Pub Date : 2025-03-01DOI: 10.1016/j.ccrj.2025.100102
Viveka K. Nainani MBBS BMedSci , Byron Arcia Data analyst , David Pilcher MBBS MRCP (UK) FCICM FRACP , Joshua Ihle FCICM , Arne Diehl FCICM , Samuel Radford FCICM FRACP , Rohit D'Costa FRACP FCICM MBioEth , Vinodh B. Nanjayya FCICM
Objective
To describe the characteristics and the trend of organ donation from donors on extracorporeal membrane oxygenation (ECMO) or ventricular assist devices (LVAD).
Design
Retrospective, observational, cohort study from June 2014 to June 2021.
Setting
A multicentre study in Victoria, Australia, using DonateLife Victoria databases.
Participants
All patients on ECMO/LVAD were referred to DonateLife for organ donation.
Main outcome measures
Number, proportion, time trend and type of organ donations from the patients on ECMO/LVAD.
Results
There were 78 donor referrals [mean (SD) age 42 (18.8) yrs, 56 (72 %) males] from patients on Veno-arterial ECMO (73 %), Veno-venous ECMO (16 %) or LVAD (6.4 %), of which 37 (47 %) donated. The annual median (IQR) referral and donation rates were 8 (5–10)/year and 4 (3–7)/year, respectively. Medical contraindications were the main reason for declining organ donation [21(51 %)]. Donation after neurological determination of death (DNDD) occurred in 20 (54 %), and donation after circulatory determination of death (DCDD) in 17 (46 %). The median (IQR) time from admission to referral for donation was longer in DCDD compared to DNDD patients. Eighty-three organs were retrieved from 37 donors (2.24 organs per donor), out of which 68 organs (82 %) were transplanted in 68 recipients. Kidneys were the most common organs retrieved (73 %) and transplanted (79 %).
Conclusion
Organ donation on ECMO/LVAD occurs only in half of the referred patients. Further studies are needed to ascertain the barriers to donations and to assess the long-term outcomes of these donations.
{"title":"Organ donation from extracorporeal membrane oxygenation and ventricular assist devices in Victoria, Australia: Characteristics and trends","authors":"Viveka K. Nainani MBBS BMedSci , Byron Arcia Data analyst , David Pilcher MBBS MRCP (UK) FCICM FRACP , Joshua Ihle FCICM , Arne Diehl FCICM , Samuel Radford FCICM FRACP , Rohit D'Costa FRACP FCICM MBioEth , Vinodh B. Nanjayya FCICM","doi":"10.1016/j.ccrj.2025.100102","DOIUrl":"10.1016/j.ccrj.2025.100102","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the characteristics and the trend of organ donation from donors on extracorporeal membrane oxygenation (ECMO) or ventricular assist devices (LVAD).</div></div><div><h3>Design</h3><div>Retrospective, observational, cohort study from June 2014 to June 2021.</div></div><div><h3>Setting</h3><div>A multicentre study in Victoria, Australia, using DonateLife Victoria databases.</div></div><div><h3>Participants</h3><div>All patients on ECMO/LVAD were referred to DonateLife for organ donation.</div></div><div><h3>Main outcome measures</h3><div>Number, proportion, time trend and type of organ donations from the patients on ECMO/LVAD.</div></div><div><h3>Results</h3><div>There were 78 donor referrals [mean (SD) age 42 (18.8) yrs, 56 (72 %) males] from patients on Veno-arterial ECMO (73 %), Veno-venous ECMO (16 %) or LVAD (6.4 %), of which 37 (47 %) donated. The annual median (IQR) referral and donation rates were 8 (5–10)/year and 4 (3–7)/year, respectively. Medical contraindications were the main reason for declining organ donation [21(51 %)]. Donation after neurological determination of death (DNDD) occurred in 20 (54 %), and donation after circulatory determination of death (DCDD) in 17 (46 %). The median (IQR) time from admission to referral for donation was longer in DCDD compared to DNDD patients. Eighty-three organs were retrieved from 37 donors (2.24 organs per donor), out of which 68 organs (82 %) were transplanted in 68 recipients. Kidneys were the most common organs retrieved (73 %) and transplanted (79 %).</div></div><div><h3>Conclusion</h3><div>Organ donation on ECMO/LVAD occurs only in half of the referred patients. Further studies are needed to ascertain the barriers to donations and to assess the long-term outcomes of these donations.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100102"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609205","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 : 2025-03-01DOI: 10.1016/j.ccrj.2025.100099
Dominic Keuskamp PhD , Christopher E. Davies PhD , Paul J. Secombe BMBS (Hons) MClinSc FCICM , David V. Pilcher MBBS MRCP(UK) FRACP FCICM , Shaila Chavan MSPH , Sarah L. Jones MBChB (Hons) MRCP(UK) DICM(UK) FCICM FRACP , Benjamin E. Reddi MA PhD FRCP(UK) FCICM , Stephen P. McDonald MBBS (Hons) PhD FRACP
Objective
Limited data are available on intensive care unit (ICU) admissions for adults receiving kidney replacement therapy (KRT – dialysis or transplantation) in Australia. Our aim is to characterise admissions for patients receiving long-term dialysis and kidney transplant recipients relative to the general intensive care population in Australia.
Design
Retrospective registry-based data linkage cohort study.
