Javier Lorenzo

All Publications

• The Definition of the Intensivist in the Era of Global Healthcare: 2024 Consensus Statement From the Society of Critical Care Medicine Defining Intensivist Task Force. Critical care medicine Wu, D., Dzierba, A. L., Ablordeppey, E. A., Dorman, T., Du, B., Dulu, A. O., Gunnerson, K., Holly, P. B., Jansen van Rensburg, J., Kortz, T. B., Livesay, S. L., Lorenzo, J., Madden, M. A., Mathur, P., Myatra, S. N., Roberts, K. E., Rodriguez-Vega, G. M., Szakmany, T., Taha, A., Tisherman, S. A. 2025

  Abstract

  OBJECTIVES: The goal of this task force was to examine the 1992 definition of the intensivist, identify gaps, and initiate a path forward to define a concise and practical definition that could be applied globally.DESIGN: A modified Delphi technique was used to develop a revised definition and roles of the intensivist. We determined a priori that 75% or greater participant agreement for the definition and essential roles of the intensivist was required.SETTING: A task force consisting of physicians, a respiratory therapist, advanced practice providers, and a pharmacist that practice in critical/intensive care medicine, in various settings, was established with the goal of evaluating and revising the previous definition considering evolving healthcare.SUBJECTS: The task force participated in online questionnaires related to the definition and roles of the intensivist.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: The task force agreed on the following definition of an intensivist: "A physician who has successfully completed an accredited program or equivalent critical care/intensive care medicine training and maintains advanced certification (if available); and shows dedication to the area of critical/intensive care medicine in the way of professional work." Additionally, the task force determined a list of essential roles of the intensivist categorized into Direct Clinical Care, Unit Management/Unit Involvement, Responsibility to the Community, and Administration and Leadership.CONCLUSIONS: The revised definition of the intensivist seeks to integrate the intensivist in the current realm of team-based healthcare. The intensivist is a physician who provides care to critically ill patients in collaboration with an interprofessional team. Establishment of a single, revised definition is intended to render clarity of an intensivist's role and responsibilities for patients, families, and the interprofessional team.

  View details for DOI 10.1097/CCM.0000000000006580

  View details for PubMedID 39982148

• OPTIMIZING ANALGESIC ADMINISTRATION WITH SMART PUMPS: A VALUE-BASED CARE STRATEGY Lorenzo, J., Antonio, D., Sarram, M., Henley, C. LIPPINCOTT WILLIAMS & WILKINS. 2025

  View details for DOI 10.1097/01.ccm.0001104084.70108.12

  View details for Web of Science ID 001411607300020

• More isn't always better: Technology in the intensive care unit HEALTH CARE MANAGEMENT REVIEW Olsen, E., Novikov, Z., Sakata, T., Lambert, M. H., Lorenzo, J., Bohn, R., Singer, S. J. 2024; 49 (2): 127-138

  Abstract

  Clinical care in modern intensive care units (ICUs) combines multidisciplinary expertise and a complex array of technologies. These technologies have clearly advanced the ability of clinicians to do more for patients, yet so much equipment also presents the possibility for cognitive overload.The aim of this study was to investigate clinicians' experiences with and perceptions of technology in ICUs.We analyzed qualitative data from 30 interviews with ICU clinicians and frontline managers within four ICUs.Our interviews identified three main challenges associated with technology in the ICU: (a) too many technologies and too much data; (b) inconsistent and inaccurate technologies; and (c) not enough integration among technologies, alignment with clinical workflows, and support for clinician identities. To address these challenges, interviewees highlighted mitigation strategies to address both social and technical systems and to achieve joint optimization.When new technologies are added to the ICU, they have potential both to improve and to disrupt patient care. To successfully implement technologies in the ICU, clinicians' perspectives are crucial. Understanding clinicians' perspectives can help limit the disruptive effects of new technologies, so clinicians can focus their time and attention on providing care to patients.As technology and data continue to play an increasingly important role in ICU care, everyone involved in the design, development, approval, implementation, and use of technology should work together to apply a sociotechnical systems approach to reduce possible negative effects on clinical care for critically ill patients.

  View details for DOI 10.1097/HMR.0000000000000398

  View details for Web of Science ID 001174535500008

  View details for PubMedID 38393982

• CONTINUOUS VERSUS INTERMITTENT VANCOMYCIN INFUSION IN ICU PATIENTS WITH AUGMENTED RENAL CLEARANCE Keil, E., Diep, C., Meng, L., Ran, R., Lorenzo, J. LIPPINCOTT WILLIAMS & WILKINS. 2023: 375

  View details for Web of Science ID 000921450901069

• Use of the Change in Weaning Parameters as a Predictor of Successful Re-Extubation. Journal of intensive care medicine Trivedi, S., Davis, R., Engoren, M. C., Lorenzo, J., Mentz, G., Jewell, E. S., Maile, M. D. 2021: 885066620988675

