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Article ; Online: Ventilator Weaning and Extubation.

Burns, Karen E A / Rochwerg, Bram / Seely, Andrew J E

2024 Volume 40, Issue 2, Page(s) 391–408

Abstract: Increasing evidence supports specific approaches to liberate patients from invasive ventilation including the use of liberation protocols, inspiratory assistance during spontaneous breathing trials (SBTs), early extubation of patients with chronic ... ...

Abstract	Increasing evidence supports specific approaches to liberate patients from invasive ventilation including the use of liberation protocols, inspiratory assistance during spontaneous breathing trials (SBTs), early extubation of patients with chronic obstructive pulmonary disease to noninvasive ventilation, and prophylactic use of noninvasive support strategies after extubation. Additional research is needed to elucidate the best criteria to identify patients who are ready to undergo an SBT and to inform optimal screening frequency, the best SBT technique and duration, extubation assessments, and extubation decision-making. Additional clarity is also needed regarding the optimal timing to measure and report extubation success.
MeSH term(s)	Humans ; Ventilator Weaning ; Airway Extubation ; Noninvasive Ventilation ; Pulmonary Disease, Chronic Obstructive/therapy
Language	English
Publishing date	2024-02-06
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.2024.01.007
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Article ; Online: 10 Ways to Empower Yourself as a Woman in Science or Academic Medicine.

Burns, Karen E A

The American journal of medicine

2020 Volume 133, Issue 8, Page(s) 881–882

MeSH term(s)	Empowerment ; Female ; Humans ; Leadership ; Physicians, Women
Language	English
Publishing date	2020-04-14
Publishing country	United States
Document type	Editorial
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2020.02.044
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Article ; Online: Response.

Trivedi, Vatsal / Chaudhuri, Dipayan / Burns, Karen E A

Chest

2022 Volume 161, Issue 6, Page(s) e394

Language	English
Publishing date	2022-06-08
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2022.02.020
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Article ; Online: Systemic lupus erythematosus associated with development of macrophage activation syndrome and disseminated aspergillosis.

Phoophiboon, Vorakamol / Brown, Paula / Burns, Karen E A

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2023 Volume 70, Issue 7, Page(s) 1255–1260

Abstract: Purpose: Macrophage activation syndrome (MAS) is a rare illness, especially in critically ill adults. The diagnosis of MAS is challenging, requiring the expertise of multiple specialists, and treatments for MAS can be associated with catastrophic ... ...

Title translation	Lupus érythémateux disséminé associé au développement du syndrome d’activation macrophagique et à une aspergillose disséminée.
Abstract	Purpose: Macrophage activation syndrome (MAS) is a rare illness, especially in critically ill adults. The diagnosis of MAS is challenging, requiring the expertise of multiple specialists, and treatments for MAS can be associated with catastrophic complications. Clinical features: We describe the case of a 31-yr-old Vietnamese student who was diagnosed with cutaneous systemic lupus erythematosus (SLE) in November 2020 and was initiated on treatment with low-dose corticosteroids and hydroxychloroquine as an outpatient. Ten days later, she presented to hospital with decreased consciousness, fever, periorbital swelling, and hypotension necessitating intubation. Computed tomography angiography (CTA) and lumbar puncture did not show a stroke or central nervous system infection. Serology and clinical presentation were consistent with MAS. She was initially treated with 4.5 g pulse methylprednisolone and subsequently with the interleukin-1 receptor antagonist, anakinra, and maintenance corticosteroids because of persistently elevated inflammatory markers. Her intensive care unit stay was complicated by aspiration, airway obstruction due to fungal tracheobronchitis necessitating extracorporeal membrane oxygenation (ECMO), and ring-enhancing cerebral lesions, and, ultimately, massive hemoptysis resulting in death. Conclusions: Four features of this case merit discussion, including the: 1) infrequent association of SLE with MAS; 2) short interval between SLE diagnosis and critical illness; 3) manifestation of fungal tracheobronchitis with airway obstruction; and 4) lack of response to antifungal treatment while receiving ECMO.
MeSH term(s)	Humans ; Adult ; Female ; Macrophage Activation Syndrome/complications ; Macrophage Activation Syndrome/drug therapy ; Lupus Erythematosus, Systemic/complications ; Lupus Erythematosus, Systemic/drug therapy ; Hydroxychloroquine ; Adrenal Cortex Hormones/therapeutic use ; Aspergillosis/complications ; Aspergillosis/drug therapy
Chemical Substances	Hydroxychloroquine (4QWG6N8QKH) ; Adrenal Cortex Hormones
Language	English
Publishing date	2023-06-22
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/s12630-023-02506-2
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Article ; Online: Development and initial validation of a family activation measure for acute care.