Setting
All ICUs in Australia that reported to the Australian and New Zealand Intensive Care Society Adult Patient Database, 1 January 2018–31 December 2020.
Participants
All admissions were included. Data were deterministically linked to the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Subgroups analysed were defined by sex, age, admission type, APACHE III-j diagnostic category, diabetes status, body mass index (BMI), dialysis modality, dialysis vintage, and kidney transplant vintage.
Outcome measures
Admission to ICU for patients receiving KRT at the time of admission (as reported to the ANZDATA Registry).
Results
Patients receiving long-term dialysis prior to admission and those with a kidney transplant numbered 2826 (0.6% of all admissions) and 1194 (0.3%), respectively. Age-sex standardised admission rates relative to the non-KRT cohort (n = 438,271 or 99.1%) were highest for long-term dialysis patients (relative rate 10.18 [95% CI: 9.46,10.93]) and associated with diabetes and sepsis, cardiovascular and respiratory diagnoses.
Conclusions
Rates of ICU admission for people receiving long-term dialysis or kidney transplantation were many times higher than the general population, with particularly increased relative risk among younger age groups and for key medical diagnoses. Given the burden on patients and health services, exploration of strategies to reduce this risk is important.
{"title":"Intensive care admissions for adults with treated kidney failure in Australia: A national retrospective cohort study","authors":"Dominic Keuskamp PhD , Christopher E. Davies PhD , Paul J. Secombe BMBS (Hons) MClinSc FCICM , David V. Pilcher MBBS MRCP(UK) FRACP FCICM , Shaila Chavan MSPH , Sarah L. Jones MBChB (Hons) MRCP(UK) DICM(UK) FCICM FRACP , Benjamin E. Reddi MA PhD FRCP(UK) FCICM , Stephen P. McDonald MBBS (Hons) PhD FRACP","doi":"10.1016/j.ccrj.2025.100099","DOIUrl":"10.1016/j.ccrj.2025.100099","url":null,"abstract":"<div><h3>Objective</h3><div>Limited data are available on intensive care unit (ICU) admissions for adults receiving kidney replacement therapy (KRT – dialysis or transplantation) in Australia. Our aim is to characterise admissions for patients receiving long-term dialysis and kidney transplant recipients relative to the general intensive care population in Australia.</div></div><div><h3>Design</h3><div>Retrospective registry-based data linkage cohort study.</div></div><div><h3>Setting</h3><div>All ICUs in Australia that reported to the Australian and New Zealand Intensive Care Society Adult Patient Database, 1 January 2018–31 December 2020.</div></div><div><h3>Participants</h3><div>All admissions were included. Data were deterministically linked to the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Subgroups analysed were defined by sex, age, admission type, APACHE III-j diagnostic category, diabetes status, body mass index (BMI), dialysis modality, dialysis vintage, and kidney transplant vintage.</div></div><div><h3>Outcome measures</h3><div>Admission to ICU for patients receiving KRT at the time of admission (as reported to the ANZDATA Registry).</div></div><div><h3>Results</h3><div>Patients receiving long-term dialysis prior to admission and those with a kidney transplant numbered 2826 (0.6% of all admissions) and 1194 (0.3%), respectively. Age-sex standardised admission rates relative to the non-KRT cohort (n = 438,271 or 99.1%) were highest for long-term dialysis patients (relative rate 10.18 [95% CI: 9.46,10.93]) and associated with diabetes and sepsis, cardiovascular and respiratory diagnoses.</div></div><div><h3>Conclusions</h3><div>Rates of ICU admission for people receiving long-term dialysis or kidney transplantation were many times higher than the general population, with particularly increased relative risk among younger age groups and for key medical diagnoses. Given the burden on patients and health services, exploration of strategies to reduce this risk is important.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100099"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511064","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 : 2025-03-01DOI: 10.1016/j.ccrj.2024.12.001
Paul J. Young MBChB, PhD , Rinaldo Bellomo MBBS, MD, FCICM, FRACP , Abdulrahman Al-Fares MBChB, FRCPC, ABIM, MRCP , David GC. Antognini MBBS , Yaseen M. Arabi MD , Muhammad Sheharyar Ashraf MD , Sean M. Bagshaw MD, MSc , Alastair J. Brown MBChB , Sarah Buabbas MD , Lewis Campbell MBChB, MSc , Jonathan M. Chen MBChB , Ross C. Freebairn MBChB , Tomoko Fujii MD, PhD , Mohd Shahnaz Hasan MBBS, MAnes , Aditi Jain DNB, FRCPC, FCCCM, AFIC , Nai An Lai MBBS, MRCSEd, FRCP(Edin), FCICM , Sanjay Lakhey MD , Matthew Mac Partlin MBChB, FCICM, FACEM, MRCPI , Sam Marment MBChB , James P.A. McCullough MBChB, MMed , François Lamontagne MD, MSc
Objective
This study aimed to evaluate intensive care doctors’ views about a large-scale pragmatic minimum mean arterial pressure (MAP) targets trial and their attitudes and beliefs about minimum MAP targets in different clinical scenarios.
Design
An online survey was conducted.
Setting and participants
An online survey was distributed to intensive care doctors in sites participating in a large-scale international randomised clinical trial evaluating oxygen therapy targets in 15 countries and to additional intensive care clinicians from Canada.
Main outcome measures
Outcomes included the expressed level of support for a large pragmatic trial to evaluate minimum MAP targets in critically ill adults and stated current practice and acceptability of minimum MAP for specific scenarios.
