Pub Date : 2024-06-01DOI: 10.1016/j.ccrj.2024.04.002
Paul J. Young BSc (Hons), MBChB, PhD , Michael Bailey PhD , the ANZICS CORE Management Committee
Objective
To describe the characteristics and outcomes of Pacific and European patients admitted to New Zealand (NZ) intensive care units (ICUs) 2009–2018.
Design
Retrospective cohort study.
Setting and participants
The NZ Ministry of Health National Minimum Dataset and the Australia NZ Intensive Care Society Adult Patient Database were matched. Data were for ICU admissions in NZ hospitals from July 2009 until June 2018; long-term mortality outcomes were obtained from the NZ death registry until June 2020.
Main outcome measures
The primary outcome was day 180 mortality. Secondary outcomes were ICU mortality, hospital mortality, discharge to home, ICU and hospital length of stay, and survival. We evaluated the associations between Pacific ethnicity and outcomes with European as the reference using regression analyses. We adjusted sequentially for site, deprivation status, sex, year of admission, Charlson Comorbidity Index, age, admission source and type, ICU admission diagnosis, ventilation status, and illness severity.
Results
Pacific people had a median age of 14 years younger than Europeans. 644/4603 (14.0%) Pacific, and 6407/42,871 (14.9%) European patients died within 180 days of ICU admission; odds ratio (OR) 0.93; 95% CI, 0.85–1.01. When adjusting for age, the OR for day 180 mortality for Pacific vs. European patients increased. The OR decreased after adjustment for admission source and type, and after accounting for Pacific patients having a higher comorbidity index and more severe illness. In the final model, incorporating adjustments for all specified variables, Pacific ethnicity was not significantly associated with day 180 mortality (adjusted OR 0.91; 95% CI, 0.80–1.05). Findings were similar for secondary outcomes except for the proportion of patients discharged home; Pacific ethnicity was associated with significantly increased odds of being discharged home compared to European ethnicity.
Conclusions
Pacific ethnicity was not associated with increased day 180 mortality compared to European ethnicity; Pacific patients admitted to the ICU were more likely to be discharged home than European patients.
目的描述2009-2018年入住新西兰(NZ)重症监护病房(ICU)的太平洋地区和欧洲地区患者的特征和预后.设计回顾性队列研究.设置和参与者新西兰卫生部国家最低数据集与澳大利亚新西兰重症监护协会成人患者数据库进行了匹配。数据来自2009年7月至2018年6月期间新西兰医院的重症监护病房入院情况;长期死亡率结果来自2020年6月之前的新西兰死亡登记。次要结果为重症监护室死亡率、住院死亡率、出院回家率、重症监护室和住院时间以及存活率。我们使用回归分析评估了太平洋岛屿族裔与以欧洲裔为参照的结果之间的关系。我们依次对地点、贫困状况、性别、入院年份、夏尔森综合症指数、年龄、入院来源和类型、ICU入院诊断、通气状况和疾病严重程度进行了调整。644/4603(14.0%)名太平洋裔患者和 6407/42,871 (14.9%)名欧洲裔患者在入住 ICU 后 180 天内死亡;几率比 (OR) 为 0.93;95% CI 为 0.85-1.01。在对年龄进行调整后,太平洋裔患者与欧裔患者的 180 天死亡率比值增加。在对入院来源和类型进行调整,并考虑到太平洋裔患者的合并症指数更高、病情更严重的因素后,OR 有所下降。在对所有特定变量进行调整后的最终模型中,太平洋岛屿族裔与第 180 天死亡率无显著相关性(调整后 OR 为 0.91;95% CI 为 0.80-1.05)。除了出院回家的患者比例外,其他次要结果的研究结果相似;与欧洲裔患者相比,太平洋岛屿族裔患者出院回家的几率明显增加。结论与欧洲裔患者相比,太平洋岛屿族裔患者与第180天死亡率增加无关;与欧洲裔患者相比,入住重症监护室的太平洋岛屿族裔患者更有可能出院回家。
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Pub Date : 2024-06-01DOI: 10.1016/j.ccrj.2024.04.003
Laurent Bitker MD, PhD , Inès Noirot MD , Louis Chauvelot MD , Mehdi Mezidi MD, MSc , François Dhelft MD, MSc , Maxime Gaillet MD , Hodane Yonis MD , Guillaume Deniel MD, MSc , Jean-Christophe Richard MD, PhD
Objective
To evaluate the accuracy of non-calibrated multi-beat analysis continuous cardiac output (CCOMBA), against calibrated pulse-contour analysis continuous cardiac output (CCOPCA) during a passive leg raise (PLR) and/or a fluid challenge (FC).
Design
Observational, single-centre, prospective study.
Setting
Tertiary academic medical intensive care unit, Lyon, France.
Participants
Adult patients receiving norepinephrine, monitored by CCOPCA, and in which a PLR and/or a FC was indicated.
Main outcome measures
CCOMBA and CCOPCA were recorded prior to and during the PLR/FC to evaluate bias and evaluate changes in CCOMBA and CCOPCA (∆%CCOMBA and ∆%CCOPCA). Fluid responsiveness was identified by an increase >15% in calibrated cardiac output after FC, to identify the optimal ∆%CCOMBA threshold during PLR to predict fluid responsiveness.
