Margaret Herridge's research while affiliated with University of Toronto and other places

Publications (79)

Article
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Abstract Background While early mobilization is commonly implemented in intensive care unit treatment guidelines to improve functional outcome, the characterization of the optimal individual dosage (frequency, level or duration) remains unclear. The aim of this study was to demonstrate that artificial intelligence-based clustering of a large ICU co...
Article
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Background Late mortality risk in sepsis-survivors persists for years with high readmission rates and low quality of life. The present study seeks to link the clinical sepsis-survivors heterogeneity with distinct biological profiles at ICU discharge and late adverse events using an unsupervised analysis. Methods In the original FROG-ICU prospectiv...
Article
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Background With ICU mortality rates decreasing, it is increasingly important to identify interventions to minimize functional impairments and improve outcomes for survivors. Simultaneously, we must identify robust patient-centered functional outcomes for our trials. Our objective was to investigate the clinimetric properties of a progression of thr...
Article
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Rationale The COVID-19 pandemic disrupted non-COVID critical care trials globally as intensive care units (ICUs) prioritized patient care and COVID-specific research. The international randomized controlled trial CYCLE ( C ritical Care C yc ling to Improve L ower E xtremity Strength) was forced to halt recruitment at all sites in March 2020, creati...
Article
Mortality is a well-established patient-important outcome in critical care studies. In contrast, morbidity is less uniformly reported (given the myriad of critical care illnesses and complications of each) but may have a common end-impact on a patient’s functional capacity and health-related quality-of-life (HRQoL). Survival with a poor quality-of-...
Article
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Health consequences that persist beyond the acute infection phase of COVID-19, termed post-COVID-19 condition (also commonly known as long COVID), vary widely and represent a growing global health challenge. Research on post-COVID-19 condition is expanding but, at present, no agreement exists on the health outcomes that should be measured in people...
Preprint
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HostSeq was launched in April 2020 as a national initiative to integrate whole genome sequencing data from 10,000 Canadians infected with SARS-CoV-2 with clinical information related to their disease experience. The mandate of HostSeq is to support the Canadian and international research communities in their efforts to understand the risk factors f...
Article
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Background: A substantial portion of people with COVID-19 subsequently experience lasting symptoms including fatigue, shortness of breath, and neurological complaints such as cognitive dysfunction many months after acute infection. Emerging evidence suggests that this condition, commonly referred to as long COVID but also known as post-acute seque...
Article
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Background: Disability-related considerations have largely been absent from the COVID-19 response, despite evidence that people with disabilities are at elevated risk for acquiring COVID-19. We evaluated clinical outcomes in patients who were admitted to hospital with COVID-19 with a disability compared with patients without a disability. Methods...
Article
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Background: Intensive care unit (ICU)-acquired weakness is characterized by muscle atrophy and impaired contractility that may persist after ICU discharge. Dysregulated muscle repair and regeneration gene co-expression networks are present in critical illness survivors with persistent muscle wasting and weakness. We aimed to identify microRNAs (mi...
Preprint
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Muscle diseases share common pathological features suggesting common underlying mechanisms. We hypothesized there is a common set of genes dysregulated across muscle diseases compared to healthy muscle and that these genes correlate with severity of muscle disease. We performed meta-analysis of transcriptional profiles of muscle biopsies from human...
Preprint
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Rationale The COVID-19 pandemic disrupted non-COVID critical care trials globally as intensive care units (ICUs) prioritized patient care and COVID-specific research. The international randomized controlled trial CYCLE (Critical Care Cycling to Improve Lower Extremity Strength) was forced to halt recruitment at all sites in March 2020, creating imm...
Article
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...
Article
Purpose: We aimed to determine the association between sepsis and long-term cardiovascular events. Methods: We conducted a systematic review of observational studies evaluating post-sepsis cardiovascular outcomes in adult sepsis survivors. MEDLINE, Embase, and the Cochrane Controlled Trials Register and Database of Systematic Reviews were searched...
Article
Les caractéristiques des patients, les soins cliniques, l’utilisation des ressources et les issues cliniques des personnes atteintes de la maladie à coronavirus 2019 (COVID-19) hospitalisées au Canada ne sont pas bien connus. MÉTHODES: Nous avons recueilli des données sur tous les adultes hospitalisés atteints de la COVID-19 ou de l’influenza ayant...
Article
Background: Patient characteristics, clinical care, resource use and outcomes associated with admission to hospital for coronavirus disease 2019 (COVID-19) in Canada are not well described. Methods: We described all adults with COVID-19 or influenza discharged from inpatient medical services and medical-surgical intensive care units (ICUs) betwe...
