Maureen Meade

McMaster University | McMaster · Department of Clinical Epidemiology and Biostatistics

PurposeCurrently, there is little empirical data on family understanding about brain death and death determination. The purpose of this study was to describe family members’ (FMs’) understanding of brain death and the process of determining death in the context of organ donation in Canadian intensive care units (ICUs).Methods We conducted a qualita...

Introduction In donation after circulatory determination of death, death is declared 5 min after circulatory arrest. This practice assumes, but does not explicitly confirm, permanent loss of brain activity. While this assumption is rooted a strong physiological rationale, paucity of direct human data regarding temporal relationship between cessatio...

Purpose: To characterize differences in directives to limit treatments and discontinue invasive mechanical ventilation (IMV) in elderly (65 - 80 years) and very elderly (> 80 years) intensive care unit (ICU) patients. Measurements: We prospectively described new orders to limit treatments, IMV discontinuation strategies [direct extubation, direct t...

Background: Decisions about organ donation are stressful for family members of potential organ donors. We sought to comprehensively explore the donation process from interviews conducted with family members of patients admitted to pediatric and adult intensive care units in Canada. Methods: We conducted a qualitative study using semistructured,...

Background: Studies that have evaluated the use of intravenous vitamin C in adults with sepsis who were receiving vasopressor therapy in the intensive care unit (ICU) have shown mixed results with respect to the risk of death and organ dysfunction. Methods: In this randomized, placebo-controlled trial, we assigned adults who had been in the ICU...

Importance: The efficacy and safety of prone positioning is unclear in nonintubated patients with acute hypoxemia and COVID-19. Objective: To evaluate the efficacy and adverse events of prone positioning in nonintubated adult patients with acute hypoxemia and COVID-19. Design, setting, and participants: Pragmatic, unblinded randomized clinical...

Background Prognostic factors in lung transplantation are those variables that are associated with transplant outcomes. Knowledge of donor and recipient prognostic variables can aid in the optimal allocation of donor lungs to transplant recipients and can also inform post-operative discussions with patients about prognosis. Current research finding...

Rationale: The most beneficial positive end-expiratory pressure (PEEP) selection strategy in patients with acute respiratory distress syndrome (ARDS) is unknown and current practice is variable. Objectives: To compare the relative effects of different PEEP selection strategies on mortality in adults with moderate to severe ARDS. Methods: We co...

Importance The COVID-19 pandemic created the need for rapid and urgent guidance for clinicians to manage COVID-19 among patients and prevent transmission. Objective To appraise the quality of clinical practice guidelines (CPGs) using the National Academy of Medicine (NAM) criteria. Evidence Review A search of MEDLINE, EMBASE, and the Cochrane Cen...

Purpose We evaluated characteristics associated with neuromuscular blockade (NMB) use, center-level variation, and whether NMB mediated excess mortality among patients assigned to high-frequency oscillatory ventilation (HFOV) in the OSCILLATE trial. Materials and methods NMB exposure was defined as receipt after randomization; the primary outcome...

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...

Purpose We sought to examine changes in acute respiratory distress syndrome (ARDS) management over a 12-year period of two successive randomized trials. Methods Analyses included baseline data, from eligible patients, prior to influence of trial protocols, and daily study data, from randomized patients, of variables not determined by trial protoco...

Donation after circulatory death determination (DCDD) frequently involves antemortem heparin administration to mitigate peri-arrest microvascular thrombosis. We systematically reviewed the literature to: (1) describe heparin administration practices, and (2) explore the effects on transplant outcomes. We searched MEDLINE and EMBASE for studies repo...

Rationale: Mortality in Acute Respiratory Distress Syndrome (ARDS) has decreased after the adoption of lung-protective strategies. Lower tidal-volumes, lower driving pressures, lower respiratory rates, and higher end-expiratory pressures have all been suggested as key components of lung protection strategies. A unifying theoretical explanation has...

Importance Although most critically ill patients receive invasive mechanical ventilation (IMV), few studies have characterized how IMV is discontinued in practice. Objective To describe practice variation in IMV discontinuation internationally, associations between initial discontinuation events and outcomes, and factors associated with the use of...

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...

