{"title":"In this Issue of CCR","authors":"Rinaldo Bellomo (Editor-in-Chief)","doi":"10.51893/2022.4.ITI","DOIUrl":"https://doi.org/10.51893/2022.4.ITI","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000339/pdfft?md5=fb020eb766ed3e7b93363b38a245dfa7&pid=1-s2.0-S1441277223000339-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90025219","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}
Background: Acute respiratory distress syndrome (ARDS) occurs commonly in intensive care units. The reported mortality rates in studies evaluating ARDS are highly variable.
Objective: To investigate mortality rates due to ARDS from before the 2009 H1N1 influenza pandemic began until the start of coronavirus disease 2019 (COVID-19) pandemic.
Design: We performed a systematic search and then ran a proportional meta-analysis for mortality. We ran our analysis in three ways: for randomised controlled trials only, for observational studies only, and for randomised controlled trials and observational studies combined.
Data sources: MEDLINE and Embase, using a highly sensitive criterion and limiting the search to studies published from January 2009 to December 2019.
Review methods: Two of us independently screened titles and abstracts to first identify studies and then complete full text reviews of selected studies. We assessed risk of bias using the Cochrane RoB-2 (a risk-of-bias tool for randomised trials) and the Cochrane ROBINS-1 (a risk-of-bias tool for non-randomised studies of interventions).
Results: We screened 5844 citations, of which 102 fully met our inclusion criteria. These included 34 randomised controlled trials and 68 observational studies, with a total of 24 158 patients. The weighted pooled mortality rate for all 102 studies published from 2009 to 2019 was 39.4% (95% CI, 37.0–41.8%). Mortality was higher in observational studies compared with randomised controlled trials (41.8% [95% CI, 38.9–44.8%] v 34.5% [95% CI, 30.6–38.5%]; P = 0.005).
Conclusions: Over the past decade, mortality rates due to ARDS were high. There is a clear distinction between mortality in observational studies and in randomised controlled trials. Future studies need to report mortality for different ARDS phenotypes and closely adhere to evidence-based medicine.
{"title":"Mortality associated with acute respiratory distress syndrome, 2009-2019: a systematic review and meta-analysis","authors":"Divyajot Sadana , Simrat Kaur , Kesavan Sankaramangalam , Ishan Saini , Kinjal Banerjee , Matthew Siuba , Valentina Amaral , Shruti Gadre , Heather Torbic , Sudhir Krishnan , Abhijit Duggal","doi":"10.51893/2022.4.OA4","DOIUrl":"10.51893/2022.4.OA4","url":null,"abstract":"<div><p><strong>Background:</strong> Acute respiratory distress syndrome (ARDS) occurs commonly in intensive care units. The reported mortality rates in studies evaluating ARDS are highly variable.</p><p><strong>Objective:</strong> To investigate mortality rates due to ARDS from before the 2009 H1N1 influenza pandemic began until the start of coronavirus disease 2019 (COVID-19) pandemic.</p><p><strong>Design:</strong> We performed a systematic search and then ran a proportional meta-analysis for mortality. We ran our analysis in three ways: for randomised controlled trials only, for observational studies only, and for randomised controlled trials and observational studies combined.</p><p><strong>Data sources:</strong> MEDLINE and Embase, using a highly sensitive criterion and limiting the search to studies published from January 2009 to December 2019.</p><p><strong>Review methods:</strong> Two of us independently screened titles and abstracts to first identify studies and then complete full text reviews of selected studies. We assessed risk of bias using the Cochrane RoB-2 (a risk-of-bias tool for randomised trials) and the Cochrane ROBINS-1 (a risk-of-bias tool for non-randomised studies of interventions).</p><p><strong>Results:</strong> We screened 5844 citations, of which 102 fully met our inclusion criteria. These included 34 randomised controlled trials and 68 observational studies, with a total of 24 158 patients. The weighted pooled mortality rate for all 102 studies published from 2009 to 2019 was 39.4% (95% CI, 37.0–41.8%). Mortality was higher in observational studies compared with randomised controlled trials (41.8% [95% CI, 38.9–44.8%] <em>v</em> 34.5% [95% CI, 30.6–38.5%]; <em>P</em> = 0.005).</p><p><strong>Conclusions:</strong> Over the past decade, mortality rates due to ARDS were high. There is a clear distinction between mortality in observational studies and in randomised controlled trials. Future studies need to report mortality for different ARDS phenotypes and closely adhere to evidence-based medicine.</p><p><strong>PROSPERO registration:</strong> CRD42020149712 (April 2020).</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000406/pdfft?md5=2ced95a89cd7f28d3b50d590ca66fd16&pid=1-s2.0-S1441277223000406-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42669568","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}
