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Article ; Online: Mummification maneuver for pediatric dermatology procedures.

Nair, Priya Prabhakaran

Journal of the American Academy of Dermatology

2019 Volume 85, Issue 3, Page(s) e143

MeSH term(s)	Child ; Dermatology ; Humans
Language	English
Publishing date	2019-02-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	603641-7
ISSN	1097-6787 ; 0190-9622
ISSN (online)	1097-6787
ISSN	0190-9622
DOI	10.1016/j.jaad.2019.02.054
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Article ; Online: Prevalence, Risk Factors, and Outcomes of Airway Versus Non-Airway Pediatric Extubation Failure.

Loberger, Jeremy M / Manchikalapati, Ananya / Borasino, Santiago / Prabhakaran, Priya

Respiratory care

2023 Volume 68, Issue 3, Page(s) 374–383

Abstract: Background: Pediatric extubation failure is associated with morbidity and mortality. The most common cause is upper-airway obstruction. Subglottic edema is common, but upper-airway obstruction can occur from the oral cavity to the trachea. Dichotomous ... ...

Abstract	Background: Pediatric extubation failure is associated with morbidity and mortality. The most common cause is upper-airway obstruction. Subglottic edema is common, but upper-airway obstruction can occur from the oral cavity to the trachea. Dichotomous categorization of extubation failure as airway versus non-airway may help identify risk factors as well as strategies that translate to lower extubation failure rates. Methods: This was as single-center, retrospective cohort study of invasive mechanical ventilation encounters within a quality improvement database between October 1, 2017-November 30, 2020. Utilizing a 3-physician adjudication process, all extubation failures were categorized as airway versus non-airway. Primary outcome was failure subtype prevalence. Secondary outcome was failure subtype risk factors. Clinical outcomes were explored. Results: The all-cause extubation failure rate was 10% in a cohort of 844 encounters. Airway and non-airway extubation failure represented 60.7% and 39.3%, respectively. Most airway failures were due to upper-airway obstruction (84.3%)-35.3% were supraglottic, 25.5% subglottic, and 23.5% mixed. Other causes of airway failure were airway patency/secretions (11.8%) and aspiration (3.9%). Non-airway failures were attributed to respiratory failure (75.8%), encephalopathy (15.2%), and other (9%). All-cause extubation failure was associated with dysgenetic/syndromic comorbidity ( Conclusions: Airway extubation failure prevalence was 1.5 times higher than non-airway failure. Potential risk factors for airway failure were identified. These findings are hypothesis generating for future study focused on key evidence gaps and pragmatic bedside application.
MeSH term(s)	Humans ; Child ; Airway Extubation/adverse effects ; Retrospective Studies ; Prevalence ; Intubation, Intratracheal ; Respiration, Artificial/adverse effects ; Risk Factors ; Airway Obstruction/etiology
Language	English
Publishing date	2023-02-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.10341
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Article: Pre-Extubation Ultrasound Measurement of In Situ Cuffed Endotracheal Tube Laryngeal Air Column Width Difference: Single-Center Pilot Study of Relationship With Post-Extubation Stridor in Subjects Younger Than 5 Years Old.

Burton, Luke / Loberger, Jeremy / Baker, Mark / Prabhakaran, Priya / Bhargava, Vidit

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2023 Volume 25, Issue 3, Page(s) 222–230

Abstract: Objectives: Post-extubation stridor (PES) is difficult to predict before extubation. We therefore evaluated the potential diagnostic performance of pre-extubation laryngeal air column width difference (LACWD) measurement, as assessed by intensivist- ... ...

Abstract	Objectives: Post-extubation stridor (PES) is difficult to predict before extubation. We therefore evaluated the potential diagnostic performance of pre-extubation laryngeal air column width difference (LACWD) measurement, as assessed by intensivist-performed point-of-care laryngeal ultrasound, in relation to clinically important PES. Design: Prospective observational cohort study. Setting: Single quaternary care PICU (July 19, 2021, to October 31, 2022). Patients: Included subjects were younger than 5 years old, intubated with a cuffed endotracheal tube, requiring invasive mechanical ventilation for greater than 24 hours, and nearing extubation. Subjects at high risk for supraglottic airway obstruction were excluded. Interventions: Laryngeal ultrasound with measurement of laryngeal air column width with the endotracheal tube cuff inflated and deflated. Clinically important PES was defined as a high-pitched inspiratory respiratory noise suspected to be from a subglottic focus necessitating received medical intervention or reintubation. Measurements and main results: Among 53 enrolled subjects, 18 of 53 (34%) experienced PES and three of 53 (6%) were reintubated because of severe subglottic upper airway obstruction. Median LACWD was significantly lower in the stridor group compared with the nonstridor group (∆ 0.41 mm; 95% CI, 0.37-0.48; p < 0.001). The area under the receiver operating characteristic curve for LACWD as a diagnosis of PES was 0.94 (95% CI, 0.89-1.00; p < 0.001). The LACWD cutoff for PES was less than or equal to 0.47 mm, which yielded a diagnostic sensitivity of 91.4% and specificity of 88.9%. In this population, the pre-to-post-test change in probability of PES for LACWD less than or equal to 0.47 mm is 0.34 to 0.81. Conclusions: Pre-extubation LACWD is a novel, noninvasive assessment that can be performed and interpreted by the intensivist at the bedside. There is, however, diagnostic uncertainty in the use of this measurement for identifying those at-risk of PES and larger validation studies are needed.
MeSH term(s)	Humans ; Child, Preschool ; Pilot Projects ; Prospective Studies ; Respiratory Sounds/etiology ; Airway Extubation/adverse effects ; Airway Obstruction/diagnostic imaging ; Airway Obstruction/etiology ; Intubation, Intratracheal/adverse effects
Language	English
Publishing date	2023-10-16
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000003377
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Article: Cardiac dysfunction in severe pediatric acute respiratory distress syndrome: the right ventricle in search of the right therapy.

