Pub Date : 2023-12-01DOI: 10.1016/j.ccrj.2023.10.002
David M. Golding MBBCh, BSc, PGDip , Tak Wai Chan BMedSci, BMBS , Nikola G. Orozov MPharm, PGDipClinPharm , Paul J. Young MBChB, PhD
Background
Intravenous antibiotics are often evaluated in clinical trials in hospitalised patients but for blinded trials masking of antibiotics is required.
Objective
To evaluate the effectiveness of masking of ceftriaxone and amoxicillin / clavulanic acid for use in blinded clinical trials.
Design, setting, and participants
Amoxicillin / clavulanic acid (1.2g) and ceftriaxone (1g and 2g) were diluted in 100mL of sodium chloride. Clinicians from a single centre were asked to attempt to distinguish solutions containing antibiotics from solutions without added antibiotics at time points up to 12 hours following dilution.
Results
1g of ceftriaxone diluted in 100 mL of 0.9 sodium chloride stored in a light-protected bag and refrigerated at 3–4 °C for up to 10 h could not readily be distinguished from 100 mL of 0.9 % sodium chloride. However, solutions containing either amoxicillin / clavulanic acid (1.2g) or ceftriaxone (2g) were readily identifiable.
Conclusions
1 g of ceftriaxone can be effectively masked by dilution in 100mL of sodium chloride.
{"title":"Masking of an intravenous preparation of ceftriaxone for use in clinical trials: A technical report","authors":"David M. Golding MBBCh, BSc, PGDip , Tak Wai Chan BMedSci, BMBS , Nikola G. Orozov MPharm, PGDipClinPharm , Paul J. Young MBChB, PhD","doi":"10.1016/j.ccrj.2023.10.002","DOIUrl":"https://doi.org/10.1016/j.ccrj.2023.10.002","url":null,"abstract":"<div><h3>Background</h3><p>Intravenous antibiotics are often evaluated in clinical trials in hospitalised patients but for blinded trials masking of antibiotics is required.</p></div><div><h3>Objective</h3><p>To evaluate the effectiveness of masking of ceftriaxone and amoxicillin / clavulanic acid for use in blinded clinical trials.</p></div><div><h3>Design, setting, and participants</h3><p>Amoxicillin / clavulanic acid (1.2g) and ceftriaxone (1g and 2g) were diluted in 100mL of sodium chloride. Clinicians from a single centre were asked to attempt to distinguish solutions containing antibiotics from solutions without added antibiotics at time points up to 12 hours following dilution.</p></div><div><h3>Results</h3><p>1g of ceftriaxone diluted in 100 mL of 0.9 sodium chloride stored in a light-protected bag and refrigerated at 3–4 °C for up to 10 h could not readily be distinguished from 100 mL of 0.9 % sodium chloride. However, solutions containing either amoxicillin / clavulanic acid (1.2g) or ceftriaxone (2g) were readily identifiable.</p></div><div><h3>Conclusions</h3><p>1 g of ceftriaxone can be effectively masked by dilution in 100mL of sodium chloride.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 4","pages":"Pages 172-174"},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223005197/pdfft?md5=e7dacd1406f9e34280d35ca19a0c7474&pid=1-s2.0-S1441277223005197-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038538","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 : 2023-12-01DOI: 10.1016/j.ccrj.2023.10.001
William B. Blackburne MBChB, BMedSc(Hons), Paul J. Young MBChB, PhD, FCICM
Objective
Intensive care (ICU) beds are scarce and decision-making regarding admission is complex and multi-factorial. This study aimed to characterise differences in admission decision making between Australia and New Zealand and compare to previous data to establish changes over time.
Design
Online Survey.
Setting and Participants
An online survey was distributed to Australian and New Zealand intensive care doctors measuring triage behaviours in the last week and responses to ICU triage scenarios.
Main Outcome Measures
Perceived ICU admission behaviours.
Results
103 responses were obtained, 83(80.6%) from Australia and 97 (94.2%) from specialist intensivists. The median number of triage decisions and patients declined were 6-10 and 1-5 respectively. No difference was noted in the role of ICU bed capacity in decision making between Australia and New Zealand. Compared to Australian intensivists, New Zealand intensivists were less likely to admit a patient: with relapsed acute myeloid leukaemia (AML) and acute respiratory distress syndrome (ARDS)(p=0.03), with persistent vegetative state and community acquired (p=0.02) or iatrogenic (p=0.03) pneumonia. Compared to respondents in 2009 (n=238), 2023 respondents were more likely to admit a patient: with a severe intracranial bleed who may become braindead (p=0.005), with relapsed AML and ARDS (p=0.02), with stroke for palliative care (p<0.001); and less likely to admit a patient with persistent vegetative state and iatrogenic pneumonia (p=0.03). In a multivariable analysis, respondents from Australian compared to New Zealand and from 2023 compared to 2009 were more likely to indicate they would admit patients to the ICU in the scenarios described (p<0.001 for both comparisons).
Conclusions
Our study suggests that New Zealand intensivists may apply more restrictive ICU admission criteria than Australian intensivists. Changes in attitudes to admission since 2009 may reflect increased awareness of the importance of facilitating organ donation and the role of ICU as providers of palliative care.