  Abstract

  OBJECTIVE: Weaning parameters are well studied in patients undergoing first time extubation. Fewer data exists to guide re-extubation of patients who failed their first extubation attempt. It is reasonable to postulate that improved weaning parameters between the first and second extubation attempt would lead to improved rates of re-extubation success. To investigate, we studied a cohort of patients who failed their first extubation attempt and underwent a second attempt at extubation. We hypothesized that improvement in weaning parameters between the first and the second extubation attempt is associated with successful reextubation.INTERVENTIONS: Rapid shallow breathing index (RSBI), maximum inspiratory pressure (MIP), vital capacity (VC), and the blood partial pressure of CO2 (PaCO2) were measured and recorded in the medical record prior to extubation along with demographic information. We examined the relationship between the change in extubation and re-extubation weaning parameters and re-extubation success.MEASUREMENTS AND MAIN RESULTS: A total of 1283 adult patients were included. All weaning parameters obtained prior to re-extubation differed between those who were successful and those who required a second reintubation. Those with reextubation success had slightly lower PaCO2 values (39.5 ± 7.4 mmHg vs. 41.6 ± 9.1 mmHg, p = 0.0045) and about 13% higher vital capacity volumes (1021 ± 410 mL vs. 907 ± 396 mL, p = 0.0093). Lower values for RSBI (53 ± 32 breaths/min/L vs. 69 ± 42 breaths/min/L, p < 0.001) and MIP (-41 ± 12 cmH2O vs. -38 ± 13 cm H2O), p = 0.0225) were seen in those with re-extubation success. Multivariable logistical regression demonstrates lack of independent associated between the change in parameters between the 2 attempts and re-extubation success.CONCLUSIONS: The relationship between the changes in extubation parameters through successive attempts is driven primarily by the value obtained immediately prior to re-extubation. These findings do not support waiting for an improvement in extubation parameters to extubate patients who failed a first attempt at extubation if extubation parameters are compatible with success.

  View details for DOI 10.1177/0885066620988675

  View details for PubMedID 33461374

• Modified percutaneous tracheostomy in patients with COVID-19. Trauma surgery & acute care open Sun, B. J., Wolff, C. J., Bechtold, H. M., Free, D., Lorenzo, J., Minot, P. R., Maggio, P. G., Spain, D. A., Weiser, T. G., Forrester, J. D. 2020; 5 (1): e000625

  Abstract

  Patients hospitalized with COVID-19 are at risk of developing hypoxic respiratory failure and often require prolonged mechanical ventilation. Indication and timing to perform tracheostomy is controversial in patients with COVID-19.This was a single-institution retrospective review of tracheostomies performed on patients admitted for COVID-19 between April 8, 2020 and August 1, 2020 using a modified percutaneous tracheostomy technique to minimize hypoxia and aerosolization.Twelve tracheostomies were performed for COVID-related respiratory failure. Median patient age was 54 years (range: 36-76) and 9 (75%) were male. Median time to tracheostomy was 17 days (range: 10-27), and 5 (42%) patients had failed attempts at extubation prior to tracheostomy. There were no intraprocedural complications, including hypoxia. Post-tracheostomy bleeding was noted in two patients. Eight (67%) patients have been discharged at the time of this study, and there were four patient deaths unrelated to tracheostomy placement. No healthcare worker transmissions resulted from participating in the tracheostomy procedure.A modified percutaneous tracheostomy is feasible and can be safely performed in patients infected with COVID-19.Level V, case series.

  View details for DOI 10.1136/tsaco-2020-000625

  View details for PubMedID 34192161

  View details for PubMedCentralID PMC7736959

• Perioperative Care and Airway Management for a Patient With Sagliker Syndrome CUREUS Chen, Q., Lorenzo, J., Lu, A. 2020; 12 (9)

  View details for DOI 10.7759/cureus.10691

  View details for Web of Science ID 000573185700003

• Perioperative Care and Airway Management for a Patient With Sagliker Syndrome. Cureus Chen, Q., Lorenzo, J., Lu, A. 2020; 12 (9): e10691

  Abstract

  In this report, we present a case of a patient with a history of complex airway anatomy secondary to Sagliker syndrome (SS) who presented with acute exacerbation of chronic respiratory failure. The patient's difficult airway, complicated medical comorbidities, and poor psychosocial status posed a unique challenge for providing safe care during an emergency. The perioperative anesthesia service (PAS), led by critical care anesthesiologists, coordinated a multidisciplinary airway management plan. The PAS team also assisted this medically complex patient with her decision-making process. A 37-year-old female with SS, which is characterized by irreversible disfiguring of head and neck anatomy secondary to end-stage renal disease (ESRD) and poorly controlled hyperparathyroidism, presented with acute exacerbation of chronic respiratory failure due to hypervolemia. The patient's respiratory status rapidly deteriorated despite aggressive hemodialysis, requiring transfer to the ICU. Given the challenging anatomy and poor respiratory reserve in this patient, the PAS team helped coordinate a comprehensive airway plan that involved transnasal fiberoptic intubation, and in case of emergency, extracorporeal membrane oxygenation (ECMO) as a bridge to a surgical airway. During the decision-making process, the patient was found to be in psychological distress and had limited insights into her condition. The PAS team helped facilitated multidisciplinary goals-of-care discussions for the patient and her family. Fortunately, the patient's oxygenation improved with noninvasive oxygen support and aggressive hemodialysis without the need for intubation. She was discharged with outpatient follow-up appointments arranged to discuss long-term management. This is the first reported case of SS in the United States. The early involvement by the PAS team helped coordinate a multidisciplinary care plan for this patient with a difficult airway and complex comorbidities. This report highlights an innovative airway algorithm for a potentially "cannot-intubate, cannot ventilate" complex airway, and the PAS team's role in providing support for the patient's physical and psychological needs, suggesting that a comprehensive perioperative service can improve the quality and safety of care, not only for surgical patients but also for medically complex patients as well.

