Publications by authors named "Allison M Liddell"

9 Publications

  • Page 1 of 1

The Combination of Tocilizumab and Methylprednisolone Along With Initial Lung Recruitment Strategy in Coronavirus Disease 2019 Patients Requiring Mechanical Ventilation: A Series of 21 Consecutive Cases.

Crit Care Explor 2020 Jun 15;2(6):e0145. Epub 2020 Jun 15.

Department of Internal Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX.

Objective: To describe the outcomes with use of a combination of tocilizumab and methylprednisolone administered around the time of endotracheal intubation in patients with confirmed coronavirus disease 2019-associated hypoxemic respiratory failure requiring mechanical ventilation.

Data Sources: Retrospective chart review.

Study Selection/data Extraction: Twenty-one consecutive patients with confirmed coronavirus disease 2019-associated hypoxemic respiratory failure requiring mechanical ventilation. Initial ventilator parameters were positive end-expiratory pressure 14 cm Ho and target plateau pressure 29 cm Ho to maximize lung recruitment. Methylprednisolone (125 mg every 6hr for 24 hr with tapering to 60 mg every 12 hr) was administered shortly after patients were intubated (median 11 hr after intubation).

Data Synthesis: No patient in the cohort died while hospitalized (mortality, 0%; 95% CI, 0%-18%) and 18 patients have been discharged from the acute care setting. Twenty of 21 patients (95%) have been liberated from mechanical ventilation after a median duration of 8 days (range, 4-30 d). Following 48 hours of methylprednisolone, the A-a o gradient decreased from 455 ± 103 to 228 ± 109 mm Hg (difference 227 ± 108 mm Hg; < 0.01).

Conclusions: Our positive experience with tocilizumab in combination with methylprednisolone started early after endotracheal intubation may be one avenue for reducing the morbidity and mortality seen with severe coronavirus disease 2019 and merits further exploration in clinical studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CCE.0000000000000145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314352PMC
June 2020

The authors reply.

Crit Care Med 2016 06;44(6):e447-8

Division of Pulmonary, Department of Medicine, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA; Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, TX; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, and Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA; Infectious Diseases Institute, Mulago Hospital Complex, Kampala, Uganda; Division of Infectious Diseases, Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, TX; Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA; Department of Internal Medicine, Renal Section, Texas Health Presbyterian Hospital, Dallas, TX; Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE; Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, TX; Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CCM.0000000000001744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792741PMC
June 2016

Addressing Infection Prevention and Control in the First U.S. Community Hospital to Care for Patients With Ebola Virus Disease: Context for National Recommendations and Future Strategies.

Ann Intern Med 2016 10;165(1):41-49. Epub 2016 May 10.

Health care personnel (HCP) caring for patients with Ebola virus disease (EVD) are at increased risk for infection with the virus. In 2014, a Texas hospital became the first U.S. community hospital to care for a patient with EVD; 2 nurses were infected while providing care. This article describes infection control measures developed to strengthen the hospital's capacity to safely diagnose and treat patients with EVD. After admission of the first patient with EVD, a multidisciplinary team from the Centers for Disease Control and Prevention (CDC) joined the hospital's infection preventionists to implement a system of occupational safety and health controls for direct patient care, handling of clinical specimens, and managing regulated medical waste. Existing engineering and administrative controls were strengthened. The personal protective equipment (PPE) ensemble was standardized, HCP were trained on donning and doffing PPE, and a system of trained observers supervising PPE donning and doffing was implemented. Caring for patients with EVD placed substantial demands on a community hospital. The experiences of the authors and others informed national policies for the care of patients with EVD and protection of HCP, including new guidance for PPE, a rapid system for deploying CDC staff to assist hospitals ("Ebola Response Team"), and a framework for a tiered approach to hospital preparedness. The designation of regional Ebola treatment centers and the establishment of the National Ebola Training and Education Center address the need for HCP to be prepared to safely care for patients with EVD and other high-consequence emerging infectious diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7326/M15-2944DOI Listing
May 2016

Clinical Management of Ebola Virus Disease in the United States and Europe.