Preprint
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Background Patient characteristics, clinical care, resource use, and outcomes associated with hospitalization for coronavirus disease (COVID-19) in Canada are not well described. Methods We described all adult discharges from inpatient medical services and medical-surgical intensive care units (ICU) between November 1, 2019 and June 30, 2020 at 7...
Chapter
Improvements in critical care have led to reduced mortality but paradoxically may have promoted survival with increased morbidity. A myriad of functional disabilities range from impairment in lung function, to physical weakness and muscle dysfunction, to a wide range of neuropsychological morbidities, impairment in health-related quality of life, a...
Book
This book, part of the European Society of Intensive Care Medicine textbook series, provides detailed up-to-date information on the physical, cognitive, and psychological impairments that are frequently present following a stay in an intensive care unit and examines in depth the available preventive and therapeutic strategies, including adapted reh...
Article
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Purpose Hemodynamic management of adults with distributive shock often includes the use of catecholamine-based vasoconstricting medications. It is unclear whether adding vasopressin or vasopressin analogues to catecholamine therapy is beneficial in the management of patients with distributive shock. The purpose of this guideline was to develop an e...
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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Introduction Diversity has become a key-strategic element of success in various political and economic fields. The European Society of Intensive Care Medicine (ESICM) decided to make diversity a key strategic priority for the future and appointed a Task-Force on this topic. Methods In a consensus process, three Working-Groups, nominated by Task-Fo...
Article
Background and objectives: Older patients in the intensive care unit are at greater risk of AKI; however, use of kidney replacement therapy in this population is poorly characterized. We describe the triggers and outcomes associated with kidney replacement therapy in older patients with AKI in the intensive care unit. Design, setting, participant...
Article
The acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in critically ill patients and is defined by the acute onset of noncardiogenic pulmonary oedema, hypoxaemia and the need for mechanical ventilation. ARDS occurs most often in the setting of pneumonia, sepsis, aspiration of gastric contents or severe trauma and i...
Article
Disability after critical illness is heterogeneous and related to multiple morbidities. Muscle and nerve injury represent prevalent and important determinants of long-term disability. As the population ages and accrues a greater burden of comorbid illness and medical complexity, those patients admitted to an intensive care unit will be challenged i...
Article
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...
Article
Objectives: To review women's participation as faculty at five critical care conferences over 7 years. Design: Retrospective analysis of five scientific programs to identify the proportion of females and each speaker's profession based on conference conveners, program documents, or internet research. Setting: Three international (European Soci...
Article
Objectives: To evaluate functional outcomes and evaluate predictors of an unfavorable functional outcome in children following a critical illness. Design: Prospective observational longitudinal cohort study. Setting: Two tertiary care, Canadian PICUs: McMaster Children's Hospital and London Health Sciences. Patients: Children 12 months to 17...
Article
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In this review, we seek to highlight how critical illness and critical care affect longer-term outcomes, to underline the contribution of ICU delirium to cognitive dysfunction several months after ICU discharge, to give new insights into ICU acquired weakness, to emphasize the importance of value-based healthcare, and to delineate the elements of f...
Article
Background: The path to recovery of muscle strength and mobility following discharge from the intensive care unit (ICU) has not been well described. Objective: The study objective was to quantify muscle function, gait, and postural control at 3 and 6 months after discharge in people who were recovering from critical illness and who were ventilat...
Article
Purpose: Investigate the relationship between psychoactive drugs and delirium. Materials and methods: Prospective observational study of 520 critically ill adult patients admitted ≥24h to 6 intensive care units (ICUs). Data were collected on psychoactive drug exposure, use of sedation administration strategies, and incident delirium (Intensive C...
Article
Low muscle mass is common in lung transplant (LTx) candidates, however, the clinical implications have not been well described. The study aims were to compare skeletal muscle mass in LTx candidates with controls using thoracic muscle cross-sectional area (CSA) from computed tomography and assess the association with pre- and post-transplant clinica...
Article
Background: Lung transplantation (LTx) is offered to older and more complex patients who may be at higher risk of skeletal muscle dysfunction, but the clinical implications of this remain uncertain. The study aims were to characterize deficits in skeletal muscle mass, strength and physical performance and examine the associations of these deficits...
Article
We present areas of uncertainty concerning intensive care unit-acquired weakness (ICUAW) and identify areas for future research. Age, pre-ICU functional and cognitive state, concurrent illness, frailty, and health trajectories impact outcomes and should be assessed to stratify patients. In the ICU, early assessment of limb and diaphragm muscle stre...
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
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Physical rehabilitation of lung transplant candidates and recipients plays an important in optimizing physical function prior to transplant and facilitating recovery of function post-transplant. As medical and surgical interventions in lung transplantation have evolved over time, there has been a demographic shift of individuals undergoing lung tra...
