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Article ; Online: Elderly Patients and Management in Intensive Care Units (ICU): Clinical Challenges.

Brunker, Lucille B / Boncyk, Christina S / Rengel, Kimberly F / Hughes, Christopher G

2023 Volume 18, Page(s) 93–112

Abstract: There is a growing population of older adults requiring admission to the intensive care unit (ICU). This population outpaces the ability of clinicians with geriatric training to assist in their management. Specific training and education for intensivists ...

Abstract	There is a growing population of older adults requiring admission to the intensive care unit (ICU). This population outpaces the ability of clinicians with geriatric training to assist in their management. Specific training and education for intensivists in the care of older patients is valuable to help understand and inform clinical care, as physiologic changes of aging affect each organ system. This review highlights some of these aging processes and discusses clinical implications in the vulnerable older population. Other considerations when caring for these older patients in the ICU include functional outcomes and morbidity, as opposed to merely a focus on mortality. An overall holistic approach incorporating physiology of aging, applying current evidence, and including the patient and their family in care should be used when caring for older adults in the ICU.
MeSH term(s)	Humans ; Aged ; Intensive Care Units ; Aging/physiology
Language	English
Publishing date	2023-01-22
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2364924-0
ISSN	1178-1998 ; 1176-9092
ISSN (online)	1178-1998
ISSN	1176-9092
DOI	10.2147/CIA.S365968
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Article ; Online: The Blessing and the Curse of the Administrative Database.

Boncyk, Christina S / Jelly, Christina A / Freundlich, Robert E

Annals of the American Thoracic Society

2020 Volume 17, Issue 2, Page(s) 174–175

MeSH term(s)	Canada ; Data Collection ; Data Management ; Hospitals
Language	English
Publishing date	2020-01-31
Publishing country	United States
Document type	Editorial ; Research Support, N.I.H., Extramural ; Comment
ZDB-ID	2717461-X
ISSN	2325-6621 ; 1943-5665 ; 2325-6621
ISSN (online)	2325-6621 ; 1943-5665
ISSN	2325-6621
DOI	10.1513/AnnalsATS.201906-430ED
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Zs.A 5828: Show issues

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Article ; Online: Perioperative Neurocognitive Disorders in Adults Requiring Cardiac Surgery: Screening, Prevention, and Management.

Rengel, Kimberly F / Boncyk, Christina S / DiNizo, Daniella / Hughes, Christopher G

Seminars in cardiothoracic and vascular anesthesia

2022 Volume 27, Issue 1, Page(s) 25–41

Abstract: Neurocognitive changes are the most common complication after cardiac surgery, ranging from acute postoperative delirium to prolonged postoperative neurocognitive disorder. Changes in cognition are distressing to patients and families and associated with ...

Abstract	Neurocognitive changes are the most common complication after cardiac surgery, ranging from acute postoperative delirium to prolonged postoperative neurocognitive disorder. Changes in cognition are distressing to patients and families and associated with worse outcomes overall. This review outlines definitions and diagnostic criteria, risk factors for, and mechanisms of Perioperative Neurocognitive Disorders and offers strategies for preoperative screening and perioperative prevention and management of neurocognitive complications.
MeSH term(s)	Humans ; Adult ; Delirium/prevention & control ; Postoperative Complications/etiology ; Anesthesia ; Emergence Delirium ; Cardiac Surgical Procedures/adverse effects
Language	English
Publishing date	2022-09-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2012371-1
ISSN	1940-5596 ; 1089-2532
ISSN (online)	1940-5596
ISSN	1089-2532
DOI	10.1177/10892532221127812
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Zs.A 5308: Show issues

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Article ; Online: The Association of Nonmodifiable Patient Factors on Antipsychotic Medication use in the Intensive Care Unit.

Connell, Jennifer / McCann, Brittany / Feng, Xiaoke / Shotwell, Matthew S / Hughes, Christopher G / Boncyk, Christina S

Journal of intensive care medicine

2023 Volume 39, Issue 2, Page(s) 176–182

Abstract: Purpose: We investigated the association of age, sex, race, and insurance status on antipsychotic medication use among intensive care unit (ICU) patients.: Materials and methods: Retrospective study of adults admitted to ICUs at a tertiary academic ... ...

