Browsing by Author "Whittle, John"

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    2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
    (Circulation) Thompson, Annemarie; Fleischmann, Kirsten E; Smilowitz, Nathaniel R; de Las Fuentes, Lisa; Mukherjee, Debabrata; Aggarwal, Niti R; Ahmad, Faraz S; Allen, Robert B; Altin, S Elissa; Auerbach, Andrew; Berger, Jeffrey S; Chow, Benjamin; Dakik, Habib A; Eisenstein, Eric L; Gerhard-Herman, Marie; Ghadimi, Kamrouz; Kachulis, Bessie; Leclerc, Jacinthe; Lee, Christopher S; Macaulay, Tracy E; Mates, Gail; Merli, Geno J; Parwani, Purvi; Poole, Jeanne E; Rich, Michael W; Ruetzler, Kurt; Stain, Steven C; Sweitzer, BobbieJean; Talbot, Amy W; Vallabhajosyula, Saraschandra; Whittle, John; Williams, Kim Allan
    Aim: The “2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery” provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. Methods: A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Structure: Recommendations from the “2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery” have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed.
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    Assessments of frailty in bladder cancer.
    (Urologic oncology, 2020-05-22) Grimberg, Dominic C; Shah, Ankeet; Molinger, Jeroen; Whittle, John; Gupta, Rajan T; Wischmeyer, Paul E; McDonald, Shelley R; Inman, Brant A
    BACKGROUND AND AIMS:The incidence of frailty is increasing as the population ages, which has important clinical implications given the associations between frailty and poor outcomes in the bladder cancer population. Due to a multi-organ system decline and decreased physiologic reserve, frail patients are vulnerable to stressors of disease and have poorer mortality and morbidity rates than their nonfrail peers. The association between frailty and poor outcomes has been documented across multiple populations, including radical cystectomy, creating a need for frailty assessments to be used preoperatively for risk stratification. We aim to provide a review of the common frailty assessments and their relevance to radical cystectomy patients. FINDINGS:A variety of assessments for frailty exist, from short screening items to comprehensive geriatric assessments. The syndrome spans multiple organ systems, as do the potential diagnostic instruments. Some instruments are less practical for use in clinical practice by urologists, such as the Canadian Study of Health and Aging Frailty Index and Comprehensive Geriatric Assessment. The tool most studied in radical cystectomy is the modified Frailty Index, associated with high grade complications and 30-days mortality. Frailty often coexists with malnutrition and sarcopenia, stressing the importance of screening for and addressing these syndromes to improve patient's perioperative outcomes. CONCLUSIONS:There is no universally agreed upon frailty assessment, but the most studied in radical cystectomy is the modified Frailty Index, providing valuable data with which to counsel patients preoperatively. Alterations in immune phenotypes provide potential future diagnostic biomarkers for frailty.
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    Effects of Acetaminophen, NSAIDs, Gabapentinoids, and Their Combinations on Postoperative Pulmonary Complications After Total Hip or Knee Arthroplasty.
