The Use of Inhaled Epoprostenol for Acute Respiratory Distress Syndrome Secondary Due To COVID-19: a Case Series.

Introduction: Inhaled epoprostenol (iEpo) is a pulmonary vasodilator used to treat refractory respiratory failure, including that caused by Coronavirus 2019 (COVID-19) pneumonia.

Aim Of Study: To describe the experience at three teaching hospitals using iEpo for severe respiratory failure due to COVID-19 and evaluate its efficacy in improving oxygenation.

Methods: Fifteen patients were included who received iEpo, had confirmed COVID-19 and had an arterial blood gas measurement in the 12 hours before and 24 hours after iEpo initiation.

Different Harm and Mortality in Critically Ill Medical vs Surgical Patients: Retrospective Analysis of Variation in Adverse Events in Different Intensive Care Units.

Background: Institutional harm reduction campaigns are essential in improving safe practice in critical care. Our institution embarked on an aggressive project to measure harm. We hypothesized that critically ill surgical patients were at increased risk of harm compared with medical intensive care patients.

Anaerobic antibiotic usage for pneumonia in the medical intensive care unit.

Background And Objective: Pneumonia is a common admitting diagnosis in the intensive care unit (ICU). When aspiration is suspected, antibiotics to cover anaerobes are frequently used, but in the absence of clear risk factors, current guidelines have questioned their role. It is unknown how frequently these guidelines are followed.

A Feasibility Assessment of Behavioral-based Interviewing to Improve Candidate Selection for a Pulmonary and Critical Care Medicine Fellowship Program.

Traditional interviews for residency and fellowship training programs are an important component in the selection process, but can be of variable value due to a nonstandardized approach. We redesigned the candidate interview process for our large pulmonary and critical care medicine fellowship program in the United States using a behavioral-based interview (BBI) structure. The primary goal of this approach was to standardize the assessment of candidates within noncognitive domains with the goal of selecting those with the best fit for our institution's fellowship program.

Protocol-Based Resuscitation Bundle to Improve Outcomes in Septic Shock Patients: Evaluation of the Michigan Health and Hospital Association Keystone Sepsis Collaborative.

Objectives: To evaluate the impact of a multi-ICU quality improvement collaborative implementing a protocol-based resuscitation bundle to treat septic shock patients.

Design: A difference-in-differences analysis compared patient outcomes in hospitals participating in the Michigan Health & Hospital Association Keystone Sepsis collaborative (n = 37) with noncollaborative hospitals (n = 50) pre- (2010-2011) and postimplementation (2012-2013). Collaborative hospitals were also stratified as high (n = 19) and low (n = 18) adherence based on their overall bundle adherence.

Benefits of Early Active Mobility in the Medical Intensive Care Unit: A Pilot Study.

Background: Pressure ulcer formation continues to be problematic in acute care settings, especially intensive care units (ICUs). Our institution developed a program for early mobility in the ICU using specially trained nursing aides. The goal was to impact hospital-acquired pressure ulcers incidence as well as factors associated with ICU deconditioning by using specially trained personnel to perform the acute early mobility interventions.

Outcome of hypotensive ward patients who re-deteriorate after initial stabilization by the Medical Emergency Team.

Purpose: We evaluated the outcome of hypotensive ward patients who re-deteriorated after initial stabilization by the Medical Emergency Team (MET) in our hospital, due to limited data in this regard.

Methods: One thousand one hundred seventy-nine MET calls in 32184 ward patients from January 2009 to August 2011 were evaluated. Four hundred ten hypotensive patients met study criteria and were divided into: (1)"Immediate Transfers (IT), n = 136":admitted by MET to intensive care unit (ICU) immediately; (2)"Re-deteriorated Transfers (RDT) n = 72":initially stabilized and signed off by MET, but later re-deteriorated within 48-hours and admitted to ICU; (3)"Ward Patients (WP) n = 202": remained stable on ward after treatment.

Dedicated multidisciplinary ventilator bundle team and compliance with sedation vacation.

Background: How compliance with a ventilator bundle is monitored varies from institution to institution. Some institutions rely on the primary intensive care unit team to review the bundle during their rounds; others rely on a separate team of health care personnel that may include representatives from disciplines such as nursing, respiratory therapy, and pharmacy.

Objectives: To compare rates of compliance with ventilator bundle components between a dedicated ventilator bundle rounding team and the primary intensive care unit rounding team in a 68-bed medical intensive care unit.

A multicenter collaborative approach to reducing pediatric codes outside the ICU.

Objectives: The Child Health Corporation of America formed a multicenter collaborative to decrease the rate of pediatric codes outside the ICU by 50%, double the days between these events, and improve the patient safety culture scores by 5 percentage points.

Methods: A multidisciplinary pediatric advisory panel developed a comprehensive change package of process improvement strategies and measures for tracking progress. Learning sessions, conference calls, and data submission facilitated collaborative group learning and implementation.

Using spirometry to rule out restriction in patients with concomitant low forced vital capacity and obstructive pattern.

Background: Different formulas have been proposed to exclude restriction based on spirometry, however none of them have specifically tested the patients whose spirometry show both obstruction and a low forced vital capacity (FVC).

Study Objective: The study was designed to create an algorithm that would better predict the absence of restriction in such patients.

Design: Retrospective analysis of prospectively collected data.

