Joshua Malo

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Scholarly Contributions

Chapters

• Mosier, J., & Malo, J. (2023). Extracorporeal Membrane Oxygenation: Indications and Use. In Mechanical Circulatory Support. doi:10.1007/978-3-030-86172-8_2-1
• Malo, J., Knox, K. S., & Fass, R. (2013). Dysphagia, GER, and Aspiration in the Elderly. In Gastroesophageal reflux and the lung(pp 71-94). New York: Springer.
• Malo, J., Knox, K. S., & Fass, R. (2012).

  Dysphagia, GER, and Aspiration in the Elderly

  . In Ger and the Lung. Springer New York. doi:10.1007/978-1-4614-5502-8_5
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  Within the United States, where it is estimated that >20 % of the population will be over the age of 65 by 2050 [1], a greater understanding of the impact of disorders affecting older adults is paramount. Due to physiologic changes of aging, an increased prevalence of comorbid conditions, and abundance of medication usage, the elderly comprise a distinct segment of the population at increased risk for upper gastrointestinal (GI) disorders. Furthermore, the risk for lung disease, either directly or indirectly related to impaired swallowing or GI function, is high among older adults. The elderly manifest distinct presentations of certain GI disorders when compared to younger adults. Additionally, as people age, alterations in normal lung physiology place them at risk for pulmonary complications of GI disorders.

Journals/Publications

• Scott, A., Lim, J., Randhawa, R., Lee, J., Yaddanapudi, K., Rabe, B., & Malo, J. (2024). Examining Miliary Disease Etiology in a Coccidioides-Endemic Center: A Retrospective Cohort Study. Journal of Fungi, 10(1). doi:10.3390/jof10010029
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  Background: A miliary pattern on chest imaging is often attributed to tuberculosis (TB) infection. However, a myriad of conditions can cause a miliary pattern, many of which are imminently life-threatening. Research Question: The primary aim of our study is to elucidate the potential causes of miliary chest imaging patterns to improve workup and empiric therapy selection. The secondary aims are to discern the predictors of miliary disease etiology and to determine whether appropriate empiric antimicrobial therapies were given. Study Design and Methods: In this retrospective cohort study, we searched a radiology database for patients with chest imaging studies described by the word “miliary”. Subjects were excluded if they were under 18 years of age and if there were insufficient objective data to support a miliary disease etiology. A radiologist independently reviewed all imaging studies, and studies that did not appear to have a true miliary pattern were excluded. The collected data include patient demographics, immunocompromising risk factors, conditions associated with miliary disease, β-D-glucan levels, serum eosinophil count, and empiric therapies received. Results: From our 41-patient cohort, 22 patients (53.7%) were clinically diagnosed with coccidioidomycosis, 8 (19.5%) with TB, 7 (17.1%) with metastatic solid cancer, 1 (2.4%) with lymphoma, 1 (2.4%) with other (Mycobacterium simiae), and 3 (7.3%) with unknown diseases (the sum equals 42 patients because one individual was diagnosed with both coccidioidomycosis and TB). All six patients with greater than 500 eosinophils/μL were diagnosed with coccidioidomycosis. Of the 22 patients diagnosed with coccidioidomycosis, 20 (90.91%) were empirically treated with an antifungal regimen. Of the eight patients with TB, six were empirically treated for TB. Interpretation: Based on our data from a Coccidioides-endemic region with close proximity to tuberculosis-endemic areas, the leading cause of miliary disease is coccidioidomycosis, although TB and cancer are also common etiologies. Serum eosinophilia and elevated β-D-glucan levels were strongly predictive of coccidioidomycosis in our patient cohort with a miliary chest imaging pattern.
• 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.
• Scott, A. M., Lim, J. R., Randhawa, R., Lee, J., Yaddanapudi, K., Rabe, B., & Malo, J. (2023). Examining Miliary Disease Etiology in a -Endemic Center: A Retrospective Cohort Study. Journal of fungi (Basel, Switzerland), 10(1).
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  A miliary pattern on chest imaging is often attributed to tuberculosis (TB) infection. However, a myriad of conditions can cause a miliary pattern, many of which are imminently life-threatening. The primary aim of our study is to elucidate the potential causes of miliary chest imaging patterns to improve workup and empiric therapy selection. The secondary aims are to discern the predictors of miliary disease etiology and to determine whether appropriate empiric antimicrobial therapies were given. In this retrospective cohort study, we searched a radiology database for patients with chest imaging studies described by the word "miliary". Subjects were excluded if they were under 18 years of age and if there were insufficient objective data to support a miliary disease etiology. A radiologist independently reviewed all imaging studies, and studies that did not appear to have a true miliary pattern were excluded. The collected data include patient demographics, immunocompromising risk factors, conditions associated with miliary disease, β-D-glucan levels, serum eosinophil count, and empiric therapies received. From our 41-patient cohort, 22 patients (53.7%) were clinically diagnosed with coccidioidomycosis, 8 (19.5%) with TB, 7 (17.1%) with metastatic solid cancer, 1 (2.4%) with lymphoma, 1 (2.4%) with other (), and 3 (7.3%) with unknown diseases (the sum equals 42 patients because one individual was diagnosed with both coccidioidomycosis and TB). All six patients with greater than 500 eosinophils/μL were diagnosed with coccidioidomycosis. Of the 22 patients diagnosed with coccidioidomycosis, 20 (90.91%) were empirically treated with an antifungal regimen. Of the eight patients with TB, six were empirically treated for TB. Based on our data from a -endemic region with close proximity to tuberculosis-endemic areas, the leading cause of miliary disease is coccidioidomycosis, although TB and cancer are also common etiologies. Serum eosinophilia and elevated β-D-glucan levels were strongly predictive of coccidioidomycosis in our patient cohort with a miliary chest imaging pattern.
• 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.
• Knox, K. S., Natt, B., Malo, J., & Chaudhary, S. (2022). Prophylaxis in Lung Transplant Recipients. Clinical Infectious Diseases, 76(2), 368-369. doi:10.1093/cid/ciac706
• Scott, A., Lim, J., Randhawa, R., Yaddanapudi, K., & Malo, J. (2022). Retrospective Determination of Miliary Disease Etiology in a Coccidioides-Endemic Center. American Journal of Respiratory and Critical Care Medicine. doi:10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4541
• Yang, C. X., Tomchaney, M., Landecho, M. F., Zamacona, B. R., Marin Oto, M., Zulueta, J., Malo, J., Knoper, S., Contoli, M., Papi, A., Vasilescu, D. M., Sauler, M., Straub, C., Tan, C., Martinez, F. D., Bhattacharya, D., Rosas, I. O., Kheradmand, F., Hackett, T. L., & Polverino, F. (2022). Lung Spatial Profiling Reveals a T Cell Signature in COPD Patients with Fatal SARS-CoV-2 Infection. Cells, 11(12).
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  People with pre-existing lung diseases such as chronic obstructive pulmonary disease (COPD) are more likely to get very sick from SARS-CoV-2 disease 2019 (COVID-19). Still, an interrogation of the immune response to COVID-19 infection, spatially throughout the lung structure, is lacking in patients with COPD. For this study, we characterized the immune microenvironment of the lung parenchyma, airways, and vessels of never- and ever-smokers with or without COPD, all of whom died of COVID-19, using spatial transcriptomic and proteomic profiling. The parenchyma, airways, and vessels of COPD patients, compared to control lungs had (1) significant enrichment for lung-resident CD45RO memory CD4 T cells; (2) downregulation of genes associated with T cell antigen priming and memory T cell differentiation; and (3) higher expression of proteins associated with SARS-CoV-2 entry and primary receptor ubiquitously across the ROIs and in particular the lung parenchyma, despite similar SARS-CoV-2 structural gene expression levels. In conclusion, the lung parenchyma, airways, and vessels of COPD patients have increased T-lymphocytes with a blunted memory CD4 T cell response and a more invasive SARS-CoV-2 infection pattern and may underlie the higher death toll observed with COVID-19.
• Cosgrove, R. H., Basken, R., Finger, J., Smith, R. G., Malo, J., Fox, K. A., Kazui, T., Derby, C. D., Meyer, R. J., & Mosier, J. (2021). Mitigating Bleeding Risk in COVID-19 Infected Patients Undergoing Extracorporeal Membranous Oxygenator Support. A Focus on Fibrinogen. ASAIO Journal.