Casamento A and Niccol T. Efficacy and safety of ketamine in mechanically ventilated intensive care unit patients: a scoping review (erratum). Crit Care Resusc 2022; 24 (2): 195-195; https://doi.org/10.51893/2022.2.L The authors wish to correct an error in the recently published erratum letter. In the introductory paragraph, “……. a further two randomised controlled trials comparing fentanyl with placebo in mechanically ventilated Intensive Care Unit (ICU) patients have come to our attention.” should read: “……. a further two randomised controlled trials comparing ketamine with placebo in mechanically ventilated Intensive Care Unit (ICU) patients have come to our attention.”
{"title":"Erratum 1","authors":"Andrew Casamento, Thomas Niccol","doi":"10.51893/2022.2.le","DOIUrl":"https://doi.org/10.51893/2022.2.le","url":null,"abstract":"Casamento A and Niccol T. Efficacy and safety of ketamine in mechanically ventilated intensive care unit patients: a scoping review (erratum). Crit Care Resusc 2022; 24 (2): 195-195; https://doi.org/10.51893/2022.2.L The authors wish to correct an error in the recently published erratum letter. In the introductory paragraph, “……. a further two randomised controlled trials comparing fentanyl with placebo in mechanically ventilated Intensive Care Unit (ICU) patients have come to our attention.” should read: “……. a further two randomised controlled trials comparing ketamine with placebo in mechanically ventilated Intensive Care Unit (ICU) patients have come to our attention.”","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43237595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Conditions associated with circulatory disturbance are common causes of admission to the intensive care unit (ICU)1 as well as clinical deterioration after admission has occurred. Accordingly, it is important for ICU clinicians to have a thorough knowledge of the causes of circulatory failure and an approach to assessing them. Circulatory conditions are also a common cause of clinical deterioration in hospital ward.
{"title":"A four-step model to aid teaching, clinical assessment and communication of circulatory disorders among junior clinicians","authors":"Daryl Jones , Paula Carty , Dharshi Karalapillai","doi":"10.51893/2022.4.POV","DOIUrl":"10.51893/2022.4.POV","url":null,"abstract":"Conditions associated with circulatory disturbance are common causes of admission to the intensive care unit (ICU)1 as well as clinical deterioration after admission has occurred. Accordingly, it is important for ICU clinicians to have a thorough knowledge of the causes of circulatory failure and an approach to assessing them. Circulatory conditions are also a common cause of clinical deterioration in hospital ward.","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000340/pdfft?md5=0b2ba441eac0d6ddffe31b603e79a679&pid=1-s2.0-S1441277223000340-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41735060","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}
Pub Date : 2022-10-05DOI: 10.1101/2022.10.03.22280567
O. P. Frota, J. N. Pinho, M. A. Ferreira-Júnior, Elaine Cristina Fernandes Baez Sarti, Fabiana M. Paula, D. N. Ferreira
Aim: To investigate the incidence and risk factors for medical adhesive-related skin injury (MARSI) in catheters of critically ill patients. Methods: A prospective cohort study was conducted in adult intensive care units of two Brazilian university hospitals. A total of 150 patients (439 catheters) were included. Skin exposed to the catheter fixation adhesives (central venous, nasogastric, nasoenteral and indwelling urinary) was examined daily by four trained researchers. The patients sociodemographic and clinical data were collected from their electronic medical records. The association between independent variables and MARSI was investigated by bivariate statistics, followed by multiple logistic regression. Results: The MARSI incidence was 42% (8.64 MARSIs per 100 patients/day). Advanced age, prolonged hospital stay, dry skin, repetitive adhesive removal, low Braden Scale score and hypoalbuminemia were associated with MARSI (p < .05). According to multivariate logistic regression, dry skin increased the chance of MARSI by 5.21 times (odds ratio [OR] 5.21; 95% confidence interval [95% CI] 2.43-11.11), while the Braden Scale score was a protective factor, showing 31% less chance of MARSI for each added score (OR 0.69; 95% CI 0.57-0.85). A higher incidence of MARSI was observed in nasoenteral catheters and in those fixed with adhesive using natural rubber. The MARSI types were predominantly mechanical (70.3%): skin stripping (41.3%), skin tear (26.1%) and tension injury or blister (2.9%). Conclusions: MARSI is a common event in adult intensive care units and most risk factors are modifiable. Preventive actions are potentially capable of reducing incidence, optimizing financial resources and improving clinical results.
目的:探讨危重患者导管内医用粘胶性皮肤损伤(MARSI)的发生率及危险因素。方法:在巴西两所大学医院的成人重症监护病房进行前瞻性队列研究。共纳入150例患者(439根导管)。每天由四名训练有素的研究人员检查暴露于导管固定粘合剂(中心静脉,鼻胃,鼻肠和留置尿)的皮肤。从电子病历中收集患者的社会人口学和临床资料。采用双变量统计和多元逻辑回归分析自变量与MARSI之间的关系。结果:MARSI发生率为42%(每100例患者/天8.64例MARSI)。高龄、住院时间延长、皮肤干燥、反复去除粘接剂、布雷登量表评分低和低白蛋白血症与MARSI相关(p < 0.05)。根据多因素logistic回归,皮肤干燥使MARSI的几率增加5.21倍(优势比[OR] 5.21;95%可信区间[95% CI] 2.43-11.11),而布雷登量表评分是一个保护因素,每增加一分,MARSI的可能性降低31% (OR 0.69;95% ci 0.57-0.85)。在鼻肠导管和用天然橡胶粘接剂固定的导管中观察到较高的MARSI发生率。MARSI类型主要为机械性(70.3%):皮肤剥离(41.3%)、皮肤撕裂(26.1%)和张力损伤或水疱(2.9%)。结论:MARSI是成人重症监护病房的常见事件,大多数危险因素是可以改变的。预防行动有可能降低发病率、优化财政资源和改善临床结果。
{"title":"Incidence and risk factors for medical adhesive-related skin injury in catheters of critically ill patients: A prospective cohort study","authors":"O. P. Frota, J. N. Pinho, M. A. Ferreira-Júnior, Elaine Cristina Fernandes Baez Sarti, Fabiana M. Paula, D. N. Ferreira","doi":"10.1101/2022.10.03.22280567","DOIUrl":"https://doi.org/10.1101/2022.10.03.22280567","url":null,"abstract":"Aim: To investigate the incidence and risk factors for medical adhesive-related skin injury (MARSI) in catheters of critically ill patients. Methods: A prospective cohort study was conducted in adult intensive care units of two Brazilian university hospitals. A total of 150 patients (439 catheters) were included. Skin exposed to the catheter fixation adhesives (central venous, nasogastric, nasoenteral and indwelling urinary) was examined daily by four trained researchers. The patients sociodemographic and clinical data were collected from their electronic medical records. The association between independent variables and MARSI was investigated by bivariate statistics, followed by multiple logistic regression. Results: The MARSI incidence was 42% (8.64 MARSIs per 100 patients/day). Advanced age, prolonged hospital stay, dry skin, repetitive adhesive removal, low Braden Scale score and hypoalbuminemia were associated with MARSI (p < .05). According to multivariate logistic regression, dry skin increased the chance of MARSI by 5.21 times (odds ratio [OR] 5.21; 95% confidence interval [95% CI] 2.43-11.11), while the Braden Scale score was a protective factor, showing 31% less chance of MARSI for each added score (OR 0.69; 95% CI 0.57-0.85). A higher incidence of MARSI was observed in nasoenteral catheters and in those fixed with adhesive using natural rubber. The MARSI types were predominantly mechanical (70.3%): skin stripping (41.3%), skin tear (26.1%) and tension injury or blister (2.9%). Conclusions: MARSI is a common event in adult intensive care units and most risk factors are modifiable. Preventive actions are potentially capable of reducing incidence, optimizing financial resources and improving clinical results.","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83459812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Improving capacity to conduct observational studies in Australian and New Zealand ICUs","authors":"Daryl Jones , Glenn Eastwood , Carol Hodgson","doi":"10.51893/2022.3.L","DOIUrl":"10.51893/2022.3.L","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000583/pdfft?md5=e42c7ed56e8fcc23d7e9a6239be365d9&pid=1-s2.0-S1441277223000583-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43243431","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}
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.