{"title":"Perceptions of intensive care triage in Australia and New Zealand in 2009 and 2023","authors":"William B. Blackburne MBChB, BMedSc(Hons), Paul J. Young MBChB, PhD, FCICM","doi":"10.1016/j.ccrj.2023.10.001","DOIUrl":"https://doi.org/10.1016/j.ccrj.2023.10.001","url":null,"abstract":"<div><h3>Objective</h3><p>Intensive care (ICU) beds are scarce and decision-making regarding admission is complex and multi-factorial. This study aimed to characterise differences in admission decision making between Australia and New Zealand and compare to previous data to establish changes over time.</p></div><div><h3>Design</h3><p>Online Survey.</p></div><div><h3>Setting and Participants</h3><p>An online survey was distributed to Australian and New Zealand intensive care doctors measuring triage behaviours in the last week and responses to ICU triage scenarios.</p></div><div><h3>Main Outcome Measures</h3><p>Perceived ICU admission behaviours.</p></div><div><h3>Results</h3><p>103 responses were obtained, 83(80.6%) from Australia and 97 (94.2%) from specialist intensivists. The median number of triage decisions and patients declined were 6-10 and 1-5 respectively. No difference was noted in the role of ICU bed capacity in decision making between Australia and New Zealand. Compared to Australian intensivists, New Zealand intensivists were less likely to admit a patient: with relapsed acute myeloid leukaemia (AML) and acute respiratory distress syndrome (ARDS)(p=0.03), with persistent vegetative state and community acquired (p=0.02) or iatrogenic (p=0.03) pneumonia. Compared to respondents in 2009 (n=238), 2023 respondents were more likely to admit a patient: with a severe intracranial bleed who may become braindead (p=0.005), with relapsed AML and ARDS (p=0.02), with stroke for palliative care (p<0.001); and less likely to admit a patient with persistent vegetative state and iatrogenic pneumonia (p=0.03). In a multivariable analysis, respondents from Australian compared to New Zealand and from 2023 compared to 2009 were more likely to indicate they would admit patients to the ICU in the scenarios described (p<0.001 for both comparisons).</p></div><div><h3>Conclusions</h3><p>Our study suggests that New Zealand intensivists may apply more restrictive ICU admission criteria than Australian intensivists. Changes in attitudes to admission since 2009 may reflect increased awareness of the importance of facilitating organ donation and the role of ICU as providers of palliative care.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 4","pages":"Pages 161-171"},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223005173/pdfft?md5=fdcf748f336da0e420536690d82dd950&pid=1-s2.0-S1441277223005173-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038539","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 : 2023-12-01DOI: 10.1016/j.ccrj.2023.10.008
Ken Kuljit S. Parhar MD, MSc , Andrea Soo PhD , Gwen Knight BA , Kirsten Fiest PhD , Daniel J. Niven MD MSc PhD , Gordon Rubenfeld MD, MSc , Damon Scales MD, PhD , Henry T. Stelfox MD, PhD , Danny J. Zuege MD MSc , Sean Bagshaw MD, MSc
Objective
To describe a study protocol and statistical analysis plan (SAP) for the identification and treatment of hypoxemic respiratory failure (HRF) and acute respiratory distress syndrome (ARDS) with protection, paralysis, and proning (TheraPPP) study prior to completion of recruitment, electronic data retrieval, and analysis of any data.
Design
TheraPPP is a stepped-wedge cluster randomised study evaluating a care pathway for HRF and ARDS patients. This is a type-1 hybrid effectiveness-implementation study design evaluating both intervention effectiveness and implementation; however primarily powered for the effectiveness outcome.
Setting
Seventeen adult intensive care units (ICUs) across Alberta, Canada.
Participants
We estimate a sample size of 18816 mechanically ventilated patients, with 11424 patients preimplementation and 7392 patients postimplementation. We estimate 2688 sustained ARDS patients within our study cohort.
Intervention
An evidence-based, stakeholder-informed, multidisciplinary care pathway called Venting Wisely that standardises diagnosis and treatment of HRF and ARDS patients.
Main outcome measures
The primary outcome is 28-day ventilator-free days (VFDs). The primary analysis will compare the mean 28-day VFDs preimplementation and postimplementation using a mixed-effects linear regression model. Prespecified subgroups include sex, age, HRF, ARDS, COVID-19, cardiac surgery, body mass index, height, illness acuity, and ICU volume.
Results
This protocol and SAP are reported using the Standard Protocol Items: Recommendations for Interventional Trials guidance and the Guidelines for the Content of Statistical Analysis Plans in Clinical Trials. The study received ethics approval and was registered (ClinicalTrials.gov-NCT04744298) prior to patient enrolment.
Conclusions
TheraPPP will evaluate the effectiveness and implementation of an HRF and ARDS care pathway.
