Pub Date : 2025-10-17DOI: 10.1016/j.ccrj.2025.100118
John D. Santamaria MBBS, MD , Ebony Selers MD , David Reid
Objective
Hyperglycaemia requiring insulin infusions is common among critically ill patients. Attempts to tightly control glucose levels in the intensive care unit (ICU) have had mixed results partly due to hypoglycaemia. Continuous glucose monitoring (CGM) has been widely adopted among ambulatory persons with diabetes but tested only on small numbers of patients in the ICU. This study was undertaken to address the accuracy of CGM in a group of critically ill patients.
Setting and outcomes
This observational study included critically ill ICU patients admitted between 2019 and 2023 to a tertiary referral, university-affiliated hospital with a single 19-bed ICU. Patients requiring insulin to control hyperglycaemia had a sensor (Dexcom G4 or G6) attached. Accuracy was assessed as bias and mean absolute relative difference (MARD). Results are presented as median (interquartile range).
Results
103 patients were assessed. The majority (97%) were mechanically ventilated and on vasopressors (92%), and a quarter required renal replacement therapy. Men comprised 68% of the cohort; median age was 63 years, and body mass index was 29.8. Sensors were applied for 79.5 (48–160) hours. The median bias was −0.30 mmol/L (−0.55, 0.05), and MARD was 11.23 (8.10–15.03). No clinical hypoglycaemia occurred with sensors in place.
Conclusion
In 103 patients with multiorgan failure on insulin for hyperglycaemia, CGM had acceptable bias and MARD and no hypoglycaemia. Given the accuracy seen in this trial, CGM could be considered in future trials of glucose management and used as a safety measure to reduce hypoglycaemic events.
Cinical trials registration
The study was not registered with the Australian and New Zealand Clinical Trials Registry).
{"title":"Accuracy of continuous glucose monitoring in critically ill patients","authors":"John D. Santamaria MBBS, MD , Ebony Selers MD , David Reid","doi":"10.1016/j.ccrj.2025.100118","DOIUrl":"10.1016/j.ccrj.2025.100118","url":null,"abstract":"<div><h3>Objective</h3><div>Hyperglycaemia requiring insulin infusions is common among critically ill patients. Attempts to tightly control glucose levels in the intensive care unit (ICU) have had mixed results partly due to hypoglycaemia. Continuous glucose monitoring (CGM) has been widely adopted among ambulatory persons with diabetes but tested only on small numbers of patients in the ICU. This study was undertaken to address the accuracy of CGM in a group of critically ill patients.</div></div><div><h3>Setting and outcomes</h3><div>This observational study included critically ill ICU patients admitted between 2019 and 2023 to a tertiary referral, university-affiliated hospital with a single 19-bed ICU. Patients requiring insulin to control hyperglycaemia had a sensor (Dexcom G4 or G6) attached. Accuracy was assessed as bias and mean absolute relative difference (MARD). Results are presented as median (interquartile range).</div></div><div><h3>Results</h3><div>103 patients were assessed. The majority (97%) were mechanically ventilated and on vasopressors (92%), and a quarter required renal replacement therapy. Men comprised 68% of the cohort; median age was 63 years, and body mass index was 29.8. Sensors were applied for 79.5 (48–160) hours. The median bias was −0.30 mmol/L (−0.55, 0.05), and MARD was 11.23 (8.10–15.03). No clinical hypoglycaemia occurred with sensors in place.</div></div><div><h3>Conclusion</h3><div>In 103 patients with multiorgan failure on insulin for hyperglycaemia, CGM had acceptable bias and MARD and no hypoglycaemia. Given the accuracy seen in this trial, CGM could be considered in future trials of glucose management and used as a safety measure to reduce hypoglycaemic events.</div></div><div><h3>Cinical trials registration</h3><div>The study was not registered with the Australian and New Zealand Clinical Trials Registry).</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 4","pages":"Article 100118"},"PeriodicalIF":1.7,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324266","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}
Pub Date : 2025-10-16DOI: 10.1016/j.ccrj.2025.100136
Maria de Freitas BM BS, BSc, BMedSci, Lucinda Roberts MBBS, Alexandra Cockroft MBChB, BSc, Graeme Duke MBBS, MD, FCICM, FANZCA
Objective
Evaluate the quality of documentation and delivery of EOLC in the Intensive Care Unit (ICU) during the COVID-19 pandemic and compare with a pre-pandemic audit.
Design
Retrospective clinical audit of medical records of patients who died in ICU during the COVID-19 pandemic, January 2021 to February 2022, using the Documentation and Evaluation of Care of Dying Equation (DECODE) survey tool.