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  Study: Different fibrinogen management approaches for COVID-19 patients on extracorporeal membranous oxygenation (ECMO) support are compared in two patients. Observations of measured levels and blood transfusion requirements are reported. Methods: Case #1. A 25-year-old obese, asthmatic male progressed to septic shock requiring two courses of ECMO support. The fibrinogen replacement threshold for this patient was 100 mg/dL. The patient's fibrinogen level prior to ECMO cannulation was 808 mg/dL, and fell to a low of 184 mg/dL by Day 7 of the first ECMO course. The patient's anticoagulation regimen consisted of heparin infusion at an average rate of 17 units/kg/hr for a goal anti Xa level of 0.15-0.3 IU/mL until he developed a large chest wall hematoma requiring multiple packed red blood cell (pRBC) l transfusions. The patient was eventually extubated and discharged. Case #2. A 25-year-old post-partum female also developed septic shock requiring ECMO support. This patient's fibrinogen replacement threshold was set at 250 mg/dL initially. Anticoagulation was initiated with heparin infusion then was changed to bivalirudin with an average rate of 0.2 mg/kg/hr and an aPTT goal range of 60-80 seconds. This patient received multiple transfusions of cryoprecipitate. As concern for fibrin accumulation in the patient's oxygenator prompted a circuit replacement, the fibrinogen threshold was reset to 100mg/dL. She then experienced moderate oral bleeding. Her highest fibrinogen level was 840 mg/dL prior to cannulation, falling to 85 mg/dL after threshold/circuit change. She was able to be discharged with respiratory support. Results: Fibrinogen level management led to the following blood product utilization. Patient #1 received 14 units of pRBC's and was noted to have had both an internal jugular vein thrombus and pulmonary embolism during his 13 days of ECMO. Patient #2 received 12 units of cryoprecipitate and 3 units of pRBC's through her 20-day ECMO course.
• 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
• Qadir, N., Bartz, R. R., Cooter, M., Hough, C. L., Lanspa, M. J., Banner‐Goodspeed, V., Chen, J., Giovanni, S. P., Gomaa, D., Sjoding, M. W., Hajizadeh, N., Duggal, A., Khanna, A. K., Kashyap, R., Khan, A., Chang, S. Y., Tonna, J. E., Anderson, H. L., Liebler, J. M., , Mosier, J., et al. (2021). Variation in Early Management Practices in Moderate-to-Severe ARDS in the United States. CHEST. doi:10.1016/j.chest.2021.05.047
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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.What is the impact of treatment variability on mortality in patients with moderate to severe ARDS in the United States?We conducted a multicenter, observational cohort study of mechanically ventilated adults with ARDS and Pao2 to Fio2 ratio of ≤ 150 with positive end-expiratory pressure of ≥ 5 cm H2O, who were admitted to 29 US centers between October 1, 2016, and April 30, 2017. The primary outcome was 28-day in-hospital mortality. Center variation in ventilator management, adjunctive therapy use, and mortality also were assessed.A total of 2,466 patients were enrolled. Median baseline Pao2 to Fio2 ratio was 105 (interquartile range, 78.0-129.0). In-hospital 28-day mortality was 40.7%. Initial adherence to lung protective ventilation (LPV; tidal volume, ≤ 6.5 mL/kg predicted body weight; plateau pressure, or when unavailable, peak inspiratory pressure, ≤ 30 mm H2O) was 31.4% and varied between centers (0%-65%), as did rates of adjunctive therapy use (27.1%-96.4%), methods used (neuromuscular blockade, prone positioning, systemic steroids, pulmonary vasodilators, and extracorporeal support), and mortality (16.7%-73.3%). Center standardized mortality ratios (SMRs), calculated using baseline patient-level characteristics to derive expected mortality rate, ranged from 0.33 to 1.98. Of the treatment-level factors explored, only center adherence to early LPV was correlated with SMR.Substantial center-to-center variability exists in ARDS management, suggesting that further opportunities for improving ARDS outcomes exist. Early adherence to LPV was associated with lower center mortality and may be a surrogate for overall quality of care processes. Future collaboration is needed to identify additional treatment-level factors influencing center-level outcomes.ClinicalTrials.gov; No.: NCT03021824; URL: www.clinicaltrials.gov.
• Qadir, N., Bartz, R., Cooter, M., Hough, C., Lanspa, M., Banner-Goodspeed, V., Chen, J., Giovanni, S., Gomaa, D., Sjoding, M., Hajizadeh, N., Komisarow, J., Duggal, A., Khanna, A., Kashyap, R., Khan, A., Chang, S., Tonna, J., Anderson, H., , Liebler, J., 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). doi:10.1016/j.chest.2021.05.047
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  Background: 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. Research Question: What is the impact of treatment variability on mortality in patients with moderate to severe ARDS in the United States? Study Design and Methods: We conducted a multicenter, observational cohort study of mechanically ventilated adults with ARDS and PaO2 to FIO2 ratio of ≤ 150 with positive end-expiratory pressure of ≥ 5 cm H2O, who were admitted to 29 US centers between October 1, 2016, and April 30, 2017. The primary outcome was 28-day in-hospital mortality. Center variation in ventilator management, adjunctive therapy use, and mortality also were assessed. Results: A total of 2,466 patients were enrolled. Median baseline PaO2 to FIO2 ratio was 105 (interquartile range, 78.0-129.0). In-hospital 28-day mortality was 40.7%. Initial adherence to lung protective ventilation (LPV; tidal volume, ≤ 6.5 mL/kg predicted body weight; plateau pressure, or when unavailable, peak inspiratory pressure, ≤ 30 mm H2O) was 31.4% and varied between centers (0%-65%), as did rates of adjunctive therapy use (27.1%-96.4%), methods used (neuromuscular blockade, prone positioning, systemic steroids, pulmonary vasodilators, and extracorporeal support), and mortality (16.7%-73.3%). Center standardized mortality ratios (SMRs), calculated using baseline patient-level characteristics to derive expected mortality rate, ranged from 0.33 to 1.98. Of the treatment-level factors explored, only center adherence to early LPV was correlated with SMR. Interpretation: Substantial center-to-center variability exists in ARDS management, suggesting that further opportunities for improving ARDS outcomes exist. Early adherence to LPV was associated with lower center mortality and may be a surrogate for overall quality of care processes. Future collaboration is needed to identify additional treatment-level factors influencing center-level outcomes. Trial Registry: ClinicalTrials.gov; No.: NCT03021824; URL: www.clinicaltrials.gov
• Tomchaney, M., Contoli, M., Mayo, J., Baraldo, S., Li, S., Cabel, C. R., Bull, D. A., Lick, S. D., Malo, J., Knoper, S., Kim, S. S., Tram, J., Rojas-Quintero, J., Kraft, M., Ledford, J., Tesfaigzi, Y., Martinez, F., Thorne, C. A., Kheradmand, F., , Campos, S. K., et al. (2021). Paradoxical effects of cigarette smoke and COPD on SARS-CoV-2 infection and disease. BMC Pulmonary Medicine.
• Azar, M. M., Malo, J., & Hage, C. A. (2020). Endemic Fungi Presenting as Community-Acquired Pneumonia: A Review. Seminars in respiratory and critical care medicine, 41(4), 522-537.
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  In endemic areas, dimorphic fungal infections due to , and account for up to 30% of cases of community-acquired pneumonia. Because respiratory manifestations are often indistinguishable from common bacterial causes of pneumonia, the diagnosis of pulmonary histoplasmosis, blastomycosis, and coccidioidomycosis is often delayed and associated with antibiotics overuse. In addition to being highly endemic to certain regions of North America, dimorphic fungi have global significance due to established areas of endemicity in all six inhabited continents, an increasingly interconnected world of travelers and transported goods, and a changing epidemiology as a result of global heating and anthropomorphic land utilization. In this review, we discuss the epidemiology, pathogenesis, clinical presentation, diagnostic modalities, and treatment strategies for histoplasmosis, blastomycosis, and coccidioidomycosis.
• 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.
• Malo, J., Chand, A., & Bergin, E. (2020). PLEURAL SPINDLE CELL NEOPLASM IN A PATIENT WITH NEUROFIBROMATOSIS TYPE I. Chest, 158(4), A1243. doi:10.1016/j.chest.2020.08.1132
• Malo, J., Chand, A., & Bergin, E. (2020). PLEURAL SPINDLE CELL NEOPLASM IN A PATIENT WITH NEUROFIBROMATOSIS TYPE I. Chest, 158(4). doi:10.1016/j.chest.2020.08.1132
• Malo, J., Holbrook, E., Zangeneh, T., Strawter, C., Oren, E., Robey, I., Erickson, H., Carranza-Chahal, R., Durkin, M., Thompson, C., Hoover, S. E., Ampel, N. M., Wheat, L. J., & Knox, K. S. (2020). Comparison of three anti-coccidioides antibody enzyme immunoassay kits for the diagnosis of coccidioidomycosis. Medical mycology, 58(6), 774-778.
