Publications by authors named "Jonathon P Fanning"
Background: In this COVID-19 Critical Care Consortium (CCCC) sub-study, we qualified neurological complications associated with SARS-CoV2 infection.
Methods: The CCCC is an international, multicenter study. Eligible patients were COVID-19 patients admitted to intensive care units (ICU) across 23 centers between 1/7/2020 to 6/23/2022.
Background: Packed red blood cell (pRBC) transfusion is a relatively safe and mainstay treatment commonly used in cardiac surgical patients. However, there is limited evidence on clinical effects of transfusing blood nearing end-of shelf life that has undergone biochemical changes during storage.
Objective: To investigate evidence of associations between morbidity/mortality and transfusion of blood near end of shelf-life (> 35 days) in cardiac surgical patients.
Article Synopsis
- The study investigates the survival outcomes of adult COVID-19 patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) across different regions and timeframes, analyzing data from 1060 patients in 351 institutions worldwide between January 2020 and December 2021.
- It found that the in-hospital mortality rate for the overall cohort was 47.12%, with notable differences in mortality trends among regions, especially a spike in deaths in North America and Europe during mid-2020, while Latin America maintained better survival rates for longer.
- The results suggest that various factors, including the timing of ECMO initiation and patient demographics, contribute to mortality variances, emphasizing the need for improved patient selection
Article Synopsis
- ECMO is utilized as a critical therapy for COVID-19 patients suffering from severe ARDS, but bleeding and thrombotic complications are significant issues during treatment.
- Data from a global study involving over 1,200 severe COVID-19 patients on ECMO indicates that 38% experienced coagulation issues, with 54% facing hemorrhagic complications and higher mortality rates among those with bleeding.
- The study suggests that while coagulation disorders are common and serious in these patients, the associated mortality risk may be lower than earlier reports from single-nation studies.
Article Synopsis
- The study examines the connection between initial neurological symptoms of COVID-19 and long-term neurological issues (PANSC) in hospitalized adults across 407 international sites from January 2020 to April 2022.
- It analyzes the prevalence and risk factors for PANSC, with a focus on how male and female patients experience symptom resolution over time.
- Results show that fatigue and muscle/joint pain were the most common symptoms post-hospitalization, with a higher prevalence in females compared to males, and highlights differences in ICU admission rates and mechanical ventilation usage between the sexes.
Article Synopsis
- * Patients who experience perioperative strokes face worse outcomes compared to those who have strokes in the community, including higher mortality rates and increased long-term disability.
- * There is a need for tailored clinical guidelines for perioperative strokes, as existing recommendations are primarily based on community strokes and may not fully address the unique aspects of strokes that occur in the hospital setting.
Article Synopsis
- * It involved 100 trauma patients and assessed the consistency of four measurement methods: ROTEM® Delta, ROTEM® Sigma, TEG® 6s, and the standard Clauss Fibrinogen measure.
- * Results showed that ROTEM® machines (both Delta and Sigma) performed similarly for fibrinogen levels, indicating these assays could be used interchangeably in clinical settings to support patient resuscitation efforts.
Article Synopsis
- Shock-induced endotheliopathy (SHINE) is a condition characterized by severe endothelial dysfunction due to extreme sympathetic activation during shock states, which can worsen organ perfusion despite aggressive resuscitation efforts.
- This study systematically reviewed literature from Jan 2011 to July 2023, focusing on how resuscitation can affect endothelial health in critically ill patients, while excluding animal studies and reviews.
- Out of 32 relevant studies analyzed, many identified biomarkers related to endothelial damage, but only a few comparable studies were suitable for a quantitative meta-analysis on specific markers like syndecan-1 and thrombomodulin, indicating significant variability in the results.
Guidelines for transcatheter aortic valve replacement (TAVR) antithrombotic prophylaxis are extrapolated predominantly from percutaneous coronary intervention (PCI) data. Here, we examined temporal coagulation changes occurring in the early perioperative period to determine the pathobiologic validity of this supposition. This was a prospective observational study of consecutive patients who underwent transfemoral TAVR (n = 27), PCI (n = 12), or surgical aortic valve replacement (SAVR) requiring cardiopulmonary bypass and cross-clamping (n = 12).
View Article and Find Full Text PDFBackground: Influenza-associated pulmonary aspergillosis (IAPA) increasingly is being reported in critically ill patients. We conducted this systematic review and meta-analysis to examine the prevalence, risk factors, clinical features, and outcomes of IAPA.
Study Question: What are the prevalence, risk factors, clinical features, and outcomes of IAPA in critically ill patients?
Study Design And Methods: Studies reporting IAPA were searched in the following databases: PubMed MEDLINE, CINAHL, Cochrane Library, Embase, Scopus, Cochrane Trials, and ClinicalTrials.
Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry.
Res Pract Thromb Haemost
July 2023
Article Synopsis
- COVID-19 coagulopathy complications were investigated in a study comparing low- and middle-income countries (LMICs) to high-income countries (HICs), focusing on their frequency and impact on in-hospital mortality.
- The study involved 495,682 patients from 52 countries, showing higher rates of complications and associated mortality in HICs (0.76%-3.4%) compared to LMICs (0.09%-1.22%), with more severe cases in advanced treatment cohorts.
- Findings indicated that coagulopathy complications significantly increased in-hospital mortality, particularly in LMICs (58.5%) compared to HICs (35.4%), suggesting that patients in LMICs face
Article Synopsis
- This study examined the impact of transfusing blood products that are close to their shelf-life on clinical outcomes in obstetric patients in Queensland, Australia, from 2007 to 2013.