{"title":"Protocol and statistical analysis plan for the identification and treatment of hypoxemic respiratory failure and acute respiratory distress syndrome with protection, paralysis, and proning: A type-1 hybrid stepped-wedge cluster randomised effectiveness-implementation study","authors":"Ken Kuljit S. Parhar MD, MSc , Andrea Soo PhD , Gwen Knight BA , Kirsten Fiest PhD , Daniel J. Niven MD MSc PhD , Gordon Rubenfeld MD, MSc , Damon Scales MD, PhD , Henry T. Stelfox MD, PhD , Danny J. Zuege MD MSc , Sean Bagshaw MD, MSc","doi":"10.1016/j.ccrj.2023.10.008","DOIUrl":"10.1016/j.ccrj.2023.10.008","url":null,"abstract":"<div><h3>Objective</h3><p>To describe a study protocol and statistical analysis plan (SAP) for the identification and treatment of hypoxemic respiratory failure (HRF) and acute respiratory distress syndrome (ARDS) with protection, paralysis, and proning (TheraPPP) study prior to completion of recruitment, electronic data retrieval, and analysis of any data.</p></div><div><h3>Design</h3><p>TheraPPP is a stepped-wedge cluster randomised study evaluating a care pathway for HRF and ARDS patients. This is a type-1 hybrid effectiveness-implementation study design evaluating both intervention effectiveness and implementation; however primarily powered for the effectiveness outcome.</p></div><div><h3>Setting</h3><p>Seventeen adult intensive care units (ICUs) across Alberta, Canada.</p></div><div><h3>Participants</h3><p>We estimate a sample size of 18816 mechanically ventilated patients, with 11424 patients preimplementation and 7392 patients postimplementation. We estimate 2688 sustained ARDS patients within our study cohort.</p></div><div><h3>Intervention</h3><p>An evidence-based, stakeholder-informed, multidisciplinary care pathway called Venting Wisely that standardises diagnosis and treatment of HRF and ARDS patients.</p></div><div><h3>Main outcome measures</h3><p>The primary outcome is 28-day ventilator-free days (VFDs). The primary analysis will compare the mean 28-day VFDs preimplementation and postimplementation using a mixed-effects linear regression model. Prespecified subgroups include sex, age, HRF, ARDS, COVID-19, cardiac surgery, body mass index, height, illness acuity, and ICU volume.</p></div><div><h3>Results</h3><p>This protocol and SAP are reported using the Standard Protocol Items: Recommendations for Interventional Trials guidance and the Guidelines for the Content of Statistical Analysis Plans in Clinical Trials. The study received ethics approval and was registered (ClinicalTrials.gov-NCT04744298) prior to patient enrolment.</p></div><div><h3>Conclusions</h3><p>TheraPPP will evaluate the effectiveness and implementation of an HRF and ARDS care pathway.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 4","pages":"Pages 207-215"},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022196/pdfft?md5=2ae1ea805852b74cbfed73d30f40408e&pid=1-s2.0-S1441277223022196-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139025239","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 : 2023-12-01DOI: 10.1016/j.ccrj.2023.10.007
Edward Litton MBChB FCICM PhD , Craig French FCICM , Alan Herschtal PhD , Simon Stanworth FRACP PhD , Susan Pellicano RN , Anne Marie Palermo RN , Samantha Bates RN , Sarah Van Der Laan MBChb , Ege Eroglu BSc , David Griffith MRCP PhD , Akshay Shah MRCP PhD
Objective
To determine the feasibility of a pivotal randomised clinical trial of intravenous (IV) iron and erythropoietin in adult survivors of critical illness with anaemia requiring treatment in the intensive care unit.
Design
An investigator-initiated, parallel group, placebo-controlled, randomised feasibility trial.
Setting
A tertiary intensive care unit (ICU) in Perth, Western Australia.
Participants
Adults with anaemia (haemoglobin <100 g/L), requiring ICU-level care for more than 48 h, and likely to be ready for ICU discharge within 24 h.
Interventions
A single dose of IV ferric carboxymaltose and Epoetin alfa (active group) or an equal volume of 0.9% saline (placebo group).
Main outcome measures
Study feasibility was considered met if the pilot achieved a recruitment rate of ≥2 participants per site per month, ≥90% of participants received their allocated study treatment, and≥ 90% of participants were followed up for the proposed pivotal trial primary outcome - days alive and at home to day 90 (DAH90).
Results
The 40-participant planned sample size included twenty in each group and was enrolled between 1/9/2021 and 2/3/2022. Participants spent a median of 3.4 days (interquartile range 2.8–5.1) in the ICU prior to enrolment and had a mean baseline haemoglobin of 83.7 g/L (standard deviation 6.7). The recruitment rate was 6.7 participants per month [95% confidence interval (CI) 4.8–9.0], DAH90 follow-up was 100% (95% CI 91.2%–100%), and 39 (97.5%, 95% CI 86.8%–99.9%) participants received the allocated study intervention. No serious adverse events were reported.
Conclusion
The iron and erythropoietin to heal and recover after intensive care (ITHRIVE) pilot demonstrated feasibility based on predefined participant recruitment, study drug administration, and follow-up thresholds.
{"title":"Iron and erythropoietin to heal and recover after intensive care (ITHRIVE): A pilot randomised clinical trial","authors":"Edward Litton MBChB FCICM PhD , Craig French FCICM , Alan Herschtal PhD , Simon Stanworth FRACP PhD , Susan Pellicano RN , Anne Marie Palermo RN , Samantha Bates RN , Sarah Van Der Laan MBChb , Ege Eroglu BSc , David Griffith MRCP PhD , Akshay Shah MRCP PhD","doi":"10.1016/j.ccrj.2023.10.007","DOIUrl":"10.1016/j.ccrj.2023.10.007","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the feasibility of a pivotal randomised clinical trial of intravenous (IV) iron and erythropoietin in adult survivors of critical illness with anaemia requiring treatment in the intensive care unit.</p></div><div><h3>Design</h3><p>An investigator-initiated, parallel group, placebo-controlled, randomised feasibility trial.</p></div><div><h3>Setting</h3><p>A tertiary intensive care unit (ICU) in Perth, Western Australia.</p></div><div><h3>Participants</h3><p>Adults with anaemia (haemoglobin <100 g/L), requiring ICU-level care for more than 48 h, and likely to be ready for ICU discharge within 24 h.</p></div><div><h3>Interventions</h3><p>A single dose of IV ferric carboxymaltose and Epoetin alfa (active group) or an equal volume of 0.9% saline (placebo group).</p></div><div><h3>Main outcome measures</h3><p>Study feasibility was considered met if the pilot achieved a recruitment rate of ≥2 participants per site per month, ≥90% of participants received their allocated study treatment, and≥ 90% of participants were followed up for the proposed pivotal trial primary outcome - days alive and at home to day 90 (DAH<sub>90</sub>).</p></div><div><h3>Results</h3><p>The 40-participant planned sample size included twenty in each group and was enrolled between 1/9/2021 and 2/3/2022. Participants spent a median of 3.4 days (interquartile range 2.8–5.1) in the ICU prior to enrolment and had a mean baseline haemoglobin of 83.7 g/L (standard deviation 6.7). The recruitment rate was 6.7 participants per month [95% confidence interval (CI) 4.8–9.0], DAH<sub>90</sub> follow-up was 100% (95% CI 91.2%–100%), and 39 (97.5%, 95% CI 86.8%–99.9%) participants received the allocated study intervention. No serious adverse events were reported.</p></div><div><h3>Conclusion</h3><p>The iron and erythropoietin to heal and recover after intensive care (ITHRIVE) pilot demonstrated feasibility based on predefined participant recruitment, study drug administration, and follow-up thresholds.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 4","pages":"Pages 201-206"},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022184/pdfft?md5=c4a3fa18a31ed9b694b8d67d791717ab&pid=1-s2.0-S1441277223022184-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138989066","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 : 2023-12-01DOI: 10.1016/j.ccrj.2023.10.006
Andrew W.J. Flint MBBS (MD) , Karina Brady PhD , Erica M. Wood MBBS (MD) , Le Thi Phuong Thao PhD , Naomi Hammond PhD (RN) , Serena Knowles PhD (RN) , Conrad Nangla BMsc , Michael C. Reade PhD (MD) , Zoe K. McQuilten PhD (MD) , The George Institute for Global Health, the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Blood Synergy Program
Objective
To describe current transfusion practices in intensive care units (ICUs) in Australia and New Zealand, compare them against national guidelines, and describe how viscoelastic haemostatic assays (VHAs) are used in guiding transfusion decisions.
