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Article ; Online: Advanced management of intermediate-high risk pulmonary embolism.

Weinstein, Tatiana / Deshwal, Himanshu / Brosnahan, Shari B

2021 Volume 25, Issue 1, Page(s) 311

Abstract: This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2021. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2021 . Further information about the ... ...

Abstract	This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2021. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2021 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 .
MeSH term(s)	Embolectomy/methods ; Humans ; Intensive Care Units/organization & administration ; Pulmonary Embolism/diagnosis ; Pulmonary Embolism/therapy ; Risk Factors ; Severity of Illness Index ; Thrombolytic Therapy/methods ; Thrombolytic Therapy/trends
Language	English
Publishing date	2021-08-31
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-021-03679-2
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Article ; Online: Reply: Low-Dose Tocilizumab With High-Dose Corticosteroids in Patients Hospitalized for COVID-19 Hypoxic Respiratory Failure Improves Mortality Without Increased Infection Risk.

Chen, Xian Jie Cindy / Altshuler, Diana / Spiegler, Peter / Brosnahan, Shari B

The Annals of pharmacotherapy

2021 Volume 56, Issue 4, Page(s) 507–508

MeSH term(s)	Adrenal Cortex Hormones/adverse effects ; Antibodies, Monoclonal, Humanized ; COVID-19/drug therapy ; Humans ; Respiratory Insufficiency ; SARS-CoV-2
Chemical Substances	Adrenal Cortex Hormones ; Antibodies, Monoclonal, Humanized ; tocilizumab (I031V2H011)
Language	English
Publishing date	2021-07-30
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	1101370-9
ISSN	1542-6270 ; 1060-0280
ISSN (online)	1542-6270
ISSN	1060-0280
DOI	10.1177/10600280211036047
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Article ; Online: Cardiovascular Critical Care Training: A Collaboration between Intensivists and Cardiologists.

Yuriditsky, Eugene / Pradhan, Deepak / Brosnahan, Shari B / Horowitz, James M / Addrizzo-Harris, Doreen

ATS scholar

2022 Volume 3, Issue 4, Page(s) 522–534

Abstract: With growing patient complexity, the cardiovascular intensive care unit (CICU) of today has evolved substantially from the coronary care unit (CCU) of decades ago. The growing burden of noncardiac critical illness and highly specialized acute ... ...

Abstract	With growing patient complexity, the cardiovascular intensive care unit (CICU) of today has evolved substantially from the coronary care unit (CCU) of decades ago. The growing burden of noncardiac critical illness and highly specialized acute cardiovascular disease requires a degree of expertise beyond that afforded through a general cardiology training program. Therefore, the American Heart Association (AHA) has proposed a CICU staffing model to include dedicated cardiac intensivists; in the present day, "dual-trained" physicians are extremely sparse. Guidance on designing critical care fellowships for cardiologists is limited but will require collaboration between cardiologists and medical intensivists. Here, we review the evolution of the CICU, describe training pathways, and offer guidance on creating a cardiology critical care training program.
Language	English
Publishing date	2022-11-11
Publishing country	United States
Document type	Journal Article
ISSN	2690-7097
ISSN (online)	2690-7097
DOI	10.34197/ats-scholar.2022-0087PS
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Article ; Online: Impact of Time to Intervention on Catheter-Directed Therapy for Pulmonary Embolism.

Lehr, Andrew / Guichet, Phillip / Garimella, Bhaskara / Krolikowski, Kelsey / Amoroso, Nancy / Sista, Akhilesh / Brosnahan, Shari B

Critical care explorations

2023 Volume 5, Issue 1, Page(s) e0828

Abstract: Cather-directed therapies (CDTs) are an evolving therapeutic option for patients with intermediate-risk pulmonary embolism (PE). Although many techniques have been studied, there is limited evidence for the impact of timing of intervention on patient ... ...

