John W Bloom
- Associate Professor, Pharmacology
- Associate Professor, Medicine
- Research Associate, Respiratory Sciences
- Member of the Graduate Faculty
- Excellence in Teaching Department of Medicine
- Department of Medicine, Spring 2018
- Outstanding Achievement in Teaching by a Block, Year 1, Block Director
- University of Arizona College of Medicine, Spring 2018
- Basic Science Educator of the Year Lifetime Award
- College of Medicine, Fall 2017
- Outstanding Achievement in Teaching by a Block: Cardiovascular, Pulmonary and Renal Systems. John W. Bloom, MD Block Director
- College of Medicine, Fall 2017
- Outstanding Achievement in Teaching by a Block
- College of Medicine, Spring 2016
- Outstanding Teacher in a Block
- College of Medicine, Spring 2016
No activities entered.
Pharmacology-Chemo,Endo,& ISDPHCL 601B (Fall 2022)
Cardio,Pulmnr,Renal SystMED 805 (Spring 2022)
Pharm of Cardio,Pulm,GI&CNSPHCL 601C (Fall 2021)
Pharmacology-Chemo,Endo,& ISDPHCL 601B (Fall 2021)
Pharmacology: Gen. PrinciplesPHCL 601A (Fall 2021)
Cardio,Pulmnr,Renal SystMED 805 (Spring 2021)
Pharm of Cardio,Pulm,GI&CNSPHCL 601C (Fall 2020)
Pharmacology-Chemo,Endo,& ISDPHCL 601B (Fall 2020)
Pharmacology: Gen. PrinciplesPHCL 601A (Fall 2020)
Cardio,Pulmnr,Renal SystMED 805 (Spring 2020)
Pharm of Cardio,Pulm,GI&CNSPHCL 601C (Fall 2019)
Pharmacology-Chemo,Endo,& ISDPHCL 601B (Fall 2019)
Pharmacology: Gen. PrinciplesPHCL 601A (Fall 2019)
Cardio,Pulmnr,Renal SystMED 805 (Spring 2019)
Pharmacology-Chemo,Endo,& ISDPHCL 601B (Fall 2018)
Pharmacology: Gen. PrinciplesPHCL 601A (Fall 2018)
Cardio,Pulmnr,Renal SystMED 805 (Spring 2018)
Pharmacology-Chemo,Endo,& ISDPHCL 601B (Fall 2017)
Pharmacology: Gen. PrinciplesPHCL 601A (Fall 2017)
Cardio,Pulmnr,Renal SystMED 805 (Spring 2017)
Pharm of Cardio,Pulm,GI&CNSPHCL 601C (Fall 2016)
Pharmacology-Chemo,Endo,& ISDPHCL 601B (Fall 2016)
Pharmacology: Gen. PrinciplesPHCL 601A (Fall 2016)
Cardio,Pulmnr,Renal SystMED 805 (Spring 2016)
- Bloom, J. W. (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.
- Bloom, J. W. (2017). Evaluation of Deprescribing Amiodarone After New-Onset Atrial Fibrillation in Critical Illness.. American Journal of Medicine, 130(7), 864-866.
- 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.
- 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.More infoUrgent 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.More infoThe 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.
- Joshi, R., Hypes, C. D., Greenberg, J., Snyder, L., Malo, J., Bloom, J. W., Chopra, H., Sakles, J. C., & Mosier, J. M. (2016). Difficult Airway Characteristics Associated with First Attempt Failure at Intubation Using Video Laryngoscopy in the Intensive Care Unit. Annals of the American Thoracic Society.More infoVideo laryngoscopy has overcome the need to align the anatomic axes to obtain a view of the glottic opening in order 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.
- 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.More infoAirway 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.More infoThe 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.
