Publications by authors named "Chima R"
Article Synopsis
- The study examines how different post-contrast phases in CT scans impact measurements of body composition, focusing on pancreatic tumors.
- A total of 278 patients were analyzed using an AI-based software that segmented body compartments during three phases of contrast: noncontrast, arterial, and venous.
- Findings indicate that while muscle and fat area measurements showed relatively smaller biases across phases, the Hounsfield units for skeletal muscle and intermuscular adipose tissue demonstrated larger biases, suggesting these factors should be accounted for in CT assessments.
Article Synopsis
- The study’s goal was to investigate how home and neighborhood environments affect neurobehavioral outcomes in children who experienced severe traumatic brain injuries (TBIs).
- It involved children under 18 years old, who were admitted to intensive care with a Glasgow Coma Scale score of 8 or lower, and used a multicenter observational design to track various outcomes after 12 months.
- Results showed that factors related to home and neighborhood life significantly influenced neurobehavioral outcomes like intellectual ability and behavior adjustment, particularly in older children, while global functioning was not as affected.
Early identification of pancreatitis remains a significant clinical diagnostic challenge that impacts patient outcomes. The evolution of quantitative imaging followed by deep learning models has shown great promise in the non-invasive diagnosis of pancreatitis and its complications. We provide an overview of advancements in diagnostic imaging and quantitative imaging methods along with the evolution of artificial intelligence (AI).
View Article and Find Full Text PDFA bronchogenic cyst (BC), although a rare congenital abnormality, represents the most common cystic lesion in the mediastinum and can present with chest pain and shortness of breath, especially due to compression of adjacent vital structures. The most common diagnostic modalities used are computed tomography (CT) and magnetic resonance imaging (MRI). These cysts may elude even a seasoned clinician unless they become symptomatic.
View Article and Find Full Text PDFArticle Synopsis
- This study aims to define immunocompromised-associated pediatric acute respiratory distress syndrome (I-PARDS) and contrast it with regular pediatric acute respiratory distress syndrome (PARDS).
- Data were analyzed from the PARDIE study, which included a wide dataset of children with PARDS across 145 PICUs in 27 countries.
- Findings indicate that children with I-PARDS have a higher severity of illness, increased PICU mortality, and are less likely to be extubated successfully within 28 days compared to those with regular PARDS.
Article Synopsis
- Overview of Study Purpose
- : The study evaluated the impact of the Trial in AKI using NGAL and Fluid Overload to optimize CRRT Use (TAKING FOCUS 2; TF2) on personalizing fluid management and initiating continuous renal replacement therapy (CRRT) for critically ill patients at risk of acute kidney injury (AKI).
- Methods and Patient Follow-Up
- : It involved a prospective follow-up of 286 ICU patients from July 2017, employing automated renal angina index (RAI) assessments and urinary biomarker uNGAL to guide CRRT initiation based on fluid accumulation.
- Results and Findings
- : Post-TF2 implementation, patients experienced a shorter median time
Background: Optimal design of healthcare spaces can enhance patient care. We applied design thinking and human factors principles to optimize communication and signage on high risk patients to improve situation awareness in a new clinical space for the pediatric ICU.
Objective: To assess the impact of these tools in mitigating situation awareness concerns within the new clinical space.
Intussusception, a rare cause of bowel obstruction in adults, is even less common in the elderly population. Unlike pediatric cases, adult intussusception is primarily associated with pathologic diseases acting as lead points, often requiring surgical intervention. We present a case of an 84-year-old male with a medical history significant for multiple comorbidities, who was diagnosed with a large segment jejunojejunal intussusception resulting in small bowel obstruction.
View Article and Find Full Text PDFObjectives: To describe our institutional experience utilizing adjunctive synthetic angiotensin II in critically ill children with catecholamine-resistant vasodilatory shock (CRVS).
Design: Single-center, retrospective case series.
Setting: PICU and cardiac ICU (CICU) at a large, quaternary children's hospital in the United States.
We describe the clinical characteristics and outcomes of 16 children and young adults with severe acute COVID-19 who were treated with tocilizumab. Patients who were discharged by day 28 were more likely to be treated with tocilizumab earlier in their COVID-19 illness and had lower ferritin and interleukin-6 levels compared with those who were not discharged by day 28.
View Article and Find Full Text PDFIntroduction: Acute kidney injury (AKI) occurs in one-fourth of children and young adults admitted to pediatric intensive care unit (PICU). Severe AKI (sAKI; Kidney Disease: Improving Global Outcomes stage 2 or 3) is associated with morbidity and mortality. An AKI risk stratification system, the Renal Angina Index (RAI) calculated at 12 hours of admission, exhibits excellent performance to rule out sAKI at 72 hours of admission.
View Article and Find Full Text PDFBackground: The functional acute kidney injury (AKI) diagnostic tests serum creatinine (SCr) and urine output are imprecise and make management challenging. Combining tubular injury biomarkers with functional markers reveal AKI phenotypes that may facilitate personalized care. However, when and in whom to obtain injury biomarkers remains unclear.
