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Article ; Online: Respiratory Drive, Dyspnea, and Silent Hypoxemia: A Physiological Review in the Context of COVID-19.

Kallet, Richard H / Branson, Richard D / Lipnick, Michael S

2022 Volume 67, Issue 10, Page(s) 1343–1360

Abstract: Infection with SARS-CoV-2 in select individuals results in viral sepsis, pneumonia, and hypoxemic respiratory failure, collectively known as COVID-19. In the early months of the pandemic, the combination of novel disease presentation, enormous surges of ... ...

Abstract	Infection with SARS-CoV-2 in select individuals results in viral sepsis, pneumonia, and hypoxemic respiratory failure, collectively known as COVID-19. In the early months of the pandemic, the combination of novel disease presentation, enormous surges of critically ill patients, and severity of illness lent to early observations and pronouncements regarding COVID-19 that could not be scientifically validated owing to crisis circumstances. One of these was a phenomenon referred to as "happy hypoxia." Widely discussed in the lay press, it was thought to represent a novel and perplexing phenomenon: severe hypoxemia coupled with the absence of respiratory distress and dyspnea. Silent hypoxemia is the preferred term describing an apparent lack of distress in the presence of hypoxemia. However, the phenomenon is well known among respiratory physiologists as hypoxic ventilatory decline. Silent hypoxemia can be explained by physiologic mechanisms governing the control of breathing, breathing perception, and cardiovascular compensation. This narrative review examines silent hypoxemia during COVID-19 as well as hypotheses that viral infection of the central and peripheral nervous system may be implicated. Moreover, the credulous embrace of happy hypoxia and the novel hypotheses proposed to explain it has exposed significant misunderstandings among clinicians regarding the physiologic mechanisms governing both the control of breathing and the modulation of breathing sensations. Therefore, a substantial focus of this paper is to provide an in-depth review of these topics.
MeSH term(s)	COVID-19/complications ; Dyspnea/etiology ; Humans ; Hypoxia/epidemiology ; Hypoxia/etiology ; Pandemics ; SARS-CoV-2
Language	English
Publishing date	2022-05-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.10075
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Article ; Online: End-Tidal-to-Arterial P

Kallet, Richard H / Lipnick, Michael S

Respiratory care

2020 Volume 66, Issue 2, Page(s) 263–268

Abstract: Background: The ratio of end-tidal CO: Methods: We evaluated the correspondence between [Formula: see text] and the ratio of dead space to tidal volume (V: Results: [Formula: see text] correlated strongly with V: Conclusions: Using [Formula: ... ...

Abstract	Background: The ratio of end-tidal CO Methods: We evaluated the correspondence between [Formula: see text] and the ratio of dead space to tidal volume (V Results: [Formula: see text] correlated strongly with V Conclusions: Using [Formula: see text] as a surrogate for V
MeSH term(s)	Arterial Pressure ; COVID-19 ; Carbon Dioxide/blood ; Humans ; Partial Pressure ; Respiratory Dead Space ; Respiratory Distress Syndrome/diagnosis ; Respiratory Distress Syndrome/physiopathology ; Tidal Volume
Chemical Substances	Carbon Dioxide (142M471B3J)
Keywords	covid19
Language	English
Publishing date	2020-07-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.08061
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Article ; Online: Utilization of a Risk Stratification Tool and Volume-Based Cuff Leak Test to Assess Postextubation Stridor.

Kallet, Richard H / Matsushima, Aya / Yoo, Susan / Lipnick, Michael S

Respiratory care

2022 Volume 68, Issue 3, Page(s) 309–319

Abstract: Background: Postextubation stridor (PES) is an imminently life-threatening event. Maximizing patient safety requires a systematic approach to screen patients for PES risk factors and a standardized test to evaluate that risk. This retrospective study of ...

