Paul Mohabir

All Publications

• COVID-19-Associated Hyperactive Intensive Care Unit Delirium With Proposed Pathophysiology and Treatment: A Case Report PSYCHOSOMATICS Sher, Y., Rabkin, B., Maldonado, J. R., Mohabir, P. 2020; 61 (5): 544–50

  View details for Web of Science ID 000575913300013

• When the Patient Says No to Transplant: A Life Well Lived and Well Ended PSYCHOSOMATICS Sher, Y., Mohabir, P. K., Maldonado, J. R. 2020; 61 (4): 379–84

  View details for Web of Science ID 000549388900009

• Critical Care Transesophageal Echocardiography in Patients during the COVID-19 Pandemic. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography Teran, F., Burns, K. M., Narasimhan, M., Goffi, A., Mohabir, P., Horowitz, J. M., Yuriditsky, E., Nagdev, A., Panebianco, N., Chin, E. J., Gottlieb, M., Koenig, S., Arntfield, R. 2020

  Abstract

  BACKGROUND: The COVID-19 pandemic has placed an extraordinary strain on healthcare systems across North America. Defining the optimal approach for managing a critically ill COVID-19 patient is rapidly changing. Goal-directed transesophageal echocardiography (TEE) is frequently used by physicians caring for intubated critically ill patients as a reliable imaging modality that is well suited to answer questions at bedside.METHODS: A multidisciplinary (intensive care, critical care cardiology, and emergency medicine) group of experts in point-of-care echocardiography and TEE from the United States and Canada convened to review the available evidence, share experiences, and produce a consensus statement aiming to provide clinicians with a framework to maximize the safety of patients and healthcare providers when considering focused point-of-care TEE in critically ill patients during the COVID-19 pandemic.RESULTS: Although transthoracic echocardiography can provide the information needed in most patients, there are specific scenarios in which TEE represents the modality of choice. TEE provides acute care clinicians with a goal-directed framework to guide clinical care and represents an ideal modality to evaluate hemodynamic instability during prone ventilation, perform serial evaluations of the lungs, support cardiac arrest resuscitation, and guide veno-venous ECMO cannulation. To aid other clinicians in performing TEE during the COVID-19 pandemic, we describe a set of principles and practical aspects for performing examinations with a focus on the logistics, personnel, and equipment required before, during, and after an examination.CONCLUSIONS: In the right clinical scenario, TEE is a tool that can provide the information needed to deliver the best and safest possible care for the critically ill patients.

  View details for DOI 10.1016/j.echo.2020.05.022

  View details for PubMedID 32600742

• COVID-19-Associated Hyperactive Intensive Care Unit Delirium With Proposed Pathophysiology and Treatment: A Case Report. Psychosomatics Sher, Y., Rabkin, B., Maldonado, J. R., Mohabir, P. 2020

  View details for DOI 10.1016/j.psym.2020.05.007

  View details for PubMedID 32591212

• Cystic Fibrosis and COVID-19: Care Considerations. Respiratory medicine case reports Mirza, A. A., Rad, E. J., Mohabir, P. K. 2020: 101226

  Abstract

  The coronavirus disease 2019 (COVID-19) pandemic has demanded large scale changes in patient care. People with cystic fibrosis have unique considerations, including underlying lung disease and routine aerosolizing therapies, but there is insufficient evidence to create comprehensive practice guidelines. We share a case of a patient with CF and COVID-19 as well as alterations to routine CF care at a large academic center. Key considerations include accessible COVID-19 screening, augmented infection control practices, and rapid integration of telemedicine.

  View details for DOI 10.1016/j.rmcr.2020.101226

  View details for PubMedID 32953446

  View details for PubMedCentralID PMC7492163

• Bronchial Artery Embolization for Hemoptysis in Cystic Fibrosis Patients: A 17-Year Review. Journal of vascular and interventional radiology : JVIR Martin, L. N., Higgins, L., Mohabir, P., Sze, D. Y., Hofmann, L. V. 2019