Rationale: Choosing the best ventilation strategy for acute respiratory distress syndrome (ARDS) is complex, yet highly relevant to clinicians during a respiratory pandemic. Objectives: To compare the effects of low tidal volumes (Vt), high Vt, high positive end-expiratory pressure (high PEEP), prone ventilation, high frequency oscillation (HFO)...

Purpose Existing clinical practice guidelines support the use of neuromuscular blocking agents (NMBA) in acute respiratory distress syndrome (ARDS); however, a recent large randomized clinical trial (RCT) has questioned this practice. Therefore, we updated a previous systematic review to determine the efficacy and safety of NMBAs in ARDS. Methods...

Objective: The objectives of this study were to systematically identify and describe guidelines for the care of neurologically deceased donors and to evaluate their methodological quality, with the aim of informing and supporting the new Canadian guidelines for the management of organ donors. Methodology: Following a systematic search, we includ...

End-of-life (EOL) care is a key aspect of critical care medicine (CCM) training. The goal of this study was to survey CCM residents and program directors (PDs) across Canada to describe current EOL care education. Using a literature review, we created a self-administered survey encompassing 10 CCM national objectives of training to address: (1) cur...

Background: Poor recruitment of patients is the predominant reason for early termination of randomized clinical trials (RCTs). Systematic empirical investigations and validation studies of existing recruitment models, however, are lacking. We aim to provide evidence-based guidance on how to predict and monitor recruitment of patients into RCTs. Ou...

Introduction Cardiac transplantation remains the best treatment for patients with end-stage heart disease that is refractory to medical or device therapies, however, a major challenge for heart transplantation is the persistent discrepancy between the number of patients on waiting lists and the number of available hearts. While other countries (eg,...

Introduction In a patient-centred and family-centred approach to organ donation, compassion is paramount. Recent guidelines have called for more research, interventions and approaches aimed at improving and supporting the families of critically ill patients. The objective of this study is to help translate patient-centred and family-centred care in...

PurposeCanadian donor management practices have not been reported. Our aim was to inform clinicians and other stakeholders about the range of current practices.Methods This prospective observational cohort study enrolled consecutive, newly consented organ donors from August 1 2015 to July 31 2018 at 27 academic and five community adult intensive ca...

Research to inform the care of neurologically deceased organ donors is complicated by a lack of standards for research consent. In this systematic review, we aim to describe current practices of soliciting consent for participation in prospective studies of neurologically deceased donors, including the frequency and justification for these various...

Purpose The 3 Wishes Project (3WP) promotes holistic end-of-life care in the intensive care unit (ICU) to honor dying patients, support families, and encourage clinician compassion. Organ donation is a wish that is sometimes made by, or on behalf of, critically ill patients. Our objective was to describe the interface between the 3WP and organ dona...

Inhaled vasodilators have a compelling physiologic rationale in the management of critically ill patients with acute respiratory distress syndrome (ARDS). Accordingly, early preclinical and clinical observational studies suggested that inhaled nitric oxide (NO) could substantially improve arterial oxygenation. Other laboratory investigations report...

Purpose Clinicians lack well-validated, non-invasive, objective tools to guide volume management in the post-resuscitative period. Bioimpedance analysis (BIA) represents a novel method for guiding fluid management. We studied the relationship of BIA vector length (VL), an indicator of volume status, to the need for mechanical ventilation in patient...

Introduction In Canada, deceased organ donation provides over 80% of transplanted organs. At the time of death, families, friends or others assume responsibility as substitute decision-makers (SDMs) to consent to organ donation. Despite their central role in this process, little is known about what barriers, enablers and beliefs influence decision-...

Objectives: Clinical research is a collaborative enterprise; researchers benefit from the expertise, experience, and resources of their collaborators. We sought to describe the extent and patterns of collaboration among pediatric critical care trialists, and to identify the most influential individuals, centers, and countries. Design: Social net...

Background and objectives: With expansion of the pool of kidney grafts, through the use of higher-risk donors, and increased attention to donor management strategies, the 1-year graft survival rate is subject to change. It is, therefore, useful to elucidate 1-year graft survival rates by dissecting the characteristics of the low-risk and high-risk...

Introduction Research supports the use of specific strategies to discontinue mechanical ventilation (MV) in critically ill patients. Little is known about how clinicians actually wean and discontinue MV in practice or the association between different discontinuation strategies and outcomes. The primary objective of this study is to describe intern...

