Christopher Doig

• MD MSc FRCPC
• Head of Faculty at University of Calgary

Background Muscle loss is a common and debilitating complication of critical illness. Understanding the prevalence, severity, and risk factors associated with muscle loss is challenging. Muscle cross‐sectional area obtained from computed tomography (CT) scans can be used to assess changes in muscle over the course of critical illness. The objective...

We performed a systematic review with meta-analysis examining the relationship between pain or pain medications and delirium occurence, duration, and severity. We searched MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials from inception to May 15, 2023. We included randomised or observational studies among critically il...

Controlled donation after circulatory determination of death (DCD) is feasible only if circulatory arrest occurs soon after withdrawal of life-sustaining measures (WLSM). When organ recovery cannot proceed because this time interval is too long, there are potential negative implications, including perceptions of “secondary loss” for patients’ famil...

There is significant variability in the application of positive end-expiratory pressure (PEEP) in patients undergoing invasive mechanical ventilation. There are numerous studies assessing methods of determining optimal PEEP, but many methods, patient populations, and study settings lack high-quality evidence. Guidelines make no recommendations abou...

We evaluated the cost-effectiveness of a bundled intervention including an antimicrobial stewardship program (ASP), procalcitonin (PCT) testing, and rapid blood culture identification (BCID), compared with pre-implementation standard care in critically ill adult patients with sepsis. We conducted a decision tree model-based cost-effectiveness analy...

Background We aimed to synthesize the qualitative evidence on the impacts of COVID-19-related restricted family presence policies from the perspective of patients, families, and healthcare professionals from neonatal (NICU), pediatric (PICU), or adult ICUs. Methods We searched MEDLINE, EMBASE, Cochrane Databases of Reviews and Clinical Trials, CIN...

Purpose Muscle weakness is a common and debilitating complication of critical illness. Understanding the prevalence, severity, and risk factors associated with intensive care unit (ICU) acquired weakness is challenging, as critically ill patients are often unable to participate in muscle strength assessments. Muscle cross-sectional area obtained fr...

Background The Berlin definition of acute respiratory distress syndrome (ARDS) includes only clinical characteristics. Understanding unique patient pathobiology may allow personalized treatment. We aimed to define and describe ARDS phenotypes/endotypes combining clinical and pathophysiologic parameters from a Canadian ARDS cohort. Methods A cohort...

Background Untreated pain is associated with short-term and long-term consequences, including post-traumatic stress disorder and insomnia. Side effects of some analgesic medications include dysphoria, hallucinations and delirium. Therefore, both untreated pain and analgesic medications may be risk factors for delirium. Delirium is associated with l...

Ilofotase alfa is a human recombinant alkaline phosphatase with reno-protective effects that showed improved survival and reduced Major Adverse Kidney Events by 90 days (MAKE90) in sepsis-associated acute kidney injury (SA-AKI) patients. REVIVAL, was a phase-3 trial conducted to confirm its efficacy and safety. In this international double-blinded...

Purpose: Ilofotase alfa is a human recombinant alkaline phosphatase with reno-protective effects that showed improved survival and reduced MAKE90 in sepsis-associated acute kidney injury (SA-AKI) patients. ‘REVIVAL’, was aphase 3 trial, conducted to confirm its efficacy and safety. Methods: In this international double-blinded randomized-controlled...

We examined the effect of an antimicrobial stewardship program (ASP), procalcitonin testing and rapid blood-culture identification on hospital mortality in a prospective quality improvement project in critically ill septic adults. Secondarily, we have reported antimicrobial guideline concordance, acceptance of ASP interventions, and antimicrobial a...

Death is common in the ICU often preceded by withdrawal of life-sustaining interventions. Therefore, health care professionals working in critical care should be experts in patient-family-centred care: this should include evaluating individuals for the potential of organ and tissue donation, and ensuring that the option of organ and tissue donation...

Objective To address an important care issue in Canada, we tested the association between paramedic system hospital offload and response time, while considering the impact of other system-level factors.Methods Data from Calgary, Alberta (2014–2017), included median offload (exposure) and response (outcome) time aggregated by hour, with covariates p...

Background Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option...

