Scholars@Duke
Craig Rackley

Craig Rackley

Associate Professor of Medicine
Medicine, Pulmonary, Allergy, and Critical Care Medicine
craig.rackley@duke.edu
DUMC 102355, Durham, NC 27710
Dept of Medicine, Box 3221D, Durham, NC 27710

Selected Publications

Extracorporeal Membrane Oxygenation for COVID-19 During the Delta and Omicron Waves in North America.

Journal Article ASAIO J · October 23, 2024 Clinical outcomes for patients with severe acute respiratory failure caused by different variants of the coronavirus disease 2019 (COVID-19) supported with extracorporeal membrane oxygenation (ECMO) are incompletely understood. Clinical characteristics, pr ... Full text Link to item Cite

A 36-Year-Old Woman With Intermittent Cyanosis.

Journal Article Chest · August 2024 A 36-year-old woman with a medical history of opioid use disorder and frequent urinary tract infections presented to the ED from her opioid use disorder clinic, where she was found to have an oxygen saturation by pulse oximetry (Spo2) of 82% on room air. S ... Full text Link to item Cite

Association of RBC Transfusion Thresholds and Outcomes in Medical Patients With Acute Respiratory Failure Supported With Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Cohort Study.

Journal Article Chest · July 8, 2024 BACKGROUND: The hemoglobin value to trigger RBC transfusion for patients receiving venovenous extracorporeal membrane oxygenation (ECMO) is controversial. Previous guidelines recommended transfusing to a normal hemoglobin level, but recent studies suggest ... Full text Link to item Cite

Prevalence and Survival of Prolonged Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: An Analysis of the Extracorporeal Life Support Organization Registry.

Journal Article Crit Care Med · June 1, 2024 OBJECTIVES: To examine trends in utilization and outcomes among patients with the acute respiratory distress syndrome (ARDS) requiring prolonged venovenous extracorporeal membrane oxygenation (VV ECMO) support. DESIGN: Retrospective observational cohort st ... Full text Link to item Cite

Diagnosis and Epidemiology of Acute Respiratory Failure.

Journal Article Crit Care Clin · April 2024 Acute respiratory failure is a common clinical finding caused by insufficient oxygenation (hypoxemia) or ventilation (hypocapnia). Understanding the pathophysiology of acute respiratory failure can help to facilitate recognition, diagnosis, and treatment. ... Full text Link to item Cite

Extracorporeal Carbon Dioxide Removal to Avoid Invasive Ventilation During Exacerbations of Chronic Obstructive Pulmonary Disease: VENT-AVOID Trial - A Randomized Clinical Trial.

Journal Article Am J Respir Crit Care Med · March 1, 2024 Rationale: It is unclear whether extracorporeal CO2 removal (ECCO2R) can reduce the rate of intubation or the total time on invasive mechanical ventilation (IMV) in adults experiencing an exacerbation of chronic obstructive pulmonary disease (COPD). Object ... Full text Link to item Cite

Mortality in Patients with Obesity and Acute Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation: The Multicenter ECMObesity Study.

Journal Article Am J Respir Crit Care Med · September 15, 2023 Rationale: Patients with obesity are at increased risk for developing acute respiratory distress syndrome (ARDS). Some centers consider obesity a relative contraindication to receiving extracorporeal membrane oxygenation (ECMO) support, despite growing imp ... Full text Link to item Cite

Propofol-Associated Hypertriglyceridemia in Adults With Acute Respiratory Distress Syndrome on Extracorporeal Membrane Oxygenation.

Journal Article ASAIO J · September 1, 2023 The incidence and risk factors for propofol-associated hypertriglyceridemia (HTG) in patients receiving extracorporeal membrane oxygenation (ECMO) have not been evaluated. The purpose of this study was to determine the incidence and risk factors for propof ... Full text Link to item Cite

Ability of the respiratory ECMO survival prediction (RESP) score to predict survival for patients with COVID-19 ARDS and non-COVID-19 ARDS: a single-center retrospective study.

Journal Article J Intensive Care · September 1, 2023 The respiratory ECMO survival prediction (RESP) score is used to predict survival for patients managed with extracorporeal membrane oxygenation (ECMO), but its performance in patients with Coronavirus Disease 2019 (COVID-19) acute respiratory distress synd ... Full text Link to item Cite

U-Shaped Association Between Carboxyhemoglobin and Mortality in Patients With Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation.

Journal Article Crit Care Explor · August 2023 BACKGROUND: Carbon monoxide (CO) is an endogenous signaling molecule that activates cytoprotective programs implicated in the resolution of acute respiratory distress syndrome (ARDS) and survival of critical illness. Because CO levels can be measured in bl ... Full text Link to item Cite

Extracorporeal Membrane Oxygenation for COVID-19: Comparison of Outcomes to Non-COVID-19-Related Viral Acute Respiratory Distress Syndrome From the Extracorporeal Life Support Organization Registry

Journal Article Critical Care Explorations · February 3, 2023 OBJECTIVES: To compare complications and mortality between patients that required extracorporeal membrane oxygenation (ECMO) support for acute respiratory distress syndrome (ARDS) due to COVID-19 and non-COVID-19 viral pathogens. DESIGN: Retrospective obse ... Full text Cite

Baby Powder and Protein in an Unexpected Cause of Dyspnea in Pregnancy

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2023 Cite

Effect of Initial Anticoagulation Targets on Bleeding and Thrombotic Complications for Patients With Acute Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation.

