Peter G. Brindley
University of Alberta
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Publication
Featured researches published by Peter G. Brindley.
Canadian Medical Association Journal | 2011
Demetrios J. Kutsogiannis; Sean M. Bagshaw; Bryce Laing; Peter G. Brindley
Background: Survival outcomes after cardiac or respiratory arrest occurring outside of intensive care units (ICUs) has been well described. We investigated survival outcomes of adults whose arrest occurred in ICUs and determined predictors of decreased survival. Methods: We reviewed all records of adults who experienced cardiac or respiratory arrest from Jan. 1, 2000, to Apr. 30, 2005, in ICUs at four hospitals serving Edmonton, Alberta. We evaluated patient and clinical characteristics, as well as survival outcomes during a five-year follow-up period. We determined risk factors for immediate (within 24 hours) and later death. Results: Of the 517 patients included in the study, 59.6% were able to be resuscitated, 30.4% survived to discharge from ICU, 26.9% survived to discharge from hospital, 24.3% survived to one year, and 15.9% survived to five years. Pulseless electrical activity or asystole was the most common rhythm (45.8% of the arrests). Survival was lowest among patients with an arrest due to pulseless electrical activity or asystole: only 10.6% survived to one year, compared with 36.3% who had other arrest rhythms (p < 0.001). Independent predictors of decreased later survival (eight months or more after arrest) were increasing age (adjusted hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03–1.09) and longer duration of cardiopulmonary resuscitation (CPR) (adjusted HR 1.38, 95% CI 1.03–1.83, per additional logarithm of a minute of CPR). Interpretation: Our study showed no major improvement in survival following cardiac arrest with pulseless electrical activity or asystole as the presenting rhythm in the ICU despite many advances in critical care over the previous two decades. The independent predictors of death within 24 hours after arrest in an ICU were sex, the presenting rhythm and the duration of CPR. Predictors of later death (eight months or more after arrest) were age and duration of CPR.
Canadian Medical Association Journal | 2007
Peter G. Brindley; Matthew S. Butler; George Cembrowski; David N. Brindley
Background: A patient presented with severe acidosis and a point-of-care lactate measurement of 42 mmol/L. Mesenteric ischemia was suspected, with a potential need for laparotomy; however, plasma lactate measurements were below 4 mmol/L. Ethylene glycol ingestion was subsequently diagnosed. We therefore wished to determine why discrepancies in lactate measurements occur and whether this “lactate gap” could be clinically useful. Methods: We phlebotomized blood, added various concentrations of metabolites of ethylene glycol, and tested the resulting samples with the 5 most common lactate analyzers. Results: With the Radiometer 700 point-of-care analyzer, glycolate addition resulted in an artifactual, massive lactate elevation, even at low glycolate concentrations. Another major ethylene glycol metabolite, glyoxylate (but not oxalate or formate), caused similar elevations. The i-STAT and Bayer point-of-care analyzers and the Beckman and Vitros laboratory analyzers reported minimal lactate elevations. Lactate gap was determined by comparing the Radiometer result with the corresponding result from any of the other analyzers. Interpretation: We demonstrated how inappropriate laparotomy or delayed therapy might occur if clinicians are unaware of this phenomenon or have access to only a single analyzer. We also showed that lactate gap can be exploited to expedite treatment, diagnose late ethylene-glycol ingestion and terminate dialysis. By comparing lactate results from the iSTAT or Bayer devices with that from the Radiometer, ethylene-glycol ingestion can be diagnosed at the point of care. This can expedite diagnosis and treatment by hours, compared with waiting for laboratory results for plasma ethylene glycol.
Critical Care | 2010
Peter G. Brindley
This article is one of ten reviews selected from the Yearbook of Intensive Care and Emergency Medicine 2010 (Springer Verlag) and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/yearbook. Further information about the Yearbook of Intensive Care and Emergency Medicine is available from http://www.springer.com/series/2855.
