D. Amariei

University of Maryland, Baltimore

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N. Dodia

University of Maryland, Baltimore

Jeffrey D. Hasday

University of Maryland, Baltimore

Ashutosh Sachdeva

University of Maryland, Baltimore

Stella E. Hines

University of Maryland, Baltimore

Jeffrey R. Galvin

University of Maryland, Baltimore

Mary Richert

National Institutes of Health Clinical Center

Janaki Deepak

University of Maryland, Baltimore

Carl Shanholtz

University of Maryland, Baltimore

Nevins W. Todd

Baltimore VA Medical Center

N.W. Todd

University of Maryland, Baltimore

Cooperative Institutions

University of Maryland, Baltimore

University of Maryland Medical Center

Pulmonary and Critical Care Associates

Carol Davila University of Medicine and Pharmacy

Clinical Emergency Hospital Bucharest

Baltimore VA Medical Center

University of Maryland, College Park

Boston University

University of Baltimore

Johns Hopkins University

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Troubleshooting a dialysis line: when blue runs red

BMJ Case Reports (2018)

D. Amariei Robert M. Reed

We present the case of a critically ill woman whose dialysis line was noted to be circulating bright red blood. Located in the right internal jugular vein, the line had previously been working normally with the change occurring shortly after the patient was liberated from positive pressure mechanical ventilation. An arterial malposition was ruled out and subsequent investigations revealed the presence of a left-sided partial anomalous pulmonary venous connection (PAPVC) that had been previously undiagnosed. The identification of a left-sided PAPVC from blood gas measurements taken from a right internal jugular vein dialysis catheter in this case provides an informative opportunity to consider the intricate physiological relationship between the respiratory and cardiovascular systems in critically ill patients requiring invasive procedures and treatments.

Dialysis catheter

Trouble shooting

Arterial line

Internal jugular vein

10.1136/bcr-2018-225972

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Citations (2)

A Survey of Academic Intensivists' Use of Neuromuscular Blockade in Subjects With ARDS

Respiratory Care (2019)

N. Dodia Mary Richert A. Deitchman Charlene C. Quinn Ellen Marciniak

BACKGROUND:

Our Cooling to Help Injured Lungs (CHILL) trial of therapeutic hypothermia in ARDS includes neuromuscular blockade (NMB) as an inclusion criterion to avoid shivering. NMB has been used to facilitate mechanical ventilation in ARDS and was shown to reduce mortality in the ACURASYS trial. To assess the feasibility of a multi-center CHILL trial, we conducted a survey of academic intensivists about their NMB use in patients with ARDS.

METHODS:

We distributed via email a 16-question survey about NMB use in patients with ARDS including frequency, indications, and dosing strategy.

RESULTS:

212 (24.3%) of 871 respondents completed the survey: 94.7% were board-certified in internal medicine, 88% in pulmonary and critical care; 90.3% practiced in academic medical centers, with 87% working in medical ICUs; 96.6% of respondents who treat ARDS use NMB, and 39.7% use NMB in ≥ 50% of these patients. Of 4 listed indications for initiating NMB in ARDS, allowing adherence with lung-protective ventilator strategies and patient–ventilator synchrony were cited as the most important reasons, followed by the results of the ACURASYS trial and facilitating prone positioning.

CONCLUSIONS:

We conclude that NMB is frequently used by academic intensivists to facilitate mechanical ventilation in patients with moderate to severe ARDS.

10.4187/respcare.07026

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Citations (13)

A comprehensive assessment of environmental exposures and the medical history guides multidisciplinary discussion in interstitial lung disease

Respiratory Medicine (2021)

N. Dodia D. Amariei Blaine Kenaa Doug Corwin Lydia Chelala

Hypersensitivity pneumonitis

Medical History

Histopathology

10.1016/j.rmed.2021.106333

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A Survey of Academic Pulmonary and Critical Care Physician Use of Neuromuscular Blocking Agents in Patients with ARDS

N. Dodia Mary Richert A. Deitchman D. Amariei Carl Shanholtz

Blocking (statistics)

Neuromuscular Blocking Agents

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a3454

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Combined Pulmonary Fibrosis and Emphysema: Pulmonary Function Testing and a Pathophysiology Perspective

Medicina (2019)

