Publications by authors named "Herridge M"
Background: Survivorship after coronavirus disease 2019 (COVID-19) critical illness may be associated with important long-term sequelae, but little is known regarding mental health outcomes.
Research Question: What is the association between COVID-19 critical illness and new post-discharge mental health diagnoses.
Study Design: AND METHODS: We conducted a population-based cohort study in Ontario, Canada (January 1, 2020-March 31, 2022).
Purpose: To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resource-limited settings.
Methods: An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacific Sepsis Alliance (APSA). The committee selected an international panel of clinicians and researchers with expertise in sepsis management.
Background: People with disabilities are at elevated risk of adverse short-term outcomes following hospitalization for acute infectious illness. No prior studies have compared long-term healthcare use among this high-risk population. We compared the healthcare use of adults with disabilities in the one year following hospitalization for COVID-19 vs.
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- 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.!*
The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented.
View Article and Find Full Text PDFPurpose: Physical rehabilitation (PR) in the intensive care unit (ICU) may improve outcomes for survivors but clinical trial results have been discordant. We hypothesized that discordant results may reflect treatment heterogeneity received by "usual care" comparator groups in PR studies. Usual-care PR is typically underspecified, which is a barrier to comparing results across treatment studies.
View Article and Find Full Text PDFPurpose Of Review: To highlight the emerging crisis of critically ill elderly patients and review the unique burden of multidimensional morbidity faced by these patients and caregivers and potential interventions.
Recent Findings: Physical, psychological, and cognitive sequelae after critical illness are frequent, durable, and robust across the international ICU outcome literature. Elderly patients are more vulnerable to the multisystem sequelae of critical illness and its treatment and the resultant multidimensional morbidity may be profound, chronic, and significantly affect functional independence, transition to the community, and quality of life for patients and families.
Background: Cardiogenic shock due to acute myocardial infarction (AMI-CS) is associated with significant short- and long-term morbidity and mortality. Despite this, little is known about associated cost.
Objectives: The purpose of this study was to evaluate the health care costs and resource use associated with AMI-CS using administrative data from the province of Ontario, Canada.
Recovery from sepsis is a key global health issue, impacting 38 million sepsis survivors worldwide per year. Sepsis survivors face a wide range of physical, cognitive, and psychosocial sequelae. Readmissions to hospital following sepsis are an important driver of global healthcare utilization and cost.
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- 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.
Objectives: To estimate the expected value of undertaking a future randomized controlled trial of thresholds used to initiate invasive ventilation compared with usual care in hypoxemic respiratory failure.
Perspective: Publicly funded healthcare payer.
Setting: Critical care units capable of providing invasive ventilation and unconstrained by resource limitations during usual (nonpandemic) practice.
Purpose: Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short- and long-term morbidity and mortality. However, there are limited data on mental health sequelae that survivors experience following discharge.
Methods: We conducted a retrospective, population-based cohort study in Ontario, Canada of critically ill adult (≥ 18 years) survivors of AMI-CS, admitted to hospital between April 1, 2009 and March 31, 2019.
Purpose: Patients with hematologic malignancy (HM) commonly develop critical illness. Their long-term survival and functional outcomes have not been well described.
Methods: We conducted a prospective, observational study of HM patients admitted to seven Canadian intensive care units (ICUs) (2018-2020).
This statement outlines a review of the literature and current practice concerning the prevalence, clinical significance, diagnosis and management of dyspnoea in critically ill, mechanically ventilated adult patients. It covers the definition, pathophysiology, epidemiology, short- and middle-term impact, detection and quantification, and prevention and treatment of dyspnoea. It represents a collaboration of the European Respiratory Society (ERS) and the European Society of Intensive Care Medicine (ESICM).
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- The statement reviews the literature regarding dyspnoea in critically ill, mechanically ventilated adults, focusing on its prevalence, diagnosis, and management.
- Dyspnoea is a significant source of distress, with around 40% of ICU patients on ventilation experiencing it at high intensity, eliciting a strong fear response.
- The importance of identifying, preventing, and alleviating dyspnoea in ICU patients is emphasized, as healthcare has concentrated more on pain management while respiratory distress is often overlooked.
Article Synopsis
- The healthcare system needs to rethink how it treats very old patients (over 80 years) who are seriously ill, especially due to changes in population and finances.
- It's important to include doctors, patients, and their families in decisions about care so that resources are used wisely without doing too much or too little.
- This review offers ideas from experts to help make better decisions before, during, and after ICU care, focusing on improving the patient's quality of life instead of just preventing death.
Article Synopsis
- This study investigates the long-term health outcomes of survivors of cardiogenic shock (CS) using clinical data collected from ICU patients to identify distinct survivor phenotypes and their associated risks.
- Two main phenotypes of CS survivors were discovered: Phenotype A, which showed better overall health outcomes, and Phenotype B, which had worse health markers and a significantly higher risk of mortality within one year of ICU discharge.
- Patients in Phenotype B exhibited more severe symptoms and disabilities, including higher levels of anemia and inflammation, leading to poorer quality of life and increased mortality risk compared to those in Phenotype A.
Article Synopsis
- Despite advances in critical care, there’s a lack of focus on sex and gender disparities affecting ICU patient management and outcomes.
- Sex refers to biological traits, while gender encompasses sociocultural roles; current data on these differences in the ICU is inconsistent and insufficient.
- Addressing these disparities is essential for improving patient care, requiring future research on the mechanisms behind these differences and development of targeted interventions for better outcomes.
Background: Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short-term mortality; however, there are limited data on long-term outcomes and trends.
Objectives: This study sought to examine long-term outcomes of AMI-CS patients.
Methods: This was a population-based, retrospective cohort study in Ontario, Canada of critically ill adult patients with AMI-CS who were admitted to hospitals between April 1, 2009 and March 31, 2019.
A New Global Definition of Acute Respiratory Distress Syndrome.
Am J Respir Crit Care Med
January 2024
Since publication of the 2012 Berlin definition of acute respiratory distress syndrome (ARDS), several developments have supported the need for an expansion of the definition, including the use of high-flow nasal oxygen, the expansion of the use of pulse oximetry in place of arterial blood gases, the use of ultrasound for chest imaging, and the need for applicability in resource-limited settings. A consensus conference of 32 critical care ARDS experts was convened, had six virtual meetings (June 2021 to March 2022), and subsequently obtained input from members of several critical care societies. The goal was to develop a definition that would ) identify patients with the currently accepted conceptual framework for ARDS, ) facilitate rapid ARDS diagnosis for clinical care and research, ) be applicable in resource-limited settings, ) be useful for testing specific therapies, and ) be practical for communication to patients and caregivers.
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