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Improving capacity to conduct observational studies in Australian and New Zealand ICUs 提高澳大利亚和新西兰icu开展观察性研究的能力
IF 2.9 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2022-09-05 DOI: 10.51893/2022.3.L
Daryl Jones , Glenn Eastwood , Carol Hodgson
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引用次数: 0
Pain assessment and analgesic management in patients admitted to intensive care: an Australian and New Zealand point prevalence study 重症监护患者的疼痛评估和镇痛管理:一项澳大利亚和新西兰的点患病率研究
IF 2.9 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2022-09-05 DOI: 10.51893/2022.3.OA1
Benjamin L. Moran , David A. Scott , Elizabeth Holliday , Serena Knowles , Manoj Saxena , Ian Seppelt , Naomi Hammond , John A. Myburgh , For the George Institute for Global Health, the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Pain in Survivors of Intensive Care Units (PAIN-ICU) Study Investigators

Objective: To describe pain assessment and analgesic management practices in patients in intensive care units (ICUs) in Australia and New Zealand.

Design, setting and participants: Prospective, observational, multicentre, single-day point prevalence study conducted in Australian and New Zealand ICUs. Observational data were recorded for all adult patients admitted to an ICU without a neurological, neurosurgical or postoperative cardiac diagnosis. Demographic characteristics and data on pain assessment and analgesic management for a 24-hour period were collected.

Main outcome measures: Types of pain assessment tools used and frequency of their use, use of opioid analgesia, use of adjuvant analgesia, and differences in pain assessment and analgesic management between postoperative and non-operative patients.

Results: From the 499 patients enrolled from 45 ICUs, pain assessment was performed at least every 4 hours in 56% of patients (277/499), most commonly with a numerical rating scale. Overall, 286 patients (57%) received an opioid on the study day. Of the 181 mechanically ventilated patients, 135 (75%) received an intravenous opioid, with the predominant opioid infusion being fentanyl. The median dose of opioid infusion for ventilated patients was 140 mg oral morphine equivalents. Of the 318 non-ventilated patients, 41 (13%) received patient-controlled analgesia and 76 (24%) received an oral opioid, with the predominant opioid being oxycodone. Paracetamol was administered to 63 ventilated patients (35%) and 164 non-ventilated patients (52%), while 2% of all patients (11/499) received a non-steroidal anti-inflammatory drug. Ketamine infusion and regional analgesia were used in 15 patients (3%) and 17 patients (3%), respectively. Antineuropathic agents (predominantly gabapentinoids) were used in 53 patients (11%).

Conclusions: Although a majority of ICU patients were frequently assessed for pain with a validated pain assessment tool, cumulative daily doses of opioids were high, and the use of multimodal adjuvant analgesia was low. Our data on current pain assessment and analgesic management practices may inform further research in this area.

目的:描述澳大利亚和新西兰重症监护病房(icu)患者的疼痛评估和镇痛管理实践。设计、环境和参与者:在澳大利亚和新西兰icu中进行的前瞻性、观察性、多中心、单天点患病率研究。观察性数据记录了所有没有神经、神经外科或术后心脏诊断的ICU成年患者。收集24小时内的人口学特征和疼痛评估和镇痛管理数据。主要结局指标:使用的疼痛评估工具的类型和使用频率,阿片类镇痛的使用,辅助镇痛的使用,以及术后和非手术患者在疼痛评估和镇痛管理方面的差异。结果:从45个icu纳入的499例患者中,56%的患者(277/499)至少每4小时进行一次疼痛评估,最常见的是数字评分量表。总体而言,286名患者(57%)在研究当天接受了阿片类药物治疗。在181例机械通气患者中,135例(75%)接受静脉注射阿片类药物,主要输注阿片类药物为芬太尼。阿片类药物输注的中位剂量为140 mg口服吗啡当量。318例非通气患者中,41例(13%)接受患者自控镇痛,76例(24%)接受口服阿片类药物,主要阿片类药物为羟考酮。63例通气患者(35%)和164例非通气患者(52%)使用扑热息痛,2%的患者(11/499)使用非甾体类抗炎药。氯胺酮输注和局部镇痛分别为15例(3%)和17例(3%)。53例(11%)患者使用抗神经病变药物(主要是加巴喷丁类药物)。结论:尽管大多数ICU患者经常使用经过验证的疼痛评估工具进行疼痛评估,但阿片类药物的日累积剂量较高,而多模式辅助镇痛的使用较低。我们关于当前疼痛评估和镇痛管理实践的数据可以为该领域的进一步研究提供信息。
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引用次数: 1
Prevalence, features and workplace factors associated with burnout among intensivists in Australia and New Zealand 澳大利亚和新西兰重症监护人员职业倦怠的患病率、特征和工作场所因素
IF 2.9 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2022-09-05 DOI: 10.51893/2022.3.OA8
Shona Mair , Liz Crowe , Mark Nicholls , Siva Senthuran , Kristen Gibbons , Daryl Jones

