Publications

Scholarly Journals--Published

  • Pringle, Charlene P. MSN, CPNP; Filipp, Stephanie L. MPH; Morrison, Wynne E.; Fainberg, Nina A. MD5; Aczon, Melissa D. PhD; Avesar, Michael MD; Burkiewicz, Kimberly F. DNP, APRN, CPNP-AC; Chandnani, Harsha K. MD, MBA, MPH; Hsu, Stephanie C. MD; Laksana, Eugene BS; Ledbetter, David R. BS; McCrory, Michael C. MD, MS, FCCM; Morrow, Katie R. MSN, CPNP-AC; Noguchi, Anna E. BSN, RN; O’Brien, Caitlin E. MD, MPH; Ojha, Apoorva BS; Ross, Patrick A. MD; Shah, Sareen MD; Shah, Jui K. MD; Siegel, Linda B. MD; Tripathi, Sandeep MD, MS, FCCM; Wetzel, Randall C. MBBS, FAAP, FCCM; Zhou, Alice X. BA; Winter, Meredith C. MD. Ventilator Weaning and Terminal Extubation: Withdrawal of Life-Sustaining Therapy in Children. Secondary Analysis of the Death One Hour After Terminal Extubation Study. Critical Care Medicine ():10.1097/CCM.0000000000006101, October 27, 2023. | DOI: 10.1097/CCM.0000000000006101 (10/2023) (link)
  • Tripathi S, Laksana E, McCrory MC, Hsu S, Zhou AX, Burkiewicz K, Ledbetter DR, Aczon MD, Shah S, Siegel L, Fainberg N, Morrow KR, Avesar M, Chandnani HK, Shah J, Pringle C, Winter MC. Analgesia and Sedation at Terminal Extubation: A Secondary Analysis From Death One Hour After Terminal Extubation Study Data. Pediatr Crit Care Med. 2023 Mar 6. doi: 10.1097/PCC.0000000000003209.  PMID: 36877028. Abstract Objectives: To describe the doses of opioids and benzodiazepines administered around the time of terminal extubation (TE) to children who died within 1 hour of TE and to identify their association with the time to death (TTD). Design: Secondary analysis of data collected for the Death One Hour After Terminal Extubation study. Setting: Nine U.S. hospitals. Patients: Six hundred eighty patients between 0 and 21 years who died within 1 hour after TE (2010-2021). Measurements and main results: Medications included total doses of opioids and benzodiazepines 24 hours before and 1 hour after TE. Correlations between drug doses and TTD in minutes were calculated, and multivariable linear regression performed to determine their association with TTD after adjusting for age, sex, last recorded oxygen saturation/Fio2 ratio and Glasgow Coma Scale score, inotrope requirement in the last 24 hours, and use of muscle relaxants within 1 hour of TE. Median age of the study population was 2.1 years (interquartile range [IQR], 0.4-11.0 yr). The median TTD was 15 minutes (IQR, 8-23 min). Forty percent patients (278/680) received either opioids or benzodiazepines within 1 hour after TE, with the largest proportion receiving opioids only (23%, 159/680). Among patients who received medications, the median IV morphine equivalent within 1 hour after TE was 0.75 mg/kg/hr (IQR, 0.3-1.8 mg/kg/hr) (n = 263), and median lorazepam equivalent was 0.22 mg/kg/hr (IQR, 0.11-0.44 mg/kg/hr) (n = 118). The median morphine equivalent and lorazepam equivalent rates after TE were 7.5-fold and 22-fold greater than the median pre-extubation rates, respectively. No significant direct correlation was observed between either opioid or benzodiazepine doses before or after TE and TTD. After adjusting for confounding variables, regression analysis also failed to show any association between drug dose and TTD. Conclusions: Children after TE are often prescribed opioids and benzodiazepines. For patients dying within 1 hour of TE, TTD is not associated with the dose of medication administered as part of comfort care. (03/2023) (link)
  • Billy C. Wang, Richard P. Lion, Michael Avesar, Jonathan Abdala, Douglas D. Deming, and Christopher G. Wilson. Comparison of Local and Systemic Inflammation During Invasive Versus Noninvasive Ventilation in Rats. Journal of Interferon & Cytokine Research. printhttp://doi.org/10.1089/jir.2022.0040 Mentor and collaborator for fascinating work comparing inflamation of invasive vs non-invasive ventialtion in healthy and sick rats.  (06/2022) (link)
  • Udrea D., Lopez M., Avesar M., Qureshi S., Moretti A., Abd-Allah S.A., Chandnani H. K., Acute COVID-19 Infection in a Pediatric Patient with ROHHAD. J Pediatr Genet. Oct 26 2020. DOI: 10.1055/s-0040-1718874.  Abstract: The novel coronavirus (severe acute respiratory syndrome coronavirus-2) has led to a global pandemic. In the adult population, coronavirus disease 2019 (COVID-19) has been found to cause multiorgan system damage with predicted long-term sequelae. We present a case of a 10-year-old boy with a history of ROHHAD (rapid-onset obesity with hypothalamic dysregulation, hypoventilation, and autonomic dysregulation) who presented with hypoxia, emesis, and abdominal pain. Imaging found bilateral ground glass opacities in the lungs and a pericardial effusion. Laboratory evaluation was concerning for elevated inflammatory markers. Remdesivir, hydroxychloroquine, and anticoagulation (heparin and enoxaparin) were utilized. The patient's severe respiratory failure was managed with conventional mechanical ventilation, inhaled nitric oxide, and airway pressure release ventilation. We hope that this report provides insight into the course and management of the severe acute pediatric COVID-19 patient, specifically with underlying comorbidities such as ROHHAD. Clinical trial registration is none. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0040-1718874 (10/2020) (link)