Purpose: To synthesize the available evidence comparing noninvasive methods of measuring the cessation of circulation in patients who are potential organ donors undergoing death determination by circulatory criteria (DCC) with the current accepted standard of invasive arterial blood pressure (IAP) monitoring. Source: We searched (from inception...

This 2023 Clinical Practice Guideline provides the biomedical definition of death based on permanent cessation of brain function that applies to all persons, as well as recommendations for death determination by circulatory criteria for potential organ donors and death determination by neurologic criteria for all mechanically ventilated patients re...

Introduction: Sepsis, the leading cause of acute kidney injury (AKI), is associated with a high morbidity and mortality. Alkaline phosphatase (ALP) is an endogenous detoxifying enzyme. A recombinant human ALP compound, ilofotase alfa, showed no safety or tolerability concerns in a phase 2 trial. Renal function improvement over 28 days was signific...

Critically ill patients in intensive care units experience profound alterations of their gut microbiota that have been linked to a high risk of hospital-acquired (nosocomial) infections and adverse outcomes through unclear mechanisms. Abundant mouse and limited human data suggest that the gut microbiota can contribute to maintenance of systemic imm...

NOT PUBLISHED AT AUTHOR’S REQUEST Please acknowledge all funding agencies by checking the applicable boxes below CIHR, Other Please indicate your source of funding; Government of Alberta Disclosure of Interest None Declared

· Background: Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic opt...

Objectives: To compare health service utilization of patients interacting with a mobile integrated health care program consisting of advanced care paramedics delivering community paramedic care to people experiencing homelessness before and after their initial visit. Methods: ED visits, physician claims, and pharmaceutical dispensations were com...

Background Family visitation in intensive care units (ICU) has been impacted by the severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic. While studies report on perceptions of families completely restricted from ICUs, little is known about the burden experienced by designated family caregivers allowed to visit their critically ill l...

Background Morbidity and mortality associated with opioid use has become a North American crisis. Harm reduction is an evidence-based approach to substance use. Targeted harm reduction strategies that consider the needs of specific populations are required. The objective of this scoping review was to document the range of opioid harm reduction inte...

Background Fluctuating course of delirium and complexities of ICU care mean delirium symptoms are hard to identify or commonly confused with other disorders. Delirium is difficult to diagnose, and clinicians and researchers may combine assessments from multiple tools. We evaluated diagnostic accuracy of different combinations of delirium assessment...

Purpose: Hospital policies forbidding or limiting families from visiting relatives on the intensive care unit (ICU) has affected patients, families, healthcare professionals, and patient- and family-centered care (PFCC). We sought to refine evidence-informed consensus statements to guide the creation of ICU visitation policies during the current C...

Background Lack of family visitation in ICU can have long-term consequences on ICU patients post-discharge. Efect of family visitation on the incidence of patient psychiatric disorders is unknown. Research Question What is the association between family visitation in the ICU and incidence of psychiatric outcomes in ICU patients 1-year post-hospita...

Background Restricted visitation policies in acute care settings because of the COVID-19 pandemic have negative consequences. The objective of this scoping review is to identify impacts of restricted visitation policies in acute care settings, and describe perspectives and mitigation approaches among patients, families, and healthcare professionals...

To create evidence-based consensus statements for restricted ICU visitation policies to support critically ill patients, families, and healthcare professionals during current and future pandemics. Design: Three rounds of a remote modified Delphi consensus process. Setting: Online survey and virtual polling from February 2, 2021, to April 8, 202...

Objective: To determine if the Study To Optimize Peritoneal Infection Therapy (STOP-IT) randomized controlled trial (RCT) changed antibiotic prescribing in patients with Complicated Intra-Abdominal Infection (CIAI). Summary background data: CIAI is common and causes significant morbidity. In May 2015, the STOP-IT RCT showed equivalent outcomes b...

Importance Growing interest in microbial dysbiosis during critical illness has raised questions about the therapeutic potential of microbiome modification with probiotics. Prior randomized trials in this population suggest that probiotics reduce infection, particularly ventilator-associated pneumonia (VAP), although probiotic-associated infections...

Objective: Linking emergency medical services (EMS) data to hospital outcomes is important for quality assurance and research initiatives. However, non-linkage due to missing or incomplete patient information may increase the risk of bias and distort findings. The purpose of this study was to explore if an optimization strategy, in addition to an e...