    (Pain medicine (Malden, Mass.), 2020-02-26) Ohnuma, Tetsu; Raghunathan, Karthik; Ellis, Alan R; Whittle, John; Pyati, Srinivas; Bryan, William E; Pepin, Marc J; Bartz, Raquel R; Krishnamoorthy, Vijay
    OBJECTIVE:Multimodal analgesia has gained popularity in total hip arthroplasty (THA) and total knee arthroplasty (TKA), but large multicenter studies evaluating specific analgesic combinations are lacking. DESIGN:A retrospective study using the Premier Healthcare Database (2009-2014). SUBJECTS:Adults who underwent elective primary THA or TKA. METHODS:We categorized day-of-surgery analgesic exposure using eight mutually exclusive categories: acetaminophen (Ac), nonsteroidal anti-inflammatory drugs (Ns), gabapentinoids (Ga; gabapentin or pregabalin), Ac+Ns, Ac+Ga, Ns+Ga, Ac+Ns+Ga, and none of the three drugs. Multilevel models measured associations of the analgesic categories with a composite of postoperative pulmonary complications (PPCs). RESULTS:Among 863,139 patients, 75.2% received at least one of the three drugs. In multilevel models, compared with none of the three drugs, Ga use was associated with increased odds of PPCs when used alone (adjusted odds ratio [aOR] = 1.35, 95% confidence interval [CI] = 1.27 to 1.44), combined with Ac (aOR = 1.16, 95% CI = 1.08 to 1.26), or combined with Ns (aOR = 1.28, 95% CI = 1.21 to 1.34). In contrast, the Ac+Ns pair was associated with decreased odds of PPCs (OR = 0.86, 95% CI = 0.83 to 0.90) and lower opioid consumption. Ac+Ns+Ga was not associated with PPCs, whereas it was associated with the lowest opioid consumption on the day of surgery. CONCLUSIONS:Gabapentinoids, alone and in single combination with either acetaminophen or nonsteroidal anti-inflammatory drugs, were associated with higher PPCs, whereas the Ac+Ns pair was associated with fewer PPCs and an opioid-sparing effect. Ac+Ns+Ga was not associated with PPCs, whereas it was associated with the lowest opioid consumption on the day of surgery.
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    Focused cardiac ultrasound in preoperative assessment: the perioperative provider’s new stethoscope?
    (Perioperative Medicine, 2019-12) Lenk, Tara; Whittle, John; Miller, Timothy E; Williams, David GA; Bronshteyn, Yuriy S
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    Impact of an enhanced recovery pathway on length of stay and complications in elective radical cystectomy: a before and after cohort study
    (Perioperative Medicine, 2019-12) Dunkman, W Jonathan; Manning, Michael W; Whittle, John; Hunting, John; Rampersaud, Edward N; Inman, Brant A; Thacker, Julie K; Miller, Timothy E
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    Implications for Neuromodulation Therapy to Control Inflammation and Related Organ Dysfunction in COVID-19
    (Journal of Cardiovascular Translational Research) Fudim, Marat; Qadri, Yawar J; Ghadimi, Kamrouz; MacLeod, David B; Molinger, Jeroen; Piccini, Jonathan P; Whittle, John; Wischmeyer, Paul E; Patel, Manesh R; Ulloa, Luis
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    Novel approaches to metabolic assessment and structured exercise to promote recovery in ICU survivors
    (Current Opinion in Critical Care, 2020-06-19) Molinger, Jeroen; Pastva, Amy M; Whittle, John; Wischmeyer, Paul E
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    Perioperative Quality Initiative (POQI) consensus statement on fundamental concepts in perioperative fluid management: fluid responsiveness and venous capacitance
    (Perioperative Medicine, 2020-12) Martin, Greg S; Kaufman, David A; Marik, Paul E; Shapiro, Nathan I; Levett, Denny ZH; Whittle, John; MacLeod, David B; Chappell, Desiree; Lacey, Jonathan; Woodcock, Tom; Mitchell, Kay; Malbrain, Manu LNG; Woodcock, Tom M; Martin, Daniel; Imray, Chris HE; Manning, Michael W; Howe, Henry; Grocott, Michael PW; Mythen, Monty G; Gan, Tong J; Miller, Timothy E
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    Persistent hypermetabolism and longitudinal energy expenditure in critically ill patients with COVID-19.