Abstract	Purpose: We investigated the association of age, sex, race, and insurance status on antipsychotic medication use among intensive care unit (ICU) patients. Materials and methods: Retrospective study of adults admitted to ICUs at a tertiary academic center. Patient characteristics, hospital course, and medication (olanzapine, quetiapine, and haloperidol) data were collected. Logistic regression models evaluated the independent association of age, sex, race, and insurance status on the use of each antipsychotic, adjusting for prespecified covariates. Results: Of 27,137 encounters identified, 6191 (22.8%) received antipsychotics. Age was significantly associated with the odds of receiving olanzapine ( Conclusions: Age, sex, race, and insurance status were associated with the use of all antipsychotic medications investigated, highlighting the importance of investigating the potential impact of these prescribing decisions on patient outcomes across diverse populations. Recognizing how nonmodifiable patient factors have the potential to influence prescribing practices may be considered an important factor toward optimizing medication regimens.
MeSH term(s)	Adult ; Humans ; Male ; Female ; Antipsychotic Agents/therapeutic use ; Olanzapine ; Haloperidol/therapeutic use ; Quetiapine Fumarate/therapeutic use ; Retrospective Studies ; Intensive Care Units ; Benzodiazepines/therapeutic use
Chemical Substances	Antipsychotic Agents ; Olanzapine (N7U69T4SZR) ; Haloperidol (J6292F8L3D) ; Quetiapine Fumarate (2S3PL1B6UJ) ; Benzodiazepines (12794-10-4)
Language	English
Publishing date	2023-08-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	632828-3
ISSN	1525-1489 ; 0885-0666
ISSN (online)	1525-1489
ISSN	0885-0666
DOI	10.1177/08850666231198030
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Zs.A 2158: Show issues

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Article ; Online: Continuous Intrathecal Morphine Infusion for Pain Management in a Polytrauma Patient: A Case Report.

Boncyk, Christina S / Brennan, Kaitlyn A / Guillamondegui, Oscar / Benson, Clayne

A&A practice

2020 Volume 14, Issue 13, Page(s) e01338

Abstract: Polytrauma patients are at high risk for neurologic complications as a result of the primary mechanism of their trauma and/or delirium caused by subsequent pain, sedatives and analgesic exposure, sleep disturbances, infections, metabolic derangements, ... ...

Abstract	Polytrauma patients are at high risk for neurologic complications as a result of the primary mechanism of their trauma and/or delirium caused by subsequent pain, sedatives and analgesic exposure, sleep disturbances, infections, metabolic derangements, organ dysfunctions, withdrawal syndromes, or other factors. The high prevalence of delirium within trauma intensive care units increases risks for both patients and providers and is associated with worsened patient outcomes. This case report explains the rationale and utilization of continuous intrathecal morphine administration to improve pain control while reducing and eliminating intravenous (IV) analgesics and sedatives to enable wakefulness in a polytrauma patient with refractory agitated delirium.
MeSH term(s)	Humans ; Injections, Spinal ; Morphine/therapeutic use ; Multiple Trauma/complications ; Pain/drug therapy ; Pain Management
Chemical Substances	Morphine (76I7G6D29C)
Language	English
Publishing date	2020-11-13
Publishing country	United States
Document type	Case Reports ; Journal Article
ISSN	2575-3126
ISSN (online)	2575-3126
DOI	10.1213/XAA.0000000000001338
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Article ; Online: In the ICU - delirium post cardiac arrest.

Boncyk, Christina S / Rengel, Kimberly F / Pandharipande, Pratik P / Hughes, Christopher G

Current opinion in critical care

2019 Volume 25, Issue 3, Page(s) 218–225

Abstract: Purpose of review: The present review aims to describe the clinical impact and assessment tools capable of identifying delirium in cardiac arrest survivors and providing strategies aimed at preventing and treating delirium.: Recent findings: Patient ... ...

