Bhupinder S Natt

Interests

Teaching

Airway Management,Interstitial Lung Disease,Extracorporeal Membrane OxygenationMechanical Ventilation

Research

Airway ManagementInterstitial Lung DiseaseExtracorporeal Membrane Oxygenation

Courses

No activities entered.

Scholarly Contributions

Journals/Publications

• , N. H., Shapiro, N. I., Douglas, I. S., Brower, R. G., Brown, S. M., Exline, M. C., Ginde, A. A., Gong, M. N., Grissom, C. K., Hayden, D., Hough, C. L., Huang, W., Iwashyna, T. J., Jones, A. E., Khan, A., Lai, P., Liu, K. D., Miller, C. D., Oldmixon, K., , Park, P. K., et al. (2023). Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. The New England journal of medicine, 388(6), 499-510.
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  Intravenous fluids and vasopressor agents are commonly used in early resuscitation of patients with sepsis, but comparative data for prioritizing their delivery are limited.
• Malo, J., Natt, B., Chaudhary, S., & Knox, K. S. (2023). Prophylaxis in Lung Transplant Recipients. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 76(2), 368-369.
• Kazui, T., Hsu, C. H., Lick, S. D., Hypes, C. D., Natt, B., Malo, J., Mosier, J. M., & Bull, D. A. (2022). Outcomes of Venovenous Extracorporeal Membrane Oxygenation in Viral Acute Respiratory Distress Syndrome. ASAIO journal (American Society for Artificial Internal Organs : 1992), 68(11), 1399-1406.
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  Our study assessed the relationship between the duration of venovenous extracorporeal membrane oxygenation (V-V ECMO) and patient outcomes. We studied patients undergoing V-V ECMO support for acute respiratory distress syndrome (ARDS) between 2009 and 2017 who were reported to the Extracorporeal Life Support Organization registry. We evaluated survival, major bleeding, renal failure, pulmonary complications, mechanical complications, neurologic complications, infection, and duration of V-V ECMO support. Multivariable regression modeling assessed risk factors for adverse events. Of the 4,636 patients studied, the mean support duration was 12.2 ± 13.7 days. There was a progressive increase in survival after the initiation of V-VECMO, peaking at a survival rate of 73% at 10 days of support. However, a single-day increase in V-V ECMO duration was associated with increased bleeding events (odds ratio [OR] 1.038; 95% confidence interval [CI]: 1.029-1.047; p < 0.0001), renal failure (OR 1.018; 95% CI: 1.010-1.027; p < 0.0001), mechanical complications (OR 1.065; 95% CI: 1.053-1.076; p < 0.0001), pulmonary complications (OR 1.04; 95% CI: 1.03-1.05; p < 0.0001), and infection (OR 1.04; 95% CI: 1.03-1.05; p < 0.0001). V-V ECMO progressively increases survival for ARDS over the first 10 days of support. Thereafter, rising complications associated with prolonged durations of support result in a progressive decline in survival.
• Lee, J., White, E., Freiheit, E., Scholand, M. B., Strek, M. E., Podolanczuk, A. J., Patel, N. M., & , P. F. (2022). Cough-Specific Quality of Life Predicts Disease Progression Among Patients With Interstitial Lung Disease: Data From the Pulmonary Fibrosis Foundation Patient Registry. Chest, 162(3), 603-613.
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  Cough is a common symptom of interstitial lung disease (ILD) and negatively impacts health-related quality of life (QOL). Previous studies have shown that among patients with idiopathic pulmonary fibrosis, cough may predict progression of lung disease and perhaps even respiratory hospitalizations and mortality.
• Harris, D. T., Badowski, M., Jernigan, B., Sprissler, R., Edwards, T., Cohen, R., Paul, S., Merchant, N., Weinkauf, C. C., Bime, C., Erickson, H. E., Bixby, B., Parthasarathy, S., Chaudhary, S., Natt, B., Cristan, E., El Aini, T., Rischard, F., Campion, J., , Chopra, M., et al. (2021). SARS-CoV-2 Rapid Antigen Testing of Symptomatic and Asymptomatic Individuals on the University of Arizona Campus. Biomedicines, 9(5).
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  SARS-CoV-2, the cause of COVID19, has caused a pandemic that has infected more than 80 M and killed more than 1.6 M persons worldwide. In the US as of December 2020, it has infected more than 32 M people while causing more than 570,000 deaths. As the pandemic persists, there has been a public demand to reopen schools and university campuses. To consider these demands, it is necessary to rapidly identify those individuals infected with the virus and isolate them so that disease transmission can be stopped. In the present study, we examined the sensitivity of the Quidel Rapid Antigen test for use in screening both symptomatic and asymptomatic individuals at the University of Arizona from June to August 2020. A total of 885 symptomatic and 1551 asymptomatic subjects were assessed by antigen testing and real-time PCR testing. The sensitivity of the test for both symptomatic and asymptomatic persons was between 82 and 90%, with some caveats.
