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Article ; Online: Mechanical ventilation with lung protective strategies: what works?

Haas, Carl F

2011 Volume 27, Issue 3, Page(s) 469–486

Abstract: Essentially all patients with acute lung injury or acute respiratory distress syndrome require mechanical ventilatory assistance to support gas exchange and reduce the work of breathing associated with the lung impairment. Unfortunately, this life- ... ...

Abstract	Essentially all patients with acute lung injury or acute respiratory distress syndrome require mechanical ventilatory assistance to support gas exchange and reduce the work of breathing associated with the lung impairment. Unfortunately, this life-sustaining support may actually cause further lung damage and possibly lead to increased mortality. This article reviews strategies that may help minimize ventilator-induced lung injury.
MeSH term(s)	Acute Lung Injury/therapy ; Evidence-Based Medicine ; Humans ; Respiration, Artificial/adverse effects ; Respiration, Artificial/methods ; Respiratory Distress Syndrome, Adult/therapy ; Ventilator-Induced Lung Injury/etiology ; Ventilator-Induced Lung Injury/prevention & control
Language	English
Publishing date	2011-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1006423-0
ISSN	1557-8232 ; 0749-0704
ISSN (online)	1557-8232
ISSN	0749-0704
DOI	10.1016/j.ccc.2011.05.008
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Article: Reduced Dorsal Visual Oscillatory Activity During Working Memory Maintenance in the First-Episode Schizophrenia Spectrum.

Coffman, Brian A / Haas, Gretchen / Olson, Carl / Cho, Raymond / Ghuman, Avniel Singh / Salisbury, Dean F

Frontiers in psychiatry

2020 Volume 11, Page(s) 743

Abstract: Cognitive deficits in people with schizophrenia are among the hardest to treat and strongly predict functional outcome. The ability to maintain sensory precepts in memory over a short delay is impacted early in the progression of schizophrenia and has ... ...

Abstract	Cognitive deficits in people with schizophrenia are among the hardest to treat and strongly predict functional outcome. The ability to maintain sensory precepts in memory over a short delay is impacted early in the progression of schizophrenia and has been linked to reliable neurophysiological markers. Yet, little is known about the mechanisms of these deficits. Here, we investigated possible neurophysiological mechanisms of impaired visual short-term memory (vSTM, aka working memory maintenance) in the first-episode schizophrenia spectrum (FESz) using magnetoencephalography (MEG). Twenty-eight FESz and 25 matched controls performed a lateralized change detection task where they were cued to selectively attend and remember colors of circles presented in either the left or right peripheral visual field over a 1 s delay. Contralateral alpha suppression (CAS) during the delay period was used to assess selective attention to cued visual hemifields held in vSTM. Delay-period CAS was compared between FESz and controls and between trials presenting one vs three items per visual hemifield. CAS in dorsal visual cortex was reduced in FESz compared to controls in high-load trials, but not low-load trials. Group differences in CAS were found beginning 100 ms after the disappearance of the memory set, suggesting deficits were not due to the initial deployment of attention to the cued visual hemifield prior to stimulus presentation. CAS was not greater for high-load vs low-load trials in FESz subjects, although this effect was prominent in controls. Further, lateralized gamma (34-40 Hz) power emerged in dorsal visual cortex prior to the onset of CAS in controls but not FESz. Gamma power in this cluster differed between groups at both high and low load. CAS deficits observed in FESz were correlated with change detection accuracy, working memory function, estimated IQ, and negative symptoms. Our results implicate deficits in CAS in trials requiring broad, but not narrow, focus of attention to spatially distributed objects maintained in vSTM in FESz, possibly due to reduced ability to broadly distribute visuospatial attention (alpha) or disruption of object-location binding (gamma) during encoding/consolidation. This early pathophysiology may shed light upon mechanisms of emerging working memory deficits that are intrinsic to schizophrenia.
Language	English
Publishing date	2020-08-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564218-2
ISSN	1664-0640
ISSN	1664-0640
DOI	10.3389/fpsyt.2020.00743
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Article ; Online: Evaluating Delivery of Low Tidal Volume Ventilation in Six ICUs Using Electronic Health Record Data.

Sjoding, Michael W / Gong, Michelle N / Haas, Carl F / Iwashyna, Theodore J

Critical care medicine

2018 Volume 47, Issue 1, Page(s) 56–61

Abstract: Objectives: Mechanical ventilation with low tidal volumes is recommended for all patients with acute respiratory distress syndrome and may be beneficial to other intubated patients, yet consistent implementation remains difficult to obtain. Using ... ...

