The Experts below are selected from a list of 42438 Experts worldwide ranked by ideXlab platform
Neal J Thomas - One of the best experts on this subject based on the ideXlab platform.
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multicohort analysis of whole blood gene expression data does not form a robust diagnostic for acute Respiratory Distress Syndrome
Critical Care Medicine, 2018Co-Authors: Timothy E Sweeney, Neal J Thomas, Judie A Howrylak, Hector R Wong, Angela J Rogers, Purvesh KhatriAbstract:Objectives:To identify a novel, generalizable diagnostic for acute Respiratory Distress Syndrome using whole-blood gene expression arrays from multiple acute Respiratory Distress Syndrome cohorts of varying etiologies.Data Sources:We performed a systematic search for human whole-blood gene expressio
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disassociating lung mechanics and oxygenation in pediatric acute Respiratory Distress Syndrome
Critical Care Medicine, 2017Co-Authors: Nadir Yehya, Neal J ThomasAbstract:Objectives:Both oxygenation and peak inspiratory pressure are associated with mortality in pediatric acute Respiratory Distress Syndrome. Since oxygenation and Respiratory mechanics are linked, it is difficult to identify which variables, pressure or oxygenation, are independently associated with ou
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pediatric acute Respiratory Distress Syndrome consensus recommendations from the pediatric acute lung injury consensus conference
Pediatric Critical Care Medicine, 2015Co-Authors: Philippe Jouvet, Douglas F Willson, Neal J Thomas, Simon Erickson, Robinder G Khemani, Lincoln S Smith, Jerry J Zimmerman, Mary K Dahmer, Heidi R Flori, Michael W QuasneyAbstract:Objective: To describe the final recommendations of the Pediatric Acute Lung Injury Consensus Conference. Design: Consensus conference of experts in pediatric acute lung injury. Setting: Not applicable. Subjects: PICU patients with evidence of acute lung injury or acute Respiratory Distress Syndrome. Interventions: None. Methods: A panel of 27 experts met over the course of 2 years to develop a taxonomy to define pediatric acute Respiratory Distress Syndrome and to make recommendations regarding treatment and research priorities. When published, data were lacking a modified Delphi approach emphasizing strong professional agreement was used. Measurements and Main Results: A panel of 27 experts met over the course of 2 years to develop a taxonomy to define pediatric acute Respiratory Distress Syndrome and to make recommendations regarding treatment and research priorities. When published data were lacking a modified Delphi approach emphasizing strong professional agreement was used. The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 151 recommendations addressing the following topics related to pediatric acute Respiratory Distress Syndrome: 1) Definition, prevalence, and epidemiology; 2) Pathophysiology, comorbidities, and severity; 3) Ventilatory support; 4) Pulmonary-specific ancillary treatment; 5) Nonpulmonary treatment; 6) Monitoring; 7) Noninvasive support and ventilation; 8) Extracorporeal support; and 9) Morbidity and long-term outcomes. There were 132 recommendations with strong agreement and 19 recommendations with weak agreement. Once restated, the final iteration of the recommendations had none with equipoise or disagreement. Conclusions: The Consensus Conference developed pediatric-specific definitions for acute Respiratory Distress Syndrome and recommendations regarding treatment and future research priorities. These are intended to promote optimization and consistency of care for children with pediatric acute Respiratory Distress Syndrome and identify areas of uncertainty requiring further investigation.
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pediatric calfactant in acute Respiratory Distress Syndrome trial
Pediatric Critical Care Medicine, 2013Co-Authors: Douglas F Willson, Robert F Tamburro, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edward J Truemper, Neal J Thomas, Edmund E EganAbstract:Rationale Our previous studies in children with acute lung injury/acute Respiratory Distress Syndrome demonstrated improved outcomes with exogenous surfactant (calfactant) administration. Sample sizes in those studies were small, however, and the subject populations heterogeneous, thus making recommendations tenuous. Objective To investigate the efficacy of surfactant administration in a larger, more homogenous population of children with lung injury/acute Respiratory Distress Syndrome due to direct lung injury. Design and setting Masked, randomized, placebo-controlled trial in 24 children's hospitals in six different countries. Patients and methods Children 37 weeks postconception to 18 years old with lung injury/acute Respiratory Distress Syndrome due to direct lung injury were randomized to receive up to three doses of 30 mg/cm height of surfactant (calfactant) versus placebo (air) within 48 hours of intubation and initiation of mechanical ventilation. The primary outcome was mortality at 90 days. Ventilator-free days, changes in oxygenation, and adverse events were also assessed. Results The study was stopped at the sponsor's request after the second interim analysis for presumed futility. A total of 110 subjects were enrolled, with consent withdrawn from one whose data are unavailable. There were no significant differences between groups except in hospital-free days (10.4 ± 7.8 placebo vs 6.4 ± 7.8 surfactant; p = 0.01). Overall 90-day mortality was 11% (seven surfactant, five placebo). No immediate improvement in oxygenation was associated with surfactant administration. Conclusions Surfactant did not improve outcomes relative to placebo in this trial of children with direct lung injury/acute Respiratory Distress Syndrome. Differences in concentration of the surfactant, failure to recruit the lung during surfactant administration, or using two rather than four position changes during administration are possible explanations for the difference from previous studies. Exogenous surfactant cannot be recommended at this time for children with direct lung injury/acute Respiratory Distress Syndrome.
