Publications by authors named "JD Truwit"
Article Synopsis
- Obstructive sleep apnoea increases risks during sedation in hospitals, prompting the implementation of the STOP-BANG screening to ensure proper respiratory monitoring for patients receiving sedatives, narcotics, or anxiolytics.
- * The STOP-BANG measure was integrated into the admission process, requiring monitoring via pulse oximetry and capnography for patients scoring ≥3 who were prescribed sedatives or narcotics.
- * An analysis of over 250,000 patients showed that after implementing the protocol, mortality rates for those on sedatives decreased and monitoring was particularly beneficial for high-risk patients with STOP-BANG scores of 5 or more.
Article Synopsis
- The institution faced a staffing crisis in respiratory therapy during the COVID-19 pandemic, which prompted the need to ease their workload by limiting the use of 3% hypertonic saline and N-acetylcysteine nebulizer therapies.
- A new policy was introduced that allowed respiratory therapists to stop administering these therapies if they didn't align with AARC Clinical Practice Guidelines, following a 3-month education period for relevant medical staff.
- After implementing the policy, there was a significant reduction in the number of treatments, orders, and required staff for these therapies, while maintaining stable levels of non-3%HTS/NAC treatments.
(1) Background: The disease-modifying mechanisms of high-dose intravenous vitamin C (HDIVC) in sepsis induced acute respiratory distress syndrome (ARDS) is unclear. (2) Methods: We performed a post hoc study of plasma biomarkers from subjects enrolled in the randomized placebo-controlled trial CITRIS-ALI. We explored the effects of HDIVC on cell-free DNA (cfDNA) and syndecan-1, surrogates for neutrophil extracellular trap (NET) formation and degradation of the endothelial glycocalyx, respectively.
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- Clinical decision-making often relies on clinicians' knowledge and experience, but this can lead to biases and variations in care, complicating the goal of providing only the right care.
- Current electronic health records (EHRs) mostly serve administrative purposes and contribute to clinician stress, lacking robust decision-support tools that could enhance personalized patient care.
- The proposed solution is "eActions," which are computer protocols designed to help clinicians make consistent, evidence-based decisions for patients, thereby improving healthcare quality and reducing unwarranted variations in treatment.
Background: The SARS-CoV-2 outbreak prompted public health interventions and changes in public behavior that may have affected the 2019-2020 influenza season.
Methods: Using data from a laboratory in southeastern Wisconsin, we compared the number of weekly influenza tests and their positivity rates during the 2019-2020 influenza season with the previous 4 seasons.
Results: The number of influenza tests per week at the outset of the SARS-CoV-2 outbreak was higher than the average the previous 4 years, and positivity rates declined to 0% earlier than any of the previous 4 seasons.
Importance: Experimental data suggest that intravenous vitamin C may attenuate inflammation and vascular injury associated with sepsis and acute respiratory distress syndrome (ARDS).
Objective: To determine the effect of intravenous vitamin C infusion on organ failure scores and biological markers of inflammation and vascular injury in patients with sepsis and ARDS.
Design, Setting, And Participants: The CITRIS-ALI trial was a randomized, double-blind, placebo-controlled, multicenter trial conducted in 7 medical intensive care units in the United States, enrolling patients (N = 167) with sepsis and ARDS present for less than 24 hours.
Acute respiratory distress syndrome (ARDS) is a clinically and biologically heterogeneous disorder associated with many disease processes that injure the lung, culminating in increased non-hydrostatic extravascular lung water, reduced compliance, and severe hypoxemia. Despite enhanced understanding of molecular mechanisms, advances in ventilatory strategies, and general care of the critically ill patient, mortality remains unacceptably high. The Berlin definition of ARDS has now replaced the American-European Consensus Conference definition.
View Article and Find Full Text PDFBackground: Acute kidney injury (AKI) commonly occurs in patients with sepsis and acute respiratory distress syndrome (ARDS).
Objective: To investigate whether statin treatment is protective against AKI in sepsis-associated ARDS.
Design: Secondary analysis of data from Statins for Acutely Injured Lungs in Sepsis (SAILS), a randomized controlled trial that tested the impact of rosuvastatin therapy on mortality in patients with sepsis-associated ARDS.
Purpose: We performed an individual patient data meta-analysis to assess the possible benefits and harms of statin therapy in adults with acute respiratory distress syndrome (ARDS) and to investigate effects in specific ARDS subgroups.
Methods: We identified randomised clinical trials up to 31 October 2016 that had investigated statin therapy versus placebo in patients with ARDS. Individual patient data from each trial were compiled.
Background: An update of evidence-based guidelines concerning liberation from mechanical ventilation is needed as new evidence has become available. The American College of Chest Physicians (CHEST) and the American Thoracic Society (ATS) have collaborated to provide recommendations to clinicians concerning liberation from the ventilator.
Methods: Comprehensive evidence syntheses, including meta-analyses, were performed to summarize all available evidence relevant to the guideline panel's questions.
Background: This clinical practice guideline addresses six questions related to liberation from mechanical ventilation in critically ill adults. It is the result of a collaborative effort between the American Thoracic Society (ATS) and the American College of Chest Physicians (CHEST).
Methods: A multidisciplinary panel posed six clinical questions in a population, intervention, comparator, outcomes (PICO) format.
Background: This clinical practice guideline addresses six questions related to liberation from mechanical ventilation in critically ill adults. It is the result of a collaborative effort between the American Thoracic Society and the American College of Chest Physicians.
Methods: A multidisciplinary panel posed six clinical questions in a Population, Intervention, Comparator, and Outcomes format.
An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests.
Am J Respir Crit Care Med
January 2017
Background: Interventions that lead to earlier liberation from mechanical ventilation can improve patient outcomes. This guideline, a collaborative effort between the American Thoracic Society and the American College of Chest Physicians, provides evidence-based recommendations to optimize liberation from mechanical ventilation in critically ill adults.
Methods: Two methodologists performed evidence syntheses to summarize available evidence relevant to key questions about liberation from mechanical ventilation.
Background: Surfactant has been shown to be dysfunctional in ARDS, and exogenous surfactant has proven effective in many forms of neonatal and pediatric acute lung injury (ALI). In view of the positive results of our studies in children along with evidence that surfactant-associated protein B containing pharmaceutical surfactants might be more effective, we designed a multiinstitutional, randomized, controlled, and masked trial of calfactant, a calf lung surfactant, in adults and children with ALI/ARDS due to direct lung injury.
Methods: Adult subjects within 48 h of initiation of mechanical ventilation for direct ARDS were randomized to receive up to three interventions with instilled calfactant vs air placebo.
Purpose: Extubation failure is associated with adverse outcomes in mechanically ventilated patients, and it is believed that high rates of failed planned extubation (FPE) should be avoided. However, many believe that very low rates may also correlate with adverse outcomes if resulting from overly conservative weaning practices. We examined the relationship between the percentage of FPE (%FPE) and associated outcomes, with the aim of elucidating a favorable middle range.
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