Journal Article J Cardiothorac Vasc Anesth · September 2022 OBJECTIVE: To evaluate the effect of anticoagulation targets and intensity on bleeding events, thrombotic events, and transfusion requirements in patients with acute respiratory distress syndrome (ARDS) receiving venovenous extracorporeal membrane oxygenat ... Full text Link to item Cite

Analysis of Bloodstream Infection in Patients with Femoral Venovenous ECMO cannulation

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2022 Cite

Performance of RESP Score to Predict Survival in Patients with COVID-19 ARDS managed with VV-ECMO

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2022 Cite

A Daily, Respiratory Therapist Assessment of Readiness to Liberate From Venovenous Extracorporeal Membrane Oxygenation in Patients With Acute Respiratory Distress Syndrome.

Journal Article Crit Care Explor · December 2021 UNLABELLED: We assessed the effect of implementing a protocol-directed strategy to determine when patients can be liberated from venovenous extracorporeal membrane oxygenation on extracorporeal membrane oxygenation duration, time to initiation of first swe ... Full text Link to item Cite

Hemoglobin Transfusion Thresholds in Patients on VV-ECMO for ARDS

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2021 Cite

Blood Gases and Critical Care Testing: Physiology, Clinical Interpretations, and Laboratory Applications

Book · January 1, 2021 Blood gas tests are a group of tests that are widely used and essential for the evaluation and management of a patient’s ventilation, oxygenation, and acid-base balance, often in emergent situations, and along with blood gases are other critical care analy ... Full text Cite

Monitoring During Mechanical Ventilation.

Journal Article Respir Care · June 2020 Mechanical ventilation is an indispensable form of life support for patients undergoing general anesthesia or experiencing respiratory failure in the setting of critical illness. These patients are at risk for a number of complications related to both thei ... Full text Link to item Cite

A Smart-Phrase to Improve Documentation of Supportive Measures for Idiopathic Pulmonary Fibrosis

Journal Article Journal for Nurse Practitioners · February 1, 2020 Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease of unknown cause occurring in adults and affecting approximately 5 million people worldwide. The American Thoracic Society 2015 guidelines provide recommendations for the treatment ... Full text Cite

Hyperpolarized 129Xe Magnetic Resonance Imaging Is Sensitive to Therapy Response in Idiopathic Pulmonary Fibrosis

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2020 Cite

When Is Prolonged Too Long? Outcomes for Extended Duration VV-ECMO in ARDS

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · 2020 Cite

Low Tidal Volumes for Everyone?

Journal Article Chest · October 2019 Since the first description of mechanical ventilation, our understanding of the positive and negative effects of this form of life support has continued to evolve. To maintain "normal" aeration of the lungs and "normal" blood gas measurements, patients oft ... Full text Link to item Cite

A protocol for quantifying cardiogenic oscillations in dynamic 129 Xe gas exchange spectroscopy: The effects of idiopathic pulmonary fibrosis.

Journal Article NMR Biomed · January 2019 The spectral parameters of hyperpolarized 129 Xe exchanging between airspaces, interstitial barrier, and red blood cells (RBCs) are sensitive to pulmonary pathophysiology. This study sought to evaluate whether the dynamics of 129 Xe spectroscopy provide ad ... Full text Link to item Cite

Airway pressure release ventilation: a step forward?

Journal Article Intensive Care Med · February 2018 Full text Link to item Cite

Using hyperpolarized 129Xe MRI to quantify regional gas transfer in idiopathic pulmonary fibrosis.

Journal Article Thorax · January 2018 BACKGROUND: Assessing functional impairment, therapeutic response and disease progression in patients with idiopathic pulmonary fibrosis (IPF) continues to be challenging. Hyperpolarized 129Xe MRI can address this gap through its unique capability to image ... Full text Link to item Cite

Longitudinal Follow Up After Xe-129 MRI Scan; Potential to Stratify Idiopathic Pulmonary Fibrosis Disease Progression

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · January 1, 2018 Link to item Cite

Uncovering a third dissolved-phase 129 Xe resonance in the human lung: Quantifying spectroscopic features in healthy subjects and patients with idiopathic pulmonary fibrosis.

Journal Article Magn Reson Med · October 2017 PURPOSE: The purpose of this work was to accurately characterize the spectral properties of hyperpolarized 129 Xe in patients with idiopathic pulmonary fibrosis (IPF) compared to healthy volunteers. METHODS: Subjects underwent hyperpolarized 129 Xe breath- ... Full text Link to item Cite

Quantitative analysis of hyperpolarized 129 Xe gas transfer MRI.