- Mosier, J. M., Sakles, J. C., Whitmore, S. P., Hypes, C. D., Hallett, D. K., Hawbaker, K. E., Snyder, L. S., & Bloom, J. W. (2015). Failed noninvasive positive-pressure ventilation is associated with an increased risk of intubation-related complications. Annals of intensive care, 5, 4.More infoNoninvasive positive-pressure ventilation (NIPPV) use has increased in the treatment of patients with respiratory failure. However, despite decreasing the need for intubation in some patients, there are no data regarding the risk of intubation-related complications associated with delayed intubation in adult patients who fail NIPPV. The objective of this study is to evaluate the odds of a composite complication of intubation following failed NIPPV compared to patients intubated primarily in the medical intensive care unit (ICU).
- 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.More infoThe 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.
- Mosier, J. M., Stolz, L. A., Bloom, J. W., Malo, J., Snyder, L. S., Fiorello, A. B., & Adhikari, S. R. (2014). Resuscitative Echocardiography for the Evaluation and Management of Shock: The RECES protocol. Southwest Journal of Pulmonary and Critical Care, 8(2), 110-25.
- Mosier, J. M., Whitmore, S. P., Bloom, J. W., Snyder, L. S., Graham, L. A., Carr, G. E., & Sakles, J. C. (2013). Video laryngoscopy improves intubation success and reduces esophageal intubations compared to direct laryngoscopy in the medical intensive care unit. Critical care (London, England), 17(5), R237.More infoTracheal intubation in the Intensive Care Unit (ICU) can be challenging as patients often have anatomic and physiologic characteristics that make intubation particularly difficult. Video laryngoscopy (VL) has been shown to improve first attempt success compared to direct laryngoscopy (DL) in many clinical settings and may be an option for ICU intubations.
- Doungngern, T., Huckleberry, Y., Bloom, J. W., & Erstad, B. (2012). Effect of albumin on diuretic response to furosemide in patients with hypoalbuminemia. American journal of critical care : an official publication, American Association of Critical-Care Nurses, 21(4), 280-6.More infoAlbumin is broadly prescribed for critically ill patients although it does not have a mortality benefit over crystalloids. One common use of albumin is to promote diuresis. Objectives To compare urine output in patients treated with furosemide with and without albumin and to assess other variables possibly associated with enhanced diuresis.
- Bloom, J. W. (2004). Mitogen-activated protein kinase pathways: therapeutic targets in steroid resistance?. The Journal of allergy and clinical immunology, 114(5), 1055-8.
- Bloom, J. W., Chacko, J., Lohman, I. C., Halonen, M., Martinez, F. D., & Miesfeld, R. L. (2004). Differential control of eosinophil survival by glucocorticoids. Apoptosis : an international journal on programmed cell death, 9(1), 97-104.More infoGlucocorticoids are effective drugs for eosinophil-related disorders, such as asthma and allergy. Previous studies have demonstrated that glucocorticoids increase eosinophil apoptosis and block the survival effect of submaximal concentrations of interleukin-5 (IL-5). We investigated the effect of glucocorticoids on eosinophil survival in the presence of a higher concentration of IL-5 (1 ng/ml), comparable to IL-5 levels in bronchoalveolar lavage and sputum specimens from patients with asthma. In contrast to incubation in the presence of submaximal concentrations of IL-5, the addition of dexamethasone (DEX) to media containing 1 ng/ml IL-5 led to a significant increase in eosinophil cell viability from 58 +/- 6.9% to 87 +/- 2.4% ( p < 0.005) after 72 hours in culture. We found that RU486 blocked the DEX effect on cell viability confirming that glucocorticoid receptor functions are required. We investigated the possibility that the glucocorticoid enhancement of eosinophil survival may be due to an effect on IL-5 receptor expression. Our results show that the IL-5 associated decrease in IL-5 receptor alpha-subunit expression was blocked significantly after 24 hrs in culture with media containing IL-5 plus DEX compared to IL-5 alone. It is tempting to speculate that the observed glucocorticoid enhancement of eosinophil survival in the presence of elevated concentrations of IL-5 could be a mechanism that contributes to glucocorticoid resistance in asthma.