Design, setting and participants
Prospective, multicentre, binational point-prevalence study. All adult patients admitted to participating ICUs on a single day in 2021.
Main outcome measures
Transfusion types, amounts, clinical reasons, and triggers; use of anti-platelet medications, anti-coagulation, and VHA.
Results
Of 712 adult patients in 51 ICUs, 71 (10%) patients received a transfusion during the 24hr period of observation. Compared to patients not transfused, these patients had higher Acute Physiology and Chronic Health Evaluation II scores (19 versus 17, p = 0.02), a greater proportion were mechanically ventilated (49.3% versus 37.3%, p < 0.05), and more had systemic inflammatory response syndrome (70.4% versus 51.3%, p < 0.01). Overall, 63 (8.8%) patients received red blood cell (RBC) transfusions, 10 (1.4%) patients received platelet transfusions, 6 (0.8%) patients received fresh frozen plasma (FFP), and 5 (0.7%) patients received cryoprecipitate. VHA was available in 42 (82.4%) sites but only used in 6.6% of transfusion episodes when available. Alignment with guidelines was found for 98.6% of RBC transfusions, but only 61.6% for platelet, 28.6% for FFP, and 20% for cryoprecipitate transfusions.
Conclusions
Non-RBC transfusion decisions are often not aligned with guidelines and VHA is commonly available but rarely used to guide transfusions. Better evidence to guide transfusions in ICUs is needed.
{"title":"Transfusion practices in intensive care units: An Australian and New Zealand point prevalence study","authors":"Andrew W.J. Flint MBBS (MD) , Karina Brady PhD , Erica M. Wood MBBS (MD) , Le Thi Phuong Thao PhD , Naomi Hammond PhD (RN) , Serena Knowles PhD (RN) , Conrad Nangla BMsc , Michael C. Reade PhD (MD) , Zoe K. McQuilten PhD (MD) , The George Institute for Global Health, the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Blood Synergy Program","doi":"10.1016/j.ccrj.2023.10.006","DOIUrl":"10.1016/j.ccrj.2023.10.006","url":null,"abstract":"<div><h3>Objective</h3><p>To describe current transfusion practices in intensive care units (ICUs) in Australia and New Zealand, compare them against national guidelines, and describe how viscoelastic haemostatic assays (VHAs) are used in guiding transfusion decisions.</p></div><div><h3>Design, setting and participants</h3><p>Prospective, multicentre, binational point-prevalence study. All adult patients admitted to participating ICUs on a single day in 2021.</p></div><div><h3>Main outcome measures</h3><p>Transfusion types, amounts, clinical reasons, and triggers; use of anti-platelet medications, anti-coagulation, and VHA.</p></div><div><h3>Results</h3><p>Of 712 adult patients in 51 ICUs, 71 (10%) patients received a transfusion during the 24hr period of observation. Compared to patients not transfused, these patients had higher Acute Physiology and Chronic Health Evaluation II scores (19 versus 17, <em>p</em> = 0.02), a greater proportion were mechanically ventilated (49.3% versus 37.3%, <em>p</em> < 0.05), and more had systemic inflammatory response syndrome (70.4% versus 51.3%, <em>p</em> < 0.01). Overall, 63 (8.8%) patients received red blood cell (RBC) transfusions, 10 (1.4%) patients received platelet transfusions, 6 (0.8%) patients received fresh frozen plasma (FFP), and 5 (0.7%) patients received cryoprecipitate. VHA was available in 42 (82.4%) sites but only used in 6.6% of transfusion episodes when available. Alignment with guidelines was found for 98.6% of RBC transfusions, but only 61.6% for platelet, 28.6% for FFP, and 20% for cryoprecipitate transfusions.</p></div><div><h3>Conclusions</h3><p>Non-RBC transfusion decisions are often not aligned with guidelines and VHA is commonly available but rarely used to guide transfusions. Better evidence to guide transfusions in ICUs is needed.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 4","pages":"Pages 193-200"},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022172/pdfft?md5=c6344f857a0f4b723f765b5b46f53869&pid=1-s2.0-S1441277223022172-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138993732","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 : 2023-12-01DOI: 10.1016/j.ccrj.2023.11.002
Daryl Jones BSc Hons, MB BS, FRACP, FCICM, MD, PhD , Kartik Kishore MSc Data Science , Glenn Eastwood RN, BN, BNHons GDipNurs CritCare, PhD , Stephanie K. Sprogis RN, BN, MuNrsPrac, PhD , Neil J. Glassford BSc, MBChB, PhD, MRCP, FCICM
Objectives and outcomes
To evaluate the 24hrs before medical emergency team (MET) calls to examine: 1) the frequency, nature, and timing of pre-MET criteria breaches; 2) differences in characteristics and outcomes between patients who did and didn't experience pre-MET breaches.
