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Dive into the research topics where Eric J.T. Smith is active.

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Featured researches published by Eric J.T. Smith.


JAMA Surgery | 2017

Analysis of Survival After Initiation of Continuous Renal Replacement Therapy in a Surgical Intensive Care Unit

James M. Tatum; Galinos Barmparas; Ara Ko; Navpreet K. Dhillon; Eric J.T. Smith; Daniel R. Margulies; Eric J. Ley

Importance Continuous renal replacement therapy (CRRT) benefits patients with renal failure who are too hemodynamically unstable for intermittent hemodialysis. The duration of therapy beyond which continued use is futile, particularly in a population of patients admitted to and primarily cared for by a surgical service (hereinafter referred to as surgical patients), is unclear. Objective To analyze proportions of and independent risk factors for survival to discharge after initiation of CRRT among patients in a surgical intensive care unit (SICU). Design, Setting, and Participants This retrospective cohort study included all patients undergoing CRRT from July 1, 2012, through January 31, 2016, in an SICU of an urban tertiary medical center. The population included patients treated before or after general surgery and patients admitted to a surgical service during inpatient evaluation and care before liver transplant. The pretransplant population was censored from further survival analysis on receipt of a transplant. Exposures Continuous renal replacement therapy. Main Outcomes and Measures Hospital mortality among patients in an SICU after initiation of CRRT. Results Of 108 patients (64 men [59.3%] and 44 women [40.7%]; mean [SD] age, 62.0 [12.7] years) admitted to the SICU, 53 were in the general surgical group and 55 in the pretransplant group. Thirteen of the 22 patients in the pretransplant group who required 7 or more days of CRRT died (in-hospital mortality, 59.1%); among the 12 patients in the general surgery group who required 7 or more days of CRRT, 12 died (in-hospital mortality, 100%). In the general surgical group, each day of CRRT was associated with an increased adjusted odds ratio of death of 1.39 (95% CI, 1.01-1.90; P = .04). Conclusions and Relevance Continuous renal replacement therapy is valuable for surgical patients with an acute and correctable indication; however, survival decreases significantly with increasing duration of CRRT. Duration of CRRT does not correlate with survival among patients awaiting liver transplant.


JAMA Surgery | 2017

Potentially Avoidable Surgical Intensive Care Unit Admissions and Disposition Delays

Navpreet K. Dhillon; Ara Ko; Eric J.T. Smith; Mayumi Kharabi; Joseph Castongia; Michael Nurok; Bruce L. Gewertz; Eric J. Ley

Importance High health care costs encourage initiatives that avoid overuse of resources and identify opportunities to promote appropriate care. Objective To investigate the causes of potentially avoidable surgical intensive care unit (SICU) admissions and disposition delays to determine whether targeted interventions could decrease these stays. Design, Setting, and Participants This prospective, observational study focused on potentially avoidable SICU days, as determined by observers with input from the rounding intensivists at a 24-bed open SICU at an urban, academic hospital. The preintervention phase occurred from April 6 through June 21, 2015; after implementation of targeted interventions, the postintervention phase occurred from April 4 through June 28, 2016. Data collected included demographic characteristics, reason for admission, and length of stay. All patients admitted to the SICU during the preintervention and postintervention phases were included in the analysis. Interventions Based on results collected in the preintervention phase, targeted interventions were designed and implemented from July 1, 2015, through March 31, 2016, including (1) reducing SICU care for minor traumatic brain injury, (2) optimizing postoperative airway management, (3) enhancing communication between services regarding transfers to the SICU, (4) identifying and facilitating more timely end-of-life conversations and supportive care consultations, and (5) encouraging early disposition of patients to floor beds. Main Outcomes and Measures Changes in the proportion of potentially avoidable SICU days owing to potentially avoidable admissions and/or disposition delays. Results A total of 459 patients (253 men [55.1%] and 206 women [44.9%]; median age, 62 years [interquartile range, 46-75 years]) were admitted during the preintervention and postintervention phases. Of 261 patients admitted during the preintervention period and 245 during the postintervention period, median SICU and hospital length of stay remained unchanged. A reduction was noted in the percentage of postintervention SICU days owing to potentially avoidable admissions (152 of 1168 days [13%] vs 118 of 1338 days [8.8%]; P = .001) and disposition delays (138 of 1168 days [11.8%] vs 97 of 1338 days [7.2%]; P < .001). During the postintervention period, decreases were noted in the SICU days related to the most common sources of potentially avoidable admissions (SICU stay ⩽24 hours, airway concerns, and somnolence) and disposition delays (end-of-life decisions and floor bed unavailable) as well as in the overall rate of potentially avoidable days (269 of 1168 days [23%] vs 205 of 1338 days [15.3%]; P < .001). Conclusions and Relevance Nearly one-fourth of SICU days could be categorized as potentially avoidable. Targeted interventions resulted in a significant reduction of potentially avoidable SICU days.


International Journal of Surgery | 2018

Trauma patients with lower extremity and pelvic fractures: Should anti-factor Xa trough level guide prophylactic enoxaparin dose?

