Jorge A Guzman

Cleveland Clinic, Cleveland, Ohio, United States

Are you Jorge A Guzman?

Claim your profile

Publications (34)116.02 Total impact

  • Anita Reddy · Seth Bauer · Thomas Fraser · Steven Gordon · Jorge Guzman ·

    Critical care medicine 11/2015; 43(12 Suppl 1):217. DOI:10.1097/01.ccm.0000474692.11983.d7 · 6.31 Impact Factor

  • Critical care medicine 11/2015; 43(12 Suppl 1):201. DOI:10.1097/01.ccm.0000474627.79221.42 · 6.31 Impact Factor

  • Critical care medicine 11/2015; 43(12 Suppl 1):42-43. DOI:10.1097/ · 6.31 Impact Factor
  • Anita J Reddy · Simon W Lam · Seth R Bauer · Jorge A Guzman ·
    [Show abstract] [Hide abstract]
    ABSTRACT: In hospitalized patients, elevated serum lactate levels are both a marker of risk and a target of therapy. The authors describe the mechanisms underlying lactate elevations, note the risks associated with lactic acidosis, and outline a strategy for its treatment.
    Cleveland Clinic Journal of Medicine 09/2015; 82(9):615-624. DOI:10.3949/ccjm.82a.14098 · 2.71 Impact Factor
  • Anita J Reddy · Jorge A Guzman ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Quality improvement in the health care setting is a complex process, and even more so in the critical care environment. The development of intensive care unit process measures and quality improvement strategies are associated with improved outcomes, but should be individualized to each medical center as structure and culture can differ from institution to institution. The purpose of this report is to describe the structure of quality improvement processes within a large medical intensive care unit while using examples of the study institution's successes and challenges in the areas of stat antibiotic administration, reduction in blood product waste, central line-associated bloodstream infections, and medication errors. © The Author(s) 2015.
    American Journal of Medical Quality 07/2015; DOI:10.1177/1062860615593999 · 1.25 Impact Factor

  • SCCM; 01/2015

  • SCCM; 01/2015
  • Jonathan Wiesen · Dhruv Joshi · Jorge Guzman · Abhijit Duggal ·

    SCCM; 01/2015
  • Abhijit Duggal · Shruti1 Gadre · Jorge Guzman ·

    Society For Critical Care Medicine, Critical Care Medicine:; 01/2015
  • Abhijit Duggal · Shruti1 Gadre · Jorge Guzman ·

    Society for Critical Care Medicine, Critical Care Medicine; 01/2015
  • Shruti Gadre · Abhijit Duggal · Jorge Guzman ·

