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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (2)
- (-) Adverse Events (18)
- Antibiotics (1)
- Antimicrobial Stewardship (1)
- Cardiovascular Conditions (2)
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- Children/Adolescents (10)
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- Intensive Care Unit (ICU) (3)
- Medication (2)
- Neurological Disorders (1)
- Outcomes (3)
- Patient-Centered Outcomes Research (2)
- Patient Safety (10)
- Pneumonia (3)
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- (-) Respiratory Conditions (18)
- Risk (2)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 18 of 18 Research Studies DisplayedDifazio RL, Shore BJ, Melvin P
Pneumonia after hip surgery in children with neurological complex chronic conditions.
The purpose of this retrospective cohort study was to estimate rates of postoperative pneumonia in children with neurological complex chronic conditions (CCC) undergoing hip surgery, to determine the effect of pneumonia on postoperative hospital resource use, and to identify predictors. Researchers used data from the Pediatric Health Information System for children 4 years and older with a neurological CCC who had undergone hip surgery from 2016 to 2018 in U.S. children's hospitals. Findings indicate that postoperative pneumonia in children with a neurological CCC was associated with longer length-of-stay, readmissions, and higher costs. Children who had undergone pelvic osteotomies and who had multimorbidity needed additional clinical support to prevent postoperative pneumonia and to decrease resource utilization.
AHRQ-funded; HS024453.
Citation: Difazio RL, Shore BJ, Melvin P .
Pneumonia after hip surgery in children with neurological complex chronic conditions.
Dev Med Child Neurol 2023 Feb; 65(2):232-42. doi: 10.1111/dmcn.15339..
Keywords: Children/Adolescents, Surgery, Neurological Disorders, Pneumonia, Respiratory Conditions, Hospital Readmissions, Adverse Events
Napolitano N, Polikoff L, Edwards L
Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children.
This study’s goal was to determine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI) reduces adverse TI-associated events (TIAEs) in children. AO was implemented at 14 pediatric intensive care units as a quality improvement intervention from 2016 through 2020. Implementation consisted of an intubation safety checklist, leadership endorsement, use of a local champion, and data feedback to frontline clinicians. Of 6549 TIs during the study period, 2554 occurred during the pre-implementation phase and 3995 during post-implementation phase. AO utilization increased from 23 to 68%. It was utilized less often when intubating infants, those with a primary cardiac diagnosis or difficult airway features, and patients intubated due to respiratory or neurological failure or shock. Conversely, it was used more often in TIs done for procedures or those associated by video laryngoscopy. AO utilization was associated with a lower incidence of adverse TIAEs (AO 10.5% vs. without AO 13.5%). However, after further adjusting for patient and provider characteristics (secondary analysis), AO utilization was not independently associated with the occurrence of adverse TIAEs, and the occurrence of hypoxemia was not different (AO 14.2% versus without AO 15.2%).
AHRQ-funded; HS024511.
Citation: Napolitano N, Polikoff L, Edwards L .
Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children.
Crit Care 2023 Jan 17; 27(1):26. doi: 10.1186/s13054-023-04304-0..
Keywords: Children/Adolescents, Critical Care, Adverse Events, Respiratory Conditions
Wang Y, Eldridge N, Metersky ML
AHRQ Author: Eldridge N, Rodrick D
Analysis of hospital-level readmission rates and variation in adverse events among patients with pneumonia in the United States.
The purpose of this AHRQ-authored cross-sectional study was to assess whether patients with pneumonia who were admitted to hospitals with higher risk-standardized readmission rates had a higher risk of in-hospital adverse events. The researchers linked patient-level adverse events data from the Medicare Patient Safety Monitoring System (MPSMS) to the hospital-level pneumonia-specific all-cause readmissions data from the Centers for Medicare & Medicaid Services. The MPSMS data included 46,047 patients with pneumonia across 2,590 hospitals discharged from July 1, 2010, through December 31, 2019. For data from 2010 to 2017, analysis was completed from October 2019 through July 2020, and for data from 2018 to 2019 analysis was completed from March through April 2022. The study concluded that readmission rates are associated with the quality of hospital care for pneumonia; patients with pneumonia admitted to hospitals with high all-cause readmission rates had a higher likelihood of developing adverse events during the initial hospitalization.