Webb, Lece / Burton, Luke / Manchikalapati, Ananya / Prabhakaran, Priya / Loberger, Jeremy M / Richter, Robert P

Frontiers in medicine

2023 Volume 10, Page(s) 1216538

Abstract: Severe acute respiratory distress syndrome in children, or PARDS, carries a high risk of morbidity and mortality that is not fully explained by PARDS severity alone. Right ventricular (RV) dysfunction can be an insidious and often under-recognized ... ...

Abstract	Severe acute respiratory distress syndrome in children, or PARDS, carries a high risk of morbidity and mortality that is not fully explained by PARDS severity alone. Right ventricular (RV) dysfunction can be an insidious and often under-recognized complication of severe PARDS that may contribute to its untoward outcomes. Indeed, recent evidence suggest significantly worse outcomes in children who develop RV failure in their course of PARDS. However, in this narrative review, we highlight the dearth of evidence regarding the incidence of and risk factors for PARDS-associated RV dysfunction. While we wish to draw attention to the absence of available evidence that would inform recommendations around surveillance and treatment of RV dysfunction during severe PARDS, we leverage available evidence to glean insights into potentially helpful surveillance strategies and therapeutic approaches.
Language	English
Publishing date	2023-08-16
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2023.1216538
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Article ; Online: Synergistic effects of combined cisplatin and

Abu Bakar, Nur Fitriyani Afiqah Binti / Yeo, Zhin Leng / Hussin, Faisal / Madhavan, Priya / Lim, Vuanghao / Jemon, Khairunadwa / Prabhakaran, Praseetha

Journal of Taibah University Medical Sciences

2023 Volume 18, Issue 6, Page(s) 1220–1236

Abstract: Objective: Triple negative breast cancer (TNBC) is the most invasive breast cancer subtype enriched with cancer stem cells. TNBCs do not express estrogen, progesterone, or human epidermal growth factor receptor 2 (HER2) receptors, making them difficult ... ...

Abstract	Objective: Triple negative breast cancer (TNBC) is the most invasive breast cancer subtype enriched with cancer stem cells. TNBCs do not express estrogen, progesterone, or human epidermal growth factor receptor 2 (HER2) receptors, making them difficult to be targeted by existing chemotherapy treatments. In this study, we attempted to identify the effects of combined cisplatin and Methods: The phytochemical fingerprint of Results: Derivatives of fatty acids, carboxylic acid ester, and glycosides, were identified as the major bioactive compounds with potential anticancer properties in Conclusion: Our findings demonstrate that the combination of cisplatin and
Language	English
Publishing date	2023-04-15
Publishing country	Saudi Arabia
Document type	Journal Article
ZDB-ID	2817396-X
ISSN	1658-3612 ; 1658-3612
ISSN (online)	1658-3612
ISSN	1658-3612
DOI	10.1016/j.jtumed.2023.04.003
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Article: Exploration of Sepsis-Associated Coagulopathy Severity and Pediatric Septic Shock Outcomes.

Loberger, Jeremy M / Aban, Inmaculada B / Prabhakaran, Priya

Journal of pediatric intensive care

2020 Volume 10, Issue 1, Page(s) 38–44

Abstract: The objective of this study was to explore correlations between sepsis-associated coagulopathy (SAC) in pediatric septic shock and clinical outcomes. This was a retrospective cohort study of all children admitted to a single, academic pediatric intensive ...