  Abstract

  PURPOSE: To review safety and efficacy of bronchial artery embolization (BAE) for treatment of hemoptysis in adult patients with cystic fibrosis (CF) and to report 30-day, 1-year, and 3-year outcomes.MATERIALS AND METHODS: Between January 2001 and April 2018, 242 patients with CF were evaluated for hemoptysis. Thirty-eight BAEs were performed in 28 patients with hemoptysis. Technical success was defined as freedom from repeat embolization and hemoptysis-related mortality. Clinical success was defined as freedom from repeat embolization and mortality from any cause. Technical and clinical success were examined at 30 days, 1 year, and 3 years after initial BAE. Mean patient age was 32 years, and median follow-up was 4.8 years (range, 10 mo to 16.7 y).RESULTS: Technical and clinical success rates at 30 days were 89% (25/28) and 82% (23/28), respectively. Success rates at 1 year were 86% (24/28) and 79% (22/28), respectively, and at 3 years were 82% (23/28) and 75% (21/28), respectively. The 30-day overall complication rate was 7.9% (3/38) with 2.6% (1/38) major complication rate and 5.2% (2/38) minor complication rate. Overall 3-year mortality rate was 25% (7/28).CONCLUSIONS: BAE is safe and effective in patients with CF presenting with life-threatening hemoptysis. BAE results in high rates of long-term technical and clinical success in this patient population despite progressive chronic disease. Repeat embolization is necessary only in a minority of patients.

  View details for DOI 10.1016/j.jvir.2019.08.028

  View details for PubMedID 31899109

• When the Patient Says No to Transplant: A Life Well Lived and Well Ended. Psychosomatics Sher, Y., Mohabir, P. K., Maldonado, J. R. 2019

  View details for DOI 10.1016/j.psym.2019.10.001

  View details for PubMedID 31739994

• Skin Necrosis Distal to a Rapid Infusion Catheter: Understanding Possible Complications of Large-bore Vascular Access Devices. Cureus Chou, W. H., Rinderknecht, T. N., Mohabir, P. K., Phillips, A. W. 2019; 11 (1): e3854

  Abstract

  Rapid infusion catheters (RICs) allow expedient conversion of peripheral intravenous (PIV) catheters to peripheral sheaths; however, little is known about potential complications. In this case, a 64-year-old male polytrauma patient had a 20-gauge PIV catheter in the right cephalic vein upsized to an 8.5 French (Fr) RIC without incident during an arrest with pulseless electrical activity (PEA). On RIC post-placement day two, the patient developed edema and ecchymosis extending from the right dorsal mid-hand to the antecubital fossa, just distal to the RIC insertion point. Compartments were soft; the volar surface (including an arterial line location), fingers, and upper arm were normal. The RIC flushed and returned blood appropriately. Ultrasound revealed a noncompressible cephalic vein either related to the catheter or thrombosis, and imaging of the hand showed an ulnar styloid fracture and a minimally displaced triquetral fracture. The RIC was removed immediately. Over the next week, the areas of ecchymosis developed bullae and then sloughed, leaving open wounds extending into the dermis. The patient later expired from unrelated causes. The area and timing of the skin necrosis were highly suspicious for a catheter-associated complication, despite the presence of the arterial line and small distal fractures. The necrosis was potentially due to thrombosis of the superficial venous outflow system, leading to congestion and skin compromise, but we found no similar reports. Alternatively, the catheter may have ruptured the vein and caused a gravity-dependent ecchymosis, but the volar surface was not impacted, and the catheter was functioning properly. The RIC may also have encroached on the arterial space, decreasing flow, but we would have expected distal hand changes. The only published reports we could find on RIC complications involved a lost guide wire, fragmentation of a catheter during placement, and a case of compartment syndrome, raising the question of whether skin necrosis is truly a rare event or simply underreported with the RIC. Although the exact causal relationship remains unknown in our case, RICs should be removedas soon as possible after immediate stabilization.

  View details for DOI 10.7759/cureus.3854

  View details for PubMedID 30891394

• Estimated Impact of Hepatitis C Positive Lung Donor Utilization on US Donor Lung Supply. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons Mooney, J. J., Purington, N. n., Mohabir, P. n., Dhillon, G. S. 2019

