Rahul Kashyap | Mayo Clinic (original) (raw)

Papers by Rahul Kashyap

Epidemiology of Critical Care Syndromes, Organ Failures, and Life-Support Interventions in a Suburban US CommunityEpidemiology of Critical Care Syndromes

ICU services represent a significant and increasing proportion of medical care. Population-based ... more ICU services represent a significant and increasing proportion of medical care. Population-based epidemiologic studies are essential to inform physicians and policymakers about current and future ICU demands. We aimed to determine the incidence of critical care syndromes, organ failures, and life-support interventions in a defined US suburban community with unrestricted access to critical care services. This population-based observational cohort from January 1 to December 31, 2006, in Olmsted County, Minnesota, included all consecutive critically ill adult residents admitted to the ICU. Main outcomes were incidence of critical care syndromes, life-support interventions, and organ failures as defined by standard criteria. Incidences are reported per 100,000 population (95% CIs) and were age adjusted to the 2006 US population. A total of 1,707 ICU admissions were identified from 1,461 patients. Incidences of critical care syndromes were respiratory failure, 430 (390-470); acute kidney injury, 290 (257-323); severe sepsis, 286 (253-319); all-cause shock, 194 (167-221); acute lung injury, 86 (68-105); all-cause coma, 43 (30-55); and overt disseminated intravascular coagulation, 18 (10-26). Incidence of mechanical ventilation was invasive, 310 (276-344); noninvasive, 180 (154-206); vasopressors and inotropes, 183(155-208). Renal replacement therapy incidence was 96 (77-116). Of the cohort, 1,330 patients (91%) survived to hospital discharge. Short- and long-term survival decreased by the number of failing organs. In a suburban US community with high access to critical care services, cumulative incidences of critical care syndromes and life-support interventions were higher than previously reported. The results of this study have important implications for future planning of critical care delivery.

PloS one, 2018

To evaluate the clinical features and outcomes of acute cardiorenal syndrome type-5 in patients w... more To evaluate the clinical features and outcomes of acute cardiorenal syndrome type-5 in patients with severe sepsis and septic shock. Historical cohort study of all adult patients with severe sepsis and septic shock admitted to the intensive care units (ICU) at Mayo Clinic Rochester from January 1, 2007 through December 31, 2014. Patients with prior renal or cardiac dysfunction were excluded. Patients were divided into groups with and without cardiorenal syndrome type-5. Acute Kidney Injury (AKI) was defined by both serum creatinine and urine output criteria of the AKI Network and the cardiac injury was determined by troponin-T levels. Outcomes included in-hospital mortality, ICU and hospital length of stay, and one-year survival. Of 602 patients meeting the study inclusion criteria, 430 (71.4%) met criteria for acute cardiorenal syndrome type-5. Patients with cardiorenal syndrome type-5 had higher severity of illness, greater vasopressor and mechanical ventilation use. Cardiorenal s...

Six-month quality-of-life and functional status of acute respiratory distress syndrome survivors compared to patients at risk: a population-based study

Critical Care, 2015

Introduction The long-term attributable burden related to acute respiratory distress syndrome (AR... more Introduction The long-term attributable burden related to acute respiratory distress syndrome (ARDS) is not fully investigated. The aim of this study is to evaluate the quality of life (QOL) and functional status at 6 months after hospitalization in patients at risk for ARDS who did and did not develop the syndrome. Method This is a population-based prospective cohort study of adult patients from Olmsted County, Minnesota, with or at risk for ARDS hospitalized from October 2008 to July 2011. The primary outcomes were changes in QOL and functional status, measured through 12-Item Short Form Survey (SF-12) and Barthel Index (BI) respectively, from baseline to 6 months, compared between survivors who did and did not develop ARDS. Results Of 410 patients with or at risk for ARDS, 98 had baseline surveys collected and 67 responded to a 6-month survey (26 ARDS, 41 non-ARDS). Both ARDS and non-ARDS groups had lower physical component of SF-12 at baseline compared to general population (P