- Comparing fresh (less than 21 days old for RBC, less than 3 days for PLT) to old blood products (35 days or older for RBC, 4 days or older for PLT), researchers found no significant difference in patient outcomes such as hospital stay length or morbidity.
- The results indicated that using older RBC or PLT did not lead to higher rates of complications or mortality among the patients studied.
Article Synopsis
- ECMO is increasingly used to support patients with respiratory failure who are awaiting lung transplants, but evidence for its effectiveness in this role is still limited.
- A study analyzed data from 40,866 lung transplant patients over nearly two decades (2000-2019) to evaluate trends in patient characteristics, demographics, and mortality outcomes for those on ECMO compared to those not on it.
- Results indicate that while ECMO patients are increasingly older and sicker, their post-transplant survival rates have improved significantly in recent years, reflecting better outcomes overall for both ECMO and non-ECMO groups.
Objectives: Evidence of cerebrovascular complications in COVID-19 requiring venovenous extracorporeal membrane oxygenation (ECMO) is limited. Our study aims to characterize the prevalence and risk factors of stroke secondary to COVID-19 in patients on venovenous ECMO.
Design: We analyzed prospectively collected observational data, using univariable and multivariable survival modeling to identify risk factors for stroke.
Objectives: To determine the prevalence and outcomes associated with hemorrhage, disseminated intravascular coagulopathy, and thrombosis (HECTOR) complications in ICU patients with COVID-19.
Design: Prospective, observational study.
Setting: Two hundred twenty-nine ICUs across 32 countries.
Article Synopsis
- This study investigates the effect of early use of neuromuscular blocking agents (NMBAs) on 90-day mortality in COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS).
- A sample of 1953 patients from multiple intensive care units was analyzed, comparing those who received NMBAs early to those who did not or received them later.
- Results show that there was no significant difference in 90-day mortality between the two groups, and while there were some differences in ventilator-free days, they were not conclusive, indicating that early NMBA use may not improve outcomes in this patient population.
Noncardiac surgery conveys a substantial risk of secondary organ dysfunction and injury. Neurocognitive dysfunction and covert stroke are emerging as major forms of perioperative organ dysfunction, but a better understanding of perioperative neurobiology is required to identify effective treatment strategies. The likelihood and severity of perioperative brain injury may be increased by intraoperative hemodynamic dysfunction, tissue hypoperfusion, and a failure to recognize complications early in their development.
View Article and Find Full Text PDFObjectives: Fluid bolus resuscitation in African children is harmful. Little research has evaluated physiologic effects of maintenance-only fluid strategy.
Design: We describe the efficacy of fluid-conservative resuscitation of septic shock using case-fatality, hemodynamic, and myocardial function endpoints.
Background: The influence of renin-angiotensin-aldosterone system (RAAS) inhibitors on the critically ill COVID-19 patients with pre-existing hypertension remains uncertain. This study examined the impact of previous use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) on the critically ill COVID-19 patients.
Methods: Data from an international, prospective, observational cohort study involving 354 hospitals spanning 54 countries were included.
Article Synopsis
- SARS-CoV-2 infection is linked to severe neurological complications, making it crucial to identify at-risk patients and anticipate healthcare resource needs.
- A review analyzed 14 cohort studies and 53 case reports involving 8,577 hospitalized COVID-19 patients, documenting various central and peripheral nervous system issues.
- The estimated prevalence of ischemic stroke in hospitalized patients was 1.3%, with higher rates in ICU, highlighting a significant long-term neurological burden that needs further research for better understanding and management.
Article Synopsis
- The study explored the effects of high flow nasal oxygen (HFNO) versus conventional oxygen therapy on patients with obesity after bariatric surgery, focusing on respiratory mechanics using electrical impedance tomography (EIT).
- Fifty patients participated in the trial, showing a higher delta end-expiratory lung index (EELI) in the HFNO group at 1 hour, but no significant differences in respiratory function or postoperative complications after 6 hours.
- The conclusion indicated that conducting a large-scale RCT on HFNO for this patient group may be impractical, suggesting that future research should aim at identifying patients most at risk for pulmonary complications.
Background: The initial research requirements in pandemics are predictable. But how is it possible to study a disease that is so quickly spreading and to rapidly use that research to inform control and treatment?
Main Body: In our view, a dilemma with such wide-reaching impact mandates multi-disciplinary collaborations on a global scale. International research collaboration is the only means to rapidly address these fundamental questions and potentially change the paradigm of data sharing for the benefit of patients throughout the world.
Background: Heterogeneous respiratory system static compliance (C) values and levels of hypoxemia in patients with novel coronavirus disease (COVID-19) requiring mechanical ventilation have been reported in previous small-case series or studies conducted at a national level.
Methods: We designed a retrospective observational cohort study with rapid data gathering from the international COVID-19 Critical Care Consortium study to comprehensively describe C-calculated as: tidal volume/[airway plateau pressure-positive end-expiratory pressure (PEEP)]-and its association with ventilatory management and outcomes of COVID-19 patients on mechanical ventilation (MV), admitted to intensive care units (ICU) worldwide.
Results: We studied 745 patients from 22 countries, who required admission to the ICU and MV from January 14 to December 31, 2020, and presented at least one value of C within the first seven days of MV.
Background: Silent brain infarcts (SBIs) are frequently identified after transcatheter aortic valve implantation (TAVI), when patients are screened with diffusion-weighted magnetic resonance imaging (DW-MRI). Outside the cardiac literature, SBIs have been correlated with progressive cognitive dysfunction; however, their prognostic utility after TAVI remains uncertain. This study's main goals were to explore (i) the incidence of and potential risk factors for SBI after TAVI; and (ii) the effect of SBI on early post-procedural cognitive dysfunction (PCD).
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