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie | 2005
Dean D. Bell; Peter G. Brindley; David M. Forrest; Osama Al Muslim; David A. Zygun
PurposeTo propose a strategy for the management of patients admitted to critical care units after resuscitation from cardiac arrest.SourcePrior to the conference relevant studies were identified via literature searches and brief reviews circulated on the following topics: glucose and blood pressure management; therapeutic hypothermia; prearrest outcome prediction; post-arrest outcome prediction; and management of myocardial ischemia. Two days were devoted to assessing evidence and developing a management strategy at the conference. Consensus opinion of conference participants [intensive care unit (ICU) physicians] was used when high grade evidence was unavailable. Additional literature searches and data grading were performed post-conference.Principal findingsHigh grade evidence was lacking in most areas. Specific goals of treatment were proposed for: general care; neurologic care; respiratory care; cardiac care; and gastrointestinal care. There was adequate evidence to recommend therapeutic hypothermia for comatose patients who had witnessed ventricular fibrillation or ventricular tachycardia arrests. Conference participants supported extending therapeutic hypothermia to other presenting rhythms in selected circumstances. Additional goals included mean arterial pressure 80 to 100 mmHg, glucose 5 to 8 mmol·L-1 using insulin infusions, and PaO2 > 100 mmHg for the first 24 hr. Absent withdrawal to pain 72 hr after resuscitation should prompt consideration of palliative care. The level of evidence for other recommendations was low.ConclusionsThe proposed management strategy represents an approach to manage patients in the ICU following resuscitation from cardiac arrest. Most of the recommendations are based on low grade evidence. Additional research is needed to improve the evidence base. A standard post-arrest management strategy could help facilitate future research.RésuméObjectifProposer une stratégie de traitement à adopter avec les patients admis aux unités de soins intensifs (USI) après la réanimation post-arrêt cardiaque.SourceAvant la conférence, les études utiles ont été repérées dans les publications et de brèves revues ont circulé sur : le glucose et le traitement de la tension artérielle; l’hypothermie thérapeutique; la prédiction de l’évolution pré-arrêt; la prédiction des suites de l’arrêt cardiaque et le traitement de l’ischémie myocardique. Deux jours ont été alloués à l’évaluation de la preuve et au développement d’une approche thérapeutique à la conférence. L’opinion générale des par-ticipants, médecins intensivistes, a prévalu quand une preuve de haut niveau n’était pas assurée. Des recherches de documents et une clas-sification de données supplémentaires ont été faites après la con-férence.Constatations principalesUne preuve de haut niveau manquait dans la majorité des domaines. On a proposé des objectifs spécifiques de traitement pour : les soins généraux, neurologiques, respiratoires, cardiaques et gastro-intestinaux. Des preuves suffisantes ont permis de recommander l’hypothermie thérapeutique chez les patients comateux victimes d’arrêts cardiaques causés par une fibrillation ou une tachycardie ventriculaire. Les participants à la conférence ont appuyé l’extension de l’hypothermie thérapeutique aux rythmes présentés dans des circonstances choisies. D’autres objectifs incluent une tension artérielle moyenne de 80 à 100 mmHg, le glucose à 5 àObjectif Proposer une strategie de traitement a adopter avec les patients admis aux unites de soins intensifs (USI) apres la reanimation post-arret cardiaque.
BMC Anesthesiology | 2013
Peter G. Brindley
A study by Burkle et al. in BMC Anesthesiology examined attitudes around perioperative do-not-resuscitate orders. Questionnaires were given to patients, as well as to anesthesiologists, internists and surgeons. The study has limitations and is open to interpretation. However, the findings are important. There appear to be attitudinal differences between patients and doctors, and between specialties. A small majority of patients are content to have a do-not-resuscitate order postponed during the perioperative period. A large majority expects open communication from doctors before proceeding. However, this article could also encourage a broader debate. This is about how to respect patient autonomy, while ensuring that resuscitation truly serves the patient’s best interests. This commentary outlines how more communication is needed at the bedside and in wider society.
