Browsing by Author "Martin, Gregory S."

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    Fluid Response Evaluation in Sepsis Hypotension and Shock: A Randomized Clinical Trial
    (Elsevier, 2020) Douglas, Ivor S.; Alapat, Philip M.; Corl, Keith A.; Exline, Matthew C.; Forni, Lui G.; Holder, Andre L.; Kaufman, David A.; Khan, Akram; Levy, Mitchell M.; Martin, Gregory S.; Sahatjian, Jennifer A.; Seeley, Eric; Self, Wesley H.; Weingarten, Jeremy A.; Williams, Mark; Hansell, Douglas M.; Medicine, School of Medicine
    Background: Fluid and vasopressor management in septic shock remains controversial. In this randomized controlled trial, we evaluated the efficacy of dynamic measures (stroke volume change during passive leg raise) to guide resuscitation and improve patient outcome. Research question: Will resuscitation that is guided by dynamic assessments of fluid responsiveness in patients with septic shock improve patient outcomes? Study design and methods: We conducted a prospective, multicenter, randomized clinical trial at 13 hospitals in the United States and United Kingdom. Patients presented to EDs with sepsis that was associated hypotension and anticipated ICU admission. Intervention arm patients were assessed for fluid responsiveness before clinically driven fluid bolus or increase in vasopressors occurred. The protocol included reassessment and therapy as indicated by the passive leg raise result. The control arm received usual care. The primary clinical outcome was positive fluid balance at 72 hours or ICU discharge, whichever occurred first. Results: In modified intent-to-treat analysis that included 83 intervention and 41 usual care eligible patients, fluid balance at 72 hours or ICU discharge was significantly lower (-1.37 L favoring the intervention arm; 0.65 ± 2.85 L intervention arm vs 2.02 ± 3.44 L usual care arm; P = .021. Fewer patients required renal replacement therapy (5.1% vs 17.5%; P = .04) or mechanical ventilation (17.7% vs 34.1%; P = .04) in the intervention arm compared with usual care. In the all-randomized intent-to-treat population (102 intervention, 48 usual care), there were no significant differences in safety signals. Interpretation: Physiologically informed fluid and vasopressor resuscitation with the use of the passive leg raise-induced stroke volume change to guide management of septic shock is safe and demonstrated lower net fluid balance and reductions in the risk of renal and respiratory failure. Dynamic assessments to guide fluid administration may improve outcomes for patients with septic shock compared with usual care.
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    Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey
    (Wolters Kluwer, 2022) Burns, Karen E.A.; Moss, Marc; Lorens, Edmund; Jose, Elizabeth Karin Ann; Martin, Claudio M.; Viglianti, Elizabeth M.; Fox-Robichaud, Alison; Mathews, Kusum S.; Akgun, Kathleen; Jain, Snigdha; Gershengorn, Hayley; Mehta, Sangeeta; Han, Jenny E.; Martin, Gregory S.; Liebler, Janice M.; Stapleton, Renee D.; Trachuk, Polina; Vranas, Kelly C.; Chua, Abigail; Herridge, Margaret S.; Tsang, Jennifer L.Y.; Biehl, Michelle; Burnham, Ellen L.; Chen, Jen-Ting; Attia, Engi F.; Mohamed, Amira; Harkins, Michelle S.; Soriano, Sheryll M.; Maddux, Aline; West, Julia C.; Badke, Andrew R.; Bagshaw, Sean M.; Binnie, Alexandra; Carlos, W. Graham; Çoruh, Başak; Crothers, Kristina; D'Aragon, Frederick; Denson, Joshua Lee; Drover, John W.; Eschun, Gregg; Geagea, Anna; Griesdale, Donald; Hadler, Rachel; Hancock, Jennifer; Hasmatali, Jovan; Kaul, Bhavika; Kerlin, Meeta Prasad; Kohn, Rachel; Kutsogiannis, D. James; Matson, Scott M.; Morris, Peter E.; Paunovic, Bojan; Peltan, Ithan D.; Piquette, Dominique; Pirzadeh, Mina; Pulchan, Krishna; Schnapp, Lynn M.; Sessler, Curtis N.; Smith, Heather; Sy, Eric; Thirugnanam, Subarna; McDonald, Rachel K.; McPherson, Katie A.; Kraft, Monica; Spiegel, Michelle; Dodek, Peter M.; Diversity-Related Research Committee of the Women in Critical Care (WICC) Interest Group of the American Thoracic Society; Medicine, School of Medicine
    Objectives: Few surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic. Design: Cross-sectional survey using four validated instruments. Setting: Sixty-two sites in Canada and the United States. Subjects: Attending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs. Intervention: None. Measurements and main results: We analysed 431 questionnaires (43.3% response rate) from 25 states and eight provinces. Respondents were predominantly male (229 [55.6%]) and in practice for 11.8 ± 9.8 years. Compared with prepandemic, respondents reported significant intrapandemic increases in days worked/mo, ICU bed occupancy, and self-reported moral distress (240 [56.9%]) and burnout (259 [63.8%]). Of the 10 top-ranked items that incited moral distress, most pertained to regulatory/organizational ( n = 6) or local/institutional ( n = 2) issues or both ( n = 2). Average moral distress (95.6 ± 66.9), professional fulfilment (6.5 ± 2.1), and burnout scores (3.6 ± 2.0) were moderate with 227 physicians (54.6%) meeting burnout criteria. A significant dose-response existed between COVID-19 patient volume and moral distress scores. Physicians who worked more days/mo and more scheduled in-house nightshifts, especially combined with more unscheduled in-house nightshifts, experienced significantly more moral distress. One in five physicians used at least one maladaptive coping strategy. We identified four coping profiles (active/social, avoidant, mixed/ambivalent, infrequent) that were associated with significant differences across all wellness measures. Conclusions: Despite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness.