Pub Date : 2023-10-18eCollection Date: 2021-09-06DOI: 10.51893/2021.3.OA8
Aidan J C Burrell, Ary Serpa Neto, Tessa Broadley, Tony Trapani, Husna Begum, Lewis T Campbell, Allen C Cheng, Winston Cheung, D James Cooper, Simon J Erickson, Craig J French, John M Kaldor, Edward Litton, Srinivas Murthy, Richard E McAllister, Alistair D Nichol, Annamaria Palermo, Mark P Plummer, Mahesh Ramanan, Benjamin A J Reddi, Claire Reynolds, Steve A Webb, Andrew A Udy
Objective: To report longitudinal differences in baseline characteristics, treatment, and outcomes in patients with coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) between the first and second waves of COVID-19 in Australia. Design, setting and participants: SPRINT-SARI Australia is a multicentre, inception cohort study enrolling adult patients with COVID-19 admitted to participating ICUs. The first wave of COVID-19 was from 27 February to 30 June 2020, and the second wave was from 1 July to 22 October 2020. Results: A total of 461 patients were recruited in 53 ICUs across Australia; a higher number were admitted to the ICU during the second wave compared with the first: 255 (55.3%) versus 206 (44.7%). Patients admitted to the ICU in the second wave were younger (58.0 v 64.0 years; P = 0.001) and less commonly male (68.9% v 60.0%; P = 0.045), although Acute Physiology and Chronic Health Evaluation (APACHE) II scores were similar (14 v 14; P = 0.998). High flow oxygen use (75.2% v 43.4%; P < 0.001) and non-invasive ventilation (16.5% v 7.1%; P = 0.002) were more common in the second wave, as was steroid use (95.0% v 30.3%; P < 0.001). ICU length of stay was shorter (6.0 v 8.4 days; P = 0.003). In-hospital mortality was similar (12.2% v 14.6%; P = 0.452), but observed mortality decreased over time and patients were more likely to be discharged alive earlier in their ICU admission (hazard ratio, 1.43; 95% CI, 1.13–1.79; P = 0.002). Conclusion: During the second wave of COVID-19 in Australia, ICU length of stay and observed mortality decreased over time. Multiple factors were associated with this, including changes in clinical management, the adoption of new evidence-based treatments, and changes in patient demographic characteristics but not illness severity.
目的:报告澳大利亚第一波和第二波COVID-19入住重症监护病房(icu)的2019冠状病毒病(COVID-19)患者的基线特征、治疗和结局的纵向差异。设计、环境和参与者:SPRINT-SARI澳大利亚是一项多中心、初始队列研究,纳入了进入icu的成年COVID-19患者。第一波COVID-19疫情发生在2020年2月27日至6月30日,第二波疫情发生在2020年7月1日至10月22日。结果:澳大利亚53个icu共招募了461名患者;第二波入住ICU的人数高于第一波:255人(55.3%)对206人(44.7%)。第二波入住ICU的患者较年轻(58.0 v 64.0岁;P = 0.001),男性较少(68.9% vs 60.0%;P = 0.045),尽管急性生理和慢性健康评估(APACHE) II评分相似(14 v 14;P = 0.998)。高流量耗氧量(75.2% v 43.4%;P < 0.001)和无创通气(16.5% v 7.1%;P = 0.002)在第二波中更为常见,类固醇使用也更为常见(95.0% vs 30.3%;P < 0.001)。ICU住院时间较短(6.0 v 8.4 d);P = 0.003)。住院死亡率相似(12.2% vs 14.6%;P = 0.452),但观察到的死亡率随着时间的推移而下降,患者更有可能在ICU入院时更早活着出院(风险比,1.43;95% ci, 1.13-1.79;P = 0.002)。结论:在澳大利亚第二波COVID-19期间,ICU住院时间和观察死亡率随时间而下降。多种因素与此相关,包括临床管理的变化,采用新的循证治疗方法,以及患者人口统计学特征的变化,但不包括疾病严重程度的变化。
{"title":"Comparison of baseline characteristics, treatment and celinical outcomes of critically ill COVID-19 patients admitted in the first and second waves in Australia.","authors":"Aidan J C Burrell, Ary Serpa Neto, Tessa Broadley, Tony Trapani, Husna Begum, Lewis T Campbell, Allen C Cheng, Winston Cheung, D James Cooper, Simon J Erickson, Craig J French, John M Kaldor, Edward Litton, Srinivas Murthy, Richard E McAllister, Alistair D Nichol, Annamaria Palermo, Mark P Plummer, Mahesh Ramanan, Benjamin A J Reddi, Claire Reynolds, Steve A Webb, Andrew A