Hallot, Sophie / Debay, Vanessa / Foster, Nadine / Burns, Karen E A / Goldfarb, Michael

PloS one

2024 Volume 19, Issue 1, Page(s) e0286844

Abstract: Background: Activation of a family member refers to their desire, knowledge, confidence, and skills that can inform engagement in healthcare. Family activation combined with opportunity can lead to engagement in care. No tool currently exists to measure ...

Abstract	Background: Activation of a family member refers to their desire, knowledge, confidence, and skills that can inform engagement in healthcare. Family activation combined with opportunity can lead to engagement in care. No tool currently exists to measure family activation in acute care. Therefore, we aimed to develop and validate a tool to measure family activation in acute care. Methods: An interdisciplinary team of content experts developed the FAMily Activation Measure (FAM-Activate) through an iterative process. The FAM-Activate tool is a 4-item questionnaire with 5 Likert-type response options (ranging from strongly agree to strongly disagree). Scale scores are converted to a 0-100 point scoring range so that higher FAM-Activate scores indicate increased family activation. An overall FAM-Activate score (range 0-100) is calculated by adding the scores for each item and dividing by 4. We conducted reliability and predictive validity assessments to validate the instrument by administering the FAM-Activate tool to family members of patients in an acute cardiac unit at a tertiary care hospital. We obtained preliminary estimates of family engagement and satisfaction with care. Results: We surveyed 124 family participants (age 54.1±14.4; 73% women; 34% non-white). Participants were predominantly the adult child (38%) or spouse/partner (36%) of patients. The mean FAM-Activate score during hospitalization was 84.1±16.1. FAM-Activate had acceptable internal consistency (Cronbach's a = 0.74) and showed test-retest responsiveness. FAM-Activate was moderately correlated with engagement behavior (Pearson's correlation r = 0.47, P <0.0001). The FAM-Activate score was an independent predictor of family satisfaction, after adjusting for age, gender, relationship, and living status. Conclusion: The FAM-Activate tool was reliable and had predictive validity in the acute cardiac population. Further research is needed to explore whether improving family activation can lead to improved family engagement in care.
MeSH term(s)	Adult ; Humans ; Female ; Middle Aged ; Aged ; Male ; Reproducibility of Results ; Mental Processes ; Surveys and Questionnaires ; Personal Satisfaction ; Adult Children ; Psychometrics
Language	English
Publishing date	2024-01-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0286844
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Article ; Online: Does a Speaker Gender Gap Exist in Symposia Presentations within the Critical Care Assembly at the American Thoracic Society Conference?

Armstrong, Valerie M / Burns, Karen E A

Annals of the American Thoracic Society

2021 Volume 18, Issue 10, Page(s) 1738–1740

MeSH term(s)	Critical Care ; Humans ; Sex Factors ; Societies, Medical ; United States
Language	English
Publishing date	2021-04-13
Publishing country	United States
Document type	Letter
ZDB-ID	2717461-X
ISSN	2325-6621 ; 1943-5665 ; 2325-6621
ISSN (online)	2325-6621 ; 1943-5665
ISSN	2325-6621
DOI	10.1513/AnnalsATS.202012-1478RL
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Zs.A 5828: Show issues

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Article ; Online: Liberation from Mechanical Ventilation: Established and New Insights.