Introduction Flexible visitation policies in hospitals are an important component of care that contributes to reduced stress and increased satisfaction among patients and their family members. Early evidence suggests restricted visitation policies enacted in hospitals during the COVID-19 pandemic are having unintended consequences on patients, fami...

Background There is international variability in whether neurological determination of death (NDD) is conceptually defined based on permanent loss of brainstem function or “whole brain death.” Canadian guidelines are not definitive. Patients with infratentorial stroke may meet clinical criteria for NDD despite persistent cerebral blood flow (CBF) a...

West Nile virus neuroinvasive disease (WNV-NID) is challenging to diagnose. Procalcitonin (PCT) is a useful diagnostic test to identify bacterial infections. We present four cases of WNV-NID with serum PCT measurements. Methods: Daily (days 1-7) serum PCT (bioMérieux) was examined for critically ill patients with sepsis enrolled in a provincial s...

Background: Neurological injury can alter the systemic immune system, modifying the functional capacity of immune cells and causing a dysfunctional balance of cytokines, although mechanisms remain incompletely understood. The objective of this study was to assess the temporal relationship between changes in the activation status of circulating inv...

Objectives:. Treatment of hypoxemic respiratory failure and acute respiratory distress syndrome is complex. Evidence-based therapies that can improve survival and guidelines advocating their use exist; however, implementation is inconsistent. Our objective was to develop and validate an evidence-based, stakeholder-informed standardized management p...

Objectives: Determine effect of mental health interventions on psychologic outcomes in informal caregivers of critically ill patients. Data sources: Searches conducted in MEDLINE, Embase, and other databases from inception to October 31, 2019. Study selection: Interventions for informal caregivers of critically ill patients in adult ICU, PICU,...

Rationale: Delirium is common in the intensive care unit (ICU) and portends worse ICU and hospital outcomes. The effect of delirium in the ICU on post-hospital discharge mortality and health resource utilization is less well known. Objectives: To estimate mortality and health resource utilization 2.5-years post-hospital discharge in critically i...

Background The minimum duration of pulselessness required before organ donation after circulatory determination of death has not been well studied. Methods We conducted a prospective observational study of the incidence and timing of resumption of cardiac electrical and pulsatile activity in adults who died after planned withdrawal of life-sustain...

Critically ill patients with intra-abdominal hypertension and abdominal compartment syndrome are at an increased risk of death. The pathophysiologic processes associated with raised intra-abdominal pressures result in significant cardiovascular and hemodynamic effects. These effects include impaired cardiac contractility through decreased preload,...

Objectives: To examine long-term mortality, resource utilization, and healthcare costs in sepsis patients compared to hospitalized nonsepsis controls. Design: Propensity-matched population-based cohort study using administrative data. Setting: Ontario, Canada. Patients: We identified a cohort of adults (≥ 18) admitted to hospitals in Ontario...

BACKGROUND Treatment of hypoxemic respiratory failure (HRF) and Acute Respiratory Distress Syndrome (ARDS) is complex. Standardized management of HRF and ARDS may improve adherence to evidence informed practice and improve outcomes. RESEARCH QUESTION To examine the effect of standardized management compared to usual care on survival in HRF and ARD...

Background Compassion fatigue is recognized as impacting the health and effectiveness of healthcare providers, and consequently, patient care. Compassion fatigue is distinct from “burnout.” Reliable measurement tools, such as the Professional Quality of Life scale, have been developed to measure the prevalence, and predict risk of compassion fatigu...

The Tobacco and Vaping Products Act (Canada, 2018) (the “TVPA”) aims to protect the health of young persons by restricting access to vaping products. We studied whether the TVPA achieves this goal by sending young ‘secret shoppers’ to 120 shops in Calgary, Edmonton and Red Deer to attempt to buy nicotine vaping-initiation products, and by asking mi...

Surviving a critical illness can have long-term effects on both patients and families. These effects can be physical, emotional, cognitive, and social, and they affect both the patient and the family. Family members play a key role in helping their loved one recover, and this recovery process can take considerable time. Transferring out of an inten...