Long-Term Use Of Beta Blockers Is Protective In Severe Sepsis And Septic Shock

ABSTRACT INTROCUCTION The adrenergic system plays a major role in regulating the immune and cardi... more ABSTRACT INTROCUCTION The adrenergic system plays a major role in regulating the immune and cardiovascular responses to sepsis. The pro-inflammatory response is thought to be balanced by down-regulation of the β-1 receptors and up-regulation of β-2 receptors. Blockade of β-1 receptors reduces sepsis-induced hypercoagulability. The myocardium is rich in beta receptors of the β -1 subtype, antagonists of which decrease myocardial oxygen consumption. Blockade of β-2 receptors may counteract the catabolic effects of catecholamines seen in sepsis. Given the apparent importance of these pathways, we sought to explore the potential effects of beta-blocker medications in patients with sepsis admitted to the medical intensive care unit. METHODS This is a retrospective study of patients with severe sepsis and septic shock admitted to the medical ICU at Mayo Clinic over three years from 2007-2009. Diagnosis was based on SCCM/international sepsis conference definitions. Patient with comfort care were excluded. Chronic beta-blockers use was defined as being on a beta-blocking agent for 3 or more months prior to ICU admission. Demographics, SOFA and APACHE III were obtained from a previously validated electronic medical record database. Electronic records were reviewed to note chronic beta-blockers use. Adjustment for age, gender, and severity of illness was performed. RESULTS A total of 651 patients were included. The median age (interquartile range, IQR) was 71 years (58- 81). Total of 362 (55%) of patients were males and 375 (58%) were on chronic beta-blockers. Patients who were on chronic beta-blockers had lower mortality (21.3%) compared to patients who were not (27.2%), (p=0.09). After adjusting for age, gender, and severity of illness using SOFA and APACHE III scores, the mortality was significantly lower in those on beta blockers (OR 0.62, p=0.023). CONCLUSION In patients admitted to the ICU with severe sepsis and septic shock, those who take beta blockers on a chronic basis have improved survival compared to patients who do not take beta blockers.

Epidemiology of Clostridium difficile Infection Screening and Incident Cases in the Intensive Care Unit

CHEST Journal, 2014

Critical Care Medicine, 2014

Increased fluid administration in the first three hours of sepsis resuscitation is associated with reduced mortality: a retrospective cohort study

Chest, 2014

The surviving sepsis guidelines recommend early aggressive fluid resuscitation within 6 h of seps... more The surviving sepsis guidelines recommend early aggressive fluid resuscitation within 6 h of sepsis onset. Although rapid fluid administration may offer benefit, studies on the timing of resuscitation are lacking. We hypothesized that there is an association between quicker, adequate fluid resuscitation and patient outcome from sepsis onset time. This is a retrospective cohort study of consecutive adults with severe sepsis and septic shock admitted to a quaternary care medical ICU between January 2007 and December 2009. Data were collected from a previously validated electronic medical database. Multivariate regression modeling was performed, adjusting for age, admission weight, Sequential Organ Failure Assessment score, APACHE (Acute Physiology and Chronic Health Examination) III score, and total fluid administration within the first 6 h of sepsis onset time. Of 651 patients with severe sepsis and septic shock screened, 594 had detailed fluid data. In a univariate analysis, the med...

Derivation and Validation of Automated Electronic Search Strategies to Extract Charlson Comorbidities From Electronic Medical Records

Feasibility Study Of Automated Surveillance Of Septic Shock Outside Of The Intensive Care Unit

American Journal of …, 2010

Page 1. / Thematic Poster Session / Wednesday, May 19/8:15 D53 SEPSIS: MECHANISMS AND IMPLICATION... more Page 1. / Thematic Poster Session / Wednesday, May 19/8:15 D53 SEPSIS: MECHANISMS AND IMPLICATIONS FOR MANAGEMENT AM-4:00 PM / Area A, Hall G (First Level), Morial Convention Center Feasibility Study Of ...

Risk Factors For Recurrent Acute Respiratory Distress Syndrome (ARDS): A Population-Based Case Control Study

American Journal of …, 2010

Mayo Clinic, Rochester, MN, United States of America, Mayo Clinic Rochester, Rochester, MN, Unite... more Mayo Clinic, Rochester, MN, United States of America, Mayo Clinic Rochester, Rochester, MN, United States of America, Division of 1 ... Pulmonary and Critical Care Medicine, College of Medicine, Mayo Clinic, Rochester, MN; (METRIC) Multidisciplinary Epidemiology and ...