Udy","doi":"10.51893/2021.3.OA8","DOIUrl":"10.51893/2021.3.OA8","url":null,"abstract":"Objective: To report longitudinal differences in baseline characteristics, treatment, and outcomes in patients with coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) between the first and second waves of COVID-19 in Australia. Design, setting and participants: SPRINT-SARI Australia is a multicentre, inception cohort study enrolling adult patients with COVID-19 admitted to participating ICUs. The first wave of COVID-19 was from 27 February to 30 June 2020, and the second wave was from 1 July to 22 October 2020. Results: A total of 461 patients were recruited in 53 ICUs across Australia; a higher number were admitted to the ICU during the second wave compared with the first: 255 (55.3%) versus 206 (44.7%). Patients admitted to the ICU in the second wave were younger (58.0 v 64.0 years; P = 0.001) and less commonly male (68.9% v 60.0%; P = 0.045), although Acute Physiology and Chronic Health Evaluation (APACHE) II scores were similar (14 v 14; P = 0.998). High flow oxygen use (75.2% v 43.4%; P < 0.001) and non-invasive ventilation (16.5% v 7.1%; P = 0.002) were more common in the second wave, as was steroid use (95.0% v 30.3%; P < 0.001). ICU length of stay was shorter (6.0 v 8.4 days; P = 0.003). In-hospital mortality was similar (12.2% v 14.6%; P = 0.452), but observed mortality decreased over time and patients were more likely to be discharged alive earlier in their ICU admission (hazard ratio, 1.43; 95% CI, 1.13–1.79; P = 0.002). Conclusion: During the second wave of COVID-19 in Australia, ICU length of stay and observed mortality decreased over time. Multiple factors were associated with this, including changes in clinical management, the adoption of new evidence-based treatments, and changes in patient demographic characteristics but not illness severity.","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10692524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41984365","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 : 2023-10-16eCollection Date: 2022-12-05DOI: 10.51893/2022.4.OA1
Geoffrey Wigmore, Adam M Deane, James Anstey, Michael Bailey, Shailesh Bihari, Glenn Eastwood, Rashmi Ghanpur, Matthew J Maiden, Jeffrey J Presneill, Jaishankar Raman, Rinaldo Bellomo
Background: Fluid bolus therapy with 20% albumin may shorten the duration of vasopressor therapy in patients after cardiac surgery. Objective: To describe the study protocol and statistical analysis plan for the 20% Human Albumin Solution Fluid Bolus Administration Therapy in Patients after Cardiac Surgery-II (HAS FLAIR-II) trial. Design, setting, participants and intervention: HAS FLAIR-II is a phase 2b, multicentre, parallel group, openlabel, randomised controlled trial that will be conducted at six Australian intensive care units. Patients requiring fluid bolus therapy after cardiac surgery will be randomly assigned in a 1:1 ratio to the intervention of fluid bolus therapy with 20% albumin or a comparator of fluid bolus therapy with a crystalloid solution. Main outcome measures: The primary outcome measure is the cumulative duration of vasopressor therapy. Secondary outcomes include vasopressor use, service utilisation, and mortality. All analyses will be conducted on an intention-to-treat basis. Results and conclusion: The study protocol and statistical analysis plan will guide the conduct and analysis of the HAS FLAIR-II trial, such that analytical and reporting biases are minimised. Trial registration: This trial has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN No. 12620000137998).