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the relationship of fluid administration to outcome in the pediatric calfactant in acute Respiratory Distress Syndrome trial
Pediatric Critical Care Medicine, 2013Co-Authors: Douglas F Willson, Robert F Tamburro, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edward J Truemper, Neal J Thomas, Edmund E EganAbstract:Objectives:Adult studies have demonstrated the relationship between fluid overload and poor outcomes in acute lung injury/acute Respiratory Distress Syndrome. The approach of pediatric intensivists to fluid management in acute lung injury/acute Respiratory Distress Syndrome and its effect on outcome
Stephen Derdak - One of the best experts on this subject based on the ideXlab platform.
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high frequency oscillatory ventilation for acute Respiratory Distress Syndrome in adults a randomized controlled trial
American Journal of Respiratory and Critical Care Medicine, 2002Co-Authors: Stephen Derdak, Thomas E Stewart, Terry Smith, Mark Rogers, Timothy G Buchman, Brian Carlin, Stuart Lowson, Sangeeta Mehta, John GrantonAbstract:Observational studies of high-frequency oscillatory ventilation in adults with the acute Respiratory Distress Syndrome have demonstrated improvements in oxygenation. We designed a multicenter, randomized, controlled trial comparing the safety and effectiveness of high-frequency oscillatory ventilation with conventional ventilation in adults with acute Respiratory Distress Syndrome; 148 adults with acute Respiratory Distress Syndrome (Pa O2 /fraction of inspired oxygen � 200 mm Hg on 10 or more cm H 2 O positive end-expiratory pressure) were randomized to high-frequency oscillatory ventilation (n � 75) or conventional ventilation (n � 73). Applied mean airway pressure was significantly higher in the highfrequency oscillation group compared with the conventional ventilation group throughout the first 72 hours (p � 0.0001). The high-frequency oscillation group showed early (less than 16 hours) improvement in Pa O2 /fraction of inspired oxygen compared with the conventional ventilation group (p � 0.008); however, this difference did not persist beyond 24 hours. Oxygenation index decreased similarly over the first 72 hours in both groups. Thirty-day mortality was 37% in the high-frequency oscillation group and was 52% in the conventional ventilation group (p � 0.102). The percentage of patients alive without mechanical ventilation at Day 30 was 36% and 31% in the high-frequency oscillation and conventional ventilation groups, respectively (p � 0.686). There were no significant differences in hemodynamic variables, oxygenation failure, ventilation failure, barotraumas, or mucus plugging between treatment groups. We conclude that high-frequency oscillation is a safe and effective mode of ventilation for the treatment of acute Respiratory Distress Syndrome in adults.
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high frequency oscillatory ventilation for adult Respiratory Distress Syndrome a pilot study
Critical Care Medicine, 1995Co-Authors: Peter Fort, Christopher J Farmer, Jan Westerman, Jay A Johannigman, William Beninati, Stephen Dolan, Stephen DerdakAbstract:Objective To evaluate the safety and effectiveness of high-frequency oscillatory ventilation using a protocol designed to recruit and maintain optimal lung volume in patients with severe adult Respiratory Distress Syndrome (ARDS).Setting Surgical and medical intensive care units in a tertiary care,
Douglas F Willson - One of the best experts on this subject based on the ideXlab platform.