Setting
Three metropolitan adult ICUs in Victoria, Australia.
Main outcomes
DECODE audit score, patient characteristics, demographics, end of life planning, quality of death indicators, management of dying.
Results
There were 194 deaths over a 14-month period. 2 cases were excluded. Patients wishes were documented in 83 (43%) cases. A total of 175 patients (91%) were receiving active treatment 24 h before death. A total of 166 deaths (86%) were expected and occurred a mean of 4.5 (IQR 2-9) days from admission to ICU. A total of 52 (27%) had palliative or symptom control care plans. The median DECODE score was 14 (IQR 12-15) with statistical variation across the three sites (p=0.001). Compared to pre pandemic audits, the DECODE score was higher (p=0.001) despite pandemic restrictions.
Conclusion
EOLC in ICU remains challenging due to diagnostic dilemmas, prognostic uncertainty, and short time-frames. Assessment of quality of EoLC care helps assess and possibly improve provision of care. The DECODE questionnaire provides a semi-objective measure of quality of care provided to the dying patient in ICU.
{"title":"Documentation and evaluation of care of dying patients","authors":"Maria de Freitas BM BS, BSc, BMedSci, Lucinda Roberts MBBS, Alexandra Cockroft MBChB, BSc, Graeme Duke MBBS, MD, FCICM, FANZCA","doi":"10.1016/j.ccrj.2025.100136","DOIUrl":"10.1016/j.ccrj.2025.100136","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate the quality of documentation and delivery of EOLC in the Intensive Care Unit (ICU) during the COVID-19 pandemic and compare with a pre-pandemic audit.</div></div><div><h3>Design</h3><div>Retrospective clinical audit of medical records of patients who died in ICU during the COVID-19 pandemic, January 2021 to February 2022, using the Documentation and Evaluation of Care of Dying Equation (DECODE) survey tool.</div></div><div><h3>Setting</h3><div>Three metropolitan adult ICUs in Victoria, Australia.</div></div><div><h3>Main outcomes</h3><div>DECODE audit score, patient characteristics, demographics, end of life planning, quality of death indicators, management of dying.</div></div><div><h3>Results</h3><div>There were 194 deaths over a 14-month period. 2 cases were excluded. Patients wishes were documented in 83 (43%) cases. A total of 175 patients (91%) were receiving active treatment 24 h before death. A total of 166 deaths (86%) were expected and occurred a mean of 4.5 (IQR 2-9) days from admission to ICU. A total of 52 (27%) had palliative or symptom control care plans. The median DECODE score was 14 (IQR 12-15) with statistical variation across the three sites (<em>p=0.001</em>). Compared to pre pandemic audits, the DECODE score was higher (<em>p=0.001</em>) despite pandemic restrictions.</div></div><div><h3>Conclusion</h3><div>EOLC in ICU remains challenging due to diagnostic dilemmas, prognostic uncertainty, and short time-frames. Assessment of quality of EoLC care helps assess and possibly improve provision of care. The DECODE questionnaire provides a semi-objective measure of quality of care provided to the dying patient in ICU.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 4","pages":"Article 100136"},"PeriodicalIF":1.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324280","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}
To determine whether type of consent model was associated with recruitment rate in critical care randomised clinical trials (RCT).
Data sources
PubMed was searched for relevant articles.
Study selection
Individual patient RCTs in critical care with a primary outcome of mortality published between 1990 and 2020 were included.
Data extraction
Two authors independently reviewed titles, abstracts, and full-text articles for eligibility, and data was entered into a structured custom database.
Data synthesis
186 RCTs were included, of which 141(75.8%) used a priori consent, while 45 (24.2%) used alternative consent models, including consent waiver and consent-to-continue. The alternate consent RCTs recruited significantly larger sample sizes (median 680 patients, IQR 300–2410) compared to the a priori group (350 patients, IQR 118–725) over similar recruitment periods (mean 3.06 years for both). The unadjusted mean weekly recruitment rate was significantly higher in the alternate consent group (mean difference +8.57 patients per week, 95% CI: 5.02–12.12). After adjustment for number of recruiting sites, diagnostic group of patients included, intervention type, investigator-initiated trial, and continent of primary trial sponsor, the alternate consent group still had a significantly higher mean weekly recruitment rate (mean difference +6.78 patients per week, 95% CI, 3.30–10.26). The proportion of RCTs that were ceased early and that reached target recruitment were similar between the two groups, as were rates of withdrawn consent.
Conclusion
Alternate consent models for critical care RCTs were associated with higher recruitment rates compared to a priori consent. A study-within-a-trial analysis may be required for definitive evaluation.
