Allan Walkey

Allan Walkey
Boston University | BU · Pulmonary Center

MD, MSc

About

234
Publications
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Publications

Publications (234)
Article
Full-text available
Background: The use of high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) for hypoxemic respiratory failure secondary to coronavirus disease 2019 (COVID-19) are recommended by critical-care guidelines; however, apprehension about viral particle aerosolization and patient self-inflicted lung injury may have limited use. We aimed to de...
Article
Objectives: Suggested therapeutic options for Multisystem Inflammatory Syndrome in Children (MIS-C) include intravenous immunoglobulins (IVIG) and steroids. Prior studies have shown the benefit of combination therapy with both agents on fever control or the resolution of organ dysfunction. The primary objective of this study was to analyze the imp...
Article
Full-text available
Background: Describe the incidence and associated outcomes of gastrointestinal (GI) manifestations of acute coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in hospitalized children (MIS-C). Methods: Retrospective review of the Viral Infection and Respiratory Illness Universal Study registry, a prospective observational,...
Article
Background Atrial fibrillation (AF) is a common complication of sepsis. It is unclear if norepinephrine, an α- and β-agonist, and phenylephrine, an α-agonist, are associated with different heart rates among patients with sepsis and AF. Research Question Among patients with sepsis and AF, what is the difference in heart rate after phenylephrine ini...
Article
Background: Clinical decision support systems (CDSS) are used to improve processes of care. CDSS proliferation may have unintended consequences impacting effectiveness. Objective: To evaluate the effectiveness of CDSS in altering clinician behavior. Design: Electronic searches were performed in EMBASE, PubMed, and Cochrane Central Register of...
Article
Background There is urgent need for safe, effective, and easily implementable treatments that reduce the progression of respiratory failure in COVID-19. Despite increased adoption during the pandemic, the effectiveness of prone positioning on respiratory failure progression among non-intubated patients is unclear. Research Question What is the eff...
Article
Objectives: Sepsis survivors face increased risk for cardiovascular complications; however, the contribution of intrasepsis events to cardiovascular risk profiles is unclear. Setting: Kaiser Permanente Northern California (KPNC) and Intermountain Healthcare (IH) integrated healthcare delivery systems. Subjects: Sepsis survivors (2011-2017 [KPN...
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To describe the prevalence, associated risk factors, and outcomes of serious neurologic manifestations (encephalopathy, stroke, seizure, and meningitis/encephalitis) among patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Design: Prospective observational study. Setting: One hundred seventy-nine...
Preprint
Background The COVID-19 pandemic produced unprecedented demands and rapidly changing evidence and practices within critical care settings. The purpose of this study was to identify factors and strategies that hindered and facilitated effective implementation of new critical care practices and policies in response to the pandemic. Methods We used a...
Preprint
Background The COVID-19 pandemic produced unprecedented demands and rapidly changing evidence and practices within critical care settings. The purpose of this study was to identify factors and strategies that hindered and facilitated effective implementation of new critical care practices and policies in response to the pandemic. Methods We used a...
Article
Full-text available
Background: The coronavirus disease 2019 (COVID-19) course may be affected by environmental factors. Ecological studies previously suggested a link between climatological factors and COVID-19 fatality rates. However, individual-level impact of these factors has not been thoroughly evaluated yet. Aim: To study the association of climatological fa...
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Background Awake prone positioning has been broadly utilised for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure, but the results from published randomised controlled trials (RCTs) in the past year are contradictory. We aimed to systematically synthesise the outcomes associated with awake prone positioning, and eva...
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Background Hospitalized patients with SARS-CoV2 develop acute kidney injury (AKI) frequently, yet gaps remain in understanding why adults seem to have higher rates compared to children. Our objectives were to evaluate the epidemiology of SARS-CoV2-related AKI across the age spectrum and determine if known risk factors such as illness severity contr...
Article
Rationale: In critically ill patients, a hemoglobin transfusion threshold of <7.0 G/dl compared to <10.0 G/dl improves organ dysfunction. However, it is unclear if transfusion at a hemoglobin of <7.0 g/dL is superior to no transfusion. Objectives: To compare levels of organ dysfunction between transfusion and no transfusion at a hemoglobin thres...
Article
Introduction: Coronavirus disease 2019 (COVID-19) is associated with high rates of morbidity and mortality. Primary Hypothyroidism is a common comorbid condition, but little is known about its association with COVID-19 severity and outcomes. This study aims to identify the frequency of Hypothyroidism in hospitalized patients with COVID-19 as well...