    American College of Chest Physicians; 10/2014

  • Chest- American College of Chest Physicians; 10/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Intensive care unit (ICU) resources are scarce, yet demand is increasing at a rapid rate. Optimizing throughput efficiency while balancing patient safety and quality of care is of utmost importance during times of high ICU utilization. Continuous improvement methodology was used to develop a multidisciplinary workflow to improve throughput in the ICU while maintaining a high quality of care and minimizing adverse outcomes. The research team was able to decrease ICU occupancy and therefore ICU length of stay by implementing this process without increasing mortality or readmissions to the ICU. By improving throughput efficiency, more patients were able to be provided with care in the ICU.
    American Journal of Medical Quality 04/2014; 30(4). DOI:10.1177/1062860614531614 · 1.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Outcomes/Quality Control PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PMPURPOSE: High acuity centers struggle to preserve open communication between nurses and primary teams in the medical intensive care unit (MICU) in the face of increasing patient volumes. Compounding the complexity of this issue, reimbursements are tied to performance metrics such as communication scores and patient experience. Heretofore, patient care teams were assigned by chronologic rotation of admissions, independent of location. This study examines the impact of geographically aligned patient care teams on perceived communication, education and employee satisfaction.METHODS: Surveys were distributed to pulmonary and critical care fellows, nurses and respiratory therapists (RT) before and two months after the switch to a geographic system to assess their impressions of team communication, delivery of care, education and overall satisfaction. Employee engagement surveys and HCAHPS scores were reviewed as well.RESULTS: Although there were no differences in the communication of nurses and RT with patient's families and consultants after the switch to geographic distribution, many more nurses (71 vs. 34) and RT (25 vs. 2) reported improved communication with the primary team (p<0.001). Overall satisfaction with the MICU experience improved as well after the geographic distribution of patients was implemented (67 vs. 44 nurses, 25 vs. 2 RT, p<0.001). Fellows similarly felt that the geographic distribution allowed them to monitor patients more closely (20 vs. 5), respond more quickly to crashing patients during rounds (20 vs. 8), communicate more effectively with nurses (19 vs. 6) and patient families (17 vs. 10), and optimize time for education (12 vs. 3, for all p<0.001). Satisfaction among fellows was improved with the geographic distribution of patients as well (p<0.001).CONCLUSIONS: Geographic patient distribution significantly improved the morale of both fellows and nurses, and was thought to improve communication with all vital members of the clinical team. Education in the MICU was thought to be enhanced as well.CLINICAL IMPLICATIONS: Improved communication within a multidisciplinary team is important to enhance patient experiences and outcomes. The study demonstrates the benefit of low-cost strategic organizational initiatives. Opportunities for future research exist in correlating value-based purchasing metrics with non-clinical initiatives to improve patient care, experience and cost.DISCLOSURE: The following authors have nothing to disclose: Jonathan Wiesen, Rafid Fadul, Joseph Khabbaza, James Middleton, Jorge GuzmanNo Product/Research Disclosure Information.
    Chest 10/2013; 144(4_MeetingAbstracts):557A. DOI:10.1378/chest.1703515 · 7.48 Impact Factor
  • Simon W Lam · Seth R Bauer · Jorge A Guzman ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Our understanding of the pathophysiology and treatment of sepsis has advanced over the last decade, and evidence-based protocols have improved its outcomes. Here, we review its management in the first hours and afterward, including topics of ongoing study and debate.
    Cleveland Clinic Journal of Medicine 03/2013; 80(3):175-84. DOI:10.3949/ccjm.80a.12002 · 2.71 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Little is known about endotracheal tube (ETT) migration during routine care among critically ill patients. AirWave is a novel device that uses sonar waves to measure ETT migration and obstructions in real time. The aim of the present study is to assess the accuracy of the AirWave to evaluate ETT migration. In addition, we determined the degree of variation in ETT position and tested whether more pronounced migration occurs in specific clinical scenarios. Methods: After institutional review board approval, we included mechanically ventilated patients from February 2012 to May 2012. A chest radiography (CXR) was obtained at baseline and 24 hours when clinically