Purpose: Sepsis is a considerable health system burden. Population-based epidemiological surveillance of sepsis is limited to basic data available in administrative databases. We sought to determine if routinely collected Census data, linked to hospitalization data, can provide a broad socio-demographic profile of patients admitted to Canadian hos...

Background Multiple organ dysfunction is a common cause of morbidity and mortality in intensive care units (ICUs). Original development of the Sequential Organ Failure Assessment (SOFA) score was not to predict outcome, but to describe temporal changes in organ dysfunction in critically ill patients. Organ dysfunction scoring may be a reasonable su...

Background: Major trauma is associated with high incidence of septic complications and multiple organ dysfunction (MOD), which markedly influence the outcome of injured patients. Early identification of patients at risk of developing posttraumatic complications is crucial to provide early treatment and improve outcomes. We sought to evaluate the p...

The original article [1] contained a typo in author, Federico Coccolini’s name. This has now been corrected.

Background: Severe complicated intra-abdominal sepsis (SCIAS) has high mortality, thought due in part to progressive bio-mediator generation, systemic inflammation, and multiple organ failure. Treatment includes early antibiotics and operative source control. At surgery, open abdomen management with negative-peritoneal-pressure therapy (NPPT) has...

Rationale: Limited data on the epidemiology of acute respiratory distress syndrome (ARDS) using a standardized screening program exist. Objectives: To describe the population-based incidence of hypoxemic respiratory failure and ARDS using a prospective standardized screening protocol; and to describe the mechanical ventilation practice and the mech...

Background Transplantation is the most effective treatment for many patients with end-stage organ failure. There is a gap between the number of patients who would benefit from transplantation and availability of organs. We assessed maximum potential for deceased donation in Alberta and barriers to increasing the donation rate. Methods All deaths t...

Background Community Paramedics (CPs) require access to timely blood analysis in the field to guide treatment and transport decisions. Point of care testing (POCT), as opposed to laboratory analysis, may offer a solution, but limited research exists on CP POCT. The purpose of this study was to compare the validity of two devices (Abbott i-STAT® and...

Purpose: Values and value systems are fundamental to medical school admissions processes. An axiological analysis was carried out to explore the individual values and value systems found within the University of Calgary's Cumming School of Medicine's undergraduate admissions process. Method: A mixed methods case study methodology was developed w...

Abstract Background Although mandatory laparotomy has been standard of care for patients with abdominal gunshot wounds (GSWs) for decades, this approach is associated with non-therapeutic operations, morbidity, and long hospital stays. This systematic review and meta-analysis sought to summarize outcomes of selective nonoperative management (SNOM)...

Purpose: This study evaluated a complex initiative to increase evidence-based use of low molecular weight heparin for venous thromboembolism prophylaxis among adult medical-surgical ICU patients. Materials and methods: This study included: quantitative survey and interviews. Participants were healthcare providers within four ICUs. Surveys collec...

IntroductionSepsis is not well known. Only 58% of Americans know the word sepsis, less than 1% can identify its symptoms and one-third wrongly believe the disease is contagious (1). What if social media educated users about sepsis? There are at least 500 million tweets worldwide per day on Twitter. Objectives and ApproachEarly detection of sepsis w...

Introduction Emergency Medical Services (EMS) systems dispatch paramedics to emergencies in the community. For critically ill patients, paramedic interventions and transport destination decisions may impact outcomes. Research is needed to inform paramedic care, but linking EMS data to health system outcomes is a barrier. Limited research exists on...

Background: Mortality in patients with intra-abdominal sepsis remains high. Recognition and classification of patients with sepsis are challenging; about 70% of critical care specialists find the existing definitions confusing and not clinically useful. Objective: To assess the usefulness of the predisposition, infection/injury, response, organ...

Purpose: This study measured the quality of data extracted from a clinical information system widely used for critical care quality improvement and research. Materials and methods: We abstracted data from 30 fields in a random sample of 207 patients admitted to nine adult, medical-surgical intensive care units. We assessed concordance between da...

Background Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. Principles of treatment incl...

JCI Insight. 2018;3(9):e99364. https://doi.org/10.1172/jci.insight.99364. Sepsis-associated encephalopathy manifesting as delirium is a common problem in critical care medicine. In this study, patients that had delirium due to sepsis had significant cognitive impairments at 12-18 months after hospital discharge when compared with controls and Cambr...

