Paul Boiteau - Academia.edu (original) (raw)

Papers by Paul Boiteau

The International Journal of Cardiovascular Imaging

During acute pulmonary embolism (PE) a compensatory increase in right ventricular (RV) contractil... more During acute pulmonary embolism (PE) a compensatory increase in right ventricular (RV) contractility is required to match increased afterload to maintain right ventricular-pulmonary arterial (RV-PA) coupling. The aim of this study was to assess the prognostic utility of RV-PA decoupling in acute PE. Methods We assessed the association between measures of transthoracic echocardiography (TTE)-derived RV-PA coupling including tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) and right ventricular fractional area change (FAC)/PASP as well as stroke volume index (SVI)/PASP (a measure of pulmonary artery capacitance) with adverse PE-related events (in-hospital PErelated mortality or cardiopulmonary decompensation) using logistic regression analysis. Results In 820 normotensive patients TTE-derived markers of RV-PA coupling were associated with PE-related adverse events. For each 0.1mm/mmHg decrease in TAPSE/PASP the odds of an adverse event increased by 2.5-fold (adjusted OR (aOR) 2.49, 95% con dence interval (CI) 1.46-4.24, p = 0.001), for every 0.1%/mmHg decrease in FAC/PASP the odds of an adverse event increased by 1.4-fold (aOR 1.42, CI 1.09-1.86, p = 0.010), and for every 0.1mL/mmHg•m 2 decrease in SVI/PASP the odds of an event increased by 2.75-fold (aOR 2.78, CI 1.72-4.50, p < 0.001). In multivariate analysis, TAPSE/PASP and SVI/PASP were independent of other risk strati cation methods including computed tomography-derived RVD, the Bova score, and subjective assessment of TTE-derived RVD. Conclusion In patients with normotensive acute PE, TTE-derived measures of RV-PA coupling are strongly associated with adverse in-hospital PE-related events and provide incremental value in the risk assessment beyond computed tomography-derived RVD, the Bova score, or subjective TTE-derived RVD.

Dr. Richard Chiou's background is in mechanical engineering with an emphasis on manufacturing. Dr... more Dr. Richard Chiou's background is in mechanical engineering with an emphasis on manufacturing. Dr. Chiou is currently an associate professor in the Goodwin School of Technology and Professional Studies at Drexel University. His areas of research include machining, mechatronics, and internet based robotics and automation. He has secured many research and education grants from the NSF, the SME Education Foundation, and industries.

© 2004 Bagshaw et al; licensee BioMed Central Ltd. This is an open-access article distributed und... more © 2004 Bagshaw et al; licensee BioMed Central Ltd. This is an open-access article distributed under the terms of the Creative Commons Attribution License

ERJ Open Research, 2021

Background Acute pulmonary embolism (PE) has a wide spectrum of outcomes, but the best method to ... more Background Acute pulmonary embolism (PE) has a wide spectrum of outcomes, but the best method to risk-stratify normotensive patients for adverse outcomes remains unclear. Methods A multicentre retrospective cohort study of acute PE patients admitted from emergency departments in Calgary, Canada, between 2012 and 2017 was used to develop a refined acute PE risk score. The composite primary outcome of in-hospital PE-related death or haemodynamic decompensation. The model was internally validated using bootstrapping and the prognostic value of the derived risk score was compared to the Bova score. Results Of 2067 patients with normotensive acute PE, the primary outcome (haemodynamic decompensation or PE-related death) occurred in 32 (1.5%) patients. In simplified Pulmonary Embolism Severity Index high-risk patients (n=1498, 78%), a multivariable model used to predict the primary outcome retained computed tomography (CT) right–left ventricular diameter ratio ≥1.5, systolic blood pressur...

$Research paper thumbnail of Effectiveness of anticoagulation with unfractionated heparin for acute pulmonary embolism$

American Journal of Medical Quality

The purpose is to provide a descriptive overview of relevant material exploring improvement of ha... more The purpose is to provide a descriptive overview of relevant material exploring improvement of handovers from the operating room (OR) to intensive care unit (ICU). An online search (MEDLINE, Cochrane, EMBASE, CINAHL, and Joanna Briggs), including gray literature and relevant reference lists, was completed. In all, 4574 unique citations were screened and 155 full-text reviews performed; 65 articles were included in the final analysis. The majority of articles discuss an ideal structure for handover (n = 63; 97%); 43 (66%) articles mentioned strategies for implementing such an approach. Only 21 (32%) explicitly described formal quality improvement (QI) methods. Few explored project sustainability and impact of a structured handover on patient safety outcomes (n = 15, 23%). Published literature suggests that there is a significant gap in evidence of measured patient outcomes from standardization of OR to ICU handover processes. Identifying formal QI strategies used to sustain standardi...

