Publications by authors named "Frederick D'Aragon"
Background: The effect of a liberal red-cell transfusion strategy as compared with a restrictive strategy in patients during the critical care period after an aneurysmal subarachnoid hemorrhage is unclear.
Methods: We randomly assigned critically ill adults with acute aneurysmal subarachnoid hemorrhage and anemia to a liberal strategy (mandatory transfusion at a hemoglobin level of ≤10 g per deciliter) or a restrictive strategy (optional transfusion at a hemoglobin level of ≤8 g per deciliter). The primary outcome was an unfavorable neurologic outcome, defined as a score of 4 or higher on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability) at 12 months.
Objectives: Our primary objective was to assess the association between symptoms at the time of surgery and postoperative pulmonary complications and mortality in patients with COVID-19. Our secondary objective was to compare postoperative outcomes between patients who had recovered from COVID-19 and asymptomatic patients and explore the effect of the time elapsed between infection and surgery in the former. Our hypotheses were that symptomatic patients had a higher risk of pulmonary complications, whereas patients who had recovered from the infection would exhibit outcomes similar to those of asymptomatic patients.
View Article and Find Full Text PDFEarly In-Bed Cycle Ergometry With Critically Ill, Mechanically Ventilated Patients: Statistical Analysis Plan for CYCLE (Critical Care Cycling to Improve Lower Extremity Strength), an International, Multicenter, Randomized Clinical Trial.
JMIR Res Protoc
October 2024
Article Synopsis
- Survivors of critical illness often experience physical dysfunction post-ICU discharge, and the CYCLE trial aims to evaluate the effectiveness of in-bed cycle ergometry for improving short-term physical function in these patients.!* -
- The CYCLE trial, involving 360 patients across multiple centers, employs a prespecified statistical analysis plan to assess outcomes like the PFIT-s score three days after ICU discharge, while considering variables such as age, frailty, and sex.!* -
- Funded in 2017, the CYCLE study completed enrollment in May 2023, with data analyses finished and first results expected to be published in 2024.!*
Article Synopsis
- The study investigates how often to screen critically ill adults on ventilators and the best method for conducting spontaneous breathing trials (SBT) to successfully extubate them.
- It involves a randomized clinical trial with 797 participants who required mechanical ventilation, comparing once-daily and more frequent screenings alongside two SBT techniques: pressure-supported and T-piece.
- Results show no significant differences in the time to successful extubation based on screening frequency or SBT technique, indicating that both methods may be similarly effective.
First Nations are most at risk of developing end-stage kidney disease. Kidney transplantation is the best treatment option for these patients; however, First Nations donors are underrepresented. The aim of this study was to describe and understand barriers and facilitators of culturally safe organ transplantation and donation from the perspective of First Nations and Health Professionals in the Province of Quebec, Canada.
View Article and Find Full Text PDFArticle 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
- * A pilot randomized trial will involve 90 donors and 324 organ recipients across nine hospitals in Ontario and Québec, with participants receiving either tacrolimus or a placebo before organ retrieval.
- * Researchers will assess the trial's feasibility, including donor enrollment and recipient consent, while monitoring graft function and survival; findings will be shared publicly through publications and conferences.
Article Synopsis
- Critical illness requiring invasive mechanical ventilation can lead to significant physical disability, and early in-bed cycle ergometry may help reduce this impairment when added to standard physiotherapy in ICU patients.
- A study with 360 adult patients randomly assigned to either early in-bed cycling plus usual physiotherapy or just usual physiotherapy found no significant difference in physical function scores three days after ICU discharge.
- The addition of cycling did not result in any serious adverse events, indicating it is safe, but did not enhance recovery outcomes compared to standard therapy alone.
Article Synopsis
- The study aimed to analyze how sex and gender are considered in acute care trials and whether there have been changes in reporting practices since the 2016 guidelines on sex and gender equity in research.
- The systematic review included 88 trials published in major medical journals, finding that the representation of female participants was low at 34.2%, and only 28.4% reported race or ethnicity, predominantly featuring white and male participants.
- Results revealed limited use of sex and gender-based analysis (SGBA), with cardiovascular trials performing better than ICU trials, indicating a significant need for improvement in inclusivity and reporting practices in clinical research.*
Background: The amount of same-day surgery has increased markedly worldwide in recent decades, but there remains limited evidence on chronic postsurgical pain in this setting.
Methods: This study assessed pain 90 days after ambulatory surgery in an international, multicenter prospective cohort study of patients at least 45 yr old with comorbidities or at least 65 yr old. Pain was assessed using the Brief Pain Inventory.
Article Synopsis
- Donor interventions can potentially improve the quality and quantity of transplantable organs, but there's limited high-quality evidence due to ethical, practical, and regulatory challenges.