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pediatric acute Respiratory Distress Syndrome consensus recommendations from the pediatric acute lung injury consensus conference
Pediatric Critical Care Medicine, 2015Co-Authors: Philippe Jouvet, Douglas F Willson, Neal J Thomas, Simon Erickson, Robinder G Khemani, Lincoln S Smith, Jerry J Zimmerman, Mary K Dahmer, Heidi R Flori, Michael W QuasneyAbstract:Objective: To describe the final recommendations of the Pediatric Acute Lung Injury Consensus Conference. Design: Consensus conference of experts in pediatric acute lung injury. Setting: Not applicable. Subjects: PICU patients with evidence of acute lung injury or acute Respiratory Distress Syndrome. Interventions: None. Methods: A panel of 27 experts met over the course of 2 years to develop a taxonomy to define pediatric acute Respiratory Distress Syndrome and to make recommendations regarding treatment and research priorities. When published, data were lacking a modified Delphi approach emphasizing strong professional agreement was used. Measurements and Main Results: A panel of 27 experts met over the course of 2 years to develop a taxonomy to define pediatric acute Respiratory Distress Syndrome and to make recommendations regarding treatment and research priorities. When published data were lacking a modified Delphi approach emphasizing strong professional agreement was used. The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 151 recommendations addressing the following topics related to pediatric acute Respiratory Distress Syndrome: 1) Definition, prevalence, and epidemiology; 2) Pathophysiology, comorbidities, and severity; 3) Ventilatory support; 4) Pulmonary-specific ancillary treatment; 5) Nonpulmonary treatment; 6) Monitoring; 7) Noninvasive support and ventilation; 8) Extracorporeal support; and 9) Morbidity and long-term outcomes. There were 132 recommendations with strong agreement and 19 recommendations with weak agreement. Once restated, the final iteration of the recommendations had none with equipoise or disagreement. Conclusions: The Consensus Conference developed pediatric-specific definitions for acute Respiratory Distress Syndrome and recommendations regarding treatment and future research priorities. These are intended to promote optimization and consistency of care for children with pediatric acute Respiratory Distress Syndrome and identify areas of uncertainty requiring further investigation.
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pediatric calfactant in acute Respiratory Distress Syndrome trial
Pediatric Critical Care Medicine, 2013Co-Authors: Douglas F Willson, Robert F Tamburro, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edward J Truemper, Neal J Thomas, Edmund E EganAbstract:Rationale Our previous studies in children with acute lung injury/acute Respiratory Distress Syndrome demonstrated improved outcomes with exogenous surfactant (calfactant) administration. Sample sizes in those studies were small, however, and the subject populations heterogeneous, thus making recommendations tenuous. Objective To investigate the efficacy of surfactant administration in a larger, more homogenous population of children with lung injury/acute Respiratory Distress Syndrome due to direct lung injury. Design and setting Masked, randomized, placebo-controlled trial in 24 children's hospitals in six different countries. Patients and methods Children 37 weeks postconception to 18 years old with lung injury/acute Respiratory Distress Syndrome due to direct lung injury were randomized to receive up to three doses of 30 mg/cm height of surfactant (calfactant) versus placebo (air) within 48 hours of intubation and initiation of mechanical ventilation. The primary outcome was mortality at 90 days. Ventilator-free days, changes in oxygenation, and adverse events were also assessed. Results The study was stopped at the sponsor's request after the second interim analysis for presumed futility. A total of 110 subjects were enrolled, with consent withdrawn from one whose data are unavailable. There were no significant differences between groups except in hospital-free days (10.4 ± 7.8 placebo vs 6.4 ± 7.8 surfactant; p = 0.01). Overall 90-day mortality was 11% (seven surfactant, five placebo). No immediate improvement in oxygenation was associated with surfactant administration. Conclusions Surfactant did not improve outcomes relative to placebo in this trial of children with direct lung injury/acute Respiratory Distress Syndrome. Differences in concentration of the surfactant, failure to recruit the lung during surfactant administration, or using two rather than four position changes during administration are possible explanations for the difference from previous studies. Exogenous surfactant cannot be recommended at this time for children with direct lung injury/acute Respiratory Distress Syndrome.
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the relationship of fluid administration to outcome in the pediatric calfactant in acute Respiratory Distress Syndrome trial
Pediatric Critical Care Medicine, 2013Co-Authors: Douglas F Willson, Robert F Tamburro, Jonathon D Truwit, Mark R Conaway, Christine Traul, Edward J Truemper, Neal J Thomas, Edmund E EganAbstract:Objectives:Adult studies have demonstrated the relationship between fluid overload and poor outcomes in acute lung injury/acute Respiratory Distress Syndrome. The approach of pediatric intensivists to fluid management in acute lung injury/acute Respiratory Distress Syndrome and its effect on outcome
Nadir Yehya - One of the best experts on this subject based on the ideXlab platform.