Article
Background: The promotion of early mobilization following critical illness is tempered by national reports of patient and institutional barriers to this approach. We carried out a survey to assess current knowledge, perceptions and practices of Canadian physicians and physiotherapists with respect to acquired weakness and early mobilization in adul...
Article
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Background: Probiotics are live microorganisms that may confer health benefits when ingested. Randomized trials suggest that probiotics significantly decrease the incidence of ventilator-associated pneumonia (VAP) and the overall incidence of infection in critically ill patients. However, these studies are small, largely single-center, and at risk...
Article
In the March issue of Critical Care Medicine, Hodgson and colleagues from the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group, published a multicenter pilot randomized controlled trial (RCT) conducted across international ICUs to evaluate the feasibility of implementing early goal directed mobility (EGDM) to achieve...
Article
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Rationale: Critical illness survivors often experience permanent functional disability due to intensive care unit (ICU)-acquired weakness. The mechanisms responsible for long-term weakness persistence versus resolution are unknown. Objectives: To delineate cellular mechanisms underlying long-term weakness persistence in ICU survivors. Methods:...
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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In patients with severe acute kidney injury (AKI) but no urgent indication for renal replacement therapy (RRT), the optimal time to initiate RRT remains controversial. While starting RRT preemptively may have benefits, this may expose patients to unnecessary RRT. To study this, we conducted a 12-center open-label pilot trial of critically ill adult...
Article
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IntroductionThis third article for the 2014 Year in Review will report publications from intensive care on severe infections (including endocarditis and peritonitis), septic shock, healthcare and ventilator associated pneumonia, highly resistant bacteria, antimicrobial therapy (including antibiotic stewardship, therapeutic drug monitoring and de-es...
Article
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Acute respiratory distress syndromePrognosis of ARDS is not only related to physiological alterations and therapeutic strategies but to the underlying disease. Patients with malignancies and ARDS have received less attention. Outcomes were studied in a huge cohort of more than 1,000 patients with mainly haematological malignancies and infection-ind...
Article
If there were machines bearing the image of our bodies, and capable of imitating our actions as far as it is practically possible, there would still remain two most certain tests whereby to know that they were not therefore really men.Renè Descartes 1596-1650Experienced intensivists, cardiologists and perfusionists come together at the bedside of a...
Article
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Intensive Care Medicine is changing. New types of pa pers, such as “What’s New in Intensive Care?”, “Understanding the Disease” and “My Paper 20 Years Later”, form a stable proportion of the articles published in the 2014 issues. This diversification has been received with an extraordinary enthusiasm and appreciation by the worldwide readership, as...
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
To identify risk factors for failure of anticoagulant thromboprophylaxis in critically ill patients in the ICU. Multivariable regression analysis of thrombosis predictors from a randomized thromboprophylaxis trial. Sixty-seven medical-surgical ICUs in six countries. Three thousand seven hundred forty-six medical-surgical critically ill patients. Al...
Book
“Texbook of Post-ICU Medicine: The Legacy of Critical Care”, is a new book edited by Robert Stevens, Nicholas Hart and Margaret Herridge and published by Oxford University Press. Written by leading clinicians-scientists working in the field, it offers a multidisciplinary and multifaceted overview of the biology of recovery following critical illnes...
Article
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Acute kidney injury Despite significant advance of knowledge in the field, acute kidney injury (AKI) still remains a syndrome with significant morbidity and mortality. The commonness of this syndrome in critically ill patients has been highlighted by the prospective FINNAKI study [1] including 2,901 patients from 17 Finnish ICUs, which found an AKI...
Article
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Critical illness creates new neurocognitive and functional disabilities and further compromises preexisting organ dysfunction. These are truths borne out in multiple international studies.(1)-(6) Recovery from severe illness is complex and relies on a fragile interdependence of adequate premorbid organ reserve, attentive care in the intensive care...
Article
An episode of critical illness is transformative. Patients suffer important new nerve, brain, and muscle injury. The spectrum of morbidity varies according to individual risks, but prevalent disabilities transcend diagnostic groupings. In the context of intensive care unit-acquired weakness (ICUAW), each patient who enters the ICU will begin to deg...
Article
Intensive care unit-acquired weakness (ICUAW) begins within hours of mechanical ventilation and may not be completely reversible over time. It represents a major functional morbidity of critical illness and is an important patient-centered outcome with clear implications for quality of life and resumption of prior work and lifestyle. There is heter...
Article
Full-text available
Protocolized sedation and daily sedation interruption are 2 strategies to minimize sedation and reduce the duration of mechanical ventilation and intensive care unit (ICU) stay. We hypothesized that combining these strategies would augment the benefits. To compare protocolized sedation with protocolized sedation plus daily sedation interruption in...