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  Coccidioidomycosis is a common cause of community-acquired pneumonia in endemic areas of the southwestern United States. Clinical presentations range from self-limited disease to severe, disseminated disease. As such, early and accurate diagnosis is essential to ensure appropriate treatment and monitoring. Currently available diagnostic testing has variable accuracy, particularly in certain patient populations, and new tests may offer improved accuracy for the diagnosis of coccidioidomycosis. Serum samples from patients with coccidioidomycosis and controls were tested for immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies using the MVista Coccidioides antibody detection EIA and two commonly used commercial enzyme immunoassay (EIA) kits: the IMMY Omega EIA and the Meridian Premier EIA. The sensitivity of the IgG antibody detection was 87.4% using the MVista test compared to 46.6% for IMMY and 70.9% for Meridian. The sensitivity for IgM antibody detection was 61.2% for the MVista test, 22.3% for IMMY and 29.1% for Meridian. For IgG antibody detection, specificity was 90% for the MVista EIA, 94.6% for IMMY, 96.4% for Meridian. For IgM antibody detection, specificity was 95.3% for the MVista test 98.2% for IMMY and 99.1% for Meridian. The MVista Coccidioides antibody EIA offers improved sensitivity, including among high-risk patient populations, for the detection of IgG and IgM antibodies in comparison to other currently available EIAs.
• Basken, R., Cosgrove, R., Malo, J., Romero, A., Patanwala, A., Finger, J., Kazui, T., Khalpey, Z., & Mosier, J. (2019). Predictors of Oxygenator Exchange in Patients Receiving Extracorporeal Membrane Oxygenation. The journal of extra-corporeal technology, 51(2), 61-66.
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  Thrombosis within the membrane oxygenator (MO) during extracorporeal membrane oxygenation (ECMO) can lead to sudden oxygenator dysfunction with deleterious effects to the patient. The purpose of this study was to identify predictors of circuit exchange during ECMO. This is a single-center, retrospective study of all patients who received ECMO at our institution from January 2010 to December 2015. Changes in potential markers were compared on Day 3 vs. Day 0 before MO exchange. Of the 150 patients who received ECMO, there were 58 MO exchanges in 35 patients. Mean ECMO duration was 21.1 (±12.7) days. D-dimer (DD) (μg/mL) (mean difference -2.6; 95% confidence interval [CI]: -4.2 to -1.1; = .001) increased significantly in the 3 days leading up to MO exchange, whereas fibrinogen (mg/dL) (mean difference 90.7; 95% CI: 41.8-139.6; = .001), platelet (PLT) count (1,000/μL) (mean difference 23.3; 95% CI: 10.2-36.4; = .001), and heparin dose (units/h) (mean difference 261.7; 95% CI: 46.3-477.1; = .02) decreased. Increasing DD or decreasing fibrinogen, PLT count, or heparin dose may indicate an impending need for MO exchange in patients receiving ECMO. Early identification of these changes may help prevent sudden MO dysfunction.
• Insel, M., Natt, B., Mosier, J., Malo, J., & Bime, C. (2019). The Association of Non-Cardiac ECMO With Influenza Incidence: A Time Series Analysis. Respiratory care, 64(3), 279-284.
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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.
• Yu, J. J., Holbrook, E., Liao, Y. R., Zarnowski, R., Andes, D. R., Wheat, L. J., Malo, J., & Hung, C. Y. (2019). Characterization of an Uncinocarpus reesii-expressed recombinant tube precipitin antigen of Coccidioides posadasii for serodiagnosis. PloS one, 14(8), e0221228.
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  Early and accurate diagnosis of coccidioidomycosis, also known as Valley fever, is critical for appropriate disease treatment and management. Current serodiagnosis is based on the detection of patient serum antibodies that react with tube precipitin (TP) and complement fixation (CF) antigens of Coccidioides. IgM is the first class of antibodies produced by hosts in response to coccidioidal insults. The highly glycosylated β-glucosidase 2 (BGL2) is a major active component of the TP antigen that stimulates IgM antibody responses during early Coccidioides infection. The predominant IgM epitope on BGL2 is a unique 3-O-methyl-mannose moiety that is not produced by commonly used protein expression systems. We genetically engineered and expressed a recombinant BGL2 (rBGL2ur), derived from Coccidioides, in non-pathogenic Uncinocarpus reesii, a fungus phylogenetically related to the Coccidioides pathogen. The rBGL2ur protein was purified from the culture medium of transformed U. reesii by nickel affinity chromatography, and the presence of 3-O-methyl mannose was demonstrated by gas chromatography. Seroreactivity of the purified rBGL2ur protein was tested by enzyme-linked immunosorbent assays using sera from 90 patients with coccidioidomycosis and 134 control individuals. The sensitivity and specificity of the assay with rBGL2ur were 78.8% and 87.3%, respectively. These results were comparable to those obtained using a proprietary MiraVista Diagnostic (MVD) IgM (63.3% sensitivity; 96.3% specificity), but significantly better than the ID-TP assay using non-concentrated patient sera (33.3% sensitivity; 100% specificity). Expression of rBGL2ur in U. reesii retains its antigenicity for coccidioidomycosis serodiagnosis and greatly reduces biosafety concerns for antigen production, as Coccidioides spp. are biological safety level 3 agents.
• Insel, M., Natt, B., Mosier, J. M., Malo, J., & Bime, C. (2018). The Association of Non-Cardiac ECMO With Influenza Incidence: A Time Series Analysis.. Respiratory Care.
• Malo, J. (2018). Airway registry and training curriculum improve intubation outcomes in the intensive care unit. Southwest Journal of Pulmonary and Critical Care, 4, 212-223. doi:10.13175/swjpcc03718 PDF
• Malo, J. (2018). Peripheral VA-ECMO with direct biventricular decompression for refractory cardiogenic shock. Perfusion, 6, 493-495. doi:10.1177/0267659118761558
• Malo, J., Natt, B., Kazui, T., Hypes, C., Natt, B., Mosier, J., Khalpey, Z., Kazui, T., Hypes, C., Crabbe, S., & Chaudhury, A. R. (2018). 1061: DURATION OF MECHANICAL VENTILATION AND PATIENT OUTCOMES FOR EXTRACORPOREAL MEMBRANE OXYGENATION. Critical Care Medicine, 46(1), 514-514. doi:10.1097/01.ccm.0000529067.98515.04
• Malo, J., Natt, B., Kazui, T., Natt, B., Mosier, J., Khalpey, Z., Kazui, T., Hypes, C., Crabbe, S., & Chaudhury, A. R. (2018). 1097: EVALUATION OF THE RESP SCORE FOR SURVIVAL PREDICTION IN VENOVENOUS ECMO. Critical Care Medicine, 46(1), 532-532. doi:10.1097/01.ccm.0000529102.89106.1e
• Rao, P., Mosier, J., Malo, J., Dotson, V., Mogan, C., Smith, R., Keller, R., Slepian, M., & Khalpey, Z. (2018). Peripheral VA-ECMO with direct biventricular decompression for refractory cardiogenic shock. Perfusion, 33(6), 493-495.
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  Cardiogenic shock and cardiac arrest are life-threatening emergencies that result in high mortality rates. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) via peripheral cannulation is an option for patients who do not respond to conventional therapies. Left ventricular (LV) distention is a major limitation with peripheral VA-ECMO and is thought to contribute to poor recovery and the inability to wean off VA-ECMO. We report on a novel technique that combines peripheral VA-ECMO with off-pump insertion of a trans-apical LV venting cannula and a right ventricular decompression cannula.
• Donovan, F. M., Zangeneh, T. T., Malo, J., & Galgiani, J. N. (2017). Top Questions in the Diagnosis and Treatment of Coccidioidomycosis. Open forum infectious diseases, 4(4), ofx197.
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  Revised and greatly expanded treatment guidelines for coccidioidomycosis were published last year by the Infectious Diseases Society of America. We have selected 4 questions that commonly arise in the management of patients suspected of this disease and for which there remain divided opinions.
• Donovan, F., Malo, J., Zangeneh, T. T., & Galgiani, J. N. (2017). Top Questions in Diagnosis and Treatment of Coccidioidomycosis. Open Forum Infectious Diseases.
• Gabe, L. M., Malo, J., & Knox, K. S. (2017). Diagnosis and Management of Coccidioidomycosis. Clinics in chest medicine, 38(3), 417-433.