View Article and Find Full Text PDFTransplantation-associated thrombotic microangiopathy (TA-TMA) can range from a self-limiting condition to a lethal transplantation complication. It is important to identify TA-TMA patients at risk for severe multiorgan endothelial injury to implement targeted therapies in a timely manner. Current therapeutic approaches with complement blockade have improved survival markedly in high-risk TA-TMA patients, yet one-third of these patients respond inadequately to eculizumab therapy.
View Article and Find Full Text PDFBackground: Pediatric patients with ARDS will on occasion need venovenous extracorporeal membrane oxygenation (VV-ECMO) for organ support. As these patients recover, they may benefit from lung recruitment maneuvers including flexible bronchoscopy (FB). The objective of this study was to assess the clinical course of patients who underwent FB while on VV-ECMO for ARDS.
View Article and Find Full Text PDFAlthough some pediatric sepsis survivors experience worsening health-related quality of life (HRQL), many return to their pre-illness HRQL. Whether children can improve beyond baseline is not known. We examined a cohort of pediatric sepsis survivors to determine if those with baseline HRQL scores below the population mean could exhibit ≥10% improvement and evaluated factors associated with improvement.
View Article and Find Full Text PDFObjectives: To use improved situation awareness to decrease cardiopulmonary resuscitation events by 25% over 18 months and demonstrate process and outcome sustainability.
Design: Structured quality improvement initiative.
Setting: Single-center, 35-bed quaternary-care PICU.
Background & Aim: The American College of Radiology Ultrasound Liver Imaging Reporting and Data System (ACR US LI-RADS) Visualization Score conveys the expected level of sensitivity of screening and surveillance ultrasound exams in patients at risk for hepatocellular carcinoma (HCC). We sought to determine inter-reader agreement of the Visualization Score which is currently unknown.
Methods: Consecutive 6998 ultrasound HCC screening and surveillance studies in 3115 patients from 2017 to 2020 were retrospectively retrieved.
Article Synopsis
- The study aimed to analyze the occurrence of tracheostomy placements and long-term mechanical ventilation needs in children who underwent ECMO due to acute respiratory failure.
- Conducted across 10 pediatric centers from 2011 to 2016, the research found that 67% of the 202 patients survived to ICU discharge, with a 14% tracheostomy rate and 9% of survivors needing long-term ventilation.
- Findings indicate that older and heavier patients were more likely to receive a tracheostomy, while neither pre-ECMO illness severity nor chronic conditions influenced the need for either intervention; this study provides valuable patient insights and sets the stage for future research.
Objectives: To determine whether single-phase dual-energy CT (DECT) differentiates vascular and nonvascular renal lesions in the portal venous phase (PVP). Optimal iodine threshold was determined and compared to Hounsfield unit (HU) measurements.
Methods: We retrospectively included 250 patients (266 renal lesions) who underwent a clinically indicated PVP abdominopelvic CT on a rapid-kilovoltage-switching single-source DECT (rsDECT) or a dual-source DECT (dsDECT) scanner.
We performed a multicenter retrospective cohort study of children with 14 days to 18 years of age in the United States from 2011 to 2016 with cancer or hematopoietic cell transplant (HCT) who were supported with veno-venous extracorporeal membrane oxygenation (V-V ECMO). We compared the outcomes of children with oncological diagnoses or HCT supported with V-V ECMO to other children who have received V-V ECMO support. In this cohort of 204 patients supported with V-V ECMO, 30 (15%) had a diagnosis of cancer or a history of HCT.
View Article and Find Full Text PDFArticle Synopsis
- Transplant-associated thrombotic microangiopathy (TA-TMA) is a serious complication that occurs in patients undergoing hematopoietic stem cell transplantation (HSCT), with a much higher incidence rate found in a single-center study compared to older studies that did not use systematic screening.
- In a multicenter study involving 614 pediatric patients, TA-TMA was found in 16% of cases diagnosed within a median of 22 days after transplant, affecting their health outcomes significantly.
- Results showed that patients with TA-TMA had higher rates of infections and longer hospital stays, leading to a lower overall survival rate (78%) compared to those without TA-TMA (93%), highlighting the importance of systematic screening for better patient management
Objectives: We obtained preliminary evidence on the efficacy of early prophylaxis on the risk of central venous catheter-associated deep venous thrombosis and its effect on thrombin generation in critically ill children.
Design: Bayesian phase 2b randomized clinical trial.
Setting: Seven PICUs.
Objectives: To serially evaluate health-related quality of life during the first year after community-acquired septic shock in children with preexisting severe developmental disabilities and explore factors associated with health-related quality of life changes in these children.
Design: Secondary analysis of the Life after Pediatric Sepsis Evaluation investigation.
Setting: Twelve academic PICU in the United States.