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ventilator weaning pathway associated with decreased ventilator days in pediatric acute Respiratory Distress Syndrome
Critical Care Medicine, 2021Co-Authors: Sanjiv Mehta, Kelly Martin, Nancy Mcgowan, Cheryl Dominick, Chinonyerem Madu, Blair Kraus Denkin, Nadir YehyaAbstract:OBJECTIVES There is limited evidence on the impact of protocolized ventilator weaning in pediatric acute Respiratory Distress Syndrome, despite utilization in clinical trials and clinical care. We aimed to determine whether protocolized ventilator weaning shortens mechanical ventilation duration and PICU length of stay in pediatric acute Respiratory Distress Syndrome survivors. DESIGN Secondary analysis of a prospective pediatric acute Respiratory Distress Syndrome (Berlin definition) cohort from July 2011 to June 2019 analyzed using interrupted time series analysis pre- and postimplementations of a ventilator-weaning pathway. We compared duration of invasive ventilation and PICU length of stay in survivors before and after implementation of a ventilator-weaning pathway. We excluded PICU nonsurvivors and subjects with greater than 100 ventilator days. SETTING Large academic tertiary-care PICU. PATIENTS Children with acute Respiratory Distress Syndrome who survived to PICU discharge with less than or equal to 100 days of invasive mechanical ventilation. INTERVENTIONS Implementation of a ventilator-weaning pathway on May 2016. MEASUREMENTS AND MAIN RESULTS Of 723 children with acute Respiratory Distress Syndrome, 132 subjects died and six subjects with ventilation greater than 100 days were excluded. Of the remaining 585 subjects, 375 subjects had acute Respiratory Distress Syndrome prior to pathway intervention and 210 after. Patients in the preintervention epoch were younger, more likely to have infectious acute Respiratory Distress Syndrome, and had increased use of alternative ventilator modes. Pathway adoption was rapid and sustained. Controlling for temporality, pathway implementation was associated with a decrease of a median 3.6 ventilator days (95% CI, -5.4 to -1.7; p < 0.001). There was no change in the reintubation rates. Results were robust to multiple sensitivity analyses adjusting for confounders. CONCLUSIONS Ventilator-weaning pathway implementation shortened invasive ventilation duration in pediatric acute Respiratory Distress Syndrome survivors with no change in reintubation. The effect size of this intervention was comparable with those targeted in acute Respiratory Distress Syndrome trials.
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disassociating lung mechanics and oxygenation in pediatric acute Respiratory Distress Syndrome
Critical Care Medicine, 2017Co-Authors: Nadir Yehya, Neal J ThomasAbstract:Objectives:Both oxygenation and peak inspiratory pressure are associated with mortality in pediatric acute Respiratory Distress Syndrome. Since oxygenation and Respiratory mechanics are linked, it is difficult to identify which variables, pressure or oxygenation, are independently associated with ou
Richard G Wunderink - One of the best experts on this subject based on the ideXlab platform.
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viral pneumonia and acute Respiratory Distress Syndrome
Clinics in Chest Medicine, 2017Co-Authors: Raj D Shah, Richard G WunderinkAbstract:Respiratory viruses are a common cause of severe pneumonia and acute Respiratory Distress Syndrome (ARDS) in adults. The advent of new diagnostic technologies, particularly multiplex reverse transcription polymerase chain reaction, have increased the recognition of viral Respiratory infections in critically ill adults. Supportive care for adults with ARDS caused by Respiratory viruses is similar to the care of patients with ARDS from other causes. Although antiviral therapy is available for some Respiratory viral infections, further research is needed to determine which groups of patients would benefit.
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low tidal volume ventilation use in acute Respiratory Distress Syndrome
Critical Care Medicine, 2016Co-Authors: Curtis H Weiss, David W Baker, Shayna Weiner, Meagan Bechel, Margaret Ragland, Alfred W Rademaker, Bing Bing Weitner, Abha Agrawal, Richard G WunderinkAbstract:Objective:Low tidal volume ventilation lowers mortality in the acute Respiratory Distress Syndrome. Previous studies reported poor low tidal volume ventilation implementation. We sought to determine the rate, quality, and predictors of low tidal volume ventilation use.Design:Retrospective cross-sect