Alejandro C Arroliga

Scott & White, Temple, Texas, United States

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Publications (162)806.17 Total impact

  • Article: The Reply.
    John D Myers, Christian T Cable, Alejandro C Arroliga
    The American journal of medicine. 08/2014; 127(8):e35.
  • Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 07/2014;
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    ABSTRACT: 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.
    Journal of Hospital Medicine 06/2014; · 1.40 Impact Factor
  • Clinics in Chest Medicine. 01/2014;
  • The American journal of medicine 11/2013; · 5.30 Impact Factor
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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. · 3.40 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. · 11.04 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; · 1.47 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; · 54.42 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 01/2013; 8(5):e64396. · 3.53 Impact Factor
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    ABSTRACT: BACKGROUND:: Despite advances in medical therapies, pleural infections remain a common disease. The characteristics of this disease seem to change over time, with alterations in patient characteristics and bacteriology. The purpose of this study was to provide a retrospective descriptive analysis of pleural infections during a 9-year period. METHODS:: We performed a single-center retrospective review of all culture-positive pleural infections between January 2000 and December 2008. The primary outcome was assessment of long-term survival and associated independent risk factors affecting survival. Length of survival was determined using the Social Security Death Index. Case characteristics and bacteriology were reviewed for descriptive analysis. RESULTS:: During a 9-year period, 187 culture-positive pleural infections were identified. Review of bacteriology revealed gram-positive cocci as the predominate organisms, most commonly Streptococcus and Staphylococcus. Anaerobes were found in 9.1% of the cases. Independent risk factors associated with risk of death based on multivariable survival analysis were age older than 65, cirrhosis and past and present malignancy. The hospital mortality was 10.7%, and the 1-year, 3-year and 5-year estimated survival rates were 73.8%, 63.3% and 60.6%, respectively. CONCLUSIONS:: Pleural infections continue to remain a major health problem and carry significant morbidly and mortality. The importance of Staphylococcus aureus in this population has yet to be fully examined, and although potentially underestimated in this study, anaerobic infections remain a common pathogen.
    The American Journal of the Medical Sciences 10/2012; · 1.33 Impact Factor
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    ABSTRACT: SESSION TYPE: Neuro Critical CarePRESENTED ON: Tuesday, October 23, 2012 at 04:30 PM - 05:45 PMPURPOSE: Delirium is a frequent complication in intensive care unit (ICU) patients and alterations in circadian rhythms may have a role. Melatonin is a marker of circadian rhythmicity and peaks around 4:00 am. Evidence suggests that ICU patients have irregular circadian rhythms but no studies address a link between circadian rhythms and ICU delirium.METHODS: We performed a prospective observational study of 45 subjects admitted to the ICU with an expected stay of >48 hours. Excluded subjects had history of dementia, mental retardation, alcohol intoxication or withdrawal, infectious encephalopathy, stroke, active psychosis, suspicion of seizures, end stage renal or liver disease. Demographics, urinary samples for 6-sulphatoxymelatonin every three hours and delirium assessments twice daily were collected. Circadian rhythms of melatonin were determined using a Lomb-Scargle Fourier Transform analysis. A least-square fitting of the data was applied with a sinusoidal parametric function. Through regression analysis, the period was extracted. Peak melatonin levels between 2-6 am were accepted as normal.RESULTS: 80% of subjects experienced delirium at least once (Ever delirium) versus 20% who did not (Never delirium). A single peak of melatonin occurred in 35/36 Ever delirium subjects and in 6/9 Never delirium subjects. While more Ever delirious subjects had peaks outside the normal time, (63% vs. 50%) in the first 24 hours, the opposite was true in the second 24 hours (58% vs. 100%). Over 48 hours, more subjects had peak melatonin levels outside of the normal time regardless of delirium. Peak melatonin between 2-6 am did not correlate with delirium (p= 0.45). In subjects with 48 hours of data, a greater range in period was observed in Ever delirious subjects (17.8 hours to 31.8 hours) compared to Never delirious (24.2 hours to 27.9 hours) but the small sample size limits its interpretation.CONCLUSIONS: The timing of peak melatonin level does not correlate with ICU delirium.CLINICAL IMPLICATIONS: ICU delirium does not appear to be related to alterations in the circadian rhythm of melatonin.DISCLOSURE: The following authors have nothing to disclose: Shirley Jones, Rhonda Wardlow, Heath White, Angela Hochhalter, Alan Stevens, Chanhee Jo, Phyllis Zee, David Earnest, Alejandro ArroligaNo Product/Research Disclosure InformationScott and White Healthcare/Texas A&M Health Science Center, Temple, TX.
    Chest 10/2012; 142(4_MeetingAbstracts):369A. · 7.13 Impact Factor
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    ABSTRACT: SESSION TYPE: Sepsis/Shock PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: Severe sepsis and septic shock are life-threatening conditions within the intensive care unit that frequently require analysis of acid-base status and oxygenation. Arterial blood gases have traditionally been used for this evaluation but their collection carries risk and may be difficult. Venous blood gases may serve as an alternative but have not been studied in this population. The purpose of this study was to evaluate correlation and agreement between ABG, peripheral VBG (pVBG) and central VBG (cVBG) values in severe sepsis and septic shock to determine if a VBG can be used as an alternative to an ABG.METHODS: We performed a single center prospective observational study on medical intensive care unit (MICU) subjects with severe sepsis and septic shock to evaluate the correlation and agreement between ABG, pVBG and cVBG for pH, pCO2, pO2 and O2 saturation. Subjects requiring an ABG underwent simultaneous pVBG and cVBG sampling. Demographic characteristics, disease severity scores, use of vasopressors and mechanical ventilation were collected. Statistic analysis was performed using descriptive statistics, intraclass correlation, and Bland-Altman agreement analysis.RESULTS: Sixty-seven subjects were enrolled with a mean (±SD) age of 59.5±16.9 and 52.2% female. Severity of illness scores revealed a mean SOFA of 7.9±3.3 and SAPS II of 49.3±16.5. The mortality rate for the MICU and hospital was 11.9% and 16.4% respectively. Community acquired pneumonia was the most common etiology (34.3%). Intraclass correlation analysis of ABG/pVBG, ABG/cVBG and pVBG/cVBG comparisons revealed a strong correlation for pH and pCO2 (ICC > 0.85). Bland-Altman analysis revealed excellent agreement in all three comparisons of pH (bias, 0.03±0.04, 0.03±0.02 and 0.00±0.03 respectively) but not for pCO2, pO2 or O2 saturation.CONCLUSIONS: In subjects with severe sepsis or septic shock, central and peripheral venous pH showed a high degree of correlation and agreement with arterial pH.CLINICAL IMPLICATIONS: In critically ill subjects with severe sepsis and septic shock, the pH from a central or peripheral VBG can be used to screen for acid-base disturbances.DISCLOSURE: The following authors have nothing to disclose: Heath White, Pedro Quiroga, Juhee Song, Alfredo Vazquez-Sandoval, Alejandro Arroliga, Shirley JonesNo Product/Research Disclosure InformationScott & White Memorial Hospital, Temple, TX.
