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  • 1
    Online Resource
    Online Resource
    Effect of inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults: a systematic review and meta-analysis
    Elsevier BV ; 2023
    In:  British Journal of Anaesthesia Vol. 131, No. 2 ( 2023-08), p. 314-327
    Details
    In: British Journal of Anaesthesia, Elsevier BV, Vol. 131, No. 2 ( 2023-08), p. 314-327
    Type of Medium: Online Resource
    ISSN: 0007-0912
    URL: Article
    DOI: 10.1016/j.bja.2023.05.004
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2011968-9
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  • 2
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    Cerebrovascular Responses to Hypoxia and Hypocapnia in Ethiopian High Altitude Dwellers
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Stroke Vol. 39, No. 2 ( 2008-02), p. 336-342
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 39, No. 2 ( 2008-02), p. 336-342
    Abstract: Background and Purpose— Cerebrovascular responses to hypoxia and hypocapnia in Peruvian altitude dwellers are impaired. This could contribute to the high incidence of altitude-related illness in Andeans. Ethiopian high altitude dwellers may show a different pattern of adaptation to high altitude. We aimed to examine cerebral reactivity to hypoxia and hypocapnia in healthy Ethiopian high altitude dwellers. Responses were compared with our previous data from Peruvians. Methods— We studied 9 Ethiopian men at their permanent residence of 3622 m, and one day after descent to 794 m. We continuously recorded cerebral blood flow velocity (CBFV; transcranial Doppler). End-tidal oxygen (P ET o 2 ) was decreased from 100 mm Hg to 50 mm Hg with end-tidal carbon dioxide (P ET co 2 ) clamped at the subject’s resting level. P ET co 2 was then manipulated by voluntary hyper- and hypoventilation, with P ET o 2 clamped at 100 mm Hg (normoxia) and 50 mm Hg (hypoxia). Results— During spontaneous breathing, P ET co 2 increased after descent, from 38.2±1.0 mm Hg to 49.8±0.6 mm Hg ( P 〈 0.001). There was no significant response of CBFV to hypoxia at either high (−0.19±3.1%) or low (1.1±2.9%) altitudes. Cerebrovascular reactivity to normoxic hypocapnia at high and low altitudes was 3.92±0.5%.mm Hg −1 and 3.09±0.4%.mm Hg −1 ; reactivity to hypoxic hypocapnia was 4.83±0.7%.mm Hg −1 and 2.82±0.5%.mm Hg −1 . Responses to hypoxic hypocapnia were significantly smaller at low altitude. Conclusions— The cerebral circulation of Ethiopian high altitude dwellers is insensitive to hypoxia, unlike Peruvian high altitude dwellers. Cerebrovascular responses to P ET co 2 were greater in Ethiopians than Peruvians, particularly at high altitude. This, coupled with their high P ET co 2 levels, would lead to high cerebral blood flows, and may be advantageous for altitude living.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.107.491498
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Proteinase 3 contributes to endothelial dysfunction in an experimental model of sepsis
    SAGE Publications ; 2021
    In:  Experimental Biology and Medicine Vol. 246, No. 21 ( 2021-11), p. 2338-2345
    Details
    In: Experimental Biology and Medicine, SAGE Publications, Vol. 246, No. 21 ( 2021-11), p. 2338-2345
    Abstract: In sepsis-induced inflammation, polymorphonuclear neutrophils (PMNs) contribute to vascular dysfunction. The serine proteases proteinase 3 (PR3) and human leukocyte elastase (HLE) are abundant in PMNs and are released upon degranulation. While HLE’s role in inflammation-induced endothelial dysfunction is well studied, PR3’s role is largely uninvestigated. We hypothesized that PR3, similarly to HLE, contributes to vascular barrier dysfunction in sepsis. Plasma PR3 and HLE concentrations and their leukocyte mRNA levels were measured by ELISA and qPCR, respectively, in sepsis patients and controls. Exogenous PR3 or HLE was applied to human umbilical vein endothelial cells (HUVECs) and HUVEC dysfunction was assessed by FITC-dextran permeability and electrical resistance. Both PR3 and HLE protein and mRNA levels were significantly increased in sepsis patients ( P  〈  0.0001 and P  〈  0.05, respectively). Additionally, each enzyme independently increased HUVEC monolayer FITC-dextran permeability ( P  〈  0.01), and decreased electrical resistance in a time- and dose-dependent manner ( P  〈  0.001), an effect that could be ameliorated by novel treatment with carbon monoxide-releasing molecule 3 (CORM-3). The serine protease PR3, in addition to HLE, lead to vascular dysfunction and increased endothelial permeability, a hallmark pathological consequence of sepsis-induced inflammation. CORMs may offer a new strategy to reduce serine protease-induced vascular dysfunction.
    Type of Medium: Online Resource
    ISSN: 1535-3702 , 1535-3699
    URL: Article
    DOI: 10.1177/15353702211029284
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2020856-X
    SSG: 12
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  • 4
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    Assessing the relationship between near-infrared spectroscopy-derived regional cerebral oxygenation and neurological dysfunction in critically ill adults: a prospective observational multicentre protocol, on behalf of the Canadian Critical Care Trials Group
    BMJ ; 2019
    In:  BMJ Open Vol. 9, No. 6 ( 2019-06), p. e029189-
    Details
    In: BMJ Open, BMJ, Vol. 9, No. 6 ( 2019-06), p. e029189-
    Abstract: Survivors of critical illness frequently exhibit acute and chronic neurological complications. The underlying aetiology of this dysfunction remains unknown but may be associated with cerebral ischaemia. This study will use near-infrared spectroscopy to non-invasively quantify regional cerebral oxygenation (rSO 2 ) to assess the association between poor rSO 2 during the first 72 hours of critical illness with delirium severity, as well as long-term sensorimotor and cognitive impairment among intensive care unit (ICU) survivors. Further, the physiological determinants of rSO 2 will be examined. Methods and analysis This multicentre prospective observational study will consider adult patients (≥18 years old) eligible for enrolment if within 24 hours of ICU admission, they require mechanical ventilation and/or vasopressor support. For 72 hours, rSO 2 will be continuously recorded, while vital signs (eg, heart rate) and peripheral oxygenation saturation will be concurrently captured with data monitoring software. Arterial and central venous gases will be sampled every 12 hours for the 72 hours recording period and will include: pH, PaO2, PaCO2, and haemoglobin concentration. Participants will be screened daily for delirium with the confusion assessment method (CAM)-ICU, whereas the brief-CAM will be used on the ward. At 3 and 12 months post-ICU discharge, neurological function will be assessed with the Repeatable Battery for the Assessment of Neuropsychological Status and KINARM sensorimotor and cognitive robot-based behavioural tasks. Ethics and dissemination The study protocol has been approved in Ontario by a central research ethics board (Clinical Trials Ontario); non-Ontario sites will obtain local ethics approval. The study will be conducted under the guidance of the Canadian Critical Care Trials Group (CCCTG) and the results of this study will be presented at national meetings of the CCCTG for internal peer review. Results will also be presented at national/international scientific conferences. On completion, the study findings will be submitted for publication in peer-reviewed journals. Trial registration number NCT03141619
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2019-029189
    Language: English
    Publisher: BMJ
    Publication Date: 2019
    detail.hit.zdb_id: 2599832-8
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  • 5
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    Protocol for a systematic review on effective patient positioning for rapid sequence intubation
    BMJ ; 2022
    In:  BMJ Open Vol. 12, No. 11 ( 2022-11), p. e062988-
    Details
    In: BMJ Open, BMJ, Vol. 12, No. 11 ( 2022-11), p. e062988-
    Abstract: Rapid sequence intubation (RSI) is an advanced airway technique to perform endotracheal intubation in patients at high risk of aspiration. Although RSI is recognised as a life-saving technique and performed by many physicians in various settings (emergency departments, intensive care units), there is still a lack of consensus on various features of the procedure, most notably patient positioning. Previously, experts have commented on the unique drawbacks and benefits of various positions and studies have been published comparing patient positions and how it can affect endotracheal intubation in the context of RSI. The purpose of this systematic review is to compile the existing evidence to understand and compare how different patient positions can potentially affect the success of RSI. Methods and analysis We will use MEDLINE, EMBASE and the Cochrane Library to source studies from 1946 to 2021 that evaluate the impact