Browsing by Author "Ferland, Andre"

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    Adverse events associated with administration of vasopressor medications through a peripheral intravenous catheter: a systematic review and meta-analysis
    (2021-04-16) Owen, Victoria S; Rosgen, Brianna K; Cherak, Stephana J; Ferland, Andre; Stelfox, Henry T; Fiest, Kirsten M; Niven, Daniel J
    Abstract Background It is unclear whether vasopressors can be safely administered through a peripheral intravenous (PIV). Systematic review and meta-analysis methodology was used to examine the incidence of local anatomic adverse events associated with PIV vasopressor administration in patients of any age cared for in any acute care environment. Methods MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of controlled trials, and the Database of Abstracts of Reviews of Effects were searched without restriction from inception to October 2019. References of included studies and related reviews, as well as relevant conference proceedings were also searched. Studies were included if they were: (1) cohort, quasi-experimental, or randomized controlled trial study design; (2) conducted in humans of any age or clinical setting; and (3) reported on local anatomic adverse events associated with PIV vasopressor administration. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials or the Joanna Briggs Institute checklist for prevalence studies where appropriate. Incidence estimates were pooled using random effects meta-analysis. Subgroup analyses were used to explore sources of heterogeneity. Results Twenty-three studies were included in the systematic review, of which 16 and 7 described adults and children, respectively. Meta-analysis from 11 adult studies including 16,055 patients demonstrated a pooled incidence proportion of adverse events associated with PIV vasopressor administration as 1.8% (95% CI 0.1–4.8%, I2 = 93.7%). In children, meta-analysis from four studies and 388 patients demonstrated a pooled incidence proportion of adverse events as 3.3% (95% CI 0.0–10.1%, I2 = 82.4%). Subgroup analyses did not detect any statistically significant effects associated with stratification based on differences in clinical location, risk of bias or design between studies, PIV location and size, or vasopressor type or duration. Most studies had high or some concern for risk of bias. Conclusion The incidence of adverse events associated with PIV vasopressor administration is low. Additional research is required to examine the effects of PIV location and size, vasopressor type and dose, and patient characteristics on the safety of PIV vasopressor administration.
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    An Analysis of a Cohort of Surgical-Related Intra-Abdominal Sepsis with PIRO
    (2013-07-10) Posadas Calleja, Juan Gabriel; Doig, Christopher James; Stelfox, H. Tomas; Ferland, Andre
    Introduction: Sepsis constitutes an important cause of morbidity and mortality; mortality in patients with intraabdominal sepsis remains high. The PIRO concept is a classification scheme for sepsis. Methods: Retrospective analysis of a prospective observational cohort. Results: 905 patients were analyzed. A PIRO score was developed including the following variables: age > 65 years, comorbidities, leukopenia, hypothermia, cardiovascular, renal, respiratory, and CNS failure, one point was given for each present feature. The mean PIRO score was significantly higher in nonsurvivors than in survivors (3.9 vs. 2.3 respectively, p < 0.0001). When the patients were distributed according PIRO scoring, mortality rate increased (p <0.0001). The aROC showed consistent mortality discrimination by PIRO score (0.80, 95%CI 0.79 to 0.83), outperforming APACHE II (0.72, 95%CI 0.68 to 0.75) and SOFA (0.72, 95%CI 0.68 to 0.76) p <0.0001. Conclusion: The PIRO score performed well as an ICU mortality predictor tool for surgical related intra-abdominal sepsis.m
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    Another Whipple’s triad? Pericardial, myocardial and valvular disease in an unusual case presentation from a Canadian perspective
    (2019-12-23) Thornton, Christina S; Wang, Yinong; Köebel, Martin; Bernard, Kathryn; Burdz, Tamara; Maitland, Andrew; Ferraz, Jose G; Beck, Paul L; Ferland, Andre
    Abstract Background Whipple’s disease is a clinically relevant multi-system disorder that is often undiagnosed given its elusive nature. We present an atypical case of Whipple’s disease involving pan-valvular endocarditis and constrictive pericarditis, requiring cardiac intervention. A literature review was also performed assessing the prevalence of atypical cases of Whipple’s disease. Case presentation A previously healthy 56-year-old male presented with a four-year history of congestive heart failure with weight loss and fatigue. Notably, he had absent gastrointestinal symptoms. He went on to develop pan-valvular endocarditis and constrictive pericarditis requiring urgent cardiac surgery. A clinical diagnosis of Whipple’s disease was suspected, prompting duodenal biopsy sampling which was unremarkable, Subsequently, Tropheryma whipplei was identified by 16S rDNA PCR on the cardiac valvular tissue. He underwent prolonged antibiotic therapy with recovery of symptoms. Conclusions Our study reports the first known case of Whipple’s disease involving pan-valvular endocarditis and constrictive pericarditis. A literature review also highlights this presentation of atypical Whipple’s with limited gastrointestinal manifestations. Duodenal involvement was limited and the gold standard of biopsy was not contributory. We also highlight the Canadian epidemiology of the disease from 2012 to 2016 with an approximate 4% prevalence rate amongst submitted samples. Routine investigations for Whipple’s disease, including duodenal biopsy, in this case may have missed the diagnosis. A high degree of suspicion was critical for diagnosis of unusual manifestations of Whipple’s disease.