AHRQ-authored; AHRQ-funded; 290201800005C.
Citation: Wang Y, Eldridge N, Metersky ML .
Analysis of hospital-level readmission rates and variation in adverse events among patients with pneumonia in the United States.
JAMA Netw Open 2022 May 2;5(5):e2214586. doi: 10.1001/jamanetworkopen.2022.14586..
Keywords: Hospital Readmissions, Hospitals, Adverse Events, Pneumonia, Respiratory Conditions
McGrath SP, McGovern KM, Perreard IM
Inpatient respiratory arrest associated with sedative and analgesic medications: impact of continuous monitoring on patient mortality and severe morbidity.
Inpatient respiratory arrest associated with sedative and analgesic medications: impact of continuous monitoring on patient mortality and severe morbidity.
The purpose of this study was to investigate the impact of surveillance monitoring on mortality and severe morbidity associated with administration of sedative/analgesic medications in the general care setting. A review of available rescue event and patient safety data from a tertiary care hospital in a rural setting was conducted. Findings showed that, for a 10-year period, the rescue system with continuous surveillance monitoring had a profound effect on prevention of death due to sedative/analgesic administration in the general care setting.
The purpose of this study was to investigate the impact of surveillance monitoring on mortality and severe morbidity associated with administration of sedative/analgesic medications in the general care setting. A review of available rescue event and patient safety data from a tertiary care hospital in a rural setting was conducted. Findings showed that, for a 10-year period, the rescue system with continuous surveillance monitoring had a profound effect on prevention of death due to sedative/analgesic administration in the general care setting.
AHRQ-funded; HS024403.
Citation: McGrath SP, McGovern KM, Perreard IM .
Inpatient respiratory arrest associated with sedative and analgesic medications: impact of continuous monitoring on patient mortality and severe morbidity.
J Patient Saf 2021 Dec 1;17(8):557-61. doi: 10.1097/pts.0000000000000696..
Keywords: Respiratory Conditions, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Dobler CC, Morrow AS, Beuschel B
Pharmacologic therapies in patients with exacerbation of chronic obstructive pulmonary disease: a systematic review with meta-analysis.
The authors evaluated the comparative effectiveness and adverse events of pharmacologic interventions for adults with exacerbation of COPD. Sixty-eight randomized controlled trials were selected for evaluation and data extraction. They found that antibiotics and systemic corticosteroids reduced treatment failure in adults with mild to severe exacerbation of COPD.
AHRQ-funded.
Citation: Dobler CC, Morrow AS, Beuschel B .
Pharmacologic therapies in patients with exacerbation of chronic obstructive pulmonary disease: a systematic review with meta-analysis.
Ann Intern Med 2020 Mar 17;172(6):413-23. doi: 10.7326/m19-3007..
Keywords: Respiratory Conditions, Chronic Conditions, Evidence-Based Practice, Patient-Centered Outcomes Research, Comparative Effectiveness, Medication, Antibiotics, Treatments, Adverse Drug Events (ADE), Adverse Events
Mathis MR, Duggal NM, Likosky DS
Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery.
In this study, the authors hypothesized that a bundled intraoperative protective ventilation strategy was independently associated with decreased odds of pulmonary complications after cardiac surgery. They identified an intraoperative lung-protective ventilation bundle as independently associated with pulmonary complications after cardiac surgery. Their findings offer insight into components of protective ventilation associated with adverse outcomes and may serve as targets for future prospective interventional studies investigating the impact of specific protective ventilation strategies on postoperative outcomes after cardiac surgery.
AHRQ-funded; HS022535.
Citation: Mathis MR, Duggal NM, Likosky DS .
Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery.
Anesthesiology 2019 Nov;131(5):1046-62. doi: 10.1097/aln.0000000000002909..
Keywords: Adverse Events, Cardiovascular Conditions, Patient Safety, Respiratory Conditions, Surgery
Sanders R, Edwards L, Nishisaki A
Tracheal intubations for critically Ill children outside specialized centers in the United Kingdom-patient, provider, practice factors, and adverse events.