Abstract	Cather-directed therapies (CDTs) are an evolving therapeutic option for patients with intermediate-risk pulmonary embolism (PE). Although many techniques have been studied, there is limited evidence for the impact of timing of intervention on patient outcomes. Our objective was to assess the association between time to CDT in patients presenting with PE on patient-related outcomes such as length of stay (LOS) and mortality. Design: Retrospective cohort study. Setting: Single academic center. Patients: We identified patients for which the PE response team had been activated from January 2014 to October 2021. Patients were split into two cohorts depending on whether they went to CDT less than 24 hours from admission (early) versus greater than 24 hours (late). Interventions: None. Measurements and main results: Data on demographics, timing of interventions, pulmonary hemodynamics, and outcomes were collected. Sixty-four patients were included in analysis. Thirty-nine (63.8%) underwent their procedure less than 24 hours from admission, whereas 25 (36.2%) underwent the procedure after 24 hours. The time from admission to CDT was 15.9 hours (9.1-20.3 hr) in the early group versus 33.4 (27.9-41) in the late group ( Conclusions: Patients who underwent CDT within 24 hours of admission were more likely to have shorter hospital and ICU LOS. The magnitude of change in LOS between the two cohorts was not fully explained by the difference in time to CDT. There were modest improvements in pulmonary hemodynamics in the patients who underwent CDT earlier.
Language	English
Publishing date	2023-01-17
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000828
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Article ; Online: Low dose vs high dose tocilizumab in COVID-19 patients with hypoxemic respiratory failure.

Chung, Juri / Brosnahan, Shari B / Islam, Shahidul / Altshuler, Diana / Spiegler, Peter / Li, Wai Kin / Wang, Wai Man / Chen, Xian Jie Cindy

Journal of critical care

2023 Volume 76, Page(s) 154291

Abstract: Purpose: Tocilizumab has been shown to decrease mortality when used concomitantly with steroids in COVID-19 with 8 mg/kg (max 800 mg) being the standard dose. Our study sought to assess whether a low dose (400 mg) shows similar benefit compared to a ... ...

Abstract	Purpose: Tocilizumab has been shown to decrease mortality when used concomitantly with steroids in COVID-19 with 8 mg/kg (max 800 mg) being the standard dose. Our study sought to assess whether a low dose (400 mg) shows similar benefit compared to a high dose for COVID patients concurrently on the same median dose of steroids. Materials/methods: A retrospective, multihospital observational study of COVID-19 patients who received tocilizumab in conjunction with steroids between March 2020 and August 2021 was conducted. Results: A total of 407 patients were analyzed with low dose group being significantly more ill at baseline as a higher percentage of patients received vasopressors, were admitted to the ICU and on mechanical ventilation. In the propensity-matched analysis, both groups receiving a median dexamethasone equivalent dose of 10 mg showed no difference in 28-day mortality (p = 0.613). The high dose group had a higher rate of fungal and viral infections. Conclusion: Compared to low dose tocilizumab, the high dose did not provide additional efficacy and mortality benefit but resulted in higher fungal and viral infections. This study illustrates that low dose tocilizumab can be an alternative to high dose during a drug shortage of tocilizumab without compensating for efficacy and safety, conserving resources for more patients.
MeSH term(s)	Humans ; COVID-19 ; SARS-CoV-2 ; Retrospective Studies ; Treatment Outcome ; COVID-19 Drug Treatment ; Respiratory Insufficiency/drug therapy
Chemical Substances	tocilizumab (I031V2H011)
Language	English
Publishing date	2023-04-10
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2023.154291
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Article ; Online: Pulmonary Critical Care Fellows' Use of and Self-reported Barriers to Learning Bedside Ultrasound During Training: Results of a National Survey.

Brady, Anna K / Spitzer, Carleen R / Kelm, Diana / Brosnahan, Shari B / Latifi, Mani / Burkart, Kristin M

Chest

2021 Volume 160, Issue 1, Page(s) 231–237

Abstract: Background: Competence in ultrasonography is essential for pulmonary and critical care medicine (PCCM) fellows, but little is known about fellow-reported barriers to acquiring this crucial skill during fellowship training.: Research question: How do ... ...