Introduction: Outside of key conditions such as cardiac arrest and trauma, little is known about the epidemiology of mortality of all transported EMS patients. The objective of this study is to describe characteristics of EMS patients who after transport die in a health care facility. Methods: EMS transport events over one year (April, 2015-16) fro...

Introduction: EMS time factors such as total prehospital, activation, response, scene and transport intervals have been used as a measure of EMS system quality with the assumption that shorter EMS time factors save lives. The objective was to assess in adults and children accessing ground EMS (population), whether operational time factors (interven...

Introduction: Community Paramedics (CPs) require access to timely blood analysis in the field to guide treatment and transport decisions. Point of care testing (POCT), as opposed to traditional laboratory analysis, may offer a solution, but limited research exists on CP POCT. The objective of this study is to compare the validity of two POCT device...

Background Severe complicated intra-abdominal sepsis (SCIAS) is a worldwide challenge with increasing incidence. Open abdomen management with enhanced clearance of fluid and biomediators from the peritoneum is a potential therapy requiring prospective evaluation. Given the complexity of powering multi-center trials, it is essential to recruit an in...

Cases of liraglutide overdose are rare in the literature. Prior reports have not found hypoglycemia related to the medication overdose. We describe a case of a non-diabetic patient who intentionally overdosed on liraglutide leading to severe hypoglycemia. The patient required admission to the intensive care unit for a dextrose infusion and close mo...

The purpose is to provide a descriptive overview of relevant material exploring improvement of handovers from the operating room (OR) to intensive care unit (ICU). An online search (MEDLINE, Cochrane, EMBASE, CINAHL, and Joanna Briggs), including gray literature and relevant reference lists, was completed. In all, 4574 unique citations were screene...

Objective: Academic medical centers in North America are expanding their missions from the traditional triad of patient care, research, and education to include the broader issue of healthcare delivery improvement. In recent years, integrated Critical Care Organizations have developed within academic centers to better meet the challenges of this b...

Background The optimal prehospital fluid for the treatment of hypotension is unknown. Hypertonic fluids may increase circulatory volume and mute the pro-inflammatory response of the body to injury and illness. The purpose of this systematic review is to determine whether in patients presenting with hypotension in the prehospital setting (population...

A 42-year-old woman presented with a 5-day history of fever, chills, myalgias, vomiting, diarrhea, and headache after returning from a 10-month trip to Mozambique. She was diagnosed with severe Plasmodium falciparum malaria and rapidly developed acute renal failure, disseminated intravascular coagulation (DIC), decreased level of consciousness, and...

Severe longitudinally extensive transverse myelitis (LETM) can cause quadriplegia, marked sensory dysfunction, and respiratory failure. Some patients are unresponsive to conventional immune therapy. We report two cases of severe immune-mediated LETM requiring intensive care admission that failed to respond to high-dose corticosteroids, plasma excha...

Background Platelet transfusions are commonly used to treat critically ill patients with thrombocytopenia. Whether platelet transfusions are associated with a reduction in the risk of major bleeding is unknown. Patients/Methods Observational cohort study nested in a previous multicenter, randomized thromboprophylaxis trial in the intensive care un...

Background Apnea testing is an essential step in the clinical diagnosis of brain death. Current international guidelines recommend placement of an oxygen (O2) insufflation catheter into the endotracheal tube to prevent hypoxemia, but use of a continuous positive airway pressure (CPAP) valve may be more effective at limiting arterial partial pressur...

Background: The cause of brain injury may influence the number of organs that can be procured and transplanted with donation following neurologic determination of death. We investigated whether the distribution of causes responsible for neurologic death has changed over time and, if so, whether this has had an impact on organ quality, transplantati...

Clinical decision making requires knowledge, experience and analytical/non-analytical types of decision processes. As clinicians progress from novice to expert, research indicates decision-making becomes less reliant on foundational biomedical knowledge and more on previous experience. In this study, we investigated how knowledge and experience wer...

Clinical reasoning is dependent upon working memory (WM). More precisely, during the clinical reasoning process stored information within long-term memory is brought into WM to facilitate the internal deliberation that affords a clinician the ability to reason through a case. In the present study, we examined the relationship between clinical reaso...