Abstract	Purpose of review: The present review aims to describe the clinical impact and assessment tools capable of identifying delirium in cardiac arrest survivors and providing strategies aimed at preventing and treating delirium. Recent findings: Patient factors leading to a cardiac arrest, initial resuscitation efforts, and postresuscitation management all influence the potential for recovery and the risk for development of delirium. Data suggest that delirium in cardiac arrest survivors is an independent risk factor for morbidity and mortality. Recognizing delirium in postcardiac arrest patients can be challenging; however, detection is not only achievable, but important as it may aid in predicting adverse outcomes. Serial neurologic examinations and delirium assessments, targeting light sedation when possible, limiting psychoactive medications, and initiating patient care bundles are important care aspects for not only allowing early identification of primary and secondary brain injury, but in improving patient morbidity and mortality. Summary: Developing delirium after cardiac arrest is associated with increased morbidity and mortality. The importance of addressing modifiable risk factors, recognizing symptoms early, and initiating coordinated treatment strategies can help to improve outcomes within this high risk population.
MeSH term(s)	Delirium/etiology ; Heart Arrest/complications ; Humans ; Intensive Care Units ; Neurologic Examination ; Survivors
Language	English
Publishing date	2019-04-08
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1235629-3
ISSN	1531-7072 ; 1070-5295
ISSN (online)	1531-7072
ISSN	1070-5295
DOI	10.1097/MCC.0000000000000615
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Zs.A 4999: Show issues

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Article ; Online: Antipsychotics and the QTc Interval During Delirium in the Intensive Care Unit: A Secondary Analysis of a Randomized Clinical Trial.

Stollings, Joanna L / Boncyk, Christina S / Birdrow, Caroline I / Chen, Wencong / Raman, Rameela / Gupta, Deepak K / Roden, Dan M / Rivera, Erika L / Maiga, Amelia W / Rakhit, Shayan / Pandharipande, Pratik P / Ely, E Wesley / Girard, Timothy D / Patel, Mayur B

JAMA network open

2024 Volume 7, Issue 1, Page(s) e2352034

Abstract: Importance: Antipsychotic medications, often prescribed for delirium in intensive care units (ICUs), may contribute to QTc interval prolongation.: Objective: To determine whether antipsychotics increase the QTc interval in patients with delirium in ... ...

Abstract	Importance: Antipsychotic medications, often prescribed for delirium in intensive care units (ICUs), may contribute to QTc interval prolongation. Objective: To determine whether antipsychotics increase the QTc interval in patients with delirium in the ICU. Design, setting, and participants: An a priori analysis of a randomized clinical trial in medical/surgical ICUs within 16 centers across the US was conducted. Participants included adults with delirium in the ICU with baseline QTc interval less than 550 ms. The study was conducted from December 2011 to August 2017. Data analysis was performed from April 25 to August 18, 2021. Interventions: Patients were randomized 1:1:1 to intravenous haloperidol, ziprasidone, or saline placebo administered twice daily until resolution of delirium, ICU discharge, or 14 days. Main outcomes and measures: Twelve-lead electrocardiograms were used to measure baseline QTc before study drug initiation and telemetry was used to measure QTc before each subsequent dose of study drug. Unadjusted day-to-day changes in QTc were calculated and multivariable proportional odds regression was used to estimate the effects of antipsychotics vs placebo on next-day maximum QTc interval, adjusting for prespecified baseline covariates and potential interactions with sex. Safety end points, including the occurrence of torsade de pointes, were evaluated. All analyses were conducted based on the intention to treat principle. Results: A total of 566 patients were randomized to haloperidol (n = 192), ziprasidone (n = 190), or placebo (n = 184). Median age was 60.1 (IQR, 51.4-68.7) years; 323 were men (57%). Baseline median QTc intervals across the groups were similar: haloperidol, 458.0 (IQR, 432.0-479.0) ms; ziprasidone, 451.0 (IQR, 424.0-472.0) ms; and placebo, 452.0 (IQR, 432.0-472.0) ms. From day 1 to day 2, median QTc changed minimally: haloperidol, -1.0 (IQR, -28.0 to 15.0) ms; ziprasidone, 0 (IQR, -23.0 to 20.0) ms; and placebo, -3.5 (IQR, -24.8 to 17.0) ms. Compared with placebo, neither haloperidol (odds ratio [OR], 0.95; 95% CI, 0.66-1.37; P = .78) nor ziprasidone (OR, 1.09; 95% CI, 0.75-1.57; P = .78) was associated with next-day QTc intervals. Effects were not significantly modified by sex (P = .41 for interaction). There were 2 occurrences of nonfatal torsade de pointes, both in the haloperidol group. Neither was associated with study drug administration. Conclusions and relevance: The findings of this trial suggest that daily QTc interval monitoring during antipsychotic use may have limited value in patients in the ICU with normal baseline QTc and few risk factors for QTc prolongation. Trial registration: ClinicalTrials.gov Identifier: NCT01211522.
MeSH term(s)	Adult ; Male ; Humans ; Middle Aged ; Female ; Antipsychotic Agents/adverse effects ; Haloperidol/adverse effects ; Torsades de Pointes ; Electrocardiography ; Intensive Care Units ; Delirium/chemically induced ; Delirium/drug therapy ; Piperazines ; Thiazoles
Chemical Substances	Antipsychotic Agents ; Haloperidol (J6292F8L3D) ; ziprasidone (6UKA5VEJ6X) ; Piperazines ; Thiazoles
Language	English
Publishing date	2024-01-02
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.52034
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Article ; Online: Association of Time to Surgery After COVID-19 Infection With Risk of Postoperative Cardiovascular Morbidity.