{"title":"The influence of consent models on recruitment rates in randomised trials in critical care: A systematic review","authors":"Mahesh Ramanan FCICM PhD , Aashish Kumar FCICM MBBS , Laurent Billot AStat MRes , John Myburgh FCICM PhD , Balasubramanian Venkatesh FCICM MD","doi":"10.1016/j.ccrj.2025.100119","DOIUrl":"10.1016/j.ccrj.2025.100119","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine whether type of consent model was associated with recruitment rate in critical care randomised clinical trials (RCT).</div></div><div><h3>Data sources</h3><div>PubMed was searched for relevant articles.</div></div><div><h3>Study selection</h3><div>Individual patient RCTs in critical care with a primary outcome of mortality published between 1990 and 2020 were included.</div></div><div><h3>Data extraction</h3><div>Two authors independently reviewed titles, abstracts, and full-text articles for eligibility, and data was entered into a structured custom database.</div></div><div><h3>Data synthesis</h3><div>186 RCTs were included, of which 141(75.8%) used <em>a priori</em> consent, while 45 (24.2%) used alternative consent models, including consent waiver and consent-to-continue. The alternate consent RCTs recruited significantly larger sample sizes (median 680 patients, IQR 300–2410) compared to the <em>a priori</em> group (350 patients, IQR 118–725) over similar recruitment periods (mean 3.06 years for both). The unadjusted mean weekly recruitment rate was significantly higher in the alternate consent group (mean difference +8.57 patients per week, 95% CI: 5.02–12.12). After adjustment for number of recruiting sites, diagnostic group of patients included, intervention type, investigator-initiated trial, and continent of primary trial sponsor, the alternate consent group still had a significantly higher mean weekly recruitment rate (mean difference +6.78 patients per week, 95% CI, 3.30–10.26). The proportion of RCTs that were ceased early and that reached target recruitment were similar between the two groups, as were rates of withdrawn consent.</div></div><div><h3>Conclusion</h3><div>Alternate consent models for critical care RCTs were associated with higher recruitment rates compared to <em>a priori</em> consent. A study-within-a-trial analysis may be required for definitive evaluation.</div></div><div><h3>Registration</h3><div>PROSPERO Record ID: Record ID: <span><span>CRD42020215950</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 4","pages":"Article 100119"},"PeriodicalIF":1.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324182","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}
Pub Date : 2025-10-16DOI: 10.1016/j.ccrj.2025.100137
R. Daltro-Oliveira MD , A. Quintairos MD, PhD , L.I.O. Santos MD , F. Amado MD , J.I.F. Salluh MD, PhD , A.P. Nassar Jr. MD, PhD
Objective
To evaluate the global distribution of original research articles in intensive care journals, analysing differences by country income level and assessing study characteristics, including type, funding, and accessibility.
Design
A retrospective bibliometric analysis of original research articles published between 2018 and 2022.
Setting
The 10 intensive care journals with the highest 2022 Impact Factors, as identified by Clarivate Analytics.
Participants
Original research articles (observational studies and randomised controlled trials) in adult intensive care, excluding paediatric and preclinical studies.
Main outcome measures
Country of affiliation of the corresponding author (classified by World Bank income level), study type, funding source, number of participating centres, open-access status, and thematic category.
Results
Among 12,441 manuscripts reviewed, we included 4982 original research articles. Of these, 4479 (89.9 %) were from high-income countries (HICs), 446 (9.0 %) from upper-middle-income countries (UMICs), 53 (1.1 %) from lower-middle-income countries (LMICs), and 4 (0.1 %) from low-income countries (LICs). Overall, 434 (8.7 %) were randomised controlled trials, with higher proportions in UMICs (13.2 %) and LMIC (20.8 %) studies compared with HICs (8.1 %). Multicenter design was reported in 44.6 % of all studies, but less frequently in UMICs (29.1 %) and LMICs (30.2 %). The median sample size was 228 patients (interquartile range, 76-1052), ranging from 231 in HICs to 211 in UMICs and 100 in LMICs. Funding was reported in 56.9 % of studies, most often from public sources. Public funding supported 28.0 % of UMICs and 9.4 % of LMICs studies, compared with 14.3 % of HIC studies. Open-access articles represented 44.8 % overall and were more common among funded studies.
Conclusions
Publications from UMICs, LMICs, and LICs remain underrepresented in high-impact intensive care journals. Structural barriers, limited funding, and potential publication bias contribute to this imbalance. Addressing these gaps requires greater funding opportunities, equitable collaborations, and stronger editorial commitment to inclusivity.
