Scholars@Duke
William J. Fulkerson Jr.

William J. Fulkerson Jr.

Professor of Medicine
Medicine, Pulmonary, Allergy, and Critical Care Medicine
william.fulkerson@duke.edu
Box 3708 Med Ctr, Durham, NC 27710
108 Davison Bldg, Durham, NC 27710

Selected Publications

Accelerating health system innovation: principles and practices from the Duke Institute for Health Innovation.

Journal Article Patterns (N Y) · April 14, 2023 The Duke Institute for Health Innovation (DIHI) was launched in 2013. Frontline staff members submit proposals for innovation projects that align with strategic priorities set by organizational leadership. Funded projects receive operational and technical ... Full text Link to item Cite

Training the next generation of physician-executives: an innovative residency pathway in management and leadership.

Journal Article Acad Med · May 2011 The rapidly changing field of medicine demands that future physician-leaders excel not only in clinical medicine but also in the management of complex health care enterprises. However, many physicians have become leaders "by accident," and the active culti ... Full text Link to item Cite

Prognostic and pathogenetic value of combining clinical and biochemical indices in patients with acute lung injury.

Journal Article Chest · February 2010 BACKGROUND: No single clinical or biologic marker reliably predicts clinical outcomes in acute lung injury (ALI)/ARDS. We hypothesized that a combination of biologic and clinical markers would be superior to either biomarkers or clinical factors alone in p ... Full text Link to item Cite

Reasons for nonenrollment in a clinical trial of acute lung injury.

Journal Article Chest · October 2008 BACKGROUND: Enrolling critically ill patients in clinical trials is challenging. We observed that eligible patients at San Francisco General Hospital (SFGH), a public hospital that cares largely for indigent patients, were less likely to be enrolled in a c ... Full text Link to item Cite

Higher urine nitric oxide is associated with improved outcomes in patients with acute lung injury.

Journal Article Am J Respir Crit Care Med · February 1, 2007 RATIONALE: Nitrogen oxide (NO) species are markers for oxidative stress that may be pathogenic in acute lung injury (ALI). OBJECTIVES: We tested two hypotheses in patients with ALI: (1) higher levels of urine NO would be associated with worse clinical outc ... Full text Link to item Cite

Should an academic radiation oncologist be allowed to "opt out" of medicare?

Journal Article J Am Coll Radiol · October 2005 Federal law permits physicians to "opt out" of Medicare. When a radiation oncologist chooses this option, he or she may neither bill nor collect from Medicare, but may legally attempt to charge and collect what he or she considers the value of services pro ... Full text Link to item Cite

Randomized, placebo-controlled trial of lisofylline for early treatment of acute lung injury and acute respiratory distress syndrome.

Journal Article Crit Care Med · January 2002 OBJECTIVE: To determine whether the administration of lisofylline (1-[5R-hydroxyhexyl]-3,7-dimethylxanthine) would decrease mortality in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). DESIGN: A prospective, randomized, ... Full text Link to item Cite

Outcomes and cost-effectiveness of ventilator support and aggressive care for patients with acute respiratory failure due to pneumonia or acute respiratory distress syndrome.

Journal Article Am J Med · December 1, 2000 PURPOSE: Many patients with acute respiratory failure die despite prolonged and costly treatment. Our objective was to estimate the cost-effectiveness of providing rather than withholding mechanical ventilation and intensive care for patients with acute re ... Full text Link to item Cite

Family communication enhanced by 24 hour in house intensivists

Journal Article CRITICAL CARE MEDICINE · December 1, 2000 Link to item Cite

Changing pattern of organ dysfunction in early human sepsis is related to mortality.

Journal Article Crit Care Med · October 2000 OBJECTIVE: We examined the pattern of organ system dysfunction, the evolution of this pattern over time, and the relationship of these features to mortality in patients who had sepsis syndrome. DESIGN: Prospective, multicenter, observational study. SETTING ... Full text Link to item Cite

Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.

Conference N Engl J Med · May 4, 2000 BACKGROUND: Traditional approaches to mechanical ventilation use tidal volumes of 10 to 15 ml per kilogram of body weight and may cause stretch-induced lung injury in patients with acute lung injury and the acute respiratory distress syndrome. We therefore ... Full text Link to item Cite

Ketoconazole for early treatment of acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. The ARDS Network.

Journal Article JAMA · April 19, 2000 CONTEXT: Three clinical studies have suggested that ketoconazole, a synthetic imidazole with anti-inflammatory activity, may prevent the development of acute respiratory distress syndrome (ARDS) in critically ill patients. However, the use of ketoconazole ... Full text Link to item Cite

Effects of ibuprofen on the physiology and survival of hypothermic sepsis. Ibuprofen in Sepsis Study Group.

