Research Spotlight

Hamadeh, A., N. H. Patel and J. W. Choi (2020). “Pulmonary Artery Pseudoaneurysm Associated With Abandoned Epicardial Defibrillator Patch.” Am J Cardiol 128: 161-162.

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We describe an 84-year-old man who presented with hemoptysis and acute blood loss anemia due to a pulmonary artery pseudoaneurysm (PAP). The etiology of his PAP was thought to be an abandoned epicardial defibrillator patch that was implanted at age 55. To our knowledge, PAP has never been reported as a possible complication of an abandoned epicardial defibrillator patch.

Gupta, S., S. S. Hayek, W. Wang, L. Chan, K. S. Mathews, M. L. Melamed, S. K. Brenner, A. Leonberg-Yoo, E. J. Schenck, J. Radbel, J. Reiser, A. Bansal, A. Srivastava, Y. Zhou, A. Sutherland, A. Green, A. M. Shehata, N. Goyal, A. Vijayan, J. C. Q. Velez, S. Shaefi, C. R. Parikh, J. Arunthamakun, A. M. Athavale, A. N. Friedman, S. A. P. Short, Z. A. Kibbelaar, S. Abu Omar, A. J. Admon, J. P. Donnelly, H. B. Gershengorn, M. A. Hernán, M. W. Semler and D. E. Leaf (2020). “Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US.” JAMA Intern Med 2020 Jul 15;e203596. [Epub ahead of print.].

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IMPORTANCE: The US is currently an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet few national data are available on patient characteristics, treatment, and outcomes of critical illness from COVID-19. OBJECTIVES: To assess factors associated with death and to examine interhospital variation in treatment and outcomes for patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study assessed 2215 adults with laboratory-confirmed COVID-19 who were admitted to intensive care units (ICUs) at 65 hospitals across the US from March 4 to April 4, 2020. EXPOSURES: Patient-level data, including demographics, comorbidities, and organ dysfunction, and hospital characteristics, including number of ICU beds. MAIN OUTCOMES AND MEASURES: The primary outcome was 28-day in-hospital mortality. Multilevel logistic regression was used to evaluate factors associated with death and to examine interhospital variation in treatment and outcomes. RESULTS: A total of 2215 patients (mean [SD] age, 60.5 [14.5] years; 1436 [64.8%] male; 1738 [78.5%] with at least 1 chronic comorbidity) were included in the study. At 28 days after ICU admission, 784 patients (35.4%) had died, 824 (37.2%) were discharged, and 607 (27.4%) remained hospitalized. At the end of study follow-up (median, 16 days; interquartile range, 8-28 days), 875 patients (39.5%) had died, 1203 (54.3%) were discharged, and 137 (6.2%) remained hospitalized. Factors independently associated with death included older age (≥80 vs <40 years of age: odds ratio [OR], 11.15; 95% CI, 6.19-20.06), male sex (OR, 1.50; 95% CI, 1.19-1.90), higher body mass index (≥40 vs <25: OR, 1.51; 95% CI, 1.01-2.25), coronary artery disease (OR, 1.47; 95% CI, 1.07-2.02), active cancer (OR, 2.15; 95% CI, 1.35-3.43), and the presence of hypoxemia (Pao2:Fio2<100 vs ≥300 mm Hg: OR, 2.94; 95% CI, 2.11-4.08), liver dysfunction (liver Sequential Organ Failure Assessment score of 2 vs 0: OR, 2.61; 95% CI, 1.30-5.25), and kidney dysfunction (renal Sequential Organ Failure Assessment score of 4 vs 0: OR, 2.43; 95% CI, 1.46-4.05) at ICU admission. Patients admitted to hospitals with fewer ICU beds had a higher risk of death (<50 vs ≥100 ICU beds: OR, 3.28; 95% CI, 2.16-4.99). Hospitals varied considerably in the risk-adjusted proportion of patients who died (range, 6.6%-80.8%) and in the percentage of patients who received hydroxychloroquine, tocilizumab, and other treatments and supportive therapies. CONCLUSIONS AND RELEVANCE: This study identified demographic, clinical, and hospital-level risk factors that may be associated with death in critically ill patients with COVID-19 and can facilitate the identification of medications and supportive therapies to improve outcomes.

Guerrero-Miranda, C. Y. and S. A. Hall (2020). “Rethinking the Future with Evolving Technology: It’s Time to Empower Change in Heart Transplantation.” Am J Transplant 2020 Jul 27. [Epub ahead of print.].

