Pravin Amin - Academia.edu (original) (raw)

Papers by Pravin Amin

Intensive Care Medicine, 2022

We assessed long-term outcomes of dexamethasone 12 mg versus 6 mg given daily for up to 10 days i... more We assessed long-term outcomes of dexamethasone 12 mg versus 6 mg given daily for up to 10 days in patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia. Methods: We assessed 180-day mortality and health-related quality of life (HRQoL) using EuroQoL (EQ)-5D-5L index values and EQ visual analogue scale (VAS) in the international, stratified, blinded COVID STEROID 2 trial, which randomised 1000 adults with confirmed COVID-19 receiving at least 10 L/min of oxygen or mechanical ventilation in 26 hospitals in Europe and India. In the HRQoL analyses, higher values indicated better outcomes, and deceased patients were given a score of zero. Results: We obtained vital status at 180 days for 963 of 982 patients (98.1%) in the intention-to-treat population, EQ-5D-5L index value data for 922 (93.9%) and EQ VAS data for 924 (94.1%). At 180 days, 164 of 486 patients (33.7%) had died in the 12 mg group versus 184 of 477 (38.6%) in the 6 mg group [adjusted risk difference − 4.3%; 99% confidence interval (CI) − 11.7-3.0; relative risk 0.89; 0.72-1.09; P = 0.13]. The adjusted mean differences between the 12 mg and the 6 mg groups in EQ-5D-5L index values were 0.06 (99% CI − 0.01 to 0.12; P = 0.10) and in EQ VAS scores 4 (− 3 to 10; P = 0.22).

Table 1: Risk factors for daily development of delirium in 2016 cohort. (DOCX 56 kb)

ventilated patients after cardiac arrest associated with 28-day hospital mortality were: older ag... more ventilated patients after cardiac arrest associated with 28-day hospital mortality were: older age, PaO2 <60 mmHg, cardiovascular dysfunction and less use

The Lancet Respiratory Medicine, 2022

Two acute respiratory distress syndrome (ARDS) subphenotypes (hyperinflammatory and hypoinflammat... more Two acute respiratory distress syndrome (ARDS) subphenotypes (hyperinflammatory and hypoinflammatory) with distinct clinical and biological features and differential treatment responses have been identified using latent class analysis (LCA) in seven individual cohorts. To facilitate bedside identification of subphenotypes, clinical classifier models using readily available clinical variables have been described in four randomised controlled trials. We aimed to assess the performance of these models in observational cohorts of ARDS. In this observational, multicohort, retrospective study, we validated two machine-learning clinical classifier models for assigning ARDS subphenotypes in two observational cohorts of patients with ARDS: Early Assessment of Renal and Lung Injury (EARLI; n=335) and Validating Acute Lung Injury Markers for Diagnosis (VALID; n=452), with LCA-derived subphenotypes as the gold standard. The primary model comprised only vital signs and laboratory variables, and the secondary model comprised all predictors in the primary model, with the addition of ventilatory variables and demographics. Model performance was assessed by calculating the area under the receiver operating characteristic curve (AUC) and calibration plots, and assigning subphenotypes using a probability cutoff value of 0·5 to determine sensitivity, specificity, and accuracy of the assignments. We also assessed the performance of the primary model in EARLI using data automatically extracted from an electronic health record (EHR; EHR-derived EARLI cohort). In Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE; n=2813), a multinational, observational ARDS cohort, we applied a custom classifier model (with fewer variables than the primary model) to determine the prognostic value of the subphenotypes and tested their interaction with the positive end-expiratory pressure (PEEP) strategy, with 90-day mortality as the dependent variable. The primary clinical classifier model had an area under receiver operating characteristic curve (AUC) of 0·92 (95% CI 0·90-0·95) in EARLI and 0·88 (0·84-0·91) in VALID. Performance of the primary model was similar when using exclusively EHR-derived predictors compared with manually curated predictors (AUC=0·88 [95% CI 0·81-0·94] vs 0·92 [0·88-0·97]). In LUNG SAFE, 90-day mortality was higher in patients assigned the hyperinflammatory subphenotype than in those with the hypoinflammatory phenotype (414 [57%] of 725 vs 694 [33%] of 2088; p<0·0001). There was a significant treatment interaction with PEEP strategy and ARDS subphenotype (p=0·041), with lower 90-day mortality in the high PEEP group of patients with the hyperinflammatory subphenotype (hyperinflammatory subphenotype: 169 [54%] of 313 patients in the high PEEP group vs 127 [62%] of 205 patients in the low PEEP group; hypoinflammatory subphenotype: 231 [34%] of 675 patients in the high PEEP group vs 233 [32%] of 734 patients in the low PEEP group). Classifier models using clinical variables alone can accurately assign ARDS subphenotypes in observational cohorts. Application of these models can provide valuable prognostic information and could inform management strategies for personalised treatment, including application of PEEP, once prospectively validated. US National Institutes of Health and European Society of Intensive Care Medicine.

