Publications by authors named "Jan O Friedrich"
Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections.
N Engl J Med
November 2024
Background: Bloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain.
Methods: In a multicenter, noninferiority trial, we randomly assigned hospitalized patients (including patients in the intensive care unit [ICU]) who had bloodstream infection to receive antibiotic treatment for 7 days or 14 days.
Article Synopsis
- A study was conducted to evaluate a machine learning-based early warning system aimed at improving patient outcomes in a general internal medicine (GIM) unit at a hospital, focusing on its effect on non-palliative in-hospital deaths.
- The research compared patient data from before and after the system's implementation, looking at admissions from Nov. 2016 to Jun. 2022, using various statistical methods to analyze the results.
- Findings showed that the intervention period had a significant reduction in non-palliative deaths in the GIM unit, with a lower risk of mortality for high-risk patients receiving alerts, while no such improvements were observed in other medical units.
Article Synopsis
- Researchers wanted to find out which method of helping people breathe (called the Spontaneous Breathing Trial, or SBT) worked best for those who are really sick and need help with breathing tubes.
- They looked at a bunch of studies involving over 6,700 patients to compare different SBT methods, focusing on how well they helped people breathe on their own without needing tubes again.
- Results showed that methods using support like Pressure Support (PS) and Automatic Tube Compensation (ATC) were better at helping patients breathe and stay off the breathing tubes compared to a method called T-piece, but some of these methods had a higher chance of needing to put the tube back in.
Article Synopsis
- Severe acute respiratory distress syndrome (ARDS) with low PaO/FiO levels is life-threatening, and this study aimed to compare different management methods like low tidal volumes, moderate tidal volumes, prone ventilation, and venovenous ECMO on patient mortality.
- A meta-analysis included 10 randomized controlled trials involving 812 participants, revealing that both VV-ECMO and prone ventilation significantly reduced mortality compared to low and moderate tidal volume strategies.
- Though VV-ECMO showed some advantages, the comparison between VV-ECMO and prone ventilation remains unclear due to limited and indirect evidence.
Background: There is mounting evidence at experienced centers that aortic annular enlargement (AAE) procedures are safe adjuncts to surgical aortic valve replacement (SAVR) that do not increase perioperative morbidity and mortality. This systematic review and meta-analysis aims to assess the impact of AAE procedures on mid-term outcomes after SAVR.
Methods: OVID MEDLINE, OVID Embase, and Cochrane Library were searched comprehensively.
Background: Reverse triggering (RT) was described in 2013 as a form of patient-ventilator asynchrony, where patient's respiratory effort follows mechanical insufflation. Diagnosis requires esophageal pressure (P) or diaphragmatic electrical activity (EA), but RT can also be diagnosed using standard ventilator waveforms.
Hypothesis: We wondered (1) how frequently RT would be present but undetected in the figures from literature, especially before 2013; (2) whether it would be more prevalent in the era of small tidal volumes after 2000.
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.*
Importance: Considerable controversy exists regarding the best spontaneous breathing trial (SBT) technique to use.
Objective: To summarize trials comparing alternative SBTs.
Data Sources: Several databases (MEDLINE [from inception to February 2023], the Cochrane Central Register of Controlled Trials [in February 2023], and Embase [from inception to February 2023] and 5 conference proceedings (from January 1990 to April 2023) were searched in this systematic review and meta-analysis.
Background: Kinetic asymmetries during sit-to-stand have been consistently observed early after total knee arthroplasty; however, the longer-term outcomes are less clear. The purpose of this systematic review and meta-analysis was to analyze the results of studies examining inter-limb kinetic symmetry during sit-to-stand performance among individuals who were at least one-year post unilateral total knee arthroplasty.
Methods: PubMed, SPORTDiscus, CINAHL, and Health Source databases were searched.
Objectives: All-cause mortality is a common measure of treatment effect in ICU-based randomized clinical trials (RCTs). We sought to understand the performance characteristics of a mortality endpoint by evaluating its temporal course, responsiveness to differential treatment effects, and impact when used as an outcome measure in trials of acute illness.
Data Sources: We searched OVID Medline for RCTs published from 1990 to 2018.
Article Synopsis
- Some sick patients in the ICU get a lot of blood tests, and many of them aren't really needed.
- A study in Toronto aimed to cut down on these unnecessary blood tests over a year by educating staff and changing how tests were ordered.
- After the changes, they found that the amount of blood taken from each patient went down, and they saved a lot of blood tubes, but there was no change in how long patients stayed in the ICU or in their chances of survival.
Article Synopsis
- Tracheostomy is frequently performed on critically ill patients needing extended mechanical ventilation, and this study analyzed the outcomes of such patients after one year, comparing those who received tracheostomy to those who did not.
