Publications by authors named "Shannon Fernando"
Background: Continuous waveform monitoring is standard-of-care for patients at risk for or with critically illness. Derived from waveforms, heart rate, respiratory rate and blood pressure variability contain useful diagnostic and prognostic information; and when combined with machine learning, can provide predictive indices relating to severity of illness and/or reduced physiologic reserve. Integration of predictive models into clinical decision support software (CDSS) tools represents a potential evolution of monitoring.
View Article and Find Full Text PDFArticle Synopsis
- The eighth annual summary from the International Liaison Committee on Resuscitation (ILCOR) focuses on the latest findings in cardiopulmonary resuscitation (CPR) and emergency cardiovascular care, building on a comprehensive review from 2020.
- This summary is based on the evaluation of recent resuscitation evidence by experts from six different ILCOR task forces, who utilized specific criteria to assess the quality of evidence and reached consensus treatment recommendations.
- The document also identifies key areas where more research is needed, sharing insights into the task forces’ discussions through sections like Justification and Evidence-to-Decision Framework Highlights.
This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations.
View Article and Find Full Text PDFBackground: Cardiogenic shock remains highly associated with early mortality, with mortality often exceeding 50%. We sought to determine the association between prognostic factors and in-hospital and 30-day mortality in cardiogenic shock.
Methods: We performed a systematic review and meta-analysis of prognostic factors in cardiogenic shock, searching MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for records up to June 5, 2023.
Background: The incidence of nosocomial meningitis, and utility of lumbar puncture, is unclear in hospitalized patients without preceding neurosurgery or head trauma.
Aim: We planned for a systematic review and meta-analysis to evaluate accuracy of clinical features and diagnostic utility of lumbar puncture in nosocomial meningitis.
Methods: We searched MEDLINE, MEDLINE In-Process/ePubs, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science from inception until June 5, 2024.
Background: Cardiogenic shock due to acute myocardial infarction (AMI-CS) is associated with significant short- and long-term morbidity and mortality. Despite this, little is known about associated cost.
Objectives: The purpose of this study was to evaluate the health care costs and resource use associated with AMI-CS using administrative data from the province of Ontario, Canada.
Objectives: Although clinicians may use methylene blue (MB) in refractory septic shock, the effect of MB on patient-important outcomes remains uncertain. We conducted a systematic review and meta-analysis to investigate the benefits and harms of MB administration in patients with septic shock.
Data Sources: We searched six databases (including PubMed, Embase, and Medline) from inception to January 10, 2024.
Article Synopsis
- The study aimed to evaluate the effectiveness and safety of physical rehabilitation and mobilization (PR&M) for adult patients on extracorporeal life support (ECLS), analyzing various studies comparing PR&M approaches with standard care.
- Seventeen studies with nearly 1,000 patients were reviewed, primarily focusing on those undergoing venovenous and venoarterial ECMO in the ICU; however, the analysis lacked sufficient data for a meta-analysis, leading to a narrative summary.
- Overall, the findings indicate an uncertain impact of high-intensity PR&M on patient outcomes like mortality and quality of life compared to low-intensity methods, with very low certainty in the evidence due to serious biases and im
Purpose: Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short- and long-term morbidity and mortality. However, there are limited data on mental health sequelae that survivors experience following discharge.
Methods: We conducted a retrospective, population-based cohort study in Ontario, Canada of critically ill adult (≥ 18 years) survivors of AMI-CS, admitted to hospital between April 1, 2009 and March 31, 2019.
Introduction: Trauma patients are at increased risk of venous thromboembolism (VTE), including deep venous thrombosis and/or pulmonary embolism. We conducted a systematic review and meta-analysis summarizing the association between prognostic factors and the occurrence of VTE following traumatic injury.
Methods: We searched the Embase and Medline databases from inception to August 2023.
Purpose: Venovenous extracorporeal membrane oxygenation (VV-ECMO) can be used to support patients with refractory acute respiratory failure, though guidance on patient selection is lacking. While age is commonly utilized as a factor in establishing the potential VV-ECMO candidacy of these patients, little is known regarding its association with outcome. We studied the association between increasing patient age and outcomes among patients with acute respiratory failure receiving VV-ECMO.
View Article and Find Full Text PDFBackground & Objectives: Blunt cerebrovascular injury (BCVI) includes carotid and/or vertebral artery injury following trauma, and conveys an increased stroke risk. We conducted a systematic review and meta-analysis to provide a comprehensive summary of prognostic factors associated with risk of stroke following BCVI.
