Pub Date : 2025-09-01DOI: 10.1016/j.ccrj.2025.100141
{"title":"Unveiling “The Bellomo Effect”: A tribute from Professor Rinaldo Bellomo’s Research Fellow Family","authors":"","doi":"10.1016/j.ccrj.2025.100141","DOIUrl":"10.1016/j.ccrj.2025.100141","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 3","pages":"Article 100141"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278191","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.2025.100124
Michael Bailey PhD , Ary Serpa Neto MD, PhD , Paul J. Young MD, PhD
Professor Rinaldo Bellomo's legacy as a world-leading clinician-scientist is unmatched in the field of critical care. This tribute explores the depth, breadth, and global influence of his publication record, spanning more than four decades. With over 2000 peer-reviewed articles, 81 elite journal publications, and a remarkable H-index above 200, Rinaldo's academic contributions helped shape international definitions of acute kidney injury and sepsis, advanced critical care nephrology, and guided fluid resuscitation practice worldwide. Through editorial leadership, strategic authorship, and mentorship, he transformed the landscape of intensive care research.
{"title":"A legacy in print: The publication impact of Professor Rinaldo Bellomo","authors":"Michael Bailey PhD , Ary Serpa Neto MD, PhD , Paul J. Young MD, PhD","doi":"10.1016/j.ccrj.2025.100124","DOIUrl":"10.1016/j.ccrj.2025.100124","url":null,"abstract":"<div><div>Professor Rinaldo Bellomo's legacy as a world-leading clinician-scientist is unmatched in the field of critical care. This tribute explores the depth, breadth, and global influence of his publication record, spanning more than four decades. With over 2000 peer-reviewed articles, 81 elite journal publications, and a remarkable H-index above 200, Rinaldo's academic contributions helped shape international definitions of acute kidney injury and sepsis, advanced critical care nephrology, and guided fluid resuscitation practice worldwide. Through editorial leadership, strategic authorship, and mentorship, he transformed the landscape of intensive care research.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 3","pages":"Article 100124"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278076","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.2025.100144
Derek C. Angus MD, MPH
{"title":"Seeking truth: Less about being right, more about being less wrong","authors":"Derek C. Angus MD, MPH","doi":"10.1016/j.ccrj.2025.100144","DOIUrl":"10.1016/j.ccrj.2025.100144","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 3","pages":"Article 100144"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278075","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.2025.100127
Daryl Jones BSc(Hons), MBBS, FRACP, FCICM, MD, PhD , Donna Goldsmith BN, MN, MBA , Michael DeVita MD, FRCP, FCCM , Ken Hillman AO MBBS, FRCA, FCICM, FRCP, MD
In the 1990s, there was emerging evidence that patients admitted to hospitals frequently suffered in-hospital cardiac arrest, unplanned admission to the intensive care unit (ICU), and potentially preventable in-hospital death. These events were often preceded by objective signs of instability and suboptimal recognition and response by hospital ward staff. Rinaldo Bellomo collaborated with key Australian and international leaders to develop a novel and paradigm-shifting model of care referred to as the medical emergency team (MET). This team is comprised of senior staff members who are experts in the assessment and management of acutely deteriorating patients.
In Australia and New Zealand, staff members from the ICU are frequently the team leaders for the MET. The team is called when a patient develops objective signs of clinical deterioration, prior to the onset of cardiac arrest. Rinaldo led, mentored, and supervised a systematic and structured research program that evaluated the nature and effectiveness of the MET at Austin Health and throughout Australia. This commenced with single-centre before-and-after studies and progressed to the first Australian ICU cluster-randomised controlled trial. His unique skillset was pivotal in the emergence and promulgation of this model of care worldwide resulting in countless lives saved from preventable morbidity and mortality.