Burns, Karen E A / Agarwal, Arnav / Bosma, Karen J / Chaudhuri, Dipayan / Girard, Timothy D

Seminars in respiratory and critical care medicine

2022 Volume 43, Issue 3, Page(s) 461–470

Abstract: ... been made in identifying patients who are likely to be liberated (e.g., through the use of SBTs) and ... management strategies that speed liberation from the ventilator (e.g., protocolized SBTs, lighter sedation ...

Abstract	A substantial proportion of critically ill patients require ventilator support with the majority requiring invasive mechanical ventilation. Timely and safe liberation from invasive mechanical ventilation is a critical aspect of patient care in the intensive care unit (ICU) and is a top research priority for patients and clinicians. In this article, we discuss how to (1) identify candidates for liberation from mechanical ventilation, (2) conduct spontaneous breathing trials (SBTs), and (3) optimize patients for liberation from mechanical ventilation. We also discuss the roles for (4) extubation to noninvasive ventilation and (5) newer modes of mechanical ventilation during liberation from mechanical ventilation. We conclude that, though substantial progress has been made in identifying patients who are likely to be liberated (e.g., through the use of SBTs) and management strategies that speed liberation from the ventilator (e.g., protocolized SBTs, lighter sedation, and early mobilization), many important questions regarding liberation from mechanical ventilation in clinical practice remain unanswered.
MeSH term(s)	Airway Extubation/methods ; Critical Illness/therapy ; Humans ; Noninvasive Ventilation/methods ; Respiration, Artificial/methods ; Ventilator Weaning/methods
Language	English
Publishing date	2022-06-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	1183617-9
ISSN	1098-9048 ; 1069-3424
ISSN (online)	1098-9048
ISSN	1069-3424
DOI	10.1055/s-0042-1747929
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Article ; Online: Improving Diversity in Activities of Critical Care Societies: Missed Opportunities Due to Missing Data.

Han, Jenny E / Burns, Karen E A / Dodek, Peter M / Mehta, Sangeeta

Chest

2021 Volume 159, Issue 4, Page(s) 1334–1337

Language	English
Publishing date	2021-04-06
Publishing country	United States
Document type	Editorial
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2020.12.006
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Article ; Online: Bioluminescence imaging of Cyp1a1-luciferase reporter mice demonstrates prolonged activation of the aryl hydrocarbon receptor in the lung.

Veland, Nicolas / Gleneadie, Hannah J / Brown, Karen E / Sardini, Alessandro / Pombo, Joaquim / Dimond, Andrew / Burns, Vanessa / Sarkisyan, Karen / Schiering, Chris / Webster, Zoe / Merkenschlager, Matthias / Fisher, Amanda G

Communications biology

2024 Volume 7, Issue 1, Page(s) 442

Abstract: Aryl hydrocarbon receptor (AHR) signalling integrates biological processes that sense and respond to environmental, dietary, and metabolic challenges to ensure tissue homeostasis. AHR is a transcription factor that is inactive in the cytosol but upon ... ...

