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  1. Article ; Online: Insights into Endotheliopathy in COVID-19.

    Filbin, Michael R

    American journal of respiratory and critical care medicine

    2022  Volume 206, Issue 8, Page(s) 926–928

    MeSH term(s) COVID-19 ; Endothelium, Vascular ; Humans ; Lung ; Pneumonia ; SARS-CoV-2
    Language English
    Publishing date 2022-07-11
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202207-1258ED
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  2. Article ; Online: Atypical symptoms in emergency department patients with urosepsis challenge current urinary tract infection management guidelines.

    Biebelberg, Brett / Kehoe, Iain E / Zheng, Hui / O'Connell, Abigail / Filbin, Michael R / Heldt, Thomas / Reisner, Andrew T

    Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

    2024  

    Language English
    Publishing date 2024-04-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1329813-6
    ISSN 1553-2712 ; 1069-6563
    ISSN (online) 1553-2712
    ISSN 1069-6563
    DOI 10.1111/acem.14914
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  3. Article ; Online: Reply to Akin

    Leisman, Daniel E / Mehta, Arnav / Thompson, B Taylor / Hacohen, Nir / Filbin, Michael R / Goldberg, Marcia B

    American journal of respiratory and critical care medicine

    2022  Volume 205, Issue 10, Page(s) 1253–1254

    MeSH term(s) Angiotensins ; COVID-19 ; Humans ; Renin ; Renin-Angiotensin System ; SARS-CoV-2
    Chemical Substances Angiotensins ; Renin (EC 3.4.23.15)
    Language English
    Publishing date 2022-03-27
    Publishing country United States
    Document type Letter ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural ; Comment
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 0003-0805 ; 1073-449X
    ISSN (online) 1535-4970
    ISSN 0003-0805 ; 1073-449X
    DOI 10.1164/rccm.202202-0292LE
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  4. Article: Modeling of Usual Care: Vasopressor Initiation for Sepsis With Hypotension.

    Prasad, Varesh / Reisner, Andrew T / Lynch, James C / Filbin, Michael R / Heldt, Thomas

    Frontiers in medicine

    2022  Volume 9, Page(s) 715856

    Abstract: Usual care regarding vasopressor initiation is ill-defined. We aimed to develop a quantitative "dynamic practice" model for usual care in the emergency department (ED) regarding the timing of vasopressor initiation in sepsis. In a retrospective study of ... ...

    Abstract Usual care regarding vasopressor initiation is ill-defined. We aimed to develop a quantitative "dynamic practice" model for usual care in the emergency department (ED) regarding the timing of vasopressor initiation in sepsis. In a retrospective study of 589 septic patients with hypotension in an urban tertiary care center ED, we developed a multi-variable model that distinguishes between patients who did and did not subsequently receive sustained (>24 h) vasopressor therapy. Candidate predictors were vital signs, intravenous fluid (IVF) volumes, laboratory measurements, and elapsed time from triage computed at timepoints leading up to the final decision timepoint of either vasopressor initiation or ED hypotension resolution without vasopressors. A model with six independently significant covariates (respiratory rate, Glasgow Coma Scale score, SBP, SpO
    Language English
    Publishing date 2022-03-11
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2775999-4
    ISSN 2296-858X
    ISSN 2296-858X
    DOI 10.3389/fmed.2022.715856
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  5. Book: Emergency management of the coding patient

    Senecal, Emily L. / Filbin, Michael R.

    cases, algorithms, evidence

    (Emergency management series)

    2005  

    Author's details Emily L. Senecal ; Michael R. Filbin
    Series title Emergency management series
    Keywords Cardiopulmonary Resuscitation / methods ; Emergency Treatment / methods ; Tachycardia / therapy
    Language English
    Size XI, 170 S. : Ill., graph. Darst.
    Publisher Blackwell
    Publishing place Malden, Mass. u.a.
    Publishing country United States
    Document type Book
    HBZ-ID HT014307762
    ISBN 1-4051-0455-4 ; 978-1-4051-0455-5
    Database Catalogue ZB MED Medicine, Health

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    Shelf markLoan statusLocation
    2006 A 5337 order for loan Magazin

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  6. Article ; Online: ACE inhibitors and angiotensin receptor blockers differentially alter the response to angiotensin II treatment in vasodilatory shock.

    Leisman, Daniel E / Handisides, Damian R / Busse, Laurence W / Chappell, Mark C / Chawla, Lakhmir S / Filbin, Michael R / Goldberg, Marcia B / Ham, Kealy R / Khanna, Ashish K / Ostermann, Marlies / McCurdy, Michael T / Adams, Christopher D / Hodges, Tony N / Bellomo, Rinaldo

    Critical care (London, England)

    2024  Volume 28, Issue 1, Page(s) 130

    Abstract: Background: Angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blockers (ARB) medications are widely prescribed. We sought to assess how pre-admission use of these medications might impact the response to angiotensin-II treatment ... ...