D. Amariei N. Dodia Janaki Deepak Stella E. Hines Jeffrey R. Galvin

Combined pulmonary fibrosis and emphysema (CPFE) has been increasingly recognized over the past 10–15 years as a clinical entity characterized by rather severe imaging and gas exchange abnormalities, but often only mild impairment in spirometric and lung volume indices. In this review, we explore the gas exchange and mechanical pathophysiologic abnormalities of pulmonary emphysema, pulmonary fibrosis, and combined emphysema and fibrosis with the goal of understanding how individual pathophysiologic observations in emphysema and fibrosis alone may impact clinical observations on pulmonary function testing (PFT) patterns in patients with CPFE. Lung elastance and lung compliance in patients with CPFE are likely intermediate between those of patients with emphysema and fibrosis alone, suggesting a counter-balancing effect of each individual process. The outcome of combined emphysema and fibrosis results in higher lung volumes overall on PFTs compared to patients with pulmonary fibrosis alone, and the forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio in CPFE patients is generally preserved despite the presence of emphysema on chest computed tomography (CT) imaging. Conversely, there appears to be an additive deleterious effect on gas exchange properties of the lungs, reflecting a loss of normally functioning alveolar capillary units and effective surface area available for gas exchange, and manifested by a uniformly observed severe reduction in the diffusing capacity for carbon monoxide (DLCO). Despite normal or only mildly impaired spirometric and lung volume indices, patients with CPFE are often severely functionally impaired with an overall rather poor prognosis. As chest CT imaging continues to be a frequent imaging modality in patients with cardiopulmonary disease, we expect that patients with a combination of pulmonary emphysema and pulmonary fibrosis will continue to be observed. Understanding the pathophysiology of this combined process and the abnormalities that manifest on PFT testing will likely be helpful to clinicians involved with the care of patients with CPFE.

DLCO

Pathophysiology

Vital capacity

10.3390/medicina55090580

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Citations (33)

Primary Pulmonary Alveolar Proteinosis in a Patient with Chronic Lymphoblastic Leukemia

J. Assadi A.S. Ray D. Amariei Ashutosh Sachdeva

Pulmonary alveolar proteinosis

Primary (astronomy)

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a3166

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Multidisciplinary Conference Provides Diagnostic Clarity in Interstitial Lung Disease

N. Dodia D. Amariei Stella E. Hines Allen Burke Jeffrey R. Galvin

CLARITY

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a3360

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The role of statins in chronic obstructive pulmonary disease

Current Opinion in Pulmonary Medicine (2018)

D. Amariei Robert M. Reed

The pleiotropic anti-inflammatory effects of statins that have proven to improve outcomes in cardiovascular disease have also been of interest in the treatment of COPD, a disease with considerable morbidity and little available treatment that improves mortality. In-vitro and animal studies have supported biologic plausibility of statin therapy for lung health and function. Retrospective observational studies in humans have echoed this potential as well but confirmatory data from randomized studies are limited and somewhat disappointing.Despite discouraging clinical trial results, the possibility remains that statins can help patients with COPD characterized by systemic inflammation. At the same time, increasing recognition of the considerable cardiovascular disease burden and its suboptimal treatment in patients with COPD has also contributed to continued enthusiasm for statin use in COPD.When it comes to defining the role for statins as a disease-modifying therapy, the jury is still out; however, the importance of more careful cardiovascular risk stratification that includes assessing levels of inflammatory markers in patients with COPD and the benefit of statins in those with increased risk is gaining increasing recognition.

10.1097/mcp.0000000000000551

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Treating Orthostatic Hypotension in Patients with Parkinson's Disease and Atypical Parkinsonism Improves Function

Journal of Parkinson s Disease (2012)

Anna DePold Hohler D. Amariei Douglas I. Katz Theslee Joy DePiero Valerie Allen

Patients with idiopathic Parkinson's disease (PD) or atypical Parkinsonism (AP) often present with orthostatic hypotension (OH) as a result of the dysautonomia associated with the disease or as a side effect of the dopaminergic medications used to treat it. Our recent study suggested that OH negatively impacts gross motor, balance, and cognitive functions in patients with PD.To determine if correcting the orthostatic hypotension (OH) of patients with PD or AP improves their gross motor, balance, and cognitive functions.Forty patients with PD or AP were assessed before and after correcting their OH using a staged approach with a goal of SBP >80 when standing and SBP <180 when laying. Step 1 of treatment included reducing antihypertensive medications, as possible, maintaining hydration with 1500cc/day, decreasing dietary salt, wearing high compression stockings, and keeping the head of bed elevated at 30 degrees when supine. If SBP <80 with standing after step 1, then treatment was started with fludrocortisone and/or midodrine.Patients' OH was managed as part of a rehabilitation program. Tests such as the Motor and Cognitive Functional Independence Measures, Berg Balance Scale, Two Minute Walking test, and the Finger Tapping test showed significant improvements (p < 0.05) in their gross motor, walking, balance and cognitive function with our OH management plan. No significant differences between admission and discharge were found in the Timed Up and Go test.Our data suggest that monitoring and correcting the OH of patients with PD or AP improves their gross motor, balance, and cognitive function.

Midodrine

Fludrocortisone

Gross motor skill

10.3233/jpd-2012-012101

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Citations (16)

Multi-Organ Failure in Hemophagocytic Lymphohistiocytosis Secondary to Ehrlichiosis: A Success Story

D. Amariei Timothy C Beer Faith Armstrong N.W. Todd Janaki Deepak

Hemophagocytic Lymphohistiocytosis

Ehrlichiosis

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a6522

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Citations (1)