- Chauhan, S., Leach, C. H., Kunz, S., Bloom, J. W., & Miesfeld, R. L. (2003). Glucocorticoid regulation of human eosinophil gene expression. The Journal of steroid biochemistry and molecular biology, 84(4), 441-52.More infoMolecular analysis of steroid-regulated gene expression in freshly isolated human eosinophils is difficult due to the inherent high rate of spontaneous apoptosis and elevated levels of endogenous ribonucleases. To circumvent these limitations, we determined if the human eosinophilic cell line EoL-1 could serve as an in vitro model of glucocorticoid signaling. We found by optimizing growth conditions in low serum-containing media that dexamethasone (Dex) treatment of EoL-1 cells induced an apoptotic pathway that was inhibited by interleukin-5 (IL-5). Moreover, gene expression profiling using RNA from untreated EoL-1 cells and from freshly isolated human eosinophils identified 380 commonly expressed genes, including the eosinophil markers granule major basic protein, prostaglandin-endoperoxide synthase 1 and arachidonate 15-lipoxygenase. Expression profiling was performed using EoL-1 cells that had been treated with dexamethasone for 0, 4, 12, 24 and 48h identifying 162 genes as differentially expressed. Two of the most highly upregulated genes based on expression profiling were the transcription factor Ets-2 and the MHC Class II genes (Q, R, and P). Expression of these genes in EoL-1 cells was shown to be dexamethasone-induced at the RNA and protein levels which is consistent with the known function of Ets-2 in controlling cell cycle progression and the role of MHC Class II antigens in mediating eosinophil functions.
- Kunz, S., Sandoval, R., Carlsson, P., Carlstedt-Duke, J., Bloom, J. W., & Miesfeld, R. L. (2003). Identification of a novel glucocorticoid receptor mutation in budesonide-resistant human bronchial epithelial cells. Molecular endocrinology (Baltimore, Md.), 17(12), 2566-82.More infoWe developed a molecular genetic model to investigate glucocorticoid receptor (GR) signaling in human bronchial epithelial cells in response to the therapeutic steroid budesonide. Based on a genetic selection scheme using the human Chago K1 cell line and integrated copies of a glucocorticoid-responsive herpes simplex virus thymidine kinase gene and a green fluorescent protein gene, we isolated five Chago K1 variants that grew in media containing budesonide and ganciclovir. Three spontaneous budesonide-resistant subclones were found to express low levels of GR, whereas two mutants isolated from ethylmethane sulfonate-treated cultures contained normal levels of GR protein. Analysis of the GR coding sequence in the budesonide-resistant subclone Ch-BdE5 identified a novel Val to Met mutation at amino acid position 575 (GRV575M) which caused an 80% decrease in transcriptional regulatory functions with only a minimal effect on ligand binding activity. Homology modeling of the GR structure in this region of the hormone binding domain and molecular dynamic simulations suggested that the GRV575M mutation would have a decreased affinity for the LXXLL motif of p160 coactivators. To test this prediction, we performed transactivation and glutathione-S-transferase pull-down assays using the p160 coactivator glucocorticoid interacting protein 1 (GRIP1)/transcriptional intermediary factor 2 and found that GRV575M transcriptional activity was not enhanced by GRIP1 in transfected cells nor was it able to bind GRIP1 in vitro. Identification of the novel GRV575M variant in human bronchial epithelial cells using a molecular genetic selection scheme suggests that functional assays performed in relevant cell types could identify subtle defects in GR signaling that contribute to reduced steroid sensitivities in vivo.
- Leung, D. Y., & Bloom, J. W. (2003). Update on glucocorticoid action and resistance. The Journal of allergy and clinical immunology, 111(1), 3-22; quiz 23.More infoGlucocorticoids (GCs) are the most common group of medications used in the treatment of allergic and autoimmune disorders. They produce potent anti-inflammatory effects by inducing or repressing the expression of target genes. Although most patients with allergic diseases and autoimmune disorders respond to GC therapy, a small subset of patients demonstrate persistent tissue inflammation despite treatment with high doses of GCs. This condition results from an interaction between susceptibility genes, the host's environment, and immunologic factors. The treatment of these patients requires a systematic approach to rule out underlying conditions that lead to steroid resistance or treatment failure, as well as the use of alternative strategies to inhibit tissue inflammation.