{"title":"Global disparities in scientific publications: A 5-year analysis of 10 critical care journals","authors":"R. Daltro-Oliveira MD , A. Quintairos MD, PhD , L.I.O. Santos MD , F. Amado MD , J.I.F. Salluh MD, PhD , A.P. Nassar Jr. MD, PhD","doi":"10.1016/j.ccrj.2025.100137","DOIUrl":"10.1016/j.ccrj.2025.100137","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the global distribution of original research articles in intensive care journals, analysing differences by country income level and assessing study characteristics, including type, funding, and accessibility.</div></div><div><h3>Design</h3><div>A retrospective bibliometric analysis of original research articles published between 2018 and 2022.</div></div><div><h3>Setting</h3><div>The 10 intensive care journals with the highest 2022 Impact Factors, as identified by Clarivate Analytics.</div></div><div><h3>Participants</h3><div>Original research articles (observational studies and randomised controlled trials) in adult intensive care, excluding paediatric and preclinical studies.</div></div><div><h3>Main outcome measures</h3><div>Country of affiliation of the corresponding author (classified by World Bank income level), study type, funding source, number of participating centres, open-access status, and thematic category.</div></div><div><h3>Results</h3><div>Among 12,441 manuscripts reviewed, we included 4982 original research articles. Of these, 4479 (89.9 %) were from high-income countries (HICs), 446 (9.0 %) from upper-middle-income countries (UMICs), 53 (1.1 %) from lower-middle-income countries (LMICs), and 4 (0.1 %) from low-income countries (LICs). Overall, 434 (8.7 %) were randomised controlled trials, with higher proportions in UMICs (13.2 %) and LMIC (20.8 %) studies compared with HICs (8.1 %). Multicenter design was reported in 44.6 % of all studies, but less frequently in UMICs (29.1 %) and LMICs (30.2 %). The median sample size was 228 patients (interquartile range, 76-1052), ranging from 231 in HICs to 211 in UMICs and 100 in LMICs. Funding was reported in 56.9 % of studies, most often from public sources. Public funding supported 28.0 % of UMICs and 9.4 % of LMICs studies, compared with 14.3 % of HIC studies. Open-access articles represented 44.8 % overall and were more common among funded studies.</div></div><div><h3>Conclusions</h3><div>Publications from UMICs, LMICs, and LICs remain underrepresented in high-impact intensive care journals. Structural barriers, limited funding, and potential publication bias contribute to this imbalance. Addressing these gaps requires greater funding opportunities, equitable collaborations, and stronger editorial commitment to inclusivity.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 4","pages":"Article 100137"},"PeriodicalIF":1.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324271","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}
Pub Date : 2025-10-16DOI: 10.1016/j.ccrj.2025.100135
Kyle C. White FCICM MPH , Kevin B. Laupland FCICM PhD , Manoj Saxena MBBCh PhD , Bianca Crichton BHealSc , James McCullough FCICM , Prashanti Marella FCICM , Alexis Tabah FCICM , Peter Garrett FCICM , Maneesha Tol FCICM , Antony G. Attokaran FCICM , Stephen Luke FCICM , Aashish Kumar FCICM , Sananta Dash FCICM , Sebastiaan Blank FCICM , Karthik Venkatesh FCICM , Ashwin Subramaniam FCICM PhD , Julieann Coombes PhD , Chloe Edwards BN, MPH , Paul J. Young MBChB PhD , Queensland Critical Care Research Network (QCCRN)
Objective
The purpose of this study is to examine the occurrence, characteristics, and outcomes of intensive care unit (ICU) patients with sepsis and the absence of fever.
Design
Multicentre, retrospective cohort study.
Setting
Twelve ICUs in Queensland, Australia.
Participants
Adults (≥18 years) admitted to the ICU with sepsis between 1 January 2015 and 31 December 2021 were eligible for inclusion. Patients admitted with seizures, traumatic brain injury, postcardiac arrest, end-of-life care, and elective surgery were excluded, as were readmissions.
Main outcome measures
The primary outcome was fever deficit (defined as degree-hours under 38.3°C) during the first 72 h of ICU admission, and all-cause 30-day mortality was the key secondary outcome.
Results
Of 89,117 admissions, 15,612 were included. Admission temperatures were ≥38.3°C in 1026 (6.6%), 37.5–38.2°C in 2096 (13.4%), 36–37.4°C in 9216 (59.0%), and <36°C in 3274 (21.0%). Temperatures changed rapidly over the first 12 h and, by 24 h, approached reasonably stable levels. For the admission temperature groups of ≥38.3°C, 37.5–38.2°C, 36–37.4°C, and <36°C, fever deficits were a median of 47 (interquartile range (IQR), 24 to 72), 53 (IQR, 29 to 83), 69 (IQR, 40 to 100), and 85 (IQR, 52 to 123) degree-hours, respectively, and 147 (14%), 248 (12%), 1,104 (12%), and 549 (17%) died by day 30. After controlling for confounders, a high fever deficit, defined as a fever deficit above the median, during the first 24 h of ICU admission, was not associated with all-cause 30-day mortality (OR 1.02, 95% CI, 0.93–1.13; p = 0.7).