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie | 2005
Dean D. Bell; Peter G. Brindley; David M. Forrest; Osama Al Muslim; David A. Zygun
PurposeTo propose a strategy for the management of patients admitted to critical care units after resuscitation from cardiac arrest.SourcePrior to the conference relevant studies were identified via literature searches and brief reviews circulated on the following topics: glucose and blood pressure management; therapeutic hypothermia; prearrest outcome prediction; post-arrest outcome prediction; and management of myocardial ischemia. Two days were devoted to assessing evidence and developing a management strategy at the conference. Consensus opinion of conference participants [intensive care unit (ICU) physicians] was used when high grade evidence was unavailable. Additional literature searches and data grading were performed post-conference.Principal findingsHigh grade evidence was lacking in most areas. Specific goals of treatment were proposed for: general care; neurologic care; respiratory care; cardiac care; and gastrointestinal care. There was adequate evidence to recommend therapeutic hypothermia for comatose patients who had witnessed ventricular fibrillation or ventricular tachycardia arrests. Conference participants supported extending therapeutic hypothermia to other presenting rhythms in selected circumstances. Additional goals included mean arterial pressure 80 to 100 mmHg, glucose 5 to 8 mmol·L-1 using insulin infusions, and PaO2 > 100 mmHg for the first 24 hr. Absent withdrawal to pain 72 hr after resuscitation should prompt consideration of palliative care. The level of evidence for other recommendations was low.ConclusionsThe proposed management strategy represents an approach to manage patients in the ICU following resuscitation from cardiac arrest. Most of the recommendations are based on low grade evidence. Additional research is needed to improve the evidence base. A standard post-arrest management strategy could help facilitate future research.RésuméObjectifProposer une stratégie de traitement à adopter avec les patients admis aux unités de soins intensifs (USI) après la réanimation post-arrêt cardiaque.SourceAvant la conférence, les études utiles ont été repérées dans les publications et de brèves revues ont circulé sur : le glucose et le traitement de la tension artérielle; l’hypothermie thérapeutique; la prédiction de l’évolution pré-arrêt; la prédiction des suites de l’arrêt cardiaque et le traitement de l’ischémie myocardique. Deux jours ont été alloués à l’évaluation de la preuve et au développement d’une approche thérapeutique à la conférence. L’opinion générale des par-ticipants, médecins intensivistes, a prévalu quand une preuve de haut niveau n’était pas assurée. Des recherches de documents et une clas-sification de données supplémentaires ont été faites après la con-férence.Constatations principalesUne preuve de haut niveau manquait dans la majorité des domaines. On a proposé des objectifs spécifiques de traitement pour : les soins généraux, neurologiques, respiratoires, cardiaques et gastro-intestinaux. Des preuves suffisantes ont permis de recommander l’hypothermie thérapeutique chez les patients comateux victimes d’arrêts cardiaques causés par une fibrillation ou une tachycardie ventriculaire. Les participants à la conférence ont appuyé l’extension de l’hypothermie thérapeutique aux rythmes présentés dans des circonstances choisies. D’autres objectifs incluent une tension artérielle moyenne de 80 à 100 mmHg, le glucose à 5 àObjectif Proposer une strategie de traitement a adopter avec les patients admis aux unites de soins intensifs (USI) apres la reanimation post-arret cardiaque.
Journal of Trauma-injury Infection and Critical Care | 2013
Markus T. Ziesmann; Sandy Widder; Jason Park; John B. Kortbeek; Peter G. Brindley; Morad Hameed; John Damian Paton-Gay; Paul T. Engels; Christopher Hicks; Paola Fata; Chad G. Ball; Lawrence M. Gillman
BACKGROUND Most medical errors are nontechnical and include failures in team communication, situational awareness, resource use, and leadership. Other high-risk industries have adopted team-based crisis resource management (CRM) training strategies to address “nontechnical” skills and to improve human error and safety. Here, we describe the development and evaluation of a national multidisciplinary trauma CRM curriculum. METHODS A needs analysis survey was distributed to general surgery program directors across Canada. With the use of this feedback, a course called STARTT [Standardized Trauma and Resuscitation Team Training] was developed and held in conjunction with the Canadian Surgery Forum. Participants completed a precourse and postcourse evaluation exploring changes in attitudes toward simulation and CRM principles using previously validated instruments. RESULTS Twenty surgical residents, 6 nurses, 4 respiratory therapists, and 11 instructors (trauma surgeons, emergency physicians, nurses, and intensivists) participated. Of the participants, 100% completed the survey. Satisfaction was very high, with 97.5% of the participants rating the course as “good” or “excellent” and 97.5% recommending it to others. The presurvey and postsurvey showed statistically significant improvement in attitudes toward simulation and overall CRM principles (136.3 vs. 140.3 of 170, p = 0.004) following the course, primarily in the domain of teamwork (69.1 vs. 72.0 of 85, p = 0.002). CONCLUSION Creation of a national multidisciplinary trauma CRM curriculum is feasible, has high satisfaction among participants, and can improve attitudes toward the importance of simulation and CRM principles with the ultimate goal of improving patient safety and care.