• Martinez, F. J., Yow, E., Flaherty, K. R., Snyder, L. D., Durheim, M. T., Wisniewski, S. R., Sciurba, F. C., Raghu, G., Brooks, M. M., Kim, D. Y., Dilling, D. F., Criner, G. J., Kim, H., Belloli, E. A., Nambiar, A. M., Scholand, M. B., Anstrom, K. J., Noth, I., & , C. I. (2021). Effect of Antimicrobial Therapy on Respiratory Hospitalization or Death in Adults With Idiopathic Pulmonary Fibrosis: The CleanUP-IPF Randomized Clinical Trial. JAMA, 325(18), 1841-1851.
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  Alteration in lung microbes is associated with disease progression in idiopathic pulmonary fibrosis.
• Mosier, J., Natt, B., & Malo, J. (2021). ARDS in COVID-19 and beyond: Let's keep our eyes on the goal instead of the straw man. Journal of the Intensive Care Society, 22(4), 267-269.
• Natt, B., & Mosier, J. (2021). Airway Management in the Critically Ill Patient. Current anesthesiology reports, 1-12.
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  This paper will evaluate the recent literature and best practices in airway management in critically ill patients.
• Natt, B., Mosier, J., & Malo, J. (2021). ARDS in COVID-19 and beyond: Let's keep our eyes on the goal instead of the straw man.. Journal of the Intensive Care Society, 22(4), 267-269. doi:10.1177/1751143720973527
• Nyquist, A., & Natt, B. (2021). IS CRITICAL CARE MYOPATHY A CONTRAINDICATION FOR SUCCINYLCHOLINE?. Chest, 160(4), A641. doi:10.1016/j.chest.2021.07.611
• Qadir, N., Bartz, R. R., Cooter, M. L., Hough, C. L., Lanspa, M. J., Banner-Goodspeed, V. M., Chen, J. T., Giovanni, S., Gomaa, D., Sjoding, M. W., Hajizadeh, N., Komisarow, J., Duggal, A., Khanna, A. K., Kashyap, R., Khan, A., Chang, S. Y., Tonna, J. E., Anderson, H. L., , Liebler, J. M., et al. (2021). Variation in Early Management Practices in Moderate-to-Severe ARDS in the United States: The Severe ARDS: Generating Evidence Study. Chest, 160(4), 1304-1315.
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  Although specific interventions previously demonstrated benefit in patients with ARDS, use of these interventions is inconsistent, and patient mortality remains high. The impact of variability in center management practices on ARDS mortality rates remains unknown.
• Casanova, N. G., Gonzalez-Garay, M. L., Sun, B., Bime, C., Sun, X., Knox, K. S., Crouser, E. D., Sammani, N., Gonzales, T., Natt, B., Chaudhary, S., Lussier, Y., & Garcia, J. G. (2020). Differential transcriptomics in sarcoidosis lung and lymph node granulomas with comparisons to pathogen-specific granulomas. Respiratory research, 21(1), 321.
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  Despite the availability of multi-"omics" strategies, insights into the etiology and pathogenesis of sarcoidosis have been elusive. This is partly due to the lack of reliable preclinical models and a paucity of validated biomarkers. As granulomas are a key feature of sarcoidosis, we speculate that direct genomic interrogation of sarcoid tissues, may lead to identification of dysregulated gene pathways or biomarker signatures.
• Chaudhary, S., Natt, B., Bime, C., Knox, K. S., & Glassberg, M. K. (2020). Antifibrotics in COVID-19 Lung Disease: Let Us Stay Focused. Frontiers in medicine, 7, 539.
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  After decades of research, two therapies for chronic fibrotic lung disease are now approved by the FDA, with dozens more anti-fibrotic therapies in the pipeline. A great deal of enthusiasm has been generated for the use of these drugs, which are by no means curative but clearly have a favorable impact on lung function decline over time. Amidst a flurry of newly developed and repurposed drugs to treat the coronavirus disease 2019 (COVID-19) and its accompanying acute respiratory distress syndrome (ARDS), few have emerged as effective. Historically, survivors of severe viral pneumonia and related acute lung injury with ARDS often have near full recovery of lung function. While the pathological findings of the lungs of patients with COVID-19 can be diverse, current reports have shown significant lung fibrosis predominantly in autopsy studies. There is growing enthusiasm to study anti-fibrotic therapy for inevitable lung fibrosis, and clinical trials are underway using currently FDA-approved anti-fibrotic therapies. Given the relatively favorable outcomes of survivors of virus-mediated ARDS and the low prevalence of clinically meaningful lung fibrosis in survivors, this perspective examines if there is a rationale for testing these repurposed antifibrotic agents in COVID-19-associated lung disease.
• Chaudhary, S., Natt, B., Bime, C., Knox, K. S., & Glassberg, M. K. (2020). Corrigendum: Antifibrotics in COVID-19 Lung Disease: Let Us Stay Focused. Frontiers in medicine, 7, 604640.
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  [This corrects the article DOI: 10.3389/fmed.2020.00539.].
