Alejandro C Arroliga

Scott & White, Temple, Texas, United States

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Publications (193)1070.14 Total impact

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    ABSTRACT: Pleural infections are associated with significant morbidity and mortality. The recently developed RAPID score consists of five clinical factors that can identify patients at risk for increased mortality. The objective of this study is to further validate the RAPID score in a diverse cohort, identify factors associated with mortality, and provide long-term outcomes. We evaluated a single-center retrospective cohort of 187 patients with culture positive pleural infections. Patients were classified by RAPID scores into low (0-2), medium (3-4), and high risk (5-7) groups. Social security death index was used to determine date of death. All-cause mortality was assessed at 3 months, 1 year, 3 years, and 5 years. Clinical factors and comorbid conditions were evaluated for association. Three-month mortality for low, medium, and high risk groups was 1.5%, 17.8%, and 47.8%, respectively. Increased odds were observed among medium (OR 14.3; 95% CI=1.8-112.6; p=0.01) and high risk groups (OR 53.3; 95% CI=6.8-416.8; p<0.01). This trend continued at 1, 3, and 5 years. Factors associated with high risk scores include gram-negative rods infections, heart disease, diabetes, cancer, lung disease, and increased length of stay. When applied to a diverse patient cohort, the RAPID score predicts outcomes in patients up to 5 years and may aide in long term risk stratification on presentation.
    Annals of the American Thoracic Society 07/2015; 12(9). DOI:10.1513/AnnalsATS.201505-272OC
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    ABSTRACT: There are limited data available about the role of sedation and analgesia during noninvasive positive pressure ventilation (NPPV). The objective of study was to estimate the effect of analgesic or sedative drugs on the failure of NPPV. We studied patients who received at least 2 h of NPPV as first-line therapy in a prospective observational study carried out in 322 intensive care units from 30 countries. A marginal structural model (MSM) was used to analyze the association between the use of analgesic or sedative drugs and NPPV failure (defined as need for invasive mechanical ventilation). 842 patients were included in the analysis. Of these, 165 patients (19.6 %) received analgesic or sedative drugs at some time during NPPV; 33 of them received both. In the adjusted analysis, the use of analgesics (odds ratio 1.8, 95 % confidence interval 0.6-5.4) or sedatives (odds ratio 2.8, 95 % CI 0.85-9.4) alone was not associated with NPPV failure, but their combined use was associated with failure (odds ratio 5.7, 95 % CI 1.8-18.4). Slightly less than 20 % of patients received analgesic or sedative drugs during NPPV, with no apparent effect on outcome when used alone. However, the simultaneous use of analgesics and sedatives may be associated with failure of NPPV.
    Intensive Care Medicine 05/2015; 41(9). DOI:10.1007/s00134-015-3854-6 · 7.21 Impact Factor
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    ABSTRACT: Health care-acquired infections are a major contributor of mortality; therefore, prevention of these infections is a priority. Hand hygiene compliance among health care workers is low. We report the process at our institution to increase the hand hygiene compliance rate (HHCR).We implemented interventions over 6 months. The periods were divided into preintervention, intervention, and postintervention, and the monthly HHCR was calculated. The primary objective was to measure the HHCR after the intervention period and ensure sustainability. There were 25,372 observations, with 22,501 compliant events, for an overall HHCR of 88.7%. The HHCR improved over time (preintervention, 72.7%; invention, 79.7%; postintervention, 93.2%), with significance between pre-and postintervention periods (P < .002). The HHCR stabilized after all interventions and was sustained over 22 months. Our study highlights a multifaceted intervention, including administrative leadership, that led to an increase in the HHCR. Institutions should individualize their multimodal approach to include administrative leadership to achieve a high, sustained HHCR. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
    American Journal of Infection Control 03/2015; 43(5). DOI:10.1016/j.ajic.2015.01.024 · 2.21 Impact Factor