Design
Retrospective observational study November 2020–June 2021.
Setting
Tertiary referral Australian hospital.
Participants
Adults (≥18 years) experiencing MET calls.
Results
Breaches in pre-MET criteria occurred prior to 1886/2255 (83.6%) MET calls, and 1038/1281 (81.0%) of the first MET calls. Patients with pre-MET breaches were older (median [IQR] 72 [57–81] vs 66 [56–77] yrs), more likely to be admitted from home (87.8% vs 81.9%) and via the emergency department (73.0% vs 50.2%), but less likely to be for full resuscitation after (67.3% vs 76.5%) the MET. The three most common pre-MET breaches were low SpO2 (48.0%), high pulse rate (39.8%), and low systolic blood pressure (29.0%) which were present for a median (IQR) of 15.4 (7.5–20.8), 13.2 (4.3–21.0), and 12.6 (3.5–20.1) hrs before the MET call, respectively. Patients with pre-MET breaches were more likely to need intensive care admission within 24 h (15.6 vs 11.9%), have repeat MET calls (33.3 vs 24.7%), and die in hospital (15.8 vs 9.9%).
Conclusions
Four-fifths of MET calls were preceded by pre-MET criteria breaches, which were present for many hours. Such patients were older, had more limits of treatment, and experienced worse outcomes. There is a need to improve goals of care documentation and pre-MET management of clinical deterioration.
目标和结果评估医疗急救小组（MET）呼叫前 24 小时的情况，以检查：1）违反 MET 前标准的频率、性质和时间；2）违反和未违反 MET 前标准的患者的特征和结果差异：1）违反 MET 前标准的频率、性质和时间；2）违反和未违反 MET 前标准的患者在特征和预后方面的差异。结果1886/2255（83.6%）次 MET 呼叫前违反了 MET 前标准，1038/1281（81.0%）次首次 MET 呼叫前违反了 MET 前标准。违反 MET 前标准的患者年龄较大（中位数 [IQR] 72 [57-81] 岁 vs 66 [56-77] 岁），更有可能从家中（87.8% vs 81.9%）或通过急诊科（73.0% vs 50.2%）入院，但在 MET 后（67.3% vs 76.5%）进行全面复苏的可能性较小。MET 前最常见的三种失常情况是 SpO2 低（48.0%）、脉搏率高（39.8%）和收缩压低（29.0%），分别出现在 MET 呼叫前 15.4 小时（7.5-20.8）、13.2 小时（4.3-21.0）和 12.6 小时（3.5-20.1）。五分之四的 MET 呼叫在呼叫前就已违反了 MET 标准，且已持续多小时。这些患者年龄较大，治疗限制较多，预后较差。有必要改进护理目标记录和 MET 前的临床恶化管理。
{"title":"Breaches of pre-medical emergency team call criteria in an Australian hospital","authors":"Daryl Jones BSc Hons, MB BS, FRACP, FCICM, MD, PhD , Kartik Kishore MSc Data Science , Glenn Eastwood RN, BN, BNHons GDipNurs CritCare, PhD , Stephanie K. Sprogis RN, BN, MuNrsPrac, PhD , Neil J. Glassford BSc, MBChB, PhD, MRCP, FCICM","doi":"10.1016/j.ccrj.2023.11.002","DOIUrl":"10.1016/j.ccrj.2023.11.002","url":null,"abstract":"<div><h3>Objectives and outcomes</h3><p>To evaluate the 24hrs before medical emergency team (MET) calls to examine: 1) the frequency, nature, and timing of pre-MET criteria breaches; 2) differences in characteristics and outcomes between patients who did and didn't experience pre-MET breaches.</p></div><div><h3>Design</h3><p>Retrospective observational study November 2020–June 2021.</p></div><div><h3>Setting</h3><p>Tertiary referral Australian hospital.</p></div><div><h3>Participants</h3><p>Adults (≥18 years) experiencing MET calls.</p></div><div><h3>Results</h3><p>Breaches in pre-MET criteria occurred prior to 1886/2255 (83.6%) MET calls, and 1038/1281 (81.0%) of the first MET calls. Patients with pre-MET breaches were older (median [IQR] 72 [57–81] vs 66 [56–77] yrs), more likely to be admitted from home (87.8% vs 81.9%) and via the emergency department (73.0% vs 50.2%), but less likely to be for full resuscitation after (67.3% vs 76.5%) the MET. The three most common pre-MET breaches were low SpO<sub>2</sub> (48.0%), high pulse rate (39.8%), and low systolic blood pressure (29.0%) which were present for a median (IQR) of 15.4 (7.5–20.8), 13.2 (4.3–21.0), and 12.6 (3.5–20.1) hrs before the MET call, respectively. Patients with pre-MET breaches were more likely to need intensive care admission within 24 h (15.6 vs 11.9%), have repeat MET calls (33.3 vs 24.7%), and die in hospital (15.8 vs 9.9%).</p></div><div><h3>Conclusions</h3><p>Four-fifths of MET calls were preceded by pre-MET criteria breaches, which were present for many hours. Such patients were older, had more limits of treatment, and experienced worse outcomes. There is a need to improve goals of care documentation and pre-MET management of clinical deterioration.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 4","pages":"Pages 223-228"},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022251/pdfft?md5=49d96d5a66bdf44a262331a16cc3fe49&pid=1-s2.0-S1441277223022251-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139013131","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 : 2023-12-01DOI: 10.1016/j.ccrj.2023.10.012
Arvind Rajamani FCICM, DDU , Ashwin Subramaniam FCICM, PHD , Brian Lung MBBS , Kristy Masters BN , Rebecca Gresham BN , Christina Whitehead BN, MBioethics , Julie Lowrey BN , Ian Seppelt FCICM , Hemant Kumar BSc, BE, MEngg , Jayashree Kumar BSc,BE, MCompSc , Anwar Hassan MPhty , Sam Orde PhD , Pranav Arun Bharadwaj HSC , Hemamalini Arvind PhD , Stephen Huang MPhtySam Orde PhD , the SPARTAN Collaborative
Objective
To evaluate the feasibility of conducting a prospective randomised controlled trial (pRCT) comparing remifentanil and fentanyl as adjuncts to sedate mechanically ventilated patients.