{"title":"Rinaldo’s role in the medical emergency team and rapid response systems","authors":"Daryl Jones BSc(Hons), MBBS, FRACP, FCICM, MD, PhD , Donna Goldsmith BN, MN, MBA , Michael DeVita MD, FRCP, FCCM , Ken Hillman AO MBBS, FRCA, FCICM, FRCP, MD","doi":"10.1016/j.ccrj.2025.100127","DOIUrl":"10.1016/j.ccrj.2025.100127","url":null,"abstract":"<div><div>In the 1990s, there was emerging evidence that patients admitted to hospitals frequently suffered in-hospital cardiac arrest, unplanned admission to the intensive care unit (ICU), and potentially preventable in-hospital death. These events were often preceded by objective signs of instability and suboptimal recognition and response by hospital ward staff. Rinaldo Bellomo collaborated with key Australian and international leaders to develop a novel and paradigm-shifting model of care referred to as the medical emergency team (MET). This team is comprised of senior staff members who are experts in the assessment and management of acutely deteriorating patients.</div><div>In Australia and New Zealand, staff members from the ICU are frequently the team leaders for the MET. The team is called when a patient develops objective signs of clinical deterioration, prior to the onset of cardiac arrest. Rinaldo led, mentored, and supervised a systematic and structured research program that evaluated the nature and effectiveness of the MET at Austin Health and throughout Australia. This commenced with single-centre before-and-after studies and progressed to the first Australian ICU cluster-randomised controlled trial. His unique skillset was pivotal in the emergence and promulgation of this model of care worldwide resulting in countless lives saved from preventable morbidity and mortality.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 3","pages":"Article 100127"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278414","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.2025.100148
Emily J. See MBBS , Lakhmir S. Chawla MD
Vasodilatory shock remains a leading cause of morbidity and mortality in the intensive care unit. Vasopressors are the cornerstone of treatment when vasodilatory shock persists despite adequate fluid resuscitation, yet their effects on organ-specific blood flow, perfusion, and oxygenation are complex and may contribute to harm. This review summarises the extensive contributions of Professor Rinaldo Bellomo to advancing our knowledge of vasopressor therapy in clinical practice. Central to his work was the concept of personalised haemodynamic targets, introduced through the concept of “mean perfusion pressure deficit”, which linked premorbid perfusion pressure to outcomes and challenged the universal application of a mean arterial pressure threshold of ≥65 mmHg. In collaboration with Professor Clive May, Bellomo established a chronically instrumented large animal model of hyperdynamic sepsis, yielding fundamental insights into the discordance between the macrocirculation and microcirculation, the vulnerability of the renal medulla to hypoxia, and the mechanisms of septic acute kidney injury. This model enabled direct comparison of vasopressor drugs in both healthy animals and during septic shock, demonstrating their heterogeneous effects on global and regional blood flow, perfusion, and tissue oxygenation. Knowledge translation to the bedside was achieved through the conduct of pivotal clinical trials, from early studies refuting the utility of “renal-dose dopamine” to landmark contributions to the ATHOS (angiotensin II treatment of high-ouput shock) program, which established angiotensin II as a novel vasopressor in refractory vasodilatory shock. Collectively, Bellomo’s work has transformed vasopressor therapy from empirical convention towards individualised practice, and it continues to inform clinical investigation and guideline development.