CJEM

Background: Pulmonary embolism (PE) is a common illness with significant mortality without approp... more Background: Pulmonary embolism (PE) is a common illness with significant mortality without appropriate treatment. Its disease severity is variable, difficult to prognosticate and triage of severe PE remains a patient safety concern. Some PE may benefit from invasive and advanced medical therapy, but these decisions require complex multi-disciplinary coordinated care. We have launched a multi-disciplinary rapid response team at the Foothills Medical Center Hospital (FMC) to assist prognostication, treatment, disposition planning, and followup for high-risk PE: The Pulmonary Embolism Response Team (PERT). Aim Statement: PERT has been implemented to improve patient-oriented outcomes however, as severe PE is infrequent, we initially target process measures. In the first year of PERT rollout, we aim for: 1) 100% of high risk PE be detected by emergency for PERT consult 2) PERT response be within 45 minutes of activation 3) PERT treatment and disposition be made within 1 hour of consult. ...

JAMA: The Journal of …, 1995

... Paul C. H\l=e&amp;amp;amp;#x27;\bert,MD,MHSc, FRCPC; George Wells, PhD; John Marshall... more ... Paul C. H\l=e&amp;amp;amp;#x27;\bert,MD,MHSc, FRCPC; George Wells, PhD; John Marshall, MD, FRCSC; Claudio Martin, MD, MSc, FRCPC; Martin Tweeddale, MD, PhD, FRCPC; Giuseppe Pagliarello, MD, FRCSC; Morris Blajchman, MD, FRCPC; for the Canadian Critical Care Trials Group ...

• Understand a successful model for spreading changes beyond your unit/site. • Work on key compon... more • Understand a successful model for spreading changes beyond your unit/site. • Work on key components of the model for your team. • Set the stage for planning session this afternoon. ... Spread means disseminating the changes beyond the scope of the original aim or team.

Case Reports in Medicine

Right heart thrombus in transit clot (RHTT) associated with a pulmonary thromboembolism (PTE) is ... more Right heart thrombus in transit clot (RHTT) associated with a pulmonary thromboembolism (PTE) is a rare but potentially fatal diagnosis. Early diagnosis and immediate intervention are crucial. This report describes the case of a healthy, physically active 32-year-old female who presented 19 days postoperatively, following an anterior cruciate ligament reconstruction and partial lateral meniscectomy with a saddle PE, RHTT, and right ventricular (RV) strain. The patient received half of the standard dose of intravenous tissue plasminogen activator (TPA) in combination with anticoagulation and survived. Case reports of RHTT will inform future studies designed to evaluate whether and when thrombolysis should be administered.

Surgery Today, Feb 1, 2006

num and neck via the visceral space. We report a case of diagnostic colonoscopy-induced colonic p... more num and neck via the visceral space. We report a case of diagnostic colonoscopy-induced colonic perforation at the site of an ileocolic anastamosis performed 3 years earlier. The perforation was complicated by bilateral pneumothoraces, tension pneumothorax, pneumomediastinum, pneumoperitoneum, and subcutaneous emphysema of the face, neck, and chest. Case Report A 77-year-old woman underwent a diagnostic colonoscopy for iron deficiency anemia 3 years after a right hemicolectomy for appendiceal adenocarcinoma. She was otherwise well. The colonoscope was advanced to about the mid-transverse colon, when the patient complained of acute shortness of breath and chest pain. No biopsy or other treatments had been performed. Extensive subcutaneous emphysema of the patient's face and neck was evident. There were decreased breath sounds bilaterally and hypoxemia was reflected by an ambient air oxygen saturation of 86%. We gave the patient supplemental 100% oxygen, naloxone, and flumazenil, and she was immediately transferred to the intensive care unit where a chest X-ray showed bilateral pneumothoraces, pneumomediastinum, and free pneumoperitoneum (Fig. 1). During preparation for chest tube placement, the patient's acute respiratory failure worsened, requiring bilateral needle decompression thoracenteses. A large release of tensioned air was immediate on the right side. Bilateral chest tubes were placed and the patient was intubated. Follow-up chest computed tomography (CT) scan (Figs. 2 and 3) and chest X-rays showed good lung re-expansion. On physical examination, her abdomen was diffusely distended and tender. A midline laparotomy revealed multiple and dense intraperitoneal adhesions, as well as an obvious pneumoretroperitoneum. A 5-mm posterior Abstract We report a case of tension pneumothorax, which occurred secondary to colonic perforation during a colonoscopy. The patient was a 77-year-old woman in whom acute respiratory decompensation developed suddenly during a diagnostic colonoscopy for iron deficiency anemia. We diagnosed bilateral pneumothoraces, tension pneumothorax, pneumomediastinum, pneumoperitoneum, and emphysema of the face, neck, and chest. At laparotomy, a posterior colonic perforation was identified at the site of an ileocolic anastamosis performed 3 years earlier. We performed a primary repair and the patient was discharged from hospital 12 days later. Although diagnostic colonoscopy-induced intestinal perforation is rare, it is the most common and serious complication associated with this procedure. Occasionally, air spreads from the retroperitoneum into continuous tissue planes and decompresses into the adjacent structures. To our knowledge, this is the first report of two unique manifestations of diagnostic colonoscopy-induced intestinal perforation: tension pneumothorax and perforation at the site of a previous anastomosis. Both of these conditions should be considered in the event of acute respiratory failure in the endoscopy suite.