Comparison of Long-term Survival and Functional Status of Patients at High Risk for ALI Who Did and Who Did Not Develop ALI

En 1994 un estudio observacional reporto una mejoria en el outcome con el uso de menor VC e hiper... more En 1994 un estudio observacional reporto una mejoria en el outcome con el uso de menor VC e hipercapnia permisiva. Un estudio posterior realizado por el NIH ARDS Network confirmo la superioridad de la ventilacion pulmonar protectiva, reportando una tasa de mortalidad menor (31% vs 41%) en pacientes con IPA/SDRA ventilados con VC de 6 mL/kg de peso ideal, comparado con un VC de 12 mL/kg de peso ideal. Un metaanalisis de trials clinicos asocio una mejoria del outcome con un VC de 7.7 mL/kg de peso ideal y una presion plateau de 30 cmH2O.

Bedside Implementation of a Readmission Prediction Model (Stability and Workload Index for Transfer) in the Medical Intensive Care Unit

Cureus, 2021

The emergence of the coronavirus disease 2019 (COVID-19) pandemic has made us appreciate how impo... more The emergence of the coronavirus disease 2019 (COVID-19) pandemic has made us appreciate how important it is to quickly develop treatments and save lives. The race to develop a vaccine for this novel coronavirus began as soon as the pandemic emerged. Time was the only limiting factor. From the first vaccine developed in 1796 against smallpox to the latest COVID-19 vaccine, there have been several vaccines that have reduced the burden of disease, with the associated mortality and morbidity. Over the years we have seen many new advancements in organism isolation, cell culture, whole-genome sequencing, and recombinant nuclear techniques. These techniques have greatly facilitated the development of vaccines. Each vaccine has its own development story and there is much wisdom to be gained from learning about breakthroughs in vaccine development.

Incidence of and Risk Factors For Post-Intubation Hypotension in the Critically Ill

Medical science monitor : international medical journal of experimental and clinical research, 2016

BACKGROUND We aim to report the incidence of post-intubation hypotension in the critically ill, t... more BACKGROUND We aim to report the incidence of post-intubation hypotension in the critically ill, to report in-hospital mortality and length of stay in those who developed post-intubation hypotension, and to explore possible risk factors associated with post-intubation hypotension. MATERIAL AND METHODS Adult (≥18 years) ICU patients who received emergent endotracheal intubation were included. We excluded patients if they were hemodynamically unstable 60 minutes pre-intubation. Post-intubation hypotension was defined as the administration of any vasopressor within 60 minutes following intubation. RESULTS Twenty-nine patients developed post-intubation hypotension (29/147, 20%). Post-intubation hypotension was associated with increased in-hospital mortality (11/29, 38% vs. 19/118, 16%) and length of stay (21 [10-37] vs. 12 [7-21] days) on multivariate analysis. Three risk factors for post-intubation hypotension were identified on multivariate analysis: 1) decreasing mean arterial pressur...

Prone Positioning in Severe Acute Respiratory Distress Syndrome

The Journal of Emergency Medicine, 2013

Previous trials involving patients with the acute respiratory distress syndrome (ARDS) have faile... more Previous trials involving patients with the acute respiratory distress syndrome (ARDS) have failed to show a beneficial effect of prone positioning during mechanical ventilatory support on outcomes. We evaluated the effect of early application of prone positioning on outcomes in patients with severe ARDS. In this multicenter, prospective, randomized, controlled trial, we randomly assigned 466 patients with severe ARDS to undergo prone-positioning sessions of at least 16 hours or to be left in the supine position. Severe ARDS was defined as a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (FiO2) of less than 150 mm Hg, with an FiO2 of at least 0.6, a positive end-expiratory pressure of at least 5 cm of water, and a tidal volume close to 6 ml per kilogram of predicted body weight. The primary outcome was the proportion of patients who died from any cause within 28 days after inclusion. A total of 237 patients were assigned to the prone group, and 229 patients were assigned to the supine group. The 28-day mortality was 16.0% in the prone group and 32.8% in the supine group (P<0.001). The hazard ratio for death with prone positioning was 0.39 (95% confidence interval [CI], 0.25 to 0.63). Unadjusted 90-day mortality was 23.6% in the prone group versus 41.0% in the supine group (P<0.001), with a hazard ratio of 0.44 (95% CI, 0.29 to 0.67). The incidence of complications did not differ significantly between the groups, except for the incidence of cardiac arrests, which was higher in the supine group. In patients with severe ARDS, early application of prolonged prone-positioning sessions significantly decreased 28-day and 90-day mortality. (Funded by the Programme Hospitalier de Recherche Clinique National 2006 and 2010 of the French Ministry of Health; PROSEVA ClinicalTrials.gov number, NCT00527813.).

