Yoanna Skrobik

Yoanna Skrobik
McGill University | McGill

MD FRCP(c)

About

216
Publications
104,257
Reads
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24,029
Citations
Additional affiliations
January 2015 - January 2017
Université de Montréal
Position
  • Clinician Scientist

Publications

Publications (216)
Article
Full-text available
Background: We previously published the protocol and statistical analysis plan for a randomized controlled trial of Proportional Assist Ventilation for Minimizing the Duration of Mechanical Ventilation: the PROMIZING study in Trials ( https://doi.org/10.1186/s13063-023-07163-w ). This update summarizes changes made to the statistical analysis plan...
Article
Aims and objectives: The aim of the study was to investigate the effect of supporting family members to partner with health professionals on nutrition intakes and decision-making and to evaluate intervention and study feasibility. Background: Family partnerships can improve outcomes for critically ill patients and family members. Interventions t...
Article
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Background Proportional assist ventilation with load-adjustable gain factors (PAV+) is a mechanical ventilation mode that delivers assistance to breathe in proportion to the patient’s effort. The proportional assistance, called the gain, can be adjusted by the clinician to maintain the patient’s respiratory effort or workload within a normal range....
Article
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Background Liberating patients from mechanical ventilation (MV) requires a systematic approach. In the context of a clinical trial, we developed a simple algorithm to identify patients who tolerate assisted ventilation but still require ongoing MV to be randomized. We report on the use of this algorithm to screen potential trial participants for en...
Article
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Tracheostomy is commonly performed in critically ill patients requiring prolonged mechanical ventilation (MV). We evaluated the outcomes of tracheostomy in patients who received greater than or equal to 1 week MV and were followed for 1 year. Design: In this secondary analysis of a prospective observational study, we compared outcomes in tracheos...
Chapter
Delirium and sleep disruption are each common in the intensive care unit (ICU); their potential inter-relationship is of great interest to ICU clinicians and researchers. These two conditions share common pathophysiologic mechanisms, including circadian pathways, risk factors and symptoms. Patients should be evaluated for the presence of psychologi...
Article
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Introduction Traditional advance care planning focuses on end‐of‐life planning in the context of a certain or imminent death. It is not tailored for serious illness planning, where the ‘death’ outcome is uncertain. The Plan Well Guide™ (PWG) is a decision aid that empowers lay persons to better understand different types of care and prepares them,...
Article
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Importance Delirium significantly worsens elective surgery outcomes and costs. Delirium risk is highest in elderly populations, whose surgical health care resource consumption (50%) exceeds their demographic proportion (15% to 18%) in high-resource countries. Effective nonpharmacologic delirium prevention could safely improve care in these vulnerab...
Article
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Mechanical ventilation induces a number of systemic responses for which the brain plays an essential role. During the last decade, substantial evidence has emerged showing that the brain modifies pulmonary responses to physical and biological stimuli by various mechanisms, including the modulation of neuroinflammatory reflexes and the onset of abno...
Article
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Objectives Whether and how delirium and sleep quality in the intensive care unit (ICU) are linked remains unclear. A recent randomised trial reported nocturnal low-dose dexmedetomidine (DEX) significantly reduces incident ICU delirium. Leeds Sleep Evaluation Questionnaire (LSEQ) scores were similar between intervention (DEX; n=50) and control (plac...
Article
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This systematic review and meta-analysis addresses the efficacy and safety of nonopioid adjunctive analgesics for patients in the ICU. Data sources: We searched PubMed, Embase, the Cochrane Library, CINAHL Plus, and Web of Science. Study selection: Two independent reviewers screened citations. Eligible studies included randomized controlled tri...
Article
Objectives: Numerous risk factors for sleep disruption in critically ill adults have been described. We performed a systematic review of all risk factors associated with sleep disruption in the ICU setting. Data sources: PubMed, EMBASE, CINAHL, Web of Science, Cochrane Central Register for Controlled Trials, and Cochrane Database of Systematic R...
Article
Intensive care unit (ICU) patient, and family member engagement is evolving in both critical care medicine practice and research. The results of two qualitative critical care research projects led by ICU survivors and family members show how patient-partner research training can inform the critical care community of meaningful priorities in the tra...
Chapter
Routine pain assessment and the procurement of effective analgesics are of paramount importance to critical care patients. Constant evaluation underpins the important balance between pain relief and the pharmacological side effects of administered agents. The significance of these issues was highlighted during the production of the most recent Soci...
Article
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Background: In critically ill patients, poor patient-ventilator interaction may worsen outcomes. Although sedatives are often administered to improve comfort and facilitate ventilation, they can be deleterious. Whether opioids improve asynchronies with fewer negative effects is unknown. We hypothesized that opioids alone would improve asynchronies...
Article
Managing pain and delirium are crucial to patients, families, and caregivers in intensive care units. The Society of Critical Care Medicine 2018 Pain, Agitation/Sedation, Delirium, Immobility, and Sleep disruption (PADIS) guidelines reviewed literature until October 2015 and made its recommendations for critically-ill adults. This chapter addresses...