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  Coccidioidomycosis is a leading cause of community-acquired pneumonia within its traditional endemic zone in the Southwestern United States and portions of Mexico and Central and South America. Its incidence has increased dramatically within the endemic region; its presence outside of the region, facilitated by a mobile society, is also now substantial. Although only a fraction of the incident disease progresses beyond subclinical illness, this proportion is large in absolute terms and causes substantial disease burden. Diagnosis often depends on serologic interpretation. Treatment has been revolutionized by azole therapy. Controversy remains regarding the decision to treat in less severe disease.
• Hypes, C., Natt, B., Malo, J., Bloom, J. W., Sakles, J. C., Natt, B., Mosier, J., Joshi, R., Hypes, C., Greenberg, J., Chopra, H., & Bloom, J. W. (2017). Failure to achieve first attempt success at intubation using video laryngoscopy is associated with increased complications.. Internal and emergency medicine, 12(8), 1235-1243. doi:10.1007/s11739-016-1549-9
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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 < 0.001) of those requiring more than one attempt. Logistic regression analysis shows that >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.
• Joshi, R., Hypes, C. D., Greenberg, J., Snyder, L., Malo, J., Bloom, J. W., Chopra, H., Sakles, J. C., & Mosier, J. M. (2017). Difficult Airway Characteristics Associated with First-Attempt Failure at Intubation Using Video Laryngoscopy in the Intensive Care Unit. Annals of the American Thoracic Society, 14(3), 368-375.
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  Video laryngoscopy has overcome the need to align the anatomic axes to obtain a view of the glottic opening to place a tracheal tube. However, despite this advantage, a large number of attempts are unsuccessful. There are no existing data on anatomic characteristics in critically ill patients associated with a failed first attempt at laryngoscopy when using video laryngoscopy.
• Malo, J., & Dalabih, M. (2017). Medical image of the week: lymphangitic cacinomatosis. Southwest Journal of Pulmonary and Critical Care, 14(5), 240-240. doi:10.13175/swjpcc053-17
• Malo, J., Holbrook, E., Zangeneh, T. T., Strawter, C., Oren, E., Robey, I., Erickson, H., Chahal, R., Durkin, M., Thompson, C., Hoover, S. E., Ampel, N., Wheat, L. J., & Knox, K. S. (2017). Enhanced Antibody Detection and Diagnosis of Coccidioidomycosis with the MiraVista IgG and IgM Detection Enzyme. Journal of Clinical Microbiology, 55, 1-9.
• Malo, J., Holbrook, E., Zangeneh, T., Strawter, C., Oren, E., Robey, I., Erickson, H., Chahal, R., Durkin, M., Thompson, C., Hoover, S. E., Ampel, N. M., Wheat, L. J., & Knox, K. S. (2017). Enhanced Antibody Detection and Diagnosis of Coccidioidomycosis with the MiraVista IgG and IgM Detection Enzyme Immunoassay. Journal of clinical microbiology, 55(3), 893-901.
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  Coccidioidomycosis is a common cause of community-acquired pneumonia in areas of the southwestern United States in which the disease is endemic. Clinical presentations range from self-limited disease to severe disseminated disease. Therefore, early and accurate diagnosis is essential to ensure appropriate treatment and monitoring. Currently available diagnostic tests have variable accuracy, particularly in certain patient populations, and new tests may offer improved accuracy for the diagnosis of coccidioidomycosis. Serum samples from 103 cases of coccidioidomycosis and 373 controls were tested for IgG and IgM antibodies using the MVista anti- antibody enzyme immunoassay. Serum specimens from 170 controls from areas in which the disease is endemic and 44 cases were tested by immunodiffusion at MiraVista Diagnostics. The sensitivity of the MVista antibody assay was 88.3%, and the specificity was 90%. The sensitivity was maintained in the presence of immunocompromising conditions or immunosuppressive therapies. The sensitivity of immunodiffusion was 60.2%, and the specificity was 98.8%. The sensitivity of complement fixation (62 cases) was 66.1%, but the specificity could not be determined. The MVista anti- antibody enzyme immunoassay offers improved sensitivity, compared with immunodiffusion and complement fixation, is not impaired in immunocompromised patients, and permits highly reproducible semiquantification.
• Malo, J., Smith, R. A., Skaria, R., Rao, P., Mosier, J., Malo, J., & Khalpey, Z. (2017). Abstract 18701: Temporary Mechanical Circulatory Support Using a Novel Minimally-Invasive Approach for Central VA-ECMO. Circulation.
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  Introduction: Early mechanical circulatory support may be beneficial in patients with refractory cardiogenic shock and circulatory collapse. Peripheral (p)VA-ECMO is increasingly considered because...
• 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., 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.
• Cristan, E., Hypes, C., Malo, J., Sakles, J. C., Mosier, J., Morrissette, K., Milligan, R., Hypes, C., & Greenberg, J. (2016). 1196: IMPROVEMENT IN TRACHEAL INTUBATION OVER TIME WITH THE INSTITUTION OF A QUALITY IMPROVEMENT PROGRAM. Critical Care Medicine, 44(12), 374-374. doi:10.1097/01.ccm.0000509870.14343.44
• Doraiswamy, V. A., Parbtani, R., Malo, J., Jaffer, F., Doraiswamy, V. A., Anand, S., & Ajay-obe, A. (2016). Use of Amiodarone in Management of Atrial Tachyarrhythmia in Septic Shock. Chest, 150(4), 361A. doi:10.1016/j.chest.2016.08.374
• Hypes, C. D., Stolz, U., Natt, B., Malo, J., Malo, J., Sakles, J. C., Natt, B., Mosier, J. M., Joshi, R. R., Hypes, C. D., & Bloom, J. W. (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. doi:10.1513/annalsats.201508-505oc
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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..To compare first-attempt success and complication rates during intubation when using video laryngoscopy compared with traditional direct laryngoscopy in a tertiary academic medical intensive care unit..We prospectively collected and analyzed data from a continuous quality improvement database of all intubations in one medical intensive care unit between January 1, 2012, and December 31, 2014. Propensity matching and multivariable logistic regression were used to reduce the risk of bias and control for confounding..A total of 809 intubations took place over the study period. Of these, 673 (83.2%) were performed using video laryngoscopy and 136 (16.8%) using direct laryngoscopy. First-attempt success with video laryngoscopy was 80.4% (95% confidence interval [CI], 77.2-83.3%) compared with 65.4% (95% CI, 56.8-73.4%) for intubations performed with direct laryngoscopy (P 
• 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.
• Lutrick, K., Hypes, C., Malo, J., Kazui, T., Cairns, C. B., Natt, B., Mosier, J., Lutrick, K., Kazui, T., Hypes, C., & Cairns, C. B. (2016). 993: DEMOGRAPHICS OF SEVERE INFLUENZA DURING THE 2016 SEASON: A TERTIARY CARE HOSPITAL EXPERIENCE.. Critical Care Medicine, 44(12), 324-324. doi:10.1097/01.ccm.0000509669.58415.c6
• Malo, J., Cristan, E., Hypes, C., Sakles, J. C., Mosier, J., Morrissette, K., Milligan, R., Hypes, C., & Greenberg, J. (2016). 293: REINTUBATION IN THE INTENSIVE CARE UNIT: IS IT TRULY AS DIFFICULT AS ASSUMED?. Critical Care Medicine, 44(12), 150-150. doi:10.1097/01.ccm.0000508973.82680.f5
• Natt, B., Malo, J., Hypes, C., Sakles, J. C., & Mosier, J. M. (2016). Strategies to improve first attempt success at intubation in critically ill patients.. British Journal of Anaesthesia, 117, i60-i68.
• Oren, E., Zangeneh, T. T., Wheat, L. J., Thompson, C., Strawter, C., Robey, I. F., Oren, E., Malo, J., Knox, K. S., Hoover, S. E., Holbrook, E. D., Erickson, H., Durkin, M., Chahal, R., & Ampel, N. M. (2016). Development of an Improved Antibody Detection EIA for Use in Diagnosis of Coccidioidomycosis.. Open Forum Infectious Diseases, 3(suppl_1). doi:10.1093/ofid/ofw172.1254
• Hypes, C. D., Stolz, U., Sakles, J. C., Joshi, R. R., Natt, B., Malo, J., Bloom, J. W., & Mosier, J. M. (2015). Video Laryngoscopy Improves Odds of First Attempt Success at Intubation in the ICU: A Propensity-Matched Analysis. Annals of the American Thoracic Society.