Persistent Shock With Hemorrhagic Complications

Mayo Clinic Critical Care Case Review, 2016

Incidence of Infection Among Patients on Chemotherapy With Tunneled Indwelling Pleural Catheters

CHEST Journal, 2012

ABSTRACT SESSION TYPE: Pleural Disease PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 ... more ABSTRACT SESSION TYPE: Pleural Disease PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: Tunneled indwelling pleural catheters (IPC) are a United States Food and Drug Administration-approved implantable device used for palliation of recurrent, symptomatic malignant pleural effusions. Although complication rates are low concern remains for increased infections due to this device in the setting of chemotherapy. We report our experience with infectious complications from the use of IPCs in those patients receiving concurrent chemotherapy.METHODS: The study includes retrospective chart review of little over 5 years of patients with Tunneled indwelling pleural catheters (IPC). A total of 259, patients with first time insertion of IPC were included in analysis. All patient had research authorization provided in medical records. Study was approved by Institutional Review Board.RESULTS: Out of 259 the catheter placement was as follows: 128 (49%) right sided, 122 (47%) left and 9 (4%) bilateral. In this cohort a total of 20 (7.7%) patients developed infection. Out of these 11 (55%) had Cellulitis and 9 (45%) had Empyema. Median catheter duration (N=109 patients) was 72 days (IQR= 27.5 -146). A total of 14 (9.1%) patients out of 154, who received chemotherapy had infection vs. 6 (6.2%) patients, out of 97, who didn't receive chemotherapy developed infection (p=0.4).CONCLUSIONS: Overall risk of infection in patient with Tunneled indwelling pleural catheters is mediocre, the risk of serious infection as Empyema is even lower. Being on Chemotherapy doesn't cause additional risk for infection in such patients.CLINICAL IMPLICATIONS: Every thirteenth patient, who get tunneled indwelling pleural catheters (IPC) placement, is likely to have an infection either cellulitis or empyema. Chemotherapy shouldn't be seen as a contraindication for IPC insertion.DISCLOSURE: The following authors have nothing to disclose: Essam Mekhaiel, Rahul Kashyap, Fabien Maldonado, John MullonNo Product/Research Disclosure InformationMayo Clinic College of Medicine, Rochester, MN.

Critical Care Medicine, Feb 1, 2011

Objective: To evaluate the impact of weekly feedback to clinicians and the activation of a sepsis... more Objective: To evaluate the impact of weekly feedback to clinicians and the activation of a sepsis response team on the process of care and hospital mortality in patients with severe sepsis or septic shock.

Kinetics and model development for enzymatic synthesis of fructo-oligosaccharides using fructosyltransferase

Bioprocess and Biosystems Engineering, 2015

Experimental investigations were made to synthesize fructo-oligosaccharides (FOS) from sucrose us... more Experimental investigations were made to synthesize fructo-oligosaccharides (FOS) from sucrose using fructosyltransferase. The influence of various parameters such as temperature (45-55 °C), pH (4-5), initial sucrose concentration (ISC: 300-500 g/L) and enzyme concentration (4-32 U/mL) were varied. A maximum FOS yield of 60 % was observed at ISC 500 g/L, pH 4.5 with enzyme activity 32 U/mL and at 55 °C. It was confirmed that 1-kestose (tri-) was the major product of FOS as compared to nystose (tetra-) and fructosylnystose (penta-saccharides). Further, the reaction rate increases with increase in temperature. From separate sets of experiments, it was observed that FOS formation was affected by glucose inhibition. Apart from the increase in the rate of FOS formation with increasing enzyme activity, the final values of FOS yield increase though till 16 U/mL and thereafter attain plateau. A kinetic model was also developed, based on Michaelis-Menten kinetics, and a five-step ten-parameter model, including glucose inhibition, was obtained. Model was solved using COPASI(®) (version 4.8) solver for kinetic parameter estimations followed by time course simulations.