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Objectives: To describe hospital variation in use of "guideline-based care" for acute respiratory distress syndrome (ARDS) due to COVID-19. Design: Retrospective, observational study. Setting: The Society of Critical Care Medicine's Discovery Viral Infection and RESPIRATORY ILLNESS UNIVERSAL STUDY COVID-19 REGISTRY. Patients: Adult patients...
Article
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INTRODUCTION: In the absence of evidenced-based guidelines, the use of medications repurposed for management of patients with COVID-19 likely varied idiosyncratically and practice patterns of use have not been well-characterized. We aimed to describe the variation and evolution in use of medications repurposed for management of patients hospitalize...
Article
Full-text available
Introduction: Despite critical care guidelines supporting the use of high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) in patients with acute respiratory failure from coronavirus disease of 2019 (COVID-19), concerns surrounding aerosolization of viral particles, and patient self-inflicted lung injury likely influenced use across hos...
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Full-text available
Introduction: Adherence to guideline-recommended ventilator management for acute respiratory distress syndrome (ARDS) due to COVID-19 is unknown. We sought to evaluate variation in use of ‘guideline-based care’ and adjunctive strategies for COVID-19 ARDS across 55 hospitals contributing to the Society of Critical Care Medicine Viral Infection and R...
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Importance Obesity, diabetes, and hypertension are common comorbidities in patients with severe COVID-19, yet little is known about the risk of acute respiratory distress syndrome (ARDS) or death in patients with COVID-19 and metabolic syndrome. Objective To determine whether metabolic syndrome is associated with an increased risk of ARDS and deat...
Article
Rationale The impact of palliative care consultation on end-of-life care has not previously been evaluated in a multi-center study. Objectives To evaluate the impact of palliative care consultation on the incidence of cardiopulmonary resuscitation (CPR) performed and comfort care received at the end-of-life in hospitalized patients with COVID-19....
Article
Introduction: Under-treatment with oral anticoagulants (OAC) in atrial fibrilliation (AF) is a persistent management gap, particularly in older adults. Understanding patterns of OAC adoption may enable design of implementation strategies to improve evidence-based care. Objectives: Determine changes in OAC use and overall uptake of direct oral antic...
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Importance: At the start of the coronavirus disease 2019 pandemic, medications repurposed for management of coronavirus disease 2019 were used in the absence of clinical trial evidence. Objectives: To describe the variation and evolution in use of repurposed medications for coronavirus disease 2019. Design setting and participants: Observation...
Article
Background Atrial fibrillation (AF) commonly occurs in the setting of acute conditions. We aimed to identify the acute conditions associated with secondary AF (AF precipitants) including pneumonia/sepsis, pneumothorax, respiratory failure, myocarditis, pericarditis, alcohol intoxication, thyrotoxicosis, cardiothoracic surgery, other surgery in pati...
Article
One in five survivors of critical illness who require prolonged mechanical ventilation are discharged to long-term acute care hospitals (LTCHs). Although disparities based on race and insurance have been described in LTCH use, studies have not evaluated equity in outcomes. Improvement in function (e.g., mobility) is a crucial recovery goal for pati...
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Background Interleukin-6 receptor antagonists (IL-6RAs) and steroids are emerging immunomodulatory therapies for severe and critical coronavirus disease (COVID-19). In this preliminary report, we aim to describe the epidemiology, clinical characteristics, and outcomes of adult critically ill COVID-19 patients, requiring invasive mechanical ventilat...
Article
Implantable loop recorder (ILR) is recommended to detect subclinical atrial fibrillation (AF) after cryptogenic stroke; however, the clinical outcomes of this practice is unclear. We conducted a systematic review and meta-analysis of randomized controlled trials to evaluate 12-month AF detection, change in oral anticoagulation (OAC), and recurrent...
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IMPORTANCE:. Even with its proclivity for older age, coronavirus disease 2019 has been shown to affect all age groups. However, there remains a lack of research focused primarily on the young adult population. OBJECTIVES:. To describe the epidemiology and outcomes of coronavirus disease 2019 and identify the risk factors associated with critical il...
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Objectives: Multicenter data on the characteristics and outcomes of children hospitalized with coronavirus disease 2019 are limited. Our objective was to describe the characteristics, ICU admissions, and outcomes among children hospitalized with coronavirus disease 2019 using Society of Critical Care Medicine Discovery Viral Infection and Respirat...
Article
