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Article ; Online: High-Flow Nasal Cannula Compared With Noninvasive Positive Pressure Ventilation in Acute Hypoxic Respiratory Failure: A Systematic Review and Meta-Analysis.

Chaudhuri, Dipayan / Trivedi, Vatsal / Lewis, Kimberley / Rochwerg, Bram

Critical care explorations

2023 Volume 5, Issue 4, Page(s) e0892

Abstract: To evaluate the efficacy and cost-effectiveness of high-flow nasal cannula (HFNC) when compared with noninvasive positive pressure ventilation (NIPPV) in patients with acute hypoxic respiratory failure (AHRF).: Data sources: We performed a ... ...

Abstract	To evaluate the efficacy and cost-effectiveness of high-flow nasal cannula (HFNC) when compared with noninvasive positive pressure ventilation (NIPPV) in patients with acute hypoxic respiratory failure (AHRF). Data sources: We performed a comprehensive search of MEDLINE, Embase, CINAHL, the Cochrane library, and the international Health Technology Assessment database from inception to September 14, 2022. Study selection: We included randomized control studies that compared HFNC to NIPPV in adult patients with AHRF. For clinical outcomes, we included only parallel group and crossover randomized control trials (RCTs). For economic outcomes, we included any study design that evaluated cost-effectiveness, cost-utility, or cost benefit analyses. Data extraction: Clinical outcomes of interest included intubation, mortality, ICU and hospital length of stay (LOS), and patient-reported dyspnea. Economic outcomes of interest included costs, cost-effectiveness, and cost-utility. Data synthesis: We included nine RCTs ( Conclusions: HFNC and NIPPV may be similarly effective at reducing the need for intubation with an uncertain effect on mortality in hospitalized patients with hypoxemic respiratory failure. More research evaluating different interfaces in varying clinical contexts is needed to improve generalizability and precision of findings.
Language	English
Publishing date	2023-03-28
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000892
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Conducting Prospective Research as a Trainee: Experiences with the DRIVE-SAFE Study.

Mikhaeil, Michael / Farooqi, Malik / Alenazy, Hameid / Lewis, Kimberley / Rochwerg, Bram

ATS scholar

2023 Volume 4, Issue 3, Page(s) 293–301

Abstract: Conducting clinical research during a 2-year critical care fellowship is a challenging endeavor. Fellows are often met with multiple barriers when considering clinical research projects during fellowship, including time, mentorship, resources, and ... ...

Abstract	Conducting clinical research during a 2-year critical care fellowship is a challenging endeavor. Fellows are often met with multiple barriers when considering clinical research projects during fellowship, including time, mentorship, resources, and clinical support. This paper presents the perspective and experiences of a group of critical care fellows who conducted the DRIVE-SAFE (Driving Pressure in Assisted Ventilation as a Predictor for Successful Liberation from Invasive Mechanical Ventilation) feasibility study, which aimed to determine measurable physiological variables that could be associated with lung injury and affect duration of mechanical ventilation. This paper provides a guide for trainees on how to conduct prospective clinical research at the bedside. We describe three key steps, including formulating a research question, developing appropriate methodology, and establishing outcomes. We also present the challenges that trainees may encounter when conducting prospective studies and how to overcome these challenges with proper mentorship, training, and collaboration with key stakeholders. These perspectives may provide useful guidance for current and future trainees interested in conducting prospective clinical research at the bedside.
Language	English
Publishing date	2023-07-28
Publishing country	United States
Document type	Journal Article
ISSN	2690-7097
ISSN (online)	2690-7097
DOI	10.34197/ats-scholar.2022-0130PS
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Article ; Online: Antipsychotics in the Treatment of Delirium in Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Carayannopoulos, Kallirroi Laiya / Alshamsi, Fayez / Chaudhuri, Dipayan / Spatafora, Laura / Piticaru, Joshua / Campbell, Kaitryn / Alhazzani, Waleed / Lewis, Kimberley

Critical care medicine

2024

Abstract: Objectives: To conduct a systematic review and meta-analysis assessing whether the use of antipsychotic medications in critically ill adult patients with delirium impacts patient-important outcomes.: Data sources: A medical librarian searched Ovid ... ...