Abstract	Background: Postextubation stridor (PES) is an imminently life-threatening event. Maximizing patient safety requires a systematic approach to screen patients for PES risk factors and a standardized test to evaluate that risk. This retrospective study of adult subjects was based on quality assurance data including standardized surveillance screening criteria and a volume-based cuff leak test (CLT) to evaluate PES risk among predominantly surgical-trauma and neurotrauma subjects. Data characterizing PES subjects also were collected. Methods: Data were collected between May 2010-December 2017 for all intubated subjects in our surgical-trauma, neurotrauma, and medical ICUs. Respiratory therapists were trained in performing both PES risk assessment surveillance and a volume-based CLT. A pre hoc cutoff leak volume of < 110 mL defined a true positive test result when associated with PES, and a leak ≥ 110 mL defined a true negative test if PES was absent. Multiple comparisons were analyzed by Kruskal-Wallis tests and dichotomous variables assessed by Fisher exact tests. Alpha was set at 0.05. Results: In 681 pre-extubation CLTs ∼85% produced true-negative results and 15% consisted of true-positive (∼4%), false-negative (∼5%), and false-positive (∼6%) results. Positive and negative predictive values were 0.42 (0.32-0.54) and 0.94 (0.92-0.96), respectively. The PES likelihood ratio was 7.0, and correct classification was 89%. Of the 115 PES incidences occurring in 112 PES cases, 67% were female and 48% had suffered acute brain injury. Conclusions: Among predominantly surgical-trauma and neurotrauma subjects with a CLT, leak volume of ≥ 110 mL was associated with a PES risk of ∼6%, whereas the risk of PES was 7 times greater when the leak volume was < 110 mL.
MeSH term(s)	Adult ; Humans ; Female ; Male ; Respiratory Sounds/etiology ; Retrospective Studies ; Intubation, Intratracheal/adverse effects ; Prospective Studies ; Risk Assessment
Language	English
Publishing date	2022-08-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.10285
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Article ; Online: Living the work: the HEAL Initiative as a model for perioperative health workforce transformation and health equity work.

Percy, Samuel / Sahi, Saad / Bua, Emmanuel / Shamasunder, Sriram / Lipnick, Michael / Law, Tyler

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2023 Volume 70, Issue 6, Page(s) 968–971

MeSH term(s)	Humans ; Health Workforce ; Health Equity ; Rural Health Services
Language	English
Publishing date	2023-05-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/s12630-023-02451-0
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Article ; Online: ARDS Outcomes in Non-Research Subjects Assessed by Generalized Prospective Trial Eligibility Criteria and Adherence to Lung-Protective Ventilation.

Kallet, Richard H / Lipnick, Michael S / Pirracchio, Romain

Respiratory care

2021 Volume 66, Issue 9, Page(s) 1380–1388

Abstract: Background: ARDS mortality is lower among subjects participating in randomized controlled trials (RCTs) compared to subjects in observational studies. Excluding potential subjects with inordinately high mortality risk is necessary to prevent masking the ...

Abstract	Background: ARDS mortality is lower among subjects participating in randomized controlled trials (RCTs) compared to subjects in observational studies. Excluding potential subjects with inordinately high mortality risk is necessary to prevent masking the impact of potentially effective treatments. We inquired whether observed mortality differed between RCT-eligible and RCT-ineligible subjects managed with varying degrees of lung-protective ventilation in a non-research setting. Methods: This single-center, retrospective, observational study utilized quality assurance data for monitoring lung-protective ventilation practices based upon National Institutes of Health ARDS Network (ARDSNet) protocols. Between 2002 and 2017, 1,975 subjects meeting the 1994 consensus criteria for acute lung injury/ARDS (later reclassified by the Berlin definition) were prospectively identified and classified as RCT-eligible or RCT-ineligible on the basis of the original ARDSNet exclusion criteria for comorbidities or moribund condition. Demographic and physiologic data from the day of ARDS onset and outcome data were studied. Survival was modeled with a mixed-effect Cox proportional hazard model adjusted for age, both illness and lung injury severity plateau pressure, and formal use of the ARDSNet ventilator protocol. The primary outcome of interest was all-cause mortality during the first 90 d following onset of ARDS. Results: Day 90 mortality was 27.6% in RCT-eligible subjects versus 50.4% in RCT-ineligible subjects (hazard ratio 0.47 [95% CI 0.41-0.54], Conclusions: Mortality in non-research, RCT-eligible subjects was substantially lower compared to RCT-ineligible subjects. Managing non-research patients with ARDS by keeping plateau pressure ≤ 30 cm H
MeSH term(s)	Humans ; Lung ; Respiration, Artificial ; Respiratory Distress Syndrome/therapy ; Tidal Volume ; Ventilators, Mechanical
Language	English
Publishing date	2021-04-22
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.09116
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Article ; Online: Availability of information needed to evaluate algorithmic fairness - A systematic review of publicly accessible critical care databases.