{"title":"Pain assessment and analgesic management in patients admitted to intensive care: an Australian and New Zealand point prevalence study","authors":"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","doi":"10.51893/2022.3.OA1","DOIUrl":"10.51893/2022.3.OA1","url":null,"abstract":"<div><p><strong>Objective:</strong> To describe pain assessment and analgesic management practices in patients in intensive care units (ICUs) in Australia and New Zealand.</p><p><strong>Design, setting and participants:</strong> 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.</p><p><strong>Main outcome measures:</strong> 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.</p><p><strong>Results:</strong> 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%).</p><p><strong>Conclusions:</strong> 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.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000509/pdfft?md5=864a70ce1d359a096f829edce90c2071&pid=1-s2.0-S1441277223000509-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42979209","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}
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.
{"title":"Prevalence, features and workplace factors associated with burnout among intensivists in Australia and New Zealand","authors":"Shona Mair , Liz Crowe , Mark Nicholls , Siva Senthuran , Kristen Gibbons , Daryl Jones","doi":"10.51893/2022.3.OA8","DOIUrl":"https://doi.org/10.51893/2022.3.OA8","url":null,"abstract":"<div><p><strong>Objectives:</strong> 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.</p><p><strong>Methods:</strong> 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 <em>a priori</em> and assessed using a five-point Likert scale. Thematic analysis was conducted on an open-ended question on workplace stressors.</p><p><strong>Results:</strong> 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%).</p><p><strong>Conclusion:</strong> 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.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000571/pdfft?md5=958b6f6067cfe235c4067dee5ae60ed5&pid=1-s2.0-S1441277223000571-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136705259","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}
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.
{"title":"The relationship between commencement of continuous renal replacement therapy and urine output, fluid balance, mean arterial pressure and vasopressor dose","authors":"Benjamin Sansom , Gina Tonkin-Hill , Stefanie Kalfas , Seunga Park , Jeffrey Presneill , Rinaldo Bellomo","doi":"10.51893/2022.3.OA5","DOIUrl":"https://doi.org/10.51893/2022.3.OA5","url":null,"abstract":"<div><p><strong>Background and objectives:</strong> 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.</p><p><strong>Design:</strong> Retrospective cohort study using data from existing databases and CRRT machines.</p><p><strong>Setting:</strong> Medical and surgical ICUs at a single university-associated centre.</p><p><strong>Participants:</strong> Patients undergoing CRRT between 2015 and 2018.</p><p><strong>Main outcome measures:</strong> 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.</p><p><strong>Results:</strong> 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.</p><p><strong>Conclusions:</strong> 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.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223000546/pdfft?md5=f46b7a1cb850596a8ff40ba544735c79&pid=1-s2.0-S1441277223000546-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136705761","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}
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.
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.
{"title":"Virological and clinical features of acute respiratory failure associated with COVID-19 in pregnancy: a case-control study","authors":"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","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> < 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> < 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":null,"pages":null},"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}