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Research paper thumbnail of Use of an Intravascular Heat Exchange Catheter and Intravenous Lipid Emulsion for Hypothermic Cardiac Arrest After Cyclobenzaprine Overdose

Therapeutic Hypothermia and Temperature Management, 2015

In this case report, a 22-year-old male developed severe hypothermia after an accidental overdose... more In this case report, a 22-year-old male developed severe hypothermia after an accidental overdose of cyclobenzaprine. During transport, the patient developed cardiac arrest. He received active rewarming measures, including pleural lavage, gastric lavage, an intravascular heat exchange catheter, and cardiopulmonary bypass. Intravenous lipid emulsion (ILE) was also administered. A discussion of cyclobenzaprine toxicity, hypothermia, ILE, and accidental hypothermic cardiac arrest follows.

Research paper thumbnail of Continuous cardiac index monitoring: A prospective observational study of agreement between a pulmonary artery catheter and a calibrated minimally invasive technique

Resuscitation, 2009

Introduction: Continuous cardiac index (CCI) monitoring can provide information to assist in hemo... more Introduction: Continuous cardiac index (CCI) monitoring can provide information to assist in hemodynamic support. However, pulmonary artery catheters (PAC) pose logistic challenges in acute care settings. We hypothesized that CCI measured with a calibrated minimally invasive technique (LiDCO/PulseCO, UK) would have good agreement with the PAC. Methods: We performed a prospective observational study in post-operative cardiac surgery patients. All patients had a PAC with CCI monitoring capability. We connected the LiDCO apparatus to a radial artery line and performed a one-time calibration with a lithium dilution indicator. In order to test the least invasive method possible, we used a peripheral intravenous (IV) line for indicator delivery rather than the conventional central line technique. We recorded paired PAC/LiDCO-PulseCO CCI measurements every minute for 3 h. We blinded investigators and clinicians to minimally invasive data with an opaque shield over the monitor. We assessed agreement with Bland-Altman analysis. Results: We obtained 1485 paired measurements in 8 subjects. The mean CI was 2.9 L/min/m 2 . By Bland-Altman plot, PAC and LiDCO measurements showed minimal bias (−0.01), but the 95% limits of agreement (±2SD) of ± 1.3 L/min/m 2 were relatively wide with respect to the mean. Conclusions: This calibrated minimally invasive (i.e. radial arterial line and peripheral IV) technique demonstrated low bias compared with CCI measured by PAC. However, the relatively wide confidence limits indicate that differences in the two measurements could still be clinically significant.

Research paper thumbnail of Nebulized β 2 -Agonist Use in High-Risk Inner-City Adults with Asthma

Journal of Asthma, 2003

... Also, we did not measure all asthma-related self-care/management factors that might differ ..... more ... Also, we did not measure all asthma-related self-care/management factors that might differ ... relapse following treatment for acute asthma among adults presenting to the emergency department ... New-onset bronchospasm or recrudescence of asthma associated with cocaine abuse ...

Research paper thumbnail of Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis

Intensive Care Medicine, 2008

OBJECTIVE-Sepsis mortality is closely linked to multi-organ failure, and impaired microcirculator... more OBJECTIVE-Sepsis mortality is closely linked to multi-organ failure, and impaired microcirculatory blood flow is thought to be pivotal in the pathogenesis of sepsis-induced organ failure. We hypothesized that changes in microcirculatory flow during resuscitation are associated with changes in organ failure over the first 24 hours of sepsis therapy.

Research paper thumbnail of Response to the comment of den Uil et al. for the article by the Microcirculatory Alterations in Resuscitation and Shock (MARS) investigators

Intensive Care Medicine, 2008

Research paper thumbnail of A NEW QUANTITATIVE TECHNIQUE FOR MEASURING MICROCIRCULATORY FLOW VELOCITY IN HUMAN SUBJECTS WITH SEVERE SEPSIS AND SEPTIC SHOCK

Critical Care Medicine, 2006

Research paper thumbnail of Reduced Hospital Duration of Stay Associated with Revised Emergency Department-Intensive Care Unit Admission Policy: A before and after Study

The Journal of emergency medicine, Jan 23, 2015

Emergency department (ED) and hospital crowding adversely impacts patient care. Although reductio... more Emergency department (ED) and hospital crowding adversely impacts patient care. Although reduction methods for duration of stay in the ED have been explored, few focus on medical intensive care unit (MICU) patients. To quantify duration of stay or mortality changes associated with a policy intervention that changed the role of an MICU resident to "screen" and write MICU admission orders in the ED to instead meet the patient and write orders in the MICU if there was an available bed. The intervention moved "screening" bed management-appropriateness discussions to the MICU attending or fellow level. We performed a retrospective before and after study at an urban, level 1 trauma center of adults admitted to the MICU from the ED during the first 6 months in 2009 before, and the corresponding 6 months in 2010, after the intervention. We collected demographics, ED, MICU, and hospital duration of stay, duration of mechanical ventilation, Acute Physiology and Chronic Hea...