Fong, Nicholas / Langnas, Erica / Law, Tyler / Reddy, Mallika / Lipnick, Michael / Pirracchio, Romain

Anaesthesia, critical care & pain medicine

2023 Volume 42, Issue 5, Page(s) 101248

Abstract: Background: Machine learning (ML) may improve clinical decision-making in critical care settings, but intrinsic biases in datasets can introduce bias into predictive models. This study aims to determine if publicly available critical care datasets ... ...

Abstract	Background: Machine learning (ML) may improve clinical decision-making in critical care settings, but intrinsic biases in datasets can introduce bias into predictive models. This study aims to determine if publicly available critical care datasets provide relevant information to identify historically marginalized populations. Method: We conducted a review to identify the manuscripts that report the training/validation of ML algorithms using publicly accessible critical care electronic medical record (EMR) datasets. The datasets were reviewed to determine if the following 12 variables were available: age, sex, gender identity, race and/or ethnicity, self-identification as an indigenous person, payor, primary language, religion, place of residence, education, occupation, and income. Results: 7 publicly available databases were identified. Medical Information Mart for Intensive Care (MIMIC) reports information on 7 of the 12 variables of interest, Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe) on 7, COVID-19 Mexican Open Repository on 4, and eICU on 4. Other datasets report information on 2 or fewer variables. All 7 databases included information about sex and age. Four databases (57%) included information about whether a patient identified as native or indigenous. Only 3 (43%) included data about race and/or ethnicity. Two databases (29%) included information about residence, and one (14%) included information about payor, language, and religion. One database (14%) included information about education and patient occupation. No databases included information on gender identity and income. Conclusion: This review demonstrates that critical care publicly available data used to train AI algorithms do not include enough information to properly look for intrinsic bias and fairness issues towards historically marginalized populations.
MeSH term(s)	Humans ; Male ; Female ; COVID-19 ; Gender Identity ; Algorithms ; Critical Care ; Machine Learning
Language	English
Publishing date	2023-05-20
Publishing country	France
Document type	Systematic Review ; Journal Article
ISSN	2352-5568
ISSN (online)	2352-5568
DOI	10.1016/j.accpm.2023.101248
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Is there still a role for alveolar recruitment maneuvers in acute respiratory distress syndrome?

Kallet, Richard H / Lipnick, Michael S

Journal of thoracic disease

2018 Volume 10, Issue 1, Page(s) 85–90

Language	English
Publishing date	2018-03-26
Publishing country	China
Document type	Editorial ; Comment
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd.2017.12.113
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The Nature of Recruitment and De-Recruitment and Its Implications for Management of ARDS.

Kallet, Richard H / Lipnick, Michael S / Burns, Gregory D

Respiratory care

2020 Volume 66, Issue 3, Page(s) 510–530

Abstract: Recruitment maneuvers in ARDS are used to improve oxygenation and lung mechanics by applying high airway pressures to reopen collapsed or obstructed peripheral airways and alveoli. In the early 1990s, recruitment maneuvers became a central feature of a ... ...