MICU care delivered by PAs versus residents: do PAs measure up?

Background: Data on the perfomance of physician assistants in a medical intensive care unit are scarce.

Objective: To compare clinical outcomes between patients admitted to a resident-run MICU and a PA-run MICU.

Methods: Retrospective analysis of prospectively collected MICU data was performed for 5,346 patients admitted to an MICU from January 2004 through January 2007; 3,971 patients were admitted to a resident-run MICU (resident group) and 1,375 to a PA-run MICU (PA group).

Resuscitation bundle compliance in severe sepsis and septic shock: improves survival, is better late than never.

Unlabelled: While clinicians' management of severe sepsis and septic shock has been positively influenced by a number of clinical research studies in the last decade, challenges remain regarding early hemodynamic optimization as envisioned in the Surviving Sepsis Campaign's (SSC) resuscitation bundle (RB). We examined the impact of a hospital-wide continuous quality improvement (CQI) initiative on patients presenting with severe sepsis and septic shock, and the impact of the sepsis RB on patient outcomes when completed beyond the 6-hour recommendation period. The study was an 18-month, prospective cohort study enrolling patients who met the definition of severe sepsis or septic shock.

Quality Education and Safe Systems Training (QuESST): Development and Assessment of a Comprehensive Cross-Disciplinary Resident Quality and Patient Safety Curriculum.

Background: Over the past decade, regulatory bodies have heightened their emphasis on health care quality and safety. Education of physicians is a priority in this effort, with the Accreditation Council for Graduate Medical Education requiring that trainees attain competence in practice-based learning and improvement and systems-based practice. To date, several studies about the use of resident education related to quality and safety have been published, but no comprehensive interdisciplinary curricula seem to exist.

Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation.

Objective: To determine the effect of early enteral feeding on the outcome of critically ill medical patients whose hemodynamic condition is unstable.

Methods: Prospectively collected data in a multi-institutional medical intensive care unit database were analyzed retrospectively. A total of 1174 patients were identified who required mechanical ventilation for more than 2 days and were treated with vasopressor agents to support blood pressure.

Specific conductance criteria for a positive methacholine challenge test: are the American Thoracic Society guidelines rather generous?

Background: American Thoracic Society (ATS) guidelines for methacholine challenge testing (MCT) discuss specific airways conductance (sG(aw)) as a surrogate marker for forced expiratory volume in the first second (FEV(1)) to diagnose airways obstruction. The guidelines suggest a cutoff value of 45% drop in sG(aw) to diagnose a positive MCT. However, there is no available evidence that supports this cutoff value of 45%.

Predictive value of sGaw, FEF(25-75), and FEV1 for development of asthma after a negative methacholine challenge test.

Background: A 20% change in forced expiratory volume in 1 second (FEV(1)) during methacholine challenge testing (MCT) is a reliable marker of asthma. When the FEV(1) decrease is < 20%, there is controversy whether other changes in flows and conductance may be useful. We conducted this study to determine whether changes in sGaw, FEF(25 - 75), and FEV(1) in a negative MCT could predict future occurrence of asthma over a 3-year period.

The association between depressive symptoms and acute exacerbations of COPD.

Background: Depression is an important comorbidity for patients with chronic obstructive pulmonary disease (COPD). The association between depression and acute exacerbations of COPD is unknown. This study was designed to determine the frequency of COPD exacerbations in outpatients with and without depressive symptoms.

A patient with an uncommon complication from insertion of a central venous catheter: A case report.

Background: A 72 year old male was admitted to the medical intensive care unit with septic shock.

Case Presentation: A left subclavian central venous catheter was inserted on the day of admission whose tip was pushing against the wall of the vessel lumen. The patient's condition improved with treatment, but three days later had a new episode of acute hypotension.

Patient comfort during pressure support and volume controlled-continuous mandatory ventilation.

Background: Pressure-support ventilation (PSV) is more comfortable than volume controlled-continuous mandatory ventilation (VC-CMV) in acute hypercapnic respiratory failure, in patients undergoing noninvasive ventilation. Physiologic measurements of patient status have been compared in PSV and VC-CMV in endotracheally intubated patients, but patient perception of comfort has not been measured in this population.

Objective: To determine if PSV is more comfortable than VC-CMV (volume-cycled, flow-limited) in intubated mechanically ventilated patients.

Reducing hospital standardized mortality rate with early interventions.

Henry Ford Hospital is undertaking multiple initiatives to reduce patient mortality. One such project is the deployment of a rapid response team (RRT). Rapid response teams contribute to reducing in-patient mortality rates by identifying and treating patients at risk for physiological deterioration outside the intensive care unit (ICU) setting.

Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients.

Study Objectives: To determine the impact of early enteral feeding on the outcome of critically ill medical patients.

Design: Retrospective analysis of a prospectively collected large multi-institutional ICU database.

Patients: A total of 4,049 patients requiring mechanical ventilation for > 2 days.

Evaluation of the causes for racial disparity in surgical treatment of early stage lung cancer.

Study Objectives: Black patients undergo surgical treatment for early stage lung cancer less often than whites. We wanted to determine the causes for the racial difference in resection rates.

Design: We studied a retrospective cohort of patients who presented to our institution with potentially resectable lung cancer (stage I or II) between the years 1995 and 1998, inclusive.