{"title":"Redefining the modern paradigm of vasopressor therapy for vasodilatory shock","authors":"Emily J. See MBBS , Lakhmir S. Chawla MD","doi":"10.1016/j.ccrj.2025.100148","DOIUrl":"10.1016/j.ccrj.2025.100148","url":null,"abstract":"<div><div>Vasodilatory shock remains a leading cause of morbidity and mortality in the intensive care unit. Vasopressors are the cornerstone of treatment when vasodilatory shock persists despite adequate fluid resuscitation, yet their effects on organ-specific blood flow, perfusion, and oxygenation are complex and may contribute to harm. This review summarises the extensive contributions of Professor Rinaldo Bellomo to advancing our knowledge of vasopressor therapy in clinical practice. Central to his work was the concept of personalised haemodynamic targets, introduced through the concept of “mean perfusion pressure deficit”, which linked premorbid perfusion pressure to outcomes and challenged the universal application of a mean arterial pressure threshold of ≥65 mmHg. In collaboration with Professor Clive May, Bellomo established a chronically instrumented large animal model of hyperdynamic sepsis, yielding fundamental insights into the discordance between the macrocirculation and microcirculation, the vulnerability of the renal medulla to hypoxia, and the mechanisms of septic acute kidney injury. This model enabled direct comparison of vasopressor drugs in both healthy animals and during septic shock, demonstrating their heterogeneous effects on global and regional blood flow, perfusion, and tissue oxygenation. Knowledge translation to the bedside was achieved through the conduct of pivotal clinical trials, from early studies refuting the utility of “renal-dose dopamine” to landmark contributions to the ATHOS (angiotensin II treatment of high-ouput shock) program, which established angiotensin II as a novel vasopressor in refractory vasodilatory shock. Collectively, Bellomo’s work has transformed vasopressor therapy from empirical convention towards individualised practice, and it continues to inform clinical investigation and guideline development.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 3","pages":"Article 100148"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145278413","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 : 2025-06-01DOI: 10.1016/j.ccrj.2025.100112
Tarren Zimsen MBBS, MPH (Dr) , Lachlan Quick MBBS, FCICM (Dr) , Gentry White PhD (Prof) , Rahul Costa-Pinto PhD (Dr) , Stephen Whebell MBBS, FCICM (Dr) , Jason Meyer BN, RN, MSc , James McCullough FCICM, MMed (Dr) , Kiran Shekar MBBS, FCICM, PhD (Prof) , Kevin B. Laupland MD, PhD (Prof) , Mahesh Ramanan BSc(Med), MBBS(Hons), MMed(Clin Epi), FCICM (Prof) , Sebastiaan Blank FCICM (Dr) , Alexis Tabah MD, FCICM (Prof) , Stephen Luke MBBS, BSc(Hons), FCICM (Dr) , Peter Garrett MBBS, BSc(hons), FCICM, FACEM, FCEM , Antony G. Attokaran MBBS, FCICM, FRACP (Dr) , Aashish Kumar MBBS, FCICM (Dr) , Kyle C. White BSc, MPH, MBBS, FCICM, FRACP (Dr) , the Queensland Critical Care Research Network (QCCRN)
Background
Noradrenaline is the most prescribed vasopressor in intensive care units (ICUs). Although there is limited supporting evidence, metaraminol is often used as an alternative agent in some regions. We aimed to describe current practice and elucidate the factors associated with metaraminol prescription in a large cohort of ICU patients.
Method
A multicenter, retrospective cohort study of granular, routinely collected electronic medical record–based clinical data was performed in 12 ICUs in Queensland, Australia, between January 1, 2015, and December 31, 2021. Patients who received at least four consecutive hours of either metaraminol or noradrenaline in the first 24 h of their ICU stay were included.
Results
In total, 17,432 patients received single-agent vasopressor therapy and 1,963 (11.3 %) patients were administered metaraminol. For the entire cohort, the median age was 61 (interquartile range, IQR: 47–71), and the median Charlson Comorbidity Index was 3 (IQR: 1–5). The patients who received metaraminol had less ischaemic heart disease (5.5 % vs 7.6 %; p < 0.001) and were more likely to have localised cancer (16 % vs 14 %; p < 0.004). The patients receiving metaraminol were less likely to be ventilated on admission (39 % vs 73 %; p < 0.001) and had lower median Acute Physiology and Chronic Health Evaluation III scores (51 vs 56; p < 0.001). The median duration of metaraminol was 10 h (IQR: 6–18) and two-thirds (65 %) did not convert to noradrenaline infusion. After adjustment for confounders, after-hours admission (odds ratio, OR: 1.55; 95 % confidence interval [CI]: 1.40–1.71; p < 0.001), treatment limitation orders (OR: 1.35; 95 % CI: 1.10–1.64; p < 0.004), and admission to a regional ICU (OR: 1.47; 95 % CI: 1.27–1.68; p < 0.001) were independently associated with metaraminol use.