Objectives: To investigate the prevalence and features of self-reported burnout among intensivists working in Australia and New Zealand, and evaluate potentially modifiable workplace stressors associated with increased risk of self-reported burnout.

Methods: We performed an electronic survey among registered intensivists in Australia and New Zealand. Burnout and professional quality of life were measured using the Professional Quality of Life Scale version 5 (ProQOL-5). Socio-organisational factors were defined a priori and assessed using a five-point Likert scale. Thematic analysis was conducted on an open-ended question on workplace stressors.

Results: 261 of 921 estimated intensivists responded (response rate, 28.3%). Overall, few participants (0.8%) demonstrated high scores (> 75th centile) for burnout, and 70.9% of participants scored in the average range for burnout. Of note, 98.1% of participants scored in the average to high range for compassion satisfaction. No association was found between sex, age, or years of practice with the level of burnout or compassion satisfaction. Seven themes emerged regarding intensivists' most stressful aspects of work: interpersonal interactions and workplace relationships (25.5%), workload and its impact (24.9%), resources and capacity (22.6%), health systems leadership and bureaucracy (16.1%), end-of-life issues and moral distress (8.4%), clinical management (4.9%), and job security and future uncertainty (1.3%).

Conclusion: Fewer Australian and New Zealand intensivists experienced burnout than previously reported. Many self-reported work stressors do not relate to clinical work and are due to interpersonal interactions with other colleges and hospital administrators. Such factors are potentially modifiable and could be the focus of future interventions.

目的:调查在澳大利亚和新西兰工作的重症护理人员自我报告的倦怠的患病率和特征,并评估与自我报告的倦怠风险增加相关的潜在可改变的工作场所压力因素。方法:我们对澳大利亚和新西兰的注册重症医师进行了电子调查。职业倦怠和职业生活质量采用职业生活质量量表第5版(ProQOL-5)进行测量。社会组织因素的定义是先验的,并使用五点李克特量表进行评估。对一个关于工作场所压力源的开放式问题进行了专题分析。结果:921名预估强化医师中有261人有反应(有效率28.3%)。总体而言,少数参与者(0.8%)表现出高分(>75百分位),70.9%的参与者在倦怠的平均范围内得分。值得注意的是,98.1%的参与者在同情满意度方面得分在中高区间。没有发现性别、年龄或从业年限与倦怠程度或同情心满意度之间存在关联。关于重症医生工作中压力最大的方面,出现了七个主题:人际交往和工作场所关系(25.5%)、工作量及其影响(24.9%)、资源和能力(22.6%)、卫生系统领导和官僚作风(16.1%)、临终问题和道德困扰(8.4%)、临床管理(4.9%)、工作保障和未来不确定性(1.3%)。结论:澳大利亚和新西兰的重症监护人员经历过的倦怠比以前报道的要少。许多自我报告的工作压力源与临床工作无关,而是由于与其他学院和医院管理人员的人际交往。这些因素可能是可以改变的,可能是未来干预的重点。
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引用次数: 0
The relationship between commencement of continuous renal replacement therapy and urine output, fluid balance, mean arterial pressure and vasopressor dose 持续肾替代治疗开始与尿量、体液平衡、平均动脉压和血管加压剂剂量的关系
IF 2.9 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2022-09-05 DOI: 10.51893/2022.3.OA5
Benjamin Sansom , Gina Tonkin-Hill , Stefanie Kalfas , Seunga Park , Jeffrey Presneill , Rinaldo Bellomo