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According to the National Institutes of Health (NIH) Biomarker Definition Working Group, biomarkers are characteristics objectively measured and indicators of a physiologic or pathologic process. In 1847, the first cancer biomarker was discovered when the Bence Jones proteins were found in the urine of patients with Multiple Myeloma; since then, biomarkers have played a crucial role in modern medicine. An ideal biomarker should be non-invasive, low cost, quantifiable, consistent across ethnic and gender groups, and reflect correlation in different diseases or conditions.

Gan, T. J., K. G. Belani, S. Bergese, F. Chung, P. Diemunsch, A. S. Habib, Z. Jin, A. L. Kovac, T. A. Meyer, R. D. Urman, C. C. Apfel, S. Ayad, L. Beagley, K. Candiotti, M. Englesakis, T. L. Hedrick, P. Kranke, S. Lee, D. Lipman, H. S. Minkowitz, J. Morton and B. K. Philip (2020). “Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting.” Anesth Analg 131(2): 411-448.

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This consensus statement presents a comprehensive and evidence-based set of guidelines for the care of postoperative nausea and vomiting (PONV) in both adult and pediatric populations. The guidelines are established by an international panel of experts under the auspices of the American Society of Enhanced Recovery and Society for Ambulatory Anesthesia based on a comprehensive search and review of literature up to September 2019. The guidelines provide recommendation on identifying high-risk patients, managing baseline PONV risks, choices for prophylaxis, and rescue treatment of PONV as well as recommendations for the institutional implementation of a PONV protocol. In addition, the current guidelines focus on the evidence for newer drugs (eg, second-generation 5-hydroxytryptamine 3 [5-HT3] receptor antagonists, neurokinin 1 (NK1) receptor antagonists, and dopamine antagonists), discussion regarding the use of general multimodal PONV prophylaxis, and PONV management as part of enhanced recovery pathways. This set of guidelines have been endorsed by 23 professional societies and organizations from different disciplines (Appendix 1).Guidelines currently available include the 3 iterations of the consensus guideline we previously published, which was last updated 6 years ago; a guideline published by American Society of Health System Pharmacists in 1999; a brief discussion on PONV management as part of a comprehensive postoperative care guidelines; focused guidelines published by the Society of Obstetricians and Gynecologists of Canada, the Association of Paediatric Anaesthetists of Great Britain & Ireland and the Association of Perianesthesia Nursing; and several guidelines published in other languages.The current guideline was developed to provide perioperative practitioners with a comprehensive and up-to-date, evidence-based guidance on the risk stratification, prevention, and treatment of PONV in both adults and children. The guideline also provides guidance on the management of PONV within enhanced recovery pathways.The previous consensus guideline was published 6 years ago with a literature search updated to October 2011. Several guidelines, which have been published since, are either limited to a specific populations or do not address all aspects of PONV management. The current guideline was developed based on a systematic review of the literature published up through September 2019. This includes recent studies of newer pharmacological agents such as the second-generation 5-hydroxytryptamine 3 (5-HT3) receptor antagonists, a dopamine antagonist, neurokinin 1 (NK1) receptor antagonists as well as several novel combination therapies. In addition, it also contains an evidence-based discussion on the management of PONV in enhanced recovery pathways. We have also discussed the implementation of a general multimodal PONV prophylaxis in all at-risk surgical patients based on the consensus of the expert panel.

Flannery, B., J. K. Meece, J. V. Williams, E. T. Martin, M. Gaglani, M. L. Jackson and H. K. Talbot (2020). “Systematic testing for influenza and COVID-19 among patients with respiratory illness.” Clin Infect Dis 2020 Jul 20;ciaa1023. [Epub ahead of print.].

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A recent report by Rosenberg and colleagues highlights the importance of multiple sources of information for monitoring trends in the COVID-19 pandemic [1]. The authors use influenzalike illness (ILI) surveillance data and laboratory-confirmed influenza and COVID-19 cases to estimate population-based rates of illness during the beginnings of the pandemic in New York state. Because SARS-CoV-2 testing was rapidly increasing during this period in many areas of the U.S., numbers of COVID-19 cases were likely underestimated. This raises the question of whether COVID-19 contributed to ILI trends prior to widespread testing. [No abstract; excerpt from article].