N Engl J Med 2016 Feb;374(7):636-46

From the Centers for Disease Control and Prevention (T.M.U., J.G.) and the Division of Infectious Diseases, Emory University School of Medicine (A.K.M.) - both in Atlanta; the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (R.T.D.); Texas Health Presbyterian Hospital Dallas, Dallas (A.M.L.); the Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main (T.W.), the First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg (S.S.), and Leipzig Treatment Center for Highly Contagious Diseases, Klinikum St. Georg, Leipzig (T.G.) - all in Germany; the Division of Infectious Diseases and Laboratory of Virology, Geneva University Hospitals, Geneva (P.V.); the Department of Infection, Royal Free London NHS Foundation Trust, London (M.J.); the Internal Medicine Department, Infectious Diseases Unit Madrid, Hospital La Paz-Carlos III IdiPAZ, Madrid (J.R.A.); New York University School of Medicine-Bellevue Hospital Center, New York (L.E.); University of Nebraska Medical Center, Omaha (A.L.H.); the Departments of Infectious Diseases and Acute Medicine, Oslo University Hospital, Oslo (A.B.B.); Lazzaro Spallanzani National Institute for Infectious Diseases, Rome (G.I.); the Infectious and Tropical Diseases Department, Bégin Military Hospital, Saint-Mandé, France (C.R.); and the Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands (A.I.M.H.).

Background: Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited.

Methods: We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015.

Results: A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%.

Conclusions: Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1056/NEJMoa1504874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972324PMC
February 2016

Critical Care for Multiple Organ Failure Secondary to Ebola Virus Disease in the United States.

Crit Care Med 2015 Oct;43(10):2066-75

1Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA. 2Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE. 3Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Texas Health Presbyterian Hospital, Dallas, TX. 4Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA. 5Infectious Diseases Institute, Mulago Hospital Complex, Kampala, Uganda. 6Department of Internal Medicine, Division of Infectious Diseases, Texas Health Presbyterian Hospital, Dallas, TX. 7Department of Internal Medicine, Renal Section, Texas Health Presbyterian Hospital, Dallas, TX. 8Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE. 9Department of Internal Medicine, Texas Health Presbyterian Hospital, Dallas, TX.

Objective: This report describes three patients with Ebola virus disease who were treated in the United States and developed for severe critical illness and multiple organ failure secondary to Ebola virus infection. The patients received mechanical ventilation, renal replacement therapy, invasive monitoring, vasopressor support, and investigational therapies for Ebola virus disease.

Data Sources: Patient medical records from three tertiary care centers (Emory University Hospital, University of Nebraska Medical Center, and Texas Health Presbyterian Dallas Hospital).

Study Selection: Not applicable.

Data Extraction: Not applicable.

Data Synthesis: Not applicable.

Conclusion: In the severe form, patients with Ebola virus disease may require life-sustaining therapy, including mechanical ventilation and renal replacement therapy. In conjunction with other reported cases, this series suggests that respiratory and renal failure may occur in severe Ebola virus disease, especially in patients burdened with high viral loads. Ebola virus disease complicated by multiple organ failure can be survivable with the application of advanced life support measures. This collective, multicenter experience is presented with the hope that it may inform future treatment of patients with Ebola virus disease requiring critical care treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CCM.0000000000001197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929990PMC
October 2015

Characteristics and Clinical Management of a Cluster of 3 Patients With Ebola Virus Disease, Including the First Domestically Acquired Cases in the United States.

Ann Intern Med 2015 Jul;163(2):81-90

Background: More than 26,000 cases of Ebola virus disease (EVD) have been reported in western Africa, with high mortality. Several patients have been medically evacuated to hospitals in the United States and Europe. Detailed clinical data are limited on the clinical course and management of patients with EVD outside western Africa.

Objective: To describe the clinical characteristics and management of a cluster of patients with EVD, including the first cases of Ebola virus (EBOV) infection acquired in the United States.

Design: Retrospective clinical case series.

Setting: Three U.S. hospitals in September and October 2014.

Patients: First imported EVD case identified in the United States and 2 secondary EVD cases acquired in the United States in critical care nurses who cared for the index case patient.

Measurements: Clinical recovery, EBOV RNA level, resolution of Ebola viremia, survival with discharge from hospital, or death.