  • Juan F. Sanchez · Shekhar A. Ghamande · John K. Midturi · Alejandro C. Arroliga
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    ABSTRACT: Immunosuppression predisposes the host to development of pulmonary infections, which can lead to respiratory failure and the development of acute respiratory distress syndrome (ARDS). There are multiple mechanisms by which a host can be immunosuppressed and each is associated with specific infectious pathogens. Early invasive diagnostic modalities such as fiber-optic bronchoscopy with bronchoalveolar lavage, transbronchial biopsy, and open lung biopsy are complementary to serologic and noninvasive studies and assist in rapidly establishing an accurate diagnosis, which allows initiation of appropriate therapy and may improve outcomes with relative safety. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinics in Chest Medicine 12/2014; 35(4). DOI:10.1016/j.ccm.2014.08.008 · 2.07 Impact Factor
  • Alejandro C Arroliga · Jorge F Velazco · John K Midturi · Shekhar A Ghamande
    American Journal of Respiratory and Critical Care Medicine 11/2014; 190(10):1086-8. DOI:10.1164/rccm.201410-1886ED · 13.00 Impact Factor
  • The American Journal of Medicine 11/2014; 128(3). DOI:10.1016/j.amjmed.2014.11.001 · 5.00 Impact Factor
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    ABSTRACT: Acute respiratory distress syndrome (ARDS) remains challenging to diagnose and manage. This article reviews the new definition of ARDS and the key findings of landmark studies over the last 5 years of prone-position ventilation, high-frequency oscillatory ventilation (HFOV), extracorporeal membrane oxygenation (ECMO), and neuromuscular blockade in patients with ARDS.
    Cleveland Clinic Journal of Medicine 11/2014; 81(11):683-690. DOI:10.3949/ccjm.81a.14018 · 2.71 Impact Factor
  • Chest 10/2014; 146(4_MeetingAbstracts):902A. DOI:10.1378/chest.1995008 · 7.48 Impact Factor
  • Christopher Henry · Shekhar Ghamande · Alejandro C Arroliga · Heath White
    Chest 10/2014; 146(4_MeetingAbstracts):438A. DOI:10.1378/chest.1983105 · 7.48 Impact Factor
  • Vincent Scott · Adam Hayek · Anas Al Sadi · Shekhar Ghamande · Peter Yau · Alejandro C Arroliga
    Chest 10/2014; 146(4_MeetingAbstracts):900A. DOI:10.1378/chest.1991491 · 7.48 Impact Factor
  • Article: The Reply.
    John D Myers · Christian T Cable · Alejandro C Arroliga
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    ABSTRACT: Background: Peripherally inserted central catheters (PICCs) are increasingly utilized. Patient and system factors that increase risk of complications should be identified to avoid preventable patient harm. Methods: A case control analysis of adult inpatients who underwent PICC placement from January 2009 to January 2010 at Scott & White Memorial Hospital was conducted to determine the incidence and risk factors for complications. One hundred seventy cases of inpatients who experienced PICC-related complications were identified. Age- and gender-matched controls were randomly selected among patients who underwent PICC placement without documented complications during this time. Results: A total of 1444 PICCs were placed, with a complication rate of 11.77% (95% confidence interval: 10.11%-13.44%). Complications included catheter-associated thrombosis (3%), mechanical complications (4%), catheter-associated bloodstream infections (2%), and cellulitis (1%). In multivariable logistic regression analyses, malnutrition and after-hours placement were significantly associated with increased risk of complications, as was body mass index (BMI) >30 after adjusting for anticoagulation and time of placement. In a secondary multivariable logistic regression analysis, after-hours placement and malnutrition were significantly associated with increased risk of nonmechanical complications. Additionally, in conditional univariate analyses, length of stay, malnutrition, and after-hours placement were associated with increased risk of catheter-associated thrombosis. In our multivariable logistic regression analyses, use of anticoagulation/antiplatelet agents was associated with decreased risk of all-cause complications, nonmechanical complications, and catheter-associated thrombosis. Conclusions: Screening of patients undergoing PICC placement with attention to malnutrition, BMI >30, and length of stay may reduce the risk of PICC-associated complications. Use of anticoagulation/antiplatelet agents and avoiding after-hours placement may reduce complications and enhance patient safety.
