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Dive into the research topics where James D. Fortenberry is active.

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Featured researches published by James D. Fortenberry.


American Journal of Kidney Diseases | 2010

Fluid Overload and Mortality in Children Receiving Continuous Renal Replacement Therapy: The Prospective Pediatric Continuous Renal Replacement Therapy Registry

Scott M. Sutherland; Michael Zappitelli; Steven R. Alexander; Annabelle N. Chua; Patrick D. Brophy; Timothy E. Bunchman; Richard Hackbarth; Michael J. Somers; Michelle A. Baum; Jordan M. Symons; Francisco X. Flores; Mark R. Benfield; David J. Askenazi; Deepa H. Chand; James D. Fortenberry; John D. Mahan; Kevin D. McBryde; Douglas L. Blowey; Stuart L. Goldstein

BACKGROUND Critically ill children with hemodynamic instability and acute kidney injury often develop fluid overload. Continuous renal replacement therapy (CRRT) has emerged as a favored modality in the management of such children. This study investigated the association between fluid overload and mortality in children receiving CRRT. STUDY DESIGN Prospective observational study. SETTING & PARTICIPANTS 297 children from 13 centers across the United States participating in the Prospective Pediatric CRRT Registry. PREDICTOR Fluid overload from intensive care unit (ICU) admission to CRRT initiation, defined as a percentage equal to (fluid in [L] - fluid out [L])/(ICU admit weight [kg]) x 100%. OUTCOME & MEASUREMENTS The primary outcome was survival to pediatric ICU discharge. Data were collected regarding demographics, CRRT parameters, underlying disease process, and severity of illness. RESULTS 153 patients (51.5%) developed < 10% fluid overload, 51 patients (17.2%) developed 10%-20% fluid overload, and 93 patients (31.3%) developed > or = 20% fluid overload. Patients who developed > or = 20% fluid overload at CRRT initiation had significantly higher mortality (61/93; 65.6%) than those who had 10%-20% fluid overload (22/51; 43.1%) and those with < 10% fluid overload (45/153; 29.4%). The association between degree of fluid overload and mortality remained after adjusting for intergroup differences and severity of illness. The adjusted mortality OR was 1.03 (95% CI, 1.01-1.05), suggesting a 3% increase in mortality for each 1% increase in severity of fluid overload. When fluid overload was dichotomized to > or = 20% and < 20%, patients with > or = 20% fluid overload had an adjusted mortality OR of 8.5 (95% CI, 2.8-25.7). LIMITATIONS This was an observational study; interventions were not standardized. The relationship between fluid overload and mortality remains an association without definitive evidence of causality. CONCLUSIONS Critically ill children who develop greater fluid overload before initiation of CRRT experience higher mortality than those with less fluid overload. Further goal-directed research is required to accurately define optimal fluid overload thresholds for initiation of CRRT.


American Journal of Respiratory and Critical Care Medicine | 2014

Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients

Alain Combes; Daniel Brodie; Robert H. Bartlett; Laurent Brochard; Roy G. Brower; Steve Conrad; Daniel De Backer; Eddy Fan; Niall D. Ferguson; James D. Fortenberry; John F. Fraser; Luciano Gattinoni; William R. Lynch; Graeme MacLaren; Alain Mercat; Thomas Mueller; Mark Ogino; Giles J. Peek; Vince Pellegrino; Antonio Pesenti; Marco Ranieri; Arthur S. Slutsky; Alain Vuylsteke

The use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory failure (ARF) in adults is growing rapidly given recent advances in technology, even though there is controversy regarding the evidence justifying its use. Because ECMO is a complex, high-risk, and costly modality, at present it should be conducted in centers with sufficient experience, volume, and expertise to ensure it is used safely. This position paper represents the consensus opinion of an international group of physicians and associated health-care workers who have expertise in therapeutic modalities used in the treatment of patients with severe ARF, with a focus on ECMO. The aim of this paper is to provide physicians, ECMO center directors and coordinators, hospital directors, health-care organizations, and regional, national, and international policy makers a description of the optimal approach to organizing ECMO programs for ARF in adult patients. Importantly, this will help ensure that ECMO is delivered safely and proficiently, such that future observational and randomized clinical trials assessing this technique may be performed by experienced centers under homogeneous and optimal conditions. Given the need for further evidence, we encourage restraint in the widespread use of ECMO until we have a better appreciation for both the potential clinical applications and the optimal techniques for performing ECMO.