Journal Article Crit Care Med · April 1999 OBJECTIVES: The objective was to compare the clinical and physiologic characteristics of febrile septic patients with hypothermic septic patients; and to examine plasma levels of cytokines tumor necrosis factor alpha (TNF-alpha and interleukin 6 (IL-6) and ... Full text Link to item Cite

Patient empowerment and feedback did not decrease pain in seriously ill hospitalized adults.

Journal Article Pain · April 1998 We tested a nurse clinician-mediated intervention to relieve pain in a group of seriously ill hospitalized adults using a randomized controlled trial at five tertiary care academic centers in the US. The study included 4804 patients admitted between Januar ... Full text Link to item Cite

Relationship of body mass index to subsequent mortality among seriously ill hospitalized patients. SUPPORT Investigators. The Study to Understand Prognoses and Preferences for Outcome and Risks of Treatments.

Journal Article Crit Care Med · December 1997 OBJECTIVE: To determine if body mass Index (BMI = weight [kg]/height [m]2), predictive of mortality in longitudinal epidemiologic studies, was also predictive of mortality in a sample of seriously ill hospitalized subjects. DESIGN: Prospective, multicenter ... Full text Link to item Cite

A prognostic model for patients with end-stage liver disease.

Conference Gastroenterology · October 1997 BACKGROUND & AIMS: Survival of patients with end-stage liver disease is variable and difficult to predict. A two-phase prospective cohort study was conducted at five teaching hospitals to develop and evaluate a model for prediction of death. METHODS: Five ... Full text Link to item Cite

Outcomes and cost-effectiveness of initiating dialysis and continuing aggressive care in seriously ill hospitalized adults. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.

Journal Article Ann Intern Med · August 1, 1997 BACKGROUND: Renal failure requiring dialysis in the setting of hospitalization for serious illness is a poor prognostic sign, and dialysis and aggressive care are sometimes withheld. OBJECTIVE: To evaluate the clinical outcomes and cost-effectiveness of in ... Full text Link to item Cite

Right heart catheterization in acute respiratory failure.

Journal Article New Horiz · August 1997 OBJECTIVE: To review the literature addressing the use of the pulmonary artery catheter (PAC) in patients with respiratory failure. DATA SOURCE: All pertinent English language articles dealing with pulmonary artery catheterization in patients with respirat ... Link to item Cite

Advance directives for seriously ill hospitalized patients: effectiveness with the patient self-determination act and the SUPPORT intervention. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment.

Journal Article J Am Geriatr Soc · April 1997 OBJECTIVE: To assess the effectiveness of written advance directives (ADs) in the care of seriously ill, hospitalized patients. In particular, to conduct an assessment after ADs were promoted by the Patient Self-Determination Act (PSDA) and enhanced by the ... Full text Link to item Cite

Do advance directives provide instructions that direct care? SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment.

Journal Article J Am Geriatr Soc · April 1997 OBJECTIVE: To evaluate whether the lack of effect of advance directives (ADs) on decision-making in SUPPORT might arise, in part, from the content of the actual documents. DESIGN: Advance directives placed in the medical records were abstracted for date of ... Full text Link to item Cite

The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group.

Journal Article N Engl J Med · March 27, 1997 BACKGROUND: In patients with sepsis the production of arachidonic acid metabolites by cyclooxygenase increases, but the pathophysiologic role of these prostaglandins is unclear. In animal models, inhibition of cyclooxygenase by treatment with ibuprofen bef ... Full text Link to item Cite

Pain and satisfaction with pain control in seriously ill hospitalized adults: findings from the SUPPORT research investigations. For the SUPPORT investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatmentm.

Journal Article Crit Care Med · December 1996 OBJECTIVES: To evaluate the pain experience of seriously ill hospitalized patients and their satisfaction with control of pain during hospitalization. To understand the relationship of level of pain and dissatisfaction with pain control to demographic, psy ... Full text Link to item Cite

Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments).

Journal Article Am J Respir Crit Care Med · October 1996 In order to describe the outcomes of patients hospitalized with an acute exacerbation of severe chronic obstructive pulmonary disease (COPD) and determine the relationship between patient characteristics and length of survival, we studied a prospective coh ... Full text Link to item Cite

The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators.