• Kazui, T., Hypes, C., Natt, B., Malo, J., Hsu, C. H., Lick, S. D., Bull, D. A., Smith, R. G., Natt, B., Mosier, J., Mogan, C., Malo, J., Lick, S. D., Kazui, T., Hypes, C., Hsu, C. H., & Bull, D. A. (2020). Interfacility Transfer via a Mobile Intensive Care Unit Following a Double Lumen Catheter Cannulation at the Referring Facility for Veno-Venous Extracorporeal Membrane Oxygenation.. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 39(4S), S419. doi:10.1016/j.healun.2020.01.194
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  Assess the feasibility of interfacility transfer via a mobile intensive care unit (MOBI) after a double lumen catheter cannulation at a referring facility for veno-venous extracorporeal membrane oxygenation (VV-ECMO)..This single center retrospective data analysis utilized our institutional data from January 2015-September 2019. We divided patients into 2 groups: Group A had a double lumen cannulation for in-hospital VV-ECMO; Group B had the same procedure for interfacility transfer via an MOBI. Cannulation was performed with fluoroscopic guidance at the referring facility by either one of its surgeons or the MOBI team. The MOBI consisted of an ECMO physician (either a surgeon or an intensivist), a respiratory therapist, an ECMO nurse, and a transport nurse. The 2 groups were compared in terms of pre support, complications during the ECMO support, and survival..There were no complications related to cannulation at the referring facility nor transfer. Group A had 33 patients (average age was 45.1 ± 18.0). Group B had 20 patients (average age was 48.4 ± 13.5). Pre ECMO pH, PCO2, PO2, and SaO2 were 7.2 ± 0.2, 7.3 ± 0.2 (p=0.08), 65.0 ± 21.6mmHg, 59.3 ± 24.2mmHg (p=0.27), 69.8 ± 26.3mmHg, 66.6 ± 45.0mmHg (p=0.18), 85.7 ± 9.7%, 82.5 ± 14.4% (p=0.61) in Group A and B, respectively. During ECMO support, Group A had 18 complications; Group B had 13 (p=0.57), including circuit component clots [5 and 4 (p=0.72)], circuit exchange [3 and 2 (p=1.00)], creatinine 1.5 - 3.0 [5 and 1 (p=0.39)], creatinine >3.0 [2 and 3 (p=0.35)], and renal replacement therapy [6 and 4 (p=1.00)]. Respectively, 69.7% and 50.0% of patients came off ECMO support, and 45.4% and 50.0% of patients survived to discharge (p=0.18)..Double lumen catheter cannulation at the referring facility with MOBI demonstrated equivalent results to in-house cannulation.
• Nikolich-Zugich, J., Knox, K. S., Rios, C. T., Natt, B., Bhattacharya, D., & Fain, M. J. (2020). Correction to: SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience, 42(3), 1013.
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  The affiliation of the second author (Kenneth S. Knox) should have been Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA instead of Department of Medicine, University of Arizona-Phoenix, Phoenix, AZ 85004, USA.
• Nikolich-Zugich, J., Knox, K. S., Rios, C. T., Natt, B., Bhattacharya, D., & Fain, M. J. (2020). SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience, 42(2), 505-514.
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  SARS-CoV-2 virus, the causative agent of the coronavirus infectious disease-19 (COVID-19), is taking the globe by storm, approaching 500,000 confirmed cases and over 21,000 deaths as of March 25, 2020. While under control in some affected Asian countries (Taiwan, Singapore, Vietnam), the virus demonstrated an exponential phase of infectivity in several large countries (China in late January and February and many European countries and the USA in March), with cases exploding by 30-50,000/day in the third and fourth weeks of March, 2020. SARS-CoV-2 has proven to be particularly deadly to older adults and those with certain underlying medical conditions, many of whom are of advanced age. Here, we briefly review the virus, its structure and evolution, epidemiology and pathogenesis, immunogenicity and immune, and clinical response in older adults, using available knowledge on SARS-CoV-2 and its highly pathogenic relatives MERS-CoV and SARS-CoV-1. We conclude by discussing clinical and basic science approaches to protect older adults against this disease.
• Ripperger, T. J., Uhrlaub, J. L., Watanabe, M., Wong, R., Castaneda, Y., Pizzato, H. A., Thompson, M. R., Bradshaw, C., Weinkauf, C. C., Bime, C., Erickson, H. L., Knox, K., Bixby, B., Parthasarathy, S., Chaudhary, S., Natt, B., Cristan, E., Aini, T. E., Rischard, F., , Campion, J., et al. (2020). Detection, prevalence, and duration of humoral responses to SARS-CoV-2 under conditions of limited population exposure. medRxiv : the preprint server for health sciences.