Abstract	Objectives: Mechanical ventilation with low tidal volumes is recommended for all patients with acute respiratory distress syndrome and may be beneficial to other intubated patients, yet consistent implementation remains difficult to obtain. Using detailed electronic health record data, we examined patterns of tidal volume administration, the effect on clinical outcomes, and alternate metrics for evaluating low tidal volume compliance in clinical practice. Design: Observational cohort study. Setting: Six ICUs in a single hospital system. Patients: Adult patients who received invasive mechanical ventilation more than 12 hours. Interventions: None. Measurements and main results: Tidal volumes were analyzed across 1,905 hospitalizations. Although mean tidal volume was 6.8 mL/kg predicted body weight, 40% of patients were exposed to tidal volumes greater than 8 mL/kg predicted body weight, with 11% for more than 24 hours. At a patient level, exposure to 24 total hours of tidal volumes greater than 8 mL/kg predicted body weight was associated with increased mortality (odds ratio, 1.82; 95% CI, 1.20-2.78), whereas mean tidal volume exposure was not (odds ratio, 0.87/1 mL/kg increase; 95% CI, 0.74-1.02). Initial tidal volume settings strongly predicted exposure to volumes greater than 8 mL/kg for 24 hours; the adjusted rate was 21.5% when initial volumes were greater than 8 mL/kg predicted body weight and 7.1% when initial volumes were less than 8 mL/kg predicted body weight. Across ICUs, correlation of mean tidal volume with alternative measures of low tidal volume delivery ranged from 0.38 to 0.66. Conclusions: Despite low mean tidal volume in the cohort, a significant percentage of patients were exposed to a prolonged duration of high tidal volumes which was correlated with higher mortality. Detailed ventilator records in the electronic health record provide a unique window for evaluating low tidal volume delivery and targets for improvement.
MeSH term(s)	Adult ; Body Weight ; Cohort Studies ; Critical Illness/mortality ; Female ; Humans ; Intensive Care Units ; Male ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult/mortality ; Respiratory Distress Syndrome, Adult/therapy ; Respiratory Insufficiency/mortality ; Respiratory Insufficiency/therapy ; Tidal Volume ; Time Factors
Language	English
Publishing date	2018-10-09
Publishing country	United States
Document type	Journal Article ; Observational Study ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000003469
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Article ; Online: Correction: Enzalutamide versus bicalutamide in patients with nonmetastatic castration-resistant prostate cancer: a prespecified subgroup analysis of the STRIVE trial.

Penson, David F / Armstrong, Andrew J / Concepcion, Raoul S / Agarwal, Neeraj / Olsson, Carl A / Karsh, Lawrence I / Dunshee, Curtis J / Duggan, William / Shen, Qi / Sugg, Jennifer / Haas, Gabriel P / Higano, Celestia S

Prostate cancer and prostatic diseases

2021 Volume 25, Issue 3, Page(s) 597

Language	English
Publishing date	2021-11-30
Publishing country	England
Document type	Published Erratum
ZDB-ID	1419277-9
ISSN	1476-5608 ; 1365-7852
ISSN (online)	1476-5608
ISSN	1365-7852
DOI	10.1038/s41391-021-00477-3
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Article ; Online: Lateralized evoked responses in parietal cortex demonstrate visual short-term memory deficits in first-episode schizophrenia.

Coffman, Brian A / Murphy, Tim K / Haas, Gretchen / Olson, Carl / Cho, Raymond / Ghuman, Avniel Singh / Salisbury, Dean F

Journal of psychiatric research

2020 Volume 130, Page(s) 292–299

Abstract: Working memory dysfunction may be central to neurocognitive deficits in schizophrenia. Maintenance of visual information in working memory, or visual short-term memory (vSTM), is linked to general cognitive dysfunction and predicts functional outcome. ... ...

Abstract	Working memory dysfunction may be central to neurocognitive deficits in schizophrenia. Maintenance of visual information in working memory, or visual short-term memory (vSTM), is linked to general cognitive dysfunction and predicts functional outcome. Lateralized change-detection tasks afford investigation of the contralateral delay activity (CDA), a useful tool for investigating vSTM dysfunction. Previous work suggests "hyperfocusing" of attention in schizophrenia, such that CDA is increased when a single item is maintained in vSTM but reduced for multiple items. If observed early in the disease, vSTM dysfunction may be a key feature of schizophrenia or target for intervention. We investigated CDA during lateralized vSTM of one versus three items using sensor-level electroencephalography and source-level magnetoencephalography in 26 individuals at their first episode of schizophrenia-spectrum psychosis (FESz) and 26 matched healthy controls. FESz were unable to modulate CDA with increased memory load - high-load CDA was reduced and low-load CDA was increased compared to controls. Further, sources of CDA in posterior parietal cortex were reduced in FESz and indices of working memory were correlated with neurocognitive deficits and symptom severity. These results support working memory maintenance dysfunction as a central and early component to the disorder. Targeted intervention focusing on vSTM deficits may be warranted to alleviate downstream effects of this disability.
MeSH term(s)	Electroencephalography ; Humans ; Memory, Short-Term ; Parietal Lobe ; Photic Stimulation ; Schizophrenia/complications ; Visual Perception
Language	English
Publishing date	2020-08-17
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	3148-3
ISSN	1879-1379 ; 0022-3956
ISSN (online)	1879-1379
ISSN	0022-3956
DOI	10.1016/j.jpsychires.2020.07.036
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Article: Ventilator discontinuation protocols.