{"title":"Study protocol and statistical analysis plan for the 20% Human Albumin Solution Fluid Bolus Administration Therapy in Patients after Cardiac Surgery-ll (HAS FLAIR-II) trial.","authors":"Geoffrey Wigmore, Adam M Deane, James Anstey, Michael Bailey, Shailesh Bihari, Glenn Eastwood, Rashmi Ghanpur, Matthew J Maiden, Jeffrey J Presneill, Jaishankar Raman, Rinaldo Bellomo","doi":"10.51893/2022.4.OA1","DOIUrl":"10.51893/2022.4.OA1","url":null,"abstract":"<p><p><b>Background:</b> Fluid bolus therapy with 20% albumin may shorten the duration of vasopressor therapy in patients after cardiac surgery. <b>Objective:</b> To describe the study protocol and statistical analysis plan for the 20% Human Albumin Solution Fluid Bolus Administration Therapy in Patients after Cardiac Surgery-II (HAS FLAIR-II) trial. <b>Design, setting, participants and intervention:</b> HAS FLAIR-II is a phase 2b, multicentre, parallel group, openlabel, randomised controlled trial that will be conducted at six Australian intensive care units. Patients requiring fluid bolus therapy after cardiac surgery will be randomly assigned in a 1:1 ratio to the intervention of fluid bolus therapy with 20% albumin or a comparator of fluid bolus therapy with a crystalloid solution. <b>Main outcome measures:</b> The primary outcome measure is the cumulative duration of vasopressor therapy. Secondary outcomes include vasopressor use, service utilisation, and mortality. All analyses will be conducted on an intention-to-treat basis. <b>Results and conclusion:</b> The study protocol and statistical analysis plan will guide the conduct and analysis of the HAS FLAIR-II trial, such that analytical and reporting biases are minimised. <b>Trial registration:</b> This trial has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN No. 12620000137998).</p>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10692638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44312130","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 : 2023-09-01DOI: 10.1016/j.ccrj.2023.06.007
Paul J. Young MBChB, PhD , Carol L. Hodgson PT, MPhil, PhD , Diane Mackle MN, PhD , Anne M. Mather BBiomed (Hons) , Richard Beasley MBChB, DSc , Rinaldo Bellomo MD , Stephen Bernard MD , Kathy Brickell RGN , Adam M. Deane PhD , Glenn Eastwood PhD , Simon Finfer MD , Alisa M. Higgins MPH, PhD , Anna Hunt BN , Cassie Lawrence BN , Natalie J. Linke BN , Edward Litton MD, PhD , Christine F. McDonald MBBS (Hons), PhD , James Moore MBChB, MSc , Alistair D. Nichol PhD , Shaanti Olatunji MClinImm , Jessica Kasza PhD
Background
The effect of conservative vs. liberal oxygen therapy on outcomes of intensive care unit (ICU) patients with hypoxic ischaemic encephalopathy (HIE) is uncertain and will be evaluated in the Low Oxygen Intervention for Cardiac Arrest injury Limitation (LOGICAL) trial.
Objective
The objective of this study was to summarise the protocol and statistical analysis plans for the LOGICAL trial.
Design, setting, and participants
LOGICAL is a randomised clinical trial in adults in the ICU who are comatose with suspected HIE (i.e., those who have not obeyed commands following return of spontaneous circulation after a cardiac arrest where there is clinical concern about possible brain damage). The LOGICAL trial will include 1400 participants and is being conducted as a substudy of the Mega Randomised registry trial comparing conservative vs. liberal oxygenation targets in adults receiving unplanned invasive mechanical ventilation in the ICU (Mega-ROX).
Main outcome measures
The primary outcome is survival with favourable neurological function at 180 days after randomisation as measured with the Extended Glasgow Outcome Scale (GOS-E). A favourable neurological outcome will be defined as a GOS-E score of lower moderate disability or better (i.e. a GOS-E score of 5–8). Secondary outcomes include survival time, day 180 mortality, duration of invasive mechanical ventilation, ICU length of stay, hospital length of stay, the proportion of patients discharged home, quality of life assessed at day 180 using the EQ-5D-5L, and cognitive function assessed at day 180 using the Montreal Cognitive Assessment (MoCA-blind).
Conclusions
The LOGICAL trial will provide reliable data on the impact of conservative vs. liberal oxygen therapy in ICU patients with suspected HIE following resuscitation from a cardiac arrest. Prepublication of the LOGICAL protocol and statistical analysis plan prior to trial conclusion will reduce the potential for outcome-reporting or analysis bias.
Trial registration
Australian and New Zealand Clinical Trials Registry (ACTRN12621000518864).