Conclusion
Fever deficits were large, particularly when the initial body temperature was not febrile. Only 1 in 15 ICU patients with sepsis had an initial body temperature ≥38.3°C. Approximately 2000 adults a year with sepsis and an initial body temperature <37.5°C would potentially be eligible for a trial of therapeutic hyperthermia in our 12 ICUs.
{"title":"Sepsis in the absence of fever: Determining the criteria for and feasibility of future therapeutic temperature management trials","authors":"Kyle C. White FCICM MPH , Kevin B. Laupland FCICM PhD , Manoj Saxena MBBCh PhD , Bianca Crichton BHealSc , James McCullough FCICM , Prashanti Marella FCICM , Alexis Tabah FCICM , Peter Garrett FCICM , Maneesha Tol FCICM , Antony G. Attokaran FCICM , Stephen Luke FCICM , Aashish Kumar FCICM , Sananta Dash FCICM , Sebastiaan Blank FCICM , Karthik Venkatesh FCICM , Ashwin Subramaniam FCICM PhD , Julieann Coombes PhD , Chloe Edwards BN, MPH , Paul J. Young MBChB PhD , Queensland Critical Care Research Network (QCCRN)","doi":"10.1016/j.ccrj.2025.100135","DOIUrl":"10.1016/j.ccrj.2025.100135","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study is to examine the occurrence, characteristics, and outcomes of intensive care unit (ICU) patients with sepsis and the absence of fever.</div></div><div><h3>Design</h3><div>Multicentre, retrospective cohort study.</div></div><div><h3>Setting</h3><div>Twelve ICUs in Queensland, Australia.</div></div><div><h3>Participants</h3><div>Adults (≥18 years) admitted to the ICU with sepsis between 1 January 2015 and 31 December 2021 were eligible for inclusion. Patients admitted with seizures, traumatic brain injury, postcardiac arrest, end-of-life care, and elective surgery were excluded, as were readmissions.</div></div><div><h3>Main outcome measures</h3><div>The primary outcome was fever deficit (defined as degree-hours under 38.3°C) during the first 72 h of ICU admission, and all-cause 30-day mortality was the key secondary outcome.</div></div><div><h3>Results</h3><div>Of 89,117 admissions, 15,612 were included. Admission temperatures were ≥38.3°C in 1026 (6.6%), 37.5–38.2°C in 2096 (13.4%), 36–37.4°C in 9216 (59.0%), and <36°C in 3274 (21.0%). Temperatures changed rapidly over the first 12 h and, by 24 h, approached reasonably stable levels. For the admission temperature groups of ≥38.3°C, 37.5–38.2°C, 36–37.4°C, and <36°C, fever deficits were a median of 47 (interquartile range (IQR), 24 to 72), 53 (IQR, 29 to 83), 69 (IQR, 40 to 100), and 85 (IQR, 52 to 123) degree-hours, respectively, and 147 (14%), 248 (12%), 1,104 (12%), and 549 (17%) died by day 30. After controlling for confounders, a high fever deficit, defined as a fever deficit above the median, during the first 24 h of ICU admission, was not associated with all-cause 30-day mortality (OR 1.02, 95% CI, 0.93–1.13; p = 0.7).</div></div><div><h3>Conclusion</h3><div>Fever deficits were large, particularly when the initial body temperature was not febrile. Only 1 in 15 ICU patients with sepsis had an initial body temperature ≥38.3°C. Approximately 2000 adults a year with sepsis and an initial body temperature <37.5°C would potentially be eligible for a trial of therapeutic hyperthermia in our 12 ICUs.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 4","pages":"Article 100135"},"PeriodicalIF":1.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324272","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}
Pub Date : 2025-10-16DOI: 10.1016/j.ccrj.2025.100131
Graeme J. Duke MD, FCICM, FANZCA , Steven Hirth MIT , John D. Santamaria MD, FRACP, FCICM, FCCP , Frank Shann MD, FRACP, FCICM , David Pilcher FCICM, FRACP, MRCP , Felix Oberender PhD, FRACP, FCICM , Cameron Knott FRACP, FCICM , John Moran MD, FRACP, FCICM, FANZCA
Objective
Mortality prediction models are used for benchmarking, audit, research, and epidemiology. This report describes the development and validation methodology, for version 7 of the critical care outcome prediction equation for monitoring adult intensive care unit (ICU) mortality risk.
