Scholars@Duke
Joseph Alan Govert

Joseph Alan Govert

Professor of Medicine
Medicine, Pulmonary, Allergy, and Critical Care Medicine
gover001@mc.duke.edu
Duke Box 100805, Durham, NC 27710
8 East, Room 42, Duke Medical Pavillion, Durham, NC 27710

Selected Publications

Fluid management with a simplified conservative protocol for the acute respiratory distress syndrome*.

Journal Article Crit Care Med · February 2015 OBJECTIVES: In the Fluid and Catheter Treatment Trial (FACTT) of the National Institutes of Health Acute Respiratory Distress Syndrome Network, a conservative fluid protocol (FACTT Conservative) resulted in a lower cumulative fluid balance and better outco ... Full text Link to item Cite

Body temperature and mortality in patients with acute respiratory distress syndrome.

Journal Article Am J Crit Care · January 2015 BACKGROUND: Little is known about the relationship between body temperature and outcomes in patients with acute respiratory distress syndrome (ARDS). A better understanding of this relationship may provide evidence for fever suppression or warming interven ... Full text Link to item Cite

Coping with critical drug shortages: an ethical approach for allocating scarce resources in hospitals.

Journal Article Arch Intern Med · October 22, 2012 The number of critical medication shortages in the United States has reached an unprecedented level, requiring decisions about allocating limited drug supplies. Ad hoc decisions are susceptible to arbitrary judgments, revealing preformed biases for or agai ... Full text Link to item Cite

Development of a collaborative program to provide extracorporeal membrane oxygenation for adults with refractory hypoxemia within the framework of a pandemic.

Journal Article Pediatr Crit Care Med · July 2011 OBJECTIVE: We report the process used to rapidly develop a collaborative adult respiratory extracorporeal membrane oxygenation program as a response to caring for young adult patients with refractory hypoxemia in the setting of the pH1N1 pandemic. DESIGN: ... Full text Link to item Cite

Rescue therapy in adult and pediatric patients with pH1N1 influenza infection: a tertiary center intensive care unit experience from April to October 2009.

Journal Article Crit Care Med · November 2010 OBJECTIVE: Severe respiratory failure is a well-recognized complication of pH1N1 influenza infection. Limited data regarding the efficacy of rescue therapies, including high-frequency oscillatory ventilation and extracorporeal membrane oxygenation, have be ... Full text Link to item Cite

One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study.

Journal Article Ann Intern Med · August 3, 2010 BACKGROUND: Growing numbers of critically ill patients receive prolonged mechanical ventilation. Little is known about the patterns of care as patients transition from acute care hospitals to postacute care facilities or about the associated resource utili ... 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

Expectations and outcomes of prolonged mechanical ventilation.

Journal Article Crit Care Med · November 2009 OBJECTIVE: To compare prolonged mechanical ventilation decision-makers' expectations for long-term patient outcomes with prospectively observed outcomes and to characterize important elements of the surrogate-physician interaction surrounding prolonged mec ... Full text Link to item Cite

Potentially Ineffective Care (PIC) and Prolonged Mechanical Ventilation (PMV)

Journal Article AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE · January 1, 2009 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

A prognostic model for one-year mortality in patients requiring prolonged mechanical ventilation.

Journal Article Crit Care Med · July 2008 OBJECTIVE: A measure that identifies patients who are at high risk of mortality after prolonged ventilation will help physicians communicate prognoses to patients or surrogate decision makers. Our objective was to develop and validate a prognostic model fo ... Full text Link to item Cite

Mechanical ventilation in an airborne epidemic.

Journal Article Clin Chest Med · June 2008 With the increasing threat of pandemic influenza and catastrophic bioterrorism, it is important for intensive care providers to be prepared to meet the challenge of large-scale airborne epidemics causing mass casualty respiratory failure. The severe acute ... Full text Link to item Cite

Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation.

Journal Article Crit Care Med · March 2008 OBJECTIVE: The economic implications of sedative choice in the management of patients receiving mechanical ventilation are unclear because of differences in costs and clinical outcomes associated with specific sedatives. Therefore, we aimed to determine th ... Full text Link to item Cite

Broncholith removal using cryotherapy during flexible bronchoscopy: a case report.