Crit Care Med, 2004

Multiple organ dysfunction is a common cause of death in intensive care units. We describe the da... more Multiple organ dysfunction is a common cause of death in intensive care units. We describe the daily course of multiple organ dysfunction measured by the Sequential Organ Failure Assessment score in a population-based cohort of critically ill patients. Prospective cohort study. Adult multisystem intensive care units in the Calgary Health Region. A total of 1,436 patients admitted from May 1, 2000 to April 30, 2001. Temporal change in Sequential Organ Failure Assessment score. None; observational study. The mean age was 58 yrs (range, 14-100). The mean +/- sd intensive care unit admission Acute Physiology and Chronic Health Evaluation II score was 25 +/- 9. The median intensive care unit length of stay was 4 days (interquartile range, 2-8), and the median hospital length of stay was 15 days (interquartile range, 7-32). A total of 20.5% of patients were infected at admission, and 26.0% were immediately postoperative. Intensive care unit mortality was 27.0%, and hospital mortality was 35.1%. The daily Sequential Organ Failure Assessment score was significantly higher in nonsurvivors than survivors. A population-averaged model determined a mean rate of change of Sequential Organ Failure Assessment score to be -0.29 per day (95% confidence interval, -0.32 to -0.25) for survivors and -0.03 per day (95% confidence interval, -0.08 to 0.03) for nonsurvivors (overall regression, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.0001). Patients with infection had higher admission Sequential Organ Failure Assessment scores compared with patients without infection (difference, 1.8; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.001), but a similar rate of daily change. Multiple organ dysfunction, does not follow a course of progressive and sequential failure. Evidence of differential daily change should further inform the use of organ failure scores as surrogate outcomes in clinical trials.

The American journal of physiology, 1986

We tested the hypothesis that the increased impedance to flow in canine oleic acid (OA) lung inju... more We tested the hypothesis that the increased impedance to flow in canine oleic acid (OA) lung injury is predominantly due to an increase in effective downstream pressure (EDP), obtained by extrapolating to zero flow the linear portion of the pulmonary artery pressure (PAP)/flow (Q) relationship. PAP-Q coordinates were obtained in eight anesthetized, O2-ventilated dogs by varying Q through systemic arteriovenous fistulae. PAP-Q lines were obtained before and approximately 5 h after injection of OA. A second group of six dogs served as a time control (TC) group. There was a linear relationship between PAP and Q in both experimental and control groups (mean r value 0.948). The presence of pulmonary edema in the OA group caused the EDP to almost double, from 7 to 12 mmHg (P less than 0.01). In contrast, EDP remained constant in TCs. Incremental vascular conductance (IVC), slope of the PAP/Q line, decreased (P less than 0.05) a similar amount in both groups. The above findings are consist...

Clinical and investigative medicine. Médecine clinique et experimentale, 2000

To determine the outcome of cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest an... more To determine the outcome of cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest and to identify risk factors associated with survival to the time of hospital discharge. A 2-year prospective cohort study. Foothills Medical Centre, a 700-bed tertiary, academic and regional referral centre for Calgary and southern Alberta. Adult inpatients, excluding those who had cardiac arrest in the Emergency Department or operating room. Cardiac resuscitation. Spontaneous return of the pulse with a minimum systolic blood pressure of 80 mm Hg and survival defined as survival to the time of hospital discharge. In 334 patients there were 390 cardiac arrests, of which 200 were primary cardiac arrests and 39 cardiac arrests that occurred while the resuscitation team was in attendance. Of 239 resuscitated patients, 51 (21.3%) survived. Fifteen variables were identified as being associated with survival. This association could be explained, through multivariate analysis, by the effect of th...

BMC nephrology, Jan 19, 2004

Dialysis disequilibrium syndrome (DDS) is the clinical phenomenon of acute neurologic symptoms at... more Dialysis disequilibrium syndrome (DDS) is the clinical phenomenon of acute neurologic symptoms attributed to cerebral edema that occurs during or following intermittent hemodialysis (HD). We describe a case of DDS-induced cerebral edema that resulted in irreversible brain injury and death following acute HD and review the relevant literature of the association of DDS and HD. A 22-year-old male with obstructive uropathy presented to hospital with severe sepsis syndrome secondary to pneumonia. Laboratory investigations included a pH of 6.95, PaCO2 10 mmHg, HCO3 2 mmol/L, serum sodium 132 mmol/L, serum osmolality 330 mosmol/kg, and urea 130 mg/dL (46.7 mmol/L). Diagnostic imaging demonstrated multifocal pneumonia, bilateral hydronephrosis and bladder wall thickening. During HD the patient became progressively obtunded. Repeat laboratory investigations showed pH 7.36, HCO3 19 mmol/L, potassium 1.8 mmol/L, and urea 38.4 mg/dL (13.7 mmol/L) (urea-reduction-ratio 71%). Following HD, sponta...