Methods: We searched the EMBASE and MEDLINE databases from January 1946 to June 2023.
Objectives: To perform a systematic review and meta-analysis to evaluate the association of various measures of glycemic variability, including time-domain and complexity-domain, with short-term mortality in patients with critical illness.
Data Sources: We searched Embase Classic +, MEDLINE, and the Cochrane Database of Systematic Reviews from inception to November 3, 2023.
Study Selection: We included English language studies that assessed metrics of glycemic variation or complexity and short-term mortality in patients admitted to the ICU.
Article Synopsis
- A systematic review and network meta-analysis was conducted to compare the effectiveness and safety of different intravenous medications used for procedural sedation and analgesia in emergency departments and ICUs.
- The analysis included 82 randomized controlled trials involving over 8,000 patients and focused on sedation recovery time, patient satisfaction, and adverse events related to the medications.
- Results showed that propofol had a shorter recovery time than midazolam-opioids, while ketamine-propofol combinations improved patient satisfaction; however, certain adverse events varied by medication combinations.
Background And Methods: We conducted a population-based, retrospective cohort study of first-time emergency department (ED) visits in adolescents and young adults (AYA) due to alcohol and compared mortality to AYA with nonalcohol ED visits between 2009 and 2015 using standardized all-cause mortality ratios (age, sex, income, and rurality). We described the cause of death for AYA and examined the association between clinical factors and mortality rates in the alcohol cohort using proportional hazard models.
Results: A total of 71,776 AYA had a first-time ED visit due to alcohol (56.
Objectives: Given the uncertainty regarding the optimal approach for airway management for adult patients with out-of-hospital cardiac arrest (OHCA), we conducted a systematic review and meta-analysis to compare the use of supraglottic airways (SGAs) with tracheal intubation for initial airway management in OHCA.
Data Sources: We searched MEDLINE, PubMed, Embase, Cochrane Library, as well as unpublished sources, from inception to February 7, 2023.
Study Selection: We included randomized controlled trials (RCTs) of adult OHCA patients randomized to SGA compared with tracheal intubation for initial prehospital airway management.
Background: Extracorporeal cardiopulmonary resuscitation (ECPR), has demonstrated promise in the management of refractory out-of-hospital cardiac arrest (OHCA). However, evidence from observational studies and clinical trials are conflicting and the factors influencing outcome have not been well established.
Methods: We conducted a systematic review and meta-analysis summarizing the association between pre-ECPR prognostic factors and likelihood of good functional outcome among adult patients requiring ECPR for OHCA.
Purpose: Venoarterial extracorporeal membrane oxygenation (V-A ECMO) can be used to support severely ill patients with cardiogenic shock. While age is commonly used in patient selection, little is known regarding its association with outcomes in this population. We sought to evaluate the association between increasing age and outcomes following V-A ECMO.
View Article and Find Full Text PDFBackground: Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short-term mortality; however, there are limited data on long-term outcomes and trends.
Objectives: This study sought to examine long-term outcomes of AMI-CS patients.
Methods: This was a population-based, retrospective cohort study in Ontario, Canada of critically ill adult patients with AMI-CS who were admitted to hospitals between April 1, 2009 and March 31, 2019.
Background: The evidence regarding optimal crystalloid use in the perioperative period remains unclear. As the primary aim of this study, we sought to summarise the data from RCTs examining whether use of balanced crystalloids compared with 0.9% saline (saline) leads to differences in patient-important outcomes.
View Article and Find Full Text PDFBackground: Cardiogenic shock (CS) is a state of end-organ hypoperfusion related to cardiac dysfunction. Current guidelines recommend consideration of inotrope therapy in patients with CS, however no robust data support their use. The purpose of the CAPITAL DOREMI2 trial is to examine the efficacy and safety of inotrope therapy against placebo in the initial resuscitation of patients with CS.
View Article and Find Full Text PDFObjectives: To identify factors associated with failure of noninvasive ventilation (NIV) in the post-extubation period.
Data Sources: We searched Embase Classic +, MEDLINE, and the Cochrane Database of Systematic Reviews from inception to February 28, 2022.
Study Selection: We included English language studies that provided predictors of post-extubation NIV failure necessitating reintubation.