Abstract	Aryl hydrocarbon receptor (AHR) signalling integrates biological processes that sense and respond to environmental, dietary, and metabolic challenges to ensure tissue homeostasis. AHR is a transcription factor that is inactive in the cytosol but upon encounter with ligand translocates to the nucleus and drives the expression of AHR targets, including genes of the cytochrome P4501 family of enzymes such as Cyp1a1. To dynamically visualise AHR activity in vivo, we generated reporter mice in which firefly luciferase (Fluc) was non-disruptively targeted into the endogenous Cyp1a1 locus. Exposure of these animals to FICZ, 3-MC or to dietary I3C induced strong bioluminescence signal and Cyp1a1 expression in many organs including liver, lung and intestine. Longitudinal studies revealed that AHR activity was surprisingly long-lived in the lung, with sustained Cyp1a1 expression evident in discrete populations of cells including columnar epithelia around bronchioles. Our data link diet to lung physiology and also reveal the power of bespoke Cyp1a1-Fluc reporters to longitudinally monitor AHR activity in vivo.
MeSH term(s)	Mice ; Animals ; Cytochrome P-450 CYP1A1/genetics ; Cytochrome P-450 CYP1A1/metabolism ; Receptors, Aryl Hydrocarbon/genetics ; Receptors, Aryl Hydrocarbon/metabolism ; Luciferases/genetics ; Liver/metabolism ; Lung/metabolism
Chemical Substances	Cytochrome P-450 CYP1A1 (EC 1.14.14.1) ; Receptors, Aryl Hydrocarbon ; Luciferases (EC 1.13.12.-)
Language	English
Publishing date	2024-04-10
Publishing country	England
Document type	Journal Article
ISSN	2399-3642
ISSN (online)	2399-3642
DOI	10.1038/s42003-024-06089-6
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Article ; Online: Electrical impedance tomography-guided positive end-expiratory pressure titration in ARDS: a systematic review and meta-analysis.

Songsangvorn, Nickjaree / Xu, Yonghao / Lu, Cong / Rotstein, Ori / Brochard, Laurent / Slutsky, Arthur S / Burns, Karen E A / Zhang, Haibo

Intensive care medicine

2024

Abstract: Purpose: Assessing efficacy of electrical impedance tomography (EIT) in optimizing positive end-expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) patients to enhance respiratory system mechanics and prevent ventilator-induced ... ...

Abstract	Purpose: Assessing efficacy of electrical impedance tomography (EIT) in optimizing positive end-expiratory pressure (PEEP) for acute respiratory distress syndrome (ARDS) patients to enhance respiratory system mechanics and prevent ventilator-induced lung injury (VILI), compared to traditional methods. Methods: We carried out a systematic review and meta-analysis, spanning literature from January 2012 to May 2023, sourced from Scopus, PubMed, MEDLINE (Ovid), Cochrane, and LILACS, evaluated EIT-guided PEEP strategies in ARDS versus conventional methods. Thirteen studies (3 randomized, 10 non-randomized) involving 623 ARDS patients were analyzed using random-effects models for primary outcomes (respiratory mechanics and mechanical power) and secondary outcomes (PaO Results: EIT-guided PEEP significantly improved lung compliance (n = 941 cases, mean difference (MD) = 4.33, 95% confidence interval (CI) [2.94, 5.71]), reduced mechanical power (n = 148, MD = - 1.99, 95% CI [- 3.51, - 0.47]), and lowered driving pressure (n = 903, MD = - 1.20, 95% CI [- 2.33, - 0.07]) compared to traditional methods. Sensitivity analysis showed consistent positive effect of EIT-guided PEEP on lung compliance in randomized clinical trials vs. non-randomized studies pooled (MD) = 2.43 (95% CI - 0.39 to 5.26), indicating a trend towards improvement. A reduction in mortality rate (259 patients, relative risk (RR) = 0.64, 95% CI [0.45, 0.91]) was associated with modest improvements in compliance and driving pressure in three studies. Conclusions: EIT facilitates real-time, individualized PEEP adjustments, improving respiratory system mechanics. Integration of EIT as a guiding tool in mechanical ventilation holds potential benefits in preventing ventilator-induced lung injury. Larger-scale studies are essential to validate and optimize EIT's clinical utility in ARDS management.
Language	English
Publishing date	2024-03-21
Publishing country	United States
Document type	Systematic Review
ZDB-ID	80387-x
ISSN	1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
ISSN (online)	1432-1238
ISSN	0340-0964 ; 0342-4642 ; 0935-1701
DOI	10.1007/s00134-024-07362-2
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