Background and objectives: The effect of initiating continuous renal replacement therapy (CRRT) on urine output, fluid balance and mean arterial pressure (MAP) in adult intensive care unit (ICU) patients is unclear. We aimed to evaluate the impact of CRRT on urine output, MAP, vasopressor requirements and fluid balance, and to identify factors affecting urine output during CRRT.

Design: Retrospective cohort study using data from existing databases and CRRT machines.

Setting: Medical and surgical ICUs at a single university-associated centre.

Participants: Patients undergoing CRRT between 2015 and 2018.

Main outcome measures: Hourly urine output, fluid balance, MAP and vasopressor dose 24 hours before and after CRRT commencement. Missing values were estimated via Kaplan smoothing univariate time-series imputation. Mixed linear modelling was performed with noradrenaline equivalent dose and urine output as outcomes.

Results: In 215 patients, CRRT initiation was associated with a reduction in urine output. Multivariate analysis confirmed an immediate urine output decrease (–0.092 mL/kg/h; 95% confidence interval [CI], –0.150 to –0.034 mL/kg/h) and subsequent progressive urine output decline (effect estimate, –0.01 mL/kg/h; 95% CI, –0.02 to –0.01 mL/kg/h). Age and greater vasopressor dose were associated with lower post-CRRT urine output. Higher MAP and lower rates of net ultrafiltration were associated with higher post-CRRT urine output. With MAP unchanged, vasopressor dose increased in the 24 hours before CRRT, then plateaued and declined in the 24 hours thereafter (effect estimate, –0.004 μg/kg/ min per hour; 95% CI, –0.005 to –0.004 μg/kg/min per hour). Fluid balance remained positive but declined towards neutrality following CRRT implementation.

Conclusions: CRRT was associated with decreased urine output despite a gradual decline in vasopressor and a positive fluid balance. The mechanisms behind the reduction in urine output associated with commencement of CRRT requires further investigation.

背景与目的:目前尚不清楚开始持续肾替代治疗(CRRT)对成人重症监护病房(ICU)患者尿量、体液平衡和平均动脉压(MAP)的影响。我们旨在评估CRRT对尿量、MAP、血管加压素需求和体液平衡的影响,并确定CRRT期间影响尿量的因素。设计:回顾性队列研究,使用来自现有数据库和CRRT机器的数据。环境:一个大学附属中心的内科和外科icu。参与者:2015年至2018年间接受CRRT的患者。主要观察指标:CRRT开始前后24小时每小时尿量、体液平衡、MAP和血管加压剂剂量。通过Kaplan平滑单变量时间序列imputation估计缺失值。以去甲肾上腺素当量剂量和尿量为结果进行混合线性建模。结果:在215例患者中,CRRT开始与尿量减少相关。多因素分析证实尿量立即下降(-0.092 mL/kg/h;95%置信区间[CI], -0.150至-0.034 mL/kg/h)和随后的进行性尿量下降(效应估计,-0.01 mL/kg/h;95% CI, -0.02 ~ -0.01 mL/kg/h)。年龄和较大的血管加压剂剂量与crrt后较低的尿量相关。较高的MAP和较低的净超滤率与crrt后较高的尿量相关。在MAP不变的情况下,血管加压剂剂量在CRRT前24小时升高,然后在CRRT后24小时趋于稳定并下降(效应估计为-0.004 μg/kg/ min / h;95% CI, -0.005 ~ -0.004 μg/kg/min / h)。液体平衡仍然为正,但在CRRT实施后下降到中性。结论:尽管血管加压素逐渐下降,体液平衡呈阳性,CRRT仍与尿量减少有关。与CRRT开始相关的尿量减少背后的机制需要进一步研究。
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引用次数: 0
Virological and clinical features of acute respiratory failure associated with COVID-19 in pregnancy: a case-control study 妊娠期与COVID-19相关的急性呼吸衰竭的病毒学和临床特征:一项病例对照研究
IF 2.9 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2022-09-05 DOI: 10.51893/2022.3.OA3
Jean-Christophe Richard , Emilie Frobert , Grégory Destras , Hodane Yonis , Mehdi Mezidi , Francois Dhelft , Sophie Trouillet-Assant , Paul Bastard , Adrian Gervais , William Danjou , Frederic Aubrun , Fanny Roumieu , Jean-Marc Labaune , Laurence Josset , Antonin Bal , Bruno Simon , Jean-Laurent Casanova , Bruno Lina , Jean-Charles Picaud , Corinne Dupont , Laurent Bitker

