Philip D Lumb

University of Southern California, Los Ángeles, California, United States

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Publications (45)99.35 Total impact

  • Philip D Lumb
    Journal of critical care 06/2015; 30(3):443. DOI:10.1016/j.jcrc.2015.03.020 · 2.19 Impact Factor
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    ABSTRACT: Objective: Cost comparison between three common anesthetic agents. Design: Retrospective analysis. Patients had been randomized to anesthetic maintenance with either desflurane, sevoflurane, or propofol. Setting: Operating room in an academic medical center Patients: 103 patients undergoing general endotracheal anesthesia. Patients were ASA class I-III and between 18 and 75 years old. Cardiac, Neurologic, and regional cases were excluded. Outcome Measures: Volatile anesthetic cost was determined using the following formula: Cost = [(concentration) (FGF)(duration)(MW)(cost/ml)]/[2412)(D)]. To determine propofol cost, average infusion rate (mcg/kg/min.), patient weight, and duration were measured. Cost for each agent was then divided by surgical time to compare the results on a cost/min. basis. Results: Per minute of surgery, propofol was the least expensive agent for anesthetic maintenance at $0.12/min. Sevoflurane cost $0.18/min and desflurane cost $0.48/min. The differences between all three agents were statistically significant (p <0.05). Propofol maintenance was associated with a higher intra-operative fentanyl dose. The average fentanyl dose in the propofol group was 468 mcg, sevoflurane was 321 mcg, and desflurane was 284 mcg. There was no association between intra-operative fentanyl dose and anesthetic maintenance cost per minute of surgery. Surgical time did not significantly differ between the three groups and averaged over three hours. Conclusion: Anesthetic maintenance with propofol may help peri-operative physicians deliver care in the most cost effective manner possible.. Anesthetic maintenance with propofol infusion is less expensive per minute of surgery than sevoflurane or desflurane.
    Anaesthesia, Pain and Intensive Care 09/2014; 17(September to December 2013):17(3):248-251.
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    ABSTRACT: Objective: To examine the impact of intravenous antihypertensive selection on hospital health resource utilization using data from the Evaluation of CLevidipine In the Perioperative Treatment of Hypertension Assessing Safety Events (ECLIPSE) trials. Methods: Analysis of ECLIPSE trial data comparing clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine and unit costs based on the Premier Hospital database to assess surgery duration, time to extubation, and length of stay (LOS) with the associated cost. Results: A total of 1414 patients from the ECLIPSE trials and the Premier hospital database were included for analysis. The duration of surgery and postoperative LOS were similar across groups. The time from chest closure to extubation was shorter in patients receiving clevidipine group compared with the pooled comparator group (median 7.0 vs 7.6 hours, P = 0.04). There was shorter intensive care unit (ICU) LOS in the clevidipine group versus the nitroglycerin group (median 27.2 vs 33.0 hours, P = 0.03). A trend toward reduced ICU LOS was also seen in the clevidipine compared with the pooled comparator group (median 32.3 vs 43.5 hours, P = 0.06). The costs for ICU LOS and time to extubation were lower with clevidipine than with the comparators, with median cost savings of $887 and $34, respectively, compared with the pooled comparator group, for a median cost savings of $921 per patient. Conclusions: Health resource utilization across therapeutic alternatives can be derived from an analysis of standard costs from hospital financial data to matched utilization metrics as part of a randomized controlled trial. In cardiac surgical patients, intravenous antihypertensive selection was associated with a shorter time to extubation in the ICU and a shorter ICU stay compared with pooled comparators, which in turn may decrease total costs.
    Hospital practice (1995) 08/2014; 42(3):26-32. DOI:10.3810/hp.2014.08.1115
  • Philip D Lumb
    Journal of Critical Care 08/2014; 29(4):477. DOI:10.1016/j.jcrc.2014.05.002 · 2.19 Impact Factor
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    ABSTRACT: To examine the impact of blood pressure control on hospital health resource utilization using data from the ECLIPSE trials. Post-hoc analysis of data from 3 prospective, open-label, randomized clinical trials (ECLIPSE trials). Sixty-one medical centers in the United States. Patients 18 years or older undergoing cardiac surgery. Clevidipine was compared with nitroglycerin, sodium nitroprusside, and nicardipine. The ECLIPSE trials included 3 individual randomized open-label studies comparing clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine. Blood pressure control was assessed as the integral of the cumulative area under the curve (AUC) outside specified systolic blood pressure ranges, such that lower AUC represents less variability. This analysis examined