Publications by authors named "Robert Hyzy"
Article Synopsis
- The study investigates how often to screen critically ill adults on ventilators and the best method for conducting spontaneous breathing trials (SBT) to successfully extubate them.
- It involves a randomized clinical trial with 797 participants who required mechanical ventilation, comparing once-daily and more frequent screenings alongside two SBT techniques: pressure-supported and T-piece.
- Results show no significant differences in the time to successful extubation based on screening frequency or SBT technique, indicating that both methods may be similarly effective.
Article Synopsis
- Phenobarbital (PHB) is found to be a safe and effective alternative to benzodiazepines (BZD) for treating severe alcohol withdrawal syndrome (AWS), but its safety in patients previously treated with BZD is unclear.
- A study compared critically ill patients with severe AWS receiving either PHB or BZD in the ICU to assess outcomes such as resolution of altered mentation, seizures, and length of hospital stay.
- Results showed no significant difference in the primary outcome between the two groups, but fewer seizures occurred in the PHB group, indicating that PHB may be a viable treatment option after BZD if patients are still experiencing uncontrolled withdrawal.
Background: Delirium is common during critical illness and is associated with long-term cognitive impairment and disability. Antipsychotics are frequently used to treat delirium, but their effects on long-term outcomes are unknown. We aimed to investigate the effects of antipsychotic treatment of delirious, critically ill patients on long-term cognitive, functional, psychological, and quality-of-life outcomes.
View Article and Find Full Text PDFWe present a case of reverse McConnell's sign, a rare echocardiographic finding of right ventricular apical hypokinesis and basal hyperkinesis, in a patient with acute respiratory distress syndrome and septic shock. Although multiple etiologies were hypothesized, providers attributed this cardiomyopathy to increased right heart afterload from hypoxic pulmonary vasoconstriction. Cardiac function normalized as the patient's respiratory failure and sepsis resolved.
View Article and Find Full Text PDFArticle Synopsis
- The study aimed to address diagnostic errors in respiratory cultures for ventilator-associated pneumonia (VAP) through a new diagnostic stewardship intervention (VAP-DSI) in intensive care units.
- Researchers implemented various strategies, including strict access to respiratory cultures and using specific methods for sample collection, and compared outcomes between patients after the intervention and a control group prior to it.
- Results showed that the VAP-DSI was safe and effectively reduced both the rate of positive cultures and the use of broad-spectrum antibiotics, suggesting it could improve antimicrobial stewardship in ICUs.
Article Synopsis
- The FAST-NAWC trial is a multicenter study that aims to compare different screening frequencies and techniques for spontaneous breathing trials in critically ill patients on ventilation in 20 North American ICUs.
- The original protocols have been updated to include COVID-19 patients, and changes were made to the statistical analysis plan to accommodate data reporting for both COVID-19 and non-COVID-19 participants.
- The trial has been registered on Clinical Trials.gov, and this update outlines the key protocol modifications and their purpose before the final follow-up and data analysis phases.
Article Synopsis
- The study aimed to assess the impact of P2Y12 inhibitors, specifically ticagrelor, on critically ill COVID-19 patients, as platelet activation may be a new treatment target.
- Conducted as a randomized clinical trial, it included 949 patients who were assigned to receive either the P2Y12 inhibitor or usual care for up to 14 days.
- Results showed a small increase in organ support-free days for those on the inhibitor, but the effect was uncertain due to overlapping confidence intervals, and the trial was terminated early due to slow enrollment.
Background: Chronic hypercapnic respiratory failure is associated with high mortality. Although previous work has demonstrated a mortality improvement with high-intensity noninvasive ventilation in COPD, it is unclear whether a P reduction strategy is associated with improved outcomes in other populations of chronic hypercapnia.
Methods: The objective of this study was to investigate the association between P reduction (by using transcutaneous P as an estimate for P and survival in a broad population of individuals treated with noninvasive ventilation for chronic hypercapnia.
Article Synopsis
- The guideline aims to create evidence-based recommendations for ICU clinicians treating adults with acute liver failure (ALF) or acute on chronic liver failure (ACLF).
- A panel of 27 experts conducted systematic reviews and categorized their findings into Population, Intervention, Comparison, and Outcomes (PICO) questions to guide clinical practice.
- The resulting 28 recommendations include five strong recommendations and 21 conditional ones, but many are based on low-quality evidence, highlighting areas that need further research.