indicated. The ETT distance at the lips was recorded at baseline and every 4 hours. The AirWave system continuously recorded ETT position changes from baseline, and luminal obstructions. Results: A total of 42 patients (age: 61 [SD ±13] years, men: 52%) were recruited. A total of 19 patients had measurements of ETT migration at 24 hours by the 3 methodologies used in this study. The mean (SD) of the ETT migration at 24 hours was +0.04 (1.2), -0.42 (0.7) and +0.34 (1.81) cm when measured by portable CXR, ETT distance at the teeth and AirWave device, respectively. Bland-Altman analysis of tube migration at 24 hours comparing the AirWave with CXR readings showed a bias of 0.1 cm with 95% limit of agreement of -3.8 and +4.3 cm. Comparison of tube migration at 24 hours determined by AirWave with ETT distance at the lips revealed a bias of -0.4 with 95% limit of agreement -3.7 to +3 cm, similar to the values observed between CXR and ETT distance at the lips (bias of -0.3 cm, 95% limit of agreement of -3.4 to +2.8 cm). Factors associated with ETT migration at 24 hours were ETT size and initial measurement from ETT tip to carina by portable CXR. AirWave detected in eight patients some degree of ETT obstruction (30% ± 9.6%) that resolved with prompt ETT catheter suction. Conclusions: The AirWave may provide useful information regarding ETT migration and obstruction in real time.
    Journal of critical care 02/2013; 28(4). DOI:10.1016/j.jcrc.2012.10.015 · 2.00 Impact Factor
  • Jorge A. Guzman ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Carbon monoxide (CO) poisoning is the leading cause of death as a result of unintentional poisoning in the United States. CO toxicity is the result of a combination of tissue hypoxia-ischemia secondary to carboxyhemoglobin formation and direct CO-mediated damage at a cellular level. Presenting symptoms are mostly nonspecific and depend on the duration of exposure and levels of CO. Diagnosis is made by prompt measurement of carboxyhemoglobin levels. Treatment consists of the patient's removal from the source of exposure and the immediate administration of 100% supplemental oxygen in addition to aggressive supportive measures. The use of hyperbaric oxygen is controversial.
    Critical care clinics 10/2012; 28(4):537–548. DOI:10.1016/j.ccc.2012.07.007 · 2.16 Impact Factor
  • Haala Rokadia · Esteban Walker · Rendell Ashton · Jorge Guzman ·
    [Show abstract] [Hide abstract]
    ABSTRACT: SESSION TYPE: ICU Safety and Quality PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: In the current climate of policy reform, there is increased pressure to deliver cost-effective and safe medical care. It is important to determine how increased intensive care unit (ICU) patient volume affects patient outcomes, specifically mortality and length of stay (LOS). Aim: To evaluate the role of increased ICU patient volume on risk-adjusted ICU and hospital mortality and LOS.METHODS: Methods: We performed a retrospective analysis of all patients admitted to the medical ICU (MICU) at our institution between January 2008-October 2011. We collected demographic, clinical, and admission/discharge information on each patient and calculated APACHE-IV scores. We calculated population data on weekly patient volumes, mortality rates, and LOS. Multivariate logistic and linear regression was used to assess these associations.RESULTS: Results: 7848 patient encounters were available for analysis. The population had a mean age of 59.9(15.7) years, a balanced male/female ratio, and was predominantly Caucasian (67.2%). Admissions were predominantly from nursing floors (34.3%), hospital transfers (36.7%), and emergency department (18.4%). The MICU patient volume increased 3-fold over the course of the study period. The mean (SD) weekly patient volumes for 2008, 2009, 2010, and 2011 were 38(6), 57(6), 83(13), and 103(12) patients, respectively. In multivariate analysis, hospital and ICU mortality rates adjusted for APACHE-IV score decreased with increasing ICU weekly volumes (p<0.001 for both comparisons). Additionally, we found that increased ICU weekly volume was associated with shorter ICU LOS(p=0.0006) and shorter overall hospital LOS(p<0.0001).CONCLUSIONS: Our study demonstrated that an increase in the ICU patient volume is associated with reduction in the risk-adjusted ICU mortality and overall inpatient mortality rate. In addition to mortality metrics, there was a significant reduction in ICU and in-hospital LOS with increasing ICU patient volume. Although mortality and length of stay are subject to unmeasured variables, our study demonstrated an association between higher ICU patient volumes and improved outcomes that lends itself to further study.CLINICAL IMPLICATIONS: This suggests that rapidly expanding the patient volume in the ICU can be done safely and efficiently.DISCLOSURE: The following authors have nothing to disclose: Haala Rokadia, Esteban Walker, Rendell Ashton, Jorge GuzmanNo Product/Research Disclosure InformationCleveland Clinic, Cleveland, OH.