Results
29 patients (median age 68 [IQR: 57–74]) performed 28 PLR and 16 FC. The bias between methods increased with higher CCOPCA values, with a percentage error of 64% (95%confidence interval: 52%–77%). ∆%CCOMBA adequately tracked changes in ∆%CCOPCA with an angular bias of 2 ± 29°. ∆%CCOMBA during PLR had an AUROC of 0.92 (P < 0.05), with an optimal threshold >14% to predict fluid responsiveness (sensitivity: 0.99, specificity: 0.87).
Conclusions
CCOMBA showed a non-constant bias and a percentage error >30% against calibrated CCOPCA, but an adequate ability to track changes in CCOPCA and to predict fluid responsiveness.
{"title":"Bias, trending ability and diagnostic performance of a non-calibrated multi-beat analysis continuous cardiac output monitor to identify fluid responsiveness in critically ill patients","authors":"Laurent Bitker MD, PhD , Inès Noirot MD , Louis Chauvelot MD , Mehdi Mezidi MD, MSc , François Dhelft MD, MSc , Maxime Gaillet MD , Hodane Yonis MD , Guillaume Deniel MD, MSc , Jean-Christophe Richard MD, PhD","doi":"10.1016/j.ccrj.2024.04.003","DOIUrl":"https://doi.org/10.1016/j.ccrj.2024.04.003","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the accuracy of non-calibrated multi-beat analysis continuous cardiac output (CCO<sub>MBA</sub>), against calibrated pulse-contour analysis continuous cardiac output (CCO<sub>PCA</sub>) during a passive leg raise (PLR) and/or a fluid challenge (FC).</p></div><div><h3>Design</h3><p>Observational, single-centre, prospective study.</p></div><div><h3>Setting</h3><p>Tertiary academic medical intensive care unit, Lyon, France.</p></div><div><h3>Participants</h3><p>Adult patients receiving norepinephrine, monitored by CCO<sub>PCA</sub>, and in which a PLR and/or a FC was indicated.</p></div><div><h3>Main outcome measures</h3><p>CCO<sub>MBA</sub> and CCO<sub>PCA</sub> were recorded prior to and during the PLR/FC to evaluate bias and evaluate changes in CCO<sub>MBA</sub> and CCO<sub>PCA</sub> (∆%CCO<sub>MBA</sub> and ∆%CCO<sub>PCA</sub>). Fluid responsiveness was identified by an increase >15% in calibrated cardiac output after FC, to identify the optimal ∆%CCO<sub>MBA</sub> threshold during PLR to predict fluid responsiveness.</p></div><div><h3>Results</h3><p>29 patients (median age 68 [IQR: 57–74]) performed 28 PLR and 16 FC. The bias between methods increased with higher CCO<sub>PCA</sub> values, with a percentage error of 64% (<sub>95%</sub>confidence interval: 52%–77%). ∆%CCO<sub>MBA</sub> adequately tracked changes in ∆%CCO<sub>PCA</sub> with an angular bias of 2 ± 29°. ∆%CCO<sub>MBA</sub> during PLR had an AUROC of 0.92 (<em>P</em> < 0.05), with an optimal threshold >14% to predict fluid responsiveness (sensitivity: 0.99, specificity: 0.87).</p></div><div><h3>Conclusions</h3><p>CCO<sub>MBA</sub> showed a non-constant bias and a percentage error >30% against calibrated CCO<sub>PCA</sub>, but an adequate ability to track changes in CCO<sub>PCA</sub> and to predict fluid responsiveness.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000127/pdfft?md5=b5598a5c4abd944b51bf2371a07c3fa7&pid=1-s2.0-S1441277224000127-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486190","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 : 2024-06-01DOI: 10.1016/j.ccrj.2024.03.002
Paul Ross RN, BHSc Nur, PGCert ICU, MN Research, Med Adult, PhD Candidate , Rose Jaspers RN, BN(Hons), MAdvClinNur , Jason Watterson RN, BHSc Nur, PGDipAdvNur CritCare, Med Adult, PhD , Michelle Topple RN, BHSc Nur, PGDipSci, PGCert ICU , Tania Birthisel RN, BN (Distinction), PGDip Nursing ICU, CertIV TAE, MProfEd&Trng , Melissa Rosenow , Jason McClure MB ChB, MRCP, FRCA, FCICM, Dip Engineering , Ged Williams AO, RN, PGCert ICU, BHSc. Adv. Nursing, LLM, MHA, FACN, FACHSM, FAAN , Wendy Pollock RN, RM, Grad Cert Adv Learning & Leadership, Grad Dip Ed, Grad Dip Crit Car Nsg, PhD , David Pilcher MBBS MRCP(UK) FCICM FRACP
Objective
This article aims to examine the impact of nursing workforce skill-mix (percentage of critical care registered nurses [CCRN]) in the intensive care unit (ICU) during a patient's stay.
Design
Registry linked cohort study of the Australian and New Zealand Intensive Care Society Adult Patient Database and the Critical Health Resources Information System using real-time nursing workforce data.
Settings
Fifteen public and 5 private hospital ICUs in Victoria, Australia.
Participants
There were 16,618 adult patients admitted between 1 December 2021 and 30 September 2022.