Navpreet K. Dhillon; Eric J.T. Smith; Emma Gillette; Russell Mason; Galinos Barmparas; Bruce L. Gewertz; Eric J. Ley

BACKGROUND Adequate venous thromboembolism (VTE) prophylaxis is essential after trauma, especially in patients with lower extremity and/or pelvic fractures. We sought to investigate if prophylactic enoxaparin dosed by anti-Xa trough levels could reduce clinically evident VTE in trauma patients with lower extremity or pelvic injury. METHODS Prospective data was collected on trauma patients admitted for at least two days with any lower extremity and/or pelvic fracture and who received enoxaparin for VTE prophylaxis between October 2013 and January 2016. Patients in the control cohort received enoxaparin at 30 mg twice daily. Patients in the adjustment cohort had anti-Xa trough levels measured after three or more consecutive doses of enoxaparin. Those with a trough level of 0.1 IU/mL or lower had their dosage increased by 10-mg increments. RESULTS Of the 159 patients included, 58 (36.5%) were monitored with anti-Xa trough levels. The cohorts were similar in age, sex, regional AIS, ISS score, ICU and hospital length of stay, proportion of patients with diagnostic testing for VTE, and time to first enoxaparin dose. Initial enoxaparin dosing in the majority of patients (84.5%) who had anti-Xa trough levels measured was subprophylactic. Patients receiving enoxaparin dosed by anti-Xa trough level had a significantly lower VTE rate than those who did not (1.7% v. 13.9%, p = 0.03). CONCLUSIONS Prophylactic enoxaparin adjusted by anti-factor Xa level may lead to a decreased rate of clinically evident VTE among trauma patients with lower extremity and/or pelvic fractures. Our findings indicate that the initial dose of enoxaparin was frequently too low.


Injury-international Journal of The Care of The Injured | 2018

Patterns of Vasopressor Utilization During the Resuscitation of Massively Transfused Trauma Patients

Galinos Barmparas; Navpreet K. Dhillon; Eric J.T. Smith; Russell Mason; Nicolas Melo; Gretchen M. Thomsen; Daniel R. Margulies; Eric J. Ley

BACKGROUND The use of vasopressors (VP) in the resuscitation of massively transfused trauma patients might be considered a marker of inadequate resuscitation. We sought to characterize the utilization of VP in patients receiving massive transfusion and examine the association of their use with mortality. METHODS Trauma patients admitted from January 2011 to October 2016 receiving massive transfusion, defined as 3 units of pRBC within the first hour from admission, were selected for analysis. Demographics, admission vital signs and labs, use of VP, surgical interventions and outcomes were collected. Standard statistical tools were utilized. RESULTS Over the 5-year study period, 120 trauma patients met inclusion criteria. The median age was 39 years with 77% being male and 41% sustaining a penetrating injury. Patients who received VP [VP (+)] were more likely to have a lower admission GCS (median 4.5 vs. 14.0, p <0.01) and less likely to have a penetrating injury (31% vs. 54%, p=0.02). The overall mortality was 49% and significantly higher in the VP (+) cohort (60% vs. 34%, AHR: 9.9, adjusted p=0.03). Mortality increased in a stepwise fashion with increasing number of VP utilized, starting at 34% for no VP, to 78% for 3 VP, and 100% for 5 or more. The majority of deaths in the VP (-) group (88%) occurred within one day from admission. For the VP (+) group, 57% of deaths occurred within one day, with the remaining 43% occurring at a later time. CONCLUSION In the era of massive transfusion protocols, vasopressors are commonly utilized in exsanguinating trauma patients and their use is associated with a higher mortality risk. Deaths in patients receiving vasopressors are more likely to occur later compared to those in patients who do not receive vasopressors. Further research to characterize the role of these agents in the resuscitation of trauma patients is required.


Journal of Surgical Research | 2017

Extubation to high-flow nasal cannula in critically ill surgical patients

Navpreet K. Dhillon; Eric J.T. Smith; Ara Ko; Megan Y. Harada; Danielle Polevoi; Richard Liang; Galinos Barmparas; Eric J. Ley


Journal of Critical Care | 2016

Decreasing maintenance fluids in normotensive trauma patients may reduce intensive care unit stay and ventilator days

Galinos Barmparas; Ara Ko; Megan Y. Harada; Andrea Zaw; Jason S. Murry; Eric J.T. Smith; Sogol Ashrafian; Beatrice J. Sun; Eric J. Ley


Journal of Surgical Research | 2017

Validation of a field spinal motion restriction protocol in a level I trauma center

James M. Tatum; Nicolas Melo; Ara Ko; Navpreet K. Dhillon; Eric J.T. Smith; Dorothy Yim; Galinos Barmparas; Eric J. Ley


International Journal of Surgery | 2017

10-Year trend in crystalloid resuscitation: Reduced volume and lower mortality

Megan Y. Harada; Ara Ko; Galinos Barmparas; Eric J.T. Smith; Bansuri Patel; Navpreet K. Dhillon; Gretchen M. Thomsen; Eric J. Ley


International Journal of Surgery | 2017

Assault in children admitted to trauma centers: Injury patterns and outcomes from a 5-year review of the national trauma data bank

Galinos Barmparas; Navpreet K. Dhillon; Eric J.T. Smith; James M. Tatum; Rex Chung; Nicolas Melo; Eric J. Ley; Daniel R. Margulies


American Surgeon | 2016

Pain Assessment and Control in the Injured Elderly.

Ara Ko; Megan Y. Harada; Eric J.T. Smith; Scheipe M; Rodrigo F. Alban; Nicolas Melo; D.R. Margulies; Eric J. Ley

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Eric J. Ley

Cedars-Sinai Medical Center

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Galinos Barmparas

Cedars-Sinai Medical Center

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Ara Ko

Cedars-Sinai Medical Center

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Megan Y. Harada

Cedars-Sinai Medical Center

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Nicolas Melo

Cedars-Sinai Medical Center

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James M. Tatum

Cedars-Sinai Medical Center

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Bruce L. Gewertz

Cedars-Sinai Medical Center

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