COVID-19 Pandemic, 2022

The humans’ vulnerability and fragility have been demonstrated during pandemics, and as a communi... more The humans’ vulnerability and fragility have been demonstrated during pandemics, and as a community, will need proper preparation. The coronavirus outbreak was first reported at the end of 2019 and declared a pandemic by the World Health Organization. Around the world, the response to the virus outbreak has been different. The detection, traceability, and the response for different countries have been delayed, causing the overwhelming of the health systems. However, some other nations exercised various strategies to contain the infection’s dissemination and recorded a low number of cases. The different measures taken, including contact tracing, lockdown, case detection, social distancing, and quarantine strategies, helped control the disease’s spreading. Only time will tell how well the world faced the outbreak. We also suggest the future directions that the global community should take to manage and mitigate the emergency.

Background: To determine the frequency of, and factors associated with, death in hospital followi... more Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward.Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments (‘treatment limitations’), and the subpopulations with treatment limitations.Results: 2,186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in ...

Textbook of Critical Care: Including Trauma and Emergency Care, 2016

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, 2017

Critical Care, 2020

Background Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patien... more Background Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 2...

Critical care (London, England), Jan 17, 2018

To better understand the epidemiology and patterns of tracheostomy practice for patients with acu... more To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study. This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort. Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy ...

B94. CLINICAL RESEARCH IN CRITICAL CARE, 2011

/ Mini Symposium / Monday, May 16/2:00 PM-4:30 PM / Korbel Ballroom 4E-4F B94 CLINICAL RESEARCH I... more / Mini Symposium / Monday, May 16/2:00 PM-4:30 PM / Korbel Ballroom 4E-4F B94 CLINICAL RESEARCH IN CRITICAL CARE ... Factor Associated To Failure And Outcome Of Non-Invasive Positive Pressure Ventilation ... , F. Frutos-Vivar , A. Esteban , ND Ferguson , K. ...

Surgery for Obesity and Related Diseases, 2010

Background: Obstructive sleep apnea hypopnea syndrome (OS-AHS) is frequent among morbidly obese p... more Background: Obstructive sleep apnea hypopnea syndrome (OS-AHS) is frequent among morbidly obese patients. If unrecognized, it could lead to significant postoperative complications. This study aims to design a clinical tool to assess the severity of OSAHS and maximize the benefit of preoperative polysomnography studies. Methods: Prospectively collected data from 318 consecutive patients who underwent bariatric surgery included: 1. Anthropometric (age, gender, race, body mass index (BMI), body habitus, %body fat and fat mass by TANITA scale), 2. Co-morbidities, 3. Biochemical (fasting glucose (FG), HbA1C%, CO2, leptin, insulin, erythrocyte sedimentation rate, C-reactive protein (CRP), HDL), 4. Abnormal electrocardiography, 5. Ultrasonographic (liver steatosis, ejection fraction (EF), pulmonary hypertension), 6. Respiratory (Epworth score, expiratory reserve volume (ERV), minimum O2 saturation, apnea-hypopnea index (AHI), 7. SF-36 quality of life (QoL) questionnaire. Based on AHI, OSAHS was graded as mild (5-15), moderate (16-30) and severe (Ͼ30). Spearman's correlation, Pearson Chi-Square and regression models were used for statistical analysis. Results: 198/318 (62.2%) had OSAHS, out of which 25.6% were graded as mild, 14.6% as moderate and 22% as severe. OSAHS was associated with male gender (pϽ0.001) and android habitus (pϭ0.003). OSAHS severity was linearly correlated with BMI (pϭ0.009), age (pϽ0.001), history of hypertension (pϭ0.001), FG (pϽ0.001), HbA1c% (pϭ0.001), insulin (pϭ0.04), CRP (pϭ0.03), low HDL (pϭ0.001), low EF (pϭ0.02) low ERV (pϭ0.02), liver steatosis (pϭ0.08) and poorer QoL (pϭ0.06). Conclusion: There are several risk factors predicting OSAHS severity that can be used to direct preoperative diagnostic work-up and reduce cost. An algorithm to predict OSAHS severity is proposed.