Research paper thumbnail of Use of an Intravascular Heat Exchange Catheter and Intravenous Lipid Emulsion for Hypothermic Cardiac Arrest After Cyclobenzaprine Overdose

Therapeutic Hypothermia and Temperature Management, 2015

In this case report, a 22-year-old male developed severe hypothermia after an accidental overdose... more In this case report, a 22-year-old male developed severe hypothermia after an accidental overdose of cyclobenzaprine. During transport, the patient developed cardiac arrest. He received active rewarming measures, including pleural lavage, gastric lavage, an intravascular heat exchange catheter, and cardiopulmonary bypass. Intravenous lipid emulsion (ILE) was also administered. A discussion of cyclobenzaprine toxicity, hypothermia, ILE, and accidental hypothermic cardiac arrest follows.

Research paper thumbnail of Continuous cardiac index monitoring: A prospective observational study of agreement between a pulmonary artery catheter and a calibrated minimally invasive technique

Resuscitation, 2009

Introduction: Continuous cardiac index (CCI) monitoring can provide information to assist in hemo... more Introduction: Continuous cardiac index (CCI) monitoring can provide information to assist in hemodynamic support. However, pulmonary artery catheters (PAC) pose logistic challenges in acute care settings. We hypothesized that CCI measured with a calibrated minimally invasive technique (LiDCO/PulseCO, UK) would have good agreement with the PAC. Methods: We performed a prospective observational study in post-operative cardiac surgery patients. All patients had a PAC with CCI monitoring capability. We connected the LiDCO apparatus to a radial artery line and performed a one-time calibration with a lithium dilution indicator. In order to test the least invasive method possible, we used a peripheral intravenous (IV) line for indicator delivery rather than the conventional central line technique. We recorded paired PAC/LiDCO-PulseCO CCI measurements every minute for 3 h. We blinded investigators and clinicians to minimally invasive data with an opaque shield over the monitor. We assessed agreement with Bland-Altman analysis. Results: We obtained 1485 paired measurements in 8 subjects. The mean CI was 2.9 L/min/m 2 . By Bland-Altman plot, PAC and LiDCO measurements showed minimal bias (−0.01), but the 95% limits of agreement (±2SD) of ± 1.3 L/min/m 2 were relatively wide with respect to the mean. Conclusions: This calibrated minimally invasive (i.e. radial arterial line and peripheral IV) technique demonstrated low bias compared with CCI measured by PAC. However, the relatively wide confidence limits indicate that differences in the two measurements could still be clinically significant.

Research paper thumbnail of Nebulized β 2 -Agonist Use in High-Risk Inner-City Adults with Asthma

Journal of Asthma, 2003

... Also, we did not measure all asthma-related self-care/management factors that might differ ..... more ... Also, we did not measure all asthma-related self-care/management factors that might differ ... relapse following treatment for acute asthma among adults presenting to the emergency department ... New-onset bronchospasm or recrudescence of asthma associated with cocaine abuse ...

Research paper thumbnail of Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis

Intensive Care Medicine, 2008

OBJECTIVE-Sepsis mortality is closely linked to multi-organ failure, and impaired microcirculator... more OBJECTIVE-Sepsis mortality is closely linked to multi-organ failure, and impaired microcirculatory blood flow is thought to be pivotal in the pathogenesis of sepsis-induced organ failure. We hypothesized that changes in microcirculatory flow during resuscitation are associated with changes in organ failure over the first 24 hours of sepsis therapy.

Research paper thumbnail of Response to the comment of den Uil et al. for the article by the Microcirculatory Alterations in Resuscitation and Shock (MARS) investigators

Intensive Care Medicine, 2008

Research paper thumbnail of A NEW QUANTITATIVE TECHNIQUE FOR MEASURING MICROCIRCULATORY FLOW VELOCITY IN HUMAN SUBJECTS WITH SEVERE SEPSIS AND SEPTIC SHOCK

Critical Care Medicine, 2006

Research paper thumbnail of Reduced Hospital Duration of Stay Associated with Revised Emergency Department-Intensive Care Unit Admission Policy: A before and after Study

The Journal of emergency medicine, Jan 23, 2015

Emergency department (ED) and hospital crowding adversely impacts patient care. Although reductio... more Emergency department (ED) and hospital crowding adversely impacts patient care. Although reduction methods for duration of stay in the ED have been explored, few focus on medical intensive care unit (MICU) patients. To quantify duration of stay or mortality changes associated with a policy intervention that changed the role of an MICU resident to "screen" and write MICU admission orders in the ED to instead meet the patient and write orders in the MICU if there was an available bed. The intervention moved "screening" bed management-appropriateness discussions to the MICU attending or fellow level. We performed a retrospective before and after study at an urban, level 1 trauma center of adults admitted to the MICU from the ED during the first 6 months in 2009 before, and the corresponding 6 months in 2010, after the intervention. We collected demographics, ED, MICU, and hospital duration of stay, duration of mechanical ventilation, Acute Physiology and Chronic Hea...

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