Results
The response rate to our survey for respondents who work in sites participating in the mega randomised registry trial research program was 265 out of 701 (37.8%), with an additional 56 out of 256 (21.8%) responses obtained from a direct email containing a link to the survey sent to intensive care clinicians in Canada. A total of 309 of 321 respondents (96.3%) were supportive, in principle, of conducting a very large pragmatic trial to evaluate MAP targets in intensive care unit patients receiving noradrenaline. The commonest response in all scenarios was to agree that the optimal minimum MAP target was uncertain. In all scenarios, except for active bleeding, the most common reported minimum MAP target was 65 mmHg; for patients who were actively bleeding, the most common reported target was 60 mmHg.
Conclusions
Our data suggest that intensive care clinicians are broadly supportive of a large-scale pragmatic minimum MAP targets in intensive care unit patients receiving noradrenaline.
{"title":"Mean arterial pressure targets in intensive care unit patients receiving noradrenaline: An international survey","authors":"Paul J. Young MBChB, PhD , Rinaldo Bellomo MBBS, MD, FCICM, FRACP , Abdulrahman Al-Fares MBChB, FRCPC, ABIM, MRCP , David GC. Antognini MBBS , Yaseen M. Arabi MD , Muhammad Sheharyar Ashraf MD , Sean M. Bagshaw MD, MSc , Alastair J. Brown MBChB , Sarah Buabbas MD , Lewis Campbell MBChB, MSc , Jonathan M. Chen MBChB , Ross C. Freebairn MBChB , Tomoko Fujii MD, PhD , Mohd Shahnaz Hasan MBBS, MAnes , Aditi Jain DNB, FRCPC, FCCCM, AFIC , Nai An Lai MBBS, MRCSEd, FRCP(Edin), FCICM , Sanjay Lakhey MD , Matthew Mac Partlin MBChB, FCICM, FACEM, MRCPI , Sam Marment MBChB , James P.A. McCullough MBChB, MMed , François Lamontagne MD, MSc","doi":"10.1016/j.ccrj.2024.12.001","DOIUrl":"10.1016/j.ccrj.2024.12.001","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate intensive care doctors’ views about a large-scale pragmatic minimum mean arterial pressure (MAP) targets trial and their attitudes and beliefs about minimum MAP targets in different clinical scenarios.</div></div><div><h3>Design</h3><div>An online survey was conducted.</div></div><div><h3>Setting and participants</h3><div>An online survey was distributed to intensive care doctors in sites participating in a large-scale international randomised clinical trial evaluating oxygen therapy targets in 15 countries and to additional intensive care clinicians from Canada.</div></div><div><h3>Main outcome measures</h3><div>Outcomes included the expressed level of support for a large pragmatic trial to evaluate minimum MAP targets in critically ill adults and stated current practice and acceptability of minimum MAP for specific scenarios.</div></div><div><h3>Results</h3><div>The response rate to our survey for respondents who work in sites participating in the mega randomised registry trial research program was 265 out of 701 (37.8%), with an additional 56 out of 256 (21.8%) responses obtained from a direct email containing a link to the survey sent to intensive care clinicians in Canada. A total of 309 of 321 respondents (96.3%) were supportive, in principle, of conducting a very large pragmatic trial to evaluate MAP targets in intensive care unit patients receiving noradrenaline. The commonest response in all scenarios was to agree that the optimal minimum MAP target was uncertain. In all scenarios, except for active bleeding, the most common reported minimum MAP target was 65 mmHg; for patients who were actively bleeding, the most common reported target was 60 mmHg.</div></div><div><h3>Conclusions</h3><div>Our data suggest that intensive care clinicians are broadly supportive of a large-scale pragmatic minimum MAP targets in intensive care unit patients receiving noradrenaline.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100095"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511067","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 : 2025-03-01DOI: 10.1016/j.ccrj.2024.11.003
Matthew T. Donnan MBBS , Peinan Zhao PhD , Allen C. Cheng MBBS PhD , Aaliya Ibrahim MClinEpid , Annamaria Palermo RN, BA , Benjamin Reddi FCICM PhD , Claire Reynolds MNurs , Craig French MBBS , Edward Litton MBChB PhD , Hannah Rotherham MBBS , Husna Begum PhD , Jamie Cooper MD MBBS , Jodi Dumbrell MPH , Lewis Campbell FCICM MSc. , Mark Plummer PhD , Mahesh Ramanan FCICM MMed , Patricia Alliegro MD , Richard E. McAllister RN, BN , Simon Erickson MBBS, CICM , Shweta Priyadarshini FCICM MBBS , Aidan Burrell MBBS PhD
Objective
To describe and compare the demographics, management, and outcomes for patients with COVID-19 admitted to intensive care units (ICUs) in Australia across the various waves of the COVID pandemic.
Design, setting, and participants
People aged ≥16 years who were admitted to a participating ICU with confirmed COVID-19 in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) Australia study between February 2020 and May 2024.
Main outcome measures
Primary outcome: In-hospital mortality. Secondary outcomes: ICU mortality; ICU and hospital lengths of stay; supportive and disease-specific therapies.