Main outcome measures
Primary outcome: in-hospital mortality. Secondary outcomes: in-ICU mortality, development of delirium, pressure injury, duration of stay in-ICU and hospital, after-hours discharge from ICU and readmission to ICU.
Results
In total, 6563 (39.5%) patients were cared for in ICUs with >75% CCRN, 7695 (46.3%) in ICUs with 50–75% CCRN, and 2360 (14.2%) in ICUs with <50% CCRN. In-hospital mortality was 534 (8.1%) vs. 859 (11.2%) vs. 252 (10.7%) respectively. After adjusting for confounders, patients cared for in ICUs with 50–75% CCRN (adjusted OR 1.21 [95% CI 1.02–1.45]) were more likely to die compared to patients in ICUs with >75% CCRN. A similar but non-significant trend was seen in ICUs with <50% CCRN (adjusted OR 1.21 [95% CI 0.94–1.55]), when compared to patients in ICUs with >75% CCRN. In-ICU mortality, delirium, pressure injuries, after-hours discharge and ICU length of stay were lower in ICUs with CCRN>75%.
Conclusion
The nursing skill-mix in ICU impacts outcomes and should be routinely monitored. Health system regulators, hospital administrators and ICU leaders should ensure nursing workforce planning and education align with these findings to maximise patient outcomes.
本文旨在研究重症监护病房(ICU)护理人员技能组合(重症监护注册护士[CCRN]的比例)对患者住院期间的影响。参与者2021年12月1日至2022年9月30日期间收治的16618名成人患者。主要结果测量主要结果:院内死亡率。次要结果:重症监护室内死亡率、谵妄发生率、压伤、重症监护室和住院时间、重症监护室下班后出院情况以及重症监护室再入院情况。结果共有 6563 名(39.5%)患者在 CCRN 为 75% 的重症监护室接受治疗,7695 名(46.3%)患者在 CCRN 为 50%-75% 的重症监护室接受治疗,2360 名(14.2%)患者在 CCRN 为 50% 的重症监护室接受治疗。院内死亡率分别为 534 (8.1%) vs. 859 (11.2%) vs. 252 (10.7%)。在对混杂因素进行调整后,与 CCRN 为 50%-75% 的重症监护病房的患者相比,CCRN 为 50%-75% 的重症监护病房的患者更容易死亡(调整后 OR 为 1.21 [95% CI 为 1.02-1.45])。与CCRN为75%的重症监护病房相比,CCRN为50%的重症监护病房(调整后OR值为1.21 [95% CI 0.94-1.55])的患者也有类似的趋势,但并不显著。结论 ICU 中的护理技能组合对治疗效果有影响,应进行常规监测。卫生系统监管者、医院管理者和重症监护室领导应确保护理人员的规划和教育与这些研究结果相一致,以最大限度地提高患者的治疗效果。
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Pub Date : 2024-06-01DOI: 10.1016/j.ccrj.2024.01.002
Jessica A. Schults RN, PhD , Karina R. Charles RN, MNurs PICU , Johnny Millar MBChB, PhD, MRCP, FRACP, FCICM , Claire M. Rickard RN, PhD , Vineet Chopra MD, MSc , Anna Lake RN, GradCertClinNurs , Kristen Gibbons PhD , Debbie Long RN, PhD , Sarfaraz Rahiman MD, FCICM , Katrina Hutching RN, MHlthLd , Jacinta Winderlich BNutDietet, MClinRes , Naomi E. Spotswood BMedSc, MBBS, MIPH, FRACP , Amy Johansen RN, MANP Research , Paul Secombe BA, DipAud, BMBS (Hons), MClinSc, FCICM , Georgina A. Pizimolas BPhty , Quyen Tu BPharm , Michaela Waak MBBS, MD , Meredith Allen MBBS, FRACP, FCICM, PhD, MSafSc , Brendan McMullan BMed (Hons), PhD , Lisa Hall BTech BiomedSci (Hons), PhD
Introduction
Monitoring healthcare quality is challenging in paediatric critical care due to measure variability, data collection burden, and uncertainty regarding consumer and clinician priorities.
Objective
We sought to establish a core quality measure set that (i) is meaningful to consumers and clinicians and (ii) promotes alignment of measure use and collection across paediatric critical care.
Design
We conducted a multi-stakeholder Delphi study with embedded consumer prioritisation survey. The Delphi involved two surveys, followed by a consensus meeting. Triangulation methods were used to integrate survey findings prior tobefore the consensus meeting. In the consensus panel, broad agreement was reached on a core measure set, and recommendations were made for future measurement directions in paediatric critical care.
Setting and participants
Australian and New Zealand paediatric critical care survivors (aged >18 years) and families were invited to rank measure priorities in an online survey distributed via social media and consumer groups. A concurrent Delphi study was undertaken with paediatric critical care clinicians, policy makers, and a consumer representative.
Interventions
None.
Main outcome measures
Priorities for quality measures.
Results
Respondents to the consumer survey (n = 117) identified (i) nurse-patient ratios; (ii) visible patient goals; and (iii) long-term follow-up as their quality measure priorities. In the Delphi process, clinicians (Round 1 n = 191; Round 2 n = 117 [61% retention]; Round 3 n = 14) and a consumer representative reached broad agreement on a 51-item (61% of 83 initial measures) core measure set. Clinician priorities were (i) nurse-patient ratio; (ii) staff turnover; and (iii) long term-follow up. Measure feasibility was rated low due to a perceived lack of standardised case definitions or data collection burden. Five recommendations were generated.