Article
Purpose: To develop an Arabic version of Intensive Care Delirium Screening Checklist (ICDSC) and assess its validity and reliability among critically ill patients. Materials and methods: Multicentered study of convenience sample of adult ICU patients. Arabic translation was performed with rigorous back-to-back translation methods. Concurrent val...
Article
For decades, the comfort and safety of patients who are undergoing mechanical ventilation in the intensive care unit (ICU) entailed deep sedation, the nearly ubiquitous administration of opiates, and the liberal use of neuromuscular blockade. Concomitant with rising demands on ICU resources and expenditures, clinical studies started evaluating whet...
Article
Background: Moderate to severe depressive symptoms occur in up to one-third of patients at 1 year following ICU discharge, negatively affecting patient outcomes. This study evaluated patient and caregiver factors associated with the development of these symptoms. Methods: This study used the Rehabilitation and Recovery in Patients after Critical...
Article
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Background Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients’ age, with pre-existing cognitive im...
Article
Background Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients’ age, with pre-existing cognitive im...
Article
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Introduction Delirium is a common complication of critical illness, associated with negative patient outcomes. Preventive or therapeutic interventions are mostly ineffective. Although relaxation-inducing approaches may benefit critically ill patients, no well-designed studies target delirium prevention as a primary outcome. The objective of this st...
Article
Background Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients’ age, with pre-existing cognitive im...
Article
Background Delirium is underinvestigated in the neuro‐critically ill, although the harmful effect of delirium is well established in patients in medical and surgical intensive care units (ICU).To detect delirium, a valid tool is needed. We hypothesized that delirium screening would be feasible in patients with acute brain injury and we aimed to val...
Article
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Objective: To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU. Design: Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups gathered face-to-face at annual Society of Cr...
Article
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Objectives: The Society of Critical Care Medicine recommends routine delirium monitoring, based on data in critically ill patients without primary neurologic injury. We sought to answer whether there are valid and reliable tools to monitor delirium in neurocritically ill patients and whether delirium is associated with relevant clinical outcomes (...
Article
Objectives: To describe novel guideline development strategies created and implemented as part of the Society of Critical Care Medicine's 2018 clinical practice guidelines for pain, agitation (sedation), delirium, immobility (rehabilitation/mobility), and sleep (disruption) in critically ill adults. Design: We involved critical illness survivors...
Article
The 2018 Clinical Practice Guideline for the Prevention and Management of Pain, Agitation (Sedation), Delirium, Immobility, and Sleep (Disruption) (PADIS) in adult patients in the ICU addresses new management challenges related to pain, agitation, and delirium and offers guidance on two additional topics rehabilitation/mobility and sleep (1, 2). Th...
Article
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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...
Data
List of participating hospitals. (DOCX)
Article
Rationale: Dexmedetomidine is associated with less delirium than benzodiazepines, and better sleep architecture than either benzodiazepines or propofol; its effect on delirium and sleep when administered at night to patients requiring sedation remains unclear. Objectives: To determine if nocturnal dexmedetomidine prevents delirium and improves s...
Article
Background: Delirium is highly prevalent in critically ill patients. Its detection with valid tools is crucial. Objective: To analyze the development and psychometric properties of delirium assessment tools for critically ill adults. Methods: Databases were searched to identify relevant studies. Inclusion criteria were English language, public...
Article
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Background: Over the last decade, health care delivery has shifted to partnering with patients and their families to improve health and quality of care, and to lower costs. Partnering with family members (FMs) of critically ill patients who lack capacity is particularly important for improving experiences and outcomes for both patients and FMs. Ho...
Article
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Objectives: To assess the knowledge and use of the Assessment, prevention, and management of pain; spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assessment; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle to implement the Pain, Agitation, Delirium guidelines. Design: Wor...
Article
Objectives: To evaluate the effect of an extended visitation model compared with a restricted visitation model on the occurrence of delirium among ICU patients. Design: Prospective single-center before and after study. Setting: Thirty-one-bed medical-surgical ICU. Patients: All patients greater than or equal to 18 years old with expected len...
Article
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Delirium, a prevalent organ dysfunction in critically ill patients, is independently associated with increased morbidity. This last decade has witnessed an exponential growth in delirium research in hospitalized patients, including those critically ill, and this research has highlighted that delirium needs to be better understood mechanistically to...
Article
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Background The optimal approach to titrate vasopressor therapy is unclear. Recent sepsis guidelines recommend a mean arterial pressure (MAP) target of 65 mmHg and higher for chronic hypertensive patients. As data emerge from clinical trials comparing blood pressure targets for vasopressor therapy, an accurate description of usual care is required t...
Article
