Matthew Ritter - Academia.edu (original) (raw)
Papers by Matthew Ritter
Mayo Clinic Critical and Neurocritical Care Board Review, 2019
Endotracheal intubation (ETI) is one of the most common procedures performed in the intensive car... more Endotracheal intubation (ETI) is one of the most common procedures performed in the intensive care unit (ICU). It is also associated with a high incidence of complications. Indications for ETI include acute hypoxemic or hypercapnic respiratory failure, loss of protective reflexes, and inability to manage secretions. Additionally, in the neurosciences ICU, intubation may be necessary for transient hyperventilation in patients with elevated intracranial pressure.
![Research paper thumbnail of Corrigendum to "Continuation phase intravenous ketamine in adults with treatment-resistant depression" [J. Affect. Disord. 206 (2016) 300-304]](https://attachments.academia-assets.com/117452943/thumbnails/1.jpg)
](Journal of affective disorders, Aug 26, 2017
Techniques in Regional Anesthesia and Pain Management, 2008
Southwest Journal of Pulmonary and Critical Care, 2013
A 77 year old female with a past medical history of dementia, chronic atrial fibrillation requiri... more A 77 year old female with a past medical history of dementia, chronic atrial fibrillation requiring anticoagulation, hypertension, biventricular congestive heart failure with a preserved left ventricular ejection fraction, pulmonary hypertension, and chronic obstructive pulmonary disease (COPD) presented to the emergency room after she sustained a ground level fall while sitting in a chair. The patient reportedly fell asleep while sitting at the kitchen table, and subsequently fell to her right side. According to witnesses, she did not strike her head, and there was no observed loss of consciousness. As part of her initial evaluation, at an outside hospital, radiographs of the pelvis, hip, and knee were obtained. These identified a definitive right superior pubic ramus fracture with inferior displacement and a questionable fracture of the right femoral neck. Shortly thereafter, the patient was transferred to our hospital for further management. On exam, the patient had a painful right hip limiting active motion and her right lower extremity was neurovascularly intact without paresthesias or dysesthesias. The remainder of the exam was unremarkable. In the emergency room, a repeat radiograph showed no evidence of a right femur fracture. Later in the evening a CT scan of the pelvis with intravenous contrast showed acute fractures through the right superior and inferior pubic rami with associated hematoma. Multiple tiny bony fragments were noted adjacent to the superior pubic ramus fracture (Figure 1).
Annals of surgery, 2014
Hospital surgical care is complex and subject to unwarranted variation. As part of a multiyear ef... more Hospital surgical care is complex and subject to unwarranted variation. As part of a multiyear effort, we sought to reduce variability in intraoperative care and management of mechanical ventilation in cardiac surgery. We identified a patient population whose care could be standardized and implemented a protocol-based practice model reinforced by electronic mechanisms. In a large cardiac surgery practice, we built a standardized practice model between 2009 and 2011. We compared mechanical ventilation time before (2008) and after (2012) implementation. To ensure groups were comparable, propensity analysis matched patients from the 2 operative years. In 2012, more than 50% of all cardiac surgical patients were managed with our standardized care model; of those, 769 were one-to-one matched with patients undergoing surgery in 2008. Patients had a mix of coronary artery bypass grafting, valve surgery, and combined procedures. Our practice model reduced median mechanical ventilation durat...
The American Journal of Cardiology, 2007
The Annals of Thoracic Surgery, 2018
A 40-year-old man with end-stage liver disease presented for mitral and aortic valve replacement.... more A 40-year-old man with end-stage liver disease presented for mitral and aortic valve replacement. While on cardiopulmonary bypass (CPB), the patient developed refractory vasoplegia despite high-dose phenylephrine, norepinephrine, and vasopressin therapy. A single 5-g intravenous dose of hydroxocobalamin (Cyanokit, Meridian Medical Technologies, Columbia, MD) resulted in significant hemodynamic improvement with decreased vasopressor requirements. Within minutes, the CPB ultrafiltrate color began to change from clear to reddish purple (Fig 1
Frontiers in pediatrics, 2018
Pediatric Fundamental Critical Care Support (PFCCS) is an educational tool for training non-inten... more Pediatric Fundamental Critical Care Support (PFCCS) is an educational tool for training non-intensivists, nurses, and critical care practitioners in diverse health-care settings to deal with the acute deterioration of pediatric patients. Our objective was to evaluate the PFCCS course as a tool for developing a uniform, reproducible, and sustainable model for educating local health-care workers in the optimal management of critically ill children in the Republic of Georgia. Over a period of 18 months and four visits to the country, we worked with Georgian pediatric critical care leadership to complete the following tasks: (1) survey health-care needs within the Republic of Georgia, (2) present representative PFCCS lectures and simulation scenarios to evaluate interest and obtain "buy-in" from key stakeholders throughout the Georgian educational infrastructure, and (3) identify PFCCS instructor candidates. Georgian PFCCS instructor training included the following steps: (1) ...