Abstract	Objectives: To conduct a systematic review and meta-analysis assessing whether the use of antipsychotic medications in critically ill adult patients with delirium impacts patient-important outcomes. Data sources: A medical librarian searched Ovid MEDLINE, EMBASE, APA PsycInfo, and Wiley's Cochrane Library as well as clinicaltrials.gov and the World Health Organization International Clinical Trials Registry Platform up to November 2023. Study selection: Independently and in duplicate, reviewers screened abstracts and titles for eligibility, then full text of qualifying studies. We included parallel-group randomized controlled trials (RCTs) that included critically ill adult patients with delirium. The intervention group was required to receive antipsychotic medications at any dose, whereas the control group received usual care or placebo. Data extraction: Reviewers extracted data independently and in duplicate using a piloted abstraction form. Statistical analyses were conducted using RevMan software (version 5.4). Data synthesis: Five RCTs ( n = 1750) met eligibility criteria. The use of antipsychotic medications compared with placebo did not increase the number of delirium- or coma-free days (mean difference 0.90 d; 95% CI, -0.32 to 2.12; moderate certainty), nor did it result in a difference in mortality, duration of mechanical ventilation, ICU, or hospital length of stay. The use of antipsychotics did not result in an increased risk of adverse events (risk ratio 1.27; 95% CI, 0.71-2.30; high certainty). Subgroup analysis of typical versus atypical antipsychotics did not identify any subgroup effect for any outcome. Conclusions: In conclusion, our systematic review and meta-analysis demonstrated with moderate certainty that there is no difference in delirium- or coma-free days when delirious critically ill adults are treated with antipsychotic medications. Further studies in the subset of patients with hyperactive delirium may be of benefit.
Language	English
Publishing date	2024-03-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000006251
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Article ; Online: Venous congestion in septic shock quantified with point-of-care ultrasound: a pilot prospective multicentre cohort study.

Prager, Ross / Arntfield, Robert / Wong, Michelle Y S / Ball, Ian / Lewis, Kimberley / Rochwerg, Bram / Basmaji, John

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2024 Volume 71, Issue 5, Page(s) 640–649

Abstract: Purpose: Venous congestion is a pathophysiologic state that can result in organ dysfunction, particularly acute kidney injury (AKI). We sought to evaluate the feasibility of performing a definitive observational study to determine the impact of venous ... ...

Title translation	La congestion veineuse dans le choc septique quantifiée par échographie ciblée : une étude de cohorte prospective multicentrique pilote.
Abstract	Purpose: Venous congestion is a pathophysiologic state that can result in organ dysfunction, particularly acute kidney injury (AKI). We sought to evaluate the feasibility of performing a definitive observational study to determine the impact of venous congestion quantified using point-of-care ultrasound (POCUS) in patients with septic shock. Methods: We conducted a prospective observational feasibility study at two intensive care units (ICUs). We recruited adult patients with septic shock within 12 hr of ICU admission. Using the validated Venous Excess Ultrasound Score (VEXUS), we quantified venous congestion on day 1 and day 3 of ICU admission. The primary feasibility outcome was successful completion rate of the two VEXUS scores. We performed a survival analysis to quantify the hazard of renal replacement therapy (RRT). Results: We enrolled 75 patients from January 2022 to January 2023. The success rate of completion for VEXUS scans was 94.5% (95% confidence interval [CI], 89.5 to 97.6). Severe venous congestion was present in 19% (14/75) of patients on ICU admission day 1 and in 16% (10/61) of patients on day 3. Venous congestion on ICU admission may be associated with a higher risk of requiring RRT (unadjusted hazard ratio, 3.35; 95% CI, 0.94 to 11.88; P = 0.06). Conclusions: It is feasible to conduct a definitive observational study exploring the association between venous congestion quantified with POCUS and clinical outcomes in patients with septic shock. We hypothesize that venous congestion may be associated with an increased hazard of receiving RRT.
MeSH term(s)	Adult ; Humans ; Shock, Septic/complications ; Shock, Septic/diagnostic imaging ; Prospective Studies ; Hyperemia/diagnostic imaging ; Hyperemia/complications ; Point-of-Care Systems ; Renal Replacement Therapy ; Intensive Care Units ; Acute Kidney Injury/therapy
Language	English
Publishing date	2024-03-28
Publishing country	United States
Document type	Observational Study ; Multicenter Study ; Journal Article
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/s12630-024-02717-1
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Article ; Online: Spontaneous Breathing Trial Techniques for Extubating Adults and Children Who Are Critically Ill: A Systematic Review and Meta-Analysis.