{"title":"Protocol summary and statistical analysis plan for the low oxygen intervention for cardiac arrest injury limitation (LOGICAL) trial","authors":"Paul J. Young MBChB, PhD , Carol L. Hodgson PT, MPhil, PhD , Diane Mackle MN, PhD , Anne M. Mather BBiomed (Hons) , Richard Beasley MBChB, DSc , Rinaldo Bellomo MD , Stephen Bernard MD , Kathy Brickell RGN , Adam M. Deane PhD , Glenn Eastwood PhD , Simon Finfer MD , Alisa M. Higgins MPH, PhD , Anna Hunt BN , Cassie Lawrence BN , Natalie J. Linke BN , Edward Litton MD, PhD , Christine F. McDonald MBBS (Hons), PhD , James Moore MBChB, MSc , Alistair D. Nichol PhD , Shaanti Olatunji MClinImm , Jessica Kasza PhD","doi":"10.1016/j.ccrj.2023.06.007","DOIUrl":"10.1016/j.ccrj.2023.06.007","url":null,"abstract":"<div><h3>Background</h3><p>The effect of conservative vs. liberal oxygen therapy on outcomes of intensive care unit (ICU) patients with hypoxic ischaemic encephalopathy (HIE) is uncertain and will be evaluated in the Low Oxygen Intervention for Cardiac Arrest injury Limitation (LOGICAL) trial.</p></div><div><h3>Objective</h3><p>The objective of this study was to summarise the protocol and statistical analysis plans for the LOGICAL trial.</p></div><div><h3>Design, setting, and participants</h3><p>LOGICAL is a randomised clinical trial in adults in the ICU who are comatose with suspected HIE (i.e., those who have not obeyed commands following return of spontaneous circulation after a cardiac arrest where there is clinical concern about possible brain damage). The LOGICAL trial will include 1400 participants and is being conducted as a substudy of the Mega Randomised registry trial comparing conservative vs. liberal oxygenation targets in adults receiving unplanned invasive mechanical ventilation in the ICU (Mega-ROX).</p></div><div><h3>Main outcome measures</h3><p>The primary outcome is survival with favourable neurological function at 180 days after randomisation as measured with the Extended Glasgow Outcome Scale (GOS-E). A favourable neurological outcome will be defined as a GOS-E score of lower moderate disability or better (i.e. a GOS-E score of 5–8). Secondary outcomes include survival time, day 180 mortality, duration of invasive mechanical ventilation, ICU length of stay, hospital length of stay, the proportion of patients discharged home, quality of life assessed at day 180 using the EQ-5D-5L, and cognitive function assessed at day 180 using the Montreal Cognitive Assessment (MoCA-blind).</p></div><div><h3>Conclusions</h3><p>The LOGICAL trial will provide reliable data on the impact of conservative vs. liberal oxygen therapy in ICU patients with suspected HIE following resuscitation from a cardiac arrest. Prepublication of the LOGICAL protocol and statistical analysis plan prior to trial conclusion will reduce the potential for outcome-reporting or analysis bias.</p></div><div><h3>Trial registration</h3><p>Australian and New Zealand Clinical Trials Registry (ACTRN12621000518864).</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45456033","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 : 2023-09-01DOI: 10.1016/j.ccrj.2023.09.001
{"title":"Erratum for previously published articles","authors":"","doi":"10.1016/j.ccrj.2023.09.001","DOIUrl":"https://doi.org/10.1016/j.ccrj.2023.09.001","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49711615","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 : 2023-09-01DOI: 10.1016/j.ccrj.2023.08.001
Matthew J. Summers MDiet , Lee-anne S. Chapple MNutDiet, PhD , Rinaldo Bellomo MBBS, MD , Marianne J. Chapman MBBS, PhD , Suzie Ferrie MND, PhD , Mark E. Finnis MBBS, MBiostat , Craig French MBBS , Sally Hurford Post Grad Dip Clinical Research , Nima Kakho MBBS , Amalia Karahalios PhD , Matthew J. Maiden MBBS, PhD , Stephanie N. O'Connor RN, MNSc , Sandra L. Peake MBBS, PhD , Jeffrey J. Presneill MBBS, PhD , Emma J. Ridley BNutDiet, PhD , An Tran-Duy PhD , Patricia J. Williams RGN, BNP , Paul J. Young MBChB, PhD , Sophie Zaloumis PhD , Adam M. Deane MBBS, PhD
Background
It is unknown whether increasing dietary protein to 1.2–2.0 g/kg/day as recommended in international guidelines compared to current practice improves outcomes in intensive care unit (ICU) patients. The TARGET Protein trial will evaluate this.
Objective
To describe the study protocol for the TARGET Protein trial.
Design, setting, and participants
TARGET Protein is a cluster randomised, cross-sectional, double cross-over, pragmatic clinical trial undertaken in eight ICUs in Australia and New Zealand. Each ICU will be randomised to use one of two trial enteral formulae for three months before crossing over to the other formula, which is then repeated, with enrolment continuing at each ICU for 12 months. All patients aged ≥16 years in their index ICU admission commencing enteral nutrition will be eligible for inclusion. Eligible patients will receive the trial enteral formula to which their ICU is allocated. The two trial enteral formulae are isocaloric with a difference in protein dose: intervention 100g/1000 ml and comparator 63g/1000 ml. Staggered recruitment commenced in May 2022.
Main outcomes measures
The primary outcome is days free of the index hospital and alive at day 90. Secondary outcomes include days free of the index hospital at day 90 in survivors, alive at day 90, duration of invasive ventilation, ICU and hospital length of stay, incidence of tracheostomy insertion, renal replacement therapy, and discharge destination.
Conclusion
TARGET Protein aims to determine whether augmented enteral protein delivery reduces days free of the index hospital and alive at day 90.