Design
This was a multiphase study incorporating data extraction, curation, aggregation, modelling, and validation applied to jurisdictional administrative datasets to model 90-day survival.
Setting
The study was conducted across 28 public and 19 private hospitals in state of Victoria, Australia, with an adult population of 5.28 million.
Participants
A total of 215,148 consecutive adult hospital separations receiving intensive care over 5 years, July 2019–June 2024, were included in the study.
Main outcome measures
The main outcome measures included the case fatality rate (CFR) and standardised 90-day mortality ratio (SMR) at the provider level with model fit assessed for calibration (Brier score; Hosmer–Lemeshow statistic [H10]), discrimination (area under the receiver-operator characteristic and precision-recall curves), classification (CFR and SMR results for ICU-years classified within ±3 standard deviation [SD]), and dispersion (dispersion value [ϕ]; SD random effect [τ]) characteristics.
Results
The CFR was found to be 12.0 (95% confidence interval: 11.8–12.1) per 100 separations and 16.1 (95% confidence interval: 15.7–16.4) per 100 persons. A total of 7771 (53.7%) admission diagnoses were aggregated into 24 clinical diagnosis groups and eight demographic (final) model variables. The following results were obtained: mean Brier score = 0.08; H10 = 15.95; area under the receiver-operator characteristic curve = 0.85; area under the precision-recall curve = 0.43. A total of 126 (54.1%) CFR results and 220 (94.4%) SMR values were within ±3 SD. A total of 105 (45.3%) CFR-outlier ICU-years were reclassified as SMR inliers, with no CFR inlier reclassified as an SMR outlier. Overdispersion metrics: ϕ = 2.80; τ = 0.15.
Conclusions
Critical care outcome prediction equation, version 7 is a parsimonious hospital mortality prediction model for adult intensive care admissions, derived from administrative data common to all jurisdictions.
{"title":"Critical care outcome prediction equation model, version 7","authors":"Graeme J. Duke MD, FCICM, FANZCA , Steven Hirth MIT , John D. Santamaria MD, FRACP, FCICM, FCCP , Frank Shann MD, FRACP, FCICM , David Pilcher FCICM, FRACP, MRCP , Felix Oberender PhD, FRACP, FCICM , Cameron Knott FRACP, FCICM , John Moran MD, FRACP, FCICM, FANZCA","doi":"10.1016/j.ccrj.2025.100131","DOIUrl":"10.1016/j.ccrj.2025.100131","url":null,"abstract":"<div><h3>Objective</h3><div>Mortality prediction models are used for benchmarking, audit, research, and epidemiology. This report describes the development and validation methodology, for version 7 of the critical care outcome prediction equation for monitoring adult intensive care unit (ICU) mortality risk.</div></div><div><h3>Design</h3><div>This was a multiphase study incorporating data extraction, curation, aggregation, modelling, and validation applied to jurisdictional administrative datasets to model 90-day survival.</div></div><div><h3>Setting</h3><div>The study was conducted across 28 public and 19 private hospitals in state of Victoria, Australia, with an adult population of 5.28 million.</div></div><div><h3>Participants</h3><div>A total of 215,148 consecutive adult hospital separations receiving intensive care over 5 years, July 2019–June 2024, were included in the study.</div></div><div><h3>Main outcome measures</h3><div>The main outcome measures included the case fatality rate (CFR) and standardised 90-day mortality ratio (SMR) at the provider level with model fit assessed for calibration (Brier score; Hosmer–Lemeshow statistic [H<sub>10</sub>]), discrimination (area under the receiver-operator characteristic and precision-recall curves), classification (CFR and SMR results for ICU-years classified within ±3 standard deviation [SD]), and dispersion (dispersion value [ϕ]; SD random effect [τ]) characteristics.</div></div><div><h3>Results</h3><div>The CFR was found to be 12.0 (95% confidence interval: 11.8–12.1) per 100 separations and 16.1 (95% confidence interval: 15.7–16.4) per 100 persons. A total of 7771 (53.7%) admission diagnoses were aggregated into 24 clinical diagnosis groups and eight demographic (final) model variables. The following results were obtained: mean Brier score = 0.08; H<sub>10</sub> = 15.95; area under the receiver-operator characteristic curve = 0.85; area under the precision-recall curve = 0.43. A total of 126 (54.1%) CFR results and 220 (94.4%) SMR values were within ±3 SD. A total of 105 (45.3%) CFR-outlier ICU-years were reclassified as SMR inliers, with no CFR inlier reclassified as an SMR outlier. Overdispersion metrics: ϕ = 2.80; τ = 0.15.</div></div><div><h3>Conclusions</h3><div>Critical care outcome prediction equation, version 7 is a parsimonious hospital mortality prediction model for adult intensive care admissions, derived from administrative data common to all jurisdictions.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 4","pages":"Article 100131"},"PeriodicalIF":1.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324265","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}
Pub Date : 2025-10-16DOI: 10.1016/j.ccrj.2025.100132
Angaj Ghosh MBBS, FACEM, FCICM , Tess Evans MBBS , Calum J. Walsh PhD , Matthew J. Maiden PhD , Timothy P. Stinear PhD , Adam M. Deane PhD
There is considerable interest in the gastrointestinal (GI) microbiome and its interaction with disease processes, but existing reviews tend to assume ecological and microbiological knowledge that critical care clinicians may not have. In this review, we present an overview of the GI microbiome for the critical care clinician and highlight unanswered questions pertinent to the field.