Abstract	The objective of this study was to explore correlations between sepsis-associated coagulopathy (SAC) in pediatric septic shock and clinical outcomes. This was a retrospective cohort study of all children admitted to a single, academic pediatric intensive care unit with septic shock over 6 years. The prevalence of SAC was 93.5% with 61% being severe. Those with severe SAC were more likely to have a positive blood culture and have longer median duration of ventilation. All observed mortalities occurred in the severe SAC and indeterminate SAC groups. SAC is highly prevalent in pediatric septic shock and may predict important outcomes.
Language	English
Publishing date	2020-06-26
Publishing country	Germany
Document type	Journal Article
ISSN	2146-4618
ISSN	2146-4618
DOI	10.1055/s-0040-1713436
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Article ; Online: Predicting High-Flow Nasal Cannula Therapy Outcomes Using the ROX-HR Index in the Pediatric ICU.

Webb, Lece V / Chahine, Rouba / Aban, Inmaculada / Prabhakaran, Priya / Loberger, Jeremy M

Respiratory care

2022

Abstract: Background: High-flow nasal cannula (HFNC) use is increasing in pediatric patients. Objective measures that predict HFNC outcomes are lacking. The respiratory rate-oxygenation (ROX) and ROX heart rate (ROX-HR) indices are validated to predict HFNC ... ...

Abstract	Background: High-flow nasal cannula (HFNC) use is increasing in pediatric patients. Objective measures that predict HFNC outcomes are lacking. The respiratory rate-oxygenation (ROX) and ROX heart rate (ROX-HR) indices are validated to predict HFNC therapy failure in adults. This study examined the performance of both indices in predicting HFNC therapy failure in children admitted to the pediatric ICU (PICU). Methods: This retrospective, longitudinal, observational cohort study was completed in a 24-bed PICU in a quaternary care children's hospital. All subjects ≤ 24 months of age initiated on HFNC in the PICU from January 1, 2018-August 31, 2020, were included. The ROX and ROX-HR indices were collected at standardized time points during HFNC therapy. Performance in predicting HFNC failure was evaluated using area under the receiver operating characteristic curve (AUROC) and Kaplan-Meier survival analysis. Failure was defined as escalation of respiratory support to either noninvasive ventilation or endotracheal intubation. Results: Among 446 subject encounters, 111 (24.9%) failed HFNC therapy. HFNC failure was associated with lower ROX and ROX-HR indices at termination compared to HFNC liberation ( Conclusions: ROX-HR may be a useful tool for early identification of patients ≤ 24 months at risk for HFNC failure and allow for earlier intervention. Larger prospective studies are necessary to validate the utility of the ROX-HR index in pediatric patients.
Language	English
Publishing date	2022-07-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.09765
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Article: A Respiratory Therapist-Driven Pathway Improves Timeliness of Extubation Readiness Assessment in a Single PICU.

Loberger, Jeremy M / Jones, Ryan M / Prabhakaran, Priya

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

2020 Volume 21, Issue 8, Page(s) e513–e521

Abstract: Objectives: Our smart aim was to decrease the time between when a mechanically ventilated patient was eligible for and when they underwent their first extubation readiness test (delta time) by 50% within 3 months through the development and ... ...

Abstract	Objectives: Our smart aim was to decrease the time between when a mechanically ventilated patient was eligible for and when they underwent their first extubation readiness test (delta time) by 50% within 3 months through the development and implementation of a respiratory therapist-driven extubation readiness test pathway. Design: Quality improvement project. Setting: Single, tertiary care, 24-bed, academic PICU. Patients: Pediatric patients admitted to the PICU and requiring mechanical ventilation for a primary pulmonary process. Interventions: We developed an extubation readiness test pathway that consisted of an eligibility screen and a standard testing process. Patients were screened every 3 hours. Upon passing the screen and being cleared by a prescriber, a test was initiated. No clinical management was dictated to prescribers. Measurements and main results: The preintervention and intervention cohorts included 109 and 43 mechanical ventilation courses, respectively. The mean delta time decreased from 33.77 hours to 2.92 hours after pathway implementation (p = 0.000). The medical length of stay decreased from 196.6 to 177.2 hours (p = 0.05). There were no statistically significant changes in duration of mechanical ventilation until first extubation (112.9 vs 122.3 hr; p = 0.651) and 48-hour extubation failure rate (16.5% vs 4.8%; p = 0.056). The sensitivity and positive predictive value for the extubation readiness test were 89.5% and 94.4%, respectively. The mean for all process compliance measures was 91.5%. Conclusions: A respiratory therapist-driven extubation readiness test pathway can be safely implemented in a large, academic PICU. The pathway resulted in earlier extubation readiness testing without increasing key balancing measures-the duration of mechanical ventilation, PICU length of stay, or the extubation failure rate.
MeSH term(s)	Airway Extubation ; Child ; Humans ; Intensive Care Units, Pediatric ; Quality Improvement ; Respiration, Artificial ; Ventilator Weaning
Language	English
Publishing date	2020-05-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2052349-X
ISSN	1947-3893 ; 1529-7535
ISSN (online)	1947-3893
ISSN	1529-7535
DOI	10.1097/PCC.0000000000002326
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Article ; Online: Pediatric Ventilator Liberation: One-Hour Versus Two-Hour Spontaneous Breathing Trials in a Single Center.