Conclusion(s)
We defined a 51-item core measurement set for paediatric critical care, aligned with clinician and consumer priorities. Next steps are implementation and methodological evaluation in quality programs, and where appropriate, retirement of redundant measures.
引言在儿科危重症护理中,由于衡量标准的多变性、数据收集的负担以及消费者和临床医生优先考虑事项的不确定性,医疗质量监控具有挑战性。德尔菲研究包括两项调查,然后召开共识会议。在召开共识会议之前,我们使用三角测量法对调查结果进行了整合。会议邀请澳大利亚和新西兰的儿科危重症幸存者(18 岁)及其家属通过社交媒体和消费者团体发布的在线调查,对衡量标准的优先级进行排序。与此同时,还与儿科危重症护理临床医生、政策制定者和一名消费者代表进行了德尔菲研究。结果消费者调查的受访者(n = 117)将(i) 护患比例;(ii) 患者可视目标;(iii) 长期随访确定为其优先考虑的质量措施。在德尔菲过程中,临床医生(第一轮 n = 191;第二轮 n = 117 [61% 保留];第三轮 n = 14)和一名消费者代表就 51 个项目(占 83 个初始衡量标准的 61%)的核心衡量标准集达成了广泛一致。临床医生优先考虑的是:(i) 护患比例;(ii) 人员流动;(iii) 长期随访。由于缺乏标准化病例定义或数据收集负担,衡量标准的可行性较低。结论:我们为儿科危重症护理定义了一套 51 项的核心测量指标,符合临床医生和消费者的优先考虑。接下来的步骤是在质量计划中实施和进行方法评估,并在适当的情况下取消多余的测量项目。
{"title":"Establishing a paediatric critical care core quality measure set using a multistakeholder, consensus-driven process","authors":"Jessica A. Schults RN, PhD , Karina R. Charles RN, MNurs PICU , Johnny Millar MBChB, PhD, MRCP, FRACP, FCICM , Claire M. Rickard RN, PhD , Vineet Chopra MD, MSc , Anna Lake RN, GradCertClinNurs , Kristen Gibbons PhD , Debbie Long RN, PhD , Sarfaraz Rahiman MD, FCICM , Katrina Hutching RN, MHlthLd , Jacinta Winderlich BNutDietet, MClinRes , Naomi E. Spotswood BMedSc, MBBS, MIPH, FRACP , Amy Johansen RN, MANP Research , Paul Secombe BA, DipAud, BMBS (Hons), MClinSc, FCICM , Georgina A. Pizimolas BPhty , Quyen Tu BPharm , Michaela Waak MBBS, MD , Meredith Allen MBBS, FRACP, FCICM, PhD, MSafSc , Brendan McMullan BMed (Hons), PhD , Lisa Hall BTech BiomedSci (Hons), PhD","doi":"10.1016/j.ccrj.2024.01.002","DOIUrl":"10.1016/j.ccrj.2024.01.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Monitoring healthcare quality is challenging in paediatric critical care due to measure variability, data collection burden, and uncertainty regarding consumer and clinician priorities.</p></div><div><h3>Objective</h3><p>We sought to establish a core quality measure set that (i) is meaningful to consumers and clinicians and (ii) promotes alignment of measure use and collection across paediatric critical care.</p></div><div><h3>Design</h3><p>We conducted a multi-stakeholder Delphi study with embedded consumer prioritisation survey. The Delphi involved two surveys, followed by a consensus meeting. Triangulation methods were used to integrate survey findings prior tobefore the consensus meeting. In the consensus panel, broad agreement was reached on a core measure set, and recommendations were made for future measurement directions in paediatric critical care.</p></div><div><h3>Setting and participants</h3><p>Australian and New Zealand paediatric critical care survivors (aged >18 years) and families were invited to rank measure priorities in an online survey distributed via social media and consumer groups. A concurrent Delphi study was undertaken with paediatric critical care clinicians, policy makers, and a consumer representative.</p></div><div><h3>Interventions</h3><p>None.</p></div><div><h3>Main outcome measures</h3><p>Priorities for quality measures.</p></div><div><h3>Results</h3><p>Respondents to the consumer survey (n = 117) identified (i) nurse-patient ratios; (ii) visible patient goals; and (iii) long-term follow-up as their quality measure priorities. In the Delphi process, clinicians (Round 1 n = 191; Round 2 n = 117 [61% retention]; Round 3 n = 14) and a consumer representative reached broad agreement on a 51-item (61% of 83 initial measures) core measure set. Clinician priorities were (i) nurse-patient ratio; (ii) staff turnover; and (iii) long term-follow up. Measure feasibility was rated low due to a perceived lack of standardised case definitions or data collection burden. Five recommendations were generated.</p></div><div><h3>Conclusion(s)</h3><p>We defined a 51-item core measurement set for paediatric critical care, aligned with clinician and consumer priorities. Next steps are implementation and methodological evaluation in quality programs, and where appropriate, retirement of redundant measures.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000024/pdfft?md5=1c8a257336d16ba76cf05b0274d701de&pid=1-s2.0-S1441277224000024-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140407310","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 : 2024-06-01DOI: 10.1016/j.ccrj.2024.03.003
Alayna Carrandi MPH , Cheelim Liew DNP , Matthew J. Maiden PhD , Edward Litton PhD , Colman Taylor PhD , Kelly Thompson PhD , Alisa Higgins PhD
Objective
Intensive care unit (ICU) cost estimates are critical to achieving healthcare system efficiency and sustainability. We aimed to review the published literature describing ICU costs in Australia.