Haas, Carl F / Loik, Paul S

Respiratory care

2012 Volume 57, Issue 10, Page(s) 1649–1662

Abstract: Mechanical ventilation is a life-saving supportive therapy, but it can also cause lung injury, diaphragmatic dysfunction, and lung infection. Ventilator liberation should be attempted as soon as clinically indicated, to minimize morbidity and mortality. ... ...

Abstract	Mechanical ventilation is a life-saving supportive therapy, but it can also cause lung injury, diaphragmatic dysfunction, and lung infection. Ventilator liberation should be attempted as soon as clinically indicated, to minimize morbidity and mortality. The most effective method of liberation follows a systematic approach that includes a daily assessment of weaning readiness, in conjunction with interruption of sedation infusions and spontaneous breathing trials. Protocols and checklists are decision support tools that help ensure consistent application of key elements of evidence-based practice. A majority of studies of weaning protocols applied by non-physician healthcare providers suggest faster weaning and shorter duration of ventilation and ICU stay, and some suggest reduced failed extubation and ventilator-associated pneumonia rates. Checklists can be used to reinforce application of the protocol, or possibly in lieu of one, particularly in environments where the caregiver-to-patient ratio is high and clinicians are well versed in and dedicated to applying evidence-based care. There is support for integrating best-evidence rules for weaning into the mechanical ventilator so that a substantial portion of the weaning process can be automated, which may be most effective in environments with low caregiver-to-patient ratios or those in which it is challenging to consistently apply evidence-based care. This paper reviews evidence for ventilator liberation protocols and discusses issues of implementation and ongoing monitoring.
MeSH term(s)	Decision Support Techniques ; Humans ; Predictive Value of Tests ; Respiration, Artificial/adverse effects ; Respiratory Function Tests ; Ventilator Weaning/classification ; Ventilator Weaning/methods
Language	English
Publishing date	2012-10
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603252-7
ISSN	0020-1324 ; 0098-9142
ISSN	0020-1324 ; 0098-9142
DOI	10.4187/respcare.01895
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Article ; Online: Advanced ventilator modes and techniques.

Haas, Carl F / Bauser, Kimberly A

Critical care nursing quarterly

2012 Volume 35, Issue 1, Page(s) 27–38

Abstract: In addition to improving gas exchange by mechanical ventilation, minimizing iatrogenic lung injury and making the patient comfortable are important goals. This article reviews advanced ventilator modes and techniques that might help to accomplish these ... ...

Abstract	In addition to improving gas exchange by mechanical ventilation, minimizing iatrogenic lung injury and making the patient comfortable are important goals. This article reviews advanced ventilator modes and techniques that might help to accomplish these goals. Small tidal volumes (VT) and low ventilation pressure minimize ventilator-induced lung injury. Airway pressure release ventilation and high-frequency oscillatory ventilation may provide lung-protective ventilation in certain patients with refractory hypoxemia. Adaptive support ventilation (ASV) automatically adjusts VT and rate on the basis of the patient's respiratory mechanics to provide "safe" settings. When ventilator output does not match patient respiratory center timing, patient-ventilator asynchrony occurs. Proportional assist ventilation and neutrally adjusted ventilatory assist are unique modes of ventilation that provide ventilatory support in direct proportion to patient effort and therefore may be able to better match patient need and improve comfort. Weaning protocols reduce duration of ventilation and intensive care unit stay. Certain ventilator modes purport to automate part of the ventilator discontinuance process. The ASV progressively reduces support as the patient's lung condition improves, while SmartCare/pressure support (Dräger, Lübeck, Germany) reduces support and then initiates a spontaneous breathing trial. Further research is required to determine the proper place these new modes have in the intensive care unit.
MeSH term(s)	Humans ; Respiration, Artificial/methods ; Tidal Volume ; Ventilator-Induced Lung Injury/prevention & control
Language	English
Publishing date	2012-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	639095-x
ISSN	1550-5111 ; 0887-9303
ISSN (online)	1550-5111
ISSN	0887-9303
DOI	10.1097/CNQ.0b013e31823b2670
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Article: Less complication when calculating duration? Evaluating the accuracy of the LTV-1000 cylinder duration calculator feature.