Annals of cardiothoracic surgery, 2017
The robotic approach to cardiac surgery offers patients numerous potential advantages compared wi... more The robotic approach to cardiac surgery offers patients numerous potential advantages compared with a traditional sternotomy approach including shorter hospital length of stay, reduced pain, fewer blood transfusions, and a quicker return to normal daily activities. At the same time, robotic cardiac surgery requires that the anesthesiologist employs several subspecialty skillsets in order to provide optimal care for these patients. Multiple different regional anesthesia techniques may be used to improve analgesia, reduce opioid dosages, and facilitate rapid extubation at the conclusion of the case. Several peripheral cannulation strategies for cardiopulmonary bypass (CPB) exist and the anesthesia team may assist with percutaneous cannulation of the superior vena cava (SVC) or positioning of an endo-pulmonary vent. Similarly the anesthesiologist may be asked to percutaneously cannulate the coronary sinus for retrograde cardioplegia delivery. The need for one-lung ventilation (OLV) and...
Mayo Clinic Proceedings, 2003
We treated a patient who developed transient multifocal encephalopathy with extrapyramidal sympto... more We treated a patient who developed transient multifocal encephalopathy with extrapyramidal symptoms (oromandibular dystonia, oculogyric crisis, and limb dystonia) in temporal proximity to ondansetron administration on emergence from general anesthesia. No other medications known to cause extrapyramidal reactions were administered. Although these symptoms resolved fully, the presen
Anesthesia & Analgesia, 2006
We studied the outcome of cardiopulmonary resuscitation (CPR) in patients undergoing coronary ang... more We studied the outcome of cardiopulmonary resuscitation (CPR) in patients undergoing coronary angiography (CA) and/or percutaneous coronary interventions (PCI). Of 51,985 CA and PCI patients treated between January 1, 1990, and December 31, 2000, 114 required CPR. Records were reviewed for relationships between patient characteristics and various procedures and short-term survival. Long-term survival was compared with that of a matched cohort of patients who did not have an arrest during catheterization and a matched cohort from the general Minnesota population. Over the 11-year period, the overall incidence of CPR was 21.9 per 10,000 procedures. This rate decreased from 33.9 per 10,000 before 1995 to 13.1 per 10,000 after 1995. Overall survival to hospital discharge after CPR was 56.1%. Survival to discharge was less frequent with a history of congestive heart failure, previous coronary
Case reports in pediatrics, 2017
Propylene glycol (PG) is a solvent commonly used in medications that, while benign at low doses, ... more Propylene glycol (PG) is a solvent commonly used in medications that, while benign at low doses, may cause toxicity in adults and children at high doses. We describe a case and the physiologic sequelae of propylene glycol toxicity manifested in a critically ill adolescent male with refractory myoclonic status epilepticus aggressively treated with multiple PG-containing medications (lorazepam, phenobarbital, and pentobarbital)-all within accepted dosing guidelines and a total daily PG exposure previously recognized to be safe. Hemodynamic measurements by bedside echocardiography during clinical toxicity are also reported. Clinicians should have a high index of suspicion for propylene glycol toxicity in patients treated with PG-containing medications even when the total PG exposure is lower than currently accepted limits.
Journal of Cardiothoracic and Vascular Anesthesia, 2019
Refractory ventricular arrhythmias (VAs) carry high mortality rates despite electrical and pharma... more Refractory ventricular arrhythmias (VAs) carry high mortality rates despite electrical and pharmacologic therapy utilization. These patients often require aggressive hemodynamic support, including mechanical circulatory devices such as extracorporeal membrane oxygenation because of progressive hemodynamic and metabolic deterioration. Sympathetic nervous system stimulation and neuronal remodeling after myocardial insults have been implicated as drivers of refractory VAs. This understanding has led to interest in and a growing body of experience with percutaneous blockade of the stellate ganglion as a means of interrupting the vicious cycle of refractory VAs. A number of techniques have been described for stellate ganglion blockade, including landmark-driven approaches, fluoroscopy-assisted blockade, and ultrasound guidance. Herein, the literature is evaluated and the authors' experience with stellate ganglion blockade using ultrasound guidance for refractory VAs is described.
Diagnosing a paradoxical embolism is challenging, and it can be proven only if the thrombus is id... more Diagnosing a paradoxical embolism is challenging, and it can be proven only if the thrombus is identified across the intracardiac defect. Very few cases have been diagnosed as an impending paradoxical embolism. Recently, the diagnosis and management of these entities have greatly improved with the advent of transesophageal echocardiography (compared with transthoracic echocardiography). Pulmonary hypertension may cause right-to-left shunting across a patent foramen ovale and predispose development of a paradoxical embolism. We report a patient with an impending paradoxical embolism that was caught in transit across the patent foramen ovale. The patient was treated successfully with emergent surgery.