of patient positioning on endotracheal intubation in the context of RSI. We will include randomised control trials, case–control studies, prospective/retrospective cohort studies and mannequin simulation studies for consideration in this systematic review. Subsequently, we will generate a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram to display how we selected our final studies for inclusion in the review. Two independent reviewers will complete the study screening, selection and extraction, with a third reviewer available to address any conflicts. The reviewers will extract this data in accordance with our outcomes of interest and display it in a table format to highlight patient-relevant outcomes and difficulty airway management outcomes. We will use the Risk of Bias tool and the Newcastle-Ottawa Scale to assess included studies for bias. Ethics and dissemination This systematic review does not require ethics approval, as all patient-centred data will be reported from published studies. PROSPERO registration number CRD42022289773.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2022-062988
    DOI: 10.1136/bmjopen-2022-062988.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2599832-8
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  • 6
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    Epitope-specific antibody responses differentiate COVID-19 outcomes and variants of concern
    American Society for Clinical Investigation ; 2021
    In:  JCI Insight Vol. 6, No. 13 ( 2021-7-8)
    Details
    In: JCI Insight, American Society for Clinical Investigation, Vol. 6, No. 13 ( 2021-7-8)
    Type of Medium: Online Resource
    ISSN: 2379-3708
    URL: Article
    URL: Article
    DOI: 10.1172/jci.insight.148855
    DOI: 10.1172/jci.insight.148855DS1
    Language: English
    Publisher: American Society for Clinical Investigation
    Publication Date: 2021
    detail.hit.zdb_id: 2874757-4
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  • 7
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    Calcineurin Inhibition in Deceased Organ Donors: A Systematic Review and Meta-analysis of Preclinical Studies
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Transplantation Direct Vol. 9, No. 9 ( 2023-09), p. e1519-
    Details
    In: Transplantation Direct, Ovid Technologies (Wolters Kluwer Health), Vol. 9, No. 9 ( 2023-09), p. e1519-
    Abstract: Preconditioning deceased organ donors with calcineurin inhibitors (CNIs) may reduce ischemia–reperfusion injury to improve transplant outcomes. Methods. We searched MEDLINE, EMBASE, Cochrane Library, and conference proceedings for animal models of organ donation and transplantation, comparing donor treatment with CNIs with either placebo or no intervention, and evaluating outcomes for organ transplantation. Reviewers independently screened and selected studies, abstracted data, and assessed the risk of bias and clinical relevance of included studies. Where possible, we pooled results using meta-analysis; otherwise, we summarized findings descriptively. Results. Eighteen studies used various animals and a range of CNI agents and doses and evaluated their effects on a variety of transplant outcomes. The risk of bias and clinical applicability were poorly reported. Pooled analyses suggested benefit of CNI treatment on early graft function in renal transplants (3 studies; serum creatinine: ratio of means [RoM] 0.54; 95% confidence interval [CI] , 0.34-0.86) but not for liver transplants (2 studies; serum alanine transaminase: RoM 0.61; 95% CI, 0.30-1.26; and serum aspartate aminotransferase: RoM 0.58; 95% CI, 0.26-1.31). We found no reduction in graft loss at 7 d (2 studies; risk ratio 0.54; 95% CI, 0.08-3.42). CNI treatment was associated with reduced transplant recipient levels of interleukin-6 (4 studies; RoM 0.36; 95% CI, 0.19-0.70), tumor necrosis factor-alpha (5 studies; RoM 0.36; 95% CI, 0.12-1.03), and cellular apoptosis (4 studies; RoM 0.30; 95% CI, 0.19-0.47). Conclusions. Although this compendium of animal experiments suggests that donor preconditioning with CNIs may improve early kidney graft function, the limited ability to reproduce a true clinical environment in animal experiments and to assess for risk of bias in these experiments is a serious weakness that precludes current clinical application.