Stevenson, Valerie Lw / Haas, Carl F

Respiratory care

2009 Volume 54, Issue 9, Page(s) 1165–1167

MeSH term(s)	Algorithms ; Humans ; Oxygen Inhalation Therapy/instrumentation ; Transportation of Patients ; Ventilators, Mechanical
Language	English
Publishing date	2009-09
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	603252-7
ISSN	0020-1324 ; 0098-9142
ISSN	0020-1324 ; 0098-9142
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Article: Lung protective mechanical ventilation in acute respiratory distress syndrome.

Haas, Carl F

Respiratory care clinics of North America

2003 Volume 9, Issue 3, Page(s) 363–396

Abstract: The evidence supports the idea that mechanical ventilation can potentially cause further lung injury. The only ventilator manipulation that so far has been shown definitively to reduce injury and improve mortality is the reduction of VT to 6 mL/kg PBW or ...

Abstract	The evidence supports the idea that mechanical ventilation can potentially cause further lung injury. The only ventilator manipulation that so far has been shown definitively to reduce injury and improve mortality is the reduction of VT to 6 mL/kg PBW or lower and targeting Pplat to 30 cm H2O or lower. Much research is needed to provide further guidance in applying ventilatory support techniques.
MeSH term(s)	Animals ; Disease Models, Animal ; Humans ; Lung/physiopathology ; Lung Injury ; Practice Guidelines as Topic ; Randomized Controlled Trials as Topic ; Respiration, Artificial/adverse effects ; Respiration, Artificial/methods ; Respiratory Distress Syndrome, Adult/therapy ; Tidal Volume ; Ventilator Weaning
Language	English
Publishing date	2003-12-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1384525-1
ISSN	1078-5337
ISSN	1078-5337
DOI	10.1016/s1078-5337(03)00043-1
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Article ; Online: Enzalutamide versus bicalutamide in patients with nonmetastatic castration-resistant prostate cancer: a prespecified subgroup analysis of the STRIVE trial.

Prostate cancer and prostatic diseases

2021 Volume 25, Issue 2, Page(s) 363–365

Abstract: Background: In the phase 2, randomized, double-blind STRIVE trial, enzalutamide significantly reduced the risk of prostate cancer progression or death versus bicalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC) and ... ...

Abstract	Background: In the phase 2, randomized, double-blind STRIVE trial, enzalutamide significantly reduced the risk of prostate cancer progression or death versus bicalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC) and nonmetastatic CRPC (nmCRPC). The objective of this protocol-specified subgroup analysis of STRIVE was to investigate the benefit of enzalutamide versus bicalutamide specifically in patients with nmCRPC. Methods: Patients (N = 139) were stratified by disease stage and randomized to enzalutamide 160 mg/day plus androgen deprivation therapy (ADT; n = 70) or bicalutamide 50 mg/day plus ADT (n = 69). Results: Baseline characteristics of patients with nmCRPC were comparable between groups. At a median of 17 months follow-up, enzalutamide reduced the risk of progression or death by 76% versus bicalutamide in patients with nmCRPC (hazard ratio [HR], 0.24; 95% CI 0.14-0.42). Enzalutamide reduced risk of prostate-specific antigen progression by 82% versus bicalutamide in patients with nmCRPC (HR, 0.18; 95% CI 0.10-0.34). The most frequently reported adverse events by patients receiving enzalutamide were fatigue (36.2%), hot flush (20.3%), decreased appetite (17.4%), dizziness (17.4%), and nausea (17.4%). Conclusions: This STRIVE subgroup analysis of patients with nmCRPC illustrates the benefit of enzalutamide in reducing the risk of progression or death versus bicalutamide in patients with nmCRPC. Trial registration: ClinicalTrials.gov identifier NCT01664923.
MeSH term(s)	Androgen Antagonists/adverse effects ; Anilides ; Benzamides ; Humans ; Male ; Nitriles/adverse effects ; Phenylthiohydantoin/adverse effects ; Prostatic Neoplasms, Castration-Resistant/drug therapy ; Prostatic Neoplasms, Castration-Resistant/pathology ; Tosyl Compounds ; Treatment Outcome
Chemical Substances	Androgen Antagonists ; Anilides ; Benzamides ; Nitriles ; Tosyl Compounds ; Phenylthiohydantoin (2010-15-3) ; enzalutamide (93T0T9GKNU) ; bicalutamide (A0Z3NAU9DP)
Language	English
Publishing date	2021-10-07
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	1419277-9
ISSN	1476-5608 ; 1365-7852
ISSN (online)	1476-5608
ISSN	1365-7852
DOI	10.1038/s41391-021-00465-7
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