  Abstract

  The availability of highly effective direct-acting antiviral agent (DAA) medications for Hepatitis C virus (HCV) has led to reports of safely transplanting HCV+ donor lungs to HCV- candidates. However, it remains unclear how the ability to use HCV+ donor lungs for lung transplant could impact the number of donor lungs available for transplant. Using Scientific Registry of Transplant Recipient data we identified all deceased organ donors within the United States from March 1, 2015 to February 28, 2018 and stratified by HCV status. A donor prediction model for lung donation was derived and validated within HCV- donors and applied to HCV+ donors to estimate the number of acceptable HCV+ lung donors. Of 29,481 eligible donors, 2,054 (7.0%) were HCV+ donors with 82 HCV+ donors' lungs being utilized for transplant during the study period. The prediction model for donor lung donation (specificity 92.6%, sensitivity 65.6%) estimated 248 HCV+ donors (75 non-viremic, 173 viremic) were acceptable for lung transplant during the study period, suggesting that 166 acceptable HCV+ lung donors were discarded. The ability to transplant lungs from HCV+ organ donors would lead to an estimated nationwide increase of at least 55 donor lungs per year, including 44 from HCV viremic donors. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/ajt.15558

  View details for PubMedID 31394016

• Multiple Listing in Lung Transplant Candidates: A Cohort Study. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons Mooney, J. J., Yang, L., Hedlin, H., Mohabir, P., Dhillon, G. S. 2018

  Abstract

  Lung transplant candidates can be waitlisted at more than one transplant center, a practice known as multiple listing. The factors associated with multiple listing and whether multiple listing modifies waitlist mortality or likelihood of lung transplant is unknown. US lung transplant waitlist candidates were identified as either single or multiple listed using data from the Scientific Registry of Transplant Recipients. Characteristics of single and multiple listed candidates were compared and multivariable logistic regression was used to estimate associations with multiple listing. Multiple listed candidates were matched to single listed candidates using a combination of exact and propensity score matching methods. Cox proportional hazard models were used to estimate the relationship of multiple listing on waitlist mortality and receiving a transplant. Multiple listing occurred in 2.3% of lung transplant waitlist candidates. Younger age, female gender, white race, short stature, high antibody sensitization, college or post-college education, lower lung allocation score, and a cystic fibrosis diagnosis were independently associated with multiple listing. Multiple listing was associated with an increased likelihood of lung transplant (adjusted hazard ratio [aHR] 2.74, 95% CI 2.37 to 3.16) but was not associated with waitlist mortality (aHR 0.99, 95% CI 0.68 to 1.44). This article is protected by copyright. All rights reserved.

  View details for PubMedID 30253057

• Correlations Between Cystic Fibrosis Genotype and Sinus Disease Severity in Chronic Rhinosinusitis LARYNGOSCOPE Abuzeid, W. M., Song, C., Fastenberg, J. H., Fang, C. H., Ayoub, N., Jerschow, E., Mohabir, P. K., Hwang, P. H. 2018; 128 (8): 1752–58

  Abstract

  Cystic fibrosis (CF) patients commonly develop chronic rhinosinusitis (CRS). The impact of the most common cystic fibrosis transmembrane conductance regulator (CFTR) mutation, F508del, on the severity of sinonasal disease remains inconclusive. The objective of this study is to evaluate the impact of CFTR genotype functional classification on sinonasal disease severity in patients with CRS.Retrospective chart review of patients with CF who underwent endoscopic sinus surgery for chronic rhinosinusitis from 1998 to 2015. Patients were divided into high- or low-risk genotypes based on standardized CFTR gene functional classification. The primary outcome was the 22-item Sino-Nasal Outcome Test (SNOT-22) score. Secondary outcomes included endoscopic scores, extent of surgery performed, presence of polyposis, number of revision surgeries, and Lund-MacKay computed tomography scores.Thirty-eight patients harbored a high-risk CFTR genotype, and 11 had a low-risk genotype. On bivariate analysis, there was no association between CFTR genotype risk stratification and measures of preoperative disease severity or postoperative outcomes. There were no associations between genotype risk stratification and outcome variables on multivariate linear regression, adjusted for age and gender. There were significant improvements in several SNOT-22 subdomains before and after endoscopic sinus surgery (P < 0.05), but the magnitude of improvement was not significantly different on the basis of CFTR genotype risk stratification.High-risk CFTR genotypes are not associated with worse sinonasal disease severity or postoperative symptom control than low-risk CFTR genotypes after adjusting for confounding factors.Level 4. Laryngoscope, 1752-1758, 2018.