Rationale Tracheostomy and gastrostomy tubes are frequently placed during critical illness for long-term life-support, with the majority placed in older adults. Large knowledge gaps exist regarding outcomes expressed as most important to patients. Objectives To determine days alive and out of institution and mortality after tracheostomy and gastros...
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Sepsis is defined by life-threatening organ dysfunction during infection and is the leading cause of death in hospitals. During sepsis, there is a high risk that new onset of atrial fibrillation (AF) can occur, which is associated with significant morbidity and mortality. Consequently, early prediction of AF during sepsis would allow testing of int...
Article
Widespread vaccine administration is necessary to curb the COVID-19 pandemic. To overcome COVID-19 vaccine hesitancy, states have introduced various strategies to increase vaccine uptake. On May 12, 2021, the state of Ohio announced a lottery system to pay randomly selected vaccine recipients up to $1 million.¹ After initial reports that vaccine up...
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Background Although both leukocytosis and leukopenia have been considered Systemic Inflammatory Response Syndrome criteria, leukopenia is not generally considered a normal response to infection. We sought to evaluate the prognostic validity of leukopenia as a sign of sepsis-defining hematological organ dysfunction within the Sepsis-3 framework. We...
Article
Rationale: Sepsis commonly results in elevated serum troponin I levels and increased risk for post-sepsis cardiovascular complications; however, the association between troponin I level during sepsis and cardiovascular complications after sepsis is unclear. Objectives: To evaluate the association between serum troponin levels during sepsis and 1...
Article
Rationale: A central component of septic shock treatment is the infusion of vasopressors, most commonly starting with norepinephrine. However, the optimal approach and practice patterns to initiating adjunctive vasopressors and corticosteroids are unknown. Objectives: To characterize practice pattern variation in the norepinephrine dose at which...
Article
Rationale: Several institutions have implemented phenobarbital-based pathways for the treatment of alcohol withdrawal syndrome. However, little is known about the care processes, effectiveness, and safety of phenobarbital-based pathways for intensive care unit patients. Objectives: This study aimed to examine clinician acceptability and feasibil...
Article
Observational studies in critical care medicine offer a popular and practical approach to questions of treatment effectiveness. Although observational research is widely understood to be susceptible to design and interpretation challenges, one well-described source of bias - immortal time bias (ITB) - is frequently present yet often overlooked. ITB...
Article
The unprecedented public health burdens of coronavirus disease 2019 (COVID-19) have intensified the urgency to identify effective, low-cost treatments that limit the need for advanced life support measures and improve clinical outcomes. However, personal protective equipment and staffing shortages, disease virulence, and infectivity have created si...
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Background Limitations in access to specialty diabetes care exist. Endocrinology eConsult that integrates professional continuous glucose monitoring (CGM-enhanced eConsult) may improve healthcare delivery, but has yet to be evaluated. We implemented a pilot program for patients with type 2 diabetes (T2DM) managed by primary care clinical pharmacist...
Article
Objective To benchmark rates of guideline-concordant insulin infusion initiation, identify factors associated with guideline-concordant insulin practices, and examine the association between hospital-level guideline concordance and mortality among critically ill patients with sepsis. Methods We performed a multicenter retrospective cohort study of...
Article
Rationale: Decisions in medicine are made on the basis of knowledge and reasoning, often in shared conversations with patients and families in consideration of clinical practice guideline recommendations, individual preferences, and individual goals. Observational studies can provide valuable knowledge to inform guidelines, decisions, and policy.Ob...
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Importance In the current setting of the coronavirus disease 2019 pandemic, there is concern for the possible need for triage criteria for ventilator allocation; to our knowledge, the implications of using specific criteria have never been assessed. Objective To determine which and how many admissions to intensive care units are identified as havi...
Article
Objectives: Prior work has shown substantial between-hospital variation in do-not-resuscitate orders, but stability of do-not-resuscitate preferences between hospitalizations and the institutional influence on do-not-resuscitate reversals are unclear. We determined the extent of do-not-resuscitate reversals between hospitalizations and the associa...
Article
Background Incidentalomas, or unexpectedly identified masses, are frequently identified in diagnostic imaging studies. Incidentalomas may require timely follow-up care to determine if they are benign, disease-causing, or malignant lesions; however, many incidentalomas do not receive diagnostic workup. The most effective strategies to manage inciden...