Design
Single-center, open-labelled, pRCT with blinded analysis.
Setting
Australian tertiary intensive care unit (ICU).
Participants
Consecutive adults between June 2020 and August 2021 expected to receive invasive ventilation beyond the next day and requiring opioid infusion were included. Exclusion criteria were pregnant/lactating women, intubation >12 h, or study-drug hypersensitivity.
Interventions
Open-label fentanyl and remifentanil infusions per existing ICU protocols.
Outcomes
Primary outcomes were feasibility of recruiting ≥1 patient/week and >90 % compliance, namely no other opioid infusion used during the study period. Secondary outcomes included complications, ICU-, ventilator- and hospital-free days, and mortality (ICU, hospital). Blinded intention-to-treat analysis was performed concealing the allocation group.
Results
208 patients were enrolled (mean 3.7 patients/week). Compliance was 80.6 %. More patients developed complications with fentanyl than remifentanil: bradycardia (n = 44 versus n = 21; p < 0.001); hypotension (n = 78 versus n = 53; p < 0.01); delirium (n = 28 versus n = 15; p = 0.001). No differences were seen in ICU (24.3 % versus 27.6 %,p = 0.60) and hospital mortalities (26.2 % versus 30.5 %; p = 0.50). Ventilator-free days were higher with remifentanil (p = 0.01).
Conclusions
We demonstrated the feasibility of enrolling patients for a pRCT comparing remifentanil and fentanyl as sedation adjuncts in mechanically ventilated patients. We failed to attain the study-opioid compliance target, likely because of patients with complex sedative/analgesic requirements. Secondary outcomes suggest that remifentanil may reduce mechanical ventilation duration and decrease the incidence of complications. An adequately powered multicentric phase 2 study is required to evaluate these results.
{"title":"Remi-fent 1—A pragmatic randomised controlled study to evaluate the feasibility of using remifentanil or fentanyl as sedation adjuncts in mechanically ventilated patients","authors":"Arvind Rajamani FCICM, DDU , Ashwin Subramaniam FCICM, PHD , Brian Lung MBBS , Kristy Masters BN , Rebecca Gresham BN , Christina Whitehead BN, MBioethics , Julie Lowrey BN , Ian Seppelt FCICM , Hemant Kumar BSc, BE, MEngg , Jayashree Kumar BSc,BE, MCompSc , Anwar Hassan MPhty , Sam Orde PhD , Pranav Arun Bharadwaj HSC , Hemamalini Arvind PhD , Stephen Huang MPhtySam Orde PhD , the SPARTAN Collaborative","doi":"10.1016/j.ccrj.2023.10.012","DOIUrl":"10.1016/j.ccrj.2023.10.012","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the feasibility of conducting a prospective randomised controlled trial (pRCT) comparing remifentanil and fentanyl as adjuncts to sedate mechanically ventilated patients.</p></div><div><h3>Design</h3><p>Single-center, open-labelled, pRCT with blinded analysis.</p></div><div><h3>Setting</h3><p>Australian tertiary intensive care unit (ICU).</p></div><div><h3>Participants</h3><p>Consecutive adults between June 2020 and August 2021 expected to receive invasive ventilation beyond the next day and requiring opioid infusion were included. Exclusion criteria were pregnant/lactating women, intubation >12 h<strong>,</strong> or study-drug hypersensitivity.</p></div><div><h3>Interventions</h3><p>Open-label fentanyl and remifentanil infusions per existing ICU protocols.</p></div><div><h3>Outcomes</h3><p>Primary outcomes were feasibility of recruiting ≥1 patient/week and >90 % compliance, namely no other opioid infusion used during the study period. Secondary outcomes included complications, ICU-, ventilator- and hospital-free days, and mortality (ICU, hospital). Blinded intention-to-treat analysis was performed concealing the allocation group.</p></div><div><h3>Results</h3><p>208 patients were enrolled (mean 3.7 patients/week). Compliance was 80.6 %. More patients developed complications with fentanyl than remifentanil: bradycardia (n = 44 versus n = 21; p < 0.001); hypotension (n = 78 versus n = 53; p < 0.01); delirium (n = 28 versus n = 15; p = 0.001). No differences were seen in ICU (24.3 % versus 27.6 %,p = 0.60) and hospital mortalities (26.2 % versus 30.5 %; p = 0.50). Ventilator-free days were higher with remifentanil (p = 0.01).</p></div><div><h3>Conclusions</h3><p>We demonstrated the feasibility of enrolling patients for a pRCT comparing remifentanil and fentanyl as sedation adjuncts in mechanically ventilated patients. We failed to attain the study-opioid compliance target, likely because of patients with complex sedative/analgesic requirements. Secondary outcomes suggest that remifentanil may reduce mechanical ventilation duration and decrease the incidence of complications. An adequately powered multicentric phase 2 study is required to evaluate these results.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 4","pages":"Pages 216-222"},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022238/pdfft?md5=c554bdeeac8427018f8fb72d8997cb06&pid=1-s2.0-S1441277223022238-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139015795","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 : 2023-12-01DOI: 10.1016/j.ccrj.2023.10.005
Paul J. Young MBChB, PhD, Anthony Delaney MBBS, MSc, PhD, Thomas Hills MBChB, MSc, DPhil
{"title":"Ventilator-associated pneumonia: A problematic outcome for clinical trials","authors":"Paul J. Young MBChB, PhD, Anthony Delaney MBBS, MSc, PhD, Thomas Hills MBChB, MSc, DPhil","doi":"10.1016/j.ccrj.2023.10.005","DOIUrl":"https://doi.org/10.1016/j.ccrj.2023.10.005","url":null,"abstract":"","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 4","pages":"Pages 159-160"},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022160/pdfft?md5=0c38d05fa614a2c658eb90445f4c01a5&pid=1-s2.0-S1441277223022160-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038537","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 : 2023-12-01DOI: 10.1016/j.ccrj.2023.10.004
