1.29) P \ 0.001; and less frequent use of CRRT, OR 0.18 (95% CI, 0.11-0.29) P \ 0.001. Conclusion: In this large retrospective study we found that almost 50% developed some form of AKI as defined by the RIFLE classification. Of these, 19% required RRT, and 4.9% progressed to ''ESRD''. ''ESRD'' was more likely in patients with elevated baseline creatinine and those treated with intermittent hemodialysis.

Research paper thumbnail of Towards the prevention of acute lung injury: a population based cohort study protocol

BMC Emergency Medicine, 2010

Background: Acute lung injury (ALI) is an example of a critical care syndrome with limited treatm... more Background: Acute lung injury (ALI) is an example of a critical care syndrome with limited treatment options once the condition is fully established. Despite improved understanding of pathophysiology of ALI, the clinical impact has been limited to improvements in supportive treatment. On the other hand, little has been done on the prevention of ALI. Olmsted County, MN, geographically isolated from other urban areas offers the opportunity to study clinical pathogenesis of ALI in a search for potential prevention targets. Methods/Design: In this population-based observational cohort study, the investigators identify patients at high risk of ALI using the prediction model applied within the first six hours of hospital admission. Using a validated system-wide electronic surveillance, Olmsted County patients at risk are followed until ALI, death or hospital discharge. Detailed in-hospital (second hit) exposures and meaningful short and long term outcomes (qualityadjusted survival) are compared between ALI cases and high risk controls matched by age, gender and probability of developing ALI. Time sensitive biospecimens are collected for collaborative research studies. Nested case control comparison of 500 patients who developed ALI with 500 matched controls will provide an adequate power to determine significant differences in common hospital exposures and outcomes between the two groups. Discussion: This population-based observational cohort study will identify patients at high risk early in the course of disease, the burden of ALI in the community, and the potential targets for future prevention trials.

Research paper thumbnail of Timing to the Onset of Acute Respiratory Distress Syndrome in a Population Based Sample

C92. ALI/ARDS: OUTCOMES AND PREDICTORS OF FAILURE, 2009

Research paper thumbnail of Timing of the Onset of Acute Respiratory Distress Syndrome: A Population-Based Study

BACKGROUND: Many patients with acute lung injury (ALI) and acute respiratory distress syn-drome (... more BACKGROUND: Many patients with acute lung injury (ALI) and acute respiratory distress syn-drome (ARDS) have had recent healthcare interventions prior to developing ALI/ARDS. OBJEC-TIVE: To determine the timing of ALI/ARDS onset in relation to hospital admission and other healthcare interventions. METHODS: We conducted a population-based observational cohort study with a validated electronic surveillance tool, and identified patients with possible ALI/ARDS among critically ill adults at Mayo Clinic hospitals that provide critical care services for Olmsted County, Minnesota, in 2006. Trained investigators independently reviewed electronic medical records and confirmed the presence and timing of ALI/ARDS based on the American-European consensus definition. RESULTS: Of 124 episodes of ALI in 118 patients, only 5 did not fulfill the ARDS criteria. The syndrome developed a median 30 hours (IQR 10–82 h) after hospital admission in 79 patients (67%). ARDS was present on admission in 39 pati...

Research paper thumbnail of CFTR Modulator Use in Post-Lung Transplant Recipients

TP32. TP032 EPIDEMIOLOGY, BIOMARKERS, AND THERAPY IN CF AND NON-CF BRONCHIECTASIS, 2021

Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulator therapy has previously been ... more Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulator therapy has previously been contraindicated in solid organ transplant recipients. This was due to lack of data and concern for interactions with immunosuppressive drug regimens. However, in post-lung transplant recipients, CFTR modulators may improve extrapulmonary manifestations of cystic fibrosis without impacting graft function or immunosuppressive drug levels. Herein, we present our single center experience with the use of elexacaftor/tezacaftor/ivacaftor, Trikafta, in adult post-lung transplant recipients.