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  We conducted an extensive serological study to quantify population-level exposure and define correlates of immunity against SARS-CoV-2. We found that relative to mild COVID-19 cases, individuals with severe disease exhibited elevated authentic virus-neutralizing titers and antibody levels against nucleocapsid (N) and the receptor binding domain (RBD) and the S2 region of spike protein. Unlike disease severity, age and sex played lesser roles in serological responses. All cases, including asymptomatic individuals, seroconverted by 2 weeks post-PCR confirmation. RBD- and S2-specific and neutralizing antibody titers remained elevated and stable for at least 2-3 months post-onset, whereas those against N were more variable with rapid declines in many samples. Testing of 5882 self-recruited members of the local community demonstrated that 1.24% of individuals showed antibody reactivity to RBD. However, 18% (13/73) of these putative seropositive samples failed to neutralize authentic SARS-CoV-2 virus. Each of the neutralizing, but only 1 of the non-neutralizing samples, also displayed potent reactivity to S2. Thus, inclusion of multiple independent assays markedly improved the accuracy of antibody tests in low seroprevalence communities and revealed differences in antibody kinetics depending on the viral antigen. In contrast to other reports, we conclude that immunity is durable for at least several months after SARS-CoV-2 infection.
• Ripperger, T. J., Uhrlaub, J. L., Watanabe, M., Wong, R., Castaneda, Y., Pizzato, H. A., Thompson, M. R., Bradshaw, C., Weinkauf, C. C., Bime, C., Erickson, H. L., Knox, K., Bixby, B., Parthasarathy, S., Chaudhary, S., Natt, B., Cristan, E., El Aini, T., Rischard, F., , Campion, J., et al. (2020). Orthogonal SARS-CoV-2 Serological Assays Enable Surveillance of Low-Prevalence Communities and Reveal Durable Humoral Immunity. Immunity, 53(5), 925-933.e4.
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  We conducted a serological study to define correlates of immunity against SARS-CoV-2. Compared to those with mild coronavirus disease 2019 (COVID-19) cases, individuals with severe disease exhibited elevated virus-neutralizing titers and antibodies against the nucleocapsid (N) and the receptor binding domain (RBD) of the spike protein. Age and sex played lesser roles. All cases, including asymptomatic individuals, seroconverted by 2 weeks after PCR confirmation. Spike RBD and S2 and neutralizing antibodies remained detectable through 5-7 months after onset, whereas α-N titers diminished. Testing 5,882 members of the local community revealed only 1 sample with seroreactivity to both RBD and S2 that lacked neutralizing antibodies. This fidelity could not be achieved with either RBD or S2 alone. Thus, inclusion of multiple independent assays improved the accuracy of antibody tests in low-seroprevalence communities and revealed differences in antibody kinetics depending on the antigen. We conclude that neutralizing antibodies are stably produced for at least 5-7 months after SARS-CoV-2 infection.
• Self, W. H., Semler, M. W., Leither, L. M., Casey, J. D., Angus, D. C., Brower, R. G., Chang, S. Y., Collins, S. P., Eppensteiner, J. C., Filbin, M. R., Files, D. C., Gibbs, K. W., Ginde, A. A., Gong, M. N., Harrell, F. E., Hayden, D. L., Hough, C. L., Johnson, N. J., Khan, A., , Lindsell, C. J., et al. (2020). Effect of Hydroxychloroquine on Clinical Status at 14 Days in Hospitalized Patients With COVID-19: A Randomized Clinical Trial. JAMA, 324(21), 2165-2176.
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  Data on the efficacy of hydroxychloroquine for the treatment of coronavirus disease 2019 (COVID-19) are needed.
• Nyquist, A., Natt, B., & Bardwell, J. (2019). LIGHTNING STRIKE: RECOGNITION AND MANAGEMENT. Chest, 156(4), A1242. doi:10.1016/j.chest.2019.08.1120
• Sears, S., Palacio, D., & Natt, B. (2019). Medical image of the week: diffuse pulmonary ossification. Southwest Journal of Pulmonary and Critical Care, 19(2), 65-67. doi:10.13175/swjpcc028-19
• Bime, C., Malo, J., Mosier, J. M., Natt, B., & Insel, M. (2018). The Association of Non-Cardiac ECMO With Influenza Incidence: A Time Series Analysis.. Respiratory Care.
• Goel, K., Bailey, M., Borgstrom, M., Parthasarathy, S., Natt, B., Berry, C., & Bime, C. (2018). Trends in COPD Hospitalization and In-Hospital Deaths in the United States by Sex: 2005-2014. Annals of the American Thoracic Society.
• Insel, M., Natt, B., Mosier, J., Malo, J., & Bime, C. (2018). The Association of Non-Cardiac ECMO With Influenza Incidence: A Time Series Analysis. Respiratory care.
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  The 2009 H1N1 influenza epidemic saw a rise in the use of extracorporeal membrane oxygenation (ECMO) as a supportive therapy for refractory ARDS. We sought to determine whether ECMO utilization follows a seasonal pattern that matches the influenza season, and whether it can further be explained by the incidence of each influenza subtype.
• Natt, B. (2018). Medical image of the week: plastic bronchitis. Southwest Journal of Pulmonary and Critical Care, 16(1), 28-28. doi:10.13175/swjpcc005-18
• Natt, B., Chaudhary, S., Ateeli, H., & Ali, H. (2018). Medical image of the week: Dobhoff tube placement with Roux-en-Y gastric bypass. Southwest Journal of Pulmonary and Critical Care, 16(4), 226-227. doi:10.13175/swjpcc045-18