Mayo Clinic Critical and Neurocritical Care Board Review, 2019
Endotracheal intubation (ETI) is one of the most common procedures performed in the intensive car... more Endotracheal intubation (ETI) is one of the most common procedures performed in the intensive care unit (ICU). It is also associated with a high incidence of complications. Indications for ETI include acute hypoxemic or hypercapnic respiratory failure, loss of protective reflexes, and inability to manage secretions. Additionally, in the neurosciences ICU, intubation may be necessary for transient hyperventilation in patients with elevated intracranial pressure.
Journal of affective disorders, Aug 26, 2017
Techniques in Regional Anesthesia and Pain Management, 2008
Southwest Journal of Pulmonary and Critical Care, 2013
A 77 year old female with a past medical history of dementia, chronic atrial fibrillation requiri... more A 77 year old female with a past medical history of dementia, chronic atrial fibrillation requiring anticoagulation, hypertension, biventricular congestive heart failure with a preserved left ventricular ejection fraction, pulmonary hypertension, and chronic obstructive pulmonary disease (COPD) presented to the emergency room after she sustained a ground level fall while sitting in a chair. The patient reportedly fell asleep while sitting at the kitchen table, and subsequently fell to her right side. According to witnesses, she did not strike her head, and there was no observed loss of consciousness. As part of her initial evaluation, at an outside hospital, radiographs of the pelvis, hip, and knee were obtained. These identified a definitive right superior pubic ramus fracture with inferior displacement and a questionable fracture of the right femoral neck. Shortly thereafter, the patient was transferred to our hospital for further management. On exam, the patient had a painful right hip limiting active motion and her right lower extremity was neurovascularly intact without paresthesias or dysesthesias. The remainder of the exam was unremarkable. In the emergency room, a repeat radiograph showed no evidence of a right femur fracture. Later in the evening a CT scan of the pelvis with intravenous contrast showed acute fractures through the right superior and inferior pubic rami with associated hematoma. Multiple tiny bony fragments were noted adjacent to the superior pubic ramus fracture (Figure 1).
Annals of surgery, 2014
Hospital surgical care is complex and subject to unwarranted variation. As part of a multiyear ef... more Hospital surgical care is complex and subject to unwarranted variation. As part of a multiyear effort, we sought to reduce variability in intraoperative care and management of mechanical ventilation in cardiac surgery. We identified a patient population whose care could be standardized and implemented a protocol-based practice model reinforced by electronic mechanisms. In a large cardiac surgery practice, we built a standardized practice model between 2009 and 2011. We compared mechanical ventilation time before (2008) and after (2012) implementation. To ensure groups were comparable, propensity analysis matched patients from the 2 operative years. In 2012, more than 50% of all cardiac surgical patients were managed with our standardized care model; of those, 769 were one-to-one matched with patients undergoing surgery in 2008. Patients had a mix of coronary artery bypass grafting, valve surgery, and combined procedures. Our practice model reduced median mechanical ventilation durat...
The American Journal of Cardiology, 2007
The Annals of Thoracic Surgery, 2018
A 40-year-old man with end-stage liver disease presented for mitral and aortic valve replacement.... more A 40-year-old man with end-stage liver disease presented for mitral and aortic valve replacement. While on cardiopulmonary bypass (CPB), the patient developed refractory vasoplegia despite high-dose phenylephrine, norepinephrine, and vasopressin therapy. A single 5-g intravenous dose of hydroxocobalamin (Cyanokit, Meridian Medical Technologies, Columbia, MD) resulted in significant hemodynamic improvement with decreased vasopressor requirements. Within minutes, the CPB ultrafiltrate color began to change from clear to reddish purple (Fig 1
Frontiers in pediatrics, 2018
Pediatric Fundamental Critical Care Support (PFCCS) is an educational tool for training non-inten... more Pediatric Fundamental Critical Care Support (PFCCS) is an educational tool for training non-intensivists, nurses, and critical care practitioners in diverse health-care settings to deal with the acute deterioration of pediatric patients. Our objective was to evaluate the PFCCS course as a tool for developing a uniform, reproducible, and sustainable model for educating local health-care workers in the optimal management of critically ill children in the Republic of Georgia. Over a period of 18 months and four visits to the country, we worked with Georgian pediatric critical care leadership to complete the following tasks: (1) survey health-care needs within the Republic of Georgia, (2) present representative PFCCS lectures and simulation scenarios to evaluate interest and obtain "buy-in" from key stakeholders throughout the Georgian educational infrastructure, and (3) identify PFCCS instructor candidates. Georgian PFCCS instructor training included the following steps: (1) ...