Conclusion
Metaraminol is a widely used vasoconstrictor in Queensland ICUs. Patients who receive metaraminol have specific characteristics but are overall less unwell than patients who receive noradrenaline. Most patients who receive metaraminol do not require an alternative vasoactive medication.
{"title":"Prevalence and characteristics of metaraminol usage in a large intensive care patient cohort. A multicentre, retrospective, observational study","authors":"Tarren Zimsen MBBS, MPH (Dr) , Lachlan Quick MBBS, FCICM (Dr) , Gentry White PhD (Prof) , Rahul Costa-Pinto PhD (Dr) , Stephen Whebell MBBS, FCICM (Dr) , Jason Meyer BN, RN, MSc , James McCullough FCICM, MMed (Dr) , Kiran Shekar MBBS, FCICM, PhD (Prof) , Kevin B. Laupland MD, PhD (Prof) , Mahesh Ramanan BSc(Med), MBBS(Hons), MMed(Clin Epi), FCICM (Prof) , Sebastiaan Blank FCICM (Dr) , Alexis Tabah MD, FCICM (Prof) , Stephen Luke MBBS, BSc(Hons), FCICM (Dr) , Peter Garrett MBBS, BSc(hons), FCICM, FACEM, FCEM , Antony G. Attokaran MBBS, FCICM, FRACP (Dr) , Aashish Kumar MBBS, FCICM (Dr) , Kyle C. White BSc, MPH, MBBS, FCICM, FRACP (Dr) , the Queensland Critical Care Research Network (QCCRN)","doi":"10.1016/j.ccrj.2025.100112","DOIUrl":"10.1016/j.ccrj.2025.100112","url":null,"abstract":"<div><h3>Background</h3><div>Noradrenaline is the most prescribed vasopressor in intensive care units (ICUs). Although there is limited supporting evidence, metaraminol is often used as an alternative agent in some regions. We aimed to describe current practice and elucidate the factors associated with metaraminol prescription in a large cohort of ICU patients.</div></div><div><h3>Method</h3><div>A multicenter, retrospective cohort study of granular, routinely collected electronic medical record–based clinical data was performed in 12 ICUs in Queensland, Australia, between January 1, 2015, and December 31, 2021. Patients who received at least four consecutive hours of either metaraminol or noradrenaline in the first 24 h of their ICU stay were included.</div></div><div><h3>Results</h3><div>In total, 17,432 patients received single-agent vasopressor therapy and 1,963 (11.3 %) patients were administered metaraminol. For the entire cohort, the median age was 61 (interquartile range, IQR: 47–71), and the median Charlson Comorbidity Index was 3 (IQR: 1–5). The patients who received metaraminol had less ischaemic heart disease (5.5 % vs 7.6 %; p < 0.001) and were more likely to have localised cancer (16 % vs 14 %; p < 0.004). The patients receiving metaraminol were less likely to be ventilated on admission (39 % vs 73 %; p < 0.001) and had lower median Acute Physiology and Chronic Health Evaluation III scores (51 vs 56; p < 0.001). The median duration of metaraminol was 10 h (IQR: 6–18) and two-thirds (65 %) did not convert to noradrenaline infusion. After adjustment for confounders, after-hours admission (odds ratio, OR: 1.55; 95 % confidence interval [CI]: 1.40–1.71; p < 0.001), treatment limitation orders (OR: 1.35; 95 % CI: 1.10–1.64; p < 0.004), and admission to a regional ICU (OR: 1.47; 95 % CI: 1.27–1.68; p < 0.001) were independently associated with metaraminol use.</div></div><div><h3>Conclusion</h3><div>Metaraminol is a widely used vasoconstrictor in Queensland ICUs. Patients who receive metaraminol have specific characteristics but are overall less unwell than patients who receive noradrenaline. Most patients who receive metaraminol do not require an alternative vasoactive medication.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 2","pages":"Article 100112"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366521","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 : 2025-06-01DOI: 10.1016/j.ccrj.2025.100115