• Natt, B., Elaini, T., & El-aini, T. (2018). Medical image of the week: neuromyelitis optica and sarcoidosis. Southwest Journal of Pulmonary and Critical Care, 16(6), 341-342. doi:10.13175/swjpcc081-18
• Robbins, R., Pulmonary, P., & Natt, B. (2018). Medical Image of the Week: Medical Administrative Growth. Southwest Journal of Pulmonary and Critical Care, 17(1), 35-35. doi:10.13175/swjpcc087-18
• Bime, C., Natt, B., Desai, H., Poongkunran, C., & Borgstrom, M. (2017). Reply: Racial Disparities in Acute Respiratory Distress Syndrome Mortality. Annals of the American Thoracic Society, 14(2), 300-301.
• Mosier, J. M., Kazui, T., Malo, J., Basken, R., Hypes, C., & Natt, B. (2017). Suspected Heparin Induced Thrombocytopenia in patients receiving Extracorporeal Membrane Oxygenation: a case series.. Journal of ExtraCorporeal Technology.
• Natt, B., Desai, H., Bime, C., Dill, J., Dalen, J. E., & Alpert, J. S. (2017). The Reply. The American journal of medicine, 130(4), e165.
• Natt, B., Hypes, C., Basekn, R., Malo, J., Kazui, T., & Mosier, J. M. (2017). The use of extracorporeal membrane oxygenation in the bronchoscopic management of critical upper airway obstruction. Journal of Extra Corporeal Technology, 49(1), 54-58.
• Natt, B., Hypes, C., Basken, R., Malo, J., Kazui, T., & Mosier, J. (2017). Suspected Heparin-Induced Thrombocytopenia in Patients Receiving Extracorporeal Membrane Oxygenation. The journal of extra-corporeal technology, 49(1), 54-58.
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  Heparin-induced thrombocytopenia (HIT) is an immune reaction usually secondary to unfractionated heparin. Anticoagulation management is critical in patients while on extracorporeal membrane oxygenation (ECMO) to prevent thromboembolism and for the optimal functioning of the circuit. We identified five patients with respiratory failure at our hospital managed with ECMO in the last 2 years that were treated for HIT. A brief clinical course and their management are discussed. We also briefly review the literature for best evidence for management of such patients.
• Natt, B., Knepler, J. L., Kazui, T., Mosier, J. M., Natt, B., Knepler, J. L., Kazui, T., & Mosier, J. M. (2017). The use of extracorporeal membrane oxygenation in the bronchoscopic management of critical upper airway obstruction. J Bronchology Interv Pulmonol, 24(1), e12-e14.
• Bime, C., Poongkunran, C., Borgstrom, M., Natt, B., Desai, H., Parthasarathy, S., & Garcia, J. G. (2016). Racial Differences in Mortality from Severe Acute Respiratory Failure in the United States, 2008-2012. Annals of the American Thoracic Society, 13(12), 2184-2189.
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  Racial disparities in health and healthcare in the United States are well documented and are increasingly recognized in acute critical illnesses such as sepsis and acute respiratory failure.
• Desai, H., Natt, B., Kim, S. S., Bime, C., Desai, H., Natt, B., Kim, S. S., & Bime, C. (2016). Decreased In-hospital Mortality after Lobectomy Using Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy.. Annals of American Thoracic Society.
• Desai, H., Natt, B., Kim, S., & Bime, C. (2016). Decreased In-hospital Mortality after Lobectomy Using Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy. Annals of the American Thoracic Society.
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  There is a paucity of data regarding the optimal surgical approach for lung lobectomy. Lobectomy performed by video-assisted thoracoscopic surgery (VATS) has been associated with lower morbidity as compared to thoracotomy. However, no multicenter studies have shown improved mortality with VATS lobectomy compared to open surgical lobectomy.
• Hypes, C. D., Stolz, U., Sakles, J. C., Joshi, R. R., Natt, B., Malo, J., Bloom, J. W., & Mosier, J. M. (2016). Video Laryngoscopy Improves Odds of First-Attempt Success at Intubation in the Intensive Care Unit. A Propensity-matched Analysis. Annals of the American Thoracic Society, 13(3), 382-90.
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  Urgent tracheal intubation is performed frequently in intensive care units and incurs higher risk than when intubation is performed under more controlled circumstances. Video laryngoscopy may improve the chances of successful tracheal intubation on the first attempt; however, existing comparative data on outcomes are limited.
• Hypes, C., Sakles, J., Joshi, R., Greenberg, J., Natt, B., Malo, J., Bloom, J., Chopra, H., & Mosier, J. (2016). Failure to achieve first attempt success at intubation using video laryngoscopy is associated with increased complications. Internal and emergency medicine.
