Network


Latest external collaboration on country level. Dive into details by clicking on the dots.

Hotspot


Dive into the research topics where Akmal Sarwar is active.

Publication


Featured researches published by Akmal Sarwar.


Current Opinion in Infectious Diseases | 2013

Diagnosis of ventilator-associated pneumonia: controversies and working toward a gold standard.

Philip Grgurich; Jana Hudcova; Yuxiu Lei; Akmal Sarwar; Donald E. Craven

Purpose of review The aim is to discuss the clinical, microbiologic, and radiological criteria used in the diagnosis of ventilator-associated pneumonia (VAP), distinguish between ventilator-associated tracheobronchitis (VAT) and VAP, and reconcile the proposed Centers for Disease Control surveillance criteria with clinical practice. Recent findings Numerous ventilator-associated complications (VACs), including VAP and VAT, may occur in critically ill, intubated patients. A variety of definitions for identifying VAP have been proposed, but there is no diagnostic gold standard. The proposed surveillance definition will identify infectious and noninfectious VAC, including VAP and VAT, but this definition may be inadequate for clinical practice. Summary The clinical characteristics of VAP and VAT are similar and include fever, leukocytosis, and purulent sputum. An infiltrate on chest radiograph is consistent with VAP but lacks diagnostic precision, so it is not a criterion in the proposed surveillance definition and should be interpreted cautiously by clinicians. Microbiologically, quantitative and semiquantitative endotracheal aspirate cultures may be employed to diagnose VAP and VAT. Positive bronchoalveolar lavage and protected specimen brush cultures are useful only for the diagnosis of VAP. Experts should collaborate to develop consensus definitions for VAP and VAT that can be applied in practice.


The American Journal of Medicine | 2013

Incidence and Outcomes of Ventilator-associated Tracheobronchitis and Pneumonia

Donald E. Craven; Yuxiu Lei; Robin Ruthazer; Akmal Sarwar; Jana Hudcova

BACKGROUND Prolonged intubation with mechanical ventilation carries a risk for ventilator-associated respiratory infections manifest as tracheobronchitis or pneumonia. This study analyzed natural history, incidence, and outcomes of patients developing ventilator-associated tracheobronchitis and pneumonia. METHODS We studied 188 mixed intensive care unit (ICU) patients intubated ≥48 hours for the development of tracheobronchitis defined as quantitative endotracheal aspirate ≥10(5) cfu/mL plus at least 2 clinical criteria (fever, leukocytosis, or purulent sputum). Pneumonia was defined as microbiologic criteria for tracheobronchitis and a new and persistent infiltrate on chest radiograph. RESULTS Airways of 41 (22%) patients became heavily colonized with a bacterial pathogen(s) at a concentration of ≥10(5) cfu/mL. Tracheobronchitis developed in 21 (11%) study patients, of which 6 (29%) later progressed to pneumonia. Including these 6 patients, 28 (15%) study patients developed pneumonia. Multidrug-resistant pathogens were isolated in 39% of pneumonia patients. Patients with tracheobronchitis and pneumonia had significantly more ventilator days and longer stays in the ICU (P ≤.02). CONCLUSIONS Approximately one third of tracheobronchitis patients later developed pneumonia. Patients with tracheobronchitis or pneumonia experienced significantly more ventilator days and longer ICU stays, but had no difference in mortality. Better patient outcomes and reduced health care costs may be achieved by earlier treatment of ventilator-associated respiratory infections, manifest as tracheobronchitis or pneumonia.


Expert Review of Respiratory Medicine | 2012

Management and prevention of ventilator-associated pneumonia caused by multidrug-resistant pathogens

Philip Grgurich; Jana Hudcova; Yuxiu Lei; Akmal Sarwar; Donald E. Craven

Ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) pathogens is a leading healthcare-associated infection in mechanically ventilated patients. The incidence of VAP due to MDR pathogens has increased significantly in the last decade. Risk factors for VAP due to MDR organisms include advanced age, immunosuppression, broad-spectrum antibiotic exposure, increased severity of illness, previous hospitalization or residence in a chronic care facility and prolonged duration of invasive mechanical ventilation. Methicillin-resistant Staphlococcus aureus and several different species of Gram-negative bacteria can cause MDR VAP. Especially difficult Gram-negative bacteria include Pseudomonas aeruginosa, Acinetobacter baumannii, carbapenemase-producing Enterobacteraciae and extended-spectrum β-lactamase producing bacteria. Proper management includes selecting appropriate antibiotics, optimizing dosing and using timely de-escalation based on antibimicrobial sensitivity data. Evidence-based strategies to prevent VAP that incorporate multidisciplinary staff education and collaboration are essential to reduce the burden of this disease and associated healthcare costs.