Trial registration
Australian New Zealand Clinical Trials Registry (ACTRN12621001484831).
{"title":"Study protocol for TARGET protein: The effect of augmented administration of enteral protein to critically ill adults on clinical outcomes: A cluster randomised, cross-sectional, double cross-over, clinical trial","authors":"Matthew J. Summers MDiet , Lee-anne S. Chapple MNutDiet, PhD , Rinaldo Bellomo MBBS, MD , Marianne J. Chapman MBBS, PhD , Suzie Ferrie MND, PhD , Mark E. Finnis MBBS, MBiostat , Craig French MBBS , Sally Hurford Post Grad Dip Clinical Research , Nima Kakho MBBS , Amalia Karahalios PhD , Matthew J. Maiden MBBS, PhD , Stephanie N. O'Connor RN, MNSc , Sandra L. Peake MBBS, PhD , Jeffrey J. Presneill MBBS, PhD , Emma J. Ridley BNutDiet, PhD , An Tran-Duy PhD , Patricia J. Williams RGN, BNP , Paul J. Young MBChB, PhD , Sophie Zaloumis PhD , Adam M. Deane MBBS, PhD","doi":"10.1016/j.ccrj.2023.08.001","DOIUrl":"https://doi.org/10.1016/j.ccrj.2023.08.001","url":null,"abstract":"<div><h3>Background</h3><p>It is unknown whether increasing dietary protein to 1.2–2.0 g/kg/day as recommended in international guidelines compared to current practice improves outcomes in intensive care unit (ICU) patients. The TARGET Protein trial will evaluate this.</p></div><div><h3>Objective</h3><p>To describe the study protocol for the TARGET Protein trial.</p></div><div><h3>Design, setting, and participants</h3><p>TARGET Protein is a cluster randomised, cross-sectional, double cross-over, pragmatic clinical trial undertaken in eight ICUs in Australia and New Zealand. Each ICU will be randomised to use one of two trial enteral formulae for three months before crossing over to the other formula, which is then repeated, with enrolment continuing at each ICU for 12 months. All patients aged ≥16 years in their index ICU admission commencing enteral nutrition will be eligible for inclusion. Eligible patients will receive the trial enteral formula to which their ICU is allocated. The two trial enteral formulae are isocaloric with a difference in protein dose: intervention 100g/1000 ml and comparator 63g/1000 ml. Staggered recruitment commenced in May 2022.</p></div><div><h3>Main outcomes measures</h3><p>The primary outcome is days free of the index hospital and alive at day 90. Secondary outcomes include days free of the index hospital at day 90 in survivors, alive at day 90, duration of invasive ventilation, ICU and hospital length of stay, incidence of tracheostomy insertion, renal replacement therapy, and discharge destination.</p></div><div><h3>Conclusion</h3><p>TARGET Protein aims to determine whether augmented enteral protein delivery reduces days free of the index hospital and alive at day 90.</p></div><div><h3>Trial registration</h3><p>Australian New Zealand Clinical Trials Registry (ACTRN12621001484831).</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49711861","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 : 2023-09-01DOI: 10.1016/j.ccrj.2023.06.002
Kyle C. White MBBS, MPH, FRACP, FCICM , Ahmad Nasser MBChB, Dip. Child Health, M. Paed, FCICM , Michelle L. Gatton PhD , Kevin B. Laupland MD, PhD
Objective
The overall objective of this scoping review is to assess the extent of the literature related to the fluid management of critically ill patients with acute kidney injury (AKI).
Introduction
AKI is common in critically ill patients where fluid therapy is a mainstay of treatment. An association between fluid balance (FB) and adverse patient-centred outcomes in critically ill patients with AKI regardless of severity has been demonstrated. The evidence for the prospective intervention of FB and its impact on outcomes is unknown.
Inclusion criteria
All studies investigating FB in patients with AKI admitted to an intensive care unit were included. Literature not related to FB in the critically ill patient with AKI population was excluded.
Methods
We searched MEDLINE, EMBASE, and CINAHL from January 1st, 2012, onwards. We included primary research studies, experimental and observational, recruiting adult participants admitted to an intensive care unit who had an AKI. We extracted data on study and patient characteristics, as well as FB, renal-based outcomes, and patient-centred outcomes. Two reviewers independently screened citations for eligible studies and performed data extraction.
Results
Of the 13,767 studies reviewed, 22 met the inclusion criteria. Two studies examined manipulation of fluid input, 18 studies assessed enhancing fluid removal, and two studies applied a restrictive fluid protocol. Sixteen studies examined patients receiving renal replacement therapy, five studies included non–renal replacement therapy patients, and one study included both. Current evidence is broad with varied approaches to managing fluid input and fluid removal. The studies did not demonstrate a consensus approach for any aspect of the fluid management of critically ill patients. There was a limited application of a restrictive fluid protocol with no conclusions possible.