    Journal of Hospital Medicine 08/2014; 9(8). DOI:10.1002/jhm.2207 · 2.30 Impact Factor
  • Carl D Boethel · Shekhar A Ghamande · Robert C Fader · Alejandro C Arroliga
    Clinical Infectious Diseases 07/2014; 59(10). DOI:10.1093/cid/ciu605 · 8.89 Impact Factor
  • Alejandro C Arroliga · Courtland Huber · John D Myers · J Paul Dieckert · Donald Wesson
    The American journal of medicine 11/2013; 127(3). DOI:10.1016/j.amjmed.2013.11.004 · 5.00 Impact Factor
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    Colleen Y Colbert · Enrique Diaz-Guzman · John D Myers · Alejandro C Arroliga
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    ABSTRACT: Surveys are being used increasingly in health-care research to answer questions that may be difficult to answer using other methods. While surveys depend on data that may be influenced by self-report bias, they can be powerful tools as physicians seek to enhance the quality of care delivered or the health care systems they work in. The purpose of this article is to provide readers with a basic framework for understanding survey research, with a goal of creating well-informed consumers. The importance of validation, including pretesting surveys before launch, will be discussed. Highlights from published surveys are offered as supplementary material.
    Cleveland Clinic Journal of Medicine 07/2013; 80(7):423-435. DOI:10.3949/ccjm.80a.12122 · 2.71 Impact Factor
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    ABSTRACT: MircoRNAs (miRNAs) are small non-coding RNAs that govern the gene expression and, play significant role in the pathogenesis of heart failure. The detection of miRNAs in circulation of pulmonary hypertensive (PH) human subjects remains elusive. In the current study, we determined the pattern of miRNAs of mild-to-severe human PH subjects and, compared them with the control subjects by miRNA array. Blood was obtained using fluoroscopic and waveform guided catheterization from the distal (pulmonary artery) port of the catheter. A total 40 human subjects were included in the study and, the degree of PH was determined by mean pulmonary arterial pressure. Among several miRNAs in the array, we validated 14 miRNAs and, the data were consistent with the array profile. We identified several novel downregulated miRNAs (miR-451, miR-1246) and upregulated miRNAs (miR-23b, miR-130a and miR-191) in the circulation of PH subjects. Our study showed novel set of miRNAs which are dysregulated in PH and, are directly proportional to the degree of PH. These miRNAs may be considered as potential biomarker for early detection of PH.
    PLoS ONE 05/2013; 8(5):e64396. DOI:10.1371/journal.pone.0064396 · 3.23 Impact Factor
  • Shekhar A Ghamande · Alejandro C Arroliga · David P Ciceri
    American Journal of Respiratory and Critical Care Medicine 04/2013; 187(8):789-90. DOI:10.1164/rccm.201301-0099ED · 13.00 Impact Factor
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    ABSTRACT: In recent years, there has been increased interest in stemming the tide of hospital readmissions in an attempt to improve quality of care. This study presents the Phase I results of a resident-led quality improvement initiative to determine the percentage of and risk factors for same-cause readmissions (SCRs; defined as hospital readmission within 30 days of hospital discharge for treatment of the same condition) to the internal medicine service of a multispecialty teaching hospital in central Texas. Results indicate that patients diagnosed with chronic obstructive pulmonary disease/asthma or anemia may be at increased risk for SCRs. Those patients who are insured by Medicaid and those who require assistance from social services also demonstrated an increased risk for SCRs. This study appears to be the first resident-led initiative in the field to examine 30-day SCRs to an internal medicine service for demographic and clinical risk factors.