The human GI microbiome can now be mapped and its relationship with organ function interrogated. Multiomics approaches that integrate data from multiple sources, including the microbiome, epigenome, transcriptome, metabolome, and proteome, offer promise in unravelling the hitherto inconsistent results of interventions to modify the microbiome, with a view to improving outcomes.
Resident microbes are implicated in local and systemic immune dysregulation during critical illness. While the mechanisms underlying relationships between the GI microbiome and organ function in health and disease remain incompletely understood, a byproduct of saccharolytic fermentation of dietary fibre in the colon, short-chain fatty acids (SCFAs), are a key modulator of these relationships. Pertinent to the use of prebiotic formulations in treating chronic disease and critical illness, are the comparatively unexplored bidirectional interactions between the microbiome and host. More observational and interventional data, using advanced laboratory techniques, are needed to understand if these are causal relationships.
{"title":"The gastrointestinal microbiome in critical illness: A Clinician's guide to mechanisms, emerging tools, and therapeutic questions","authors":"Angaj Ghosh MBBS, FACEM, FCICM , Tess Evans MBBS , Calum J. Walsh PhD , Matthew J. Maiden PhD , Timothy P. Stinear PhD , Adam M. Deane PhD","doi":"10.1016/j.ccrj.2025.100132","DOIUrl":"10.1016/j.ccrj.2025.100132","url":null,"abstract":"<div><div>There is considerable interest in the gastrointestinal (GI) microbiome and its interaction with disease processes, but existing reviews tend to assume ecological and microbiological knowledge that critical care clinicians may not have. In this review, we present an overview of the GI microbiome for the critical care clinician and highlight unanswered questions pertinent to the field.</div><div>The human GI microbiome can now be mapped and its relationship with organ function interrogated. Multiomics approaches that integrate data from multiple sources, including the microbiome, epigenome, transcriptome, metabolome, and proteome, offer promise in unravelling the hitherto inconsistent results of interventions to modify the microbiome, with a view to improving outcomes.</div><div>Resident microbes are implicated in local and systemic immune dysregulation during critical illness. While the mechanisms underlying relationships between the GI microbiome and organ function in health and disease remain incompletely understood, a byproduct of saccharolytic fermentation of dietary fibre in the colon, short-chain fatty acids (SCFAs), are a key modulator of these relationships. Pertinent to the use of prebiotic formulations in treating chronic disease and critical illness, are the comparatively unexplored bidirectional interactions between the microbiome and host. More observational and interventional data, using advanced laboratory techniques, are needed to understand if these are causal relationships.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 4","pages":"Article 100132"},"PeriodicalIF":1.7,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324180","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":"A study of Professor Bellomo's contribution to cardiac arrest research","authors":"Glenn M. Eastwood BN BN(Hons) GDipNurs CritCare, PhD, Niklas Nielsen MD, PhD","doi":"10.1016/j.ccrj.2025.100120","DOIUrl":"10.1016/j.ccrj.2025.100120","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 3","pages":"Article 100120"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278131","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}
Pub Date : 2025-09-01DOI: 10.1016/j.ccrj.2025.100134
Tomoko Fujii MD, PhD , Clive N. May PhD , Yugeesh R. Lankadeva PhD
Professor Rinaldo Bellomo’s lasting impact on critical care research stems from his commitment to structured, biologically grounded research programs over isolated studies. His work on vitamin C in sepsis exemplifies this approach. While early enthusiasm grew around combination therapies involving vitamin C, Rinaldo championed a cautious, rigorous, and methodical investigation. He worked closely with collaborators to address key methodological issues, including dosing, stability, and the design of appropriate control groups, which ultimately led to the international VITAMINS trial. This landmark study compared vitamin C, hydrocortisone, and thiamine to hydrocortisone alone in septic shock and found no clinical benefit. Rinaldo embedded a pharmacokinetic substudy to confirm supraphysiological serum vitamin C levels, ensuring biological plausibility of the trial design. Beyond clinical research, he fostered translational research with the Florey Institute using a preclinical sheep model of sepsis. This collaboration uncovered critical mechanisms of septic acute kidney injury and led to the development of mega-dose sodium ascorbate therapy. The program progressed from proof-of-concept to a double-blind pilot randomised trial in septic shock and now underpins a national multicentre phase Ib and II clinical trials. Rinaldo’s legacy is defined by scientific rigour, mentorship, and humility. His visionary, disciplined approach remains a model for impactful research and continues to guide ongoing efforts to advance care for critically ill patients.