    (Critical care (London, England), 2020-09-28) Whittle, John; Molinger, Jeroen; MacLeod, David; Haines, Krista; Wischmeyer, Paul E; LEEP-COVID Study Group
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    Prospective Investigation of Markers of Elevated Delirium Risk (PRIMED Risk) study protocol: a prospective, observational cohort study investigating blood and cerebrospinal fluid biomarkers for delirium and cognitive dysfunction in older patients
    (Wellcome Open Research) Whitby, Jonathan; Bampoe, Sohail; Fullerton, James N; Smaje, Ashley; Hornby, Joanna; Hajdu, Bence; Schofield, Nick; Stafford, Ronnie; Zetterberg, Henrik; McAuley, Daniel F; Passmore, Peter; Cunningham, Emma; Whittle, John; Walker, David; Davis, Daniel
    Background: Delirium is a common post-operative complication, particularly in older adults undergoing major or emergency procedures. It is associated with increased length of intensive care and hospital stay, post-operative mortality and subsequent dementia risk. Current methods of predicting delirium incidence, duration and severity have limitations. Investigation of blood and cerebrospinal fluid (CSF) biomarkers linked to delirium may improve understanding of the underlying pathophysiology, particularly with regard to the extent this is shared or distinct with underlying dementia. Together, these have the potential for development of better risk stratification tools and perioperative interventions. Methods: 200 patients over the age of 70 scheduled for surgery with routine spinal anaesthetic will be recruited from UK hospitals. Their cognitive and functional baseline status will be assessed pre-operatively by telephone. Time-matched CSF and blood samples will be taken at the time of surgery and analysed for known biomarkers of neurodegeneration and neuroinflammation. Patients will be assessed daily for delirium until hospital discharge and will have regular cognitive follow-up for two years. Primary outcomes will be change in modified Telephone Interview for Cognitive Status (TICS-m) score at 12 months and rate of change of TICS-m score. Delirium severity, duration and biomarker levels will be treated as exposures in a random effects linear regression models. PRIMED Risk has received regulatory approvals from Health Research Authority and London – South East Research Ethics Committee. Discussion: The main anticipated output from this study will be the quantification of biomarkers of acute and chronic contributors to cognitive impairment after surgery. In addition, we aim to develop better risk prediction models for adverse cognitive outcomes.
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    The MARBLE Study Protocol: Modulating ApoE Signaling to Reduce Brain Inflammation, DeLirium, and PostopErative Cognitive Dysfunction.
    (Journal of Alzheimer's disease : JAD, 2020-01) VanDusen, Keith W; Eleswarpu, Sarada; Moretti, Eugene W; Devinney, Michael J; Crabtree, Donna M; Laskowitz, Daniel T; Woldorff, Marty G; Roberts, Kenneth C; Whittle, John; Browndyke, Jeffrey N; Cooter, Mary; Rockhold, Frank W; Anakwenze, Oke; Bolognesi, Michael P; Easley, Mark E; Ferrandino, Michael N; Jiranek, William A; Berger, Miles; MARBLE Study Investigators
    BACKGROUND:Perioperative neurocognitive disorders (PND) are common complications in older adults associated with increased 1-year mortality and long-term cognitive decline. One risk factor for worsened long-term postoperative cognitive trajectory is the Alzheimer's disease (AD) genetic risk factor APOE4. APOE4 is thought to elevate AD risk partly by increasing neuroinflammation, which is also a theorized mechanism for PND. Yet, it is unclear whether modulating apoE4 protein signaling in older surgical patients would reduce PND risk or severity. OBJECTIVE:MARBLE is a randomized, blinded, placebo-controlled phase II sequential dose escalation trial designed to evaluate perioperative administration of an apoE mimetic peptide drug, CN-105, in older adults (age≥60 years). The primary aim is evaluating the safety of CN-105 administration, as measured by adverse event rates in CN-105 versus placebo-treated patients. Secondary aims include assessing perioperative CN-105 administration feasibility and its efficacy for reducing postoperative neuroinflammation and PND severity. METHODS:201 patients undergoing non-cardiac, non-neurological surgery will be randomized to control or CN-105 treatment groups and receive placebo or drug before and every six hours after surgery, for up to three days after surgery. Chart reviews, pre- and postoperative cognitive testing, delirium screening, and blood and CSF analyses will be performed to examine effects of CN-105 on perioperative adverse event rates, cognition, and neuroinflammation. Trial results will be disseminated by presentations at conferences and peer-reviewed publications. CONCLUSION:MARBLE is a transdisciplinary study designed to measure CN-105 safety and efficacy for preventing PND in older adults and to provide insight into the pathogenesis of these geriatric syndromes.