Loberger, Jeremy M / Watson, Caleb R / Clingan, Emily M / Petrusnek, Sarah D / Aban, Inmaculada B / Prabhakaran, Priya

Respiratory care

2023 Volume 68, Issue 5, Page(s) 649–657

Abstract: Background: The optimal spontaneous breathing trial (SBT) duration is not known for children who are critically ill. The study objective was to evaluate extubation outcomes between cohorts exposed to a 1- or 2-h SBT.: Methods: This was a ... ...

Abstract	Background: The optimal spontaneous breathing trial (SBT) duration is not known for children who are critically ill. The study objective was to evaluate extubation outcomes between cohorts exposed to a 1- or 2-h SBT. Methods: This was a retrospective cohort study of a quality improvement project database in a 24-bed pediatric ICU. The intervention was a respiratory therapist-driven SBT clinical pathway across 2 improvement cycles by using a 2- or 1-h SBT. The primary outcomes were extubation failure and rescue noninvasive ventilation in the first 48 h. Secondary outcomes included SBT results and process measures. Results: There were 218 and 305 encounters in the 2- and 1-h cohorts, respectively. Extubation failure (7.3 vs 8.5%; Conclusions: A 1-h SBT may be a viable alternative to a 2-h version for the average child who is critically ill. Further, a 1-h SBT may better balance extubation outcomes and duration of invasive ventilation for the general pediatric ICU population.
MeSH term(s)	Child ; Humans ; Airway Extubation/methods ; Critical Illness ; Respiration, Artificial ; Retrospective Studies ; Ventilator Weaning/methods ; Ventilators, Mechanical
Language	English
Publishing date	2023-04-04
Publishing country	United States
Document type	Evaluation Study ; Journal Article
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.10652
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Article ; Online: Fixed-dose combination therapy for the prevention of atherosclerotic cardiovascular disease.

Agarwal, Anubha / Mehta, Priya M / Jacobson, Tyler / Shah, Nilay S / Ye, Jiancheng / Zhu, JingJing / Wafford, Q Eileen / Bahiru, Ehete / de Cates, Angharad N / Ebrahim, Shah / Prabhakaran, Dorairaj / Rodgers, Anthony / Huffman, Mark D

Nature medicine

2024 Volume 30, Issue 4, Page(s) 1199–1209

Abstract: Fixed-dose combination (FDC) therapy, also known as polypill therapy, targets risk factors for atherosclerotic cardiovascular disease (ASCVD) and has been proposed as a strategy to reduce global ASCVD burden. Here we conducted a systematic search for ... ...

Abstract	Fixed-dose combination (FDC) therapy, also known as polypill therapy, targets risk factors for atherosclerotic cardiovascular disease (ASCVD) and has been proposed as a strategy to reduce global ASCVD burden. Here we conducted a systematic search for relevant studies from 2016-2022 to assess the effects of FDC therapy for prevention of ASCVD. The studies selected include randomized trials evaluating FDC therapy with at least one blood pressure-lowering drug and one lipid-lowering drug. The study data were independently extracted, the quality of evidence was appraised by multiple reviewers and effect estimates were pooled using a fixed-effect meta-analysis when statistical heterogeneity was low to moderate. The main outcomes of the analysis were all-cause mortality, fatal and nonfatal ASCVD events, adverse events, systolic blood pressure, low-density lipoprotein cholesterol and adherence. Among 26 trials (n = 27,317 participants, 43.2% female and mean age range 52.9-76.0), FDC therapy was associated with lower low-density lipoprotein cholesterol and systolic blood pressure, with higher rates of adherence and adverse events in both primary and mixed secondary prevention populations. For studies with a mostly primary prevention population, FDC therapy was associated with lower risk of all-cause mortality by 11% (5.6% versus 6.3%; relative risk (risk ratio) of 0.89; 95% confidence interval 0.78 to 1.00; I
MeSH term(s)	Humans ; Female ; Middle Aged ; Aged ; Male ; Cardiovascular Diseases/epidemiology ; Atherosclerosis/drug therapy ; Atherosclerosis/prevention & control ; Cholesterol, LDL ; Combined Modality Therapy ; Risk Factors
Chemical Substances	Cholesterol, LDL
Language	English
Publishing date	2024-03-26
Publishing country	United States
Document type	Meta-Analysis ; Journal Article
ZDB-ID	1220066-9
ISSN	1546-170X ; 1078-8956
ISSN (online)	1546-170X
ISSN	1078-8956
DOI	10.1038/s41591-024-02896-w
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