    Abstract Background: Angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blockers (ARB) medications are widely prescribed. We sought to assess how pre-admission use of these medications might impact the response to angiotensin-II treatment during vasodilatory shock.
    Methods: In a post-hoc subgroup analysis of the randomized, placebo-controlled, Angiotensin Therapy for High Output Shock (ATHOS-3) trial, we compared patients with chronic angiotensin-converting enzyme inhibitor (ACEi) use, and patients with angiotensin receptor blocker (ARB) use, to patients without exposure to either ACEi or ARB. The primary outcome was mean arterial pressure after 1-h of treatment. Additional clinical outcomes included mean arterial pressure and norepinephrine equivalent dose requirements over time, and study-drug dose over time. Biological outcomes included baseline RAS biomarkers (renin, angiotensin-I, angiotensin-II, and angiotensin-I/angiotensin-II ratio), and the change in renin from 0 to 3 h.
    Results: We included n = 321 patients, of whom, 270 were ACEi and ARB-unexposed, 29 were ACEi-exposed and 22 ARB-exposed. In ACEi/ARB-unexposed patients, angiotensin-treated patients, compared to placebo, had higher hour-1 mean arterial pressure (9.1 mmHg [95% CI 7.6-10.1], p < 0.0001), lower norepinephrine equivalent dose over 48-h (p = 0.0037), and lower study-drug dose over 48-h (p < 0.0001). ACEi-exposed patients treated with angiotensin-II showed similarly higher hour-1 mean arterial pressure compared to ACEi/ARB-unexposed (difference in treatment-effect: - 2.2 mmHg [95% CI - 7.0-2.6], p
    Conclusions: In vasodilatory shock patients, the cardiovascular and biological RAS response to angiotensin-II differed based upon prior exposure to ACEi and ARB medications. ACEi-exposure was associated with increased angiotensin II responsiveness, whereas ARB-exposure was associated with decreased responsiveness. These findings have clinical implications for patient selection and dosage of angiotensin II in vasodilatory shock. Trial Registration ClinicalTrials.Gov Identifier: NCT02338843 (Registered January 14th 2015).
    MeSH term(s) Humans ; Angiotensin-Converting Enzyme Inhibitors/adverse effects ; Angiotensin II/therapeutic use ; Renin ; Angiotensin Receptor Antagonists/adverse effects ; Shock/drug therapy ; Norepinephrine/therapeutic use
    Chemical Substances Angiotensin-Converting Enzyme Inhibitors ; Angiotensin II (11128-99-7) ; Renin (EC 3.4.23.15) ; Angiotensin Receptor Antagonists ; Norepinephrine (X4W3ENH1CV)
    Language English
    Publishing date 2024-04-18
    Publishing country England
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/s13054-024-04910-6
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    Zs.A 5517: Show issues Location:
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  7. Article ; Online: The authors reply.

    Filbin, Michael R / Heldt, Thomas / Reisner, Andrew T

    Critical care medicine

    2018  Volume 46, Issue 12, Page(s) e1222–e1223

    MeSH term(s) Humans ; Shock, Septic
    Language English
    Publishing date 2018-11-16
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000003481
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  8. Article: Plasma P-selectin is an early marker of thromboembolism in COVID-19.

    Fenyves, Bánk G / Mehta, Arnav / Kays, Kyle R / Goldberg, Marcia B / Hacohen, Nir / Filbin, Michael R

    medRxiv : the preprint server for health sciences

    2021  

    Abstract: Coagulopathy and thromboembolism are known complications of SARS-CoV-2 infection. The mechanisms of COVID-19-associated hematologic complications involve endothelial cell and platelet dysfunction and have been intensively studied. We leveraged a ... ...

    Abstract Coagulopathy and thromboembolism are known complications of SARS-CoV-2 infection. The mechanisms of COVID-19-associated hematologic complications involve endothelial cell and platelet dysfunction and have been intensively studied. We leveraged a prospectively collected acute COVID-19 biorepository to study the association of plasma levels of a comprehensive list of coagulation proteins with the occurrence of venous thromboembolic events (VTE). We included in our analysis 305 subjects with confirmed SARS-CoV-2 infection who presented to an urban Emergency Department with acute respiratory distress during the first COVID-19 surge in 2020; 13 (4.2%) were subsequently diagnosed with venous thromboembolism during hospitalization. Serial samples were obtained and assays were performed on two highly-multiplexed proteomic platforms. Nine coagulation proteins were differentially expressed in patients with thromboembolic events. P-selectin, a cell adhesion molecule on the surface of activated endothelial cells, displayed the strongest association with the diagnosis of VTE, independent of disease severity (p=0.0025). This supports the importance of endothelial activation in the mechanistic pathway of venous thromboembolism in COVID-19. P-selectin together with D-dimer upon hospital presentation provided better discriminative ability for VTE diagnosis than D-dimer alone.
    Language English
    Publishing date 2021-07-14
    Publishing country United States
    Document type Preprint
    DOI 10.1101/2021.07.10.21260293
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Risk of Misleading Conclusions in Observational Studies of Time-to-Antibiotics and Mortality in Suspected Sepsis.