Journal Article Chest · November 2007 Pulmonary broncholithiasis can cause a management dilemma depending on its location and the possible involvement of vascular structures. Many patients undergo rigid bronchoscopy or surgical interventions for the removal of broncholiths. In this case report ... Full text Link to item Cite

Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition).

Journal Article Chest · September 2007 BACKGROUND: The solitary pulmonary nodule (SPN) is a frequent incidental finding that may represent primary lung cancer or other malignant or benign lesions. The optimal management of the SPN remains unclear. METHODS: We conducted a systematic literature r ... Full text Link to item Cite

An economic evaluation of prolonged mechanical ventilation.

Journal Article Crit Care Med · August 2007 OBJECTIVE: Patients who receive prolonged mechanical ventilation have high resource utilization and relatively poor outcomes, especially the elderly, and are increasing in number. The economic implications of prolonged mechanical ventilation provision, how ... Full text Link to item Cite

Pathogenetic and prognostic significance of altered coagulation and fibrinolysis in acute lung injury/acute respiratory distress syndrome.

Journal Article Crit Care Med · August 2007 OBJECTIVE: The coagulation and inflammatory cascades may be linked in the pathogenesis of acute lung injury and acute respiratory distress syndrome. However, direct evidence for the contribution of abnormalities in coagulation and fibrinolysis proteins to ... Full text Link to item Cite

Debriefing in the intensive care unit: a feedback tool to facilitate bedside teaching.

Journal Article Crit Care Med · March 2007 OBJECTIVE: To develop an assessment tool for bedside teaching in the intensive care unit (ICU) that provides feedback to residents about their performance compared with clinical best practices. METHOD: We reviewed the literature on the assessment of reside ... 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

Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study.

Journal Article Crit Care · 2007 INTRODUCTION: The outcomes of patients ventilated for longer than average are unclear, in part because of the lack of an accepted definition of prolonged mechanical ventilation (PMV). To better understand the implications of PMV provision, we compared one- ... Full text Link to item Cite

Higher urine desmosine levels are associated with mortality in patients with acute lung injury.

Journal Article Am J Physiol Lung Cell Mol Physiol · October 2006 Desmosine is a stable breakdown product of elastin that can be reliably measured in urine samples. We tested the hypothesis that higher baseline urine desmosine would be associated with higher mortality in 579 of 861 patients included in the recent Acute R ... Full text Link to item Cite

Physician subsidies for tobacco advertising.

Journal Article Am J Respir Crit Care Med · January 15, 2006 Full text Link to item Cite

Providing palliative care for patients receiving mechanical ventilation in an intensive care unit: Part 2: Withdrawing ventilation

Journal Article Progress in Palliative Care · September 21, 2005 Mechanical ventilation is often withdrawn from patients in expectation of death in intensive care units (ICUs). This process involves close collaboration between families and loved ones, physicians, nurses, respiratory therapists, and other healthcare prov ... Full text Cite

Providing palliative care for patients receiving mechanical ventilation. Part I: Invasive and non-invasive ventilation

Journal Article Progress in Palliative Care · June 30, 2005 Intensive care units (ICUs) provide care to many patients who ultimately die while receiving, or after withdrawal of, mechanical ventilation. During the transition from curative to palliative care, it is important to emphasise comfort and symptoms' relief. ... Full text Cite

Contraindications and safety of transbronchial lung biopsy via flexible bronchoscopy. A survey of pulmonologists and review of the literature.

Journal Article Respiration · 2005 BACKGROUND: Transbronchial lung biopsy (TBLB) via flexible bronchoscopy is a common procedure performed by pulmonologists. Limited scientific data exist concerning the risk of this procedure in patients with conditions that may adversely affect the rate of ... Full text Link to item Cite

Outcome of lung transplant patients admitted to the medical ICU.

Journal Article Chest · March 2004 INTRODUCTION: Lung transplantation is an acceptable treatment option for end-stage lung disease. Short-term survival has improved, but lung transplant recipients remain at high risk for a variety of complications that can necessitate care in an ICU. Little ... Full text Link to item Cite

Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit: use of restraining therapies--American College of Critical Care Medicine Task Force 2001-2002.