Current guidelines recommend extubation only if a patient is not receiving vasopressor therapy or is receiving minimal doses of vasopressors. However, recent data indicate that extubation of patients receiving higher vasopressor doses may be safe. This study was undertaken to examine practices regarding extubation of patients receiving vasopressor therapy reported by clinician respondents to a survey by the Michigan Health and Hospital Association Keystone Center.
View Article and Find Full Text PDFSepsis causes significant morbidity and mortality worldwide. Resuscitation is a cornerstone of management. This review covers five areas of evolving practice in the management of early sepsis-induced hypoperfusion: fluid resuscitation volume, timing of vasopressor initiation, resuscitation targets, route of vasopressor administration, and use of invasive blood pressure monitoring.
View Article and Find Full Text PDFBackground: In patients with acute respiratory distress syndrome undergoing mechanical ventilation, positive end-expiratory pressure (PEEP) can lead to recruitment or overdistension. Current strategies utilized for PEEP titration do not permit the distinction. Electric impedance tomography (EIT) detects and quantifies the presence of both collapse and overdistension.
View Article and Find Full Text PDFArticle Synopsis
- The study reviews the principles of electrical impedance tomography (EIT) and explores its usefulness in managing acute respiratory distress syndrome (ARDS) by examining existing literature.
- EIT can improve understanding of treatment strategies for ARDS, such as monitoring patient response to various interventions like prone positioning and adjusting respiratory support settings.
- While EIT shows promise for personalized ARDS care, further clinical trials are necessary to confirm its effects on significant health outcomes in affected patients.
Background: SARS-CoV-2-related ARDS is associated with endothelial dysfunction and profound dysregulation of the thrombotic-fibrinolytic pathway. Defibrotide is a polyanionic compound with fibrinolytic, antithrombotic, and antiinflammatory properties.
Research Question: What is the safety and tolerability of defibrotide in patients with severe SARS-CoV-2 infections?
Study Design And Methods: We report a prospective, open-label, single-center safety trial of defibrotide for the management of SARS-CoV-2-related ARDS.
Outcomes in Temporary ICUs Versus Conventional ICUs: An Observational Cohort of Mechanically Ventilated Patients With COVID-19-Induced Acute Respiratory Distress Syndrome.
Crit Care Explor
April 2022
Article Synopsis
- A study examined the outcomes of mechanically ventilated COVID-19 patients in temporary versus conventional ICUs, focusing on mortality and ICU management from March 2020 to April 2021.
- Findings revealed that patients in temporary ICUs had a higher unadjusted 30-day in-hospital mortality rate (36.0%) compared to conventional ICUs (28.8%), indicating that temporary ICU settings may pose additional risks.
- Despite differences in mortality rates, the study found no significant differences in ventilator-free days or ICU-free days, though reintubation and readmission rates were higher in conventional ICUs.
Importance: Platelets represent a potential therapeutic target for improved clinical outcomes in patients with COVID-19.
Objective: To evaluate the benefits and risks of adding a P2Y12 inhibitor to anticoagulant therapy among non-critically ill patients hospitalized for COVID-19.
Design, Setting, And Participants: An open-label, bayesian, adaptive randomized clinical trial including 562 non-critically ill patients hospitalized for COVID-19 was conducted between February 2021 and June 2021 at 60 hospitals in Brazil, Italy, Spain, and the US.
Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19.
N Engl J Med
August 2021
Article Synopsis
- A clinical trial investigated whether therapeutic-dose anticoagulation could improve outcomes for critically ill patients with severe Covid-19 compared to standard thromboprophylaxis.
- The study found no significant difference in organ support-free days between the two groups, with the anticoagulation group showing a median of 1 day compared to 4 days for the usual-care group.
- The trial was halted due to a high probability of futility, with similar hospital discharge survival rates and a slightly higher occurrence of major bleeding in the anticoagulation group.
Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19.
N Engl J Med
August 2021
Background: Thrombosis and inflammation may contribute to the risk of death and complications among patients with coronavirus disease 2019 (Covid-19). We hypothesized that therapeutic-dose anticoagulation may improve outcomes in noncritically ill patients who are hospitalized with Covid-19.
Methods: In this open-label, adaptive, multiplatform, controlled trial, we randomly assigned patients who were hospitalized with Covid-19 and who were not critically ill (which was defined as an absence of critical care-level organ support at enrollment) to receive pragmatically defined regimens of either therapeutic-dose anticoagulation with heparin or usual-care pharmacologic thromboprophylaxis.