    Pak, Theodore R / Young, Jessica / McKenna, Caroline S / Agan, Anna / DelloStritto, Laura / Filbin, Michael R / Dutta, Sayon / Kadri, Sameer S / Septimus, Edward J / Rhee, Chanu / Klompas, Michael

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2023  Volume 77, Issue 11, Page(s) 1534–1543

    Abstract: Background: Influential studies conclude that each hour until antibiotics increases mortality in sepsis. However, these analyses often (1) adjusted for limited covariates, (2) included patients with long delays until antibiotics, (3) combined sepsis and ...

    Abstract Background: Influential studies conclude that each hour until antibiotics increases mortality in sepsis. However, these analyses often (1) adjusted for limited covariates, (2) included patients with long delays until antibiotics, (3) combined sepsis and septic shock, and (4) used linear models presuming each hour delay has equal impact. We evaluated the effect of these analytic choices on associations between time-to-antibiotics and mortality.
    Methods: We retrospectively identified 104 248 adults admitted to 5 hospitals from 2015-2022 with suspected infection (blood culture collection and intravenous antibiotics ≤24 h of arrival), including 25 990 with suspected septic shock and 23 619 with sepsis without shock. We used multivariable regression to calculate associations between time-to-antibiotics and in-hospital mortality under successively broader confounding-adjustment, shorter maximum time-to-antibiotic intervals, stratification by illness severity, and removing assumptions of linear hourly associations.
    Results: Changing covariates, maximum time-to-antibiotics, and severity stratification altered the magnitude, direction, and significance of observed associations between time-to-antibiotics and mortality. In a fully adjusted model of patients treated ≤6 hours, each hour was associated with higher mortality for septic shock (adjusted odds ratio [aOR]: 1.07; 95% CI: 1.04-1.11) but not sepsis without shock (aOR: 1.03; .98-1.09) or suspected infection alone (aOR: .99; .94-1.05). Modeling each hour separately confirmed that every hour of delay was associated with increased mortality for septic shock, but only delays >6 hours were associated with higher mortality for sepsis without shock.
    Conclusions: Associations between time-to-antibiotics and mortality in sepsis are highly sensitive to analytic choices. Failure to adequately address these issues can generate misleading conclusions.
    MeSH term(s) Adult ; Humans ; Shock, Septic ; Retrospective Studies ; Anti-Bacterial Agents/therapeutic use ; Time Factors ; Sepsis ; Hospital Mortality
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2023-08-03
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciad450
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  10. Article ; Online: Modeling of Usual Care

    Varesh Prasad / Andrew T. Reisner / James C. Lynch / Michael R. Filbin / Thomas Heldt

    Frontiers in Medicine, Vol

    Vasopressor Initiation for Sepsis With Hypotension

    2022  Volume 9

    Abstract: Usual care regarding vasopressor initiation is ill-defined. We aimed to develop a quantitative “dynamic practice” model for usual care in the emergency department (ED) regarding the timing of vasopressor initiation in sepsis. In a retrospective study of ... ...

    Abstract Usual care regarding vasopressor initiation is ill-defined. We aimed to develop a quantitative “dynamic practice” model for usual care in the emergency department (ED) regarding the timing of vasopressor initiation in sepsis. In a retrospective study of 589 septic patients with hypotension in an urban tertiary care center ED, we developed a multi-variable model that distinguishes between patients who did and did not subsequently receive sustained (>24 h) vasopressor therapy. Candidate predictors were vital signs, intravenous fluid (IVF) volumes, laboratory measurements, and elapsed time from triage computed at timepoints leading up to the final decision timepoint of either vasopressor initiation or ED hypotension resolution without vasopressors. A model with six independently significant covariates (respiratory rate, Glasgow Coma Scale score, SBP, SpO2, administered IVF, and elapsed time) achieved a C-statistic of 0.78 in a held-out test set at the final decision timepoint, demonstrating the ability to reliably model usual care for vasopressor initiation for hypotensive septic patients. The included variables measured depth of hypotension, extent of disease severity and organ dysfunction. At an operating point of 90% specificity, the model identified a minority of patients (39%) more than an hour before actual vasopressor initiation, during which time a median of 2,250 (IQR 1,200–3,300) mL of IVF was administered. This single-center analysis shows the feasibility of a quantitative, objective tool for describing usual care. Dynamic practice models may help assess when management was atypical; such tools may also be useful for designing and interpreting clinical trials.
    Keywords sepsis ; septic shock ; emergency medicine ; mathematical modeling ; usual care ; vasopressors ; Medicine (General) ; R5-920
    Subject code 310
    Language English
    Publishing date 2022-03-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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