Journal Article Med Phys · June 2017 PURPOSE: Hyperpolarized 129 Xe magnetic resonance imaging (MRI) using Dixon-based decomposition enables single-breath imaging of 129 Xe in the airspaces, interstitial barrier tissues, and red blood cells (RBCs). However, methods to quantitatively visualize ... Full text Link to item Cite

Fluid Administration And Survival In Patients Receiving Veno-Venous Ecmo For Ards

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · January 1, 2017 Link to item Cite

Managing Respiratory Failure in Obstructive Lung Disease.

Journal Article Clin Chest Med · December 2016 Exacerbations of obstructive lung disease are common causes of acute respiratory failure. Short-acting bronchodilators and systemic glucocorticoids are the foundation of pharmacologic management. For patients requiring ventilator support, use of noninvasiv ... Full text Link to item Cite

Single-breath clinical imaging of hyperpolarized (129)Xe in the airspaces, barrier, and red blood cells using an interleaved 3D radial 1-point Dixon acquisition.

Journal Article Magn Reson Med · April 2016 PURPOSE: We sought to develop and test a clinically feasible 1-point Dixon, three-dimensional (3D) radial acquisition strategy to create isotropic 3D MR images of (129)Xe in the airspaces, barrier, and red blood cells (RBCs) in a single breath. The approac ... Full text Link to item Cite

Monitoring Oxygen Status.

Journal Article Adv Clin Chem · 2016 Although part of a common "blood gas" test panel with pH and pCO2, the pO2, %O2Hb, and related parameters are independently used to detect and monitor oxygen deficits from a variety of causes. Measurement of blood gases and cooximetry may be done by labora ... Full text Link to item Cite

Differentiating Early Stage And Later Stage Ipf Using Hyperpolarized 129xe Ventilation Mri

Conference AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · January 1, 2016 Link to item Cite

Measuring diffusion limitation with a perfusion-limited gas--hyperpolarized 129Xe gas-transfer spectroscopy in patients with idiopathic pulmonary fibrosis.

Journal Article J Appl Physiol (1985) · September 15, 2014 Although xenon is classically taught to be a "perfusion-limited" gas, (129)Xe in its hyperpolarized (HP) form, when detected by magnetic resonance (MR), can probe diffusion limitation. Inhaled HP (129)Xe diffuses across the pulmonary blood-gas barrier, and ... Full text Link to item Cite

Hyperpolarized 129xe Spectroscopy As A Biomarker For Gas-Transfer Impairment In Idiopathic Pulmonary Fibrosis

Journal Article AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · January 1, 2014 Link to item Cite

Type 2 alveolar cells are stem cells in adult lung.

Journal Article J Clin Invest · July 2013 Gas exchange in the lung occurs within alveoli, air-filled sacs composed of type 2 and type 1 epithelial cells (AEC2s and AEC1s), capillaries, and various resident mesenchymal cells. Here, we use a combination of in vivo clonal lineage analysis, different ... Full text Open Access Link to item Cite

Clinical evidence of early acute lung injury often precedes the diagnosis of ALI.

Journal Article J Intensive Care Med · 2013 BACKGROUND: Acute lung injury (ALI) has been primarily defined in patients who require positive pressure ventilation. As a result, the clinical characteristics of patients with early ALI (EALI) prior to the need for mechanical ventilation have not been wel ... Full text Link to item Cite

Airway epithelial progenitors are region specific and show differential responses to bleomycin-induced lung injury.

Journal Article Stem Cells · September 2012 Mechanisms that regulate regional epithelial cell diversity and pathologic remodeling in airways are poorly understood. We hypothesized that regional differences in cell composition and injury-related tissue remodeling result from the type and composition ... Full text Link to item Cite

Building and maintaining the epithelium of the lung.

Journal Article J Clin Invest · August 2012 Airspaces of the lung are lined by an epithelium whose cellular composition changes along the proximal-to-distal axis to meet local functional needs for mucociliary clearance, hydration, host defense, and gas exchange. Advances in cell isolation, in vitro ... Full text Link to item Cite

Priming with endotoxin increases acute lung injury in mice by enhancing the severity of lung endothelial injury.

Journal Article Anat Rec (Hoboken) · January 2011 Endotoxin-induced acute lung injury (ALI) is a commonly used model. However, the effect of a priming dose of endotoxin on lung fluid balance has not been well studied. We hypothesized that endotoxin-induced ALI in mice would be enhanced under a priming con ... Full text Link to item Cite

Interhospital ECMO Transport: Regional Focus.

Journal Article Semin Thorac Cardiovasc Surg Utilization of extracorporeal membrane oxygenation (ECMO) has increased dramatically over the last decade. Despite this trend, many medical centers have limited, if any, access to this technology or the resources necessary to manage these complex patients. ... Full text Link to item Cite