The Annals of Thoracic Surgery | 1998

Modifying risk for extracorporeal circulation: trial of four antiinflammatory strategies

John Parker Gott; William A. Cooper; Frank E. Schmidt; W.Morris Brown; Carolyn E Wright; James D. Fortenberry; W. Scott Clark; Robert A. Guyton

BACKGROUND Despite recent rediscovery of beating heart cardiac surgical techniques, extracorporeal circulation remains appropriate for most heart operations. To minimize deleterious effects of cardiopulmonary bypass, antiinflammatory strategies have evolved. METHODS Four state-of-the-art strategies were studied in a prospective, randomized, preoperatively risk stratified, 400-patient study comprising primary (n = 358), reoperative (n = 42), coronary (n = 307), valve (n = 27), ascending aortic (n = 9), and combined operations (n = 23). Groups were as follows: standard, roller pump, membrane oxygenator, methylprednisolone (n = 112); aprotinin, standard plus aprotinin (n = 109); leukocyte depletion, standard plus a leukocyte filtration strategy (n = 112); and heparin-bonded circuitry, centrifugal pumping with surface modification (n = 67). RESULTS Analysis of variance, linear and logistic regression, and Pearson correlation were applied. Actual mortality (2.3%) was less than half the risk stratification predicted mortality (5.7%). The treatment strategies effectively attenuated markers of the inflammatory response to extracorporeal circulation. Compared with the other groups the heparin-bonded circuit had highly significantly decreased complement activation (p = 0.00001), leukocyte filtration blunted postpump leukocytosis (p = 0.043), and the aprotinin group had less fibrinolysis (p = 0.011). Primary end points, length of stay, and hospital charges, were positively correlated with operation type, age, pump time, body surface area, stroke, pulmonary sequelae, predicted risk for stroke, predicted risk for mortality, and risk strata/treatment group interaction (p = 0.0001). In low-risk patients, leukocyte filtration reduced length of stay by 1 day (p = 0.02) and mean charges by


Clinical Journal of The American Society of Nephrology | 2007

Demographic Characteristics of Pediatric Continuous Renal Replacement Therapy: A Report of the Prospective Pediatric Continuous Renal Replacement Therapy Registry

Jordan M. Symons; Annabelle N. Chua; Michael J. Somers; Michelle A. Baum; Timothy E. Bunchman; Mark R. Benfield; Patrick D. Brophy; Douglas L. Blowey; James D. Fortenberry; Deepa H. Chand; Francisco X. Flores; Richard Hackbarth; Steven R. Alexander; John D. Mahan; Kevin D. McBryde; Stuart L. Goldstein

2,000 to


Asaio Journal | 2017

Extracorporeal Life Support Organization Registry International Report 2016.

Ravi R. Thiagarajan; Ryan P. Barbaro; Peter T. Rycus; D. Michael McMullan; Steven A. Conrad; James D. Fortenberry; Matthew L. Paden

6,000 (p = 0.05). For high-risk patients, aprotinin reduced mean length of stay up to 10 fewer days (p = 0.02) and mean charges by


Pediatric Critical Care Medicine | 2014

Pediatric Severe Sepsis: Current Trends and Outcomes From the Pediatric Health Information Systems Database*

Amanda Ruth; Courtney McCracken; James D. Fortenberry; Matthew Hall; Harold K. Simon; Kiran Hebbar

6,000 to


Pediatric Critical Care Medicine | 2011

Recovery of renal function and survival after continuous renal replacement therapy during extracorporeal membrane oxygenation.

Matthew L. Paden; Barry L. Warshaw; Micheal L. Heard; James D. Fortenberry

48,000 (p = 0.0007). CONCLUSIONS These pharmacologic and mechanical strategies significantly attenuated the inflammatory response to extracorporeal circulation. This translated variably into improved patient outcomes. The increased cost of treatment was offset for selected strategies through the added value of significantly reduced risk.


