Publications by authors named "Shane English"
Background: The effect of a liberal red-cell transfusion strategy as compared with a restrictive strategy in patients during the critical care period after an aneurysmal subarachnoid hemorrhage is unclear.
Methods: We randomly assigned critically ill adults with acute aneurysmal subarachnoid hemorrhage and anemia to a liberal strategy (mandatory transfusion at a hemoglobin level of ≤10 g per deciliter) or a restrictive strategy (optional transfusion at a hemoglobin level of ≤8 g per deciliter). The primary outcome was an unfavorable neurologic outcome, defined as a score of 4 or higher on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability) at 12 months.
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- Survivors of critical illness often experience physical dysfunction post-ICU discharge, and the CYCLE trial aims to evaluate the effectiveness of in-bed cycle ergometry for improving short-term physical function in these patients.!* -
- The CYCLE trial, involving 360 patients across multiple centers, employs a prespecified statistical analysis plan to assess outcomes like the PFIT-s score three days after ICU discharge, while considering variables such as age, frailty, and sex.!* -
- Funded in 2017, the CYCLE study completed enrollment in May 2023, with data analyses finished and first results expected to be published in 2024.!*
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- A systematic review was conducted to evaluate the relationship between elevated blood pressure and the risk of rebleeding in patients with aneurysmal subarachnoid hemorrhage before securing the aneurysm.
- The review analyzed data from 15 observational studies, but found mixed results regarding the impact of different systolic blood pressure thresholds on rebleeding risk.
- Overall, the quality of evidence was rated very low, making it unclear whether high blood pressure increases the risk of rebleeding in these patients.
Article Synopsis
- * An international Delphi study involving 175 participants, mostly those with lived experience of aSAH, was conducted to identify and prioritize health domains that are important to patients, caregivers, healthcare providers, and researchers.
- * From the study, 32 key health domains were identified, with top priorities being cognition, aneurysm treatment, and overall quality of life, revealing a gap between stakeholder priorities and current research outcomes; the authors plan to create a standardized set of outcomes for future aSAH
Article Synopsis
- The COVID-19 pandemic significantly disrupted clinical trials globally, leading to issues such as premature closures and compromised trial integrity, necessitating changes in research protocols.
- The study aimed to assess challenges faced during interrupted critical care trials, identifying barriers and developing strategies for future trials based on input from principal investigators and project coordinators.
- Results indicated that major challenges included the prioritization of COVID-19 studies and restrictions on hospital visitation, while participants offered various solutions and suggestions to enhance trial conduct moving forward.
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- A study was conducted to evaluate the effects of the proton-pump inhibitor pantoprazole on critically ill patients undergoing invasive ventilation, comparing it to a placebo.
- The trial included 4,821 patients and found that pantoprazole significantly reduced the incidence of clinically important upper gastrointestinal bleeding compared to placebo (1.0% vs. 3.5%).
- However, there was no significant difference in overall mortality rates at 90 days between the pantoprazole group (29.1%) and the placebo group (30.9%).
Article Synopsis
- * A pilot randomized trial will involve 90 donors and 324 organ recipients across nine hospitals in Ontario and Québec, with participants receiving either tacrolimus or a placebo before organ retrieval.
- * Researchers will assess the trial's feasibility, including donor enrollment and recipient consent, while monitoring graft function and survival; findings will be shared publicly through publications and conferences.
Background: The effect of a liberal transfusion strategy as compared with a restrictive strategy on outcomes in critically ill patients with traumatic brain injury is unclear.
Methods: We randomly assigned adults with moderate or severe traumatic brain injury and anemia to receive transfusion of red cells according to a liberal strategy (transfusions initiated at a hemoglobin level of ≤10 g per deciliter) or a restrictive strategy (transfusions initiated at ≤7 g per deciliter). The primary outcome was an unfavorable outcome as assessed by the score on the Glasgow Outcome Scale-Extended at 6 months, which we categorized with the use of a sliding dichotomy that was based on the prognosis of each patient at baseline.