    Type of Medium: Online Resource
    ISSN: 2373-8731
    URL: Article
    DOI: 10.1097/TXD.0000000000001519
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2890276-2
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  • 8
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    The Use of Central Venous to Arterial Carbon Dioxide Tension Gap for Outcome Prediction in Critically Ill Patients: A Systematic Review and Meta-Analysis*
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Critical Care Medicine Vol. 48, No. 12 ( 2020-12), p. 1855-1861
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 12 ( 2020-12), p. 1855-1861
    Abstract: In this systematic review and meta-analysis, we assessed whether a high C o 2 gap predicts mortality in adult critically ill patients with circulatory shock. Data Sources: A systematic search of MEDLINE and EMBASE electronic databases from inception to October 2019. Study Selection: Studies from adult (age ≥ 18 yr) ICU patients with shock reporting C o 2 gap and outcomes of interest. Case reports and conference abstracts were excluded. Data Extraction: Data extraction and study quality assessment were performed independently in duplicate. Data Synthesis: We used the Newcastle-Ottawa Scale to assess methodological study quality. Effect sizes were pooled using a random-effects model. The primary outcome was mortality (28 d and hospital). Secondary outcomes were ICU length of stay, hospital length of stay, duration of mechanical ventilation, use of renal replacement therapy, use of vasopressors and inotropes, and association with cardiac index, lactate, and central venous oxygen saturation. Conclusions: We included 21 studies ( n = 2,155 patients) from medical ( n = 925), cardiovascular ( n = 685), surgical ( n = 483), and mixed ( n = 62) ICUs. A high C o 2 gap was associated with increased mortality (odds ratio, 2.22; 95% CI, 1.30–3.82; p = 0.004) in patients with shock, but only those from medical and surgical ICUs. A high C o 2 gap was associated with higher lactate levels (mean difference 0.44 mmol/L; 95% CI, 0.20–0.68 mmol/L; p = 0.0004), lower cardiac index (mean difference, –0.76 L/min/m 2 ; 95% CI, –1.04 to –0.49 L/min/m 2 ; p = 0.00001), and central venous oxygen saturation (mean difference, –5.07; 95% CI, –7.78 to –2.37; p = 0.0002). A high C o 2 gap was not associated with longer ICU or hospital length of stays, requirement for renal replacement therapy, longer duration of mechanical ventilation, or higher vasopressors and inotropes use. Future studies should evaluate whether resuscitation aimed at closing the C o 2 gap improves mortality in shock.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0000000000004578
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2034247-0
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  • 9
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    Use of inhalational anaesthetic agents in paediatric and adult patients for status asthmaticus, status epilepticus and difficult sedation scenarios: a protocol for a systematic review
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 11 ( 2021-11), p. e051745-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 11 ( 2021-11), p. e051745-
    Abstract: Inhaled volatile anaesthetics have a long tradition of use as hypnotic agents in operating rooms and are gaining traction as sedatives in intensive care units (ICUs). However, uptake is impeded by low familiarity with volatiles, unique equipment and education needs. Inhaled anaesthetics are often reserved in ICUs as therapies for refractory and life threatening status asthmaticus, status epilepticus, high and difficult sedation need scenarios given they possess unique pharmacological properties to manage these medical conditions while providing sedation to acutely ill patients. The objective of this systematic review is to collate evidence regarding the efficacy, safety and feasibility of volatile anaesthetics in adult and paediatric ICU patients for these three emergency conditions. Methods and analysis We will conduct a systematic review of the primary studies in adult and paediatric ICU patients with status asthmaticus, status epilepticus and high/difficult sedation needs. We will include observational and interventional studies published from 1970 to 2021 in English or French investigating patients who have received a volatile inhalational agent for the above indications. We will evaluate the efficacy, safety, feasibility and implementation barriers for the volatile anaesthetics for each of three specified indications. Included studies will not be limited by necessity of a comparator arm. We will also evaluate clinical characteristics, patient demographics and provider attitudes towards volatile anaesthetic administration in defined critical care scenarios. Data will be extracted and analysed across these domains. The databases MEDLINE, EMBASE, the Science Citation Index as well as the Cochrane Central Controlled Trials Register will be queried with our search strategy. Descriptive and statistical analysis will be employed where appropriate. Data extraction and quality assessment will be performed in duplicate using a standardised tool. A narrative approach and statistical analyses will be used to describe patient characteristics, volatile efficacy, safety concerns, technical administration, attitudes towards administration and other implementation barriers. Ethics and dissemination No ethics board approval will be necessary for this systematic review. This research is independently funded. Results will be disseminated in a peer-reviewed journal and conference presentation. PROSPERO number CRD42021233083.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2021-051745
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2599832-8
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  • 10
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    The Utility of Invasive Hemodynamics in the Management of Cardiogenic Shock
    Elsevier BV ; 2023
    In:  Canadian Journal of Cardiology Vol. 39, No. 4 ( 2023-04), p. 420-422
    Details
    In: Canadian Journal of Cardiology, Elsevier BV, Vol. 39, No. 4 ( 2023-04), p. 420-422
    Type of Medium: Online Resource
    ISSN: 0828-282X
    URL: Article
    DOI: 10.1016/j.cjca.2023.02.002
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2048214-0
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