Burns, Karen E A / Khan, Jeena / Phoophiboon, Vorakamol / Trivedi, Vatsal / Gomez-Builes, J Carolina / Giammarioli, Benedetta / Lewis, Kimberley / Chaudhuri, Dipayan / Desai, Kairavi / Friedrich, Jan O

JAMA network open

2024 Volume 7, Issue 2, Page(s) e2356794

Abstract: Importance: Considerable controversy exists regarding the best spontaneous breathing trial (SBT) technique to use.: Objective: To summarize trials comparing alternative SBTs.: Data sources: Several databases (MEDLINE [from inception to February ... ...

Abstract	Importance: Considerable controversy exists regarding the best spontaneous breathing trial (SBT) technique to use. Objective: To summarize trials comparing alternative SBTs. Data sources: Several databases (MEDLINE [from inception to February 2023], the Cochrane Central Register of Controlled Trials [in February 2023], and Embase [from inception to February 2023] and 5 conference proceedings (from January 1990 to April 2023) were searched in this systematic review and meta-analysis. Study selection: Randomized trials directly comparing SBT techniques in critically ill adults or children and reporting at least 1 clinical outcome were selected. Data extraction and synthesis: Paired reviewers independently screened citations, abstracted data, and assessed quality for the systematic review and meta-analysis using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA guidelines). Data were pooled using random-effects models. Main outcomes and measures: Primary outcomes included SBT success, extubation success, and reintubation. Results: The systematic review and meta-analysis identified 40 trials that included 6716 patients. Low-quality evidence (14 trials [n = 4459]) suggested that patients were not more likely to pass a pressure support (PS) compared with a T-piece SBT (risk ratio [RR], 1.04; 95% CI, 0.97-1.11; P = .31; I2 = 73%), unless 1 outlier trial accounting for all heterogeneity was excluded (RR, 1.09; 95% CI, 1.06-1.12; P < .001; I2 = 0% [13 trials; n = 3939]; moderate-quality evidence), but were significantly more likely to be successfully extubated (RR, 1.07; 95% CI, 1.04-1.10; P < .001; I2 = 0%; 16 trials [n = 4462]; moderate-quality evidence). Limited data (5 trials [n = 502]) revealed that patients who underwent automatic tube compensation/continuous positive airway pressure compared with PS SBTs had a significantly higher successful extubation rate (RR, 1.10; 95% CI, 1.00-1.21; P = .04; I2 = 0% [low-quality evidence]). Compared with T-piece SBTs, high-flow oxygen SBTs (3 trials [n = 386]) had significantly higher successful extubation (RR, 1.06; 95% CI, 1.00-1.11; P = .04; I2 = 0%) and lower reintubation (RR, 0.37; 95% CI, 0.21-0.65; P = <.001; I2 = 0% [both low-quality evidence]) rates. Credible subgroup effects were not found. Conclusions and relevance: In this systematic review and meta-analysis, the findings suggest that patients undergoing PS compared with T-piece SBTs were more likely to be extubated successfully and more likely to pass an SBT, after exclusion of an outlier trial. Pressure support SBTs were not associated with increased risk of reintubation. Future trials should compare SBT techniques that maximize differences in inspiratory support.
MeSH term(s)	Adult ; Child ; Humans ; Critical Illness/therapy ; Ventilator Weaning/methods ; Oxygen ; Continuous Positive Airway Pressure ; Intubation, Intratracheal
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2024-02-05
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.56794
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Article ; Online: The efficacy and safety of hydroxychloroquine for COVID-19 prophylaxis: A systematic review and meta-analysis of randomized trials.

Lewis, Kimberley / Chaudhuri, Dipayan / Alshamsi, Fayez / Carayannopoulos, Laiya / Dearness, Karin / Chagla, Zain / Alhazzani, Waleed

PloS one

2021 Volume 16, Issue 1, Page(s) e0244778

Abstract: Background: Populations such as healthcare workers (HCW) that are unable to practice physical distancing are at high risk of acquiring Coronavirus disease-2019 (COVID-19). In these cases pharmacological prophylaxis would be a solution to reduce severe ... ...