Objective: To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU. Methods: We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We assembled an international multidisciplinary...
Article
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Background: Mechanically ventilated patients may receive more sedation during the night than during the day, potentially delaying extubation. We compared nighttime and daytime benzodiazepine and opioid administration in adult patients enrolled in a multicenter sedation trial comparing protocolized sedation alone or protocolized sedation combined w...
Article
Background Few resources are available to support caregivers of patients who have survived critical illness; consequently, the caregivers’ own health may suffer. We studied caregiver and patient characteristics to determine which characteristics were associated with caregivers’ health outcomes during the first year after patient discharge from an i...
Article
Objective: To characterize analgesic administration in neurocritical care. Design: ICU pharmacy database analgesic delivery audits from five countries. A 31-question analgesic agent survey was constructed, validated, and e-distributed in four countries. Setting: International multicenter neuro-ICU database audit and electronic survey. Patient...
Article
Rationale: Disability risk groups and one-year outcome after ≥ 7 days of mechanical ventilation in medical / surgical ICU patients are unknown and may inform education, prognostication, rehabilitation and study design. Objectives: To stratify patients for post-ICU disability and recovery to one year after critical illness. Methods: We evaluate...
Article
Purpose: In shock, hypotension may contribute to inadequate oxygen delivery, organ failure and death. We conducted the Optimal Vasopressor Titration (OVATION) pilot trial to inform the design of a larger trial examining the effect of lower versus higher mean arterial pressure (MAP) targets for vasopressor therapy in shock. Methods: We randomly a...
Article
Objective: To compare the efficacy and safety of scheduled low-dose haloperidol versus placebo for the prevention of delirium (Intensive Care Delirium Screening Checklist ≥ 4) administered to critically ill adults with subsyndromal delirium (Intensive Care Delirium Screening Checklist = 1-3). Design: Randomized, double-blind, placebo-controlled...
Article
Purpose: The purpose was to describe characteristics and outcomes of restrained and nonrestrained patients enrolled in a randomized trial of protocolized sedation compared with protocolized sedation plus daily sedation interruption and to identify patient and treatment factors associated with physical restraint. Methods: This was a post hoc seco...
Article
To 1) describe factual, emotional, and delusional memories of ICU stay for patients enrolled in the SLEAP (Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol) trial; 2) compare characteristics of patients with and without ICU recall, and patients with and without delusional memories; an...
Article
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Blame has been thought to affect quality by decreasing error reporting. Very little is known about the incidence, characteristics or consequences of the distress caused by being blamed. Blame-related distress (B-RD) may be related to moral distress, but may also be a factor in burnout, compassion fatigue, lateral violence and second victim syndrome...
Article
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Venous thromboembolism (VTE) is a common complication of critical illness with important clinical consequences. The Prophylaxis for ThromboEmbolism in Critical Care Trial (PROTECT) is a multicenter, blinded, randomized controlled trial comparing the effectiveness of the two most common pharmocoprevention strategies, unfractionated heparin (UFH) and...
Article
Delirium is common during critical illness and associated with adverse outcomes. We compared characteristics and outcomes of delirious and nondelirious patients enrolled in a multicenter trial comparing protocolized sedation with protocolized sedation plus daily sedation interruption. Randomized trial. Sixteen North American medical and surgical IC...
Article
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The Lung Open Ventilation Study (LOV Study) compared a low tidal volume strategy with an experimental strategy combining low tidal volume, lung recruitment maneuvers, and higher plateau and positive end-expiratory pressures (PEEP) in adults with acute respiratory distress syndrome (ARDS). Herein, we compared sedative, opioid, and neuromuscular bloc...
Article
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Importance Venous thromboembolism (VTE) is a common complication of acute illness, and its prevention is a ubiquitous aspect of inpatient care. A multicenter blinded, randomized trial compared the effectiveness of the most common pharmocoprevention strategies, unfractionated heparin (UFH) and the low-molecular-weight heparin (LMWH) dalteparin, fin...
Book
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“Brain Disorders in Critical Illness”, edited by Robert Stevens, Tarek Sharshar and Wes Ely, offers an overview of critical illness brain dysfunction (delirium, coma, encephalopathy), a major problem in intensive care with potentially debilitating long-term consequences. Chapters on epidemiology, outcomes, relevant behavioral neurology and biologic...
Article
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Importance: Critically ill patients are at risk of venous thrombosis, and therefore guidelines recommend daily thromboprophylaxis. Deep vein thrombosis (DVT) commonly occurs in the lower extremities but can occur in other sites including the head and neck, trunk, and upper extremities. The risk of nonleg deep venous thromboses (NLDVTs), predisposi...
Article
We reviewed randomized trials of adult ICU patients of interventions hypothesized to reduce delirium burden to determine whether interventions that are more effective at reducing delirium duration are associated with a reduction in short-term mortality. We searched CINHAHL, EMBASE, MEDLINE, and the Cochrane databases from 2001 to 2012. Citations we...
Conference Paper
Introduction: Subsyndromal delirium (SSD)[Intensive Care Delirium Screening Checklist Score (ICDSC) from 1 to 3/8] is associated with worse outcomes than 'no delirium' (ND)(ICDSC=0) and is part of an outcome-predicting spectrum of symptoms [ND[right double arrow]SSD[right double arrow]Delirium(D)(ICDSC >=4/8)]. Methods: Mechanically ventilated, cri...