Design
A systematic review was conducted to identify studies that estimated the cost of ICU care in Australia. Studies conducted in specific patient cohorts or on specific treatments were excluded.
Data sources
Relevant studies were sourced from a previously published review (1970–2016), a systematic search of MEDLINE and EMBASE (2016–5 May 2023), and reference checking.
Review methods
A tool was developed to assess study quality and risk of bias (maximum score 57/57). Total and component costs were tabulated and indexed to 2022 Australian Dollars. Costing methodologies and study quality assessments were summarised.
Results
Six costing studies met the inclusion criteria. Study quality scores were low (15/41 to 35/47). Most studies were conducted only in tertiary metropolitan public ICUs; sample sizes ranged from 100 to 10,204 patients. One study used data collected within the past 10 years. Mean daily ICU costs ranged from $966 to $5381 and mean total ICU admission costs $4888 to $14,606. Three studies used a top-down costing approach, deriving cost estimates from budget reports. The other three studies used both bottom-up and top-down costing approaches. Bottom-up approaches collected individual patient resource use.
Conclusions
Available ICU cost estimates are largely outdated and lack granular data. Future research is needed to estimate ICU costs that better reflect current practice and patient complexity and to determine the best methods for generating these estimates.
{"title":"Costs of Australian intensive care: A systematic review","authors":"Alayna Carrandi MPH , Cheelim Liew DNP , Matthew J. Maiden PhD , Edward Litton PhD , Colman Taylor PhD , Kelly Thompson PhD , Alisa Higgins PhD","doi":"10.1016/j.ccrj.2024.03.003","DOIUrl":"https://doi.org/10.1016/j.ccrj.2024.03.003","url":null,"abstract":"<div><h3>Objective</h3><p>Intensive care unit (ICU) cost estimates are critical to achieving healthcare system efficiency and sustainability. We aimed to review the published literature describing ICU costs in Australia.</p></div><div><h3>Design</h3><p>A systematic review was conducted to identify studies that estimated the cost of ICU care in Australia. Studies conducted in specific patient cohorts or on specific treatments were excluded.</p></div><div><h3>Data sources</h3><p>Relevant studies were sourced from a previously published review (1970–2016), a systematic search of MEDLINE and EMBASE (2016–5 May 2023), and reference checking.</p></div><div><h3>Review methods</h3><p>A tool was developed to assess study quality and risk of bias (maximum score 57/57). Total and component costs were tabulated and indexed to 2022 Australian Dollars. Costing methodologies and study quality assessments were summarised.</p></div><div><h3>Results</h3><p>Six costing studies met the inclusion criteria. Study quality scores were low (15/41 to 35/47). Most studies were conducted only in tertiary metropolitan public ICUs; sample sizes ranged from 100 to 10,204 patients. One study used data collected within the past 10 years. Mean daily ICU costs ranged from $966 to $5381 and mean total ICU admission costs $4888 to $14,606. Three studies used a top-down costing approach, deriving cost estimates from budget reports. The other three studies used both bottom-up and top-down costing approaches. Bottom-up approaches collected individual patient resource use.</p></div><div><h3>Conclusions</h3><p>Available ICU cost estimates are largely outdated and lack granular data. Future research is needed to estimate ICU costs that better reflect current practice and patient complexity and to determine the best methods for generating these estimates.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000085/pdfft?md5=c935f67b062c4593cc05e60fc4ca039c&pid=1-s2.0-S1441277224000085-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486193","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 : 2024-06-01DOI: 10.1016/j.ccrj.2024.04.001
Reyas Aboobacker Kaniyamparambil MBBS FCICM , Charlotte Goldsmith MBBS , Nicolas Demasi MBBS , Brad Wibrow MBBS FCICM , Prakkash ParangiAnanthan MBBS FCICM , Adrian Regli MBBS PhD , Matt Anstey MBBS FCICM , Susan Pellicano RN , Anne Marie Palermo RN , Sarah Van Der Laan MBBS , Edward Litton MBBS PhD
Objective
To describe the relative importance of health concerns reported by survivors of critical illness treated in the intensive care unit (ICU), their estimate of time to achieve recovery, and their reported randomised clinical trial participation willingness.
Design
A multicentre survey.
Setting
Six Australian ICUs.
Participants
Adult patients who had received mechanical ventilation, vasopressor support or renal replacement therapy for more than 24 h were likely to be discharged from ICU within 24 h.
Interventions
Survey administration was verbal and occurred in the ICU.
Main outcome measures
A numeric rating of eight ICU survivor-related health concerns developed with consumer input (disability requiring ongoing care, prolonged hospitalisation, repeated hospitalisation, impaired activity level, pain, low mood, inability to return home, and dying). Zero indicated no concern and ten extreme concern. Respondents were also asked to estimate their expected recovery time and their willingness to participate in a randomised clinical trial.