Abstract	Background: Populations such as healthcare workers (HCW) that are unable to practice physical distancing are at high risk of acquiring Coronavirus disease-2019 (COVID-19). In these cases pharmacological prophylaxis would be a solution to reduce severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) transmission. Hydroxychloroquine has in vitro antiviral properties against SARS CoV-2. We therefore sought to determine the efficacy and safety of hydroxychloroquine as prophylaxis for COVID-19. Methods and findings: We electronically searched EMBASE, MEDLINE, the Cochrane COVID-19 Register of Controlled Trials, Epistemonikos COVID-19, clinicaltrials.gov, and the World Health Organization International Clinical Trials Registry Platform up to September 28th, 2020 for randomized controlled trials (RCTs). We calculated pooled relative risks (RRs) for dichotomous outcomes with the corresponding 95% confidence intervals (CIs) using a random-effect model. We identified four RCTs (n = 4921) that met our eligibility criteria. The use of hydroxychloroquine, compared to placebo, did not reduce the risks of developing COVID-19 (RR 0.82, 95% CI 0.65 to 1.04, moderate certainty), hospitalization (RR 0.72, 95% CI 0.34 to 1.50, moderate certainty), or mortality (RR 3.26, 95% CI 0.13 to 79.74, low certainty), however, hydroxychloroquine use increased the risk of adverse events (RR 2.76, 95% CI 1.38 to 5.55, moderate certainty). Conclusion: Although pharmacologic prophylaxis is an attractive preventive strategy against COVID-19, the current body of evidence failed to show clinical benefit for prophylactic hydroxychloroquine and showed a higher risk of adverse events when compared to placebo or no prophylaxis.
MeSH term(s)	Antibiotic Prophylaxis/methods ; Antiviral Agents/therapeutic use ; COVID-19/drug therapy ; COVID-19/metabolism ; Humans ; Hydroxychloroquine/adverse effects ; Hydroxychloroquine/metabolism ; Hydroxychloroquine/therapeutic use ; Pre-Exposure Prophylaxis/methods ; Randomized Controlled Trials as Topic ; SARS-CoV-2/pathogenicity
Chemical Substances	Antiviral Agents ; Hydroxychloroquine (4QWG6N8QKH)
Language	English
Publishing date	2021-01-06
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0244778
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Article ; Online: Mean Arterial Pressure Targets and Patient-Important Outcomes in Critically Ill Adults: A Systematic Review and Meta-Analysis of Randomized Trials.

Carayannopoulos, Kallirroi Laiya / Pidutti, Andrew / Upadhyaya, Yashita / Alshamsi, Fayez / Basmaji, John / Granholm, Anders / Alhazzani, Waleed / Lewis, Kimberley

Critical care medicine

2022 Volume 51, Issue 2, Page(s) 241–253

Abstract: Objective: To conduct a systematic review and meta-analysis to determine whether targeting a higher mean arterial pressure (MAP) compared with a lower MAP in adults with shock results in differences in patient important outcomes.: Data sources: We ... ...

Abstract	Objective: To conduct a systematic review and meta-analysis to determine whether targeting a higher mean arterial pressure (MAP) compared with a lower MAP in adults with shock results in differences in patient important outcomes. Data sources: We searched MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov through May 2021. Study selection: Titles and abstracts were screened independently and in duplicate to identify potentially eligible studies, then full text for final eligibility. We included parallel-group randomized controlled trials in adult patients with a diagnosis of shock requiring vasoactive medications. The higher MAP group was required to receive vasoactive medications to target a higher MAP as established by study authors, whereas the lower MAP group received vasoactive medications to target lower MAP. Data extraction: In triplicate, reviewers independently extracted data using a prepiloted abstraction form. Statistical analyses were conducted using the RevMan software Version 5.3. Data synthesis: Six randomized controlled trials (n = 3,690) met eligibility criteria. Targeting a higher MAP (75-85 mm Hg) compared with lower MAP of 65 mm Hg resulted in no difference in mortality (relative risk [RR], 1.06; 95% CI, 0.98-1.15; I2 = 0%; p = 0.12; moderate certainty. Targeting a higher MAP resulted in no difference in the risk of undergoing renal replacement therapy (RR, 0.96; 95% CI, 0.83-1.11; I2 = 24%; p = 0.57; moderate certainty); however, a subgroup analysis comparing patients with and without chronic hypertension demonstrated that a higher MAP may reduce the risk of undergoing renal replacement therapy (RR, 0.83; 95% CI, 0.71-0.98; I2 = 0%; p = 0.02). Conclusions: In conclusion, our systematic review and meta-analysis demonstrated with moderate certainty that there is no difference in mortality when a higher MAP is targeted in critically ill adult patients with shock. Further studies are needed to determine the impact of mean arterial pressure on need for renal replacement therapy in this population.
MeSH term(s)	Humans ; Adult ; Arterial Pressure ; Critical Illness/therapy ; Randomized Controlled Trials as Topic ; Patient Reported Outcome Measures
Language	English
Publishing date	2022-11-18
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
DOI	10.1097/CCM.0000000000005726
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Article ; Online: Critical Care Prophylaxis. Sometimes Less Is More.