This editorial discusses a research study on outcomes of performing pediatric trachael intubations (TIs) and how the results can be applied to performing intubations on critically ill children in the United Kingdom outside of specialized centers. One of the authors is from a U.S. site that submits its airway management data to the National Emergency Airway Registry for Children (NEAR4KIDS). The results from the registry were compared to the results from the study. A total of 1,051 patients out of 1,237 eligible patients were analyzed. The results came from 47 nonspecialized local hospitals in the North Thames and East Anglia region of the UK. Adverse TI-associated events (TIAEs) occurred in 22.7% of the patients, which is higher than those in PICUs and cardiac ICUs. The majority of intubations were performed by the anesthesiologist in the team. The results were similar to those in the NEAR4KIDS registry. There were more complications with children with a higher grade of airway difficulties and comorbidities. The authors believe that pediatric airway management for acutely ill children would benefit from new strategies. They recommend a system change using Plan, Do, Study, Act (PDSA) cycles.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Sanders R, Edwards L, Nishisaki A .
Tracheal intubations for critically Ill children outside specialized centers in the United Kingdom-patient, provider, practice factors, and adverse events.
Pediatr Crit Care Med 2019 Jun;20(6):572-73. doi: 10.1097/pcc.0000000000001946..
Keywords: Adverse Events, Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Outcomes, Patient Safety, Registries, Respiratory Conditions
Mokhateb-Rafii T, Bakar A, Gangadharan S
Hemodynamic impact of oxygen desaturation during tracheal intubation among critically ill children with cyanotic and noncyanotic heart disease.
The objective of this study was to determine a level of oxygen desaturation associated with increased risk of tracheal intubation events in children in a pediatric or cardiac ICU with cyanotic and noncyanotic heart disease. Oxygen desaturation was measured by a fall in pulse oximetry from baseline after pre-oxygenation. The primary outcome was occurrence of hemodynamic tracheal intubation associated events defined as cardiac arrest, hypotension, or dysrhythmia. Results indicate that oxygen desaturation by 30% or more is associated with increased odds for adverse hemodynamic events, after adjusting for confounders. Oxygen desaturation was observed more often in children with cyanotic than those with noncyanotic heart disease, but hemodynamic tracheal intubation associated event rates were similar.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Mokhateb-Rafii T, Bakar A, Gangadharan S .
Hemodynamic impact of oxygen desaturation during tracheal intubation among critically ill children with cyanotic and noncyanotic heart disease.
Pediatr Crit Care Med 2019 Jan;20(1):19-26. doi: 10.1097/pcc.0000000000001766..
Keywords: Adverse Events, Cardiovascular Conditions, Children/Adolescents, Heart Disease and Health, Respiratory Conditions, Intensive Care Unit (ICU), Patient Safety, Risk
Lee JH, Nuthall G, Ikeyama T
Tracheal intubation practice and safety across international PICUs: a report from national emergency airway registry for children.
Researchers hypothesized that there would be differences in the process of care and adverse outcomes for tracheal intubation across pediatric ICUs (PICUs) in six different geographical regions: Germany, Japan, Singapore, India, New Zealand, and North America. Adverse tracheal intubation-associated events and desaturation occurrences in PICUS in these regions were evaluated, and the international PICUs compared with those in North America. The proportion of tracheal intubations for endotracheal tube change was greater in international PICUs, and the median age for international tracheal intubations was younger when compared with North America PICUs. Occurrences of adverse tracheal intubation-associated events were slightly lower for international than for North American PICUs, except for Germany and Japan, which were slightly higher.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Lee JH, Nuthall G, Ikeyama T .
Tracheal intubation practice and safety across international PICUs: a report from national emergency airway registry for children.
Pediatr Crit Care Med 2019 Jan;20(1):1-8. doi: 10.1097/pcc.0000000000001782..
Keywords: Adverse Events, Care Management, Children/Adolescents, Intensive Care Unit (ICU), Respiratory Conditions, Outcomes, Patient Safety
Karandikar MV, Coffin SE, Priebe GP
Variability in antimicrobial use in pediatric ventilator-associated events.