Abstract	Background: Competence in ultrasonography is essential for pulmonary and critical care medicine (PCCM) fellows, but little is known about fellow-reported barriers to acquiring this crucial skill during fellowship training. Research question: How do PCCM fellows acquire experience performing and interpreting ultrasonography during their training, what is their perspective on barriers to acquiring ultrasound expertise during fellowship, and what is their comfort with a range of ultrasound examinations? Study design and methods: A 20-item survey including questions about procedural training and acquisition of ultrasound skills during PCCM fellowship was developed. The survey instrument was sent to PCCM fellowship program directors to distribute to their fellows at program directors' discretion. Results: Four hundred seventy-five responses were received. The most common method of learning ultrasonography was performing it independently at the bedside. Fellows reported that the greatest barrier to acquiring ultrasound skills was the lack of trained faculty experts, followed by lack of a formal curriculum. Fellow comfort was greatest with thoracic ultrasound and least with advanced cardiac ultrasound. Interpretation: Significant barriers to ultrasound training during PCCM fellowship exist, and future educational efforts should address these barriers at both program and institutional levels.
MeSH term(s)	Attitude of Health Personnel ; Clinical Competence ; Critical Care/standards ; Curriculum ; Education, Medical, Graduate/methods ; Humans ; Learning ; Lung Diseases/diagnosis ; Point-of-Care Testing ; Pulmonary Medicine/education ; Self Report ; Surveys and Questionnaires ; Ultrasonography
Language	English
Publishing date	2021-02-01
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2021.01.068
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Article ; Online: Pharmacologic neuroprotection in ischemic brain injury after cardiac arrest.

Katz, Alyson / Brosnahan, Shari B / Papadopoulos, John / Parnia, Sam / Lam, Jason Q

Annals of the New York Academy of Sciences

2021 Volume 1507, Issue 1, Page(s) 49–59

Abstract: Cardiac arrest has many implications for morbidity and mortality. Few interventions have been shown to improve return of spontaneous circulation (ROSC) and long-term outcomes after cardiac arrest. Ischemic-reperfusion injury upon achieving ROSC creates ... ...

Abstract	Cardiac arrest has many implications for morbidity and mortality. Few interventions have been shown to improve return of spontaneous circulation (ROSC) and long-term outcomes after cardiac arrest. Ischemic-reperfusion injury upon achieving ROSC creates an imbalance between oxygen supply and demand. Multiple events occur in the postcardiac arrest period, including excitotoxicity, mitochondrial dysfunction, and oxidative stress and inflammation, all of which contribute to ongoing brain injury and cellular death. Given that complex pathophysiology underlies global brain hypoxic ischemia, neuroprotective strategies targeting multiple stages of the neuropathologic cascade should be considered as a means of mitigating secondary neuronal injury and improving neurologic outcomes and survival in cardiac arrest victims. In this review article, we discuss a number of different pharmacologic agents that may have a potential role in targeting these injurious pathways following cardiac arrest. Pharmacologic therapies most relevant for discussion currently include memantine, perampanel, magnesium, propofol, thiamine, methylene blue, vitamin C, vitamin E, coenzyme Q
MeSH term(s)	Animals ; Antioxidants/administration & dosage ; Brain Injuries/etiology ; Brain Injuries/metabolism ; Brain Injuries/prevention & control ; Brain Ischemia/etiology ; Brain Ischemia/metabolism ; Brain Ischemia/prevention & control ; Heart Arrest/complications ; Heart Arrest/drug therapy ; Heart Arrest/metabolism ; Humans ; Memantine/administration & dosage ; Neuroprotection/drug effects ; Neuroprotection/physiology ; Neuroprotective Agents/administration & dosage ; Nitriles/administration & dosage ; Oxidative Stress/drug effects ; Oxidative Stress/physiology ; Pyridones/administration & dosage ; Thiamine/administration & dosage
Chemical Substances	Antioxidants ; Neuroprotective Agents ; Nitriles ; Pyridones ; perampanel (H821664NPK) ; Memantine (W8O17SJF3T) ; Thiamine (X66NSO3N35)
Language	English
Publishing date	2021-05-31
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	211003-9
ISSN	1749-6632 ; 0077-8923
ISSN (online)	1749-6632
ISSN	0077-8923
DOI	10.1111/nyas.14613
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Article ; Online: COVID-19 Pneumonia Hospitalizations Followed by Re-Presentation for Presumed Thrombotic Event.

Brosnahan, Shari B / Bhatt, Alok / Berger, Jeffery S / Yuriditsky, Eugene / Iturrate, Eduardo / Amoroso, Nancy E

Chest

2020 Volume 158, Issue 4, Page(s) 1665–1668

MeSH term(s)	Aged ; Aged, 80 and over ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/diagnosis ; Coronavirus Infections/therapy ; Female ; Hospitalization ; Humans ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/therapy ; Retrospective Studies ; SARS-CoV-2 ; Venous Thrombosis/diagnosis ; Venous Thrombosis/therapy ; Venous Thrombosis/virology
Keywords	covid19
Language	English
Publishing date	2020-06-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2020.06.023
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Article ; Online: Optimal dosing of heparin for prophylactic anticoagulation in critically ill COVID-19 patients a systematic review and meta-analysis of randomized controlled trials.