- Out of 398 ICU survivors, nearly half underwent tracheostomy, leading to longer hospital stays and increased risk of readmission, though their one-year mortality rates were similar to non-tracheostomy patients.
- Over the year, tracheostomy patients faced worse functional outcomes, such as lower scores on assessed physical and health-related metrics, while similar rates of follow-up visits and readmissions were observed between both groups.
Background: Left ventricular assist device (LVAD) implantation via lateral thoracotomy can offer similar effectiveness to conventional approaches with less perioperative adverse events. We performed a systematic review and meta-analysis to determine the potential benefits of lateral thoracotomy (LT) for LVAD implantation compared to median sternotomy.
Methods: We searched MEDLINE and Embase databases for studies comparing continuous-flow LVAD implantation using LT with conventional sternotomy.
Importance: The COVID-19 pandemic created the need for rapid and urgent guidance for clinicians to manage COVID-19 among patients and prevent transmission.
Objective: To appraise the quality of clinical practice guidelines (CPGs) using the National Academy of Medicine (NAM) criteria.
Evidence Review: A search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials to December 14, 2020, and a search of related articles to February 28, 2021, that included CPGs developed by societies or by government or nongovernment organizations that reported pharmacologic treatments of hospitalized patients with COVID-19.
Background: Extubation to non-invasive ventilation (NIV) has been investigated as a strategy to wean critically ill adults from invasive ventilation and reduce ventilator-related complications.
Methods: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, proceedings of four conferences and bibliographies (to June 2020) for randomised and quasi-randomised trials that compared extubation with immediate application of NIV to continued invasive weaning in intubated adults and reported mortality (primary outcome) or other outcomes. Two reviewers independently screened citations, assessed trial quality and abstracted data.
Article Synopsis
- Prolonged mechanical ventilation significantly affects life expectancy for patients with spinal cord injuries (SCI), leading this systematic review to analyze weaning success, ventilation duration, and mortality rates.
- The review included 39 studies with 14,637 adult patients, mostly with cervical lesions, revealing varied outcomes based on whether patients were in ICUs or rehabilitation centers.
- Findings showed a 63% weaning success rate and 8% mortality in ICUs, while rehabilitation centers had an 82% success rate with only 1% mortality, indicating potential benefits of early rehab intervention, though inconsistencies in defining weaning success were noted.
Article Synopsis
- The study evaluated the use of neuromuscular blockade (NMB) in patients on high-frequency oscillatory ventilation (HFOV) and its association with mortality rates.
- NMB was given to 376 out of 548 patients, who showed poorer lung function and higher hospital mortality compared to those who did not receive NMB.
- Despite these findings, NMB use itself did not contribute to the higher mortality associated with HFOV treatments.
Background: Clinicians use several measures to ascertain whether individual patients will tolerate liberation from mechanical ventilation, including the rapid shallow breathing index (RSBI).
Research Question: Given varied use of different thresholds, patient populations, and measurement characteristics, how well does RSBI predict successful extubation?
Study Design And Methods: We searched six databases from inception through September 2019 and selected studies reporting the accuracy of RSBI in the prediction of successful extubation. We extracted study data and assessed quality independently and in duplicate.
Background: The burden of frailty on cardiac surgical outcomes is incompletely understood. Here we perform a systematic review and meta-analysis of studies comparing frail versus pre-frail versus non-frail patients following cardiac surgery.
Methods: We searched MEDLINE and EMBASE databases until July 2018 for studies comparing cardiac surgery outcomes in "frail", "pre-frail" and "non-frail" patients.
Background: Transition from continuous renal replacement therapy (CRRT) to intermittent renal replacement therapy (IRRT) can be associated with intra-dialytic hypotension (IDH) although data to inform the definition of IDH, its incidence and clinical implications, are lacking. We aimed to describe the incidence and factors associated with IDH during the first IRRT session following transition from CRRT and its association with hospital mortality. This was a retrospective single-center cohort study in patients with acute kidney injury for whom at least one CRRT-to-IRRT transition occurred while in intensive care.
View Article and Find Full Text PDFBackground: The minimum duration of pulselessness required before organ donation after circulatory determination of death has not been well studied.
Methods: We conducted a prospective observational study of the incidence and timing of resumption of cardiac electrical and pulsatile activity in adults who died after planned withdrawal of life-sustaining measures in 20 intensive care units in three countries. Patients were intended to be monitored for 30 minutes after determination of death.
Background: Intensive care unit (ICU) patients are at high risk of anemia, and phlebotomy is a potentially modifiable source of blood loss. Our objective was to quantify daily phlebotomy volume for ICU patients, including blood discarded as waste during vascular access, and evaluate the impact of phlebotomy volume on patient outcomes.
Methods: This was a retrospective observational cohort study between September 2014 and August 2015 at a tertiary care academic medical-surgical ICU.