- A workshop of experts from Canada and the UK aimed to create guidance for conducting randomized controlled trials (RCTs) in this area, focusing on identifying stakeholders and unique challenges in donor intervention research.
- Key challenges include navigating research ethics, standardizing outcome data, and addressing regulatory issues, but addressing these can lead to better organ transplantation outcomes through well-designed donor intervention RCTs.
Intensive care unit healthcare workers (ICU HCW) are at risk of mental health disorders during emerging disease outbreaks. Numerous cross-sectional studies have reported psychological distress, anxiety, and depression amongst ICU HCW during the COVID-19 pandemic. However, few studies have followed HCW longitudinally, and none of these have examined the association between COVID-19 workload and mental health.
View Article and Find Full Text PDFPurpose: Regional anesthesia may favour postoperative rehabilitation by inhibiting peripheral sensitization and secondary hyperalgesia. The literature on this subject is limited. In the present FUNCTION study, we sought to compare the functional recovery post orthopedic wrist surgery with regional versus general anesthesia.
View Article and Find Full Text PDFImportance: Blood collection for laboratory testing in intensive care unit (ICU) patients is a modifiable contributor to anemia and red blood cell (RBC) transfusion. Most blood withdrawn is not required for analysis and is discarded.
Objective: To determine whether transitioning from standard-volume to small-volume vacuum tubes for blood collection in ICUs reduces RBC transfusion without compromising laboratory testing procedures.
Article Synopsis
- The FAST-NAWC trial is a multicenter study that aims to compare different screening frequencies and techniques for spontaneous breathing trials in critically ill patients on ventilation in 20 North American ICUs.
- The original protocols have been updated to include COVID-19 patients, and changes were made to the statistical analysis plan to accommodate data reporting for both COVID-19 and non-COVID-19 participants.
- The trial has been registered on Clinical Trials.gov, and this update outlines the key protocol modifications and their purpose before the final follow-up and data analysis phases.
Delirium is common after cardiac surgery and is associated with adverse outcomes. Administration of benzodiazepines before and after cardiac surgery is associated with delirium; guidelines recommend minimizing their use. Benzodiazepine administration during cardiac surgery remains common because of its recognized benefits.
View Article and Find Full Text PDFBackground: Preconditioning deceased organ donors with calcineurin inhibitors (CNIs) may reduce ischemia-reperfusion injury to improve transplant outcomes.
Methods: We searched MEDLINE, EMBASE, Cochrane Library, and conference proceedings for animal models of organ donation and transplantation, comparing donor treatment with CNIs with either placebo or no intervention, and evaluating outcomes for organ transplantation. Reviewers independently screened and selected studies, abstracted data, and assessed the risk of bias and clinical relevance of included studies.
Introduction: In-bed leg cycling with critically ill patients is a promising intervention aimed at minimising immobility, thus improving physical function following intensive care unit (ICU) discharge. We previously completed a pilot randomised controlled trial (RCT) which supported the feasibility of a large RCT. In this report, we describe the protocol for an international, multicentre RCT to determine the effectiveness of early in-bed cycling versus routine physiotherapy (PT) in critically ill, mechanically ventilated adults.
View Article and Find Full Text PDFThe purpose of this article is to document the development and validation process of an instrument adapted for French-speaking nurses and to measure the occurrence of omitted nursing care (ONC) in the intensive care unit (ICU). An electronic Delphi panel, involving ICU nursing experts from the province of Quebec (Canada), was used to develop the intensive care unit omitted nursing care (ICU-ONC) instrument. For the validation process, an electronic cross-sectional survey was conducted.
View Article and Find Full Text PDFResearch on deceased organ donors has been hindered by concerns related to seeking research consent from transplant recipients. We undertook this qualitative study to elucidate solid organ transplant recipients views on organ donor research, their role in the consent for such research, and their preferences related to providing their data. We conducted interviews with 18 participants and three themes emerged from the data.
View Article and Find Full Text PDFIntroduction: In donation after circulatory determination of death, death is declared 5 min after circulatory arrest. This practice assumes, but does not explicitly confirm, permanent loss of brain activity. While this assumption is rooted a strong physiological rationale, paucity of direct human data regarding temporal relationship between cessation of brain activity and circulatory arrest during the dying process threatens public and healthcare provider trust in deceased organ donation.
View Article and Find Full Text PDFUnlabelled: The objective of this review was to depict the physiological and clinical rationale for the use of vasopressin in hemodynamic support of organ donors. After summarizing the physiological, pharmacological concepts and preclinical findings, regarding vasopressin's pathophysiological impacts, we will present the available clinical data.
Data Sources: Detailed search strategies in PubMed, OVID Medline, and EMBASE were undertaken using Medical Subject Headings and Key Words.