Results
Of 584 eligible participants, 286 (49.0%) respondents had a mean age of 62.3 years (standard deviation (SD) 14.8) and 178 (62.2%) were male. The median ICU length of stay at the time of survey was 4 days (interquartile range (IQR) 3–7). Respondents reported high levels of concern for all health outcomes with the highest median scores being for survival with severe disability and requirement for ongoing care scoring 8 (IQR 3–10), and never being able to return home needing assisted living or a nursing home scoring 8 (IQR 1–10). The median expected recovery time was 23 days (IQR 10–33). Higher concerns were associated with an increased likelihood of trial participation willingness.
Conclusion
Survivors reported high and varied health concerns of which severe disability requiring care and inability to return home were the highest. Respondents anticipated a relatively short recovery.
{"title":"Health concerns of intensive care survivors and research participation willingness: A multicentre survey","authors":"Reyas Aboobacker Kaniyamparambil MBBS FCICM , Charlotte Goldsmith MBBS , Nicolas Demasi MBBS , Brad Wibrow MBBS FCICM , Prakkash ParangiAnanthan MBBS FCICM , Adrian Regli MBBS PhD , Matt Anstey MBBS FCICM , Susan Pellicano RN , Anne Marie Palermo RN , Sarah Van Der Laan MBBS , Edward Litton MBBS PhD","doi":"10.1016/j.ccrj.2024.04.001","DOIUrl":"https://doi.org/10.1016/j.ccrj.2024.04.001","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the relative importance of health concerns reported by survivors of critical illness treated in the intensive care unit (ICU), their estimate of time to achieve recovery, and their reported randomised clinical trial participation willingness.</p></div><div><h3>Design</h3><p>A multicentre survey.</p></div><div><h3>Setting</h3><p>Six Australian ICUs.</p></div><div><h3>Participants</h3><p>Adult patients who had received mechanical ventilation, vasopressor support or renal replacement therapy for more than 24 h were likely to be discharged from ICU within 24 h.</p></div><div><h3>Interventions</h3><p>Survey administration was verbal and occurred in the ICU.</p></div><div><h3>Main outcome measures</h3><p>A numeric rating of eight ICU survivor-related health concerns developed with consumer input (disability requiring ongoing care, prolonged hospitalisation, repeated hospitalisation, impaired activity level, pain, low mood, inability to return home, and dying). Zero indicated no concern and ten extreme concern. Respondents were also asked to estimate their expected recovery time and their willingness to participate in a randomised clinical trial.</p></div><div><h3>Results</h3><p>Of 584 eligible participants, 286 (49.0%) respondents had a mean age of 62.3 years (standard deviation (SD) 14.8) and 178 (62.2%) were male. The median ICU length of stay at the time of survey was 4 days (interquartile range (IQR) 3–7). Respondents reported high levels of concern for all health outcomes with the highest median scores being for survival with severe disability and requirement for ongoing care scoring 8 (IQR 3–10), and never being able to return home needing assisted living or a nursing home scoring 8 (IQR 1–10). The median expected recovery time was 23 days (IQR 10–33). Higher concerns were associated with an increased likelihood of trial participation willingness.</p></div><div><h3>Conclusion</h3><p>Survivors reported high and varied health concerns of which severe disability requiring care and inability to return home were the highest. Respondents anticipated a relatively short recovery.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000103/pdfft?md5=cee43030dd7e195fb4d9ed4e617f67c7&pid=1-s2.0-S1441277224000103-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486192","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 : 2024-06-01DOI: 10.1016/j.ccrj.2024.03.004
Paul J. Young MBChB, FCICM, PhD , Abdulrahman Al-Fares MBChB, FRCPC, ABIM, MRCP , Diptesh Aryal MD , Yaseen M. Arabi MD , Muhammad Sheharyar Ashraf MD , Sean M. Bagshaw MD, MSc, PhD , Abigail Beane PhD , Airton L. de Oliveira Manoel MD PhD , Layoni Dullawe BSc , Fathima Fazla BSc , Tomoko Fujii MD, PhD , Rashan Haniffa PhD , Mohd Shahnaz Hasan MBBS, MAnes , Carol L. Hodgson PT, MPhil, PhD , Anna Hunt BN , Cassie Lawrence BN , Israel Silva Maia , Diane Mackle MN, PhD , Giacomo Monti MD , Alistair D. Nichol PhD , Jessica Kasza PhD
Background
The effect of conservative vs. liberal oxygen therapy on 90-day in-hospital mortality in adults with hypoxic ischaemic encephalopathy (HIE) following a cardiac arrest who are receiving invasive mechanical ventilation in the intensive care unit (ICU) is uncertain.
Objective
To summarise the protocol and statistical analysis plan for the Mega-ROX HIE trial.
Design, setting and participants
Mega-ROX HIE is an international randomised clinical trial that will be conducted within an overarching 40,000-participant registry-embedded clinical trial comparing conservative and liberal ICU oxygen therapy regimens. We expect to enrol approximately 4000 participants with suspected HIE following a cardiac arrest who are receiving invasive mechanical ventilation in the ICU.
Main outcome measures
The primary outcome is in-hospital all-cause mortality up to 90 days from the date of randomisation. Secondary outcomes include duration of survival, duration of mechanical ventilation, ICU length of stay, hospital length of stay, and the proportion of participants discharged home.