Results: The index patient had high EBOV RNA levels, developed respiratory and renal failure requiring critical care support, and died. Both patients with secondary EBOV infection had nonspecific signs and symptoms and developed moderate illness; EBOV RNA levels were moderate, and both patients recovered.

Limitation: Both surviving patients received uncontrolled treatment with multiple investigational agents, including convalescent plasma, which limits generalizability of the results.

Conclusion: Early diagnosis, prompt initiation of supportive medical care, and moderate clinical illness likely contributed to successful outcomes in both survivors. The inability to determine the potential benefit of investigational therapies and the effect of patient-specific factors that may have contributed to less severe illness highlight the need for controlled clinical studies of these interventions, especially in the setting of a high level of supportive medical care.

Primary Funding Source: None.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7326/M15-0530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4724427PMC
July 2015

Predominance of Ehrlichia ewingii in Missouri dogs.

J Clin Microbiol 2003 Oct;41(10):4617-22

Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.

To investigate the species distribution of Ehrlichia present in Missouri dogs, we tested 78 dogs suspected of having acute ehrlichiosis and 10 healthy dogs. Blood from each dog was screened with a broad-range 16S rRNA gene PCR assay that detects known pathogenic species of Ehrlichia and ANAPLASMA: The species was determined by using species-specific PCR assays and nucleotide sequencing. Ehrlichia antibody testing was performed by using an indirect immunofluorescence assay with Ehrlichia chaffeensis as the antigenic substrate. The broad-range assay detected Ehrlichia or Anaplasma DNA in 20 (26%) of the symptomatic dogs and 2 (20%) of the asymptomatic dogs. E. ewingii accounted for 20 (91%), and E. chaffeensis accounted for 1 (5%) of the positives. Anaplasma phagocytophilum DNA was detected in one dog, and the sequences of regions of the 16S rRNA gene and the groESL operon amplified from the blood of this dog matched the published sequences of this organism. Antibodies reactive with E. chaffeensis were detected in 14 (67%) of the 21 PCR-positive dogs and in 12 (19%) of the 64 PCR-negative dogs. Combining the results of PCR and serology indicated that 33 (39%) of 85 evaluable dogs had evidence of past or current Ehrlichia infection. We conclude that E. ewingii is the predominant etiologic agent of canine ehrlichiosis in the areas of Missouri included in this survey. E. canis, a widely recognized agent of canine ehrlichiosis, was not detected in any animal. The finding of E. ewingii in asymptomatic dogs suggests that dogs could be a reservoir for this Ehrlichia species.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC254352PMC
http://dx.doi.org/10.1128/jcm.41.10.4617-4622.2003DOI Listing
October 2003

Detection of Ehrlichia spp. in the blood of wild white-tailed deer in Missouri by PCR assay and serologic analysis.

J Clin Microbiol 2003 Mar;41(3):1263-5

Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri 63110, USA.

Blood samples collected from wild deer in Missouri in November of 2000 and 2001 were positive by PCR assays for Ehrlichia chaffeensis (50 of 217; 23%), Ehrlichia ewingii (44 of 217; 20%), and Anaplasma species (214 of 217; 99%). Nucleotide sequences of selected amplicons from the assay for anaplasma matched sequences of the white-tailed deer agent. Serologic analysis of 112 deer sampled in 2000 showed a very high prevalence of antibodies to E. chaffeensis (97 of 112; 87%) and a low prevalence of antibodies reactive with Anaplasma phagocytophila (2 of 112; 2%).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC150261PMC
http://dx.doi.org/10.1128/jcm.41.3.1263-1265.2003DOI Listing
March 2003

Reinfection with Ehrlichia chaffeensis in a liver transplant recipient.

Clin Infect Dis 2002 Jun 16;34(12):1644-7. Epub 2002 May 16.

Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA.

Human monocytic ehrlichiosis is an emerging infection caused by Ehrlichia chaffeensis, but reinfection with this agent has not been described. We report a case of reinfection with E. chaffeensis after a 2-year interval in a 56-year-old liver transplant recipient with frequent tick attachments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1086/340523DOI Listing
June 2002