Ashwin Subramaniam MBBS MMed FRACP FCICM , Ryan Ruiyang Ling MBBS , Emma J. Ridley PhD , David V. Pilcher MBBS MRCP(UK) FRACP FCICM
Objective
The impact of obesity on long-term survival after intensive care unit (ICU) admission with severe coronavirus disease 2019 (COVID-19) is unclear. We aimed to quantify the impact of obesity on time to death up to two years in patients admitted to Australian and New Zealand ICUs.
Design
Retrospective multicentre study.
Setting
92 ICUs between 1st January 2020 through to 31st December 2020 in New Zealand and 31st March 2022 in Australia with COVID-19, reported in the Australian and New Zealand Intensive Care Society adult patient database.
Participants
All patients with documented height and weight to estimate the body mass index (BMI) were included. Obesity was classified patients according to the World Health Organization recommendations.
Interventions and main outcome measures
The primary outcome was survival time up to two years after ICU admission. The effect of obesity on time to death was assessed using a Cox proportional hazards model. Confounders were acute illness severity, sex, frailty, hospital type and jurisdiction for all patients.
Results
We examined 2,931 patients; the median BMI was 30.2 (IQR 25.6–36.0) kg/m2. Patients with a BMI ≥30 kg/m2 were younger (median [IQR] age 57.7 [46.2–69.0] vs. 63.0 [50.0–73.6]; p < 0.001) than those with a BMI <30 kg/m2. Most patients (76.6%; 2,244/2,931) were discharged alive after ICU admission. The mortality at two years was highest for BMI categories <18.5 kg/m2 (35.4%) and 18.5–24.9 kg/m2 (31.1%), while lowest for BMI ≥40 kg/m2 (14.5%). After adjusting for confounders and with BMI 18.5–24.9 kg/m2 category as a reference, only the BMI ≥40 kg/m2 category patients had improved survival up to 2 years (hazard ratio = 0.51; 95%CI: 0.34–0.76).
Conclusions
The obesity paradox appears to exist beyond hospital discharge in critically ill patients with COVID-19 admitted in Australian and New Zealand ICUs. A BMI ≥40 kg/m2 was associated with a higher survival time of up to two years.
{"title":"The impact of body mass index on long-term survival after ICU admission due to COVID-19: A retrospective multicentre study","authors":"Ashwin Subramaniam MBBS MMed FRACP FCICM , Ryan Ruiyang Ling MBBS , Emma J. Ridley PhD , David V. Pilcher MBBS MRCP(UK) FRACP FCICM","doi":"10.1016/j.ccrj.2023.10.004","DOIUrl":"https://doi.org/10.1016/j.ccrj.2023.10.004","url":null,"abstract":"<div><h3>Objective</h3><p>The impact of obesity on long-term survival after intensive care unit (ICU) admission with severe coronavirus disease 2019 (COVID-19) is unclear. We aimed to quantify the impact of obesity on time to death up to two years in patients admitted to Australian and New Zealand ICUs.</p></div><div><h3>Design</h3><p>Retrospective multicentre study.</p></div><div><h3>Setting</h3><p>92 ICUs between 1st January 2020 through to 31st December 2020 in New Zealand and 31st March 2022 in Australia with COVID-19, reported in the Australian and New Zealand Intensive Care Society adult patient database.</p></div><div><h3>Participants</h3><p>All patients with documented height and weight to estimate the body mass index (BMI) were included. Obesity was classified patients according to the World Health Organization recommendations.</p></div><div><h3>Interventions and main outcome measures</h3><p>The primary outcome was survival time up to two years after ICU admission. The effect of obesity on time to death was assessed using a Cox proportional hazards model. Confounders were acute illness severity, sex, frailty, hospital type and jurisdiction for all patients.</p></div><div><h3>Results</h3><p>We examined 2,931 patients; the median BMI was 30.2 (IQR 25.6–36.0) kg/m<sup>2</sup>. Patients with a BMI ≥30 kg/m<sup>2</sup> were younger (median [IQR] age 57.7 [46.2–69.0] vs. 63.0 [50.0–73.6]; p < 0.001) than those with a BMI <30 kg/m<sup>2</sup>. Most patients (76.6%; 2,244/2,931) were discharged alive after ICU admission. The mortality at two years was highest for BMI categories <18.5 kg/m<sup>2</sup> (35.4%) and 18.5–24.9 kg/m<sup>2</sup> (31.1%), while lowest for BMI ≥40 kg/m<sup>2</sup> (14.5%). After adjusting for confounders and with BMI 18.5–24.9 kg/m<sup>2</sup> category as a reference, only the BMI ≥40 kg/m<sup>2</sup> category patients had improved survival up to 2 years (hazard ratio = 0.51; 95%CI: 0.34–0.76).</p></div><div><h3>Conclusions</h3><p>The obesity paradox appears to exist beyond hospital discharge in critically ill patients with COVID-19 admitted in Australian and New Zealand ICUs. A BMI ≥40 kg/m<sup>2</sup> was associated with a higher survival time of up to two years.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 4","pages":"Pages 182-192"},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223022159/pdfft?md5=f51bc221c020ffbf242635da08c6c270&pid=1-s2.0-S1441277223022159-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038541","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 : 2023-12-01DOI: 10.1016/j.ccrj.2023.10.003
Natasha Turner , Brodie Farrow , Ashenafi H. Betrie , Mark E. Finnis , Yugeesh R. Lankadeva , Jeremy Sharman , Patrick Tan , Yasmine Ali Abdelhamid , Adam M. Deane , Mark P. Plummer
Background
Ascorbate, the biologically active form of vitamin C, is the primary neural anti-oxidant. Ascorbate concentrations have never been quantified following aneurysmal subarachnoid haemorrhage (aSAH).