Objective: Pregnancy is a risk factor for acute respiratory failure (ARF) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We hypothesised that SARS-CoV-2 viral load in the respiratory tract might be higher in pregnant intensive care unit (ICU) patients with ARF than in non-pregnant ICU patients with ARF as a consequence of immunological adaptation during pregnancy.

Design: Single-centre, retrospective observational case–control study.

Setting: Adult level 3 ICU in a French university hospital.

Participants: Eligible participants were adults with ARF associated with coronavirus disease 2019 (COVID-19) pneumonia.

Main outcome measure: The primary endpoint of the study was viral load in pregnant and non-pregnant patients.

Results: 251 patients were included in the study, including 17 pregnant patients. Median gestational age at ICU admission amounted to 28 + 3/7 weeks (interquartile range [IQR], 26 + 1/7 to 31 + 5/7 weeks). Twelve patients (71%) had an emergency caesarean delivery due to maternal respiratory failure. Pregnancy was independently associated with higher viral load (-4.6 ± 1.9 cycle threshold; P < 0.05). No clustering or over-represented mutations were noted regarding SARS-CoV-2 sequences of pregnant women. Emergency caesarean delivery was independently associated with a modest but significant improvement in arterial oxygenation, amounting to 32 ± 12 mmHg in patients needing invasive mechanical ventilation. ICU mortality was significantly lower in pregnant patients (0 v 35%; P < 0.05). Age, Simplified Acute Physiology Score (SAPS) II score, and acute respiratory distress syndrome were independent risk factors for ICU mortality, while pregnancy status and virological variables were not.

Conclusions: Viral load was substantially higher in pregnant ICU patients with COVID-19 and ARF compared with non-pregnant ICU patients with COVID-19 and ARF. Pregnancy was not independently associated with ICU mortality after adjustment for age and disease severity.