Journal Article Crit Care Med · November 2003 OBJECTIVE: To develop clinical practice guidelines for the use of restraining therapies to maintain physical and psychological safety of adult and pediatric patients in the intensive care unit. PARTICIPANTS: A multidisciplinary, multispecialty task force o ... Full text Link to item Cite

Effectiveness of medical resident education in mechanical ventilation.

Journal Article Am J Respir Crit Care Med · January 1, 2003 Specific methods of mechanical ventilation management reduce mortality and lower health care costs. However, in the face of a predicted deficit of intensivists, it is unclear whether residency programs are training internists to provide effective care for ... Full text Link to item Cite

Use of data from nonrandomized trial designs in evidence reports: an application to treatment of pulmonary disease following spinal cord injury.

Journal Article J Rehabil Res Dev · 2002 Evidence reports summarize the evidence pertaining to various health-related topics. Including evidence from nonrandomized studies into such reports involves a trade-off between availability and bias. We describe a general framework by which information fr ... Link to item Cite

Upper airway obstruction in a patient with epidermolysis bullosa acquisita

Journal Article Journal of Bronchology · January 1, 2002 Epidermolysis bullosa acquisita (EBA) is a rare, acquired autoimmune bullous disease characterized by the development of tense bullae spontaneously or due to minor trauma to the skin and mucosal surfaces. Mucosal involvement has been reported in the oral c ... Full text Cite

Treatment of pulmonary disease following cervical spinal cord injury.

Journal Article Evid Rep Technol Assess (Summ) · June 2001 Link to item Cite

Methemoglobinemia after infusion of ifosfamide chemotherapy: first report of a potentially serious adverse reaction related to ifosfamide.

Journal Article Chest · October 2000 Acute formation of methemoglobin is a life-threatening condition caused by multiple medications. In this article we report the first case of methemoglobinemia in a patient with metastatic uterine leiomyosarcoma, after infusion of ifosfamide chemotherapy. T ... 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 2000 ContextThree 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 ketoco ... Full text Cite

Methemoglobinemia after infusion of ifosfamide chemotherapy

Journal Article Chest · December 1, 1999 Cite

A prospective comparison of fiberoptic transbronchial needle aspiration and bronchial biopsy for bronchoscopically visible lung carcinoma.

Journal Article Cancer · June 25, 1999 BACKGROUND: Fiberoptic bronchoscopy is the most common modality used to diagnose endobronchial carcinoma. The authors prospectively compared the sensitivity of endobronchial needle aspiration (EBNA) and immediate cytologic assessment with bronchial biopsy ... Full text Link to item Cite

Diagnostic yield of bronchoscopies after isolated lung transplantation

Journal Article Pneumologie · December 1, 1997 Cite

Physician practices in the diagnostic evaluation of suspected Obstructive Sleep Apnea (OSA)

Journal Article Chest · October 1, 1996 Purpose: To determine if physician training alters diagnostic testing for suspected OSA. Methods: Questionnaires were mailed to a random national sample of 2000 board-certified physicians from various specialties. Physicians were asked which diagnostic tes ... Cite

Variation in physician threshold to treat Obstructive Sleep Apnea (OSA)

Journal Article Chest · October 1, 1996 Purpose: To determine the factors which influence physician decision making in regard to the threshold for treatment in OSA. Methods: Questionnaires were mailed to a random national sample of 2000 board-certified physicians from various specialties. Physic ... Cite

Diagnostic yield of bronchoscopies after isolated lung transplantation.

Journal Article Chest · July 1996 Lung transplantation has become an acceptable therapeutic option for end-stage pulmonary diseases. The most common causes of long-term mortality after transplantation are infections and obliterative bronchiolitis (OB). While acute rejection has been shown ... Full text Link to item Cite

Cost-effectiveness of collecting routine cytologic specimens during fiberoptic bronchoscopy for endoscopically visible lung tumor.

Journal Article Chest · February 1996 STUDY OBJECTIVE: Fiberoptic bronchoscopy is the most common modality used to diagnose endobronchial carcinoma. Collection of brushing and washing specimens for cytology is common during bronchoscopy for endobronchial abnormality, but it is unknown if colle ... Full text Link to item Cite

Treatment of acute myocardial infarction.

Journal Article N Engl J Med · August 5, 1993 Full text Link to item Cite

Pancytopenia from using trimethoprim and methotrexate.

Journal Article Ann Intern Med · November 15, 1992 Full text Link to item Cite