    American Journal of Medical Quality 04/2013; 28(6). DOI:10.1177/1062860613480827 · 1.25 Impact Factor
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    ABSTRACT: Background: Previous trials suggesting that high-frequency oscillatory ventilation (HFOV) reduced mortality among adults with the acute respiratory distress syndrome (ARDS) were limited by the use of outdated comparator ventilation strategies and small sample sizes. Methods: In a multicenter, randomized, controlled trial conducted at 39 intensive care units in five countries, we randomly assigned adults with new-onset, moderate-to-severe ARDS to HFOV targeting lung recruitment or to a control ventilation strategy targeting lung recruitment with the use of low tidal volumes and high positive end-expiratory pressure. The primary outcome was the rate of in-hospital death from any cause. Results: On the recommendation of the data monitoring committee, we stopped the trial after 548 of a planned 1200 patients had undergone randomization. The two study groups were well matched at baseline. The HFOV group underwent HFOV for a median of 3 days (interquartile range, 2 to 8); in addition, 34 of 273 patients (12%) in the control group received HFOV for refractory hypoxemia. In-hospital mortality was 47% in the HFOV group, as compared with 35% in the control group (relative risk of death with HFOV, 1.33; 95% confidence interval, 1.09 to 1.64; P=0.005). This finding was independent of baseline abnormalities in oxygenation or respiratory compliance. Patients in the HFOV group received higher doses of midazolam than did patients in the control group (199 mg per day [interquartile range, 100 to 382] vs. 141 mg per day [interquartile range, 68 to 240], P<0.001), and more patients in the HFOV group than in the control group received neuromuscular blockers (83% vs. 68%, P<0.001). In addition, more patients in the HFOV group received vasoactive drugs (91% vs. 84%, P=0.01) and received them for a longer period than did patients in the control group (5 days vs. 3 days, P=0.01). Conclusions: In adults with moderate-to-severe ARDS, early application of HFOV, as compared with a ventilation strategy of low tidal volume and high positive end-expiratory pressure, does not reduce, and may increase, in-hospital mortality. (Funded by the Canadian Institutes of Health Research; Current Controlled Trials numbers, ISRCTN42992782 and ISRCTN87124254, and numbers, NCT00474656 and NCT01506401.).
    New England Journal of Medicine 01/2013; 368(9). DOI:10.1056/NEJMoa1215554 · 55.87 Impact Factor
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    ABSTRACT: The objectives of this study were to determine the current staffing models of practice and the frequency of 24/7 coverage in academic medical centers in the United States and to assess the perceptions of critical care trainees and program directors toward these models. A cross-sectional national survey was conducted using an Internet-based survey platform. The survey was distributed to fellows and program directors of 374 critical care training programs in US academic medical centers. We received 518 responses: 138 from program directors (PDs) (37% of 374 programs) and 380 fellow responses. Coverage by a board-certified or board-eligible intensivist physician 24/7 was reported by 33% of PD respondents and was more common among pediatric and surgical critical care programs. Mandatory in-house call for critical care trainees was reported by 48% of the PDs. Mandatory call was also more common among pediatric-critical care programs compared with the rest (P < .001). Advanced nurse practitioners with critical care training were reported available by 27% of the PDs. The majority of respondents believed that 24/7 coverage would be associated with better patient care in the ICU and improved education for the fellows, although 65% of them believed this model would have a negative impact on trainees' autonomy. Intensivist coverage 24/7 was not commonly used in US academic centers responding to our survey. Significant differences in coverage models among critical care medicine specialties appear to exist. Program director and trainee respondents believed that 24/7 coverage was associated with better outcomes and education but also expressed concerns about the impact of this model on fellows' autonomy.
    Chest 12/2012; 141(4):959-66. DOI:10.1378/chest.11-2073 · 7.48 Impact Factor

Publication Stats

5k Citations
1,070.14 Total Impact Points


  • 2007–2014
    • Scott & White
      Temple, Texas, United States
  • 2010–2013
    • Texas A&M University System Health Science Center
      Bryan, Texas, United States
    • Georgia Health Sciences University
      • Section of Pulmonary & Critical Care
      Augusta, Georgia, United States
  • 2007–2013
    • Texas A&M University System
      TPL, Texas, United States
  • 1998–2008
    • Lerner Research Institute
      • Department of Cellular and Molecular Medicine
      Cleveland, Ohio, United States
  • 2006
    • Baylor College of Medicine
      Houston, Texas, United States
  • 1999–2006
    • Cleveland Clinic
      Cleveland, Ohio, United States
  • 2004
    • Waterbury Hospital
      Waterbury, Connecticut, United States
  • 2002
    • Kent State University
      • Department of English
      Kent, OH, United States