目的:妊娠是严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)感染后急性呼吸衰竭(ARF)的危险因素。我们假设妊娠重症监护病房(ICU) ARF患者的呼吸道SARS-CoV-2病毒载量可能高于非妊娠重症监护病房ARF患者,这可能是妊娠期间免疫适应的结果。设计:单中心、回顾性观察性病例对照研究。环境:法国大学医院成人三级ICU。参与者:符合条件的参与者是与2019冠状病毒病(COVID-19)肺炎相关的成人ARF。主要结局指标:研究的主要终点是怀孕和非怀孕患者的病毒载量。结果:251例患者纳入研究,其中孕妇17例。ICU入院时的中位胎龄为28 + 3/7周(四分位数范围[IQR], 26 + 1/7至31 + 5/7周)。12例(71%)患者因产妇呼吸衰竭而紧急剖腹产。妊娠与较高的病毒载量独立相关(-4.6±1.9周期阈值;P & lt;0.05)。在孕妇的SARS-CoV-2序列中未发现聚类或过度代表突变。紧急剖宫产与动脉氧合的适度但显著的改善独立相关,在需要有创机械通气的患者中达到32±12 mmHg。妊娠患者ICU死亡率显著降低(0 vs 35%;P & lt;0.05)。年龄、简化急性生理评分(SAPS) II评分和急性呼吸窘迫综合征是ICU死亡率的独立危险因素,而妊娠状态和病毒学变量不是。结论:妊娠ICU合并COVID-19和ARF患者的病毒载量明显高于非妊娠ICU合并COVID-19和ARF患者。在调整年龄和疾病严重程度后,妊娠与ICU死亡率没有独立关联。
{"title":"Virological and clinical features of acute respiratory failure associated with COVID-19 in pregnancy: a case-control study","authors":"Jean-Christophe Richard ,&nbsp;Emilie Frobert ,&nbsp;Grégory Destras ,&nbsp;Hodane Yonis ,&nbsp;Mehdi Mezidi ,&nbsp;Francois Dhelft ,&nbsp;Sophie Trouillet-Assant ,&nbsp;Paul Bastard ,&nbsp;Adrian Gervais ,&nbsp;William Danjou ,&nbsp;Frederic Aubrun ,&nbsp;Fanny Roumieu ,&nbsp;Jean-Marc Labaune ,&nbsp;Laurence Josset ,&nbsp;Antonin Bal ,&nbsp;Bruno Simon ,&nbsp;Jean-Laurent Casanova ,&nbsp;Bruno Lina ,&nbsp;Jean-Charles Picaud ,&nbsp;Corinne Dupont ,&nbsp;Laurent Bitker","doi":"10.51893/2022.3.OA3","DOIUrl":"https://doi.org/10.51893/2022.3.OA3","url":null,"abstract":"<div><p><strong>Objective:</strong> Pregnancy is a risk factor for acute respiratory failure (ARF) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We hypothesised that SARS-CoV-2 viral load in the respiratory tract might be higher in pregnant intensive care unit (ICU) patients with ARF than in non-pregnant ICU patients with ARF as a consequence of immunological adaptation during pregnancy.</p><p><strong>Design:</strong> Single-centre, retrospective observational case–control study.</p><p><strong>Setting:</strong> Adult level 3 ICU in a French university hospital.</p><p><strong>Participants:</strong> Eligible participants were adults with ARF associated with coronavirus disease 2019 (COVID-19) pneumonia.</p><p><strong>Main outcome measure:</strong> The primary endpoint of the study was viral load in pregnant and non-pregnant patients.</p><p><strong>Results:</strong> 251 patients were included in the study, including 17 pregnant patients. Median gestational age at ICU admission amounted to 28 + 3/7 weeks (interquartile range [IQR], 26 + 1/7 to 31 + 5/7 weeks). Twelve patients (71%) had an emergency caesarean delivery due to maternal respiratory failure. Pregnancy was independently associated with higher viral load (-4.6 ± 1.9 cycle threshold; <em>P</em> &lt; 0.05). No clustering or over-represented mutations were noted regarding SARS-CoV-2 sequences of pregnant women. Emergency caesarean delivery was independently associated with a modest but significant improvement in arterial oxygenation, amounting to 32 ± 12 mmHg in patients needing invasive mechanical ventilation. ICU mortality was significantly lower in pregnant patients (0 <em>v</em> 35%; <em>P</em> &lt; 0.05). Age, Simplified Acute Physiology Score (SAPS) II score, and acute respiratory distress syndrome were independent risk factors for ICU mortality, while pregnancy status and virological variables were not.</p><p><strong>Conclusions:</strong> Viral load was substantially higher in pregnant ICU patients with COVID-19 and ARF compared with non-pregnant ICU patients with COVID-19 and ARF. Pregnancy was not independently associated with ICU mortality after adjustment for age and disease severity.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"24 3","pages":"Pages 242-250"},"PeriodicalIF":2.9,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000522/pdfft?md5=49a5cc3dcca58584edadc7a6c84a3015&pid=1-s2.0-S1441277223000522-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136705760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
One-hour plasma glucose level after a 75 g oral glucose load and its relationship to gastric emptying in survivors of critical illness and stress hyperglycaemia 危重疾病和应激性高血糖患者口服葡萄糖负荷75 g后1小时血糖水平及其与胃排空的关系
IF 2.9 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2022-09-05 DOI: 10.51893/2022.3.OA6
Ryan J. Jalleh , Cong Xie , Adam M. Deane , Mark P. Plummer , Karen L. Jones , Michael Horowitz , Palash Kar

Objective: A 1-hour plasma glucose level ≥ 8.6 mmol/L in a 75 g oral glucose tolerance test has been strongly associated with increased morbidity and mortality in outpatients without diabetes. Our primary aim was to evaluate the 1-hour plasma glucose level in a 75 g glucose tolerance test in survivors of critical illness with stress hyperglycaemia at 3 months after intensive care unit (ICU) discharge, with the secondary aims to evaluate the 2-hour plasma glucose level, glycated haemoglobin (HbA1c), and gastric emptying.