    Chest 10/2012; 142(4_MeetingAbstracts):408A. · 7.13 Impact Factor
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    ABSTRACT: While the results of clinical research are clearly valuable in the care of critically ill patients, the limitations of such information and the role of other forms of medical knowledge for clinical decision making have not been carefully examined. The leadership of three large professional societies representing critical care practitioners convened a diverse group representing a wide variety of views regarding the role of clinical research results in clinical practice to develop a document to serve as a basis for agreement and a framework for ongoing discussion. Consensus was reached on several issues. While the results of rigorous clinical research are important in arriving at the best course of action for an individual critically ill patient, other forms of medical knowledge, including clinical experience and pathophysiologic reasoning, remain essential. No single source of knowledge is sufficient to guide clinical decisions, nor does one kind of knowledge always take precedence over others. Clinicians will find clinical research compelling for a variety of reasons that go beyond study design. While clinical practice guidelines and protocols based upon clinical research may improve care and decrease variability in practice, clinicians must be able to understand and articulate the rationale as to why a particular protocol or guideline is used or why an alternative approach is taken. Making this clinical reasoning explicit is necessary to understand practice variability. Understanding the strengths and weaknesses of different kinds of medical knowledge for clinical decision making and factors beyond study design that make clinical research compelling to clinicians can provide a framework for understanding the role of clinical research in practice.
    American Journal of Respiratory and Critical Care Medicine 05/2012; 185(10):1117-24. · 11.04 Impact Factor
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    ABSTRACT: Background. There are modes of mechanical ventilation that can select ventilator settings with computer controlled algorithms (targeting schemes). Two examples are adaptive support ventilation (ASV) and mid-frequency ventilation (MFV). We studied how different clinician-chosen ventilator settings are from these computer algorithms under different scenarios. Methods. A survey of critical care clinicians provided reference ventilator settings for a 70 kg paralyzed patient in five clinical/physiological scenarios. The survey-derived values for minute ventilation and minute alveolar ventilation were used as goals for ASV and MFV, respectively. A lung simulator programmed with each scenario's respiratory system characteristics was ventilated using the clinician, ASV, and MFV settings. Results. Tidal volumes ranged from 6.1 to 8.3 mL/kg for the clinician, 6.7 to 11.9 mL/kg for ASV, and 3.5 to 9.9 mL/kg for MFV. Inspiratory pressures were lower for ASV and MFV. Clinician-selected tidal volumes were similar to the ASV settings for all scenarios except for asthma, in which the tidal volumes were larger for ASV and MFV. MFV delivered the same alveolar minute ventilation with higher end expiratory and lower end inspiratory volumes. Conclusions. There are differences and similarities among initial ventilator settings selected by humans and computers for various clinical scenarios. The ventilation outcomes are the result of the lung physiological characteristics and their interaction with the targeting scheme.
    Critical care research and practice 01/2012; 2012:204314.
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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 12/2011; 141(4):959-66. · 7.13 Impact Factor
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    ABSTRACT: We report the process implemented in our institution by a task force focused on the reduction of ventilator-associated pneumonia (VAP). Retrospective cohort study of all adults admitted to one of our 4 adult ICUs, intubated on invasive mechanical ventilation. We implemented a ventilator bundle in April of 2007; we report the incidence of VAP in 2008, and, after adjustment in the process (oral care performed by respiratory therapists), the incidence in 2009. The primary outcome was reduction of the microbiologically confirmed VAP rate over a 2 year period. Other outcomes were duration of mechanical ventilation, antibiotic days, ICU and hospital stay, and mortality. During the study period, 2,588 patients received invasive mechanical ventilation in the adult ICUs. The VAP rate during 2008 was 4.3/1,000 ventilator days, and the 2009 rate was 1.2/1,000 ventilator days. The 2008 to 2009 VAP rate ratio was significantly greater than 1 (rate ratio 3.6, 95% CI 1.8-8.0, P < .001). Antibiotic days were less in 2009 versus 2008 (Hodges-Lehmann estimate of difference between 2008 and 2009, 1.0, 95% CI 0.0-1.0, P = .002). The median stay in the ICU was unchanged, and in the hospital was decreased in 2009 (Hodges-Lehmann estimate of difference between 2008 and 2009, 1.0, 95% CI 0.0-1.0, P < .001). The hospital mortality was 26.1%, and there was no difference between the 2 years. Adherence with the ventilator bundle was above 92% during the study period, but the oral care adherence improved from 33% to 97% after respiratory therapists assumed oral care. Reduction of the incidence of VAP occurred with an intervention that included respiratory therapists doing oral care in patients receiving invasive mechanical ventilation. Oral care done by respiratory therapists may be associated with reduction of VAP.
    Respiratory care 12/2011; 57(5):688-96. · 2.03 Impact Factor
  • American Journal of Respiratory and Critical Care Medicine 10/2011; 184(7):749-50. · 11.04 Impact Factor
  • Enrique Diaz-Guzman, Juan Sanchez, Alejandro C Arroliga
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    ABSTRACT: During the last 5 years, new randomized trials in critically ill patients have challenged a number of traditional treatment strategies in intensive care. The authors review eight studies that helped change their medical practices.
    Cleveland Clinic Journal of Medicine 10/2011; 78(10):665-74. · 3.40 Impact Factor
  • Juan F Sanchez, Long Le, Alejandro C Arroliga
    American Journal of Respiratory and Critical Care Medicine 06/2011; 183(11):1449-50. · 11.04 Impact Factor