Epidemiology of Critical Care Syndromes, Organ Failures, and Life-Support Interventions in a Suburban US CommunityEpidemiology of Critical Care Syndromes

ICU services represent a significant and increasing proportion of medical care. Population-based ... more ICU services represent a significant and increasing proportion of medical care. Population-based epidemiologic studies are essential to inform physicians and policymakers about current and future ICU demands. We aimed to determine the incidence of critical care syndromes, organ failures, and life-support interventions in a defined US suburban community with unrestricted access to critical care services. This population-based observational cohort from January 1 to December 31, 2006, in Olmsted County, Minnesota, included all consecutive critically ill adult residents admitted to the ICU. Main outcomes were incidence of critical care syndromes, life-support interventions, and organ failures as defined by standard criteria. Incidences are reported per 100,000 population (95% CIs) and were age adjusted to the 2006 US population. A total of 1,707 ICU admissions were identified from 1,461 patients. Incidences of critical care syndromes were respiratory failure, 430 (390-470); acute kidney injury, 290 (257-323); severe sepsis, 286 (253-319); all-cause shock, 194 (167-221); acute lung injury, 86 (68-105); all-cause coma, 43 (30-55); and overt disseminated intravascular coagulation, 18 (10-26). Incidence of mechanical ventilation was invasive, 310 (276-344); noninvasive, 180 (154-206); vasopressors and inotropes, 183(155-208). Renal replacement therapy incidence was 96 (77-116). Of the cohort, 1,330 patients (91%) survived to hospital discharge. Short- and long-term survival decreased by the number of failing organs. In a suburban US community with high access to critical care services, cumulative incidences of critical care syndromes and life-support interventions were higher than previously reported. The results of this study have important implications for future planning of critical care delivery.

PloS one, 2018

To evaluate the clinical features and outcomes of acute cardiorenal syndrome type-5 in patients w... more To evaluate the clinical features and outcomes of acute cardiorenal syndrome type-5 in patients with severe sepsis and septic shock. Historical cohort study of all adult patients with severe sepsis and septic shock admitted to the intensive care units (ICU) at Mayo Clinic Rochester from January 1, 2007 through December 31, 2014. Patients with prior renal or cardiac dysfunction were excluded. Patients were divided into groups with and without cardiorenal syndrome type-5. Acute Kidney Injury (AKI) was defined by both serum creatinine and urine output criteria of the AKI Network and the cardiac injury was determined by troponin-T levels. Outcomes included in-hospital mortality, ICU and hospital length of stay, and one-year survival. Of 602 patients meeting the study inclusion criteria, 430 (71.4%) met criteria for acute cardiorenal syndrome type-5. Patients with cardiorenal syndrome type-5 had higher severity of illness, greater vasopressor and mechanical ventilation use. Cardiorenal s...

Six-month quality-of-life and functional status of acute respiratory distress syndrome survivors compared to patients at risk: a population-based study

Critical Care, 2015

Introduction The long-term attributable burden related to acute respiratory distress syndrome (AR... more Introduction The long-term attributable burden related to acute respiratory distress syndrome (ARDS) is not fully investigated. The aim of this study is to evaluate the quality of life (QOL) and functional status at 6 months after hospitalization in patients at risk for ARDS who did and did not develop the syndrome. Method This is a population-based prospective cohort study of adult patients from Olmsted County, Minnesota, with or at risk for ARDS hospitalized from October 2008 to July 2011. The primary outcomes were changes in QOL and functional status, measured through 12-Item Short Form Survey (SF-12) and Barthel Index (BI) respectively, from baseline to 6 months, compared between survivors who did and did not develop ARDS. Results Of 410 patients with or at risk for ARDS, 98 had baseline surveys collected and 67 responded to a 6-month survey (26 ARDS, 41 non-ARDS). Both ARDS and non-ARDS groups had lower physical component of SF-12 at baseline compared to general population (P