Purpose: Right ventricular RV dysfunction among transplant recipients correlates with transplant outcome, but its frequency in donors is unknown. The purpose of this study was to describe the epidemiology of RV dysfunction in potential heart donors." Methods: In a seven-year retrospective study of potential heart donors, we explored the incidenc...

Purpose We sought to characterize Canadian physicians’ perspectives and stated practices regarding their hemodynamic care of deceased organ donors. Methods We designed a 24-item electronic survey that was independently pretested for relevance, clarity, and intra-rater reliability by ten critical care clinicians. With the help of provincial organ d...

Background: Upon surviving the first year post-lung transplantation, recipients can expect a median survival of 8 years. Within the first year, graft failure and multi-organ failure (possibly secondary to graft failure) are common causes of mortality. To better understand the prognosis within the first year, we plan on conducting a systematic revi...

Introduction Ventilator-associated pneumonia (VAP) is the most common healthcare-associated infection in critically ill patients. Prior studies suggest that probiotics may reduce VAP and other infections in critically ill patients; however, most previous randomised trials were small, single centre studies. The Probiotics: Prevention of Severe Pneum...

Background: Studies on the association of obesity with mortality in subjects with ARDS have yielded inconsistent results. Methods: In a sub-analysis of the Oscillation for ARDS Treated Early (OSCILLATE) randomized controlled trial, 451 subjects were divided into 5 strata based on their body mass index (BMI) using the World Health Organization de...

Introduction: Rates of successful organ donation vary between otherwise comparable intensive care units (ICUs). The ICU staff have a unique perspective into the facilitators and barriers underlying this variation in successful deceased organ donation. Research question: What do ICU staff perceive to be the most meaningful facilitators and barrie...

Objectives: It is unknown whether more frequent screening of invasively ventilated patients, identifies patients earlier for a spontaneous breathing trial, and shortens the duration of ventilation. We assessed the feasibility of conducting a large trial to evaluate screening frequency in critically ill adults in the North American context. Design...

Purpose Rates of organ donation vary between otherwise comparable intensive care units (ICUs) suggesting that the process of donation must vary between ICUs. The purpose of this study was to describe the process of organ donation from the perspective of ICU staff, identify important drivers of successful donation, and develop strategies to improve...

Background Host-associated microbial communities have important roles in tissue homeostasis and overall health. Severe perturbations can occur within these microbial communities during critical illness due to underlying diseases and clinical interventions, potentially influencing patient outcomes. We sought to profile the microbial composition of c...

Objectives: Clinical research is a complex scientific and social enterprise. Our objective was to identify strategies that pediatric critical care trialists consider acceptable, feasible, and effective to improve the design and conduct randomized controlled trials in pediatric critical care. Design: Qualitative descriptive study using semistruct...

Introduction There is concern about excessive bleeding when low-molecular-weight heparins (LMWHs) are used for venous thromboembolism (VTE) prophylaxis in renal dysfunction. Our objective was to evaluate whether LMWH VTE prophylaxis was safe and effective in critically ill patients with renal dysfunction by conducting a subgroup analysis of PROTECT...

List of participating hospitals. (DOCX)

PROTECT study protocol. (PDF)

CONSORT 2010 checklist. (PDF)

The call for meaningful patient and family engagement in healthcare and research is gaining impetus. Healthcare institutions and research funding agencies increasingly encourage clinicians and researchers to work actively with patients and their families to advance clinical care and research. Engagement is increasingly mandated by healthcare organi...

Rationale: Randomized trials and meta-analyses have informed several aspects of weaning. Results are rarely replicated in practice as evidence is applied in intensive care units (ICUs) that differ from the settings in which it was generated. Objectives: We aimed to (i) describe weaning practice variation (identifying weaning candidates, conducti...

Objective: To better understand how local policies influence organ donation rates. Research methodology/design: We conducted a document analysis of our ICU organ donation policies, protocols and order sets. We used a systematic search of our institution's policy library to identify documents related to organ donation. We used Mindnode software t...