Results
From 27 February 2020 to 18 May 2024, 10171 people were admitted to 72 ICUs with confirmed COVID-19 disease. The Wild Type wave included 518 (5.1%) patients, the Delta wave 2467 (24.3%) patients, and the Omicron wave 7186 (70.7%) patients. The median (IQR) age was 61 (49–70) years, 54 (41–66) years, and 65 (45–75) years, respectively (P < 0.001). The proportion of vaccinated cases increased in successive waves (1% vs 23.9% vs 65.1%) but plateaued in the Omicron subvariant waves (range 60.0%–71.9%). Invasive mechanical ventilation use decreased across successive waves (52.5% vs 43.6% vs 31.7%, P < 0.001). Use of extracorporeal membrane oxygenation was highest during the Delta wave (3.6%, 83 patients, median duration 18 days [IQR 9.8–35]). Multivariable analysis demonstrated an increased risk of in-hospital mortality among patients admitted during the Delta (adjusted HR 1.80, 95% CI: 1.38–2.35, p < 0.001) and Omicron (adjusted HR 1.88, 95% CI: 1.46–2.42, p < 0.001) waves when compared to the Wild Type wave.
Conclusion
COVID-19 continues to manifest significant morbidity and mortality in those requiring ICU admission. Despite a reduced need for ICU level supports, patients admitted during the Omicron wave demonstrated the highest in-hospital mortality.
目的描述和比较澳大利亚在不同的COVID-19大流行期间入住重症监护病房（icu）的COVID-19患者的人口统计学、管理和结局。设计、环境和参与者：在2020年2月至2024年5月期间，在澳大利亚严重急性呼吸道感染短期发病率研究（SPRINT-SARI）研究中，年龄≥16岁且确诊为COVID-19的患者入住ICU。主要结局指标：住院死亡率。次要结局：ICU死亡率；ICU和住院时间；支持性和疾病特异性治疗。结果2020年2月27日至2024年5月18日，72例icu确诊病例10171例。野性波518例（5.1%），德尔塔波2467例（24.3%），欧米克隆波7186例（70.7%）。中位（IQR）年龄分别为61（49 ~ 70）岁、54（41 ~ 66）岁和65（45 ~ 75）岁(P <；0.001)。接种疫苗的病例比例在连续波中增加（1% vs 23.9% vs 65.1%），但在Omicron亚变异波中稳定（60.0%-71.9%）。有创机械通气的使用在连续波中下降(52.5% vs 43.6% vs 31.7%, P <；0.001)。体外膜氧合的使用率在δ波期间最高（3.6%，83例，中位持续时间18天[IQR 9.8-35]）。多变量分析显示，入院患者住院死亡风险增加(调整HR 1.80, 95% CI: 1.38-2.35, p <；0.001)和Omicron(校正后危险度1.88,95% CI: 1.46-2.42, p <；0.001)波与野生型波相比。结论covid -19在ICU住院患者中仍有显著的发病率和死亡率。尽管对ICU水平支持的需求减少，但在欧米克隆波期间入院的患者显示出最高的住院死亡率。
{"title":"In-hospital mortality in patients admitted to Australian intensive care units with COVID-19 between 2020 and 2024","authors":"Matthew T. Donnan MBBS , Peinan Zhao PhD , Allen C. Cheng MBBS PhD , Aaliya Ibrahim MClinEpid , Annamaria Palermo RN, BA , Benjamin Reddi FCICM PhD , Claire Reynolds MNurs , Craig French MBBS , Edward Litton MBChB PhD , Hannah Rotherham MBBS , Husna Begum PhD , Jamie Cooper MD MBBS , Jodi Dumbrell MPH , Lewis Campbell FCICM MSc. , Mark Plummer PhD , Mahesh Ramanan FCICM MMed , Patricia Alliegro MD , Richard E. McAllister RN, BN , Simon Erickson MBBS, CICM , Shweta Priyadarshini FCICM MBBS , Aidan Burrell MBBS PhD","doi":"10.1016/j.ccrj.2024.11.003","DOIUrl":"10.1016/j.ccrj.2024.11.003","url":null,"abstract":"<div><h3>Objective</h3><div>To describe and compare the demographics, management, and outcomes for patients with COVID-19 admitted to intensive care units (ICUs) in Australia across the various waves of the COVID pandemic.</div></div><div><h3>Design, setting, and participants</h3><div>People aged ≥16 years who were admitted to a participating ICU with confirmed COVID-19 in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT-SARI) Australia study between February 2020 and May 2024.</div></div><div><h3>Main outcome measures</h3><div>Primary outcome: In-hospital mortality. Secondary outcomes: ICU mortality; ICU and hospital lengths of stay; supportive and disease-specific therapies.</div></div><div><h3>Results</h3><div>From 27 February 2020 to 18 May 2024, 10171 people were admitted to 72 ICUs with confirmed COVID-19 disease. The <em>Wild Type w</em>ave included 518 (5.1%) patients, the <em>Delta</em> wave 2467 (24.3%) patients, and the <em>Omicron</em> wave 7186 (70.7%) patients. The median (IQR) age was 61 (49–70) years, 54 (41–66) years, and 65 (45–75) years, respectively (P < 0.001). The proportion of vaccinated cases increased in successive waves (1% vs 23.9% vs 65.1%) but plateaued in the <em>Omicron</em> subvariant waves (range 60.0%–71.9%). Invasive mechanical ventilation use decreased across successive waves (52.5% vs 43.6% vs 31.7%, P < 0.001). Use of extracorporeal membrane oxygenation was highest during the <em>Delta</em> wave (3.6%, 83 patients, median duration 18 days [IQR 9.8–35]). Multivariable analysis demonstrated an increased risk of in-hospital mortality among patients admitted during the D<em>elta</em> (adjusted HR 1.80, 95% CI: 1.38–2.35, <em>p</em> < 0.001) and <em>Omicron</em> (adjusted HR 1.88, 95% CI: 1.46–2.42, <em>p</em> < 0.001) waves when compared to the <em>Wild Type</em> wave.</div></div><div><h3>Conclusion</h3><div>COVID-19 continues to manifest significant morbidity and mortality in those requiring ICU admission. Despite a reduced need for ICU level supports, patients admitted during the <em>Omicron</em> wave demonstrated the highest in-hospital mortality.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100094"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511066","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}
The Sepsis-3 consensus statement emphasised the need for data-based approaches to organ failure assessment and use the Sequential Organ Failure Assessment (SOFA) for this purpose. We aimed to develop a framework for a data-driven update to the SOFA score for patients with sepsis.
