Coleman College for Health Sciences

Therapeutic hypercapnia has been proposed as a potential strategy to enhance cerebral perfusion and improve outcomes in patients after cardiac arrest. However, the effects of targeted hypercapnia remain unclear. We conducted a systematic review and meta-analysis to evaluate the impact of hypercapnia compared to normocapnia on mortality and length of stay in post-cardiac arrest patients. We searched major databases for randomized controlled trials and observational studies comparing outcomes between hypercapnia and normocapnia in adult post-cardiac arrest patients. Data on in-hospital mortality and the ICU and hospital length of stay were extracted and pooled using random-effects meta-analysis. Five studies (two randomized controlled trials (RCTs) and three observational studies) with a total of 1,837 patients were included. Pooled analysis showed hypercapnia was associated with significantly higher in-hospital mortality compared to normocapnia (56.2% vs. 50.5%, OR 1.24, 95% CI 1.12-1.37, p<0.001). There was no significant heterogeneity (I2 = 25%, p = 0.26). No statistically significant differences were found for ICU length of stay (mean difference 0.72 days, 95% CI -0.51 to 1.95) or hospital length of stay (mean difference 1.13 days, 95% CI -0.67 to 2.93) between the groups. Sensitivity analysis restricted to mild hypercapnia studies did not alter the mortality findings. This meta-analysis did not find a mortality benefit with targeted hypercapnia compared to normocapnia in post-cardiac arrest patients. The results align with current guidelines recommending a normal partial pressure of arterial carbon dioxide (PaCO2) target range and do not support routinely targeting higher carbon dioxide levels in this setting.

OBJECTIVE:To risk-adjust the Potential Inpatient Complication (PIC) measure set and propose a method to identify large deviations between observed and expected PIC counts. DATA SOURCES:Acute inpatient stays from the Premier Healthcare Database from January 1, 2019 to December 31, 2021. STUDY DESIGN:In 2014, the PIC list was developed to identify a broader set of potential complications that can occur as a result of care decisions. Risk adjustment for 111 PIC measures is performed across 3 age-based strata. Using patient-level risk factors and PIC occurrences, PIC-specific probabilities of occurrence are estimated through multivariate logistic regression models. Poisson Binomial cumulative mass function estimates identify deviations between observed and expected PIC counts across levels of patient-visit aggregation. Area under the curve (AUC) estimates are used to demonstrate PIC predictive performance in an 80:20 derivation-validation split framework. DATA COLLECTION/EXTRACTION METHODS:We used N=3,363,149 administrative hospitalizations between 2019 and 2021 from the Premier Healthcare Database. PRINCIPAL FINDINGS:PIC-specific model predictive performance was strong across PICs and age strata. Average area under the curve estimates across PICs were 0.95 (95% CI: 0.93-0.96), 0.91 (95% CI: 0.90-0.93), and 0.90 (95% CI: 0.89-0.91) for the neonate and infant, pediatric, and adult strata, respectively. CONCLUSIONS:The proposed method provides a consistent quality metric that adjusts for the population's case mix. Age-specific risk stratification further addresses currently ignored heterogeneity in PIC prevalence across age groups. Finally, the proposed aggregation method identifies large PIC-specific deviations between observed and expected counts, flagging areas with a potential need for quality improvements.

Objective: To evaluate the improvement of dysphagia and the daily amounts of oral fluids served among people who had recently experienced a cerebrovascular stroke（CVS） after applying a nursing intervention protocol. Methods: A quasi-experimental design was used to examine 60 stroke patients who were randomly and alternatively divided equally into a study group and a control group. Gugging Swallowing Screen（GUSS） and fluid balance chart were used. Within the first 24 h of a patient’s admission, expert nurses were trained in nursing intervention protocol to manage dysphagia and daily oral fluids. Results: Post-nursing intervention, the severity of dysphagia decreased among the study group more than in the control group. Additionally, the study group began taking greater amounts of fluids by the oral route than before the nursing intervention. Conclusions: A standardized nursing intervention protocol is needed to decrease the severity of dysphagia after CVS and increase the amount of daily oral fluids. The presence of a structured theory-based nursing intervention protocol for dysphagia management will greatly contribute to decreasing the consequences of dysphagia after CVS, and can also be expected to attenuate the effects of aspiration pneumonia, dehydration, and malnutrition; further, it also increases adherence to the protocol by both nurses and patients.

BackgroundRadiation therapy (RT) for cancers in thoracic/mediastinal region has been linked with heart damage following years of radiation exposure. However, prevalence of takotsubo syndrome (TTS) in patients with prior intrathoracic/mediastinal malignancies treated with RT has never been analyzed on a large scale.MethodsWe identified adult hospitalizations with prior mediastinal/intrathoracic cancer and RT and TTS using ICD-9 CM codes and the National Inpatient Sample (2007–2014) after excluding current admissions for chemotherapy. We then assessed the prevalence, odds, trends and in-hospital outcomes of TTS-related admissions in patients with vs. without prior intrathoracic cancer and RT.ResultsWe identified a total of 5,991,314 hospitalizations with prior intrathoracic/mediastinal malignancies and RT (~73 yrs., 85.2% female), of which 7663 (0.13%, 128 per 100,000) were diagnosed with TTS (~74 yrs., 95.8% females, 88.1% white). Higher odds and rising trends in TTS per 100,000 hospitalizations (from 31 to 241) were seen among patients with prior intrathoracic malignancies and RT as compared to those without (from 19 to 104) (ptrend < 0.001). All-cause in-hospital mortality (4.6% vs 2.8%; OR 1.45; 95%CI 1.29–1.63, p < 0.001), cardiogenic shock (4.3% vs 0.2%), cardiac arrest (3.1% vs 0.9%), arrhythmia (34.3% vs 24.6%), stroke (3.6% vs 2.8%), respiratory failure (14.5% vs 4.6%), and median length of stay and hospital charges were significantly higher in the TTS cohort.ConclusionsThis study showed higher odds and increasing trends in TTS-related admissions with worse in-hospital outcomes among patients with prior intrathoracic/mediastinal cancer and RT, irrespective of the time interval from cancer diagnosis or RT to TTS occurrence.

Background: Cannabis (marijuana) use and depression are known to be strongly interconnected. However, amid alarming rates of mental health problems in the United States young population, the risk of arrhythmia among young cannabis users with comorbid depression has never been studied. Methods: In-hospital encounters of arrhythmia were identified among young cannabis users (18-39 years) with or without depression using the National Inpatient Sample (2007-2014) databases and apposite ICD-9 codes. Baseline characteristics and trends in prevalence of arrhythmia were evaluated among inpatient young cannabis users with or without depression. A multivariable regression was performed after adjusting for baseline demographics, comorbidities and parallel history of substance abuse. Results: Of 2,011,598 young cannabis users (59.6% male) admitted from 2007-2014, 190,146 (9.5%) of patients had comorbid depression, of which 6.9% of patients experienced arrhythmias with atrial fibrillation being most common. Cannabis users with depression were more likely older, white, females and frequently hospitalized in Midwest and rural hospitals. We observed a steadily rising trend in prevalence of arrhythmia in both groups, but a more rapid rise in cannabis users with depression (4.9% in 2007 to 8.5% in 2014 vs. 3.7% in 2007 to 5.7% in 2014). Correspondingly, young depressed cannabis users had higher odds of arrhythmia compared to non-depressed even after controlling for demographics and comorbidities (OR: 1.41, 95% CI: 1.38-1.44, p< 0.001). Conclusion: Rampant recreational use of marijuana may increase the risk of arrhythmia by 40% in young cannabis users with depression as compared to non-depressed.