Awni Al-Subu
University of Wisconsin-Madison
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Expert Review of Respiratory Medicine | 2014
Awni Al-Subu; Kyle J. Rehder; Ira M. Cheifetz; David Turner
Cardiopulmonary monitoring is a key component in the evaluation and management of critically ill patients. Clinicians typically rely on a combination of invasive and non-invasive monitoring to assess cardiac output and adequacy of ventilation. Recent technological advances have led to the introduction: of continuous non-invasive monitors that allow for data to be obtained at the bedside of critically ill patients. These advances help to identify hemodynamic changes and allow for interventions before complications occur. In this manuscript, we highlight several important methods of non-invasive cardiopulmonary monitoring, including capnography, transcutaneous monitoring, pulse oximetry, and near infrared spectroscopy.
Pediatric Critical Care Medicine | 2017
Taiki Kojima; Elizabeth Laverriere; Erin B. Owen; Ilana Harwayne-Gidansky; Asha Shenoi; Natalie Napolitano; Kyle J. Rehder; Michelle Adu-Darko; Sholeen Nett; Debbie Spear; Keith Meyer; John S. Giuliano; Keiko Tarquinio; Ronald C. Sanders; Jan Hau Lee; Dennis W. Simon; Paula Vanderford; Anthony Lee; Calvin A. Brown; Peter Skippen; Ryan Breuer; Simon Parsons; Eleanor Gradidge; Lily B. Glater; Kathleen Culver; Simon Li; Lee A. Polikoff; Joy D. Howell; Gabrielle Nuthall; Gokul Kris Bysani
Objectives: External laryngeal manipulation is a commonly used maneuver to improve visualization of the glottis during tracheal intubation in children. However, the effectiveness to improve tracheal intubation attempt success rate in the nonanesthesia setting is not clear. The study objective was to evaluate the association between external laryngeal manipulation use and initial tracheal intubation attempt success in PICUs. Design: A retrospective observational study using a multicenter emergency airway quality improvement registry. Setting: Thirty-five PICUs within general and children’s hospitals (29 in the United States, three in Canada, one in Japan, one in Singapore, and one in New Zealand). Patients: Critically ill children (< 18 years) undergoing initial tracheal intubation with direct laryngoscopy in PICUs between July 1, 2010, and December 31, 2015. Measurements and Main Results: Propensity score–matched analysis was performed to evaluate the association between external laryngeal manipulation and initial attempt success while adjusting for underlying differences in patient and clinical care factors: age, obesity, tracheal intubation indications, difficult airway features, provider training level, and neuromuscular blockade use. External laryngeal manipulation was defined as any external force to the neck during laryngoscopy. Of the 7,825 tracheal intubations, the initial tracheal intubation attempt was successful in 1,935/3,274 intubations (59%) with external laryngeal manipulation and 3,086/4,551 (68%) without external laryngeal manipulation (unadjusted odds ratio, 0.69; 95% CI, 0.62–0.75; p < 0.001). In propensity score–matched analysis, external laryngeal manipulation remained associated with lower initial tracheal intubation attempt success (adjusted odds ratio, 0.93; 95% CI, 0.90–0.95; p < 0.001). Conclusions: External laryngeal manipulation during direct laryngoscopy was associated with lower initial tracheal intubation attempt success in critically ill children, even after adjusting for underlying differences in patient factors and provider levels. The indiscriminate use of external laryngeal manipulation cannot be recommended.
Pediatric Anesthesia | 2018
Awni Al-Subu; Edmund H. Jooste; Christoph P. Hornik; Gregory A. Fleming; Ira M. Cheifetz; George Ofori-Amanfo
Assessment of pulmonary blood flow and cardiac output is critical in the postoperative management of patients with single‐ventricle physiology or 2‐ventricle physiology with intracardiac shunting. Currently, such hemodynamic data are only obtainable by invasive procedures, such as cardiac catheterization or the use of a pulmonary artery catheter. Ready availability of such information, especially if attainable noninvasively, could be a valuable addition to postoperative management.
Expert Review of Respiratory Medicine | 2017
Awni Al-Subu; Scott Hagen; Marlowe W. Eldridge; Juan P. Boriosi
ABSTRACT Introduction: High flow nasal cannula (HFNC) is increasingly used in pediatric patients suffering from respiratory failure. In some disease processes, patients may also benefit from aerosol therapy. Therefore, the use of HFNC to deliver aerosolized medications is a convenient and attractive option. Areas covered: This review aims to appraise available evidence concerning the efficiency of aerosol nebulized therapy delivery using HFNC in pediatric patients. Expert commentary: Delivery of aerosol particles is a very complex process and depends on the use of oxygen vs. heliox, nebulizer type and position within the HFNC circuit, patient’s breathing effort and pattern, and more importantly cannula size and flow rates. Current in vitro evidence suggests the amount of aerosol delivery is likely to be very low at high flows. Clinical studies are limited in pediatric patients and given the limited clinical data, it is not possible to make recommendations for or against aerosol delivery through HFNC for pediatric patients.
Journal of Pediatric Intensive Care | 2018
Awni Al-Subu; Kyle J. Rehder; George Ofori-Amanfo; David Turner
Journal of Pediatric Intensive Care | 2018
Awni Al-Subu; Christoph P. Hornik; Ira M. Cheifetz; Andrew J. Lodge; George Ofori-Amanfo
Journal of Clinical Anesthesia | 2018
Andrea Talukdar; Guelay Bilen-Rosas; Michael Wilhelm; Awni Al-Subu
Critical Care Medicine | 2018
Andrea Talukdar; Guelay Bilen-Rosas; Michael Wilhelm; Awni Al-Subu
Critical Care Medicine | 2018
Awni Al-Subu; Timothy A. Hacker; George Ofori-Amanfo; Marlowe Eldridge
Critical Care Medicine | 2018
Ichiro Watanabe; Conrad Krawiec; John S. Giuliano; Asha Shenoi; Sholeen Nett; Simon Parsons; Awni Al-Subu; Natalie Napolitano; Elizabeth Laverriere; Vinay Nadkarni; Akira Nishisaki