Acute Respiratory Distress Syndrome Phenotypes After Stem Cell Transplantation: A Latent Class Analysis.

Objective: To identify distinct phenotypes of acute respiratory distress syndrome (ARDS) developing after hematopoietic cell transplantation (HCT), using routinely available clinical data at ICU admission.

Design: Multicenter retrospective cohort study using latent class analysis.

Setting: ICUs across three Mayo Clinic campuses (Minnesota, Florida, and Arizona).

Hemodynamic Effects of Guideline-Based Sedation in Mechanically Ventilated Adults: A Multicenter Observational Analysis.

Importance: Propofol is a first-line sedative for adults receiving invasive mechanical ventilation (IMV). However, it can contribute to hemodynamic instability, especially during intubation. The magnitude, timing, risk factors, and variability of sedation-associated mean arterial pressure (MAP) changes remain poorly characterized in ICU settings.

Does direct oral anticoagulant lead-in dosing following initial parenteral therapy affect clinical outcomes in acute venous thromboembolism?: A retrospective cohort study.

Introduction: Initiation of direct oral anticoagulants (DOAC) for the management of venous thromboembolism (VTE) typically includes a lead-in dosing phase. However, some patients may receive a shortened course due to comorbid conditions and/or numerous days of parenteral therapy. Limited data exist on the outcomes of an abbreviated lead-in therapy regimen.

Outcomes following catheter ablation for structural ventricular tachycardia stratified by left ventricular ejection fraction: A retrospective cohort study.

Background: Despite advances in catheter ablation for ventricular tachycardia (VT), patients with lower left ventricular ejection fractions (LVEFs) tend to have worse outcomes. However, there is limited understanding of the periprocedural factors associated with recurrence, and whether LVEF directly influences outcomes.

Objectives: The study sought to evaluate the electrophysiological characteristics and outcomes of patients undergoing VT ablation, stratified by LVEF.

Progressive Exercise Training After Aortic Dissection in a Recreational Athlete.

Objective: Structured exercise training (ExT) has been shown to improve cardiorespiratory fitness and health-related quality of life and is safe in patients after surgery for type A aortic dissection (AD).

Key Steps: We detail the implementation of progressive ExT in a 56-year-old man former recreational triathlete 16 months after emergency repair of a type I AD, who had a residual descending aortic dissection. A home-based individualized ExT plan incorporated low- to moderate-intensity aerobic and resistance exercise with progression to interval training.

Surgeon Sex and Postoperative Resource Utilization: A Population-Based Cohort Study.

Objectives: To determine associations between physician sex and use of postoperative healthcare resources among patients undergoing common surgeries in Ontario, Canada.

Background: Prior studies have shown that patients of female physicians experience better outcomes and have lower healthcare costs compared with patients of male physicians. Understanding differences in resource utilization may offer insights into the care pathways and practice patterns contributing to these differences.

So You've Got a High AUC, Now What? An Overview of Important Considerations when Bringing Machine-Learning Models from Computer to Bedside.

Machine-learning (ML) models have the potential to transform health care by enabling more personalized and data-driven clinical decision making. However, their successful implementation in clinical practice requires careful consideration of factors beyond predictive accuracy. We provide an overview of essential considerations for developing clinically applicable ML models, including methods for assessing and improving calibration, selecting appropriate decision thresholds, enhancing model explainability, identifying and mitigating bias, as well as methods for robust validation.

Propofol-associated Hypertriglyceridemia: Development and Multicenter Validation of a Machine-Learning-Based Prediction Tool.

To develop and validate an explainable machine learning (ML) tool to help clinicians predict the risk of propofol-associated hypertriglyceridemia in critically ill patients receiving propofol sedation. Patients from 11 intensive care units (ICUs) across five Mayo Clinic hospitals were included if they met the following criteria: a) ≥ 18 years of age, b) received propofol infusion while on invasive mechanical ventilation for ≥24 h, and c) had a triglyceride level measured. The primary outcome was hypertriglyceridemia (triglyceride >400 mg/dL) onset within 10 days of propofol initiation.

Sedation Versus General Anesthesia for Ablation of Ventricular Arrhythmias: A Systematic Review and Meta-Analysis.

Ventricular arrhythmias (VA), including ventricular tachycardia and fibrillation, are critical cardiac conditions that are often managed by catheter ablation among those unresponsive to pharmacologic therapy. The choice of anesthesia and sedation regimens for VA ablations may impact arrhythmia inducibility and hemodynamic stability, which can affect procedural success and complication rates. This systematic review and meta-analysis aimed to compare the efficacy and safety of sedation versus general anesthesia (GA) among patients undergoing VA ablation.

Outcomes of high-flow versus conventional oxygen therapy in adult medical and post-surgical oncology patients: A systematic review and meta-analysis.

Background: While the outcomes of patients with cancer have improved, the prognosis for those requiring invasive mechanical ventilation (IMV) remains poor. High-flow nasal cannula (HFNC) can be used as a management strategy to avoid IMV.

Objectives: To determine the efficacy and safety of HFNC compared to other non-invasive oxygenation techniques among patients with cancer.