Sing Chee Tan FCICM, MMed(ClinEpi), MIS(Health), MBBS(Hons) , Lucy Modra FCICM, MPH, MBBS(Hons) , Tamishta Hensman FCICM, MBBS
In Australian intensive care units (ICUs), Artificial Intelligence (AI) promises to enhance efficiency and improve patient outcomes. However, ethical concerns surrounding AI must be addressed before widespread adoption. We examine the ethical challenges of of AI using the framework of the four pillars of biomedical ethics—beneficence, nonmaleficence, autonomy, and justice, and discuss the need for a fifth pillar of explicability. We consider the risks of perpetuating inequities, privacy breaches, and unintended harms, particularly in disadvantaged populations such as First Nations people. We advocate for a national strategy for ICUs to guide the ethical implementation of AI, that aligns with existing National AI Frameworks. Our recommendations for implementation of safe and ethical AI in ICU include education, developing guidelines, and ensuring transparency in AI decision-making. A coordinated strategy is essential to balance AI’s benefits with the ethical responsibility to protect patients and healthcare providers in critical care settings.
{"title":"AI ethics for the everyday intensivist","authors":"Sing Chee Tan FCICM, MMed(ClinEpi), MIS(Health), MBBS(Hons) , Lucy Modra FCICM, MPH, MBBS(Hons) , Tamishta Hensman FCICM, MBBS","doi":"10.1016/j.ccrj.2025.100115","DOIUrl":"10.1016/j.ccrj.2025.100115","url":null,"abstract":"<div><div>In Australian intensive care units (ICUs), Artificial Intelligence (AI) promises to enhance efficiency and improve patient outcomes. However, ethical concerns surrounding AI must be addressed before widespread adoption. We examine the ethical challenges of of AI using the framework of the four pillars of biomedical ethics—beneficence, nonmaleficence, autonomy, and justice, and discuss the need for a fifth pillar of explicability. We consider the risks of perpetuating inequities, privacy breaches, and unintended harms, particularly in disadvantaged populations such as First Nations people. We advocate for a national strategy for ICUs to guide the ethical implementation of AI, that aligns with existing National AI Frameworks. Our recommendations for implementation of safe and ethical AI in ICU include education, developing guidelines, and ensuring transparency in AI decision-making. A coordinated strategy is essential to balance AI’s benefits with the ethical responsibility to protect patients and healthcare providers in critical care settings.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 2","pages":"Article 100115"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481432","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 : 2025-06-01DOI: 10.1016/j.ccrj.2025.100113
Yaodong Tang PhD , Peinan Zhao PhD , Allen C. Cheng MBBS, PhD , Aaliya Ibrahim MClinEpid , Jenna Hassall MPhil , Edward Litton MBChB, PhD , Christopher R. Andersen MBBS, FCICM , Cindy Liang RN, GradCertN , Elissa M. Milford MBBS, PhD , Morgan Rose MBBS, PhD , Mark Plummer FCICM, PhD , Jing Kong RN, GradCertN , Kerry Johnson RN, GradCertN , Shailesh Bihari FCICM, PhD , Anis Chaba MBBS, MMSBR , Husna Begum PhD , Sherene Magana Cruz DipLH , Sze Ng MBBS , Tony Trapani B.Ed , Lewis Campbell MBChB, MSc Epi, FCICM , Aidan Burrell MBBS, PhD, FCICM
Objective
To assess the characteristics, treatments and outcomes of paediatric and adult intensive care unit (ICU) patients with respiratory syncytial virus (RSV) infection, and compare these with coronavirus disease (COVID-19) during the same period.
