Richard P. Dellinger
Cooper University Hospital
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Featured researches published by Richard P. Dellinger.
Critical Care | 2011
Frank Bloos; John C. Marshall; Richard P. Dellinger; Jean Louis Vincent; Guillermo Gutierrez; Emanuel P. Rivers; Robert A. Balk; Pierre-François Laterre; Derek C. Angus; Konrad Reinhart; Frank M. Brunkhorst
IntroductionThe intent of this study was to determine whether serum procalcitonin (PCT) levels are associated with prognosis, measured as organ dysfunctions and 28-day mortality, in patients with severe pneumonia.MethodsThis was a multicenter, observational study of critically ill adult patients with pneumonia requiring mechanical ventilation conducted in 10 academic hospitals in Canada, the United States, and Central Europe. PCT was measured daily for 14 days using an immuno-luminometric assay.ResultsWe included 175 patients, 57 with community acquired pneumonia (CAP), 61 with ventilator associated pneumonia (VAP) and 57 with hospital acquired pneumonia (HAP). Initial PCT levels were higher in CAP than VAP patients (median (interquartile range: IQR); 2.4 (0.95 to 15.8) vs. 0.7 (0.3 to 2.15), ng/ml, P < 0.001) but not significantly different to HAP (2.2 (0.4 to 8.0) ng/ml). The 28-day ICU mortality rate for all patients was 18.3% with a median ICU length of stay of 16 days (range 1 to 142 days). PCT levels were higher in non-survivors than in survivors. Initial and maximum PCT levels correlated with maximum Sequential Organ Failure Assessment (SOFA) score r2 = 0.50 (95% CI: 0.38 to 0.61) and r2 = 0.57 (0.46 to 0.66), respectively. Receiver operating curve (ROC) analysis on discrimination of 28-day mortality showed areas under the curve (AUC) of 0.74, 0.70, and 0.69 for maximum PCT, initial PCT, and Acute Physiology and Chronic Health Evaluation (APACHE) II score, respectively. The optimal cut-off to predict mortality for initial PCT was 1.1 ng/ml (odds ratio: OD 7.0 (95% CI 2.6 to 25.2)) and that for maximum PCT was 7.8 ng/ml (odds ratio 5.7 (95% CI 2.5 to 13.1)).ConclusionsPCT is associated with the severity of illness in patients with severe pneumonia and appears to be a prognostic marker of morbidity and mortality comparable to the APACHE II score.
Critical Care Medicine | 2014
Tiffany M. Osborn; Gary Phillips; Stanley Lemeshow; Sean R. Townsend; Christa Schorr; Mitchell M. Levy; Richard P. Dellinger
Objective:As the Surviving Sepsis Campaign was assessing patient-level data over multiple countries, we sought to evaluate the use of a pragmatic and parsimonious severity-of-illness scoring system for patients with sepsis in an attempt to provide appropriate comparisons with practical application. Design:Prospective, observational evaluation. Patients:Data from 23,438 patients with suspected or confirmed sepsis from 218 hospitals in 18 countries were evaluated. Setting:This analysis was conducted on prospective data submitted to a database from January 2005 through March 2010. Interventions:None. Measurements and Main Results:Maximum likelihood logistic regression was used to estimate model coefficients, and these were then used to develop a Sepsis Severity Score. The probability of hospital mortality was estimated using the Sepsis Severity Score as the sole variable in a logistic regression model. Univariable logistic regression determined which variables were included in the multivariable predictor model. The scale of continuous variables was assessed using fractional polynomials. Two-way interactions between variables were considered for model inclusion if the interaction p value is less than 0.05. The prediction model was developed based on randomly selecting 90% of available patients and was validated on the remaining 10%, as well as by using a bootstrapping technique. The p values for the Hosmer-Lemeshow goodnessof-fit statistic in the developmental and validation datasets were considerably greater than 0.05, suggesting good calibration. Development and validation areas under the receiver operator curve curves were 0.736 and 0.748, respectively. Observed and estimated probabilities of hospital mortality for the total population were both 0.334. The validation and the developmental datasets were gradually compared over deciles of predicted mortality and found to be very similar. Conclusion:The Sepsis Severity Score accurately estimated the probability of hospital mortality in severe sepsis and septic shock patients. It performed well with respect to calibration and discrimination, which remained consistent over deciles. It functioned well over international geographic regions. This robust, population-specific evaluation of international severe sepsis patients provides an effective and accurate mortality estimate allowing for appropriate quality comparisons with practical clinical and research application.
Critical Care Clinics | 2009
Nitin Puri; Vinod Puri; Richard P. Dellinger
Critical care medicine is a young specialty and since its inception has been heavily reliant upon technology. Invasive monitoring has its humble beginnings in the continuous monitoring of heart rate and rhythm. From the development of right heart catheterization to the adaption of the echocardiogram for use in shock, intensivists have used technology to monitor hemodynamics. The care of the critically ill has been buoyed by investigators who sought to offer renal replacement therapy to unstable patients and worked to improve the monitoring of oxygen saturation. The evolution of mechanical ventilation for the critically ill embodies innumerable technological advances. More recently, critical care has insisted upon rigorous testing and cost-benefit analysis of technological advances.
Critical Care Clinics | 2011
Nitin Puri; Richard P. Dellinger
The mortality for acute respiratory distress syndrome remains unacceptably high. Two vasodilators, inhaled prostacyclin and inhaled nitric oxide, are reviewed in this article. Knowledge of inhaled prostacyclin has grown substantially in the past 30 years, but less research exists about its utility in acute respiratory distress syndrome. Inhaled prostacyclin and other prostaglandin derivatives are used in acute respiratory distress syndrome with increasing frequency. Currently, only randomized controlled trials exist for inhaled nitric oxide in acute respiratory distress syndrome patients. Randomized controlled trials with consistent dosing methods are needed for both vasodilators to better define their role in the treatment of acute respiratory distress syndrome.
Chest | 1992
Roger C. Bone; Robert A. Balk; Frank B. Cerra; Richard P. Dellinger; Alan M. Fein; William A. Knaus; Roland M. H. Schein; William J. Sibbald
Intensive Care Medicine | 2013
Richard P. Dellinger; Mitchell M. Levy; Andrew Rhodes; Djillali Annane; Herwig Gerlach; Steven M. Opal; Jonathan E. Sevransky; Charles L. Sprung; Ivor S. Douglas; Roman Jaeschke; Tiffany M. Osborn; Mark E. Nunnally; Sean R. Townsend; Konrad Reinhart; Ruth M. Kleinpell; Derek C. Angus; Clifford S. Deutschman; Flávia Ribeiro Machado; Gordon D. Rubenfeld; Steven A R Webb; Richard Beale; Jean Louis Vincent; Rui Moreno
Chest | 2006
Smith Jean; Ismail Cinel; Susmita Rajanala; Christina Tay; Paige Durflinger; Richard P. Dellinger; Joseph E. Parrillo
Critical Care | 2006
Susmita Rajanala; Richard P. Dellinger; S Jean; M Botbol; C Tay; Joseph E. Parrillo
Chest | 2005
Susmita Rajanala; S Jean; Igal Kushnir; Richard P. Dellinger; Joseph E. Parrillo
american thoracic society international conference | 2011
Kalpalatha K. Guntupalli; Richard P. Dellinger; Mitchell M. Levy; Nathan C. Dean; Peter E. Morris; Gregory A. Schmidt; David B. Huang; Robert Taylor; Rajesh Malik; Jack Schaumberg; Thorsten Meyer