Abstract

  • Sandeep, Tripathi; Eugene, Laksana; McCrory, Michael; Hsu, Stephanie; Zhou, Alice; Ledbetter, David; Aczon, Melissa; Burkiewicz, Kimberly; Shah, Sareen; Siegel, Linda; Fainberg, Nina; Morrow, Katie; Avesar, Michael; Chandnani, Harsha; Shah, Jui; Pringle, Charlene; Winter, Meredith. PALLIATIVE MEDICATIONS AT TERMINAL EXTUBATION: A SECONDARY ANALYSIS FROM DONATE STUDY DATA. Critical Care Medicine 51(1):p 9, January 2023. | DOI: 10.1097/01.ccm.0000905944.03484.33 Introduction: The doctrine of double effect provides an ethical framework for providers to titrate medications to patient comfort at the end-of-life even if doing so hastens death, but moral distress may result from perceived under- or over- treatment. Objective of this study was to describe the doses of opioids and benzodiazepines (BZD) administered to children around the time of Terminal Extubation (TE) and to identify their association with the time to death (TTD). Methods: Secondary analysis of data collected for the Death One Hour After Terminal Extubation (DONATE) study, which included retrospective data from 9 U.S. hospitals. Medications included total doses of opioids and BZD 24 hours before and 1 hour after TE. Correlations between drug doses and TTD in minutes were calculated, and multivariable linear regression was performed to determine their association with TTD after adjusting for age, sex, last Saturation/FiO2 (SF) ratio, inotrope requirement in last 24 hours, and last recorded Glasgow Coma Scale (GCS) score. Results: Analysis cohort included 680 patients between 0-21 years who died within 1 hour in ICU after TE (2010-2021). Median age of the study population was 2.1 (IQR 0.4, 11) years. The median TTD was 15 (IQR 8, 23) minutes. 40% (278/680) of patients received either opioids or BZD within one hour after TE, with the largest proportion receiving opioids only (23%, 159/680). Among patients who received medications, the median IV morphine equivalent (eq) within 1 hour after TE was 0.75 (IQR 0 .3, 1.8) mg/kg/hr (n=263), and median lorazepam eq was 0.22 (IQR 0.11, 0.44) mg/kg/hr (n=118). The median morphine eq and lorazepam eq rates after TE were 7.5-fold and 22-fold greater than the median pre-extubation rates, respectively. No significant direct correlation was observed between either opioid or BZD doses before or after TE and TTD. After adjusting for confounding variables regression analysis also failed to show any association between drug dose and TTD. Conclusions: Children after TE are often prescribed opioids and BZD. Time to death after TE is not associated with the dose of medication administered as part of comfort care. Providers should titrate analgesic and sedative/anxiolytic medications to patient comfort after terminal extubation. (01/2023) (link)
  • Abraham A., Tan J., Cana J., Soeharsono C., Fenison A., Kim V., Sung H., Avesar M., Lopez M., Soneji M., Chandnani, H. Predictive Factors for PICU Admission in Patients with MIS-C. Pediatric Critical Care Medicine 23(Supplement 1 11S):, November 2022.  DOI: 10.1097/01.pcc.0000899836.04659.71 (11/2022) (link)