Neurocritical Care | 2007
James Scozzafava; Peter G. Brindley; Vivek Mehta; J. Max Findlay
There are a number of causes of raised intracranial pressure (ICP) following aneurysm rupture. These include primary and diffuse hypoxic brain injury, intracranial hematomas, cerebral ischemia or infarction, and obstructive hydrocephalus. More localized brain swelling can also occur: the result of vasogenic and cytotoxic edema resulting from overlying bleeding in the subar achnoid spaces. In the case of rupture of an anterior communicating artery (ACommA) aneurysm and interhemispheric subarachnoid hemorrhage (SAH), this swelling can occur in both frontal lobes and when extensive, and the resulting intracranial hypertension can be difficult to manage with ventricular drainage and medical treatment. We describe two patients in whom decompressive bifrontal craniectomy was associated with successful ICP management and good clinical outcomes.
Journal of Clinical Neuroscience | 2010
James Scozzafava; Muhammad S. Hussain; Peter G. Brindley; Michael J. Jacka; Donald W. Gross
Non-convulsive seizures and non-convulsive status epilepticus (NCSE) are believed common in comatose patients and are suggested to worsen outcome. The purpose of this study was to prospectively evaluate outcome in patients in critical care units in whom NCSE was suspected to determine how often evidence of seizure activity existed based on an isolated standard 20 minute electroencephalogram (EEG) and to determine what clinical factors predicted outcome. We prospectively reviewed EEGs and clinical charts of patients admitted to a critical care unit at a tertiary care center who were suspected to have non-convulsive seizures. Outcomes were correlated with EEG findings, clinical factors, and acute therapies using univariate and multivariate logistic analyses. Of 189 patients, complete information was available in 169. Eighty-one (47.9%) patients died, 67 (39.6%) were discharged home, and 21 (12.4%) were discharged to long-term care. Four patients had electroencephalographic seizures, two of whom had no clinical manifestations (i.e. non-convulsive). On univariate analysis, increased age, an admitting diagnosis of cardiac arrest, a Glasgow Coma Scale (GCS) score8, and burst suppression were correlated significantly with poor outcome. A past history of seizures and unequivocal tonic-clonic convulsions were correlated significantly with a better outcome. On multivariate analysis, increased age, cardiac arrest, and a GCS score8 were associated with increased mortality (p<0.05). Clinical factors, including age, underlying etiology and GCS score are the most important predicators of outcome in coma. A standard 20 minute EEG did not correlate with a high detection rate of seizure activity. Furthermore, EEG patterns and treatment with anticonvulsant medications did not correlate with outcome.
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie | 2010
Peter G. Brindley; Dominic Cave; Laurance Lequier
Severe adult respiratory distress syndrome (ARDS) remains associated with high mortality despite improved ventilatory techniques. While extracorporeal membrane oxygenation (ECMO) is not uncommon in neonatal/pediatric critical care, studies had yet to show similar benefits in adults. Therefore, the Conventional Ventilation or ECMO for Severe Adult Respiratory Failure (CESAR) Trial by Peek et al. was eagerly anticipated. It was the first randomized study of ECMO in adult patients in over 15 yr and the largest ever concerning this condition.