Indian Journal of Critical Care Medicine, 2005

This position statement aims to minimize inappropriate treatment and optimize palliative care for... more This position statement aims to minimize inappropriate treatment and optimize palliative care for terminally ill patients in Indian intensive care units by standardizing the process of forgoing life support. It also defines the ethical standards for the physician-patient relationship in the context of critical care practice in India. Evidence: Evidence was gathered through a review of recently published medical literature on the subject, as well as by evaluating the relevant statutes of Indian Law. Available empirical data from critical care practice in India were sparse. Newspaper articles reflecting lay opinion on related issues were also reviewed. The terms for search were: end-of-life care; withdrawal and withholding; intensive care; terminal care; medical futility; ethical issues; palliative care. Method: Proposals from the Chair were debated and recommendations were formulated through a consensus process. The process took into account the guiding ethical principles and clinical practices elsewhere in the world, and incorporated the socio-cultural and legal perspectives unique to this country. Recommendations 1. The physician has a duty to disclose to the capable

Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, 2007

Objective To study the magnitude of the complication of catheter associated right atrial thrombus... more Objective To study the magnitude of the complication of catheter associated right atrial thrombus (CRAT) in patients with tunnelled central venous hemodialysis catheters (THC) for maintenance hemodialysis (MHD). Material and methods A retrospective study was conducted among patients with end stage kidney disease (ESKD) with THC for MHD who had undergone screening for CRAT with a 2D-echo (2DE) just before removal of the THC. The occurrence of CRAT and other clinical parameters were documented in these patients. Results A total of 28 patients (mean [SD] age 51 [15.2] years; females 17 [60.7%]) were included in the study. CRAT was observed in 5 (17.9%) patients. There was no difference in mean age in patients with or without thrombus (48±13.02 vs 51.61 ± 15.78 years; p = 0.61). History of diabetes and hypertension was present in 2 and all 5 patients respectively. There was no significant difference in the period the THC was in place in patients with or without CRAT (13±7.8 months vs 10...

Intensive Care Medicine, 2021

We compared dexamethasone 12 versus 6 mg daily for up to 10 days in patients with coronavirus dis... more We compared dexamethasone 12 versus 6 mg daily for up to 10 days in patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia in the international, randomised, blinded COVID STEROID 2 trial. In the primary, conventional analyses, the predefined statistical significance thresholds were not reached. We conducted a pre-planned Bayesian analysis to facilitate probabilistic interpretation. Methods: We analysed outcome data within 90 days in the intention-to-treat population (data available in 967 to 982 patients) using Bayesian models with various sensitivity analyses. Results are presented as median posterior probabilities with 95% credible intervals (CrIs) and probabilities of different effect sizes with 12 mg dexamethasone. Results: The adjusted mean difference on days alive without life support at day 28 (primary outcome) was 1.3 days (95% CrI −0.3 to 2.9; 94.2% probability of benefit). Adjusted relative risks and probabilities of benefit on serious adverse reactions was 0.85 (0.63 to 1.16; 84.1%) and on mortality 0.87 (0.73 to 1.03; 94.8%) at day 28 and 0.88 (0.75 to 1.02; 95.1%) at day 90. Probabilities of benefit on days alive without life support and days alive out of hospital at day 90 were 85 and 95.7%, respectively. Results were largely consistent across sensitivity analyses, with relatively low probabilities of clinically important harm with 12 mg on all outcomes in all analyses.

Indian Journal of Critical Care Medicine, 2020

Background: Indian Society of Critical Care Medicine (ISCCM) guidelines on Planning and Designing... more Background: Indian Society of Critical Care Medicine (ISCCM) guidelines on Planning and Designing Intensive care (ICU) were first developed in 2001 and later updated in 2007. These guidelines were adopted in India, many developing Nations and major Institutions including NABH. Various international professional bodies in critical care have their own position papers and guidelines on planning and designing of ICUs; being the professional body of intensivists in India ISCCM therefore addresses the subject in contemporary context relevant to our clinical practice, its variability according to specialty and subspecialty, quality, resource limitation, size and location of the institution. Aim: To have a consensus document reflecting the philosophy of ISCCM to deliver safe & quality Critical Care in India, taking into consideration the requirement of regulatory agencies (national & international) and need of people at large, including promotion of training, education and skill upgradation. It also aiming to promote leadership and development and managerial skill among the critical care team. Material and Methods: Extensive review of literature including search of databases in English language, resources of regulatory bodies, guidelines and recommendations of international critical care societies. National Survey of ISCCM members and experts to understand their viewpoints on respective issues. Visiting of different types and levels of ICUs by team members to understand prevailing practices, aspiration and Challenges. Several face to face meetings of the expert committee members in big and small groups with extensive discussions, presentations, brain storming and development of initial consensus draft. Discussion on draft through video conferencing, phone calls, Emails circulations, one to one discussion Result: Based upon extensive review, survey and input of experts' ICUs were categorized in to three levels suitable in Indian setting. Level III ICUs further divided into sub category A and B. Recommendations were grouped in to structure, equipment and services of ICU with consideration of variation in level of ICU of different category of hospitals. Conclusion: This paper summarizes consensus statement of various aspect of ICU planning and design. Defined mandatory and desirable standards of all level of ICUs and made recommendations regarding structure and layout of ICUs. Definition of intensive care and intensivist, planning for strength of ICU and requirement of manpower were also described.

Annual Update in Intensive Care and Emergency Medicine, 2015