Alejandro C Arroliga

Scott & White, Temple, Texas, United States

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Publications (184)972.89 Total impact

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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.
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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; DOI:10.1016/j.ccm.2014.08.008 · 2.17 Impact Factor
  • American Journal of Respiratory and Critical Care Medicine 11/2014; 190(10):1086-8. DOI:10.1164/rccm.201410-1886ED · 11.99 Impact Factor
  • The American Journal of Medicine 11/2014; 128(3). DOI:10.1016/j.amjmed.2014.11.001 · 5.30 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 · 3.37 Impact Factor
  • Article: The Reply.
    John D Myers, Christian T Cable, Alejandro C Arroliga
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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 08/2014; 9(8). DOI:10.1002/jhm.2207 · 2.08 Impact Factor
  • Clinical Infectious Diseases 07/2014; 59(10). DOI:10.1093/cid/ciu605 · 9.42 Impact Factor
  • The American journal of medicine 11/2013; DOI:10.1016/j.amjmed.2013.11.004 · 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. DOI:10.3949/ccjm.80a.12122 · 3.37 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 · 3.53 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 · 11.99 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 · 1.78 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 · 54.42 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 10/2012; 2012:204314. DOI:10.1155/2012/204314
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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; 345(5). DOI:10.1097/MAJ.0b013e318259bd24 · 1.52 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. DOI:10.1378/chest.1382991 · 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. DOI:10.1378/chest.1390579 · 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. DOI:10.1164/rccm.201204-0638ST · 11.99 Impact Factor
  • American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California; 05/2012

Publication Stats

4k Citations
972.89 Total Impact Points


  • 2007–2014
    • Scott & White
      Temple, Texas, United States
    • Texas A&M University System
      TPL, 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
  • 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
  • 2005
    • University of Chicago
      Chicago, Illinois, United States
    • University of South Alabama
      Mobile, Alabama, United States
  • 2004
    • Waterbury Hospital
      Waterbury, Connecticut, United States
  • 2002
    • Kent State University
      • Department of English
      Kent, OH, United States
  • 2001–2002
    • Mercy St. Vincent Medical Center
      Toledo, Ohio, United States
    • Tan Tock Seng Hospital
      Tumasik, Singapore
  • 2000
    • Northeast Ohio Medical University
      رافينا، أوهايو, Ohio, United States