Objective
To quantify plasma and cerebrospinal fluid (CSF) ascorbate concentrations in patients following SAH.
Design, Setting, Participants, Main Outcome Measures
Cohort study in which plasma and CSF ascorbate concentrations were measured longitudinally in 12 aSAH patients admitted to a quaternary referral intensive care unit and compared to one-off samples obtained from 20 pregnant women prior to delivery in a co-located obstetric hospital. Data are median [interquartile range] or median (95 % confidence intervals).
Results
Forty-eight plasma samples were obtained from the 12 aSAH patients (eight females, age 62 [53–68] years). Eight participants with extra-ventricular drains provided 31 paired CSF-plasma samples. Single plasma and CSF samples were obtained from 20 pregnant women (age 35 [31–37] years). Initial plasma and CSF ascorbate concentrations post aSAH were less than half those in pregnant controls (plasma: aSAH: 31 [25–39] μmol/L vs. comparator: 64 [59–77] μmol/L; P < 0.001 and CSF: 116 [80–142] μmol/L vs. 252 [240–288] μmol/L; P < 0.001). Post aSAH there was a gradual reduction in the CSF:plasma ascorbate ratio from ∼4:1 to ∼1:1. Six (50 %) patients developed vasospasm and CSF ascorbate concentrations were lower in these patients (vasospasm: 61 (25, 97) vs. no vasospasm: 110 (96, 125) μmol/L; P = 0.01).
Conclusion
Post aSAH there is a marked reduction in CSF ascorbate concentration that is most prominent in those who develop vasospasm.
{"title":"Cerebrospinal fluid and plasma ascorbate concentrations following subarachnoid haemorrhage","authors":"Natasha Turner , Brodie Farrow , Ashenafi H. Betrie , Mark E. Finnis , Yugeesh R. Lankadeva , Jeremy Sharman , Patrick Tan , Yasmine Ali Abdelhamid , Adam M. Deane , Mark P. Plummer","doi":"10.1016/j.ccrj.2023.10.003","DOIUrl":"https://doi.org/10.1016/j.ccrj.2023.10.003","url":null,"abstract":"<div><h3>Background</h3><p>Ascorbate, the biologically active form of vitamin C, is the primary neural anti-oxidant. Ascorbate concentrations have never been quantified following aneurysmal subarachnoid haemorrhage (aSAH).</p></div><div><h3>Objective</h3><p>To quantify plasma and cerebrospinal fluid (CSF) ascorbate concentrations in patients following SAH.</p></div><div><h3>Design, Setting, Participants, Main Outcome Measures</h3><p>Cohort study in which plasma and CSF ascorbate concentrations were measured longitudinally in 12 aSAH patients admitted to a quaternary referral intensive care unit and compared to one-off samples obtained from 20 pregnant women prior to delivery in a co-located obstetric hospital. Data are median [interquartile range] or median (95 % confidence intervals).</p></div><div><h3>Results</h3><p>Forty-eight plasma samples were obtained from the 12 aSAH patients (eight females, age 62 [53–68] years). Eight participants with extra-ventricular drains provided 31 paired CSF-plasma samples. Single plasma and CSF samples were obtained from 20 pregnant women (age 35 [31–37] years). Initial plasma and CSF ascorbate concentrations post aSAH were less than half those in pregnant controls (plasma: aSAH: 31 [25–39] μmol/L vs. comparator: 64 [59–77] μmol/L; P < 0.001 and CSF: 116 [80–142] μmol/L vs. 252 [240–288] μmol/L; P < 0.001). Post aSAH there was a gradual reduction in the CSF:plasma ascorbate ratio from ∼4:1 to ∼1:1. Six (50 %) patients developed vasospasm and CSF ascorbate concentrations were lower in these patients (vasospasm: 61 (25, 97) vs. no vasospasm: 110 (96, 125) μmol/L; P = 0.01).</p></div><div><h3>Conclusion</h3><p>Post aSAH there is a marked reduction in CSF ascorbate concentration that is most prominent in those who develop vasospasm.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"25 4","pages":"Pages 175-181"},"PeriodicalIF":2.9,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277223005185/pdfft?md5=34bd2c887703c2d13ec1f375a3c5d391&pid=1-s2.0-S1441277223005185-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139038540","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号