Design:Post hoc analysis of a single-centre, prospective cohort study.

Setting: Single-centre, tertiary referral, mixed medical-surgical ICU.

Participants: Consecutively admitted patients aged ≥ 18 years who developed stress hyperglycaemia and survived to hospital discharge were eligible.

Interventions: Participants returned at 3 months after ICU discharge and underwent a 75 g oral glucose tolerance test.

Main outcome measures: One- and 2-hour post load plasma glucose level, HbA1c, and assessment of gastric emptying via an isotope breath test.

Results: Thirty-five patients (12 females; mean age, 58.5 years [SD, 10.5]; mean HbA1c, 37.4 mmol/mol [SD, 7.0]) attended the followup. In 32/35 patients (91%) the 1-hour post load plasma glucose level was ≥ 8.6 mmol/L. There was a positive correlation between the plasma glucose level at 1 hour (r2 = 0.21; P = 0.006), but no correlation between the 2-hour glucose level (r2 = 0.006; P = 0.63) and gastric emptying.

Conclusion: Glucose intolerance, when defined as 1-hour glucose level ≥ 8.6 mmol/L following a 75 g oral glucose load, persists at 3 months in most survivors of stress hyperglycaemia and is dependent on the rate of gastric emptying. Longitudinal studies to characterise mechanisms underlying dysglycaemia and progression to diabetes in individuals with stress hyperglycaemia are indicated.

