Tara Shree Ramaswamy

All Publications

• Nine Myths about Enteral Feeding in Critically Ill Adults: An Expert Perspective. Advances in nutrition (Bethesda, Md.) Ramaswamy, T., DeWane, M. P., Dashti, H. S., Lau, M., Wischmeyer, P. E., Nagrebetsky, A., Sparling, J. 2025; 16 (1): 100345

  Abstract

  Malnutrition is a well-studied and significant prognostic risk factor for morbidity and mortality in critically ill perioperative patients. Common nutrition myths in the critically ill may prevent early, consistent, and adequate delivery of enteral nutrition. We outlined 9 common intensive care unit (ICU) nutrition misconceptions and our recommendations to optimize enteral nutrition in critically ill patients based on the review of available literature. Our approach is to treat every patient admitted to the ICU as at risk for malnutrition and to initiate enteral nutrition upon admission in the absence of contraindications. Early enteral nutrition via the gastric route is more beneficial than delaying feeding while awaiting small bowel access and daytime-intermittent nutrition support can safely be initiated over continuous feeding. Gastric residual volumes to assess feeding tolerance should no longer be routinely measured. For perioperative nutrition, we recommend continuing enteral nutrition for most patients with secure airways undergoing anesthesia and resuming nutrition within 24 h of abdominal surgery; even patients with open abdomens can be safely fed in the absence of bowel injury. Critically ill patients who are proned, paralyzed, and on vasopressors can usually continue enteral nutrition. Finally, continuing enteral nutrition before extubation may optimize nutrition without compromising extubation success. In this review, we highlight several common misconceptions regarding ICU nutrition that may prevent achieving nutrition goals and subsequently lead to increased malnutrition, morbidity, and mortality. This knowledge may contribute to increased implementation of early and consistent enteral nutrition strategies to improve outcomes in critically ill adult patients.

  View details for DOI 10.1016/j.advnut.2024.100345

  View details for PubMedID 39551432

  View details for PubMedCentralID PMC11784768

• Awake Flexible Scope Intubation (AFSI) in Critically Ill Patients with Physiologically Difficult Airways Camire, D., Ramaswamy, T., Mihm, F. LIPPINCOTT WILLIAMS & WILKINS. 2024: 13-15

  View details for Web of Science ID 001349531300008

• Ten misconceptions regarding decision-making in critical care. World journal of critical care medicine Ramaswamy, T., Sparling, J. L., Chang, M. G., Bittner, E. A. 2024; 13 (2): 89644

  Abstract

  Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system. Patient complexity, illness severity, and the urgency in initiating proper treatment all contribute to decision-making errors. Clinician-related factors such as fatigue, cognitive overload, and inexperience further interfere with effective decision-making. Cognitive science has provided insight into the clinical decision-making process that can be used to reduce error. This evidence-based review discusses ten common misconceptions regarding critical care decision-making. By understanding how practitioners make clinical decisions and examining how errors occur, strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes.

  View details for DOI 10.5492/wjccm.v13.i2.89644

  View details for PubMedID 38855268

• Trigger Medicine and Palliative Care Consults McAvoy, J., Aslakson, R. A., Bechtold, H., Ramaswamy, T., Ji, A. X., Hylton, D. LIPPINCOTT WILLIAMS & WILKINS. 2020: 260

  View details for Web of Science ID 000619264500119

• A minimalist electronic health record-based intervention to reduce standing lab utilisation. Postgraduate medical journal Chin, K., Krishnamurthy, A., Zubair, T., Ramaswamy, T., Hom, J., Maggio, P., Shieh, L. 2020

  Abstract

  BACKGROUND: Repetitive laboratory testing in stable patients is low-value care. Electronic health record (EHR)-based interventions are easy to disseminate but can be restrictive.OBJECTIVE: To evaluate the effect of a minimally restrictive EHR-based intervention on utilisation.SETTING: One year before and after intervention at a 600-bed tertiary care hospital. 18000 patients admitted to General Medicine, General Surgery and the Intensive Care Unit (ICU).INTERVENTION: Providers were required to specify the number of times each test should occur instead of being able to order them indefinitely.MEASUREMENTS: For eight tests, utilisation (number of labs performed per patient day) and number of associated orders were measured.RESULTS: Utilisation decreased for some tests on all services. Notably, complete blood count with differential decreased 9% (p<0.001) on General Medicine and 21% (p<0.001) in the ICU.CONCLUSIONS: Requiring providers to specify the number of occurrences of labs changes significantly reduces utilisation in some cases.

  View details for DOI 10.1136/postgradmedj-2019-136992

  View details for PubMedID 32051280

• Structural, Nursing, and Physician Characteristics and 30-Day Mortality for Patients Undergoing Cardiac Surgery in Pennsylvania CRITICAL CARE MEDICINE Lane-Fall, M. B., Ramaswamy, T. S., Brown, S. S., He, X., Gutsche, J. T., Fleisher, L. A., Neuman, M. D. 2017; 45 (9): 1472–80

  Abstract

  Cardiac surgery ICU characteristics and clinician staffing patterns have not been well characterized. We sought to describe Pennsylvania cardiac ICUs and to determine whether ICU characteristics are associated with mortality in the 30 days after cardiac surgery.From 2012 to 2013, we conducted a survey of cardiac surgery ICUs in Pennsylvania to assess ICU structure, care practices, and clinician staffing patterns. ICU data were linked to an administrative database of cardiac surgery patient discharges. We used logistic regression to measure the association between ICU variables and death in 30 days.Cardiac surgery ICUs in Pennsylvania.Patients having coronary artery bypass grafting and/or cardiac valve repair or replacement from 2009 to 2011.None.Of the 57 cardiac surgical ICUs in Pennsylvania, 43 (75.4%) responded to the facility survey. Rounds included respiratory therapists in 26 of 43 (60.5%) and pharmacists in 23 of 43 (53.5%). Eleven of 41 (26.8%) reported that at least 2/3 of their nurses had a bachelor's degree in nursing. Advanced practice providers were present in most of the ICUs (37/43; 86.0%) but residents (8/42; 18.6%) and fellows (7/43; 16.3%) were not. Daytime intensivists were present in 21 of 43 (48.8%) responding ICUs; eight of 43 (18.6%) had nighttime intensivists. Among 29,449 patients, there was no relationship between mortality and nurse ICU experience, presence of any intensivist, or absence of residents after risk adjustment. To exclude patients who may have undergone transcatheter aortic valve replacement, we conducted a subgroup analysis of patients undergoing only coronary artery bypass grafting, and results were similar.Pennsylvania cardiac surgery ICUs have variable structures, care practices, and clinician staffing, although none of these are statistically significantly associated with mortality in the 30 days following surgery after adjustment.

  View details for DOI 10.1097/CCM.0000000000002578

  View details for Web of Science ID 000407843600026

  View details for PubMedID 28661969

  View details for PubMedCentralID PMC5561002