  View details for PubMedID 29193105

• Racial and ethnic disparities in lung transplant listing and waitlist outcomes. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Mooney, J. J., Hedlin, H. n., Mohabir, P. n., Bhattacharya, J. n., Dhillon, G. S. 2017

  Abstract

  The United States lung transplant registry data demonstrate differences in adult waitlist mortality by race/ethnicity. It is unknown whether these differences persist after risk adjustment or occur secondary to disparities in disease severity at the time of listing.Adult lung transplant waitlist candidates between May 4, 2005 and March 5, 2015 were identified and compared by non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic and Asian race/ethnicity. A competing risk proportional hazards model was used to assess the association of race/ethnicity with the unadjusted and adjusted risk of waitlist death or removal for too sick, transplant, or removal for other reason. Disease illness severity at transplant listing was compared by race/ethnicity.There were 20,684 lung transplant candidates identified (82% NHW, 9% NHB, 6% Hispanic, 2% Asian and 1% other). Non-white candidates had higher unadjusted waitlist mortality, which was fully mitigated by adjusting for other risk factors (NHB: hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.93 to 1.18; Hispanic: HR 1.02, 95% CI 0.99 to 1.18; Asian: HR 0.90, 95% CI 0.70 to 1.16). Adjusted waitlist access to transplant was lower in non-white candidates (NHB: HR 0.88, 95% CI 0.83 to 0.94; Hispanic: HR 0.87, 95% CI 0.81 to 0.94; Asian: HR 0.83, 95% CI 0.73 to 0.96). NHW candidates with obstructive lung disease and pulmonary fibrosis were older with less illness severity at listing than non-white candidates.Within the current lung allocation system, there is no difference in risk-adjusted waitlist mortality by race/ethnicity, but non-white waitlist candidates have lower risk-adjusted access to lung transplant. Non-white candidates are generally younger with greater disease-specific illness severity at the time of lung transplant listing.

  View details for PubMedID 29129372

• Lung Quality and Utilization in Controlled Donation After Circulatory Determination of Death Within the United States AMERICAN JOURNAL OF TRANSPLANTATION Mooney, J. J., Hedlin, H., Mohabir, P. K., Vazquez, R., Nguyen, J., Ha, R., Chiu, P., Patel, K., Zamora, M. R., Weill, D., Nicolls, M. R., Dhillon, G. S. 2016; 16 (4): 1207-1215

  Abstract

  Although controlled donation after circulatory determination of death (cDCDD) could increase the supply of donor lungs within the United States, the yield of lungs from cDCDD donors remains low compared with donation after neurologic determination of death (DNDD). To explore the reason for low lung yield from cDCDD donors, Scientific Registry of Transplant Recipient data were used to assess the impact of donor lung quality on cDCDD lung utilization by fitting a logistic regression model. The relationship between center volume and cDCDD use was assessed, and the distance between center and donor hospital was calculated by cDCDD status. Recipient survival was compared using a multivariable Cox regression model. Lung utilization was 2.1% for cDCDD donors and 21.4% for DNDD donors. Being a cDCDD donor decreased lung donation (adjusted odds ratio 0.101, 95% confidence interval [CI] 0.085-0.120). A minority of centers have performed cDCDD transplant, with higher volume centers generally performing more cDCDD transplants. There was no difference in center-to-donor distance or recipient survival (adjusted hazard ratio 1.03, 95% CI 0.78-1.37) between cDCDD and DNDD transplants. cDCDD lungs are underutilized compared with DNDD lungs after adjusting for lung quality. Increasing transplant center expertise and commitment to cDCDD lung procurement is needed to improve utilization.

  View details for DOI 10.1111/ajt.13599

  View details for Web of Science ID 000373075400021

• Increased prevalence of tracheal diverticula in cystic fibrosis patients. British journal of radiology Reicher, J. J., Mohabir, P., Rad, E., Gayer, G. 2016; 89 (1060): 20150694-?

  Abstract

  This investigation sought to evaluate the prevalence and imaging characteristics of tracheal diverticula (TD) among patients with cystic fibrosis (CF).A total of 113 patients with CF at our institution, with a median age of 29 years, had chest CT examinations between 2002 and 2014. These imaging studies were retrospectively reviewed to assess for the presence and characteristics of TD, including quantity, size and location. The severity of the CF disease was assessed using the Bhalla CT scoring system and pulmonary function tests.Of the 113 cases reviewed, 20 (17.7%) patients were found to have 1 or more TD. The presence of TD was associated with more severe disease by imaging criteria, with a Bhalla CT score of 13.9 ± 4.3 in patients with TD and 11.5 ± 4.3 in patients without TD. For the pulmonary function tests, forced expiratory volume in 1 s (FEV1) and FEV1 percent predicted demonstrated a trend towards worsening function in patients with TD, although the difference was not statistically significant.The prevalence of TD in our patient population with CF based on chest CT exams was 17.7%. In addition, the presence of TD was associated with more severe CF disease by imaging criteria.TD appear to have a higher prevalence in patients with CF than in the general population, are associated with more severe CF pulmonary disease by CT criteria and are frequently underreported by radiologists.