Long-Term Use Of Beta Blockers Is Protective In Severe Sepsis And Septic Shock

ABSTRACT INTROCUCTION The adrenergic system plays a major role in regulating the immune and cardi... more ABSTRACT INTROCUCTION The adrenergic system plays a major role in regulating the immune and cardiovascular responses to sepsis. The pro-inflammatory response is thought to be balanced by down-regulation of the β-1 receptors and up-regulation of β-2 receptors. Blockade of β-1 receptors reduces sepsis-induced hypercoagulability. The myocardium is rich in beta receptors of the β -1 subtype, antagonists of which decrease myocardial oxygen consumption. Blockade of β-2 receptors may counteract the catabolic effects of catecholamines seen in sepsis. Given the apparent importance of these pathways, we sought to explore the potential effects of beta-blocker medications in patients with sepsis admitted to the medical intensive care unit. METHODS This is a retrospective study of patients with severe sepsis and septic shock admitted to the medical ICU at Mayo Clinic over three years from 2007-2009. Diagnosis was based on SCCM/international sepsis conference definitions. Patient with comfort care were excluded. Chronic beta-blockers use was defined as being on a beta-blocking agent for 3 or more months prior to ICU admission. Demographics, SOFA and APACHE III were obtained from a previously validated electronic medical record database. Electronic records were reviewed to note chronic beta-blockers use. Adjustment for age, gender, and severity of illness was performed. RESULTS A total of 651 patients were included. The median age (interquartile range, IQR) was 71 years (58- 81). Total of 362 (55%) of patients were males and 375 (58%) were on chronic beta-blockers. Patients who were on chronic beta-blockers had lower mortality (21.3%) compared to patients who were not (27.2%), (p=0.09). After adjusting for age, gender, and severity of illness using SOFA and APACHE III scores, the mortality was significantly lower in those on beta blockers (OR 0.62, p=0.023). CONCLUSION In patients admitted to the ICU with severe sepsis and septic shock, those who take beta blockers on a chronic basis have improved survival compared to patients who do not take beta blockers.

Epidemiology of Clostridium difficile Infection Screening and Incident Cases in the Intensive Care Unit

CHEST Journal, 2014

Critical Care Medicine, 2014

Increased fluid administration in the first three hours of sepsis resuscitation is associated with reduced mortality: a retrospective cohort study

Chest, 2014

The surviving sepsis guidelines recommend early aggressive fluid resuscitation within 6 h of seps... more The surviving sepsis guidelines recommend early aggressive fluid resuscitation within 6 h of sepsis onset. Although rapid fluid administration may offer benefit, studies on the timing of resuscitation are lacking. We hypothesized that there is an association between quicker, adequate fluid resuscitation and patient outcome from sepsis onset time. This is a retrospective cohort study of consecutive adults with severe sepsis and septic shock admitted to a quaternary care medical ICU between January 2007 and December 2009. Data were collected from a previously validated electronic medical database. Multivariate regression modeling was performed, adjusting for age, admission weight, Sequential Organ Failure Assessment score, APACHE (Acute Physiology and Chronic Health Examination) III score, and total fluid administration within the first 6 h of sepsis onset time. Of 651 patients with severe sepsis and septic shock screened, 594 had detailed fluid data. In a univariate analysis, the med...

Derivation and Validation of Automated Electronic Search Strategies to Extract Charlson Comorbidities From Electronic Medical Records

Feasibility Study Of Automated Surveillance Of Septic Shock Outside Of The Intensive Care Unit

American Journal of …, 2010

Page 1. / Thematic Poster Session / Wednesday, May 19/8:15 D53 SEPSIS: MECHANISMS AND IMPLICATION... more Page 1. / Thematic Poster Session / Wednesday, May 19/8:15 D53 SEPSIS: MECHANISMS AND IMPLICATIONS FOR MANAGEMENT AM-4:00 PM / Area A, Hall G (First Level), Morial Convention Center Feasibility Study Of ...

Risk Factors For Recurrent Acute Respiratory Distress Syndrome (ARDS): A Population-Based Case Control Study

American Journal of …, 2010

Mayo Clinic, Rochester, MN, United States of America, Mayo Clinic Rochester, Rochester, MN, Unite... more Mayo Clinic, Rochester, MN, United States of America, Mayo Clinic Rochester, Rochester, MN, United States of America, Division of 1 ... Pulmonary and Critical Care Medicine, College of Medicine, Mayo Clinic, Rochester, MN; (METRIC) Multidisciplinary Epidemiology and ...