Results and conclusions
Mega-ROX HIE will compare the effect of conservative vs. liberal oxygen therapy regimens on day-90 in-hospital mortality in adults in the ICU with suspected HIE following a cardiac arrest. The protocol and planned analyses are reported here to mitigate analysis bias.
Trial registration
Australian and New Zealand Clinical Trials Registry (ACTRN 12620000391976).
{"title":"Protocol and statistical analysis plan for the mega randomised registry trial comparing conservative vs. liberal oxygenation targets in adults in the intensive care unit with suspected hypoxic ischaemic encephalopathy following a cardiac arrest (Mega-ROX HIE)","authors":"Paul J. Young MBChB, FCICM, PhD , Abdulrahman Al-Fares MBChB, FRCPC, ABIM, MRCP , Diptesh Aryal MD , Yaseen M. Arabi MD , Muhammad Sheharyar Ashraf MD , Sean M. Bagshaw MD, MSc, PhD , Abigail Beane PhD , Airton L. de Oliveira Manoel MD PhD , Layoni Dullawe BSc , Fathima Fazla BSc , Tomoko Fujii MD, PhD , Rashan Haniffa PhD , Mohd Shahnaz Hasan MBBS, MAnes , Carol L. Hodgson PT, MPhil, PhD , Anna Hunt BN , Cassie Lawrence BN , Israel Silva Maia , Diane Mackle MN, PhD , Giacomo Monti MD , Alistair D. Nichol PhD , Jessica Kasza PhD","doi":"10.1016/j.ccrj.2024.03.004","DOIUrl":"https://doi.org/10.1016/j.ccrj.2024.03.004","url":null,"abstract":"<div><h3>Background</h3><p>The effect of conservative vs. liberal oxygen therapy on 90-day in-hospital mortality in adults with hypoxic ischaemic encephalopathy (HIE) following a cardiac arrest who are receiving invasive mechanical ventilation in the intensive care unit (ICU) is uncertain.</p></div><div><h3>Objective</h3><p>To summarise the protocol and statistical analysis plan for the Mega-ROX HIE trial.</p></div><div><h3>Design, setting and participants</h3><p>Mega-ROX HIE is an international randomised clinical trial that will be conducted within an overarching 40,000-participant registry-embedded clinical trial comparing conservative and liberal ICU oxygen therapy regimens. We expect to enrol approximately 4000 participants with suspected HIE following a cardiac arrest who are receiving invasive mechanical ventilation in the ICU.</p></div><div><h3>Main outcome measures</h3><p>The primary outcome is in-hospital all-cause mortality up to 90 days from the date of randomisation. Secondary outcomes include duration of survival, duration of mechanical ventilation, ICU length of stay, hospital length of stay, and the proportion of participants discharged home.</p></div><div><h3>Results and conclusions</h3><p>Mega-ROX HIE will compare the effect of conservative vs. liberal oxygen therapy regimens on day-90 in-hospital mortality in adults in the ICU with suspected HIE following a cardiac arrest. The protocol and planned analyses are reported here to mitigate analysis bias.</p></div><div><h3>Trial registration</h3><p>Australian and New Zealand Clinical Trials Registry (ACTRN 12620000391976).</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000097/pdfft?md5=bd9cfd07b4ef9f23c523fcf07f5af277&pid=1-s2.0-S1441277224000097-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141486285","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 : 2024-03-01DOI: 10.1016/j.ccrj.2023.11.003
Tipwarin Phongmekhin BS (Bachelor of Science) , Ray Wang MBBS BMedSci FRACP
{"title":"Continuous glucose monitor accuracy during extracorporeal membrane oxygenation","authors":"Tipwarin Phongmekhin BS (Bachelor of Science) , Ray Wang MBBS BMedSci FRACP","doi":"10.1016/j.ccrj.2023.11.003","DOIUrl":"10.1016/j.ccrj.2023.11.003","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022263/pdfft?md5=93c014843713d5c9af5db9b3f8c832e8&pid=1-s2.0-S1441277223022263-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138988602","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 : 2024-03-01DOI: 10.1016/j.ccrj.2023.11.008
Trevor Duke MD, FRACP, FCICM
The population of children requiring intensive care in Victoria has increased and changed markedly since the 1990s, the result of many epidemiological, demographic, and social changes, and this is more evident during and after the Covid pandemic. The model of ultra-centralised paediatric intensive care services in the 1990s is not sufficient for the current era, and services are under daily pressure. Solutions will take time and need to be wide-ranging, including increased critical care capacity in selected regional centres, decentralisation of some services for low-risk conditions, improvements and reforms in medical and nursing education, pre-service and post-graduate, including for other acute care disciplines and for general practitioners and a more structured state-wide paediatric system.
The effects of changes in disease patterns, social trends and health practice should inform the design of an expanded model of critical and emergency care for children in Victoria that is more fit for purpose in the remainder of this decade and beyond.
