ABSTRACT
BACKGROUND: Syringomyelia is defined as dilation of the spinal cord's central canal and is often precipitated by skull base herniation disorders. Although respiratory failure (RF) can be associated with skull base abnormalities due to brainstem compression, most cases occur in pediatric patients and quickly resolve. The authors report the case of an adult patient with global spinal syringomyelia and Chiari malformation who developed refractory RF after routine administration of diazepam. OBSERVATIONS: A 31-year-old female presented with malnutrition, a 1-month history of right-sided weakness, and normal respiratory dynamics. After administration of diazepam prior to magnetic resonance imaging (MRI), she suddenly developed hypercapnic RF followed MRI and required intubation. MRI disclosed a Chiari malformation type I and syrinx extending from C1 to the conus medullaris. After decompressive surgery, her respiratory function progressively returned to baseline status, although 22 months after initial benzodiazepine administration, the patient continues to require nocturnal ventilation. LESSONS: Administration of central nervous system depressants should be closely monitored in patients with extensive syrinx formation given the potential to exacerbate diminished central respiratory drive. Early identification of syrinx in the context of Chiari malformation and hemiplegia should prompt clinical suspicion of underlying respiratory compromise and early involvement of intensive care consultants.
ABSTRACT
BACKGROUND: Recruitment and retention of Pulmonary and Critical Care Medicine (PCCM) trainees into academic research positions remain difficult. Factors influencing graduates, like salary and personal circumstances, remain unchangeable. However, some program-level factors, like research skill acquisition and mentorship, may be modifiable to encourage matriculation into academic research positions. OBJECTIVE: We aim to identify proficiency in research-specific skills in PCCM trainees and barriers to careers as research-focused academic faculty. METHODS: We surveyed PCCM fellows in a nationwide cross-sectional analysis including demographics, research intent, research skills self-assessment, and academic career barriers. The Association of Pulmonary and Critical Care Medicine Program Directors approved and disseminated the survey. Data were collected and stored using the REDCap database. Descriptive statistics were used to assess survey items. RESULTS: 612 fellows received the primary survey with 112 completing the survey for a response rate of 18.3%. A majority were male (56.2%) and training at university-based medical centers (89.2%). Early fellowship trainees (first-/second-year fellows) comprised 66.9% of respondents with 33.1% being late fellowship trainees (third-/fourth-year fellows). Most early trainees (63.2%) indicated they intended to incorporate research into their careers. A chi-square testing of independence was performed to examine the relationship between training level and perceived proficiency. Significant relationships in perceived proficiency were identified between early and late fellowship trainees with an absolute difference of 25.3% (manuscript writing), 18.7% (grant writing), 21.6% (study design), and 19.5% (quantitative/qualitative methodology). The most prevalent barriers were unfamiliarity with grant writing (59.5%) and research funding uncertainty (56.8%). CONCLUSION: With an ongoing need for academic research faculty, this study identifies self-perceived gaps in research skills including grant writing, data analytics, and study conception and design. These skills map to fellow-identified barriers to careers in academics. Mentorship and innovative curriculum focusing on the development of key research skills may enhance academic research faculty recruitment.