    Chest 10/2012; 142(4_MeetingAbstracts):381A. DOI:10.1378/chest.1390672 · 7.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: SESSION TYPE: Sepsis/ShockPRESENTED ON: Sunday, October 21, 2012 at 10:30 AM - 11:45 AMPURPOSE: PCT increases in response to severe systemic bacterial infections and sepsis early after ICU admission, however, the value of a day to day change is less understood. We studied the predictive value of PCT in comparison to lactate and absolute neutrophil count (ANC) for the diagnosis of sepsis and hospital mortality in patients admitted to a MICU.METHODS: Consecutive patients admitted for ≥12 hrs. were included in this prospective observational study. Measurements of serum PCT were obtained on admission and then daily during the MICU stay. Lactate and ANC were measured as part of the routine clinical practice. SIRS, Sepsis, Severe Sepsis, and Septic Shock were defined according to standard criteria and assessed daily. Diagnostic and predictive accuracy was assessed by the area under the receiver operating characteristic curve (AUC).RESULTS: 318 patients were enrolled in the study. Mean ± SD APACHE IV score was 69.8 ± 30. 44% were septic on ICU admission and 7 % became septic later on. The AUC and cut-offs for PCT and lactate as predictors of sepsis on admission were 0.76 (1.46 ng/mL) and 0.62 (1.0 mmol/L), respectively. The AUC for maximal PCT and lactate as sepsis predictors at any time during the ICU stay were 0.80 and 0.68 with cut-offs values similar to the admission ones. The combination of PCT + lactate did not increase the AUC (0.70 and 0.79 for admission and max any time, respectively). ANC was not better than the flip of a coin to predict sepsis development. Lactate had an AUC of 0.72 and 0.76 and PCT 0.64 and 0.66 for mortality prediction based on values on admission and at any time thereafter, respectively.CONCLUSIONS: PCT has a superior diagnostic accuracy for sepsis that was not improved by the addition of lactate to the predictive model. PCT is less helpful to predict ICU mortality.CLINICAL IMPLICATIONS: PCT is a valuable tool assisting clinicians with sepsis diagnosis at any time during the ICU stay.DISCLOSURE: Jorge Guzman: Grant monies (from industry related sources): InvestigatorMadhu Sasidhar: Grant monies (from industry related sources): InvestigatorThe following authors have nothing to disclose: Gustavo Cumbo-Nacheli, Meng Xu, Vineesha ArelliNo Product/Research Disclosure InformationCleveland Clinic, Cleveland, OH.
    Chest 10/2012; 142(4_MeetingAbstracts):285A. DOI:10.1378/chest.1388348 · 7.48 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Critical illness due to 2009 H1N1 influenza has been characterized by respiratory complications, including acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), and associated with high mortality. We studied the severity, outcomes, and hospital charges of patients with ALI/ARDS secondary to pandemic influenza A infection compared with ALI and ARDS from other etiologies. Methods A retrospective review was conducted that included patients admitted to the Cleveland Clinic MICU with ALI/ARDS and confirmed influenza A infection, and all patients admitted with ALI/ARDS from any other etiology from September 2009 to March 2010. An itemized list of individual hospital charges was obtained for each patient from the hospital billing office and organized by billing code into a database. Continuous data that were normally distributed are presented as the mean ± SD and were analyzed by the Student’s t test. The chi-square and Fisher exact tests were used to evaluate differences in proportions between patient subgroups. Data that were not normally distributed were compared with the Wilcoxon rank-sum test. Results Forty-five patients were studied: 23 in the H1N1 group and 22 in the noninfluenza group. Mean ± SD age was similar (44 ± 13 and 51 ± 17 years, respectively, p = 0.15). H1N1 patients had lower APACHE III scores (66 ± 20 vs. 89 ± 32, p = 0.015) and had higher Pplat and PEEP on days 1, 3, and 14. Hospital and ICU length of stay and duration of mechanical ventilation were comparable. SOFA scores over the first 2 weeks in the ICU indicate more severe organ failure in the noninfluenza group (p = 0.017). Hospital mortality was significantly higher in the noninfluenza group (77 vs. 39%, p = 0.016). The noninfluenza group tended to have higher overall charges, including significantly higher cost of blood products in the ICU. Conclusions ALI/ARDS secondary to pandemic influenza infection is associated with more severe respiratory compromise but has lower overall acuity and better survival rates than ALI/ARDS due to other causes. Higher absolute charges in the noninfluenza group are likely due to underlying comorbid medical conditions.
    Annals of Intensive Care 08/2012; 2(1):41. DOI:10.1186/2110-5820-2-41 · 3.31 Impact Factor