Article Synopsis
- Critical illness requiring invasive mechanical ventilation can lead to significant physical disability, and early in-bed cycle ergometry may help reduce this impairment when added to standard physiotherapy in ICU patients.
- A study with 360 adult patients randomly assigned to either early in-bed cycling plus usual physiotherapy or just usual physiotherapy found no significant difference in physical function scores three days after ICU discharge.
- The addition of cycling did not result in any serious adverse events, indicating it is safe, but did not enhance recovery outcomes compared to standard therapy alone.
Background: In aneurysmal subarachnoid hemorrhage (aSAH), rebleeding of the culprit aneurysm is associated with significant morbidity and mortality. Blood pressure reduction to specific target levels, with the goal of preventing rebleeding, has been a mainstay of care prior to definitively securing the aneurysm. Clinical practice guidelines have recently changed and no longer recommend specific blood pressure targets.
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- During the COVID-19 pandemic, many ICUs paused ongoing research to prioritize studies related to the virus, but the REVISE trial continued investigating stress ulcer prophylaxis in mechanically ventilated patients.
- The trial, which compares pantoprazole against a placebo, enrolled 2,961 patients across 59 centers, despite facing disruptions in enrollment during the pandemic.
- Changes in the informed consent process included a shift to a 'consent to continue' model and an increase in telephone consent due to restrictions, leading to a slight rise in overall consent rates.
Purpose: The ordering of routine blood test panels in advance is common in intensive care units (ICUs), with limited consideration of the pretest probability of finding abnormalities. This practice contributes to anemia, false positive results, and health care costs. We sought to understand practices and attitudes of Canadian adult intensivists regarding ordering of blood tests in critically ill patients.
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- - The study aimed to define what constitutes "patient-important" upper gastrointestinal bleeding during critical illness for a randomized trial, focusing on the perspectives of ICU survivors and their family members.
- - Using interviews and focus groups, researchers gathered qualitative data, which revealed that patient-important bleeding is linked to serious outcomes like death, disability, and extended hospital stays, along with specific medical interventions.
- - Findings highlighted that patients and families view gastrointestinal bleeding differently than traditional clinical definitions, emphasizing the context and effects of treatments as crucial to understanding its importance.
Background: Cervical spine injuries (CSI) are often challenging to diagnose in obtunded adult patients with blunt trauma and the optimal imaging modality remains uncertain. This study systematically synthesized the last decade of evidence to determine the type of imaging required to clear the c-spine in obtunded patients with blunt trauma.
Methods: A systematic review with meta-analysis was conducted and reported using PRISMA 2020 guidelines.
Background: The REVISE (Re-Evaluating the Inhibition of Stress Erosions in the ICU) trial will evaluate the impact of the proton pump inhibitor pantoprazole compared to placebo in invasively ventilated critically ill patients.
Objective: To outline the statistical analysis plan for the REVISE trial.
Methods: REVISE is a randomized clinical trial ongoing in intensive care units (ICUs) internationally.
Introduction: The e-aluating the nhibition of tress rosions (REVISE) Trial aims to determine the impact of the proton pump inhibitor pantoprazole compared with placebo on clinically important upper gastrointestinal (GI) bleeding in the intensive care unit (ICU), 90-day mortality and other endpoints in critically ill adults. The objective of this report is to describe the rationale, methodology, ethics and management of REVISE.
Methods And Analysis: REVISE is an international, randomised, concealed, stratified, blinded parallel-group individual patient trial being conducted in ICUs in Canada, Australia, Saudi Arabia, UK, US, Kuwait, Pakistan and Brazil.
Background: Normal saline (NS) and Ringer's lactate (RL) are the most common crystalloids given to hospitalized patients. Despite concern about possible harm associated with NS (eg, hyperchloremic metabolic acidosis, impaired kidney function, and death), few large multicenter randomized trials focused on critically ill patients have compared these fluids. Uncertainty exists about the effects of these fluids on clinically important outcomes across all hospitalized patients.