目的:在75 g口服葡萄糖耐量试验中,1小时血浆葡萄糖水平≥8.6 mmol/L与非糖尿病门诊患者发病率和死亡率增加密切相关。我们的主要目的是评估重症监护病房(ICU)出院后3个月伴有应激性高血糖的危重疾病幸存者的75 g葡萄糖耐量试验中1小时血糖水平,次要目的是评估2小时血糖水平、糖化血红蛋白(HbA1c)和胃排空。设计:单中心前瞻性队列研究的事后分析。环境:单中心,三级转诊,混合内科-外科ICU。受试者:年龄≥18岁的连续入院患者,发生应激性高血糖并存活至出院。干预措施:参与者在ICU出院3个月后返回,并进行75 g口服葡萄糖耐量试验。主要结局指标:负荷后1小时和2小时血浆葡萄糖水平、HbA1c,并通过同位素呼吸试验评估胃排空。结果:35例患者(女性12例;平均年龄58.5岁[SD, 10.5];平均HbA1c为37.4 mmol/mol [SD, 7.0])参加了随访。32/35例(91%)患者负荷后1小时血糖≥8.6 mmol/L。1 h时血糖水平与对照组呈正相关(r2 = 0.21;P = 0.006),但与2小时血糖水平无相关性(r2 = 0.006;P = 0.63)和胃排空。结论:葡萄糖耐受不良,定义为口服75 g葡萄糖负荷后1小时葡萄糖水平≥8.6 mmol/L,在大多数应激性高血糖幸存者中持续3个月,并依赖于胃排空率。纵向研究,以表征机制的血糖异常和进展为糖尿病的个体与应激性高血糖。
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引用次数: 0
In this Issue of CCR 在本期的CCR中
IF 2.9 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2022-09-05 DOI: 10.51893/2022.3.ITI
Rinaldo Bellomo (Editor-in-Chief)
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引用次数: 0
Reflections on Australian critical care echocardiography 澳大利亚重症监护超声心动图的思考
IF 2.9 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2022-09-05 DOI: 10.51893/2022.3.SA2
Konstantin Yastrebov , Anthony McLean , Andrew Hilton , John Evans
The four authors of this article share a combined century of experience in critical care echocardiography (CCE). Having seen its birth, adolescence and subsequent maturity, it is with considerable interest that we anticipate further evolution of its everyday clinical application, and can only guess at how the next generation’s energy and interests will be directed. Trained to intervene when a patient’s physiology becomes unstable, intensivists search for effective strategies to tackle acute problems while simultaneously considering complex underlying chronic ailments. Echocardiography is a valuable tool for the diagnosis and monitoring of a patient’s response, or perhaps lack of response, to our interventions. The evolution of critical care echocardiography from being an outcast to that of a mainstream “darling” over the past 30 years led us to give a personal perspective on this journey.
这篇文章的四位作者分享了一个世纪以来在重症监护超声心动图(CCE)方面的经验。在目睹了它的诞生、青春期和随后的成熟之后,我们怀着极大的兴趣期待着它日常临床应用的进一步发展,并且只能猜测下一代的精力和兴趣将如何发挥。强化医生接受过在患者生理不稳定时进行干预的培训,他们寻找有效的策略来解决急性问题,同时考虑复杂的潜在慢性疾病。超声心动图是诊断和监测患者对我们的干预措施的反应或可能缺乏反应的有价值的工具。在过去的30年里,重症监护超声心动图从一个被排斥的人演变成了一个主流的“宠儿”,这让我们对这段旅程有了个人的看法。
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引用次数: 1
The Australasian ANZSCTS/ANZICS guidelines on cardiothoracic advanced life support (CALS-ANZ) 澳大利亚ANZSCTS/ANZICS心肺高级生命支持指南(CALS-ANZ)
IF 2.9 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2022-09-05 DOI: 10.51893/2022.3.SA3
Christian Karcher , Craig Jurisevic , Tim Southwood , David McCormack , Amy Rogers , Adrian Levine , Joel Dunning
Every year, more than 15 000 patients undergo cardiac surgery in Australia and NewZealand. 1 The overall incidence of cardiac arrest after cardiac surgery is between 0.7% and5.2%. 2, 3, 4, 5, 6 Most cardiac arrests occur within 24 hours of surgery, with up to 50% occurring in the first 3 hours following intensive care unit (ICU)admission. 2, 7 Compared with other in-hospital cardiac arrests, survival in this patient population is high (75% v 39%). 2, 8 The reasons for this include the high degree of cardiac monitoring; a high proportion of reversible causes, such as pericardial tamponade or haemorrhage, and the effects of internal cardiacmassage. 9, 10, 11 The application of standard advanced life support protocols in post-surgical cardiothoracic patients may lead to avoidable adverse events, and hence, specific resuscitation protocols have been developed and established in Europe and NorthAmerica. 12
在澳大利亚和新西兰,每年有超过15000名患者接受心脏手术。1心脏手术后心脏骤停的总发生率在0.7%至5.2%之间。2,3,4,5,6大多数心脏骤停发生在手术后24小时内,高达50%发生在重症监护室(ICU)入院后的前3小时。2,7与其他住院心脏骤停患者相比,该患者群体的存活率较高(75%对39%)。2,8造成这种情况的原因包括高度的心脏监测;高比例的可逆原因,如心包填塞或出血,以及内部心脏穿刺的影响。9,10,11标准高级生命支持方案在心胸外科手术后患者中的应用可能会导致可避免的不良事件,因此,欧洲和北美已经制定并建立了特定的复苏方案。12
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引用次数: 0
The relationship between plasma cystatin C, mortality and acute respiratory distress syndrome subphenotype in the HARP-2 trial HARP-2试验中血浆胱抑素C、死亡率与急性呼吸窘迫综合征亚表型的关系
IF 2.9 4区 医学 Q3 CRITICAL CARE MEDICINE Pub Date : 2022-09-05 DOI: 10.51893/2022.3.OA4
Michael C. McKelvey , Ian Bradbury , Cliona McDowell , Carolyn S. Calfee , Sinead Weldon , Cecilia M. O'Kane , Daniel F. McAuley , Clifford C. Taggart

Objective: To evaluate the performance of cystatin C as a prognostic and predictive marker in a trial of patients with acute respiratory distress syndrome (ARDS).