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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., Malo, J., Malo, J., Bloom, J. W., Sakles, J. C., Mosier, J., Joshi, R., Hypes, C., & Bloom, J. W. (2015). 686: PREDICTORS OF DIFFICULT INTUBATION WHEN USING VIDEO LARYNGOSCOPY IN THE ICU. Critical Care Medicine, 43, 173. doi:10.1097/01.ccm.0000474514.77013.0b
• Hypes, C., Malo, J., Malo, J., Sakles, J. C., Mosier, J., Kelsey, M., Joshi, R., Hypes, C., & Bloom, J. W. (2015). 672: DERIVATION OF A BUNDLE TO IMPROVE FIRST ATTEMPT SUCCESS AT INTUBATION IN THE ICU. Critical Care Medicine, 43, 169-170. doi:10.1097/01.ccm.0000474500.14239.49
• Knox, K. S., Zangeneh, T. T., Wheat, L. J., Thompson, C., Strawter, C., Robey, I. F., Oren, E., Malo, J., Knox, K. S., Holbrook, E. D., Erickson, H., Chahal, R., & Ampel, N. M. (2015). Development of an Improved Antibody Detection Enzyme Immunoassay for Use in Detection of Coccidioidomycosis. Open Forum Infectious Diseases, 2(suppl_1). doi:10.1093/ofid/ofv133.128
• Malo, J., Hypes, C., Malo, J., Sakles, J. C., Mosier, J., Joshi, R., Hypes, C., Greenberg, J., & Bloom, J. W. (2015). 174: FIRST ATTEMPT SUCCESS AT INTUBATION IS ASSOCIATED WITH A LOWER ODDS OF ADVERSE EVENTS IN THE ICU.. Critical Care Medicine, 43, 45. doi:10.1097/01.ccm.0000474002.97878.d0
• Malo, J., Malo, J., Sakles, J. C., Mosier, J., Joshi, R., Johnston, D., Hypes, C., & Bloom, J. W. (2015). 154: Reason for Failed Attempts at Laryngoscopy Differs Between Video and Direct Laryngoscopes. Critical Care Medicine, 43, 40. doi:10.1097/01.ccm.0000473982.21643.4b
• Mosier, J. M., Kelsey, M., Raz, Y., Gunnerson, K. J., Meyer, R., Hypes, C. D., Malo, J., Whitmore, S. P., & Spaite, D. W. (2015). Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions. Critical care (London, England), 19, 431.
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  Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that augments oxygenation, ventilation and/or cardiac output via cannulae connected to a circuit that pumps blood through an oxygenator and back into the patient. ECMO has been used for decades to support cardiopulmonary disease refractory to conventional therapy. While not robust, there are promising data for the use of ECMO in acute hypoxemic respiratory failure, cardiac arrest, and cardiogenic shock and the potential indications for ECMO continue to increase. This review discusses the existing literature on the potential use of ECMO in critically ill patients within the emergency department.
• 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., Sakles, J. C., Stolz, U., Hypes, C. D., Chopra, H., Malo, J., & Bloom, J. W. (2015). Neuromuscular blockade improves first-attempt success for intubation in the intensive care unit. A propensity matched analysis. Annals of the American Thoracic Society, 12(5), 734-41.
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  The use of neuromuscular blocking agents (NMBAs) has been shown to be valuable in improving successful tracheal intubation in the operating room and emergency department. However, data on NMBA use in critically ill intensive care unit (ICU) patients are lacking. Furthermore, there are no data on NMBA use with video laryngoscopy.
• Nahapetian, R., & Malo, J. (2015). Medical image of the week: palmar erythema multiforme. Southwest Journal of Pulmonary and Critical Care. doi:10.13175/swjpcc102-15
• Zangeneh, T. T., Malo, J., Luraschi-Monjagatta, C., Hage, C. A., Wheat, L. J., Strawter, C., Klotz, S. A., & Knox, K. S. (2015). Positive (1-3) B-d-glucan and cross reactivity of fungal assays in coccidioidomycosis. Medical mycology, 53(2), 171-3.
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  Fungal antigen testing in immunosuppressed patients has emerged as a powerful diagnostic tool. Some assays are relatively nonspecific, and misinterpretation can have severe clinical consequences. Additionally, when new assays become commercially available it is important to evaluate the potential for cross reactivity. We recently observed several immunosuppressed patients with positive (1→3)-β-D-glucan (BG) who were eventually diagnosed with coccidioidomycosis in the endemic area of Tucson, Arizona. Although the BG assay is known to detect glucans of many fungal pathogens, reports of cross-reactivity with Coccidioides remain sparsely reported. To test the cross-reactivity of fungal antigens in detection assays, serum samples from patients with coccidioidomycosis testing positive for Coccidioides antigen were evaluated for BG. Of 12 samples positive for Coccidioides antigen (≥0.07 ng/ml), 11 (92%) were positive by BG (>80 pg/ml), and of 11 positive for Aspergillus galactomannan, 10 (91%) were positive by BG (>80 pg/ml). We conclude that the BG assay is nonspecific, detecting glucans from many fungal pathogens, including Coccidioides. In the endemic area, a positive BG warrants further specific testing.
• Hypes, C., Malo, J., Malo, J., Stolz, U., Natt, B., Bloom, J. W., Stolz, U., Sakles, J. C., Natt, B., Mosier, J., Joshi, R., Hypes, C., & Bloom, J. W. (2014). 14: VIDEO LARYNGOSCOPY IMPROVES ODDS OF FIRST ATTEMPT SUCCESS AT INTUBATION IN THE INTENSIVE CARE UNIT. Critical Care Medicine, 42, A1372. doi:10.1097/01.ccm.0000457547.64511.59
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  Rationale: 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. Objectives: To compare first-attempt success and complication rates during intubation when using video laryngoscopy compared with traditional direct laryngoscopy in a tertiary academic medical intensive care unit. Methods: We prospectively collected and analyzed data from a continuous quality improvement database of all intubations in one medical intensive care unit between January 1, 2012, and December 31, 2014. Propensity matching and multivariable logistic regression were used to reduce the risk of bias and control for confounding. Measurements and Main Results: A total of 809 intubations took place over the study period. Of these, 673 (83.2%) were performed using video laryngoscopy and 136 (16.8%) using direct laryngoscopy. First-attempt success with video laryngoscopy was 80.4% (95% confidence interval [CI], 77.2–83.3%) compared with 65.4% (95% CI, 56.8–73.4%) for intubations performed with direct laryngoscopy (P ,0.001). In a propensity-matched analysis, the odds ratio for first-attempt success with video laryngoscopy versus direct laryngoscopy was 2.81 (95% CI, 2.27–3.59). The rate of arterial oxygen desaturation events during the first intubation attempt was significantly lower for video laryngoscopy than for direct laryngoscopy (18.3% vs. 25.9%; P = 0.04). The rate of esophageal intubation during any attempt wasalso significantly lowerforvideolaryngoscopy(2.1%vs.6.6%; P = 0.008).
• Malo, J., & Knox, K. (2014). Medical image of the week: fat embolism syndrome. Southwest Journal of Pulmonary & Critical Care, 8(4), 246.
• Malo, J., & Rischard, F. (2014). Medical image of the week: lung cancer with vascular invasion.. Southwest Journal of Pulmonary & Critical Care, 8(4), 235.
• Malo, J., Hypes, C., Malo, J., Sakles, J. C., Mosier, J., Hypes, C., Chopra, H., & Bloom, J. W. (2014). 729: NEUROMUSCULAR BLOCKADE IMPROVES TRACHEAL INTUBATION SUCCESS IN THE INTENSIVE CARE UNIT. Critical Care Medicine, 42, A1535-A1536. doi:10.1097/01.ccm.0000458226.17777.65
• Malo, J., Luraschi-Monjagatta, C., Wolk, D. M., Thompson, R., Hage, C. A., & Knox, K. S. (2014). Update on the diagnosis of pulmonary coccidioidomycosis. Annals of the American Thoracic Society, 11(2), 243-53.