Lewis, Kimberley A / Spence, Jessica / Dionne, Joanna C / Rochwerg, Bram

American journal of respiratory and critical care medicine

2019 Volume 200, Issue 12, Page(s) 1539–1541

MeSH term(s)	Adult ; Critical Care ; Critical Illness ; Delirium ; Haloperidol ; Humans
Chemical Substances	Haloperidol (J6292F8L3D)
Language	English
Publishing date	2019-10-24
Publishing country	United States
Document type	Journal Article ; 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.201904-0821RR
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Article ; Online: How

de Anda, Jaime / Kuchma, Sherry L / Webster, Shanice S / Boromand, Arman / Lewis, Kimberley A / Lee, Calvin K / Contreras, Maria / Medeiros Pereira, Victor F / Schmidt, William / Hogan, Deborah A / O'Hern, Corey S / O'Toole, George A / Wong, Gerard C L

mBio

2024 Volume 15, Issue 4, Page(s) e0332223

Abstract: Swarming is a macroscopic phenomenon in which surface bacteria organize into a motile population. The flagellar motor that drives swarming ... ...

Abstract	Swarming is a macroscopic phenomenon in which surface bacteria organize into a motile population. The flagellar motor that drives swarming in
MeSH term(s)	Bacterial Proteins ; Pseudomonas aeruginosa/genetics ; Biofilms ; Movement ; Flagella/genetics
Chemical Substances	Bacterial Proteins
Language	English
Publishing date	2024-03-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2557172-2
ISSN	2150-7511 ; 2161-2129
ISSN (online)	2150-7511
ISSN	2161-2129
DOI	10.1128/mbio.03322-23
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Article ; Online: Safety and Efficacy of Dexmedetomidine in Acutely Ill Adults Requiring Noninvasive Ventilation: A Systematic Review and Meta-analysis of Randomized Trials.

Lewis, Kimberley / Piticaru, Joshua / Chaudhuri, Dipayan / Basmaji, John / Fan, Eddy / Møller, Morten Hylander / Devlin, John W / Alhazzani, Waleed

Chest

2021 Volume 159, Issue 6, Page(s) 2274–2288

Abstract: Background: Although clinical studies have evaluated dexmedetomidine as a strategy to improve noninvasive ventilation (NIV) comfort and tolerance in patients with acute respiratory failure (ARF), their results have not been summarized.: Research ... ...

Abstract	Background: Although clinical studies have evaluated dexmedetomidine as a strategy to improve noninvasive ventilation (NIV) comfort and tolerance in patients with acute respiratory failure (ARF), their results have not been summarized. Research question: Does dexmedetomidine, when compared with another sedative or placebo, reduce the risk of delirium, mortality, need for intubation and mechanical ventilation, or ICU length of stay (LOS) in adults with ARF initiated on NIV in the ICU? Study design and methods: We electronically searched MEDLINE, EMBASE, and the Cochrane Library from inception through July 31, 2020, for randomized clinical trials (RCTs). We calculated pooled relative risks (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes with the corresponding 95% CIs using a random-effect model. Results: Twelve RCTs were included in our final analysis (n = 738 patients). The use of dexmedetomidine, compared with other sedation strategies or placebo, reduced the risk of intubation (RR, 0.54; 95% CI, 0.41-0.71; moderate certainty), delirium (RR, 0.34; 95% CI, 0.22-0.54; moderate certainty), and ICU LOS (MD, -2.40 days; 95% CI, -3.51 to -1.29 days; low certainty). Use of dexmedetomidine was associated with an increased risk of bradycardia (RR, 2.80; 95% CI, 1.92-4.07; moderate certainty) and hypotension (RR, 1.98; 95% CI, 1.32-2.98; moderate certainty). Interpretation: Compared with any sedation strategy or placebo, dexmedetomidine reduced the risk of delirium and the need for mechanical ventilation while increasing the risk of bradycardia and hypotension. The results are limited by imprecision, and further large RCTs are needed. Trial registry: PROSPERO; No.: 175086; URL: www.crd.york.ac.uk/prospero/.
MeSH term(s)	Adrenergic alpha-2 Receptor Agonists/pharmacology ; Adult ; Dexmedetomidine/pharmacology ; Humans ; Noninvasive Ventilation/methods ; Randomized Controlled Trials as Topic ; Respiratory Distress Syndrome/therapy ; Treatment Outcome
Chemical Substances	Adrenergic alpha-2 Receptor Agonists ; Dexmedetomidine (67VB76HONO)
Language	English
Publishing date	2021-01-09
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2020.12.052
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