Publications by authors named "Charles St-Arnaud"
Article Synopsis
- A study was conducted to evaluate the effects of the proton-pump inhibitor pantoprazole on critically ill patients undergoing invasive ventilation, comparing it to a placebo.
- The trial included 4,821 patients and found that pantoprazole significantly reduced the incidence of clinically important upper gastrointestinal bleeding compared to placebo (1.0% vs. 3.5%).
- However, there was no significant difference in overall mortality rates at 90 days between the pantoprazole group (29.1%) and the placebo group (30.9%).
Article Synopsis
- The study analyzed ICU-acquired pneumonia using seven different definitions to estimate hospital mortality rates.
- It was part of a larger trial involving 2,650 mechanically ventilated adults, where pneumonia cases were reviewed by two blinded physicians.
- Different definitions showed varying rates of pneumonia incidence, with some, like ventilator-associated pneumonia (VAP) and Clinical Pulmonary Infection Score (CPIS), linked to a higher risk of hospital mortality.
Article Synopsis
- The study aimed to analyze feedback from monitoring visits in a multicenter trial testing probiotics for critically ill patients in Canada.
- A total of 75 unique findings from 37 centers were categorized into 10 quality management domains, with most issues related to missing operational records and the informed consent process.
- The overall results indicated that while documentation issues were prevalent, there were minimal threats to data integrity, privacy, or patient safety.
The evolution of mean arterial pressure in critically ill patients on vasopressors before and during a trial comparing a specific mean arterial pressure target to usual care.
BMC Anesthesiol
January 2022
Background: In randomized clinical controlled trials, the choice of usual care as the comparator may be associated with better clinician uptake of the study protocol and lead to more generalizable results. However, if care processes evolve to resemble the intervention during the course of a trial, differences between the intervention group and usual care control group may narrow. We evaluated the effect on mean arterial pressure of an unblinded trial comparing a lower mean arterial pressure target to reduce vasopressor exposure, vs.
View Article and Find Full Text PDFPurpose: Plastic bronchitis is a rare condition characterized by the formation of airway casts occluding the lower respiratory tract. It is described more commonly in children, especially following correction of congenital heart disease. It involves lymphatic abnormalities leading to endobronchial lymph precipitating airway cast formation.
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- The study investigates the effectiveness of probiotics, specifically Lactobacillus rhamnosus GG, in preventing ventilator-associated pneumonia (VAP) and other infections in critically ill patients in ICUs across North America and Saudi Arabia.
- A large randomized trial involved 2,653 patients, showing no significant reduction in VAP rates among those receiving probiotics compared to the placebo group (21.9% vs. 21.3%).
- None of the secondary outcomes, including rates of other infections or mortality, showed improvements, suggesting that probiotics may not offer substantial benefits in this patient population.
Introduction: Vasodilatory hypotension is common among intensive care unit (ICU) patients; vasopressors are considered standard of care. However, optimal mean arterial pressure (MAP) targets for vasopressor titration are unknown. The objective of the Optimal VAsopressor TitraTION in patients 65 years and older (OVATION-65) trial is to ascertain the effect of permissive hypotension (vasopressor titration to achieve MAP 60-65 mm Hg) versus usual care on biomarkers of organ injury in hypotensive patients aged ≥65 years.
View Article and Find Full Text PDFObjectives: Mechanisms underlying sepsis-associated encephalopathy remain unclear, but reduced cerebral blood flow, alone or in conjunction with altered autoregulation, is reported as a potential contributor. We compared cerebral blood flow of control subjects and vasopressor-dependent septic patients.
Design: Randomized crossover study.
Background: The optimal approach to titrate vasopressor therapy is unclear. Recent sepsis guidelines recommend a mean arterial pressure (MAP) target of 65 mmHg and higher for chronic hypertensive patients. As data emerge from clinical trials comparing blood pressure targets for vasopressor therapy, an accurate description of usual care is required to interpret study results.
View Article and Find Full Text PDFBackground: Without robust clinical evidence to guide titration of vasopressors in septic shock, it is unclear how dosing of these potent medications occurs. We sought to measure the proportion of vasopressor prescriptions for septic shock that were missing explicit targets and to describe the targets that we identified.
Methods: We conducted a multicentre, retrospective cohort study involving 9 intensive care units (ICUs) located at 3 academic hospitals in Canada and Australia.
A case report, focused on vasopressor use and presented in this article, is likely to resonate with many critical care nurses. In this article the authors describe opportunities to enhance safety with vasopressor therapy. Specifically, the goal of improving communication among physicians, nurses, and pharmacists around desired endpoints for vasopressor therapy, triggers for reassessment of the therapeutic strategy and cause of the patient's shock was identified as an area for improvement.
View Article and Find Full Text PDFEsophageal dilation is a rare complication of scleroderma and CREST syndrome. A case of atelectasis secondary to right inferior bronchus compression by a massively dilated esophagus is described. The authors are unaware of any previous cases of atelectasis secondary to esophageal dilation in scleroderma.
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