Article
Full-text available
Context Protocolized sedation and daily sedation interruption are 2 strategies to minimize sedation and reduce the duration of mechanical ventilation and intensive care unit (ICU) stay. We hypothesized that combining these strategies would augment the benefits. Objective To compare protocolized sedation with protocolized sedation plus daily sedatio...

Citations

... Remote monitoring, regulatory flexibility, and prioritized data collection occurred (18,19). Structured reporting of modified trial methods and conduct for extenuating pandemic circumstances (20) are being published (21,22), while large U.S. centers reported ramping down and redirecting research (23). We identified no studies on the optimal operationalization of many studies in the ICU setting. ...
... During the initial waves of the pandemic, almost every ICU restricted visitation to reduce the likelihood of transmission of COVID-19 . Emerging research has shown these policies may have exacerbated the psychological distress experienced by healthcare workers (Andrist et al., 2020;Hugelius et al., 2021;Dos Santos and Soares, 2022;Dragoi et al., 2022;Guttormson et al., 2022). For example, a recent survey of ICU nurses who worked on units that restricted visitors created new dilemmas and distress due to compromising the quality of care for patients' families (Jensen et al., 2022). ...
... Currently, there are no COVID-19-specific measurements of the post-COVID-19 outcome. However, the measurement tools used in this study are the tools that are currently being assessed by the post-COVID-19 core outcome Set study, which reduces the measurement bias in outcome assessment [35]. Lastly, the researchers also acknowledge that assuming the type of variants according to the date of infection is not equivalent to genomic sequencing. ...
... However, the 30 s STS is strongly correlated with lower limb strength [66]. In fact, this test has been proposed as a measure for assessing functional performance and lower limb strength in adults, in particular those discharged from the hospital after a severe illness in the ICU and COVID-19 survivors in the early stages of rehabilitation [66][67][68]. It is, therefore, not surprising that, in addition to the improved performance on the 30 s STS in both groups, at the end of the study, we also found improvement in the knee extensor strength in both groups. ...
... However, up to now, a one-size-fits-all approach is still being implemented for clinical practice, which ignores the heterogeneity across sepsis patients. Recently, several studies have accurately identified subphenotypes among sepsis cases; these subphenotypes have different demographics, laboratory values and clinical outcomes [5][6][7][8]. ...
... Treating patients with the post-COVID-19 condition is an emerging challenge for rehabilitation health policies, and a new organizational design to provide continued rehabilitation care to this population is necessary [16]. Researchers with different backgrounds, including members of the ISARIC Consortium, the US Centers for Disease Control and Prevention (CDC), experts involved in the WHO post-COVID condition clinical characterization group, leaders of international COVID-19 cohorts, members of the Core Outcome Measures for post-COVID-19 condition/long-COVID initiative, and patient representatives have advocated the urgent development of a Core Outcome Set for research and clinical practice in the post-COVID-19 condition, improving data quality, harmonization, and comparability across different geographic locations [17]. ...
... COVID-19 is covered in relation to emergency preparedness and response (EPR) and disability-inclusive disaster risk reduction (DiDRR) [160], risk of severe illness [161][162][163][164][165][166][167], increased risk of contracting COVID-19 [166][167][168][169][170][171][172] and other problems [173,174], increased mortality [175], increased risk of exclusion from treatment [176], risk of residential settings [177], and that disabled people are ignored as a high risk group [165,178]. Disabled people are at an increased risk of poverty and it is likely this risk will be increased further by COVID-19 [179]. ...
... Finally, in response to catabolic muscle damage, the muscle also has a great capacity for regeneration via its satellite cells [32]. This function is also impaired in ICU survivors, with both a decrease in satellite cell content 6 months after ICU stay [24] and aberrant up-regulation of genes involved in the structural and functional muscle development and extracellular matrix remodeling [33], suggesting a defect in the muscle repair process [27]. Moreover, the presence of mitochondrial dysfunction in satellite cells was demonstrated experimentally, and intramuscular injection of mesenchymal cells improved skeletal muscle function and prognosis in mice sepsis [34][35][36]. ...
... Moreover, using steroids parenterally with cases of severe COVID-19 also contributed to sarcopenia by accelerating muscle protein breakdown (2). ...
... are associated with a reduction in infections, particularly in patients with ventilator-associated pneumonia (VAP) and treated with antibiotics, but not to increased survival [118]. Conversely, a more recent study did not confirm the beneficial role of Lactobacillus rhamnosus GG in reducing VAP incidence in ICU patients [156]. Another meta-analysis, which analyzed 4893 patients, has shown that probiotics reduce VAP, ICU length of stay, and duration of antibiotic therapy; however, the high variability in treatments and type of patients prevents the introduction of the use of probiotics as VAP prophylaxis [116]. ...