Publication Stats

4k Citations
806.17 Total Impact Points


  • 2007–2014
    • Scott & White
      Temple, Texas, United States
    • The University of Tennessee Health Science Center
      • Division of Pulmonary, Critical Care, and Sleep Medicine
      Memphis, TN, United States
    • University of California, San Francisco
      • Division of Hospital Medicine
      San Francisco, CA, United States
  • 2010–2011
    • University of Kentucky
      Lexington, Kentucky, United States
    • Emory University
      • Division of Pulmonary, Allergy and Critical Care Medicine
      Atlanta, GA, United States
  • 1996–2009
    • Cleveland Clinic
      • • Department of Pathobiology
      • • Department of Pulmonary and Critical Care
      Cleveland, Ohio, United States
  • 1998–2008
    • Lerner Research Institute
      Cleveland, Ohio, United States
  • 2005
    • University of South Alabama
      Mobile, Alabama, United States
  • 2004
    • Port Huron Hospital
      Port Huron, Michigan, United States
  • 2002
    • Saint Louis University
      Saint Louis, Michigan, United States
    • Kent State University
      • Department of English
      Kent, OH, United States
  • 2001
    • Tan Tock Seng Hospital
      Tumasik, Singapore
    • Mercy St. Vincent Medical Center
      Toledo, Ohio, United States
  • 2000
    • Eastern Maine Medical Center
      Bangor, Maine, United States