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  The purpose of this investigation was to investigate the association between first attempt success and intubation-related complications in the Intensive Care Unit after the widespread adoption of video laryngoscopy. We further sought to characterize and identify the predictors of complications that occur despite first attempt success. This was a prospective observational study of consecutive intubations performed with video laryngoscopy at an academic medical Intensive Care Unit. Operator, procedural, and complication data were collected. Multivariable logistic regression was used to examine the relationship between the intubation attempts and the occurrence of one or more complications. A total of 905 patients were intubated using a video laryngoscope. First attempt success occurred in 739 (81.7 %), whereas >1 attempt was needed in 166 (18.3 %). One or more complications occurred in 146 (19.8 %) of those intubated on the first attempt versus 107 (64.5 %, p 1 attempt is associated with 6.4 (95 % CI 4.4-9.3) times the adjusted odds of at least one complication. Pre-intubation predictors of at least one complication despite first attempt success include vomit or edema in the airway as well as the presence of hypoxemia or hypotension. There are increased odds of complications with even a second attempt at intubation in the Intensive Care Unit. Complications occur frequently despite a successful first attempt, and as such, the goal of airway management should not be simply first attempt success, but instead first attempt success without complications.
• Natt, B. (2016). Medical image of the week: endobronchial valves. Medical image of the week: endobronchial valves, 13(1), 34-35.
• Natt, B. S., Desai, H., Singh, N., Poongkunran, C., Parthasarathy, S., & Bime, C. (2016). Extracorporeal Membrane Oxygenation for ARDS: National Trends in the United States 2008-2012. Respiratory care, 61(10), 1293-8.
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  Recent advances in technology and protocols have made the use of extracorporeal membrane oxygenation (ECMO) a viable rescue therapy for patients with ARDS who present with refractory hypoxemia. Despite the lack of strong evidence supporting the use of ECMO in ARDS, its use seems to be increasing. We sought to determine recent trends in the use of ECMO for ARDS. We also assessed trends in mortality among patients with ARDS in whom ECMO was used.
• Natt, B. S., Malo, J., Hypes, C. D., Sakles, J. C., & Mosier, J. M. (2016). Strategies to improve first attempt success at intubation in critically ill patients. British journal of anaesthesia, 117 Suppl 1, i60-i68.
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  Tracheal intubation in critically ill patients is a high-risk procedure. The risk of complications increases with repeated or prolonged attempts, making expedient first attempt success the goal for airway management in these patients. Patient-related factors often make visualization of the airway and placement of the tracheal tube difficult. Physiologic derangements reduce the patient's tolerance for repeated or prolonged attempts at laryngoscopy and, as a result, hypoxaemia and haemodynamic deterioration are common complications. Operator-related factors such as experience, device selection, and pharmacologic choices affect the odds of a successful intubation on the first attempt. This review will discuss the 'difficult airway' in critically ill patients and highlight recent advances in airway management that have been shown to improve first attempt success and decrease adverse events associated with the intubation of critically ill patients.
• Natt, B., & Knepler, J. L. (2016). Medical image of the week: endobronchial valves. Southwest Journal of Pulmonary and Critical Care, 13(1), 34-35.
• Natt, B., & Knepler, J. L. (2016). Medical image of the week: lung entrapment. Southwest Journal of Pulmonary and Critical Care, 13(1), 36-37.
• Natt, B., Power, E., & Beatty, N. (2016). Medical image of the week: purpura fulminans. Southwest Journal of Pulmonary and Critical Care, 13(6), 307-308.
• Tey, K. R., & Natt, B. (2016). Medical image of the week: mediastinal metastases causing right ventricular outflow obstruction. Southwest Journal of Pulmonary and Critical Care, 12(1), 22-23.
• Baalachandran, R., Hypes, C., Natt, B., & Snyder, L. (2015). Pipe dreams: concealed methamphetamine causing severe toxicity. The American journal of the medical sciences, 349(6), 548-9.
• Bull, D. A., Lick, S. D., Hypes, C., Natt, B., Mosier, J. M., Malo, J., Hsu, C., & Kazui, T. (2019). DURATION OF VENOVENOUS EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT AND ADVERSE OUTCOMES IN ACUTE RESPIRATORY DISTRESS SYNDROME: AN ANALYSIS FROM THE EXTRACORPOREAL LIFE SUPPORT ORGANIZATION REGISTRY. Journal of heart and lung transplantation.
• Bull, D. A., Lick, S. D., Hypes, C., Natt, B., Mosier, J. M., Malo, J., Hsu, C., & Kazui, T. (2021). Outcomes of venovenous extracorporeal membrane oxygenation support in acute respiratory distress syndrome. Annals of Thoracic Surgery.
• Desai, H., Bajaj, A., Hanamaikai, K., & Natt, B. (2015). Medical image of the week: acute aortic dissection. Southwest Journal of Pulmonary and Critical Care, 10(6), 348-349.
