Barbara-Jo Achuff, MD, FAAP
As an attending in the Cardiac Intensive Care Unit, my overarching career goal is to improve early and late outcomes for children with cardiac disease with a primary focus on optimization of sedation and pain management practices during the patient’s intensive care unit stay. During my advanced training, fellowship, and as attending in the CICU, I work with a team that measures applied medication and treatment options and their effect on early outcomes after cardiac surgery.
In my current leadership roles for a multi-disciplinary sedation stewardship team, I have developed an expanding, daily refreshed database including all medications administered to our ICU patients. Through novel data discovery, pattern recognition and visualizations of large amount of data over time, we have developed recommended age-based analgesia/sedation pathways and metrics to sustain those pathways for patients in the CICU. With current, accurate and timely clinical reports and dash boarding, our team continues to lead scientific processes and analytics leveraging data for quality improvement and excellent care at the bedside for the most fragile patients in the pediatric cardiac intensive care unit.
My research on medication choices and the effect on post-operative mechanical ventilation reveals that meticulous post-operatively pain and sedation management allows less opioid exposure and early liberation from mechanical ventilator support after cardiac surgery, even for the youngest patients. My more recent publications include a novel approach to analyze high fidelity hemodynamic data including millions of beat-to-beat systolic blood pressure measurements surrounding recorded medication administration in our pediatric CICU. This work showed that the basic mathematical tools for approximating such systems have sufficient accuracy for describing complex non-linear behaviors. The development of algorithms around therapies such as medication doses or other interventions in the ICU using expert systems allows the analysis of time-series data and can observe changes in physiologic data around doses. This provides insight to clinicians who can be prepared to intervene and act accordingly improving outcomes for these critically ill children.
Achuff BJ, Lemmings K; Causey JC; Sembera KA, Checchia PA Ghanayem NS: Opioid Weaning Protocol Using Morphine vs. Methadone Decreases Duration and Exposure in Patients after Norwood Procedure Pediatr Crit Care Med. 2022 Jan 5. doi: 10.1097/PCC.0000000000002885. Online ahead of print. PMID: 34982761
Savorgnan F, Bhat PN, Checchia PA, Acosta S, Tume SC, Lasa JJ, Asadourian V, Achuff BJ, Flores S, Ahmed M, Crouthamel DI, Loomba RS, Bronicki RA. RBC Transfusion Induced ST Segment Variability Following the Norwood Procedure. Crit Care Explor. 2021 May 20;3(5):e0417. doi: 10.1097/CCE.0000000000000417. eCollection 2021 May.PMID: 34036271
Afonso NS, Ninemire MR, Gowda SH, Jump JL, Lantin-Hermoso RL, Johnson KE, Puri K, Hope KD, Kritz E, Achuff BJ, Gurganious L, Bhat PN. Redefining the Relationship: Palliative Care in Critical Perinatal and Neonatal Cardiac Patients. Children. 2021; 8(7):548. PMID:34201973 https://doi.org/10.3390/children8070548
Hope KD, Bhat PN, Dreyer WJ, Elias BA, Jump JL, Santucci G, Afonso NS, Ninemire MR, Achuff BJ, Kritz EM, Gowda SH, Puri K. Pediatric Palliative Care in the Heart Failure, Ventricular Assist Device and Transplant Populations: Supporting Patients, Families and Their Clinical Teams. Children. 2021; 8(6):468. PMID:34199474 https://doi.org/10.3390/children8060468
Pollak U, Bronicki RA, Achuff BJ and Checchia, PA, 2019. Postoperative Pain Management in Pediatric Patients Undergoing Cardiac Surgery: Where Are We Heading?. Journal of Intensive Care Medicine, PMID : 31446831
Achuff BJ, Moffett, B, Acosta, S; Lasa, J; Checchia, PA; Rusin, C: Hypotensive Response to IV Acetaminophen in Pediatric Cardiac Patients; STAR Award Recognition SCCM, San Antonio, TX February 2018; Pediatric Critical Care Medicine 2019 Jan PMID: 30676493
Achuff BJ, Elias MD, O’ Connor M, et al: Risk Factors for Mortality in Pediatric Cardiac Intensive Care Unit Patients Managed with Extracorporeal Membrane Oxygenation: A Contemporary Review. Poster Presentation ACC Chicago April 2016 Cardiol Young Epub Oct 31 2018: 2019 Jan 29 PMID: 30378526
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