Objective: Use of hyperchloremic IV fluids for resuscitation in sepsis may be associated with increased mortality and use of renal replacement therapy. After crystalloids, 5% human albumin represents the second most common resuscitation fluid in the ICU. Its chloride concentration is rarely considered in the clinical setting. This study quantifies...

PurposeGuidelines for shock recommend mean arterial pressure (MAP) targets for vasopressor therapy of at least 65 mmHg and, until recently, suggested that patients with underlying chronic hypertension and atherosclerosis may benefit from higher targets. We conducted an individual patient-data meta-analysis of recent trials to determine if patient v...

Background Atraumatic needles have been proposed to lower complication rates after lumbar puncture. However, several surveys indicate that clinical adoption of these needles remains poor. We did a systematic review and meta-analysis to compare patient outcomes after lumbar puncture with atraumatic needles and conventional needles. Methods In this...

A concerted e ort to tackle the global health problem posed by traumatic brain injury (TBI) is long overdue. TBI is a public health challenge of vast, but insu ciently recognised, proportions. Worldwide, more than 50 million people have a TBI each year, and it is estimated that about half the world’s population will have one or more TBIs over their...

Rationale: By minimizing tidal lung strain and maintaining alveolar recruitment, high frequency oscillatory ventilation (HFOV) may protect against ventilator-induced lung injury. Objectives: To summarize the current evidence in support of the use of HFOV in adult patients with ARDS. Methods: We conducted a systematic review and meta-analysis o...

Rationale: Higher positive end-expiratory pressure (PEEP) levels may reduce atelectrauma but increase over-distention lung injury. Whether higher PEEP improves clinical outcomes among patients with acute respiratory distress syndrome (ARDS) is unclear. Objective: To compare clinical outcomes of mechanical ventilation strategies using higher PEEP...

Rationale: In patients with acute respiratory distress syndrome (ARDS), lung recruitment maneuvers (LRMs) may prevent ventilator-induced lung injury and improve survival. Objectives: To summarize the current evidence in support of the use of LRMs in adult patients with ARDS. Methods: We conducted a systematic review and meta-analysis of random...

Rationale: The application of prone positioning for acute respiratory distress syndrome (ARDS) has evolved, with recent trials focusing on patients with more severe ARDS, and applying prone ventilation for more prolonged periods. Objectives: This review evaluates the effect of prone positioning on 28-day mortality (primary outcome) compared with...

Rationale: Clinicians' current practice patterns in the management of acute respiratory distress syndrome (ARDS) and refractory hypoxemia are not well described. Objectives: To describe mechanical ventilation strategies and treatment adjuncts for adults with ARDS including refractory hypoxemia. Methods: Prospective cohort study (March 2014-Feb...

Introduction Research on the management of deceased organ donors aims to improve the number and quality of transplants and recipient outcomes. In Canada, this research is challenged by regionalisation of donation services within provinces and the geographical, clinical and administrative separation of donation from transplantation services. This st...

Objective A systematic summary of the observational studies informing heart transplant guideline recommendations for selection of candidates and donors has thus far been unavailable. We performed a meta-analysis to better understand the impact of such known risk factors. Methods We systematically searched and meta-analysed the association between...

Rationale: Trials investigating use of lower tidal volumes and inspiratory pressures for patients with acute respiratory distress syndrome (ARDS) have shown mixed results. Objectives: To compare clinical outcomes of mechanical ventilation strategies that limit tidal volumes and inspiratory pressures (LTV) to strategies with tidal volumes of 10-1...

Background: The standard definition for protocol adherence is the proportion of all scheduled doses that are delivered. In clinical research, this definition has several limitations when evaluating protocol adherence in trials that study interventions requiring continuous titration. Discussion: Building upon a specific case study, we analyzed a...

Introduction Observational evidence suggests physiological benefits and lower mortality with lower chloride solutions; however, 0.9% saline remains the most widely used fluid worldwide. Given uncertainty regarding the association of lower chloride on mortality, it is unlikely that practice will change without direct randomised clinical trial (RCT)...

Background: Intracranial mycotic aneurysms are rare forms of vascular abnormalities. They are typically fragile and have high tendency to bleed. Even when they are successfully secured upon intervention, the medical management can be challenging in presence of other non-ruptured aneurysms and concomitant cerebral vasospasm. Methods: A 31 year old f...