Design, setting, and participants
We conducted a multicenter, prospective, observational study using data from the short period incidence study of severe acute respiratory infection (SPRINT SARI) Australia, in 38 Australian ICUs from 1 June 2022 to 1 September 2024. Demographic, treatment, and outcome data were analysed for patients with confirmed RSV or COVID-19. The primary outcome was in-hospital mortality.
Results
Of 4693 patients were recorded in the SPRINT-SARI database, 2540 met inclusion criteria. RSV was more common in paediatric patients (410/620, 62%) than in adults (249/1920, 13%). Adult with RSV had more chronic pulmonary conditions than those with COVID-19. Paediatric patients with RSV had fewer comorbidities and less invasive mechanical ventilation (IMV) compared to those with COVID-19 (P < 0.05), but required longer duration of IMV once intubated. In-hospital mortality was similar for both adult RSV and COVID-19 (36/249, 14.5%) vs (260/1671, 15.6%), and paediatric RSV(3/410 [0.7%] vs 7/210 [3.3%] P = 0.07). Mortality in adults was associated with male sex, older age, comorbidities, and IMV. Mortality in children was associated with IMV only.
Conclusions
RSV infection can result in an attributable number of ICU admission in Australia, especially in specific populations including young children and older adults with respiratory comorbidities. Mortality in patients admitted to ICU is similar to COVID-19.
目的探讨呼吸道合胞病毒（RSV）感染的儿科和成人重症监护病房（ICU）患者的特点、治疗方法和预后，并与同期的冠状病毒病（COVID-19）进行比较。设计、环境和参与者我们进行了一项多中心、前瞻性、观察性研究，使用来自澳大利亚严重急性呼吸道感染短期发病率研究（SPRINT SARI）的数据，从2022年6月1日至2024年9月1日在38个澳大利亚icu中进行。分析确诊RSV或COVID-19患者的人口统计学、治疗和结局数据。主要终点是住院死亡率。结果在SPRINT-SARI数据库中记录的4693例患者中，2540例符合纳入标准。RSV在儿科患者（410/620,62%）中比在成人（249/1920,13%）中更常见。患有RSV的成人比患有COVID-19的成人有更多的慢性肺部疾病。与COVID-19患者相比，RSV患儿的合并症和侵入性机械通气（IMV）较少(P <；0.05)，但需要较长的IMV插管时间。成人RSV和COVID-19的住院死亡率相似（36/249,14.5%）vs(260/1671, 15.6%)，儿科RSV（3/410 [0.7%] vs 7/210 [3.3%] P = 0.07）。成人死亡率与男性、年龄、合并症和IMV有关。儿童死亡率仅与IMV有关。结论srsv感染可导致澳大利亚ICU住院人数的归因，特别是在特定人群中，包括患有呼吸道合并症的幼儿和老年人。ICU住院患者的死亡率与COVID-19相似。
{"title":"Respiratory syncytial virus infection in adult and paediatric patients admitted to intensive care in Australia: A nation-wide comparison with COVID-19","authors":"Yaodong Tang PhD , Peinan Zhao PhD , Allen C. Cheng MBBS, PhD , Aaliya Ibrahim MClinEpid , Jenna Hassall MPhil , Edward Litton MBChB, PhD , Christopher R. Andersen MBBS, FCICM , Cindy Liang RN, GradCertN , Elissa M. Milford MBBS, PhD , Morgan Rose MBBS, PhD , Mark Plummer FCICM, PhD , Jing Kong RN, GradCertN , Kerry Johnson RN, GradCertN , Shailesh Bihari FCICM, PhD , Anis Chaba MBBS, MMSBR , Husna Begum PhD , Sherene Magana Cruz DipLH , Sze Ng MBBS , Tony Trapani B.Ed , Lewis Campbell MBChB, MSc Epi, FCICM , Aidan Burrell MBBS, PhD, FCICM","doi":"10.1016/j.ccrj.2025.100113","DOIUrl":"10.1016/j.ccrj.2025.100113","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the characteristics, treatments and outcomes of paediatric and adult intensive care unit (ICU) patients with respiratory syncytial virus (RSV) infection, and compare these with coronavirus disease (COVID-19) during the same period.