{"title":"Services for critical and emergency care of children in Victoria","authors":"Trevor Duke MD, FRACP, FCICM","doi":"10.1016/j.ccrj.2023.11.008","DOIUrl":"10.1016/j.ccrj.2023.11.008","url":null,"abstract":"<div><p>The population of children requiring intensive care in Victoria has increased and changed markedly since the 1990s, the result of many epidemiological, demographic, and social changes, and this is more evident during and after the Covid pandemic. The model of ultra-centralised paediatric intensive care services in the 1990s is not sufficient for the current era, and services are under daily pressure. Solutions will take time and need to be wide-ranging, including increased critical care capacity in selected regional centres, decentralisation of some services for low-risk conditions, improvements and reforms in medical and nursing education, pre-service and post-graduate, including for other acute care disciplines and for general practitioners and a more structured state-wide paediatric system.</p><p>The effects of changes in disease patterns, social trends and health practice should inform the design of an expanded model of critical and emergency care for children in Victoria that is more fit for purpose in the remainder of this decade and beyond.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022317/pdfft?md5=1775d1b02619a27698339e8895ef43f1&pid=1-s2.0-S1441277223022317-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139021710","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}
Primary outcomes: clinically significant psychological symptoms at 3- and 12-month follow-up using Post-Traumatic Stress Syndrome-14 for post-traumatic stress disorder; Depression, Anxiety Stress Scales-21 for depression, anxiety, and stress. Secondary outcomes: HRQOL, using EuroQol-5D-5L questionnaire.
Results
Of the 133 ICU survivors, 54/116 (47 %) had at least one clinically significant psychological symptom (i.e., post-traumatic stress disorder, anxiety, depression, stress) at follow-up. Clinically significant scores for psychological symptoms were observed in 26 (39 %) versus 16 (32 %) at 3-months [odds ratio 1.4, 95 % confidence interval (0.66–3.13), p = 0.38]; 23 (37 %) versus 10 (31 %) at 12-months [odds ratio 1.3, 95 % confidence interval (0.53–3.31), p = 0.57] of intubated versus non-intubated survivors, respectively. Usual activities and mobility were the most commonly affected HRQOL dimension, with >30 % at 3 versus months and >20 % at 12-months of overall survivors reporting ≥ moderate problems. There was no difference between the groups in any of the EQ5D dimensions.
Conclusions
Nearly one-in-two (47 %) of the intubated and non-intubated ICU survivors reported clinically significant psychological symptoms at 3 and 12-month follow-ups. Overall, more than 30 % at 3-months and over 20 % at 12-months of the survivors in both groups had moderate or worse problems with their usual activities and mobility. The presence of psychological symptoms and HRQOL impairments was similar between the groups.
{"title":"Psychological symptoms and health-related quality of life in intubated and non-intubated intensive care survivors: A multicentre, prospective observational cohort study","authors":"Sumeet Rai FCICM , Teresa Neeman PhD , Rhonda Brown PhD , Krishnaswamy Sundararajan FCICM , Arvind Rajamani FCICM , Michelle Miu B.Med, MD , Rakshit Panwar PhD , Mary Nourse GradCertIntCareN , Frank M.P. van Haren PhD , Imogen Mitchell PhD , Dale M. Needham MD, PhD , for the PRICE study investigators","doi":"10.1016/j.ccrj.2023.10.011","DOIUrl":"10.1016/j.ccrj.2023.10.011","url":null,"abstract":"<div><h3>Objective</h3><p>To compare long-term psychological symptoms and health-related quality of life (HRQOL) in intubated versus non-intubated ICU survivors.</p></div><div><h3>Design</h3><p>Prospective, multicentre observational cohort study.</p></div><div><h3>Setting</h3><p>Four tertiary medical-surgical ICUs in Australia.</p></div><div><h3>Participants</h3><p>Intubated and non-intubated adult ICU survivors.</p></div><div><h3>Main outcome measures</h3><p><em>Primary outcomes</em>: clinically significant psychological symptoms at 3- and 12-month follow-up using Post-Traumatic Stress Syndrome-14 for post-traumatic stress disorder; Depression, Anxiety Stress Scales-21 for depression, anxiety, and stress. <em>Secondary outcomes</em>: HRQOL, using EuroQol-5D-5L questionnaire.</p></div><div><h3>Results</h3><p>Of the 133 ICU survivors, 54/116 (47 %) had at least one clinically significant psychological symptom (i.e., post-traumatic stress disorder, anxiety, depression, stress) at follow-up. Clinically significant scores for psychological symptoms were observed in 26 (39 %) versus 16 (32 %) at 3-months [odds ratio 1.4, 95 % confidence interval (0.66–3.13), p = 0.38]; 23 (37 %) versus 10 (31 %) at 12-months [odds ratio 1.3, 95 % confidence interval (0.53–3.31), p = 0.57] of intubated versus non-intubated survivors, respectively. Usual activities and mobility were the most commonly affected HRQOL dimension, with >30 % at 3 versus months and >20 % at 12-months of overall survivors reporting ≥ moderate problems. There was no difference between the groups in any of the EQ5D dimensions.</p></div><div><h3>Conclusions</h3><p>Nearly one-in-two (47 %) of the intubated and non-intubated ICU survivors reported clinically significant psychological symptoms at 3 and 12-month follow-ups. Overall, more than 30 % at 3-months and over 20 % at 12-months of the survivors in both groups had moderate or worse problems with their usual activities and mobility. The presence of psychological symptoms and HRQOL impairments was similar between the groups.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022226/pdfft?md5=a492e68faadb17e270bc1dfc1805a955&pid=1-s2.0-S1441277223022226-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139023796","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}