Journal of Asthma | 2001

Emergency Department Use of Ketamine in Pediatric Status Asthmaticus

Toni Petrillo; James D. Fortenberry; Jeffery F. Linzer; Harold K. Simon

BACKGROUND This article reports demographic characteristics and intensive care unit survival for 344 patients from the Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) Registry, a voluntary multicenter observational network. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Ages were newborn to 25 yr, 58% were male, and weights were 1.3 to 160 kg. Patients spent a median of 2 d in the intensive care unit before CRRT (range 0 to 135). At CRRT initiation, 48% received diuretics and 66% received vasoactive drugs. Mean blood flow was 97.9 ml/min (range 10 to 350 ml/min; median 100 ml/min); mean blood flow per body weight was 5 ml/min per kg (range 0.6 to 53.6 ml/min per kg; median 4.1 ml/min per kg). Days on CRRT were <1 to 83 (mean 9.1; median 6). A total of 56% of circuits had citrate anticoagulation, 37% had heparin, and 7% had no anticoagulation. RESULTS Overall survival was 58%; survival differed across participating centers. Survival was lowest (51%) when CRRT was started for combined fluid overload and electrolyte imbalance. There was better survival in patients with principal diagnoses of drug intoxication (100%), renal disease (84%), tumor lysis syndrome (83%), and inborn errors of metabolism (73%); survival was lowest in liver disease/transplant (31%), pulmonary disease/transplant (45%), and bone marrow transplant (45%). Overall survival was better for children who weighed >10 kg (63 versus 43%; P = 0.001) and for those who were older than 1 yr (62 versus 44%; P = 0.007). CONCLUSIONS CRRT can be used successfully for a wide range of critically ill children. Survival is best for those who have acute, specific abnormalities and lack multiple organ involvement; sicker patients with selected diagnoses may have lower survival. Center differences might suggest opportunities to define best practices with future study.


International Journal of Artificial Organs | 2007

The effect of vascular access location and size on circuit survival in pediatric continuous renal replacement therapy: a report from the PPCRRT registry.

Richard Hackbarth; Timothy E. Bunchman; Annabelle N. Chua; Michael J. Somers; Michelle A. Baum; Jordan M. Symons; Patrick D. Brophy; Douglas L. Blowey; James D. Fortenberry; Deepa H. Chand; Francisco X. Flores; Steven R. Alexander; John D. Mahan; Kevin D. McBryde; Mark R. Benfield; Stuart L. Goldstein

Data on extracorporeal life support (ECLS) use and survival submitted to the Extracorporeal Life Support Organization’s data registry from the inception of the registry in 1989 through July 1, 2016, are summarized in this report. The registry contained information on 78,397 ECLS patients with 58% survival to hospital discharge. Extracorporeal life support use and centers providing ECLS have increased worldwide. Extracorporeal life support use in the support of adults with respiratory and cardiac failure represented the largest growth in the recent time period. Extracorporeal life support indications are expanding, and it is increasingly being used to support cardiopulmonary resuscitation in children and adults. Adverse events during the course of ECLS are common and underscore the need for skilled ECLS management and appropriately trained ECLS personnel and teams.


Critical Care Medicine | 1993

Infrared tympanic thermometry in the pediatric intensive care unit

Michael J. Romano; James D. Fortenberry; Elaine Autrey; Susan Harris; Terry Heyroth; Peg Parmeter; Fernando Stein

Objective: To 1) describe the characteristics and outcomes over time of PICU patients with severe sepsis within the dedicated U.S. childrens hospitals, 2) identify patient subgroups at risk for mortality from pediatric severe sepsis, and 3) describe overall pediatric severe sepsis resource utilization. Design: Retrospective review of a prospectively collected multi-institutional children’s hospital database. Setting: PICUs in 43 U.S. children’s hospitals. Patients: PICU patients from birth to younger than 19 years were identified with severe sepsis by modified Angus criteria and International Classification of Diseases, 9th Revision, codes for severe sepsis and septic shock. Interventions: None. Measurements and Main Results: Data from the Pediatric Health Information System database collected by the Children’s Hospital Association from 2004 to 2012. Pediatric severe sepsis was defined by 1) International Classification of Diseases, 9th Revision, codes reflecting severe sepsis and septic shock and 2) International Classification of Diseases, 9th Revision, codes of infection and organ dysfunction as defined by modified Angus criteria. From 2004 to 2012, 636,842 patients were identified from 43 hospitals. Pediatric severe sepsis prevalence was 7.7% (49,153) with an associated mortality rate of 14.4%. Age less than 1 year (vs age 10 to < 19) (odds ratio, 1.4), underlying cardiovascular condition (odds ratio, 1.4) and multiple organ dysfunction, conferred higher odds of mortality. Resource burden was significant with median hospital length of stay of 17 days (interquartile range, 8–36 d) and PICU length of stay of 7 days (interquartile range, 2–17 d), with median cost/day of

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Stuart L. Goldstein

Cincinnati Children's Hospital Medical Center

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Timothy E. Bunchman

Virginia Commonwealth University

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Micheal L. Heard

Boston Children's Hospital

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