• Desai, H., Natt, B., Bime, C., Dill, J., Dalen, J. E., & Alpert, J. S. (2017). Pulmonary Embolism with Right Ventricular Dysfunction: Who Should Receive Thrombolytic Agents?. The American journal of medicine, 130(1), 93.e29-93.e32.
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  Appropriate management of pulmonary embolism patients with right ventricular dysfunction is uncertain. Recent guidelines have stressed the need for more data on the use of thrombolytic agents in the stable pulmonary embolism patient with right ventricular dysfunction. The objective of this study is to investigate the hypothesis that thrombolytic therapy in hemodynamically stable pulmonary embolism patients with right ventricular dysfunction is not associated with improved mortality.
• El Aini, T., Omar, M., & Natt, B. (2015). Medical image of the week: bilateral symmetrical nephromegaly. Southwest Journal of Pulmonary and Critical Care, 10(2), 93-94.
• Habibi, S., Natt, B., & Jenkins, C. (2015). Medical image of the week: ‘CSFoma’. Southwest Journal of Pulmonary and Critical Care, 11(4), 192.
• Mosier, J. M., Malo, J., Sakles, J. C., Hypes, C. D., Natt, B., Snyder, L., Knepler, J., Bloom, J. W., Joshi, R., & Knox, K. (2015). The impact of a comprehensive airway management training program for pulmonary and critical care medicine fellows. A three-year experience. Annals of the American Thoracic Society, 12(4), 539-48.
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  Airway management in the intensive care unit (ICU) is challenging, as many patients have limited physiologic reserve and are at risk for clinical deterioration if the airway is not quickly secured. In academic medical centers, ICU intubations are often performed by trainees, making airway management education paramount for pulmonary and critical care trainees.
• Mosier, J. M., Natt, B., Kazui, T., Hypes, C., Basken, R., Malo, J., Basken, R., Malo, J., Hypes, C., Kazui, T., Natt, B., & Mosier, J. M. (2017). Suspected Heparin Induced Thrombocytopenia in patients receiving Extracorporeal Membrane Oxygenation: a case series.. Journal of ExtraCorporeal Technology.
• Natt, B., & Raz, Y. (2015). IMAGES IN CLINICAL MEDICINE. Air Bronchogram. The New England journal of medicine, 373(27), 2663.
• Natt, B., Knepler, J., Kazui, T., & Mosier, J. M. (2017). The Use of Extracorporeal Membrane Oxygenation in the Bronchoscopic Management of Critical Upper Airway Obstruction. Journal of bronchology & interventional pulmonology, 24(1), e12-e14.
• Natt, B., Mazursky, K., & Meinke, L. E. (2015). Medical image of the week: acute amiodarone pulmonary toxicity. Southwest Journal of Pulmonary and Critical Care, 11(4), 189-190.
• Omar, M., El Aini, T., & Natt, B. (2015). Medical image of the week: Westermark sign. Southwest Journal of Pulmonary and Critical Care, 10(3), 125-126.
• Poongkunran, C., Natt, B., Singh, N., Poongkunran, C., Natt, B., Desai, H., Borgstrom, M., & Bime, C. (2015). 679: INCREASED MORTALITY IN ARDS PATIENTS REQUIRING CONTINUOUS RENAL REPLACEMENT THERAPY. Critical Care Medicine, 43, 171. doi:10.1097/01.ccm.0000474507.38895.79
• Tey, K. R., & Natt, B. (2015). Medical image of the week: empyema necessitans. Southwest Journal of Pulmonary and Critical Care, 11(6), 271-272.
• Natt, B. S., Campion, J. M., & Knox, K. S. (2014). Acute eosinophilic pneumonia associated with ingestion of Ulomoides dermestoides larvae ("Chinese beetles"). Annals of the American Thoracic Society, 11(10), 1667-8.
• Natt, B., & Arteaga, V. (2014). Medical image of the week: pneumatocele. Southwest Journal of Pulmonary and Critical Care, 9(2), 126-127. doi:10.13175/swjpcc102-14
• Natt, B., & Szerlip, H. M. (2014). The lost art of the history and physical. The American journal of the medical sciences, 348(5), 423-5.
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  The important contribution of the history and physical in making a correct medical diagnosis has been known for centuries. Despite this, these skills are being undermined by technology that many physicians mistakenly believe to be the new gold standard. The authors report 2 cases in which the history and physical trumped technology in making the correct diagnosis. Medical educators need to reemphasize the importance of the history and physical. This will require changes in curriculum and intense faculty development.
• Natt, B., Berry, C. E., Bime, C., & Gerald, J. K. (2014). Tucson critical care journal club: early goal-directed therapy. Southwest Journal of Pulmonary and Critical Care.
• Zaid, L., Natt, B., & Enakpene, E. (2014). Medical image of the week: paradoxical stroke. Southwest Journal of Pulmonary and Critical Care, 9(5), 278-280. doi:10.13175/swjpcc135-14
• Sandoval-gonzalez, J., Natt, B., Luraschi-monjagatta, C., Franco, R., Campion, J., & Arteaga, V. (2013). Medical image of the week: accessory cardiac bronchus. Southwest Journal of Pulmonary and Critical Care, 7(3), 193-193. doi:10.13175/swjpcc126-13