Conclusions
The current body of evidence for the management of FB in critically ill patients with AKI is limited in nature. The current quality of evidence is unable to guide current clinical practice. The key outcome of this review is to highlight areas for future research.
{"title":"Current management of fluid balance in critically ill patients with acute kidney injury: A scoping review","authors":"Kyle C. White MBBS, MPH, FRACP, FCICM , Ahmad Nasser MBChB, Dip. Child Health, M. Paed, FCICM , Michelle L. Gatton PhD , Kevin B. Laupland MD, PhD","doi":"10.1016/j.ccrj.2023.06.002","DOIUrl":"10.1016/j.ccrj.2023.06.002","url":null,"abstract":"<div><h3>Objective</h3><p>The overall objective of this scoping review is to assess the extent of the literature related to the fluid management of critically ill patients with acute kidney injury (AKI).</p></div><div><h3>Introduction</h3><p>AKI is common in critically ill patients where fluid therapy is a mainstay of treatment. An association between fluid balance (FB) and adverse patient-centred outcomes in critically ill patients with AKI regardless of severity has been demonstrated. The evidence for the prospective intervention of FB and its impact on outcomes is unknown.</p></div><div><h3>Inclusion criteria</h3><p>All studies investigating FB in patients with AKI admitted to an intensive care unit were included. Literature not related to FB in the critically ill patient with AKI population was excluded.</p></div><div><h3>Methods</h3><p>We searched MEDLINE, EMBASE, and CINAHL from January 1st, 2012, onwards. We included primary research studies, experimental and observational, recruiting adult participants admitted to an intensive care unit who had an AKI. We extracted data on study and patient characteristics, as well as FB, renal-based outcomes, and patient-centred outcomes. Two reviewers independently screened citations for eligible studies and performed data extraction.</p></div><div><h3>Results</h3><p>Of the 13,767 studies reviewed, 22 met the inclusion criteria. Two studies examined manipulation of fluid input, 18 studies assessed enhancing fluid removal, and two studies applied a restrictive fluid protocol. Sixteen studies examined patients receiving renal replacement therapy, five studies included non–renal replacement therapy patients, and one study included both. Current evidence is broad with varied approaches to managing fluid input and fluid removal. The studies did not demonstrate a consensus approach for any aspect of the fluid management of critically ill patients. There was a limited application of a restrictive fluid protocol with no conclusions possible.</p></div><div><h3>Conclusions</h3><p>The current body of evidence for the management of FB in critically ill patients with AKI is limited in nature. The current quality of evidence is unable to guide current clinical practice. The key outcome of this review is to highlight areas for future research.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48877915","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 : 2023-09-01DOI: 10.1016/j.ccrj.2023.06.004
Jeroen Ludikhuize MD, PhD , David Marshall MD , Misha Devchand MD, PhD , Steven Walker MD, PhD , Andrew Talman MD , Carmel Taylor RN , Tammie McIntyre RN , Jason Trubiano MD, PhD , Daryl Jones MD, PhD
Objective
To introduce a management guideline for sepsis-related MET calls to increase lactate and blood culture acquisition, as well as prescription of appropriate antibiotics.
Design
Prospective before (Jun–Aug 2018) and after (Oct–Dec 2018) study was designed.
Setting
A public university linked hospital in Melbourne, Australia.
Participants
Adult patients with MET calls related to sepsis/infection were included.
Main outcome measures
The primary outcome measure was the proportion of MET calls during which both a blood culture and lactate level were ordered. Secondary outcomes included the frequency with which new antimicrobials were commenced by the MET, and the presence and class of administered antimicrobials.
Results
There were 985 and 955 MET calls in the baseline and after periods, respectively. Patient features, MET triggers, limitations of treatment and disposition after the MET call were similar in both groups. Compliance with the acquisition of lactates (p = 0.101), respectively. There was a slight reduction in compliance with lactate acquisition in the after period (97% vs 99%; p = 0.06). In contrast, there was a significant increase in acquisition of blood cultures in the after period (69% vs 78%; p = 0.035).
Conclusions
Introducing a sepsis management guideline and enhanced linkage with an AMS program increased blood culture acquisition and decreased broad spectrum antimicrobial use but didn't change in-hospital mortality.