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  Coccidioidomycosis is a common cause of community-acquired pneumonia in the southwest United States, Mexico, and South America. The disease has seen a marked increase in incidence in the western United States in the last decade and can be acquired by individuals who travel even briefly through an endemic area, presenting a diagnostic dilemma for clinicians who are not familiar with the disease. The clinical and radiographic manifestations of pulmonary coccidioidomycosis often mimic those of other causes of pneumonia. However, because treatment recommendations and the potential for chronic sequelae of acute infection differ substantially from those for bacterial community-acquired pneumonia, accurate, timely diagnosis of coccidioidomycosis is paramount. A number of diagnostic tests are available with varying sensitivity and specificity, making the approach complex. Radiographic features, although nonspecific, sometimes demonstrate patterns more suggestive of coccidioidomycosis than bacterial community-acquired pneumonias. A routine blood count may reveal eosinophilia. Serologic testing is used most widely but may be negative early in the course of disease, potentially leading to misdiagnosis with subsequent inappropriate treatment and follow-up. The sensitivity of serologic testing is lower in immunocompromised patients, a population at the highest risk for developing severe disease. When clinically appropriate, other biologic specimens, such as sputum, bronchoalveolar lavage fluid, or lung biopsies, may allow for rapid, definitive diagnosis. In light of the significantly increased incidence and complexities in diagnosis of coccidioidomycosis, we examine the diagnostic approach and provide examples of classic clinical and radiographic presentations, discuss the utility of serologic testing, and suggest algorithms that may aid in the diagnosis.
• Malo, J., MM, A., KS, K., & CA, H. (2014). Pulmonary fungal infections – recent updates.. Current Respiratory Care Reports, 150-160.
• Malo, J., Mosier, J., Stolz, L., Bloom, J., Fiorello, A., Sydern, L., & Adhikari, S. (2014). Resuscitative EChocardiography for the Evaluation and management of Shock: The RECES protocol. Southwest Journal of Pulmonary & Critical Care, 8(2), 110-125.
• Mosier, J. M., Malo, J., Stolz, L. A., Bloom, J. W., Reyes, N. A., Snyder, L. S., & Adhikari, S. (2014). Critical care ultrasound training: a survey of US fellowship directors. Journal of Critical Care, 29(4), 645-9.
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  The purpose of this study is to describe the current state of bedside ultrasound use and training among critical care (CC) training programs in the United States.
• Siddiqi, T., Assar, S., & Malo, J. (2014). Ultrasound for critical care physicians: the big squeeze. Southwest J Pulm Crit Care, 8(4), 221-2.
• Wong, C., Elaini, T., Malo, J., & Mahmoud, N. (2014). Medical image of the week: partial anomalous pulmonary venous return. Southwest Journal of Pulmonary & Critical Care, 8(4), 219-220.
• Zangeneh, T. T., Malo, J., Luraschi-Monjagatta, C., Hage, C. A., Wheat, L. J., Strawter, C., Klotz, S. A., & Knox, K. S. (2014). Positive (1-3) B-d-Glucan and cross reactivity of fungal assays in coccidioidomycosis. Medical Mycology. doi:10.1093/mmy/myu077
• L'Heureux, D., Malo, J., & Snyder, L. (2013). Medical image of the week: duplicate superior vena cava. Southwest Journal of Pulmonary & Critical Care, 6(4), 178-9.
• Wong, C., Malo, J., & Knepler, J. (2013). Medical image of the week: tracheoesophageal fistula. Southwest Journal of Pulmonary & Critical Care, 6(6), 277.
• Malo, J., Raz, Y., Snyder, L., & Knox, K. (2012). Treatment of coccidioidomycosis-associated eosinophilic pneumonia with corticosteroids.. Southwest Journal of Pulmonary & Critical Care, 4, 61-66.
• Malo, J., Reyes, N., & Rischard, F. (2012). Medical image of the week: refractory dyspnea. Southwest Journal of Pulmonary and Critical Care, 5, 308.
• Hershcovici, T., Jha, L. K., Johnson, T., Gerson, L., Stave, C., Malo, J., Knox, K. S., Quan, S., & Fass, R. (2011). Systematic review: the relationship between interstitial lung diseases and gastro-oesophageal reflux disease. Alimentary pharmacology & therapeutics, 34(11-12), 1295-305.
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  BACKGROUND  A potential relationship has been suggested between gastro-oesophageal reflux disease (GERD) and interstitial lung diseases (ILDs). AIM  To evaluate whether there is a causal relationship between GERD and different ILDs. METHODS  We conducted a systematic search of literature published between 1980 and 2010. After a review by two independent authors, each study was assigned an evidence-based rating according to a standard scoring system. RESULTS  We identified 319 publications and 22 of them met the entry criteria. Of those, the relationship between GERD and idiopathic pulmonary fibrosis (IPF) was investigated in 14 articles, pulmonary involvement in systemic sclerosis (SSc) in six articles and pulmonary involvement in mixed connective tissue disease (MCTD) in two articles. We found the prevalence of GERD and/or oesophageal dysmotility to be higher in patients with different types of ILD as compared with those without ILD [Evidence B]. Among patients with IPF, 67-76% demonstrated abnormal oesophageal acid exposure off PPI treatment. No relationship was demonstrated between severity of GERD and severity of IPF [Evidence B]. Data are scant on outcomes of antireflux treatment in patients with IPF. There is a correlation between the severity of ILD and the degree of oesophageal motor impairment in patients with SSc and MCTD [Evidence B]. CONCLUSIONS  Based on the currently available data, a causal relationship between GERD and idiopathic pulmonary fibrosis cannot be established. There is scant evidence about antireflux therapy in idiopathic pulmonary fibrosis patients. There may be an association between lung and oesophageal involvement in systemic sclerosis and mixed connective tissue disease, but a causal relationship cannot be established.
• Ambrogio, C., Lowman, X., Kuo, M., Malo, J., Prasad, A. R., & Parthasarathy, S. (2009). Sleep and non-invasive ventilation in patients with chronic respiratory insufficiency. Intensive care medicine, 35(2), 306-13.
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  Noninvasive ventilation with pressure support (NIV-PS) therapy can augment ventilation; however, such therapy is fixed and may not adapt to varied patient needs. We tested the hypothesis that in patients with chronic respiratory insufficiency, a newer mode of ventilation [averaged volume assured pressure support (AVAPS)] and lateral decubitus position were associated with better sleep efficiency than NIV-PS and supine position. Our secondary aim was to assess the effect of mode of ventilation, body position, and sleep-wakefulness state on minute ventilation (V(E)) in the same patients.
• Ambrogio, C., Lowman, X., Kuo, M., Malo, J., Prasad, A., & Parthasarathy, S. (2008). Sleep and non-invasive ventilation in patients with chronic respiratory insufficiency. Intensive Care Medicine. doi:10.1007/s00134-008-1276-4
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  Noninvasive ventilation with pressure support (NIV-PS) therapy can augment ventilation; however, such therapy is fixed and may not adapt to varied patient needs. We tested the hypothesis that in patients with chronic respiratory insufficiency, a newer mode of ventilation [averaged volume assured pressure support (AVAPS)] and lateral decubitus position were associated with better sleep efficiency than NIV-PS and supine position. Our secondary aim was to assess the effect of mode of ventilation, body position, and sleep–wakefulness state on minute ventilation $$ (\dot{V}_{E} ) $$ in the same patients. Single-blind, randomized, cross-over, prospective study. Academic institution. Twenty-eight patients. NIV-PS or AVAPS therapy. Three sleep studies were performed in each patient; prescription validation night, AVAPS or NIV-PS, and crossover to alternate mode. Sleep was not different between AVAPS and NIV-PS. Supine body position was associated with worse sleep efficiency than lateral decubitus position (77.9 ± 22.9 and 85.2 ± 10.5%; P = 0.04). $$ \dot{V}_{E} $$ was lower during stage 2 NREM and REM sleep than during wakefulness (P < 0.0001); was lower during NIV-PS than AVAPS (P = 0.029); tended to be lower with greater body mass index (P = 0.07), but was not influenced by body position. In patients with chronic respiratory insufficiency, supine position was associated with worse sleep efficiency than the lateral decubitus position. AVAPS was comparable to NIV-PS therapy with regard to sleep, but statistically greater $$ \dot{V}_{E} $$ during AVAPS than NIV-PS of unclear significance was observed. $$ \dot{V}_{E} $$ was determined by sleep–wakefulness state, body mass index, and mode of therapy.
• Prasad, A. R., Parthasarathy, S., Malo, J., Lowman, X., Kuo, M., & Ambrogio, C. (2007). DETERMINANTS OF MINUTE VENTILATION DURING NONINVASIVE VENTILATION OF PATIENTS WITH RESPIRATORY INSUFFICIENCY. Chest, 132(4), 647A. doi:10.1378/chest.132.4_meetingabstracts.647a