Single-agent versus combination regimens containing propofol: a retrospective cohort study of recovery metrics and complication rates in a hospital-based endoscopy suite.

Background: Anesthesiologists are often tasked with overseeing sedation in non-surgical settings. We aim to determine whether adding adjuvant sedatives to propofol affects the recovery times and complication rates after endoscopy.

Methods: We conducted a retrospective cohort study of adults (≥18) who received propofol while undergoing esophagogastroduodenoscopy (EGD) and/or colonoscopy (COL) at a large academic institution over a four-year period.

Outcomes of anesthesia-supported versus endoscopist-driven sedation modalities: a retrospective cohort study.

Background And Aims: The use of anesthesia has become commonplace in many procedural settings. The goal of this study is to compare sedation modalities used by endoscopists and anesthesiologists in the endoscopy suite, particularly with respect to recovery time and adverse events.

Methods: We conducted a retrospective cohort study including adults (≥18 years of age) undergoing outpatient EGD and/or colonoscopy at Mayo Clinic in Jacksonville, Florida between October 1st, 2018 and December 31st, 2022.

Development and validation of machine-learning models for predicting the risk of hypertriglyceridemia in critically ill patients receiving propofol sedation using retrospective data: a protocol.

Introduction: Propofol is a widely used sedative-hypnotic agent for critically ill patients requiring invasive mechanical ventilation (IMV). Despite its clinical benefits, propofol is associated with increased risks of hypertriglyceridemia. Early identification of patients at risk for propofol-associated hypertriglyceridemia is crucial for optimising sedation strategies and preventing adverse outcomes.

Eligibility Criteria of Randomized Clinical Trials in Critical Care Medicine.

Importance: Eligibility criteria for randomized clinical trials (RCTs) are designed to select clinically relevant patient populations. However, not all eligibility criteria are strongly justified, potentially excluding marginalized groups, and limiting the generalizability of trial findings.

Objective: To summarize and evaluate the justification of exclusion criteria in published RCTs in critical care medicine.

The association between physician sex and patient outcomes: a systematic review and meta-analysis.

Background: Some prior studies have found that patients treated by female physicians may experience better outcomes, as well as lower healthcare costs than those treated by male physicians. Physician-patient sex concordance may also contribute to better patient outcomes. However, other studies have not identified a significant difference.

Protocol for the development and validation of machine-learning models for predicting the risk of hypertriglyceridemia in critically ill patients receiving propofol sedation using retrospective data.

Introduction: Propofol is a widely used sedative-hypnotic agent for critically-ill patients requiring invasive mechanical ventilation (IMV). Despite its clinical benefits, propofol is associated with increased risks of hypertriglyceridemia. Early identification of patients at risk for propofol-associated hypertriglyceridemia is crucial for optimizing sedation strategies and preventing adverse outcomes.

Efficacy and Safety of Hydrocortisone, Ascorbic Acid, and Thiamine Combination Therapy for the Management of Sepsis and Septic Shock: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Introduction: This systematic review aimed to assess the efficacy and safety of hydrocortisone, ascorbic acid, and thiamine (HAT) combination therapy in patients with sepsis and septic shock.

Methods: We conducted a database search in MEDLINE, Embase, CENTRAL, Web of Science, and CNKI for randomised controlled trials (RCTs) comparing HAT against placebo/standard of care or against hydrocortisone in sepsis/septic shock patients. Outcomes included mortality, ICU/hospital length of stay (LOS), vasopressor durations, mechanical ventilation durations, change in SOFA at 72 h, and adverse events.

Days alive and out of hospital for adult female and male cardiac surgery patients: a population-based cohort study.

Background: Research shows women experience higher mortality than men after cardiac surgery but information on sex-differences during postoperative recovery is limited. Days alive and out of hospital (DAH) combines death, readmission and length of stay, and may better quantify sex-differences during recovery. This main objective is to evaluate (i) how DAH at 30-days varies between sex and surgical procedure, (ii) DAH responsiveness to patient and surgical complexity, and (iii) longer-term prognostic value of DAH.

Outcomes of Vasopressin-Receptor Agonists Versus Norepinephrine in Adults With Perioperative Hypotension: A Systematic Review.

Consensus statements recommend the use of norepinephrine and/or vasopressin for hypotension in cardiac surgery. However, there is a paucity of data among other surgical subgroups and vasopressin analogs. Therefore, the authors conducted a systematic review of randomized controlled trials (RCTs) to compare vasopressin-receptor agonists with norepinephrine for hypotension among those undergoing surgery with general anesthesia.

Outcomes of Acute Respiratory Failure in Patients With Cancer in the United States.

Objective: To determine the epidemiological effect-magnitude and outcomes of patients with cancer vs those without cancer who are hospitalized with acute respiratory failure (ARF).

Patients And Methods: We reviewed hospitalizations within the National Inpatient Sample (NIS) database between January 1, 2016, and December 31, 2018. Patients were classified based on a diagnosis of solid-organ cancer, hematologic cancer, or no cancer.