{"title":"Improving the management of medical emergency team calls due to suspected infections: A before–after study","authors":"Jeroen Ludikhuize MD, PhD , David Marshall MD , Misha Devchand MD, PhD , Steven Walker MD, PhD , Andrew Talman MD , Carmel Taylor RN , Tammie McIntyre RN , Jason Trubiano MD, PhD , Daryl Jones MD, PhD","doi":"10.1016/j.ccrj.2023.06.004","DOIUrl":"10.1016/j.ccrj.2023.06.004","url":null,"abstract":"<div><h3>Objective</h3><p>To introduce a management guideline for sepsis-related MET calls to increase lactate and blood culture acquisition, as well as prescription of appropriate antibiotics.</p></div><div><h3>Design</h3><p>Prospective before (Jun–Aug 2018) and after (Oct–Dec 2018) study was designed.</p></div><div><h3>Setting</h3><p>A public university linked hospital in Melbourne, Australia.</p></div><div><h3>Participants</h3><p>Adult patients with MET calls related to sepsis/infection were included.</p></div><div><h3>Main outcome measures</h3><p>The primary outcome measure was the proportion of MET calls during which both a blood culture and lactate level were ordered. Secondary outcomes included the frequency with which new antimicrobials were commenced by the MET, and the presence and class of administered antimicrobials.</p></div><div><h3>Results</h3><p>There were 985 and 955 MET calls in the baseline and after periods, respectively. Patient features, MET triggers, limitations of treatment and disposition after the MET call were similar in both groups. Compliance with the acquisition of lactates (p = 0.101), respectively. There was a slight reduction in compliance with lactate acquisition in the after period (97% vs 99%; p = 0.06). In contrast, there was a significant increase in acquisition of blood cultures in the after period (69% vs 78%; p = 0.035).</p></div><div><h3>Conclusions</h3><p>Introducing a sepsis management guideline and enhanced linkage with an AMS program increased blood culture acquisition and decreased broad spectrum antimicrobial use but didn't change in-hospital mortality.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46176287","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 : 2023-09-01DOI: 10.1016/j.ccrj.2023.06.006
Daryl Jones , Judit Orosz , Alex Psirides , David Pilcher
{"title":"Potential metrics for rapid response systems in Australia and New Zealand","authors":"Daryl Jones , Judit Orosz , Alex Psirides , David Pilcher","doi":"10.1016/j.ccrj.2023.06.006","DOIUrl":"10.1016/j.ccrj.2023.06.006","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44535203","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 : 2023-09-01DOI: 10.1016/j.ccrj.2023.06.001
Aidan Burrell PhD , Sze Ng MBBS , Kelly Ottosen MHealthSc , Michael Bailey PhD , Hergen Buscher MD , John Fraser PhD , Andrew Udy PhD , David Gattas MMed(ClinEpi) , Richard Totaro MBBS , Rinaldo Bellomo PhD , Paul Forrest MBChB , Emma Martin BpharmSc , Liadain Reid MPH , Marc Ziegenfuss MBBS , Glenn Eastwood PhD , Alisa Higgins PhD , Carol Hodgson PhD , Edward Litton PhD , Priya Nair PhD , Neil Orford PhD , David Pilcher MBBS
Introduction
Critically ill patients supported with venoarterial extracorporeal membrane oxygenation (VA ECMO) are at risk of developing severe arterial hyperoxia, which has been associated with increased mortality. Lower saturation targets in this population may lead to deleterious episodes of severe hypoxia. This manuscript describes the protocol and statistical analysis plan for the Blend to Limit OxygEN in ECMO: A RanDomised ControllEd Registry (BLENDER) Trial.
Design
The BLENDER trial is a pragmatic, multicentre, registry-embedded, randomised clinical trial., registered at ClinicalTrials.gov (NCT03841084) and approved by The Alfred Hospital Ethics Committee project ID HREC/50486/Alfred-2019.
Participants and setting
Patients supported by VA ECMO for cardiogenic shock or cardiac arrest who are enrolled in the Australian national ECMO registry.
Intervention
The study compares a conservative oxygenation strategy (target arterial saturations 92–96%) with a liberal oxygenation strategy (target 97–100%).
Main Outcome Measures
The primary outcome is the number of intensive care unit (ICU)-free days for patients alive at day 60. Secondary outcomes include duration of mechanical ventilation, ICU and hospital mortality, the number of hypoxic episodes, neurocognitive outcomes, and health economic analyses. The 300-patient sample size enables us to detect a 3-day difference in ICU-free days at day 60, assuming a mean ICU-free days of 11 days, with a risk of type 1 error of 5% and power of 80%. Data will be analysed according to a predefined analysis plan. Findings will be disseminated in peer-reviewed publications.