Research paper thumbnail of Ustekinumab associated chronic eosinophilic pneumonia

Journal of Asthma, 2020

IntroductionUstekinumab induced eosinophilic pneumonia is rare and to our knowledge, this is the ... more IntroductionUstekinumab induced eosinophilic pneumonia is rare and to our knowledge, this is the 5th reported case of such an entity.Case StudyA 60-year-old female was admitted with worsening shortness of breath and a non-productive cough for 4 months. Her past medical history was significant for Crohn's disease and psoriatic arthritis that was previously managed with Adalimumab and switched to Ustekinumab 2 months beforesymptoms. Initial diagnostic workup showed 10% peripheral eosinophilia and a CT chest showed numerous 5 mm nodules scattered throughout the lungs along with some peripheral reticulations.Her BAL fluid analysis showed abnormally high eosinophil count (67%), greatly limiting her potential diagnoses to eosinophilic pneumonia, EGPA, and tropical pulmonary eosinophilia (TPE). AEP typically causes more severe disease with a rapid onset and there was low suspicion for TPE based on history, leaving EGPA and CEP.Based on her negative autoimmune serology, a negative biopsy of the nasal mucosa (no vasculitis/granulomata or eosinophils), and negative infectious workup, the patient was diagnosed with CEP secondary to Ustekinumab and the drug was stopped. She was started on high dose prednisone and after a prolonged taper over 5 months, her symptoms and nodules and reticulations on her CT scan resolved.DiscussionThis case exemplifies the importance of identifying drug-induced lung diseases which in many cases might not have a strong temporal association with the symptom onset. It also highlights that some drugs owing to their long elimination half-time can remain in the system for a prolonged period and continue to cause symptoms despite their cessation and require prolonged treatment and reassurance.ConclusionThe association of eosinophilic pneumonia with Ustekinumab, a drug used in the treatment of psoriasis and other autoimmune diseases, is rare and there is a paucity of literature regarding this association.

Research paper thumbnail of A rare case of disseminated Sporothrix schenckii with bone marrow involvement in a patient with idiopathic CD4 lymphocytopenia

IDCases, 2017

Sporothrix schenckii is a pathogen with a predilection for dissemination in immunocompromised ind... more Sporothrix schenckii is a pathogen with a predilection for dissemination in immunocompromised individuals, often with HIV. We report a case of disseminated sporotrichosis in an unfortunate 25 year old male (without HIV) who was originally treated for presumed pneumonia. The patient continued to worsen clinically and further work-up eventually revealed Sporothrix schenckii species with involvement of multiple organs including the skin, heart, lungs and bone marrow. Despite treatment with multiple antibacterials and antifungals, he ultimately passed away. This case illustrates the aggressive nature of this disease along with the importance of early/proper diagnosis and treatment.

Research paper thumbnail of Cryptococcal Meningitis in a Patient with Liver Cirrhosis. Case Report and Review of the Literature

Research paper thumbnail of Comparison of International Classification of Disease-Ninth Revision (ICD-9) Coding with Retrospective Case Review for the Diagnosis of Septic Shock

C56. SEPSIS: FROM BENCH TO THE BEDSIDE, 2009

Research paper thumbnail of Derivation of a Lung Injury Prediction Score (LIPS) To Identify Patients at High Risk of ARDS at the Time of Hospital Admission

C54. ALI/ARDS: DIAGNOSIS AND OUTCOMES, 2009

Research paper thumbnail of Mapping physicians' admission diagnoses to structured concepts towards fully automatic calculation of Acute Physiology and Chronic Health Evaluation score

BMJ Open, 2011

Objective: Acute Physiology and Chronic Health Evaluation (APACHE) is most widely used as a morta... more Objective: Acute Physiology and Chronic Health Evaluation (APACHE) is most widely used as a mortality prediction score in US intensive care units (ICUs), but its calculation is onerous. The authors aimed to develop and validate automatic mapping of physicians' admission diagnoses to structured concepts for automated APACHE IV calculation. Methods: This retrospective study was conducted in medical ICUs of a tertiary healthcare and academic centre. Boolean-logic text searches were used to map admission diagnoses, and these were compared with conventional APACHE database entry by bedside nurses and a gold-standard physician chart review. The primary outcome was APACHE IV predicted hospital mortality. The tool was developed in a larger cohort of ICU patients. Results: In a derivation cohort of 192 consecutive critically ill patients, the diagnosis coefficient coded by three different methods had a positive correlation, highest between manual and gold standard (r 2 ¼0.95; mean square error (MSE)¼0.040) and least between manual and automatic tool (r 2 ¼0.88; MSE¼0.066). The automatic tool had an area under the curve (95% CI) value of 0.82 (0.74 to 0.90) which was similar to the physician gold standard, 0.83 (0.75 to 0.91) and standard manual entry, 0.81 (0.73 to 0.89). The HosmereLemeshow goodness-of-fit test demonstrated good calibration of automatically calculated APACHE IV score (c 2 ¼6.46; p¼0.6). The automatic tool demonstrated excellent discrimination with an area under the curve value of 0.87 (95% CI 0.83 to 0.92) and good calibration (p¼0.58) in the validation cohort of 593 patients. Conclusion: A Boolean-logic text search is an efficient alternative to manual database entry for mapping of ICU admission diagnosis to structured APACHE IV concepts.