surgery duration, time to extubation, as well as intensive care unit (ICU) and hospital length of stay (LOS) in patients with AUC≤10 mmHg×min/h compared to patients with AUC>10 mmHg×min/h. One thousand four hundred ten patients were included for analysis; 736 patients (52%) had an AUC≤10 mmHg×min/h, and 674 (48%) had an AUC>10 mmHg×min/h. The duration of surgery and ICU LOS were similar between groups. Time to extubation and postoperative LOS were both significantly shorter (p = 0.05 and p<0.0001, respectively) in patients with AUC≤10. Multivariate analysis demonstrates AUC≤10 was significantly and independently associated with decreased time to extubation (hazard ratio 1.132, p = 0.0261) and postoperative LOS (hazard ratio 1.221, p = 0.0006). Based on data derived from the ECLIPSE studies, increased perioperative BP variability is associated with delayed time to extubation and increased postoperative LOS.
    Journal of cardiothoracic and vascular anesthesia 04/2014; 28(3). DOI:10.1053/j.jvca.2014.01.004 · 1.48 Impact Factor
  • Philip D Lumb
    Journal of critical care 01/2014; 29(2). DOI:10.1016/j.jcrc.2014.01.026 · 2.19 Impact Factor
  • Philip Lumb
    Journal of critical care 12/2013; 28(6):887-9. DOI:10.1016/j.jcrc.2013.10.001 · 2.19 Impact Factor
  • Article: Editorial.
    Philip D Lumb
    Journal of critical care 10/2013; 28(5):539-40. DOI:10.1016/j.jcrc.2013.07.060 · 2.19 Impact Factor
  • Philip D Lumb
    Journal of critical care 08/2013; 28(4):319-320. DOI:10.1016/j.jcrc.2013.05.013 · 2.19 Impact Factor
  • Philip D Lumb
    Journal of critical care 06/2013; 28(3):221-2. DOI:10.1016/j.jcrc.2013.03.016 · 2.19 Impact Factor
  • Giuseppe Ristagno · Antonino Gullo · Philip Lumb
    Journal of critical care 04/2013; 28(2):113-5. DOI:10.1016/j.jcrc.2013.02.001 · 2.19 Impact Factor
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    Philip D Lumb
    Journal of critical care 02/2013; 28(1):1. DOI:10.1016/j.jcrc.2012.11.006 · 2.19 Impact Factor
  • Philip D Lumb
    Journal of critical care 12/2012; 27(6):535-536. DOI:10.1016/j.jcrc.2012.10.009 · 2.19 Impact Factor
  • Philip D Lumb
    Journal of critical care 10/2012; 27(5):427. DOI:10.1016/j.jcrc.2012.08.008 · 2.19 Impact Factor
  • Philip D Lumb
    Journal of critical care 08/2012; 27(4):327-8. DOI:10.1016/j.jcrc.2012.06.014 · 2.19 Impact Factor
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    ABSTRACT: High-frequency percussive ventilation (HFPV) is an effective rescue therapy in ventilated patients with acute lung injury. High levels of inspired oxygen (FiO(2)) are toxic to the lungs. The objective of this study was to review a low FiO(2) (0.25)/HFPV protocol as a protective strategy in burn patients receiving mechanical ventilation greater than 10days. A single-center, retrospective study in burn patients between December 2002 and May 2005 at the LAC+USC Burn Center. Demographic and physiologic data were recorded from time of admission to extubation, 4weeks, or death. 32 subjects were included in this study, 1 patient failed the protocol. 23 of 32 (72%) patients were men and mean age was 46±15years. Average TBSA burn was 30±20 with 9 of 32 (28%) having >40% TBSA involved. Average burn index was 76±21. 22 of 32 (69%) had inhalation injury and 23 of 32 (72%) had significant comorbidities. Average ventilator parameters included ventilator days 24±12, FiO(2) 0.28±0.03, PaO(2) 107±15Torr, PaCO(2) 42±4Torr, and PaO(2)/FiO(2) ratio 395±69. 16 of 32 (50%) patients developed pneumonia and 9 of 32 (28%) died. No patient developed ARDS, barotrauma, or died from respiratory failure. There was no association between inhalation injury and mortality in this group of patients. A low FiO(2)/HFPV protocol is a safe and effective way to ventilate critically ill burn patients. Reducing the oxidative stress of high inspired oxygen levels may improve outcome.
    Burns: journal of the International Society for Burn Injuries 07/2012; 38(7):984-91. DOI:10.1016/j.burns.2012.05.026 · 1.84 Impact Factor
  • Philip D Lumb
    Journal of critical care 06/2012; 27(3):223-4. DOI:10.1016/j.jcrc.2012.04.004 · 2.19 Impact Factor
  • Philip D Lumb
    Journal of critical care 04/2012; 27(2):107. DOI:10.1016/j.jcrc.2012.02.010 · 2.19 Impact Factor
  • Philip D Lumb
    Journal of critical care 02/2012; 27(1):1-2. DOI:10.1016/j.jcrc.2011.12.015 · 2.19 Impact Factor
  • Philip D Lumb
    Journal of critical care 12/2011; 26(6):537-8. DOI:10.1016/j.jcrc.2011.10.006 · 2.19 Impact Factor

Publication Stats

249 Citations
99.35 Total Impact Points

Institutions

  • 2004–2014
    • University of Southern California
      • Department of Anesthesiology
      Los Ángeles, California, United States
  • 2013
    • Mario Negri Institute for Pharmacological Research
      • Department of Cardiovascular Research
      Milano, Lombardy, Italy
  • 2005–2013
    • University of California, Los Angeles
      • Department of Anesthesiology
      Los Ángeles, California, United States
  • 2011
    • Sapienza University of Rome
      Roma, Latium, Italy
  • 2006–2011
    • Keck School of Medicine USC
      Los Ángeles, California, United States