Design, patients and setting: A retrospective analysis was performed on plasma samples from patients included in the HARP-2 (hydroxymethylglutaryl-CoA reductase inhibition with simvastatin in acute lung injury to reduce pulmonary dysfunction) trial — a multicentre, phase 2b trial carried out in general intensive care units across 40 hospitals in the United Kingdom and Ireland. Cystatin C concentrations in plasma obtained from 466 patients with ARDS (before they were randomly assigned in the trial) were quantified by ELISA (enzyme-linked immunosorbent assay).

Results: In a univariate analysis, plasma cystatin C concentrations were significantly higher in patients with ARDS who did not survive past 28 days (odds ratio [OR], 1.39 [95% CI, 1.12–1.72]; P = 0.002). In a multivariate model adjusted for selected covariates, cystatin C concentrations remained higher among patients with ARDS who did not survive, although this did not reach statistical significance (OR, 1.28 [95% CI, 0.96–1.71]; P = 0.090). Cystatin C concentration was also significantly associated with hyperinflammatory ARDS (OR, 2.64 [95% CI, 1.83–3.89]; P < 0.001). In multivariate models adjusted for both cystatin C concentration and ARDS subphenotype, hyperinflammatory ARDS was prognostic for mortality (OR, 2.06 [95% CI, 1.16–3.64]; P = 0.013) but cystatin C concentration was not (OR, 1.16 [95% CI, 0.85–1.57]; P = 0.346). In a multivariate analysis, hyperinflammatory ARDS was predictive of a beneficial effect of simvastatin on mortality (OR, 2.05 [95% CI, 1.16–3.62]; P = 0.014) but cystatin C concentration was not (OR, 1.10 [95% CI, 0.77–1.56]; P = 0.614).

Conclusion: The association between cystatin C concentration and mortality in ARDS may be dependent on inflammatory subphenotype. Cystatin C concentration does not appear to add to existing prognostic or predictive approaches.

目的:评价胱抑素C作为急性呼吸窘迫综合征(ARDS)患者预后和预测指标的作用。设计、患者和环境:对HARP-2(辛伐他汀抑制急性肺损伤羟甲基戊二酰辅酶A还原酶以减少肺功能障碍)试验中患者的血浆样本进行了回顾性分析。HARP-2是一项多中心2b期试验,在英国和爱尔兰40家医院的普通重症监护室进行。采用酶联免疫吸附测定法(ELISA)对466例急性呼吸窘迫综合征患者血浆胱抑素C浓度进行定量分析。结果:在单因素分析中,急性呼吸窘迫综合征(ARDS)患者存活时间超过28天的血浆胱抑素C浓度显著较高(优势比[OR], 1.39 [95% CI, 1.12-1.72];P = 0.002)。在对所选协变量进行调整的多变量模型中,未存活的ARDS患者胱抑素C浓度仍然较高,尽管这没有达到统计学意义(OR, 1.28 [95% CI, 0.96-1.71];P = 0.090)。胱抑素C浓度也与高炎症性ARDS显著相关(OR, 2.64 [95% CI, 1.83-3.89];P & lt;0.001)。在调整了胱抑素C浓度和ARDS亚表型的多变量模型中,高炎症性ARDS是死亡率的预后因素(OR, 2.06 [95% CI, 1.16-3.64];P = 0.013),但胱抑素C浓度无统计学意义(OR, 1.16 [95% CI, 0.85-1.57];P = 0.346)。在多变量分析中,高炎症性ARDS可预测辛伐他汀对死亡率的有益影响(OR, 2.05 [95% CI, 1.16-3.62];P = 0.014),但胱抑素C浓度无统计学意义(OR, 1.10 [95% CI, 0.77-1.56];P = 0.614)。结论:急性呼吸窘迫综合征(ARDS)患者胱抑素C浓度与死亡率的关系可能与炎症亚表型有关。胱抑素C浓度似乎不会增加现有的预后或预测方法。
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Critical Care and Resuscitation
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