Design
Systematic analysis of potential markers of organ dysfunction in a retrospective, observational study.
Setting
Intensive care units from three tertiary hospital centres in the United States, the Netherlands, and Austria were included in the study.
Participants
28 100 American, 5339 Dutch, and 2450 Austrian patients with suspected sepsis were included in this study.
Measurements and main results
We assessed 56 organ function variables. We applied area under curve maximisation procedures to optimise the predictive power for mortality. We chose the most predictive biomarker for existing organ dysfunction domains and added a metabolic domain. We compared the area under the receiver operating characteristic curve and the area under the precision recall curve of the data-driven approach against the current SOFA system. The novel approach outperformed the current SOFA in all domains and databases (the area under the receiver operating characteristic curve: for US patients: 0.766 vs. 0.727, mortality: 10.7%; for Dutch patients: 0.70 vs. 0.653, mortality: 22.0%; for Austrian patients: 0.704 vs. 0.665, mortality: 22.0%; all p < 0.01 for the best performing score). The precision-recall curve confirmed such observations.
Conclusions
We developed and validated a framework for a data-driven update to the SOFA to identify and classify organ dysfunction in suspected septic patients. This framework can be used to revise the SOFA score and its application to the identification and classification of sepsis.
目的：脓毒症-3共识声明强调需要基于数据的器官衰竭评估方法，并为此目的使用序贯器官衰竭评估（SOFA）。我们的目的是为脓毒症患者的SOFA评分开发一个数据驱动的更新框架。设计回顾性观察性研究系统分析器官功能障碍的潜在标志物。来自美国、荷兰和奥地利三所三级医院中心的重症监护病房被纳入研究。研究纳入了100名美国、5339名荷兰和2450名奥地利疑似脓毒症患者。测量和主要结果我们评估了56个器官功能变量。我们应用曲线下面积最大化程序来优化死亡率的预测能力。我们选择了对现有器官功能障碍域最具预测性的生物标志物，并添加了一个代谢域。我们将数据驱动方法与现有的SOFA系统比较了接收者工作特征曲线下的面积和精确召回曲线下的面积。这种新方法在所有领域和数据库中都优于当前的SOFA(美国患者的受试者工作特征曲线下面积：0.766 vs 0.727，死亡率：10.7%；荷兰患者：0.70 vs 0.653，死亡率：22.0%；奥地利患者：0.704 vs 0.665，死亡率：22.0%；所有p <；最佳表现分数为0.01)。精确率-召回率曲线证实了这些观察结果。结论：我们开发并验证了一个数据驱动的SOFA更新框架，以识别和分类疑似脓毒症患者的器官功能障碍。该框架可用于修订SOFA评分及其在脓毒症识别和分类中的应用。
{"title":"A framework and analytical exploration for a data-driven update of the Sequential Organ Failure Assessment (SOFA) score in sepsis","authors":"Drago Plečko PhD , Nicolas Bennett PhD , Ida-Fong Ukor MBBS , Niklas Rodemund MD , Ary Serpa-Neto MD, PhD , Peter Bühlmann PhD","doi":"10.1016/j.ccrj.2025.100105","DOIUrl":"10.1016/j.ccrj.2025.100105","url":null,"abstract":"<div><h3>Objective</h3><div>The Sepsis-3 consensus statement emphasised the need for data-based approaches to organ failure assessment and use the Sequential Organ Failure Assessment (SOFA) for this purpose. We aimed to develop a framework for a data-driven update to the SOFA score for patients with sepsis.</div></div><div><h3>Design</h3><div>Systematic analysis of potential markers of organ dysfunction in a retrospective, observational study.</div></div><div><h3>Setting</h3><div>Intensive care units from three tertiary hospital centres in the United States, the Netherlands, and Austria were included in the study.</div></div><div><h3>Participants</h3><div>28 100 American, 5339 Dutch, and 2450 Austrian patients with suspected sepsis were included in this study.</div></div><div><h3>Measurements and main results</h3><div>We assessed 56 organ function variables. We applied area under curve maximisation procedures to optimise the predictive power for mortality. We chose the most predictive biomarker for existing organ dysfunction domains and added a metabolic domain. We compared the area under the receiver operating characteristic curve and the area under the precision recall curve of the data-driven approach against the current SOFA system. The novel approach outperformed the current SOFA in all domains and databases (the area under the receiver operating characteristic curve: for US patients: 0.766 vs. 0.727, mortality: 10.7%; for Dutch patients: 0.70 vs. 0.653, mortality: 22.0%; for Austrian patients: 0.704 vs. 0.665, mortality: 22.0%; all p < 0.01 for the best performing score). The precision-recall curve confirmed such observations.</div></div><div><h3>Conclusions</h3><div>We developed and validated a framework for a data-driven update to the SOFA to identify and classify organ dysfunction in suspected septic patients. This framework can be used to revise the SOFA score and its application to the identification and classification of sepsis.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100105"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619805","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 : 2025-03-01DOI: 10.1016/j.ccrj.2025.100097
Oystein Tronstad BPhty , John F. Fraser MBChB, PhD, FRCP Glas, FRCA, FFARCSI, FCICM
{"title":"Sleep in the ICU – A complex challenge requiring multifactorial solutions","authors":"Oystein Tronstad BPhty , John F. Fraser MBChB, PhD, FRCP Glas, FRCA, FFARCSI, FCICM","doi":"10.1016/j.ccrj.2025.100097","DOIUrl":"10.1016/j.ccrj.2025.100097","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100097"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511065","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 : 2025-03-01DOI: 10.1016/j.ccrj.2024.11.002
Sally F. Newman BN, PGCert , Zachary Munn PhD, GradDip HlthSc, BMedRad , Craig French FCICM , Hergen Buscher DEAA, EDIC, FCICM , Daniel Thomas Chung BMed MD , Myles Smith MBBS, MBiostat, EDIC, FCICM , Madeline Wilkinson MD, MN , Priya Nair MBBS MD, FCICM, PhD