  View details for DOI 10.7759/cureus.10691

  View details for PubMedID 33133856

  View details for PubMedCentralID PMC7593211

• Electrical Storm in COVID-19. JACC. Case reports O'Brien, C. n., Ning, N. n., McAvoy, J. n., Mitchell, J. E., Kalwani, N. n., Wang, P. n., Nguyen, D. n., Reejhsinghani, R. n., Rogers, A. n., Lorenzo, J. n. 2020; 2 (9): 1256–60

  Abstract

  COVID-19 is a global pandemic caused by SARS-CoV-2. Infection is associated with significant morbidity and mortality. Individuals with pre-existing cardiovascular disease or evidence of myocardial injury are at risk for severe disease and death. Little is understood about the mechanisms of myocardial injury or life-threatening cardiovascular sequelae. (Level of Difficulty: Intermediate.).

  View details for DOI 10.1016/j.jaccas.2020.05.032

  View details for PubMedID 32835266

  View details for PubMedCentralID PMC7259914

• Modified percutaneous tracheostomy in patients with COVID-19 Trauma Surg Acute Care Open Sun, B. J., Wolff, C. J., Bechtold, H. M., Free, D., Lorenzo, J., Minot, P. R., Maggio, P. G., Spain, D. A., Weiser, T. G., Forrester, J. D. 2020; 5 (1)

  View details for DOI 10.1136/tsaco-2020-000625

• BENZODIAZEPINE-SPARING REGIMEN FOR MANAGEMENT OF ALCOHOL WITHDRAWAL IN THE INTENSIVE CARE UNIT Diep, C., Nguyen, C., Kuo, J., Lorenzo, J., Ran, R. LIPPINCOTT WILLIAMS & WILKINS. 2020

  View details for Web of Science ID 000530000201325

• Unique Uses of Cooling Strategies. Therapeutic hypothermia and temperature management Friberg, H. n., Paidas, M. J., Lorenzo, J. n., Deye, N. n. 2020

  View details for DOI 10.1089/ther.2020.29076.hjf

  View details for PubMedID 32780645

• USE OF THE CHANGE IN WEANING PARAMETERS AS PREDICTORS OF SUCCESSFUL REEXTUBATION Trivedi, S., Davis, R., Engoren, M., Lorenzo, J., Jewell, E., Maile, M. LIPPINCOTT WILLIAMS & WILKINS. 2019

  View details for Web of Science ID 000498593400028

• Alterations in Spanish Language Interpretation During Pediatric Critical Care Family Meetings CRITICAL CARE MEDICINE Sinow, C. S., Corso, I., Lorenzo, J., Lawrence, K. A., Magnus, D. C., Van Cleave, A. C. 2017; 45 (11): 1915–21

  Abstract

  To characterize alterations in Spanish language medical interpretation during pediatric critical care family meetings.Descriptive, observational study using verbatim transcripts of nine PICU family meetings conducted with in-person, hospital-employed interpreters.A single, university-based, tertiary children's hospital.Medical staff, family members, ancillary staff, and interpreters.None.Interpreted speech was compared with original clinician or family speech using the qualitative research methods of directed content analysis and thematic analysis. Alterations occurred in 56% of interpreted utterances and included additions, omissions, substitutions, editorializations, answering for the patient/clinician, confessions, and patient advocacy. Longer utterances were associated with more alterations.To minimize interpreter alterations during family meetings, physicians should speak in short utterances (fewer than 20 words) and ask interpreters to interrupt in order to facilitate accurate interpretation. Because alterations occur, physicians may also regularly attempt to assess the family's understanding.

  View details for PubMedID 28777199

• Examining Health Care Costs: Opportunities to Provide Value in the Intensive Care Unit. Anesthesiology clinics Chang, B., Lorenzo, J., Macario, A. 2015; 33 (4): 753-770

  Abstract

  As health care costs threaten the economic stability of American society, increasing pressures to focus on value-based health care have led to the development of protocols for fast-track cardiac surgery and for delirium management. Critical care services can be led by anesthesiologists with the goal of improving ICU outcomes and at the same time decreasing the rising cost of ICU medicine.

  View details for DOI 10.1016/j.anclin.2015.07.012

  View details for PubMedID 26610628