  View details for DOI 10.1259/bjr.20150694

  View details for PubMedID 26838952

  View details for PubMedCentralID PMC4846202

• Outpatient endoscopic sinus surgery in cystic fibrosis patients: predictive factors for admission INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY Soudry, E., Mohabir, P. K., Miglani, A., Chen, J., Nayak, J. V., Hwang, P. H. 2014; 4 (5): 416-421

  Abstract

  An increasing number of adult patients with cystic fibrosis (CF) are becoming candidates for elective endoscopic sinus surgery (ESS). We sought to identify perioperative factors in this patient population that were predictive of postoperative admission.Retrospective chart review of CF patients who underwent ESS during the years 2005 through 2012. Multiple preoperative, intraoperative, and immediate postoperative variables were analyzed.Thirty-three patients who underwent 37 outpatient ESSs were identified. Successful same-day discharge was observed in 54%. In 46% of cases, postoperative admission was necessary, with a mean postoperative stay of 1.4 days. Pulmonary function, CF-related comorbidities, and history of lung transplant were not predictors of postoperative admission. Univariate analysis demonstrated that patients were more likely to be admitted if they had 1 of the following conditions: history of ≥4 prior ESS; procedure duration >2.5 hours; intraoperative blood loss greater than 150 mL; increased immediate postoperative pain scores; or larger narcotic requirements for pain control. On logistic regression analysis, a maximum pain score ≥ 7 out of 10 in the postanesthesia recovery unit was the only significant predisposing factor for postoperative admission.Although over 50% of adult CF patients can successfully undergo ESS on a same-day discharge basis, it is prudent to have contingent plans for potential inpatient observation postoperatively. Multivariate analysis suggests that preoperative demographics and pulmonary status cannot predict the need for postoperative admission, whereas higher pain scores in the postanesthesia care unit are predictive of the necessity for inpatient observation.

  View details for DOI 10.1002/alr.21285

  View details for Web of Science ID 000334895900013

  View details for PubMedID 24431198

• Outpatient endoscopic sinus surgery in cystic fibrosis patients: predictive factors for admission. International forum of allergy & rhinology Soudry, E., Mohabir, P. K., Miglani, A., Chen, J., Nayak, J. V., Hwang, P. H. 2014; 4 (5): 416-421

  Abstract

  An increasing number of adult patients with cystic fibrosis (CF) are becoming candidates for elective endoscopic sinus surgery (ESS). We sought to identify perioperative factors in this patient population that were predictive of postoperative admission.Retrospective chart review of CF patients who underwent ESS during the years 2005 through 2012. Multiple preoperative, intraoperative, and immediate postoperative variables were analyzed.Thirty-three patients who underwent 37 outpatient ESSs were identified. Successful same-day discharge was observed in 54%. In 46% of cases, postoperative admission was necessary, with a mean postoperative stay of 1.4 days. Pulmonary function, CF-related comorbidities, and history of lung transplant were not predictors of postoperative admission. Univariate analysis demonstrated that patients were more likely to be admitted if they had 1 of the following conditions: history of ≥4 prior ESS; procedure duration >2.5 hours; intraoperative blood loss greater than 150 mL; increased immediate postoperative pain scores; or larger narcotic requirements for pain control. On logistic regression analysis, a maximum pain score ≥ 7 out of 10 in the postanesthesia recovery unit was the only significant predisposing factor for postoperative admission.Although over 50% of adult CF patients can successfully undergo ESS on a same-day discharge basis, it is prudent to have contingent plans for potential inpatient observation postoperatively. Multivariate analysis suggests that preoperative demographics and pulmonary status cannot predict the need for postoperative admission, whereas higher pain scores in the postanesthesia care unit are predictive of the necessity for inpatient observation.

  View details for DOI 10.1002/alr.21285

  View details for PubMedID 24431198