Introduction
The last 15 years have seen a rapid expansion in the use of extracorporeal life support. ECMO has evolved from a rescue treatment available in a few expert centres to an organ support modality for many forms of severe respiratory or cardiovascular failure. There is currently wide variation around the indications for, management of, and systems to support the practice of ECMO. There are few available guidelines on this topic; most have limitations and are not readily generalisable to the Australian or New Zealand healthcare systems.
Methods and analysis
This article aims to describe the processes that will be used to produce evidence-based guidelines on the use of ECMO in Australia and New Zealand. The protocol is informed by the National Health and Medical Research Council (NHMRC) Guidelines for Guidelines, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.
Analysis of available evidence on the identified questions follows a three-phase approach. Firstly, published guidelines will be identified and an assessment of their relevance, methodology and validity carried out. If there are no guidelines on the topic, the second step involves a search and evaluation of systematic reviews. Lastly, a de-novo systematic analysis of primary literature will be undertaken where no systematic reviews are available. The development process will be conducted using the GRADEpro and Covidence software for de novo systematic reviews.
Dissemination
The guideline will be published in peer-reviewed journals and summaries will be provided to end-users via the GRADEpro GDT application.
{"title":"Protocol for the development of NHMRC-endorsed guidelines for extracorporeal membrane oxygenation using GRADE methodology","authors":"Sally F. Newman BN, PGCert , Zachary Munn PhD, GradDip HlthSc, BMedRad , Craig French FCICM , Hergen Buscher DEAA, EDIC, FCICM , Daniel Thomas Chung BMed MD , Myles Smith MBBS, MBiostat, EDIC, FCICM , Madeline Wilkinson MD, MN , Priya Nair MBBS MD, FCICM, PhD","doi":"10.1016/j.ccrj.2024.11.002","DOIUrl":"10.1016/j.ccrj.2024.11.002","url":null,"abstract":"<div><h3>Introduction</h3><div>The last 15 years have seen a rapid expansion in the use of extracorporeal life support. ECMO has evolved from a rescue treatment available in a few expert centres to an organ support modality for many forms of severe respiratory or cardiovascular failure. There is currently wide variation around the indications for, management of, and systems to support the practice of ECMO. There are few available guidelines on this topic; most have limitations and are not readily generalisable to the Australian or New Zealand healthcare systems.</div></div><div><h3>Methods and analysis</h3><div>This article aims to describe the processes that will be used to produce evidence-based guidelines on the use of ECMO in Australia and New Zealand. The protocol is informed by the National Health and Medical Research Council (NHMRC) Guidelines for Guidelines, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.</div><div>Analysis of available evidence on the identified questions follows a three-phase approach. Firstly, published guidelines will be identified and an assessment of their relevance, methodology and validity carried out. If there are no guidelines on the topic, the second step involves a search and evaluation of systematic reviews. Lastly, a de-novo systematic analysis of primary literature will be undertaken where no systematic reviews are available. The development process will be conducted using the GRADEpro and Covidence software for de novo systematic reviews.</div></div><div><h3>Dissemination</h3><div>The guideline will be published in peer-reviewed journals and summaries will be provided to end-users via the GRADEpro GDT application.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100093"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520940","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 : 2025-03-01DOI: 10.1016/j.ccrj.2025.100101
Paul J. Young FCICM, PhD, Kyle C. White FCICM, MPH
{"title":"Excessive vasopressors or excessive hypotension: Searching for the goldilocks zone in mean arterial pressure targets","authors":"Paul J. Young FCICM, PhD, Kyle C. White FCICM, MPH","doi":"10.1016/j.ccrj.2025.100101","DOIUrl":"10.1016/j.ccrj.2025.100101","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100101"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535178","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 : 2025-03-01DOI: 10.1016/j.ccrj.2025.100103
Kyle C. White MBBS MPH , Lachlan Quick MBBS , Zachary Durkin MBBS , James McCullough FCICM, MMed , Kevin B. Laupland MD, PhD , Sebastiaan Blank FCICM , Antony G. Attokaran MBBS, FCICM , Aashish Kumar MBBS, FCICM , Kiran Shekar MBBS, PhD , Peter Garrett MBBS, FCICM , Jason Meyer RN, MSc , Alexis Tabah MD, FCICM , Mahesh Ramanan FCICM, MMed , Stephen Luke MBBS, FCICM , Anis Chaba MD , Rinaldo Bellomo MD, PhD , François Lamontagne MD, MSc , Paul J. Young MBChB, PhD
Objective
Mean arterial pressure (MAP) management is a key aspect of treatment in critically ill patients receiving vasopressor therapy. Guidelines in different clinical subgroups have proposed various target MAP values. This study aimed to describe delivered MAP values and corresponding vasopressor doses in such patients.