Bryant, John M / Boncyk, Christina S / Rengel, Kimberly F / Doan, Vivian / Snarskis, Connor / McEvoy, Matthew D / McCarthy, Karen Y / Li, Gen / Sandberg, Warren S / Freundlich, Robert E

JAMA network open

2022 Volume 5, Issue 12, Page(s) e2246922

Abstract: Importance: The time interval between COVID-19 infection and surgery is a potentially modifiable but understudied risk factor for postoperative complications.: Objective: To examine the association between time to surgery after COVID-19 diagnosis and ...

Abstract	Importance: The time interval between COVID-19 infection and surgery is a potentially modifiable but understudied risk factor for postoperative complications. Objective: To examine the association between time to surgery after COVID-19 diagnosis and the risk of a composite of major postoperative cardiovascular morbidity events within 30 days of surgery. Design, setting, and participants: This single-center, retrospective cohort study was conducted among 3997 adult patients (aged ≥18 years) with a previous diagnosis of COVID-19, as documented by a positive polymerase chain reaction test result, who were undergoing surgery from January 1, 2020, to December 6, 2021. Data were obtained through Structured Query Language access of an existing perioperative data warehouse. Statistical analysis was performed March 29, 2022. Exposure: The time interval between COVID-19 diagnosis and surgery. Main outcomes and measures: The primary outcome was the composite occurrence of major cardiovascular comorbidity, defined as deep vein thrombosis, pulmonary embolism, cerebrovascular accident, myocardial injury, acute kidney injury, and death within 30 days after surgery, using multivariable logistic regression. Results: A total of 3997 patients (2223 [55.6%]; median age, 51.3 years [IQR, 35.1-64.4 years]; 667 [16.7%] African American or Black; 2990 [74.8%] White; and 340 [8.5%] other race) were included in the study. The median time from COVID-19 diagnosis to surgery was 98 days (IQR, 30-225 days). Major postoperative adverse cardiovascular events were identified in 485 patients (12.1%). Increased time from COVID-19 diagnosis to surgery was associated with a decreased rate of the composite outcome (adjusted odds ratio, 0.99 [per 10 days]; 95% CI, 0.98-1.00; P = .006). This trend persisted for the 1552 patients who had received at least 1 dose of COVID-19 vaccine (adjusted odds ratio, 0.98 [per 10 days]; 95% CI, 0.97-1.00; P = .04). Conclusions and relevance: This study suggests that increased time from COVID-19 diagnosis to surgery was associated with a decreased odds of experiencing major postoperative cardiovascular morbidity. This information should be used to better inform risk-benefit discussions concerning optimal surgical timing and perioperative outcomes for patients with a history of COVID-19 infection.
MeSH term(s)	Adult ; Humans ; Adolescent ; Middle Aged ; Retrospective Studies ; COVID-19/epidemiology ; COVID-19/complications ; COVID-19 Vaccines ; COVID-19 Testing ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-12-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2022.46922
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Article ; Online: Association between cholinesterase activity and critical illness brain dysfunction.