</div></div><div><h3>Design, setting, and participants</h3><div>We conducted a multicenter, prospective, observational study using data from the short period incidence study of severe acute respiratory infection (SPRINT SARI) Australia, in 38 Australian ICUs from 1 June 2022 to 1 September 2024. Demographic, treatment, and outcome data were analysed for patients with confirmed RSV or COVID-19. The primary outcome was in-hospital mortality.</div></div><div><h3>Results</h3><div>Of 4693 patients were recorded in the SPRINT-SARI database, 2540 met inclusion criteria. RSV was more common in paediatric patients (410/620, 62%) than in adults (249/1920, 13%). Adult with RSV had more chronic pulmonary conditions than those with COVID-19. Paediatric patients with RSV had fewer comorbidities and less invasive mechanical ventilation (IMV) compared to those with COVID-19 (P < 0.05), but required longer duration of IMV once intubated. In-hospital mortality was similar for both adult RSV and COVID-19 (36/249, 14.5%) vs (260/1671, 15.6%), and paediatric RSV(3/410 [0.7%] vs 7/210 [3.3%] P = 0.07). Mortality in adults was associated with male sex, older age, comorbidities, and IMV. Mortality in children was associated with IMV only.</div></div><div><h3>Conclusions</h3><div>RSV infection can result in an attributable number of ICU admission in Australia, especially in specific populations including young children and older adults with respiratory comorbidities. Mortality in patients admitted to ICU is similar to COVID-19.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 2","pages":"Article 100113"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491258","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 : 2025-06-01DOI: 10.1016/j.ccrj.2025.100116
Jeremy Cohen FCICM, PhD , Anthony Delaney FCICM, FACEM, PhD , Andrew Udy FCICM, PhD , Christopher Andersen FCICM, PhD , Craig S. Anderson PhD , Judith Bellapart FCICM, PhD , Louise M. Burrell MBChB, MD , Anthony Devaux PhD , David M. Evans PhD , Emily Fitzgerald RN, MN , Tessa Garside FCICM, PhD , Naomi Hammond RN, PhD , Miranda Hardie BN, GradCertCritCare , Rosalind L. Jeffree M.Sc, FRACS , Serena Knowles RN, PhD , Melissa Lassig-Smith RN , Qiang Li AStat MBiostat , Gladness Nethathe FCA (SA), Cert Crit Care (SA) , Dorrilyn Rajbhandari PGDip Clin Nurs , Mahesh Ramanan FCICM, PhD , Balasubramanian Venkatesh FCICM, MD
Background and rationale
Hyponatraemia is a common complication after aneurysmal subarachnoid haemorrhage (aSAH) and is associated with worse outcomes. Fludrocortisone, a synthetic mineralocorticoid, may be an effective treatment for hyponatraemia, but its effect on clinical outcomes is unknown.
Objectives
The objective of this study was to describe the study protocol for the Fludrocortisone in Aneurysmal Subarachnoid Haemorrhage (FLASH) trial.
Design setting and participants
The FLASH trial is a phase three randomised, blinded, placebo-controlled, multicentre trial comparing 14 days of treatment with fludrocortisone to matching placebo in adult patients with acute aSAH at hospitals in Australia, New Zealand, and the United Kingdom. The planned sample size is 524 patients.