Comparison of Long-term Survival and Functional Status of Patients at High Risk for ALI Who Did and Who Did Not Develop ALI

En 1994 un estudio observacional reporto una mejoria en el outcome con el uso de menor VC e hiper... more En 1994 un estudio observacional reporto una mejoria en el outcome con el uso de menor VC e hipercapnia permisiva. Un estudio posterior realizado por el NIH ARDS Network confirmo la superioridad de la ventilacion pulmonar protectiva, reportando una tasa de mortalidad menor (31% vs 41%) en pacientes con IPA/SDRA ventilados con VC de 6 mL/kg de peso ideal, comparado con un VC de 12 mL/kg de peso ideal. Un metaanalisis de trials clinicos asocio una mejoria del outcome con un VC de 7.7 mL/kg de peso ideal y una presion plateau de 30 cmH2O.

Bedside Implementation of a Readmission Prediction Model (Stability and Workload Index for Transfer) in the Medical Intensive Care Unit

Cureus, 2021

The emergence of the coronavirus disease 2019 (COVID-19) pandemic has made us appreciate how impo... more The emergence of the coronavirus disease 2019 (COVID-19) pandemic has made us appreciate how important it is to quickly develop treatments and save lives. The race to develop a vaccine for this novel coronavirus began as soon as the pandemic emerged. Time was the only limiting factor. From the first vaccine developed in 1796 against smallpox to the latest COVID-19 vaccine, there have been several vaccines that have reduced the burden of disease, with the associated mortality and morbidity. Over the years we have seen many new advancements in organism isolation, cell culture, whole-genome sequencing, and recombinant nuclear techniques. These techniques have greatly facilitated the development of vaccines. Each vaccine has its own development story and there is much wisdom to be gained from learning about breakthroughs in vaccine development.

Incidence of and Risk Factors For Post-Intubation Hypotension in the Critically Ill

Medical science monitor : international medical journal of experimental and clinical research, 2016

BACKGROUND We aim to report the incidence of post-intubation hypotension in the critically ill, t... more BACKGROUND We aim to report the incidence of post-intubation hypotension in the critically ill, to report in-hospital mortality and length of stay in those who developed post-intubation hypotension, and to explore possible risk factors associated with post-intubation hypotension. MATERIAL AND METHODS Adult (≥18 years) ICU patients who received emergent endotracheal intubation were included. We excluded patients if they were hemodynamically unstable 60 minutes pre-intubation. Post-intubation hypotension was defined as the administration of any vasopressor within 60 minutes following intubation. RESULTS Twenty-nine patients developed post-intubation hypotension (29/147, 20%). Post-intubation hypotension was associated with increased in-hospital mortality (11/29, 38% vs. 19/118, 16%) and length of stay (21 [10-37] vs. 12 [7-21] days) on multivariate analysis. Three risk factors for post-intubation hypotension were identified on multivariate analysis: 1) decreasing mean arterial pressur...

Prone Positioning in Severe Acute Respiratory Distress Syndrome

The Journal of Emergency Medicine, 2013

Previous trials involving patients with the acute respiratory distress syndrome (ARDS) have faile... more Previous trials involving patients with the acute respiratory distress syndrome (ARDS) have failed to show a beneficial effect of prone positioning during mechanical ventilatory support on outcomes. We evaluated the effect of early application of prone positioning on outcomes in patients with severe ARDS. In this multicenter, prospective, randomized, controlled trial, we randomly assigned 466 patients with severe ARDS to undergo prone-positioning sessions of at least 16 hours or to be left in the supine position. Severe ARDS was defined as a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (FiO2) of less than 150 mm Hg, with an FiO2 of at least 0.6, a positive end-expiratory pressure of at least 5 cm of water, and a tidal volume close to 6 ml per kilogram of predicted body weight. The primary outcome was the proportion of patients who died from any cause within 28 days after inclusion. A total of 237 patients were assigned to the prone group, and 229 patients were assigned to the supine group. The 28-day mortality was 16.0% in the prone group and 32.8% in the supine group (P<0.001). The hazard ratio for death with prone positioning was 0.39 (95% confidence interval [CI], 0.25 to 0.63). Unadjusted 90-day mortality was 23.6% in the prone group versus 41.0% in the supine group (P<0.001), with a hazard ratio of 0.44 (95% CI, 0.29 to 0.67). The incidence of complications did not differ significantly between the groups, except for the incidence of cardiac arrests, which was higher in the supine group. In patients with severe ARDS, early application of prolonged prone-positioning sessions significantly decreased 28-day and 90-day mortality. (Funded by the Programme Hospitalier de Recherche Clinique National 2006 and 2010 of the French Ministry of Health; PROSEVA ClinicalTrials.gov number, NCT00527813.).

