Publications by authors named "K R Rowan"
Background: Peripheral oxygen saturation (SpO) above 94% is typical in children in paediatric intensive critical care units (PICUs) who are receiving invasive ventilation and supplemental oxygen. In a previous report from the Oxy-PICU trial, we showed that lower (conservative) oxygenation targets (SpO 88-92%) are beneficial, showing small but statistically significant differences in duration of organ support and large but non-significant cost reductions at 30 days. In this pre-specified analysis of the Oxy-PICU trial, we compare longer-term outcomes and cost-effectiveness of conservative versus liberal (SpO >94%) oxygenation targets in children with emergency PICU admission.
View Article and Find Full Text PDFObjectives: To explain key challenges to evaluating Center for Medicare and Medicaid Innovation (CMMI) accountable care organization (ACO) models and ways to address those challenges.
Study Design: We enumerate the challenges, beginning with the conception of the alternative payment model and extending through the decision to scale up the model should the initial evaluation suggest that the model is successful. The challenges include churn at the provider and ACO levels, beneficiary leakage and spillover, participation in prior payment models, and determinants of shared savings and penalties.
Background: High flow nasal cannula therapy (HFNC) and continuous positive airway pressure (CPAP) are two widely used modes of non-invasive respiratory support in paediatric critical care units. The FIRST-ABC randomised controlled trials (RCTs) evaluated the clinical and cost-effectiveness of HFNC compared with CPAP in two distinct critical care populations: acutely ill children ('step-up' RCT) and extubated children ('step-down' RCT). Clinical effectiveness findings (time to liberation from all forms of respiratory support) showed that HFNC was non-inferior to CPAP in the step-up RCT, but failed to meet non-inferiority criteria in the step-down RCT.
View Article and Find Full Text PDFArticle Synopsis
- The study aimed to determine if setting a lower mean arterial blood pressure (MAP) target could reduce 90-day all-cause mortality in critically ill patients with vasodilatory shock compared to a higher MAP target.
- Researchers performed a meta-analysis of randomized controlled trials involving 3,352 patients across several countries, using statistical models to analyze the data.
- The results suggested that a lower MAP target might be associated with a slight reduction in mortality risk, but the evidence is uncertain, indicating that it does not rule out the possibility of potential harm from lower targets.
Article Synopsis
- Despite previous trials, it's still unclear how to effectively resuscitate patients with septic shock, prompting a deeper look into individual differences in treatment responses.
- The study utilized machine learning to predict individual patient risk differences and evaluate how their characteristics affected treatment effectiveness across two large cohorts.
- Results indicated significant variability in treatment responses; patients predicted to have the highest risks improved with early goal-directed therapy (EGDT), while those at lower risk potentially faced harm from the same treatment.