Research paper thumbnail of Timing of the Onset of Acute Respiratory Distress Syndrome: A Population-Based Study

Respiratory Care, 2011

BACKGROUND: Many patients with acute lung injury (ALI) and acute respiratory distress syndrome (A... more BACKGROUND: Many patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) have had recent healthcare interventions prior to developing ALI/ARDS. OBJECTIVE: To determine the timing of ALI/ARDS onset in relation to hospital admission and other healthcare interventions. METHODS: We conducted a population-based observational cohort study with a validated electronic surveillance tool, and identified patients with possible ALI/ARDS among critically ill adults at Mayo Clinic hospitals that provide critical care services for Olmsted County, Minnesota, in 2006. Trained investigators independently reviewed electronic medical records and confirmed the presence and timing of ALI/ARDS based on the American-European consensus definition. RESULTS: Of 124 episodes of ALI in 118 patients, only 5 did not fulfill the ARDS criteria. The syndrome developed a median 30 hours (IQR 10-82 h) after hospital admission in 79 patients (67%). ARDS was present on admission in 39 patients (33%), of whom 14 had recent hospitalization, 6 were transferred from nursing homes, and 3 had recent outpatient contact (1 antibiotic prescription, 1 surgical intervention, and 1 chemotherapy). Only 16 ARDS patients (14%) did not have known recent contact with a healthcare system. Compared to ARDS on admission, hospital-acquired ARDS was more likely to occur in surgery patients (54% vs 15%, P < .001), and had longer adjusted hospital stay (mean difference 8.9 d, 95% CI 0.3-17.4, P ‫؍‬ .04). CONCLUSIONS: ARDS in the community most often develops either during hospitalization or in patients who recently had contact with a healthcare system. These findings have important implications for potential preventive strategies.

Research paper thumbnail of Long-Term Survival in Patients With Tracheostomy and Prolonged Mechanical Ventilation in Olmsted County, Minnesota

Respiratory Care, 2011

BACKGROUND: An increasing number of patients require prolonged mechanical ventilation (PMV), whic... more BACKGROUND: An increasing number of patients require prolonged mechanical ventilation (PMV), which is associated with high morbidity and poor long-term survival, but there are few data regarding the incidence and outcome of PMV patients from a community perspective. METHODS: We retrospectively reviewed the electronic medical records of adult Olmsted county, Minnesota, residents admitted to the intensive care units at the 2 Mayo Clinic Rochester hospitals from January 1, 2003, to December 31, 2007, who underwent tracheostomy for PMV. RESULTS: Sixtyfive patients, median age 68 years (interquartile range [IQR] 49-80 y), 39 male, underwent tracheostomy for PMV, resulting in an age-adjusted incidence of 13 (95% CI 10-17) per 100,000 patient-years at risk. The median number of days on mechanical ventilation was 24 days (IQR 18-37 d). Forty-six patients (71%) survived to hospital discharge, and 36 (55%) were alive at 1-year follow-up. After adjusting for age and baseline severity of illness, the presence of COPD was independently associated with 1-year mortality (hazard ratio 3.4, 95% CI 1.4-8.2%). CONCLUSIONS: There was a considerable incidence of tracheostomy for PMV. The presence of COPD was an independent predictor of 1-year mortality.

Research paper thumbnail of Alcohol Consumption and Development of Acute Respiratory Distress Syndrome: A Population-Based Study

International Journal of Environmental Research and Public Health, 2009

This retrospective population-based study evaluated the effects of alcohol consumption on the dev... more This retrospective population-based study evaluated the effects of alcohol consumption on the development of acute respiratory distress syndrome (ARDS). Alcohol consumption was quantified based on patient and/or family provided information at the time of hospital admission. ARDS was defined according to American-European consensus conference (AECC). From 1,422 critically ill Olmsted county residents, 1,357 had information about alcohol use in their medical records, 77 (6%) of whom developed ARDS. A history of significant alcohol consumption (more than two drinks per day) was reported in 97 (7%) of patients. When adjusted for underlying ARDS risk factors (aspiration, chemotherapy, high-risk surgery, pancreatitis, sepsis, shock), smoking, cirrhosis and gender, history of significant alcohol consumption was associated with increased risk of ARDS development (odds ratio 2.9, 95% CI 1.3-6.2). This population-based study confirmed that excessive alcohol consumption is associated with higher risk of ARDS.