View Article and Find Full Text PDFBackground: Preconditioning deceased organ donors with calcineurin inhibitors (CNIs) may reduce ischemia-reperfusion injury to improve transplant outcomes.
Methods: We searched MEDLINE, EMBASE, Cochrane Library, and conference proceedings for animal models of organ donation and transplantation, comparing donor treatment with CNIs with either placebo or no intervention, and evaluating outcomes for organ transplantation. Reviewers independently screened and selected studies, abstracted data, and assessed the risk of bias and clinical relevance of included studies.
Article Synopsis
- Critically ill patients in ICUs often receive proton pump inhibitors (PPIs) to prevent GI bleeding, but there are concerns about their safety, especially for those with COVID-19 infection.
- This study is part of a larger trial testing pantoprazole against a placebo and aims to analyze patient characteristics, the effect of COVID-19 on GI bleeding and mortality, and whether pantoprazole influences outcomes differently in COVID-19 patients.
- The research includes a detailed examination of various clinical factors such as biomarkers, thromboembolism, and treatment outcomes, focusing on how these relate to both infected and non-infected cohorts.
Anemia is very common in aneurysmal subarachnoid hemorrhage (aSAH), with approximately half of the aSAH patient population developing moderate anemia during their hospital stay. The available evidence (both physiologic and clinical) generally supports an association of anemia with unfavorable outcomes. Although aSAH shares a number of common mechanisms of secondary insult with other forms of acute brain injury, aSAH also has specific features that make it unique: an early phase (in which early brain injury predominates) and a delayed phase (in which delayed cerebral ischemia and vasospasm predominate).
View Article and Find Full Text PDFBackground: Compared to younger age, older age (≥ 65 yr) is associated with worse outcomes after severe traumatic brain injury (TBI). We sought to describe the association of older age with in-hospital death and aggressiveness of intervention.
Methods: We conducted a retrospective cohort study of adult (age ≥ 16 yr) patients with severe TBI admitted to a single academic tertiary care neurotrauma centre between January 2014 and December 2015.
Introduction: In-bed leg cycling with critically ill patients is a promising intervention aimed at minimising immobility, thus improving physical function following intensive care unit (ICU) discharge. We previously completed a pilot randomised controlled trial (RCT) which supported the feasibility of a large RCT. In this report, we describe the protocol for an international, multicentre RCT to determine the effectiveness of early in-bed cycling versus routine physiotherapy (PT) in critically ill, mechanically ventilated adults.
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- - The study aims to understand the values and preferences of patients and families regarding upper gastrointestinal bleeding treatments, challenging traditional definitions that are primarily clinical.
- - Utilizing a mixed-methods approach, the research involves interviews and focus groups with ICU survivors and their families after providing educational materials to gather their insights.
- - Approved by ethics boards, the findings will contribute to creating meaningful trial outcomes for stress ulcer prophylaxis and be published for wider dissemination.
Article Synopsis
- The study aimed to evaluate the diagnostic accuracy of ancillary tests used in determining death by neurologic criteria (DNC), particularly since clinical examinations can sometimes be unreliable.
- Researchers conducted a systematic review and meta-analysis by analyzing multiple medical databases, focusing on studies that included patients diagnosed or suspected to be dead based on neurologic criteria.
- It was found that while ancillary tests had similar high sensitivities for diagnosed cases (0.82-0.93), most studies had a high risk of bias and showed significant statistical uncertainty in estimates for suspected cases.
Introduction: In donation after circulatory determination of death, death is declared 5 min after circulatory arrest. This practice assumes, but does not explicitly confirm, permanent loss of brain activity. While this assumption is rooted a strong physiological rationale, paucity of direct human data regarding temporal relationship between cessation of brain activity and circulatory arrest during the dying process threatens public and healthcare provider trust in deceased organ donation.
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