Annals of cardiothoracic surgery, 2017
The robotic approach to cardiac surgery offers patients numerous potential advantages compared wi... more The robotic approach to cardiac surgery offers patients numerous potential advantages compared with a traditional sternotomy approach including shorter hospital length of stay, reduced pain, fewer blood transfusions, and a quicker return to normal daily activities. At the same time, robotic cardiac surgery requires that the anesthesiologist employs several subspecialty skillsets in order to provide optimal care for these patients. Multiple different regional anesthesia techniques may be used to improve analgesia, reduce opioid dosages, and facilitate rapid extubation at the conclusion of the case. Several peripheral cannulation strategies for cardiopulmonary bypass (CPB) exist and the anesthesia team may assist with percutaneous cannulation of the superior vena cava (SVC) or positioning of an endo-pulmonary vent. Similarly the anesthesiologist may be asked to percutaneously cannulate the coronary sinus for retrograde cardioplegia delivery. The need for one-lung ventilation (OLV) and...
Mayo Clinic Proceedings, 2003
We treated a patient who developed transient multifocal encephalopathy with extrapyramidal sympto... more We treated a patient who developed transient multifocal encephalopathy with extrapyramidal symptoms (oromandibular dystonia, oculogyric crisis, and limb dystonia) in temporal proximity to ondansetron administration on emergence from general anesthesia. No other medications known to cause extrapyramidal reactions were administered. Although these symptoms resolved fully, the presen
Anesthesia & Analgesia, 2006
We studied the outcome of cardiopulmonary resuscitation (CPR) in patients undergoing coronary ang... more We studied the outcome of cardiopulmonary resuscitation (CPR) in patients undergoing coronary angiography (CA) and/or percutaneous coronary interventions (PCI). Of 51,985 CA and PCI patients treated between January 1, 1990, and December 31, 2000, 114 required CPR. Records were reviewed for relationships between patient characteristics and various procedures and short-term survival. Long-term survival was compared with that of a matched cohort of patients who did not have an arrest during catheterization and a matched cohort from the general Minnesota population. Over the 11-year period, the overall incidence of CPR was 21.9 per 10,000 procedures. This rate decreased from 33.9 per 10,000 before 1995 to 13.1 per 10,000 after 1995. Overall survival to hospital discharge after CPR was 56.1%. Survival to discharge was less frequent with a history of congestive heart failure, previous coronary
Case reports in pediatrics, 2017
Propylene glycol (PG) is a solvent commonly used in medications that, while benign at low doses, ... more Propylene glycol (PG) is a solvent commonly used in medications that, while benign at low doses, may cause toxicity in adults and children at high doses. We describe a case and the physiologic sequelae of propylene glycol toxicity manifested in a critically ill adolescent male with refractory myoclonic status epilepticus aggressively treated with multiple PG-containing medications (lorazepam, phenobarbital, and pentobarbital)-all within accepted dosing guidelines and a total daily PG exposure previously recognized to be safe. Hemodynamic measurements by bedside echocardiography during clinical toxicity are also reported. Clinicians should have a high index of suspicion for propylene glycol toxicity in patients treated with PG-containing medications even when the total PG exposure is lower than currently accepted limits.
Journal of Cardiothoracic and Vascular Anesthesia, 2019
Refractory ventricular arrhythmias (VAs) carry high mortality rates despite electrical and pharma... more Refractory ventricular arrhythmias (VAs) carry high mortality rates despite electrical and pharmacologic therapy utilization. These patients often require aggressive hemodynamic support, including mechanical circulatory devices such as extracorporeal membrane oxygenation because of progressive hemodynamic and metabolic deterioration. Sympathetic nervous system stimulation and neuronal remodeling after myocardial insults have been implicated as drivers of refractory VAs. This understanding has led to interest in and a growing body of experience with percutaneous blockade of the stellate ganglion as a means of interrupting the vicious cycle of refractory VAs. A number of techniques have been described for stellate ganglion blockade, including landmark-driven approaches, fluoroscopy-assisted blockade, and ultrasound guidance. Herein, the literature is evaluated and the authors' experience with stellate ganglion blockade using ultrasound guidance for refractory VAs is described.
Diagnosing a paradoxical embolism is challenging, and it can be proven only if the thrombus is id... more Diagnosing a paradoxical embolism is challenging, and it can be proven only if the thrombus is identified across the intracardiac defect. Very few cases have been diagnosed as an impending paradoxical embolism. Recently, the diagnosis and management of these entities have greatly improved with the advent of transesophageal echocardiography (compared with transthoracic echocardiography). Pulmonary hypertension may cause right-to-left shunting across a patent foramen ovale and predispose development of a paradoxical embolism. We report a patient with an impending paradoxical embolism that was caught in transit across the patent foramen ovale. The patient was treated successfully with emergent surgery.