Presentations

• Bull, D. A., Lick, S. D., Hypes, C., Natt, B., Mosier, J. M., Malo, J., & Hsu, C. (2019, May/). Duration and Outcomes of Veno-Venous Extracorporeal Membrane Oxygenation Support in Acute Respiratory Distress Syndrome: Results from ELSO database. American association for thoracic surgery 99th annual meeting. Toronto: American association for thoracic surgery.

Poster Presentations

• Kazui, T., Bull, D. A., Hsu, C., Lick, S. D., Malo, J., Hypes, C., Mosier, J. M., Natt, B., Natt, B., Mosier, J. M., Hypes, C., Malo, J., Lick, S. D., Hsu, C., Bull, D. A., & Kazui, T. (2020, April). Interfacility transfer via a mobile intensive care unit following a double lumen catheter cannulation at the referring facility for veno-venous extracorporeal membrane oxygenation. THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION 2020 Scientific Program. Montreal, Canada: THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION.
• Kazui, T., Bull, D. A., Kazui, T., Bull, D. A., Hsu, C., Lick, S. D., Hsu, C., Lick, S. D., Malo, J., Hypes, C., Malo, J., Hypes, C., Mosier, J. M., Natt, B., Mosier, J. M., Natt, B., Natt, B., Mosier, J. M., Natt, B., , Mosier, J. M., et al. (2020, April). Interfacility transfer via a mobile intensive care unit following a double lumen catheter cannulation at the referring facility for veno-venous extracorporeal membrane oxygenation. THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION 2020 Scientific Program. Montreal, Canada: THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION.
• Natt, B. (2018, February). Right ventricular dysfunction in acute respiratory distress syndrome. SCCM. San Antonio, TX: SCCM.
• Hypes, C., Sakles, J. C., Mosier, J. M., Natt, B., Greenberg, J., Morrissette, K., & Cristan, E. (2017, Feb). Rethinking NIV: when it works, it works. When it doesn't, it really doesn't. Society of Critical Care Medicine Annual Congress. Honolulu, HI.: Society of Critical Care Medicine.
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  22. Greenberg J, Mosier J, Natt B, Morrissette K, Cristan C, Sakles J, Hypes C; Rethinking NIV: when it works, it works. When it doesn't, it really doesn't [Poster]; Society of Critical Care Medicine Annual Congress; February 2017; Honolulu, HI.
• Desai, H., Natt, B., & Bime, C. (2016, May/Spring). Decreased in-hospital mortality after lobectomy using video-assisted thoracoscopic surgery compared to open thoracotomy. ATS International Conference. San Francisco, CA.
• Hypes, C., Sakles, J. C., Nararro, T., Greenberg, J., Natt, B., Chopra, H., & Mosier, J. M. (2016, Sept). Failure to achieve first attempt success is associated with a higher odds of adverse events during intubation in the Intensive Care Unit using a video laryngoscope. Society for Airway Management. Atlanta.
• Nararro, T., Mosier, J. M., Sakles, J. C., Greenberg, J., Natt, B., Chopra, H., & Hypes, C. (2016, Sept). Predictors of complications of Intensive Care Unit airway management despite first attempt success using video laryngoscopy. Society for Airway Management.
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  This submission won the SAM travel award for Dr. Navarro to present it at the conference. I mentored Dr. Navarro in this activity.
• Natt, B., Malo, J., Hypes, C., Kazui, T., Basken, R., & Mosier, J. M. (2016, August). Outcomes of Patients with Severe Influenza Treated at the Banner-University Medical Center During the 2015-16 Influenza Season. Options IX for the Control of Influenza. Chicago.
• Natt, B., Malo, J., Hypes, C., Kazui, T., Basken, R., & Mosier, J. M. (2016, August/Summer). Outcomes of Patients with Severe Influenza Treated at the Banner-University Medical Center During the 2015-16 Influenza Season. Options IX for the Control of Influenza. Chicago, IL.
• Natt, B., Malo, J., Hypes, C., Kazui, T., Basken, R., & Mosier, J. M. (2016, Summer). Outcomes of Patients with Severe Influenza Treated at the Banner-University Medical Center During the 2015-16 Influenza Season. Options IX for the Control of Influenza. Chicago, IL.
• Natt, B., Rodriguez, ., Knox, K. S., & Carr, G. E. (2016, May/Spring). Concurrent Myasthenia Gravis and autoimmune featured interstitial lung disease: a case report. ATS International Conference. San Francisco, CA.
• Bull, D. A., Lick, S. D., Hypes, C., Natt, B., Mosier, J. M., Malo, J., Hsu, C., & Kazui, T. (2020, April). Interfacility transfer via a mobile intensive care unit following a double lumen catheter cannulation at the referring facility for veno-venous extracorporeal membrane oxygenation. THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION 2020 Scientific Program. Montreal, Canada: THE INTERNATIONAL SOCIETY FOR HEART AND LUNG TRANSPLANTATION.
• Crabbe, S., Malo, J., Natt, B., Kazui, T., Khalpey, Z. I., Roy-Chaudhury, A., Mosier, J. M., & Hypes, C. (2018, February). Duration of Mechanical Ventilation and Patient Outcomes for Extracorporeal Membrane Oxygenation. SCCM Annual Meeting 2018.
• Crabbe, S., Malo, J., Natt, B., Khalpey, Z. I., Kazui, T., Roy-Chaudhury, A., Mosier, J. M., & Hypes, C. (2018, February). EVALUATION OF THE RESP SCORE FOR SURVIVAL PREDICTION IN VENOVENOUS ECMO. SCCM Annual Meeting.
• Key, T., Natt, B., Pederson, K. R., Meinel, M. K., & Carr, G. E. (2015, May/Spring). Implementing an Inpatient Chain of Survival at an Academic Medical Center. American College of Physicians National Meeting. Washington, DC.
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  (National winner)
• Key, T., Natt, B., Pederson, K. R., Meinel, M. K., & Carr, G. E. (2015, November/Fall). Implementing an Inpatient Chain of Survival at an Academic Medical Center. American College of Physicians Arizona Meet. Tucson, AZ.
• Natt, B., Desai, H., Poongkunran, C., & Bime, C. (2015, October/Fall). Extracorporeal Membrane Oxygenator Use in ARDS. CHEST Annual Meeting. Montreal, Québec, Canada.
• Natt, B., Desai, H., Singh, N., Poongkunran, C., & Bime, C. (2015, October/Fall). ARDS Prevalence and Survival Trends in the United States; 2008-2012. CHEST Annual Meeting. Montreal, Québec, Canada.
• Natt, B., Malo, J., Snyder, L. S., Knepler, J. L., Knox, K. S., & Mosier, J. M. (2015, May/Spring). Advanced Airway Management in Critical Care Fellowship Training. ATS International Conference. Denver, CO.
• Natt, B., Mosier, J. M., Lutrick, K., Hypes, C., Malo, J., Kazui, T., & Cairns, C. B. (2017, Spring). Demographics of severe influenza during the 2016 season: A tertiary care hospital experience. SCCM Annual Congress. Honolulu, HI.
• Singh, N., Natt, B., Ainapurapu, B. B., & Trowers, E. A. (2015, November/Fall). Hereditary Spherocytosis Leading to Pulmonary Hypertension. American College of Physicians Arizona Meet. Tucson, AZ.

Case Studies

• Campion, J. M., & Natt, B. (2017. ICU CXR(p. 1).
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  Image of the week