This article describes a study which assesses variability in antimicrobial use and associations with infection testing in pediatric ventilator-associated events (VAEs). 192 patients with ventilator-associated conditions were identified in neonatal, pediatric, and cardiac ICUs in six hospitals. Type and duration of antimicrobial use varied by ICU type. The authors conclude that antimicrobial use is common in pediatric ventilator-associated conditions, but pediatric VAP is uncommon; prolonged usage of antimicrobials in spite of low pediatric VAP rates or positive laboratory testing for infection suggests that pediatric ventilator-associated conditions with antimicrobial use for >/= 4 days may provide a lever for antimicrobial stewardship programs to improve utilization.
AHRQ-funded; HS021636.
Citation: Karandikar MV, Coffin SE, Priebe GP .
Variability in antimicrobial use in pediatric ventilator-associated events.
Infect Control Hosp Epidemiol 2019 Jan;40(1):32-39. doi: 10.1017/ice.2018.264..
Keywords: Adverse Events, Antimicrobial Stewardship, Children/Adolescents, Healthcare-Associated Infections (HAIs), Respiratory Conditions
Taenzer AH, Perreard IM, MacKenzie T
Characteristics of desaturation and respiratory rate in postoperative patients breathing room air versus supplemental oxygen: are they different?
Routine monitoring of postoperative patients with pulse oximetry-based surveillance monitoring has been shown to reduce adverse events. However, there is some concern that pulse oximetry is limited in its ability to detect deterioration quickly enough to allow for intervention in patients receiving supplemental oxygen. To address such concerns, this study expands on the current limited knowledge of differences in desaturation and respiratory rate characteristics between patients breathing room air and those receiving supplemental oxygen.
AHRQ-funded; HS024403.
Citation: Taenzer AH, Perreard IM, MacKenzie T .
Characteristics of desaturation and respiratory rate in postoperative patients breathing room air versus supplemental oxygen: are they different?
Anesth Analg 2018 Mar;126(3):826-32. doi: 10.1213/ane.0000000000002765..
Keywords: Adverse Events, Patient Safety, Respiratory Conditions
Eisler L, Huang G, Lee KM
Identification of perioperative pulmonary aspiration in children using quality assurance and hospital administrative billing data.
This study aims to identify the incidence of and risk factors for perioperative aspiration in children using quality assurance data supplemented by administrative billing records, and to examine the utility of billing data as a supplementary data source. The investigators found that International Classification of Diseases, Ninth Revision codes for aspiration used as a secondary data source were nonspecific for perioperative aspiration, but when combined with record review yielded a 30% increase in identified cases of aspiration over quality assurance data alone.
AHRQ-funded; HS022941.
Citation: Eisler L, Huang G, Lee KM .
Identification of perioperative pulmonary aspiration in children using quality assurance and hospital administrative billing data.
Paediatr Anaesth 2018 Mar;28(3):218-25. doi: 10.1111/pan.13319..
Keywords: Adverse Events, Children/Adolescents, Data, Pneumonia, Respiratory Conditions
Li S, Hsieh TC, Rehder KJ
Frequency of desaturation and association with hemodynamic adverse events during tracheal intubations in PICUs.
In this retrospective cohort study, the investigators aimed to determine the occurrence and severity of desaturation during tracheal intubations and the association with adverse hemodynamic tracheal intubation-associated events. They found that moderate and severe desaturation were reported among 19% and 13% of all tracheal intubation encounters; Moderate and severe desaturations were independently associated with the occurrence of adverse hemodynamic events.
AHRQ-funded; HS024511.
Citation: Li S, Hsieh TC, Rehder KJ .
Frequency of desaturation and association with hemodynamic adverse events during tracheal intubations in PICUs.
Pediatr Crit Care Med 2018 Jan;19(1):e41-e50. doi: 10.1097/pcc.0000000000001384..
Keywords: Adverse Events, Children/Adolescents, Patient Safety, Children/Adolescents, Respiratory Conditions
Costa DK, White MR, Ginier E
Identifying barriers to delivering the awakening and breathing coordination, delirium, and early exercise/mobility bundle to minimize adverse outcomes for mechanically ventilated patients: a systematic review.