Design
Multicenter, retrospective cohort study of adult intensive care unit (ICU) admissions.
Setting
12 ICUs in Queensland, Australia, from January 1, 2015, to December 31, 2021.
Participants
Patients receiving vasopressors for at least six continuous hours in the ICU. We studied the delivered MAP values using hourly data based on averaging all validated values obtained from the ICU monitors and average hourly doses of vasopressors.
Main Outcome Measure
The primary outcome was the mean MAP during the entire cohort's first 72 hours of ICU admission, whilst vasopressors were administered.
Results
In 26,519 patients who received vasopressors for at least six continuous hours, the median age was 62 years, and 9,373 (35%) were admitted after elective surgery. The median time from ICU admission to vasopressor commencement was 2 hours, and the median duration of vasopressor therapy was 27 hours. At 72 hours, 6,627 (25.0%) patients remained on vasopressors. The mean hourly MAP was 72 mmHg in the first six hours, then steadily increased to ≈75 mmHg at 72 hours. In the first 72 hours, 11,032 (41.6%) patients had a mean MAP of 70-74 mmHg, and 5,914 (22.3%) had a mean MAP of 75-79 mmHg. For every clinical subgroup, a MAP of 70-74 mmHg was the most common mean MAP, and the proportion of patients with a mean MAP of 60-65mmHg was less than 5%.
Conclusions
In a large, multicenter study of heterogeneous critically ill patients on vasopressors, the mean hourly MAP was > 70 mmHg. This mean hourly MAP was observed consistently over diverse clinical subgroups and is higher than recommended by guidelines.
{"title":"Mean arterial pressure in critically ill adults receiving vasopressors: A multicentre, observational study","authors":"Kyle C. White MBBS MPH , Lachlan Quick MBBS , Zachary Durkin MBBS , James McCullough FCICM, MMed , Kevin B. Laupland MD, PhD , Sebastiaan Blank FCICM , Antony G. Attokaran MBBS, FCICM , Aashish Kumar MBBS, FCICM , Kiran Shekar MBBS, PhD , Peter Garrett MBBS, FCICM , Jason Meyer RN, MSc , Alexis Tabah MD, FCICM , Mahesh Ramanan FCICM, MMed , Stephen Luke MBBS, FCICM , Anis Chaba MD , Rinaldo Bellomo MD, PhD , François Lamontagne MD, MSc , Paul J. Young MBChB, PhD","doi":"10.1016/j.ccrj.2025.100103","DOIUrl":"10.1016/j.ccrj.2025.100103","url":null,"abstract":"<div><h3>Objective</h3><div>Mean arterial pressure (MAP) management is a key aspect of treatment in critically ill patients receiving vasopressor therapy. Guidelines in different clinical subgroups have proposed various target MAP values. This study aimed to describe delivered MAP values and corresponding vasopressor doses in such patients.</div></div><div><h3>Design</h3><div>Multicenter, retrospective cohort study of adult intensive care unit (ICU) admissions.</div></div><div><h3>Setting</h3><div>12 ICUs in Queensland, Australia, from January 1, 2015, to December 31, 2021.</div></div><div><h3>Participants</h3><div>Patients receiving vasopressors for at least six continuous hours in the ICU. We studied the delivered MAP values using hourly data based on averaging all validated values obtained from the ICU monitors and average hourly doses of vasopressors.</div></div><div><h3>Main Outcome Measure</h3><div>The primary outcome was the mean MAP during the entire cohort's first 72 hours of ICU admission, whilst vasopressors were administered.</div></div><div><h3>Results</h3><div>In 26,519 patients who received vasopressors for at least six continuous hours, the median age was 62 years, and 9,373 (35%) were admitted after elective surgery. The median time from ICU admission to vasopressor commencement was 2 hours, and the median duration of vasopressor therapy was 27 hours. At 72 hours, 6,627 (25.0%) patients remained on vasopressors. The mean hourly MAP was 72 mmHg in the first six hours, then steadily increased to ≈75 mmHg at 72 hours. In the first 72 hours, 11,032 (41.6%) patients had a mean MAP of 70-74 mmHg, and 5,914 (22.3%) had a mean MAP of 75-79 mmHg. For every clinical subgroup, a MAP of 70-74 mmHg was the most common mean MAP, and the proportion of patients with a mean MAP of 60-65mmHg was less than 5%.</div></div><div><h3>Conclusions</h3><div>In a large, multicenter study of heterogeneous critically ill patients on vasopressors, the mean hourly MAP was > 70 mmHg. This mean hourly MAP was observed consistently over diverse clinical subgroups and is higher than recommended by guidelines.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100103"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609202","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}
The optimal choice of fluid therapy for patients with diabetic ketoacidosis (DKA) is uncertain, though preliminary data suggest that buffered crystalloid solutions (Plasma-Lyte® 148) may offer some advantages over 0.9% saline.