- LeVan, T. D., Bloom, J. W., Bailey, T. J., Karp, C. L., Halonen, M., Martinez, F. D., & Vercelli, D. (2001). A common single nucleotide polymorphism in the CD14 promoter decreases the affinity of Sp protein binding and enhances transcriptional activity. Journal of immunology (Baltimore, Md. : 1950), 167(10), 5838-44.More infoCD14 is a pattern recognition receptor that plays a central role in innate immunity through recognition of bacterial lipoglycans, primarily LPS. Recently, our group has identified a common single nucleotide polymorphism, -159C-->T, in the CD14 proximal promoter. Homozygous carriers of the T allele have a significant increase in soluble CD14, but a decreased total serum IgE. This epidemiologic evidence led us to investigate the molecular basis for the effects of CD14/-159C-->T on CD14 regulation in monocytes and hepatocytes, the two major cell types known to express this gene in vivo. EMSA analysis showed that the T allele results in decreased affinity of DNA/protein interactions at a GC box that contains a binding site for Sp1, Sp2, and Sp3 transcription factors. In reporter assays, the transcriptional activity of the T allele was increased in monocytic Mono Mac 6 cells, which express low levels of Sp3, a member of the Sp family with inhibitory potential relative to activating Sp1 and Sp2. By contrast, both alleles were transcribed equivalently in Sp3-rich hepatocytic HepG2 cells. Our data indicate that the interplay between CD14 promoter affinity and the [Sp3]:[Sp1 + Sp2] ratio plays a critical mechanistic role in regulating transcription of the two CD14 alleles. Variation in a key gene of innate immunity may be important for the pathogenesis of allergy and inflammatory disease through gene-by-gene and/or gene-by-environment interactions.
- LeVan, T. D., Babin, E. A., Yamamura, H. I., & Bloom, J. W. (1999). Pharmacological characterization of glucocorticoid receptors in primary human bronchial epithelial cells. Biochemical pharmacology, 57(9), 1003-9.More infoBronchial epithelial cells play an important role in amplifying and perpetuating airway inflammation and may be a target for inhaled steroids. We have characterized glucocorticoid receptors in primary human bronchial epithelial cells. Northern and western blot analyses demonstrated the expression of glucocorticoid receptor mRNA and protein, respectively, in primary bronchial epithelial cells. The activity of these receptors was shown using a radioligand binding assay. High-affinity binding with pharmacological specificity was demonstrated for [3H]dexamethasone. The equilibrium dissociation constant (Kd) and density of binding sites (Bmax) for [3H]dexamethasone determined from saturation isotherms were 4.4 nM x/divided by 0.95 (SEM) and 30.1 fmol/mg protein +/-6.4 (SEM). Glucocorticoid receptors were activated by dexamethasone as assessed using a glucocorticoid-responsive reporter plasmid, pTAT3-CAT. Transfection of primary human bronchial epithelial cells with this reporter plasmid resulted in 35-fold activation of transcription following dexamethasone stimulation (10(-6) M). The glucocorticoid receptor antagonist RU-486 (mifepristone) significantly counteracted the effect of dexamethasone on glucocorticoid receptor activation, indicating that the dexamethasone effect is specific and is mediated through the glucocorticoid receptor. In summary, our study demonstrated that primary cultures of human bronchial epithelial cells possess glucocorticoid receptors that function as a ligand-activated transcriptional regulator. The presence of glucocorticoid receptors confers their responsiveness to glucocorticoids and indicates that the airway epithelium may be a target for the anti-inflammatory effects of inhaled steroids.
- 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.
- 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.
- Greenberg, J., Mosier, J. M., Joshi, R., Bloom, J. W., Malo, J., Sakles, J. C., Hypes, C. D., 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.
- Johnston, D., Mosier, J. M., Joshi, R., Malo, J., Sakles, J. C., Bloom, J. W., Hypes, C. D., Johnston, D., Mosier, J. M., Joshi, R., Malo, J., Sakles, J. C., Bloom, J. W., Hypes, C. D., Johnston, D., Mosier, J. M., Joshi, R., Malo, J., Sakles, J. C., , Bloom, J. W., et al. (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.