Hughes, Christopher G / Boncyk, Christina S / Fedeles, Benjamin / Pandharipande, Pratik P / Chen, Wencong / Patel, Mayur B / Brummel, Nathan E / Jackson, James C / Raman, Rameela / Ely, E Wesley / Girard, Timothy D

Critical care (London, England)

2022 Volume 26, Issue 1, Page(s) 377

Abstract: Background: Delirium is a frequent manifestation of acute brain dysfunction and is associated with cognitive impairment. The hypothesized mechanism of brain dysfunction during critical illness is centered on neuroinflammation, regulated in part by the ... ...

Abstract	Background: Delirium is a frequent manifestation of acute brain dysfunction and is associated with cognitive impairment. The hypothesized mechanism of brain dysfunction during critical illness is centered on neuroinflammation, regulated in part by the cholinergic system. Point-of-care serum cholinesterase enzyme activity measurements serve as a real-time index of cholinergic activity. We hypothesized that cholinesterase activity during critical illness would be associated with delirium in the intensive care unit (ICU) and cognitive impairment after discharge. Methods: We enrolled adults with respiratory failure and/or shock and measured plasma acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity on days 1, 3, 5, and 7 after enrollment. AChE values were also normalized per gram of hemoglobin (AChE/Hgb). We assessed for coma and delirium twice daily using the Richmond Agitation Sedation Scale and the Confusion Assessment Method for the ICU to evaluate daily mental status (delirium, coma, normal) and days alive without delirium or coma. Cognitive impairment, disability, and health-related quality of life were assessed at up to 6 months post-discharge. We used multivariable regression to determine whether AChE, AChE/Hgb, and BChE activity were associated with outcomes after adjusting for relevant covariates. Results: We included 272 critically ill patients who were a median (IQR) age 56 (39-67) years and had a median Sequential Organ Failure Assessment score at enrollment of 8 (5-11). Higher daily AChE levels were associated with increased odds of being delirious versus normal mental status on the same day (Odds Ratio [95% Confidence Interval] 1.64 [1.11, 2.43]; P = 0.045). AChE/Hgb and BChE activity levels were not associated with delirious mental status. Lower enrollment BChE was associated with fewer days alive without delirium or coma (P = 0.048). AChE, AChE/Hgb, and BChE levels were not significantly associated with cognitive impairment, disability, or quality of life after discharge. Conclusion: Cholinesterase activity during critical illness is associated with delirium but not with outcomes after discharge, findings that may reflect mechanisms of acute brain organ dysfunction. Trial registration: NCT03098472. Registered 31 March 2017.
MeSH term(s)	Humans ; Middle Aged ; Critical Illness ; Butyrylcholinesterase ; Acetylcholinesterase ; Quality of Life ; Aftercare ; Patient Discharge ; Brain
Chemical Substances	Butyrylcholinesterase (EC 3.1.1.8) ; Acetylcholinesterase (EC 3.1.1.7)
Language	English
Publishing date	2022-12-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-022-04260-1
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Article ; Online: Peer Support Group for Intensive Care Unit Survivors: Perceptions on Supportive Recovery in the Era of Social Distancing.

Lassen-Greene, Caroline L / Nordness, Mina / Kiehl, Amy / Jones, Abigail / Jackson, James C / Boncyk, Christina S

Annals of the American Thoracic Society

2020 Volume 18, Issue 1, Page(s) 177–182

MeSH term(s)	Female ; Humans ; Intensive Care Units ; Male ; Perception ; Physical Distancing ; Self-Help Groups ; Social Support ; Survivors
Keywords	covid19
Language	English
Publishing date	2020-11-04
Publishing country	United States
Document type	Letter ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2717461-X
ISSN	2325-6621 ; 1943-5665 ; 2325-6621
ISSN (online)	2325-6621 ; 1943-5665
ISSN	2325-6621
DOI	10.1513/AnnalsATS.202007-799RL
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