Showing papers by "Alan H. Morris published in 2017"
5 citations
TL;DR: In this paper, a bedside computer clinical decision support (CDS) protocol for intravenous insulin titration, eProtocol-insulin, would be feasible and safe in critically ill children.
Abstract: Background: Computer clinical decision support (CDS) systems are uncommon in the pediatric intensive care unit (PICU), despite evidence suggesting they improve outcomes in adult ICUs. We reasoned that a bedside CDS protocol for intravenous insulin titration, eProtocol-insulin, would be feasible and safe in critically ill children. Methods: We retrospectively reviewed data from non-diabetic children admitted to the PICU with blood glucose (BG) ≥140 mg/dL who were managed with intravenous insulin by either unaided clinician titration or eProtocol-insulin. Primary outcomes were BG measurements in target range (80–110 mg/dL) and severe hypoglycemia (BG ≤40 mg/dL); secondary outcomes were 60-day mortality and PICU length of stay. We assessed bedside nurse satisfaction with the eProtocol-insulin protocol by using a 5-point Likert scale and measured clinician compliance with eProtocol-insulin recommendations. Results: Over 5 years, 69 children were titrated with eProtocol-insulin versus 104 by unaided c...
4 citations
TL;DR: The time of maximal spirometric change after BD inhalation (post-pre BD) is explored, finding alternative time points, where signals maximize, may increase sensitivity for determining BD responsiveness.
Abstract: Background: The ATS/ERS Task Force (Pellegrino, R. et al. Eur Respir J 2005; 26:948-968) recommends an increase of both 12% and 200 mL in FEV1 or FVC to define a positive bronchodilator (BD) response. The use of FEV1 for defining a positive BD response is based on expert opinion. We aimed to explore the time of maximal spirometric change after BD inhalation (post-pre BD). Methods: We evaluated 1715 adult patients with acceptable and repeatable pre- and post BD (4 inhalations of albuterol) spirograms in our PFT laboratory. We compared the percent (%) and magnitude (mL) changes every 10 msec (t), using back extrpolation to determine t=0. We determined the times (FEVt) of maximal % and mL changes between pre- and post BD spirograms to 3 seconds. Results: For the differences between pre- and post BD spirograms at each time t, the maximal changes (FIGURE) were at 0.38 sec (% change, LEFT PANEL) and 1.21 sec (mL change, RIGHT PANEL). The maximal (post-pre) BD % change occurred before 1.0 sec in 82% and the maximal (post-pre) BD mL change occurred before 1.0 sec in 36% of patients. For the 31% of patients who met ATS/ERS Task Force criteria for positive BD response, maximal (post-pre) BD % change occurred at 0.36 sec and mL change at 1.68 sec. Conclusion: Maximal spirometric changes after BD inhalation occur at times other than 1.0 sec. Alternative time points, where signals maximize, may increase sensitivity for determining BD responsiveness.
1 citations
TL;DR: The findings support the large observational studies that demonstrated that mortality decreases with increased compliance with the sepsis bundle elements and should compel us to examine what protocols this center and others with other low rates of ICH and good neurologic outcome use to establish “best practice.”
Abstract: Critical Care Medicine www.ccmjournal.org 1783 (e.g., lactate, cultures, antibiotics, fluid challenge) in both public and private hospitals. Machado et al (1) found that public hospitals in Brazil had poor compliance with minimal improvement during their observation period, whereas private hospitals had greater improvements in both compliance and in in-hospital mortality. Although this observational study does not allow for causal inferences, the assessment of compliance with the protocol in conjunction with mortality in two populations makes a compelling argument for the importance of context within which clinical care is delivered. In the private institutions, the intervention resulted in a large increase in compliance and large reduction in mortality. In the public institution, the intervention slightly increased compliance, and there was no reduction in mortality. These findings support the large observational studies that demonstrated that mortality decreases with increased compliance with the sepsis bundle elements (2, 3). This relationship is not unique to sepsis; the mortality of patients is decreased as more evidence-based care is applied (4). Perhaps the greatest improvements in healthcare over the coming decade will not be the discovery of new treatments, but rather the successful implementation of interventions we related to transport to the CT scanner are not reported, although the authors did not identify major transport events. It should be mentioned that this center is well-experienced with both intra and inter-hospital transport of ECMO patients. In summary, the current report should compel us to examine what protocols this center and others with other low rates of ICH and good neurologic outcome use to establish “best practice.” Extrapolating single-center outcomes to the field at large will likely require standardization and collaboration. With the rapidly increasing use of ECMO, establishing “best practices” is needed now more than ever. The days of “my way or the highway” need to change to “what way is the best way” to benefit patient care.