Proceedings Publications

• Tram, J., Sullivan, J., Quiroz, H., Polverino, F., Mayo, J. J., Malo, J., Lick, S., Knoper, S., Kim, S. S., Hanak, F., & Bull, D. A. (2020). Emphysema Is Associated with Upregulated and Off-Targeted B Cell Responses. In B29. INFECTION AND IMMUNE INTERPLAY IN LUNG INJURY.
• Vedantham, S., Rao, S., Parbtani, R., Malo, J., Kumar, S., Jaffer, F., & Chan, Y. M. (2020). High Risk Findings on Low Dose CT in a Coccidioidomycosis Endemic Area. In C73. THORACIC ONCOLOGY: OPTIMIZING LUNG CANCER SCREENING, DIAGNOSIS, AND SURGERY.

Presentations

• Hsu, C., Malo, J., Mosier, J. M., Natt, B., Hypes, C., Lick, S. D., & Bull, D. A. (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.
• Malo, J. (2013, May). The Role of GERD in Rheumatologic and Non-Rheumatologic ILD. American Thoracic Society International Conference.

Poster Presentations

• Bull, D. A., Bull, D. A., Bull, D. A., Kazui, T., Kazui, T., Lick, S. D., Lick, S. D., Lick, S. D., Hsu, C., Hsu, C., Hypes, C., Hypes, C., Hypes, C., Malo, J., Malo, J., Natt, B., Natt, B., Natt, B., Mosier, J. M., , 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.
• Bull, D. A., Bull, D. A., Kazui, T., Lick, S. D., Lick, S. D., Hsu, C., Hypes, C., Hypes, C., Malo, J., Natt, B., Natt, B., Mosier, J. M., Mosier, J. M., Mosier, J. M., Natt, B., Malo, J., Malo, J., Hypes, C., Hsu, C., , Hsu, C., 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.
• Greenberg, J., Hypes, C., Sakles, J. C., Mosier, J. M., Joshi, R., Malo, J., Bloom, J. W., Bloom, J. W., Joshi, R., Malo, J., Mosier, J. M., Sakles, J. C., Greenberg, J., & Hypes, C. (2016, Spring). First attempt success at intubation is associated with a lower odds of adverse events in the ICU. Society For Academic Emergency Medicine. New Orleans, LA.
• Hypes, C., Sakles, J. C., Malo, J., Mosier, J. M., Cristan, E., Milligan, R., & Morrissette, K. (2017, February). Improvement in tracheal intubation over time with the institution of a quality improvement program [Poster]. Society of Critical Care Medicine Annual Congress. Honolulu, HI.: Society of Critical Care Medicine.
• Hypes, C., Sakles, J. C., Malo, J., Mosier, J. M., Jeremy, G., Morrissette, K., Cristan, E., & Milligan, R. (2017, Feb). Re-intubation in the Intensive Care Unit: Is it Truly as Difficult as Assumed? [Poster]. Society of Critical Care Medicine Annual Congress. Honolulu, HI.: Society of Critical Care Medicine.
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  23. Greenberg J, Mosier J, Malo J, Morrissette K, Cristan E, Milligan R, Sakles J, Hypes C; Re-intubation in the Intensive Care Unit: Is it Truly as Difficult as Assumed? [Poster]; Society of Critical Care Medicine Annual Congress; February 2017; Honolulu, HI.
• Hypes, C., Sakles, J. C., Malo, J., Mosier, J. M., Milligan, R., Cristan, E., Greenberg, J., & Morrissette, K. (2017, Feb). Intubation and First Pass Success, a Comparison of C-MAC and GlideScope in the Intensive Care Unit [Poster]. Society of Critical Care Medicine Annual Congress. Honolulu, HI: Society of Critical Care Medicine.
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  21. Milligan R, Mosier J, Cristan E, Greenberg J, Morrissette K, Sakles J, Malo J, Hypes C; Intubation and First Pass Success, a Comparison of C-MAC and GlideScope in the Intensive Care Unit [Poster]; Society of Critical Care Medicine Annual Congress; February 2017; Honolulu, HI
• Hypes, C., Sakles, J. C., Malo, J., Mosier, J. M., Morrissette, K., Cristan, E., Greenberg, J., & Milligan, R. (2017, Feb). Flexible Fiberoptic vs Video Larygoscopy: Insights on Difficult Airway Success and Complications [Poster]. Society of Critical Care Medicine Annual Congress. Honolulu, HI.: Society of Critical Care Medicine.
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  20. Morrissette K, Mosier J, Cristan E, Greenberg J, Milligan R, Sakles J, Malo J, Hypes C, Flexible Fiberoptic vs Video Larygoscopy: Insights on Difficult Airway Success and Complications [Poster]; Society of Critical Care Medicine Annual Congress; February 2017; Honolulu, HI.
• Rao, P., Skaria, R., Mosier, J. M., Malo, J., Smith, R., & Khalpey, Z. I. (2017, November). Temporary Mechanical Circulatory Support Using a Novel Minimally-Invasive Approach for Central VA-ECMO. American Heart Association Annual Meeting. Chicago, IL.
• Baalachandran, R., Trutter, L., Raz, Y., Mosier, J. M., Kazui, T., & Malo, J. (2016, Spring). Successful Use of Extracorporeal Membrane Oxygenation in a Patient with Pulmonary Coccidioidomycosis-Related Acute Respiratory Distress Syndrome.. American Thoracic Society Annual Meeting. San Francisco, CA.
• Greenberg, J., Mosier, J. M., Joshi, R., Bloom, J. W., Malo, J., Sakles, J. C., & Hypes, C. (2016, Feb). First Attempt Success at Intubation is Associated with a Lower Odds of Adverse Events in the ICU. Society of Critical Care Medicine Annual Congress. Orlando.
• Holbrook, E. D., Malo, J., Zangeneh, T. T., Strawter, C., Oren, E., Robey, I., Erickson, H., Chahal, R., Durkin, M., Thompson, C., Hoover, S. E., Ampel, N., Wheat, L. J., & Knox, K. S. (2016, Fall). Development of an Improved Antibody Detection EIA for use in Diagnosis of Coccidioidomycosis. ID Week. New Orleans, LA.
• Jaffer, F., Anand, S., Ajay-Obe, A., Parbtani, R., Doraiswamy, V. A., & Malo, J. (2016, Fall). Use of Amiodarone in Management of Atrial Tachyarrhythmia in Septic Shock: an Observational Study. CHEST Annual Meeting. Los Angeles, CA.
• Johnston, D., Mosier, J. M., Joshi, R., Malo, J., Bloom, J. W., Sakles, J. C., & Hypes, C. (2016, Feb). Reason For Failed Attempts At Laryngoscopy Differs Between Video And Direct Laryngoscopes. Society of Critical Care Medicine Annual Congress. Orlando.
• Joshi, R., Hypes, C., Malo, J., Bloom, J. W., Sakles, J. C., & Mosier, J. M. (2016, Feb). Predictors of Difficult Intubation When Using Video Laryngoscopy in the Intensive Care Unit. Society of Critical Care Medicine Annual Congress.
• Kelsey, M., Sakles, J. C., Joshi, R., Malo, J., Bloom, J. W., Hypes, C., & Mosier, J. M. (2016, Feb). Derivation of a Bundle to Improve First Attempt Success at Intubation in the Intensive Care Unit. Society of Critical Care Medicine Annual Congress. Orlando.
• 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., Natt, B., Malo, J., Malo, J., Hypes, C., Hypes, C., Kazui, T., Kazui, T., Basken, R., Basken, R., Mosier, J. M., & 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.
• Greenberg, J., Mosier, J. M., Joshi, R., Bloom, J. W., Malo, J., Sakles, J. C., & Hypes, C. D. (2016, February). First attempt success at intubation is associated with a lower odds of adverse events in the ICU. SCCM Annual Conference.
• Holbrook, E. D., Zangeneh, T. T., Malo, J., Strawter, C., Oren, E., Robey, I., Erickson, H., Chahal, R., Thompson, C., Ampel, N., Wheat, L. J., & Knox, K. S. (2015, October). Development of an improved antibody detection EIA for use in detection of coccidioidomycosis. ID Week 2015.
• Johnston, D., Mosier, J. M., Joshi, R., Malo, J., Sakles, J. C., Bloom, J. W., & Hypes, C. D. (2016, February). Reason for failed attempts at laryngoscopy differs between video and direct laryngoscopes. SCCM Annual Conference.
• Joshi, R., Hypes, C. D., Malo, J., Bloom, J. W., Sakles, J. C., & Mosier, J. M. (2016, February). Predictors of difficult intubation when using video laryngoscopy in the ICU. SCCM Annual Conference.
• Kelsey, M., Hypes, C. D., Joshi, R., Malo, J., Bloom, J. W., Sakles, J. C., & Mosier, J. M. (2016, February). Derivation of a bundle to improve first attempt success at intubation in the ICU. SCCM Annual Conferece.
• 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.

Others

• Malo, J., Arteaga, V., & Knox, K. (2014, March). Diverse appearances of coccidioidomycosis – an institutional experience. Society of Thoracic Radiology Annual Meeting.
• Dalabih, M., Malo, J., Thompson, J., Mosier, J., Smith, M., & Raz, Y. (2013, September). Successful ECMO for severe ARDS complicating adenoviral pneumonia in an adult patient.. ELSO Conference September 19-22, 2013.