Conclusions
This paper details the protocol and statistical analysis plan for the BLENDER trial, a registry-embedded, multicentre interventional trial comparing liberal and conservative oxygenation strategies in VA ECMO.
{"title":"Blend to Limit OxygEN in ECMO: A RanDomised ControllEd Registry (BLENDER) Trial: Study Protocol and Statistical Analysis Plan","authors":"Aidan Burrell PhD , Sze Ng MBBS , Kelly Ottosen MHealthSc , Michael Bailey PhD , Hergen Buscher MD , John Fraser PhD , Andrew Udy PhD , David Gattas MMed(ClinEpi) , Richard Totaro MBBS , Rinaldo Bellomo PhD , Paul Forrest MBChB , Emma Martin BpharmSc , Liadain Reid MPH , Marc Ziegenfuss MBBS , Glenn Eastwood PhD , Alisa Higgins PhD , Carol Hodgson PhD , Edward Litton PhD , Priya Nair PhD , Neil Orford PhD , David Pilcher MBBS","doi":"10.1016/j.ccrj.2023.06.001","DOIUrl":"https://doi.org/10.1016/j.ccrj.2023.06.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Critically ill patients supported with venoarterial extracorporeal membrane oxygenation (VA ECMO) are at risk of developing severe arterial hyperoxia, which has been associated with increased mortality. Lower saturation targets in this population may lead to deleterious episodes of severe hypoxia. This manuscript describes the protocol and statistical analysis plan for the Blend to Limit OxygEN in ECMO: A RanDomised ControllEd Registry (BLENDER) Trial.</p></div><div><h3>Design</h3><p>The BLENDER trial is a pragmatic, multicentre, registry-embedded, randomised clinical trial., registered at <span>ClinicalTrials.gov</span><svg><path></path></svg> (NCT03841084) and approved by The Alfred Hospital Ethics Committee project ID HREC/50486/Alfred-2019.</p></div><div><h3>Participants and setting</h3><p>Patients supported by VA ECMO for cardiogenic shock or cardiac arrest who are enrolled in the Australian national ECMO registry.</p></div><div><h3>Intervention</h3><p>The study compares a conservative oxygenation strategy (target arterial saturations 92–96%) with a liberal oxygenation strategy (target 97–100%).</p></div><div><h3>Main Outcome Measures</h3><p>The primary outcome is the number of intensive care unit (ICU)-free days for patients alive at day 60. Secondary outcomes include duration of mechanical ventilation, ICU and hospital mortality, the number of hypoxic episodes, neurocognitive outcomes, and health economic analyses. The 300-patient sample size enables us to detect a 3-day difference in ICU-free days at day 60, assuming a mean ICU-free days of 11 days, with a risk of type 1 error of 5% and power of 80%. Data will be analysed according to a predefined analysis plan. Findings will be disseminated in peer-reviewed publications.</p></div><div><h3>Conclusions</h3><p>This paper details the protocol and statistical analysis plan for the BLENDER trial, a registry-embedded, multicentre interventional trial comparing liberal and conservative oxygenation strategies in VA ECMO.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49711426","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}
The use of mRNA COVID-19 vaccine can on rare occasions cause life-threatening, fulminant myopericarditis. This case report demonstrates previously reported benefit of early use of venoarterial extracorporeal membrane oxygenation mechanical assistance and supports the use of intravenous highly purified immunoglobulin pharmacotherapy to help achieve a good clinical outcome.
{"title":"Pfizer BNT 162b2 COVID-19 vaccine–induced fulminant myopericarditis: A case study","authors":"Natalie L. Montarello Cardiologist, MBBS, FRACP , Hao Zheng Wong Intensivist, MBBS, FCICM , Ashlee Jeffries Cardiology Registrar, MBBS , Griffith B. Perkins Researcher in Immunology, BSc(Adv), PhD , Pravin Hissaria Immunologist, MBBS, MD, DM, FRACP, FRCPA , Michael B. Stokes Cardiologist, MBBS, FRACP , Eamon Raith Intensivist, MBBS, MACCP, PhD , Karen Teo Cardiologist, MBBS, FRACP, PhD , Julie Bradley Cardiologist, MBBS FRACP, FCSANZ","doi":"10.1016/j.ccrj.2023.06.005","DOIUrl":"10.1016/j.ccrj.2023.06.005","url":null,"abstract":"<div><p>The use of mRNA COVID-19 vaccine can on rare occasions cause life-threatening, fulminant myopericarditis. This case report demonstrates previously reported benefit of early use of venoarterial extracorporeal membrane oxygenation mechanical assistance and supports the use of intravenous highly purified immunoglobulin pharmacotherapy to help achieve a good clinical outcome.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49004639","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}