Journal Article JAMA · September 18, 1996 OBJECTIVE: To examine the association between the use of right heart catheterization (RHC) during the first 24 hours of care in the intensive care unit (ICU) and subsequent survival, length of stay, intensity of care, and cost of care. DESIGN: Prospective ... Full text Link to item Cite

Is economic hardship on the families of the seriously ill associated with patient and surrogate care preferences? SUPPORT Investigators.

Journal Article Arch Intern Med · August 12, 1996 BACKGROUND: Serious illness often causes economic hardship for patients' families. However, it is not known whether this hardship is associated with a preference for the goal of care to focus on maximizing comfort instead of maximizing life expectancy or w ... Link to item Cite

Lack of usefulness of radiographic screening for pulmonary disease in asymptomatic HIV-infected adults. Pulmonary Complications of HIV Infection Study Group.

Journal Article Arch Intern Med · January 22, 1996 OBJECTIVE: To determine the use of chest radiographs in the screening of asymptomatic adults infected with the human immunodeficiency virus (HIV). METHODS: A prospective, multicenter study of the pulmonary complications of HIV infection in a community-base ... Link to item Cite

Pathogenesis and treatment of the adult respiratory distress syndrome.

Journal Article Arch Intern Med · January 8, 1996 The adult respiratory distress syndrome is an acute clinical illness characterized by noncardiogenic pulmonary edema and refractory hypoxemia. Injury to the alveolar-capillary barrier and lung inflammation lead to intrapulmonary shunting of blood, surfacta ... Link to item Cite

The rising tide of asthma. Trends in the epidemiology of morbidity and mortality from asthma.

Journal Article Respir Care Clin N Am · December 1995 The increase in the asthma mortality rate seen in the past decade has stimulated much discussion, research, and controversy. The epidemiology of asthma morbidity is reviewed, with special attention to the roles of demographics, socioeconomic status, and ia ... Link to item Cite

VENOUS THROMBOEMBOLISM - PREFACE

Journal Article CLINICS IN CHEST MEDICINE · June 1, 1995 Link to item Cite

The SUPPORT prognostic model. Objective estimates of survival for seriously ill hospitalized adults. Study to understand prognoses and preferences for outcomes and risks of treatments.

Journal Article Ann Intern Med · February 1, 1995 OBJECTIVE: To develop and validate a prognostic model that estimates survival over a 180-day period for seriously ill hospitalized adults (phase I of SUPPORT [Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments]) and to compa ... Full text Link to item Cite

The impact of serious illness on patients' families. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment.

Journal Article JAMA · December 21, 1994 OBJECTIVE: To examine the impact of illness on the families of seriously ill adults and to determine the correlates of adverse economic impact. DESIGN: Data were collected during the Study to Understand Prognoses and Preferences for Outcomes and Risks of T ... Full text Link to item Cite

Pulmonary embolism in the intensive care unit

Journal Article Journal of Intensive Care Medicine · January 1, 1994 DVT and PE result in substantial morbidity and mortality in hospitalized patients. ICU patients exhibit a wide array of underlying medical or surgical diseases combined with prolonged immobility. Prompt recognition of risk factors with institution of appro ... Full text Cite

Sensitive and specific detection of the 4B5 antigen in bronchial lavage specimens from patients with primary bronchogenic carcinoma.

Journal Article Cancer · September 1, 1992 The monoclonal antibody 4B5 binds to a mucin-like antigen elaborated by respiratory epithelium of patients with non-small cell bronchogenic carcinoma. Several immunoassay formats were used to determine the presence of the antigen in lavage specimens. A qua ... Full text Link to item Cite

The clinical course of pulmonary embolism.

Journal Article N Engl J Med · May 7, 1992 BACKGROUND: Pulmonary embolism is a potentially fatal disorder. Information about the outcome of clinically recognized pulmonary embolism is sparse, particularly given that new treatments for more seriously ill patients are now available. METHODS: We prosp ... Full text Link to item Cite

CORRELATES OF SURVIVAL-TIME FOLLOWING ACUTE RESPIRATORY-FAILURE

Journal Article CLINICAL RESEARCH · April 1, 1992 Link to item Cite

Responses of baboons to prolonged hyperoxia: physiology and qualitative pathology.

Journal Article J Appl Physiol (1985) · December 1991 Cardiopulmonary responses to prolonged hyperoxia and their relationships to the development of lung pathology have not been fully characterized in primates. In this study, circulatory hemodynamics and pulmonary function, vascular permeability, and leukocyt ... Full text Link to item Cite

Acute renal failure in critically ill patients: prognosis for recovery of kidney function after prolonged dialysis support.