Abstract	Recruitment maneuvers in ARDS are used to improve oxygenation and lung mechanics by applying high airway pressures to reopen collapsed or obstructed peripheral airways and alveoli. In the early 1990s, recruitment maneuvers became a central feature of a variant form of lung-protective ventilation known as open-lung ventilation. This strategy is based on the belief that repetitive opening and closing of distal airspaces induces shear injury and therefore contributes both to ventilator-induced lung injury and ARDS-associated mortality. However, the largest multi-center randomized controlled trial of open-lung ventilation in moderate to severe ARDS reported that recruitment maneuver plateau pressures of 50-60 cm H
MeSH term(s)	Acute Lung Injury ; Humans ; Positive-Pressure Respiration ; Respiration, Artificial ; Respiratory Distress Syndrome/therapy ; Ventilator-Induced Lung Injury/etiology ; Ventilator-Induced Lung Injury/prevention & control
Language	English
Publishing date	2020-10-13
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.08280
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Article: End-Tidal-to-Arterial PCO2 Ratio as Signifier for Physiologic Dead-Space Ratio and Oxygenation Dysfunction in Acute Respiratory Distress Syndrome

Kallet, Richard H / Lipnick, Michael S

Respir. care

Abstract: BACKGROUND: The ratio of end-tidal CO2 pressure to arterial partial pressure of CO2 (P ETCO2 /P aCO2 ) was recently suggested for monitoring pulmonary gas exchange in patients with ARDS associated with COVID-19, yet no evidence was offered supporting ... ...

Abstract	BACKGROUND: The ratio of end-tidal CO2 pressure to arterial partial pressure of CO2 (P ETCO2 /P aCO2 ) was recently suggested for monitoring pulmonary gas exchange in patients with ARDS associated with COVID-19, yet no evidence was offered supporting that claim. Therefore, we evaluated whether P ETCO2 /P aCO2 might be relevant in assessing ARDS not associated with COVID-19. METHODS: We evaluated the correspondence between P ETCO2 /P aCO2 and the ratio of dead space to tidal volume (VD/VT) measured in 561 subjects with ARDS from a previous study in whom P ETCO2 data were also available. Subjects also were analyzed according to 4 ranges of P ETCO2 /P aCO2 representing increasing illness severity (≥ 0.80, 0.6-0.79, 0.50-0.59, and < 0.50). Correlation was assessed by either Pearson or Spearman tests, grouped comparisons were assessed using either ANOVA or Kruskal-Wallis tests and dichotomous variables assessed by Fisher Exact tests. Normally distributed data are presented as mean and standard deviation(SD) and non-normal data are presented as median and inter-quartile range (IQR). Overall mortality risk was assessed with multivariate logistic regression. Alpha was set at 0.05. RESULTS: P ETCO2 /P aCO2 correlated strongly with VD/VT (r = -0.87 [95% CI -0.89 to -0.85], P < .001). Decreasing P ETCO2 /P aCO2 was associated with increased VD/VT and hospital mortality between all groups. In the univariate analysis, for every 0.01 decrease in P ETCO2 /P aCO2 , mortality risk increased by â¼1% (odds ratio 0.009, 95% CI 0.003-0.029, P < .001) and maintained a strong independent association with mortality risk when adjusted for other variables (odds ratio 0.19, 95% CI 0.04-0.91, P = .039). P ETCO2 /P aCO2 < 0.50 was characterized by very high mean ± SD value for VD/VT (0.82 ± 0.05, P < .001) and high hospital mortality (70%). CONCLUSIONS: Using P ETCO2 /P aCO2 as a surrogate for VD/VT may be a useful and practical measurement for both management and ongoing research into the nature of ARDS.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #636776
Database	COVID19

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Article ; Online: Pulse Oximeter Bias and Inequities in Retrospective Studies--Now What?

Moore, Kelvin L / Gudelunas, Koa / Lipnick, Michael S / Bickler, Philip E / Hendrickson, Carolyn M

Respiratory care

2022 Volume 67, Issue 12, Page(s) 1633–1636

MeSH term(s)	Humans ; Retrospective Studies ; Oximetry ; Oxygen
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2022-11-25
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	603252-7
ISSN	1943-3654 ; 0098-9142 ; 0020-1324
ISSN (online)	1943-3654
ISSN	0098-9142 ; 0020-1324
DOI	10.4187/respcare.10654
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