Liver Transplantation | 2010

Successful outcomes following living donor liver transplantation for portopulmonary hypertension

Mahesh Bandara; Fredric D. Gordon; Akmal Sarwar; M. Elizabeth Knauft; Elizabeth A. Pomfret; Richard B. Freeman; Joel A. Wirth

Pulmonary arterial hypertension (PAH) associated with portal hypertension [portopulmonary hypertension (PPHTN)] occurs in 2% to 10% of patients with advanced liver disease and carries a very poor prognosis without treatment. Most hepatic transplantation centers consider moderate to severe PPHTN to be a contraindication to liver transplantation because of the high rate of perioperative complications. We present 3 patients with PPHTN who were managed with intravenous prostacyclin therapy followed by living donor liver transplantation (LDLT). These individuals demonstrated subsequent resolution of their pulmonary hypertension and were weaned off all PAH‐specific medical therapy. We present their demographics, clinical courses, and hemodynamics. We discuss the potential indications for LDLT and risks with respect to this patient population. Limitations of the Model for End‐Stage Liver Disease scoring system and outcome data for this patient population are reviewed. Future studies should be directed toward better defining indications for LDLT in patients with PPHTN, improving medicosurgical management, and assessing long‐term outcomes. Liver Transpl 16:983‐989, 2010.


Hospital Practice | 2012

Strategies for Prevention of Ventilator-Associated Pneumonia: Bundles, Devices, and Medications for Improved Patient Outcomes

Fahad Alroumi; Akmal Sarwar; Philip Grgurich; Yuxiu Lei; Jana Hudcova; Donald E. Craven

Abstract Ventilator-associated pneumonia is associated with significant patient morbidity, mortality, and increased health care costs. In the current economic climate, it is crucial to implement cost-effective prevention strategies that have proven efficacy. Multiple prevention measures have been proposed by various expert panels. Global strategies have focused on infection control, and reduction of lower airway colonization with bacterial pathogens, intubation, duration of mechanical ventilation, and length of stay in the intensive care unit. Routine use of the Institute for Healthcare Improvement ventilator care bundle is widespread, and has been clearly demonstrated to be an effective method for reducing the incidence of ventilator-associated pneumonia. In this article, we examine specific aspects of the Institute for Healthcare Improvement bundle, better-designed endotracheal tubes, use of antibiotics and probiotics, and treatment of ventilator-associated tracheobronchitis to prevent ventilator-associated pneumonia.


Journal of Critical Care | 2017

Utility and diagnostic accuracy of bedside lung ultrasonography during medical emergency team (MET) activations for respiratory deterioration

Soumitra Sen; Ghazwan Acash; Akmal Sarwar; Yuxiu Lei; James Dargin

Purpose We investigated the feasibility and diagnostic accuracy of lung ultrasonography during medical emergency team (MET) activations for respiratory deterioration. Material and methods We performed a prospective study of inpatients requiring MET evaluation for respiratory decompensation. A blinded investigator recorded videos of lung and lower extremity ultrasonography. The videos were reviewed by blinded investigators to determine a ultrasonography diagnosis. The accuracy of MET diagnosis and ultrasonography diagnosis were compared to the final diagnosis determined by retrospective chart review. Results The ultrasound exam was completed in 49/50 (98%) patients enrolled in the study with a mean duration of 13 ± 4 min. When excluding six cases that were not amenable to diagnosis by our algorithm, we report a lung ultrasonography diagnostic accuracy of 84% (37/44) which is similar to the accuracy of the MET clinical diagnosis of 75% (33/44) (p = 0.29). Furthermore, we report in 28/37 (76%) of cases where the lung ultrasonography diagnosis was correct, patients may have received inappropriate therapies. Conclusions Lung ultrasonography can be rapidly performed in the majority of patients with MET activation for respiratory deterioration. As an independent diagnostic test, lung ultrasonography is non‐inferior to the MET clinical assessment and may prevent unnecessary treatments if used simultaneously. HighlightsLung ultrasonography is feasible in patients requiring MET evaluation for respiratory demise.Lung ultrasonography has a comparable diagnostic accuracy to MET clinical assessment.Lung ultrasound should be interpreted in clinical context.


American Journal of Cardiology | 2013

Sleep Duration and Risk of Atrial Fibrillation (from the Physicians' Health Study)

Owais Khawaja; Akmal Sarwar; Christine M. Albert; John Michael Gaziano; Luc Djoussé


Chest | 2009

A 50-Year-Old Woman With Dyspnea, Lower Extremity Edema, and Volume Loss of the Right Hemithorax

Eugene Shostak; Akmal Sarwar


Chest | 1999

A 51-Year-Old Man with Fever, Ulnar Neuropathy, and Bilateral Pleural Effusions

Akmal Sarwar; Paul F. Dellaripa; John F. Beamis


Chest | 1996

Guidelines in Need of Guidance

Akmal Sarwar; Robert D. Brandstetter

Collaboration


Dive into the Akmal Sarwar's collaboration.

Top Co-Authors

Avatar
Top Co-Authors

Avatar
Top Co-Authors

Avatar
Top Co-Authors

Avatar
Top Co-Authors

Avatar
Top Co-Authors

Avatar
Top Co-Authors

Avatar
Top Co-Authors

Avatar
Top Co-Authors

Avatar

Christine M. Albert

Brigham and Women's Hospital

View shared research outputs
Top Co-Authors

Avatar
Researchain Logo
Decentralizing Knowledge