Main outcome measures
The primary outcome measure is the Modified Rankin Scale score assessed at 6 months after randomisation. The secondary outcome is the Subarachnoid Haemorrhage Outcome Tool score assessed at the same time point. Tertiary outcomes are based on international guidelines for core outcome sets and include economic and quality-of-life analyses. Prespecified subgroups for analysis will comprise aSAH severity and the presence of hyponatraemia at randomisation.
Results and conclusions
The FLASH trial aims to commence recruitment in May 2025.
{"title":"Fludrocortisone to treat patients with aneurysmal subarachnoid haemorrhage: Protocol for an international, phase 3, randomised, placebo-controlled, multicentre trial","authors":"Jeremy Cohen FCICM, PhD , Anthony Delaney FCICM, FACEM, PhD , Andrew Udy FCICM, PhD , Christopher Andersen FCICM, PhD , Craig S. Anderson PhD , Judith Bellapart FCICM, PhD , Louise M. Burrell MBChB, MD , Anthony Devaux PhD , David M. Evans PhD , Emily Fitzgerald RN, MN , Tessa Garside FCICM, PhD , Naomi Hammond RN, PhD , Miranda Hardie BN, GradCertCritCare , Rosalind L. Jeffree M.Sc, FRACS , Serena Knowles RN, PhD , Melissa Lassig-Smith RN , Qiang Li AStat MBiostat , Gladness Nethathe FCA (SA), Cert Crit Care (SA) , Dorrilyn Rajbhandari PGDip Clin Nurs , Mahesh Ramanan FCICM, PhD , Balasubramanian Venkatesh FCICM, MD","doi":"10.1016/j.ccrj.2025.100116","DOIUrl":"10.1016/j.ccrj.2025.100116","url":null,"abstract":"<div><h3>Background and rationale</h3><div>Hyponatraemia is a common complication after aneurysmal subarachnoid haemorrhage (aSAH) and is associated with worse outcomes. Fludrocortisone, a synthetic mineralocorticoid, may be an effective treatment for hyponatraemia, but its effect on clinical outcomes is unknown.</div></div><div><h3>Objectives</h3><div>The objective of this study was to describe the study protocol for the Fludrocortisone in Aneurysmal Subarachnoid Haemorrhage (FLASH) trial.</div></div><div><h3>Design setting and participants</h3><div>The FLASH trial is a phase three randomised, blinded, placebo-controlled, multicentre trial comparing 14 days of treatment with fludrocortisone to matching placebo in adult patients with acute aSAH at hospitals in Australia, New Zealand, and the United Kingdom. The planned sample size is 524 patients.</div></div><div><h3>Main outcome measures</h3><div>The primary outcome measure is the Modified Rankin Scale score assessed at 6 months after randomisation. The secondary outcome is the Subarachnoid Haemorrhage Outcome Tool score assessed at the same time point. Tertiary outcomes are based on international guidelines for core outcome sets and include economic and quality-of-life analyses. Prespecified subgroups for analysis will comprise aSAH severity and the presence of hyponatraemia at randomisation.</div></div><div><h3>Results and conclusions</h3><div>The FLASH trial aims to commence recruitment in May 2025.</div></div><div><h3>Trial registration</h3><div>NCT06409364.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 2","pages":"Article 100116"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144513860","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 : 2025-06-01DOI: 10.1016/j.ccrj.2025.100114
Rinaldo Bellomo PhD , Jorge Salluh PhD, Antonio Paulo Nassar Jr. PhD, Elisa Estenssoro PhD, Ary Serpa Neto PhD
{"title":"Expanding the critical care collaboration between Australia, New Zealand, and Brazil: The role of journals","authors":"Rinaldo Bellomo PhD , Jorge Salluh PhD, Antonio Paulo Nassar Jr. PhD, Elisa Estenssoro PhD, Ary Serpa Neto PhD","doi":"10.1016/j.ccrj.2025.100114","DOIUrl":"10.1016/j.ccrj.2025.100114","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 2","pages":"Article 100114"},"PeriodicalIF":1.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279912","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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