Persistent Shock With Hemorrhagic Complications

Mayo Clinic Critical Care Case Review, 2016

Incidence of Infection Among Patients on Chemotherapy With Tunneled Indwelling Pleural Catheters

CHEST Journal, 2012

ABSTRACT SESSION TYPE: Pleural Disease PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 ... more ABSTRACT SESSION TYPE: Pleural Disease PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: Tunneled indwelling pleural catheters (IPC) are a United States Food and Drug Administration-approved implantable device used for palliation of recurrent, symptomatic malignant pleural effusions. Although complication rates are low concern remains for increased infections due to this device in the setting of chemotherapy. We report our experience with infectious complications from the use of IPCs in those patients receiving concurrent chemotherapy.METHODS: The study includes retrospective chart review of little over 5 years of patients with Tunneled indwelling pleural catheters (IPC). A total of 259, patients with first time insertion of IPC were included in analysis. All patient had research authorization provided in medical records. Study was approved by Institutional Review Board.RESULTS: Out of 259 the catheter placement was as follows: 128 (49%) right sided, 122 (47%) left and 9 (4%) bilateral. In this cohort a total of 20 (7.7%) patients developed infection. Out of these 11 (55%) had Cellulitis and 9 (45%) had Empyema. Median catheter duration (N=109 patients) was 72 days (IQR= 27.5 -146). A total of 14 (9.1%) patients out of 154, who received chemotherapy had infection vs. 6 (6.2%) patients, out of 97, who didn't receive chemotherapy developed infection (p=0.4).CONCLUSIONS: Overall risk of infection in patient with Tunneled indwelling pleural catheters is mediocre, the risk of serious infection as Empyema is even lower. Being on Chemotherapy doesn't cause additional risk for infection in such patients.CLINICAL IMPLICATIONS: Every thirteenth patient, who get tunneled indwelling pleural catheters (IPC) placement, is likely to have an infection either cellulitis or empyema. Chemotherapy shouldn't be seen as a contraindication for IPC insertion.DISCLOSURE: The following authors have nothing to disclose: Essam Mekhaiel, Rahul Kashyap, Fabien Maldonado, John MullonNo Product/Research Disclosure InformationMayo Clinic College of Medicine, Rochester, MN.

Critical Care Medicine, Feb 1, 2011

Objective: To evaluate the impact of weekly feedback to clinicians and the activation of a sepsis... more Objective: To evaluate the impact of weekly feedback to clinicians and the activation of a sepsis response team on the process of care and hospital mortality in patients with severe sepsis or septic shock.

Kinetics and model development for enzymatic synthesis of fructo-oligosaccharides using fructosyltransferase

Bioprocess and Biosystems Engineering, 2015

Experimental investigations were made to synthesize fructo-oligosaccharides (FOS) from sucrose us... more Experimental investigations were made to synthesize fructo-oligosaccharides (FOS) from sucrose using fructosyltransferase. The influence of various parameters such as temperature (45-55 °C), pH (4-5), initial sucrose concentration (ISC: 300-500 g/L) and enzyme concentration (4-32 U/mL) were varied. A maximum FOS yield of 60 % was observed at ISC 500 g/L, pH 4.5 with enzyme activity 32 U/mL and at 55 °C. It was confirmed that 1-kestose (tri-) was the major product of FOS as compared to nystose (tetra-) and fructosylnystose (penta-saccharides). Further, the reaction rate increases with increase in temperature. From separate sets of experiments, it was observed that FOS formation was affected by glucose inhibition. Apart from the increase in the rate of FOS formation with increasing enzyme activity, the final values of FOS yield increase though till 16 U/mL and thereafter attain plateau. A kinetic model was also developed, based on Michaelis-Menten kinetics, and a five-step ten-parameter model, including glucose inhibition, was obtained. Model was solved using COPASI(®) (version 4.8) solver for kinetic parameter estimations followed by time course simulations.