Bonfim, Luana C M G / Guerini, Isadora S / Zambon, Marjorie G / Pires, Gabriela B / Silva, Amanda C F / Gobatto, André L N / Lopes, Marcela A / Brosnahan, Shari B

Journal of critical care

2023 Volume 77, Page(s) 154344

Abstract: Purpose: The optimal amount of anticoagulation for critically ill COVID-19 patients is controversial. Therefore, we aimed to evaluate the efficacy and safety of escalated doses of anticoagulation in critically ill patients with severe COVID-19.: ... ...

Abstract	Purpose: The optimal amount of anticoagulation for critically ill COVID-19 patients is controversial. Therefore, we aimed to evaluate the efficacy and safety of escalated doses of anticoagulation in critically ill patients with severe COVID-19. Materials and methods: We conducted a systematic search of three major databases, including PubMed, Cochrane Library, and Embase, from inception to May 2022. Randomized controlled trials (RCTs) were included comparing therapeutic or intermediate doses to standard prophylactic doses of anticoagulants in critically ill COVID-19 patients, with heparins as the only anticoagulation therapy considered. Results: Out of the six RCTs, 2130 patients were administered escalated dose anticoagulation (50.2%) and standard thromboprophylaxis therapy (49.8%). The escalated dose showed no significant impact on mortality (RR, 1.01; 95% CI, 0.90-1.13). Although there was no significant difference in DVT (RR, 0.81; 95% CI, 0.61-1.08), the risk of PE was significantly reduced in patients receiving escalated dose anticoagulation (RR, 0.35; 95% CI, 0.21-0.60), with an increased risk of bleeding events (RR, 1.65; 95% CI, 1.08-2.53). Conclusion: This systematic review and meta-analysis fail to support escalated anticoagulation doses to reduce mortality in critically ill COVID-19 patients. However, higher doses of anticoagulants appear to reduce thrombotic events while increasing the risk of bleeding effectively.
MeSH term(s)	Humans ; Heparin/adverse effects ; Heparin, Low-Molecular-Weight/therapeutic use ; Critical Illness ; COVID-19 ; Neoplasms ; Randomized Controlled Trials as Topic ; Anticoagulants/adverse effects ; Hemorrhage/chemically induced ; Venous Thromboembolism/drug therapy
Chemical Substances	Heparin (9005-49-6) ; Heparin, Low-Molecular-Weight ; Anticoagulants
Language	English
Publishing date	2023-05-25
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article ; Review
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2023.154344
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Article: Successful use of an automated proning system to achieve prone positioning in a patient with severe ARDS requiring veno-venous ECMO.

Lehr, Andrew L / Smith, Deane E / Toy, Bridget / Goldenberg, Ronald / Brosnahan, Shari B

Respiratory medicine case reports

2020 Volume 31, Page(s) 101315

Abstract: A morbidly obese middle aged woman in her 40's presented to another hospital with methicillin resistant staphylococcus aureus pneumonia and subsequently developed severe acute respiratory distress syndrome. Her oxygenation demonstrated no improvement ... ...

Abstract	A morbidly obese middle aged woman in her 40's presented to another hospital with methicillin resistant staphylococcus aureus pneumonia and subsequently developed severe acute respiratory distress syndrome. Her oxygenation demonstrated no improvement with low tidal volume ventilation, paralysis, or prostagladin therapy. She was unable to be manually proned secondary to her habitus. She was subsequently transferred to our facility, where she was initiated on VV-ECMO. Maximal flow through the ECMO circuit was inadequate for oxygenation given significant systemic shunt through her native lungs. In order to optimize lung protective ventilation and treat ARDS, we used an automated kinetic system (Rotoprone Therapy System) to prone the patient. To our knowledge, this is the first description in the literature of using an automated proning system with an ECMO circuit in place. This report describes the technique we used to safely perform axial rotations for two days with fewer providers required than manual proning.
Language	English
Publishing date	2020-12-04
Publishing country	England
Document type	Case Reports
ZDB-ID	2666110-X
ISSN	2213-0071
ISSN	2213-0071
DOI	10.1016/j.rmcr.2020.101315
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