{"title":"Unravelling the paradox of vitamin C research in sepsis","authors":"Tomoko Fujii MD, PhD , Clive N. May PhD , Yugeesh R. Lankadeva PhD","doi":"10.1016/j.ccrj.2025.100134","DOIUrl":"10.1016/j.ccrj.2025.100134","url":null,"abstract":"<div><div>Professor Rinaldo Bellomo’s lasting impact on critical care research stems from his commitment to structured, biologically grounded research programs over isolated studies. His work on vitamin C in sepsis exemplifies this approach. While early enthusiasm grew around combination therapies involving vitamin C, Rinaldo championed a cautious, rigorous, and methodical investigation. He worked closely with collaborators to address key methodological issues, including dosing, stability, and the design of appropriate control groups, which ultimately led to the international VITAMINS trial. This landmark study compared vitamin C, hydrocortisone, and thiamine to hydrocortisone alone in septic shock and found no clinical benefit. Rinaldo embedded a pharmacokinetic substudy to confirm supraphysiological serum vitamin C levels, ensuring biological plausibility of the trial design. Beyond clinical research, he fostered translational research with the Florey Institute using a preclinical sheep model of sepsis. This collaboration uncovered critical mechanisms of septic acute kidney injury and led to the development of mega-dose sodium ascorbate therapy. The program progressed from proof-of-concept to a double-blind pilot randomised trial in septic shock and now underpins a national multicentre phase Ib and II clinical trials. Rinaldo’s legacy is defined by scientific rigour, mentorship, and humility. His visionary, disciplined approach remains a model for impactful research and continues to guide ongoing efforts to advance care for critically ill patients.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 3","pages":"Article 100134"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278194","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}
Pub Date : 2025-09-01DOI: 10.1016/j.ccrj.2025.100139
S. Peake MD, PhD , A. Delaney MD, PhD , B. Venkatesh MD, PhD
This paper pays tribute to Rinaldo Bellomo’s unparallelled global legacy in sepsis research. As a clinician-scientist, Rinaldo’s unending quest was to improve the lives of our patients with sepsis and septic shock. The breadth of his work encompassed all facets of research methodology from basic science through to large-scale multicentre randomised trials. Seminal papers like the early goal-directed therapy and steroids in septic shock trials have been instrumental in informing international evidence-based sepsis guidelines and changing clinical practice. Above all, he was a pioneering, yet self-effacing, leader. He brought everyone who worked with him along on his journey. His infectious enthusiasm for the next new idea never failed to inspire our community, ensuring that his legacy in sepsis research will continue for many years to come.
{"title":"Honouring Rinaldo Bellomo’s tour de force in sepsis research","authors":"S. Peake MD, PhD , A. Delaney MD, PhD , B. Venkatesh MD, PhD","doi":"10.1016/j.ccrj.2025.100139","DOIUrl":"10.1016/j.ccrj.2025.100139","url":null,"abstract":"<div><div>This paper pays tribute to Rinaldo Bellomo’s unparallelled global legacy in sepsis research. As a clinician-scientist, Rinaldo’s unending quest was to improve the lives of our patients with sepsis and septic shock. The breadth of his work encompassed all facets of research methodology from basic science through to large-scale multicentre randomised trials. Seminal papers like the early goal-directed therapy and steroids in septic shock trials have been instrumental in informing international evidence-based sepsis guidelines and changing clinical practice. Above all, he was a pioneering, yet self-effacing, leader. He brought everyone who worked with him along on his journey. His infectious enthusiasm for the next new idea never failed to inspire our community, ensuring that his legacy in sepsis research will continue for many years to come.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 3","pages":"Article 100139"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278411","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}
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