Journal Article Crit Care Med · January 1991 OBJECTIVE: To clarify the prognosis for eventual recovery of kidney function in patients who experience prolonged dialysis dependence after acute renal failure (ARF). DESIGN: Retrospective, chart review. SETTING: Inpatients of a large, referral-based hospi ... Full text Link to item Cite

Tissue plasminogen activator for the treatment of acute pulmonary embolism. A collaborative study by the PIOPED Investigators.

Journal Article Chest · March 1990 Thirteen patients with acute pulmonary embolism were treated in a randomized double-blind fashion either with recombinant tissue plasminogen activator (rt-PA) 40 to 80 mg, usually in combination with heparin, or with placebo plus heparin. The drug was admi ... Full text Link to item Cite

The authors reply

Journal Article Critical Care Medicine · August 1989 Full text Cite

Prognosis of patients with cirrhosis and chronic liver disease admitted to the medical intensive care unit.

Journal Article Crit Care Med · July 1988 Patients with hepatic failure admitted to the medical ICU (MICU) generally have a poor prognosis. To determine if there were readily identifiable clinical factors associated with a high predictive value for outcome, we reviewed retrospectively the charts o ... Full text Link to item Cite

Giant cell interstitial pneumonia in a hard-metal worker. Cytologic, histologic and analytical electron microscopic investigation.

Journal Article Acta Cytol · 1988 A case of biopsy-proven giant cell interstitial pneumonia in a patient with occupational exposure to hard-metal dust is reported. Bronchial washings performed several days prior to open-lung biopsy yielded an almost exclusive population of nonpigmented alv ... Link to item Cite

Staphylococcus aureus septicemia mimicking fulminant Rocky Mountain spotted fever.

Journal Article Am J Med · October 1987 Septicemia due to Staphylococcus aureus can be a difficult diagnosis to make early in its presentation. This report illustrates a case that mimicked fulminant Rocky Mountain spotted fever in a patient with no other medical problems that might predispose he ... Full text Link to item Cite

Occult spontaneous esophageal perforation. Unusual clinical and radiographic presentation.

Journal Article Chest · September 1987 We report a unique presentation of spontaneous esophageal perforation or Boerhaave's syndrome. Our patient had no risk factors predisposing her to barogenic rupture of the esophagus, and she had none of the "classic" presenting signs. She was asymptomatic, ... Full text Link to item Cite

Pulmonary hypertension secondary to serum hyperviscosity in a patient with rheumatoid arthritis.

Journal Article Am J Med · May 1987 A patient with rheumatoid arthritis who was evaluated for dyspnea of six months' duration is described. Although no primary cardiac or parenchymal lung disease was identified, right heart catheterization revealed marked pulmonary hypertension. The patient ... Full text Link to item Cite

Prevention of amphotericin B-induced rigors by dantrolene.

Journal Article Arch Intern Med · August 1986 Three patients had severe amphotericin B-induced rigors refractory to conventional prophylactic measures. Rigors improved or disappeared when dantrolene sodium was given prophylactically or during an episode. These observations suggest that dantrolene is u ... Link to item Cite

Adult respiratory distress syndrome after limited thoracic radiotherapy.

Journal Article Cancer · May 15, 1986 The authors report three patients who developed fatal respiratory failure after limited or unilateral thoracic radiation therapy for neoplasms. The respiratory failure was characteristic of the adult respiratory distress syndrome (ARDS) with refractory hyp ... Full text Link to item Cite

Diagnosis of pulmonary embolism.

Journal Article Arch Intern Med · May 1986 An accurate diagnosis of pulmonary embolism is essential to prevent excessive morbidity and mortality from lack of therapy or inappropriate anticoagulation. Clinical signs and symptoms are reported to be nonspecific, although published studies do not allow ... Link to item Cite

ELDERLY ADMISSIONS TO A MEDICAL ICU - 8 YEAR EXPERIENCE

Journal Article AMERICAN REVIEW OF RESPIRATORY DISEASE · April 1, 1986 Link to item Cite

ADULT FOREIGN-BODY ASPIRATION

Journal Article BIOMEDICINE & PHARMACOTHERAPY · January 1, 1986 Link to item Cite

Straw lung.

Journal Article N Engl J Med · April 4, 1985 Full text Link to item Cite

Fiberoptic bronchoscopy.

Journal Article N Engl J Med · November 29, 1984 Full text Link to item Cite

Current concepts. Fiberoptic bronchoscopy.

Journal Article N Engl J Med · August 23, 1984 Full text Link to item Cite