Objective
To describe the study protocol for the ‘Balanced Electrolyte Solution versus Saline Trial for Diabetic Ketoacidosis’ (BEST-DKA) trial.
Design, setting and participants
BEST-DKA is a Phase 3 cluster-crossover, blinded, pragmatic, randomised, controlled trial comparing the effects of saline or buffered crystalloid solution in patients with moderate to severe DKA treated in the emergency department and/or intensive care unit at twenty hospitals in Australia. Each hospital will be randomised to use either saline or buffered crystalloid solution for a period of 12 months before crossing over to the alternate fluid for the next 12 months. The blinded study fluid will be used for all resuscitation and maintenance purposes for included patients.
Main outcome measures
This cluster-randomised, crossover randomised controlled trial (RCT) has been designed with the aim of enrolling a minimum of 400 patients, which will provide >91.4% power to detect a 2-day increase in the primary outcome, days alive and out of hospital to day 28, chosen with consumer representation. Secondary outcomes include quality of life and fatigue scores at day 28, intensive care unit and hospital lengths of stay, acute kidney injury, and time to resolution of DKA. All analyses will be conducted on an intention-to-treat basis. A prespecified statistical analysis plan will be developed prior to interim analysis.
Results and conclusion
The BEST-DKA trial commenced enrolment in March 2024 and should generate results that will determine whether treatment with Plasma-Lyte® 148, compared with saline, results in increased days alive, and out of hospital to day 28 for patients with moderate or severe DKA.
{"title":"Buffered salt solution versus 0.9% sodium chloride as fluid therapy for patients presenting with moderate to severe diabetic ketoacidosis: Study protocol for a Phase-3 cluster-crossover, blinded, randomised, controlled trial","authors":"Mahesh Ramanan FCICM, MMed , Dorrilyn Rajbhandari PGDip Clin Nurs , Carolyn Koch RN PGDip ICU , Yasmine Ali Abdelhamid FCICM, FRACP, PhD , Antony Attokaran FCICM, FRACP, MBBS , Laurent Billot AStat, MRes , Severine Bompoint AStat , Jeremy Cohen FCICM, PhD , Anthony Delaney FCICM, FACEM, PhD , Anthony Devaux PhD , Elif Ekinci FRACP, PhD , Simon Finfer FCICM, DrMed , Tessa Garside FCICM, PhD , Naomi Hammond RN, PhD , Alisa Higgins PhD , Gerben Keijzers FACEM, PhD , Qiang Li AStat, MBiostat , Benjamin Moran FCICM, FANZCA, MBiostat , John Myburgh FCICM, PhD , Priya Nair FCICM, PhD , Balasubramanian Venkatesh FCICM, MD","doi":"10.1016/j.ccrj.2025.100104","DOIUrl":"10.1016/j.ccrj.2025.100104","url":null,"abstract":"<div><h3>Background</h3><div>The optimal choice of fluid therapy for patients with diabetic ketoacidosis (DKA) is uncertain, though preliminary data suggest that buffered crystalloid solutions (Plasma-Lyte® 148) may offer some advantages over 0.9% saline.</div></div><div><h3>Objective</h3><div>To describe the study protocol for the ‘Balanced Electrolyte Solution versus Saline Trial for Diabetic Ketoacidosis’ (BEST-DKA) trial.</div></div><div><h3>Design, setting and participants</h3><div>BEST-DKA is a Phase 3 cluster-crossover, blinded, pragmatic, randomised, controlled trial comparing the effects of saline or buffered crystalloid solution in patients with moderate to severe DKA treated in the emergency department and/or intensive care unit at twenty hospitals in Australia. Each hospital will be randomised to use either saline or buffered crystalloid solution for a period of 12 months before crossing over to the alternate fluid for the next 12 months. The blinded study fluid will be used for all resuscitation and maintenance purposes for included patients.</div></div><div><h3>Main outcome measures</h3><div>This cluster-randomised, crossover randomised controlled trial (RCT) has been designed with the aim of enrolling a minimum of 400 patients, which will provide >91.4% power to detect a 2-day increase in the primary outcome, days alive and out of hospital to day 28, chosen with consumer representation. Secondary outcomes include quality of life and fatigue scores at day 28, intensive care unit and hospital lengths of stay, acute kidney injury, and time to resolution of DKA. All analyses will be conducted on an intention-to-treat basis. A prespecified statistical analysis plan will be developed prior to interim analysis.</div></div><div><h3>Results and conclusion</h3><div>The BEST-DKA trial commenced enrolment in March 2024 and should generate results that will determine whether treatment with Plasma-Lyte® 148, compared with saline, results in increased days alive, and out of hospital to day 28 for patients with moderate or severe DKA.</div></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"27 1","pages":"Article 100104"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609199","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}
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