The purpose of this review was to identify and catalog the barriers to the Awakening and Breathing Coordination, Delirium, and Early exercise/mobility bundle (ABCDE) delivery based on a widely used implementation framework, and to provide a resource to guide clinicians in overcoming barriers to implementation. It provides the first, to the authors’ knowledge, systematic differential diagnosis of barriers to ABCDE delivery, moving beyond the conventional focus on patient-level factors.
AHRQ-funded; HS024552.
Citation: Costa DK, White MR, Ginier E .
Identifying barriers to delivering the awakening and breathing coordination, delirium, and early exercise/mobility bundle to minimize adverse outcomes for mechanically ventilated patients: a systematic review.
Chest 2017 Aug;152(2):304-11. doi: 10.1016/j.chest.2017.03.054.
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Keywords: Respiratory Conditions, Adverse Events, Prevention, Outcomes
Parker MM, Nuthall G, Brown C, 3rd
Relationship between adverse tracheal intubation associated events and PICU outcomes.
The aim of this study is to evaluate the association between immediate events such as tracheal intubation associated events or desaturation and ICU outcomes: length of stay, duration of mechanical ventilation, and mortality. It found that adverse tracheal intubation associated events and desaturations are common and associated with longer mechanical ventilation in critically ill children. Severe tracheal intubation associated events are associated with higher ICU mortality.
AHRQ-funded; HS021583; HS022464.
Citation: Parker MM, Nuthall G, Brown C, 3rd .
Relationship between adverse tracheal intubation associated events and PICU outcomes.
Pediatr Crit Care Med 2017 Apr;18(4):310-18. doi: 10.1097/pcc.0000000000001074.
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Keywords: Adverse Events, Children/Adolescents, Respiratory Conditions, Patient Safety, Children/Adolescents
Lee JH, Turner DA, Kamat P
The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study.
The objective of this study is to determine the association between number of tracheal intubation (TI) attempts and severe desaturation (SpO2 < 70 percent) and adverse TI associated events (TIAEs). It found that the number of TI attempts was associated with desaturations and increased occurrence of TIAEs in critically ill children with acute respiratory failure.
AHRQ-funded; HS021583; HS022464.
Citation: Lee JH, Turner DA, Kamat P .
The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study.
BMC Pediatr 2016 Apr 29;16:58. doi: 10.1186/s12887-016-0593-y.
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Keywords: Adverse Events, Children/Adolescents, Respiratory Conditions, Patient Safety, Children/Adolescents
Downes KJ, Patil NR, Rao MB
Risk factors for acute kidney injury during aminoglycoside therapy in patients with cystic fibrosis.
The aim of this study was to identify factors associated with acute kidney injury (AKI) during intravenous aminoglycoside (AG) courses in this population. It identified receipt of an AG within 90 days prior to admission, longer duration of AG therapy, low serum albumin, and receipt of trimethoprim/ sulfamethoxazole as independent risk factors for developing AKI.
AHRQ-funded; HS021114.
Citation: Downes KJ, Patil NR, Rao MB .
Risk factors for acute kidney injury during aminoglycoside therapy in patients with cystic fibrosis.
Pediatr Nephrol 2015 Oct;30(10):1879-88. doi: 10.1007/s00467-015-3097-3..
Keywords: Adverse Events, Patient-Centered Outcomes Research, Patient Safety, Respiratory Conditions
Sharma G, Meena R, Goodwin JS
Burn injury associated with home oxygen use in patients with chronic obstructive pulmonary disease.
The researchers quantified the risk of burn injury associated with home oxygen use and examined the risk factors associated with the development of this injury. They found that the absolute risk of burn injury in patients prescribed oxygen therapy was 2.98 per 1000 patients compared with 1.69 per 1000 patients not prescribed oxygen during a 22-month period.
AHRQ-funded; HS020642; HS022134.
Citation: Sharma G, Meena R, Goodwin JS .
Burn injury associated with home oxygen use in patients with chronic obstructive pulmonary disease.
Mayo Clin Proc 2015 Apr;90(4):492-9. doi: 10.1016/j.mayocp.2014.12.024..
Keywords: Injuries and Wounds, Adverse Events, Risk, Respiratory Conditions, Elderly