Research paper thumbnail of Evaluation of “Loss” and “End stage renal disease” after acute kidney injury defined by the Risk, Injury, Failure, Loss and ESRD classification in critically ill patients

Intensive Care Medicine, 2009

The Risk, Injury, Failure, Loss and ESRD (RIFLE) classification has been widely accepted for the ... more The Risk, Injury, Failure, Loss and ESRD (RIFLE) classification has been widely accepted for the definition of acute kidney injury (AKI); however, no study has described in detail the last two stages of the classification: ''Loss'' and ''ESRD''. We aim to describe and evaluate the development of ''Loss'' and ''ESRD'' in a group of critically ill patients. Methods: We conducted a retrospective analysis of cases prospectively collected from the Acute Physiology and Chronic Health Assessment (APACHE III) database. Subjects were consecutive critically ill patients [18 years of age admitted to three ICUs of two tertiary care academic hospitals, from January 2003 through August 2006, excluding those who denied research authorization, chronic hemodialysis therapy, kidney transplant recipients, readmissions, and admissions for less than 12 h for low risk monitoring. Results: 11,644 patients were included in the study. The median age was 66 (interquartile range, 52-76), 90% were Caucasians and 54% of the patients were male. Half of the patients developed AKI, and most of the patients were in the Risk and Injury stages. From the patients that developed AKI, a total of 1,065 (19%) patients required renal replacement therapy (RRT), 415 (39%) underwent continuous renal replacement therapy (CRRT) and 650 (61%) underwent intermittent hemodialysis. A total of 281 patients on RRT did not survive hospital discharge, 97 patients progressed to ''Loss'', and 282 patients progressed to ''ESRD''. After multivariable adjustment, the progression to ''ESRD'' was associated with higher baseline creatinine, odds ratio (OR) 1.19 per every increase in creatinine of 0.1 mg/dl (95% CI, 1.11-1.29) P \ 0.001; and less frequent use of CRRT, OR 0.18 (95% CI, 0.11-0.29) P \ 0.001. Conclusion: In this large retrospective study we found that almost 50% developed some form of AKI as defined by the RIFLE classification. Of these, 19% required RRT, and 4.9% progressed to ''ESRD''. ''ESRD'' was more likely in patients with elevated baseline creatinine and those treated with intermittent hemodialysis.

Research paper thumbnail of Towards the prevention of acute lung injury: a population based cohort study protocol

BMC Emergency Medicine, 2010

Background: Acute lung injury (ALI) is an example of a critical care syndrome with limited treatm... more Background: Acute lung injury (ALI) is an example of a critical care syndrome with limited treatment options once the condition is fully established. Despite improved understanding of pathophysiology of ALI, the clinical impact has been limited to improvements in supportive treatment. On the other hand, little has been done on the prevention of ALI. Olmsted County, MN, geographically isolated from other urban areas offers the opportunity to study clinical pathogenesis of ALI in a search for potential prevention targets. Methods/Design: In this population-based observational cohort study, the investigators identify patients at high risk of ALI using the prediction model applied within the first six hours of hospital admission. Using a validated system-wide electronic surveillance, Olmsted County patients at risk are followed until ALI, death or hospital discharge. Detailed in-hospital (second hit) exposures and meaningful short and long term outcomes (qualityadjusted survival) are compared between ALI cases and high risk controls matched by age, gender and probability of developing ALI. Time sensitive biospecimens are collected for collaborative research studies. Nested case control comparison of 500 patients who developed ALI with 500 matched controls will provide an adequate power to determine significant differences in common hospital exposures and outcomes between the two groups. Discussion: This population-based observational cohort study will identify patients at high risk early in the course of disease, the burden of ALI in the community, and the potential targets for future prevention trials.

Research paper thumbnail of Timing to the Onset of Acute Respiratory Distress Syndrome in a Population Based Sample

C92. ALI/ARDS: OUTCOMES AND PREDICTORS OF FAILURE, 2009